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This study describes health care decision makers' perceptions about decision making processes for the introduction, diffusion and prioritisation of new health technologies at the regional and institutional level. The aim of the study was to aid the design of a new process of technology assessment and decision making for the Northern Sydney and Central Coast Area Health Service (NSCCAHS). Twelve in-depth, semi-structured interviews were conducted with senior health service managers, nurse managers and senior medical clinicians in the NSCCAHS. Interviewees described prioritisation and decision-making processes as \"ad hoc\". Safety and effectiveness were considered the most important criteria in decision making but budgetary consideration often drove decisions about the uptake and diffusion of new technologies. Current dissatisfaction with decision- making processes creates opportunities for reform, including the introduction of consistent local technology assessments

Cytomegalovirus is an important cause of disease in the newborn. The authors report data from a randomized trial of an extension of valganciclovir therapy from 6 weeks to 6 months for symptomatic CMV disease in newborns. Congenital cytomegalovirus (CMV) infection is the leading nongenetic cause of sensorineural hearing loss 1 – 4 and is the most frequent known viral cause of mental retardation 5 ; the infection affects 0.6 to 0.7% of live births in industrialized countries. 6 – 8 A total of 10% of congenitally infected neonates have symptomatic disease at birth, of whom 35% have sensorineural hearing loss, up to two thirds have neurologic deficits, and 4% die during the newborn period. 7 – 11 Although congenital CMV infection is rare overall, it accounts for 21% of children with hearing loss at birth and 24% of those with hearing loss at . . .

This study examined California Community Colleges leaders’ perspectives and efforts associated with Latinx career education student completion at colleges performing in the top decile. Findings from this mixed-methods study suggest top decile colleges bridge opportunity gaps and respond to and affirm culture to increase Latinx career education college completion rates. This is achieved through a variety of practices, including specific completion initiatives, data-driven decision making, access to resources, effective leadership, student supports and services, and high-quality curricula. Quantitative data suggested no opportunity gap between Latinx and non-Latinx students in career education, even though collegewide, Latinx students performed almost two standard deviations below their non-Latinx counterparts. The percentage of students receiving Pell grants and college Latinx completion rates were found to be positively associated with Latinx career education completion rates. Recommendations for policy, practice, and leadership include investing in practices to bridge opportunity gaps, and both responding to and affirming Latinx culture.

To ascertain how new funding arrangements, introduced in New Zealand's 2001 Primary Health Care (PHC) Strategy, have impacted on the expansion of nurses' role in general practice. Nurses are central to the new policy that was designed to improve the health status of New Zealanders and reduce inequalities in health. Nurses were to be a crucial part of the PHC team, expanding their current roles to provide increased access to appropriate services. This paper investigates how the new funding arrangements, introduced as part of the policy, have impacted on the expansion of nurses' roles and consequently the realisation of the policy goals. Semi-structured interviews were undertaken with 128 key stakeholders five years after the introduction of the PHC Strategy, and surveys were completed by practice nurses, general practitioners and practice managers in purposively selected practices within the 20 participating Primary Health Organisations. There has been substantial growth in the development of nursing roles for some nurses in general practice; however, this expansion has not been universal and one of the main reasons for this is the way funding devolves at the practice level. One of the consequences of the policymakers not taking into account the business model of the majority of general practices, is the resulting overarching goal of the strategy not being realised, and inequalities in health status remaining.

Epidemiological reports indicate that currently in the United States, four million individuals suffer from an Alzheimer type dementia. With changing demographics, it is expected that number will triple in the next 50 years. While there is no cure for dementia, early detection can help with treatment planning that may mitigate the impact of the progressive neurodegenerative disease on both the patient and the family system. The differential diagnosis of dementia remains clinically challenging. The 7-Minute Screen has emerged as a promising tool for early screening of dementia in primary care settings. Sensitivity and specificity studies yield strong evidence of efficacy, but no study has examined the correlation between neuroimaging and the 7-Minute Screen, nor patterns of recall on the memory subscale of the screen. The investigator examined data collected as part of the routine neuropsychological evaluations conducted at a well-established memory clinic in a major hospital situated in a large southwestern city. Both retrospective and prospective analyses were performed on data from a sample of 240 consecutive patients. All four hypotheses were supported by the data. The researcher found that patients with diagnoses of probable Alzheimer's dementia had a negative Computed Tomography scan. Moreover, when tested by the memory subscale of the 7-Minute Screen, Alzheimer type dementia patients scored significantly poorer than patients with other forms of dementia. Specifically, after a five minute delay, patients with an Alzheimer's dementia demonstrated a high number of uncued errors with little benefit from cued recall trial. As predicted, two distinct patterns of recall emerged for Alzheimer and vascular dementia. Further exploratory analyses showed that the strong effect for the statistically higher mean number of errors on the un-cued recall scale of the 7-Minute Screen was maintained across ethnicity and education. Moreover, cross-validation analyses accurately predicted 85% of the vascular dementia participants and 59% of the probable Alzheimer participants. Validation of the 7-Minute Screen may have diagnostic and treatment implications to facilitate the earliest detection of the disease and to provide a reliable and objective tool for monitoring response to treatment. Keywords: dementia, 7-Minute Screen, Computed Tomography, Alzheimer's disease.

The purpose of this study is to analyze teachers' perceptions of their first year's experiences in a growth-oriented teacher evaluation program in the Franklin Regional School District. This study collected both qualitative and quantitative data to answer four research questions related to teacher perceptions of experiences, perceptions of key factors affecting implementation, teacher experiences as related to stated purposes of the plan, and comparisons of teachers' experiences between level of teaching and building. Data was collected through in-depth teacher interviews of a stratified random sampling of teachers and through a Teacher Evaluation Profile (TEP) survey. The population included all tenured teachers in the school district who elected to participate in the growth option portion of the program. A sample of twenty-one teachers was interviewed proportionally representing 15% of the teachers in each of the buildings in the district. As the data was analyzed, three themes emerged with seven elements reported as either opportunities or obstacles to teachers' perceived growth. These themes are professional learning culture, teacher autonomy, and program design. (1) Professional learning culture included peer relations, relations with the evaluator, and professional learning activities. Most teachers experienced heightened collegiality with peers and evaluators as a result of increased teaming and reflective discussions with growth from focused and sustained professional learning activities better applying educational theory to practice. (2) Teacher autonomy was experienced by most. Teachers appreciated the individualized and self-directed nature of the program; however, some stated the need for more direction. (3) The formative and summative design of the program with the embedded accountability factors relates to teachers' reflections on the performance rubric, documentation required, and final summative evaluation experience. Teachers shared that the rubric promoted reflection but needed to be redesigned to more accurately reflect their teaching level and content area. The documentation and final evaluation process need to be better explained and uniformly implemented by evaluators. The study concludes with recommendations for developing growth-oriented teacher evaluation systems. Emphasis needs to be placed on developing and nurturing the role of the building principal, maximizing stakeholder involvement in the teacher evaluation process through all stages of program design and implementation, and integrating teacher evaluation and professional development programs.