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PubMed1996

Differentiation and specialization in the California hospital industry 1983 to 1988.

This article examines changes in the service mix of California hospitals as part of their response to shifts in the system of reimbursement between 1983 and 1988. The Hospital Discharge Data Set and the Annual Hospital Disclosure Report produced by California Office of Statewide Health Planning and Development were used in this study. Characteristics of inpatient hospital services in California before and after the introduction of new reimbursement mechanisms (including the Medicare Prospective Payment System [PPS] and the growth of selective contracting plans) were compared. The factors that influence two measures of hospital service mix, one focusing on specialization and the other on differentiation, were studied. The factors included hospital characteristics and changes in hospital reimbursement. Variables describing a hospital's service mix and the level in its market were constructed from data in the annual discharge abstracts. Data pertaining to average hospital costs and reimbursements under the Medicare PPS were drawn from a file containing a 20% sample of hospital stay records for the year of PPS. Other hospital data, such as ownership and bed size, were taken from the California Annual Disclosure Report data set. The results indicate that completion among hospitals tended to increase differentiation whereas higher financial PPS pressure is associated with increased specialization. Hospitals tend to adopt some high visibility services offered by their competitors while filling market niches selectively overall. It also appears that the cost savings expected for specialization may prevail only for narrowly defined services. Study of subsequent data sets should show whether the cost containment strategies used by the hospitals to achieve these results have been maintained over a period of sustained financial pressure.

California↗
PubMed2006

Computer vocabulary training in kindergarten children with special needs.

The aim of the present study was to determine whether vocabulary training on a computer can enhance vocabulary learning of young children with special needs and whether the task-on-behaviour of these children differed when story reading was carried out by the teacher or by the computer. An experimental group (n=9) listened to a story read to them by the computer and played additional computer vocabulary games during three 20-min sessions. The control group (n=9) had the same story read to them by a teacher and then followed the normal school curriculum. The results showed that children with special needs were equally able to keep their attention on the story when it was read to them by the computer as when it was read to them by the teacher. For vocabulary growth, the intervention showed positive effects. The children from the experimental group learned more experimental words between the pre-test and retention test than the children in the control group. The study shows that a group of kindergarten children with special needs can enhance their vocabulary by working with a computer program without human intervention.

Child↗
PubMedDate not supplied

Differences in reading achievement between spina bifida children attending normal schools and those attending special schools.

This paper reports the reading scores measured on Neale's Analysis of Reading Ability of a series of 55 spina bifida children, some of whom attended normal schools and the remainder attended special schools and matched controls. A multiple regression equation was used to compare observed scores with the expected scores. The children receiving a normal school education were reading up to the level expected from their intelligence test scores, but the children in special schools had significant differences between observed and expected scores. The discrepancies may be accounted for by more profound physical handicap among the special school children but teachers' expectations may also be important in influencing reading achievement.

Achievement↗
PubMedDate not supplied

Andrology. Origin and development of a special discipline in medicine. Reflection and view in the future.

A general survey comments on the problems of andrology as a special medica discipline. A retrospective and an outlook concerning the different future possibilities of andrology is given. Special emphasis is placed on: examination of the ejaculate, morphology of the testicles, andrological training and further education; in the discussion of the future prospects special consideration is given to the responsibility of andrologists--also with respect to in-vitro-fertilization--and the significance of andrology for the inhabitants of the Third World.

Developing Countries↗
PubMed1995

Bridging the "med-ed gap" for students with special health care needs: a model school liaison program.

A successful school experience is critical to the development of all children, particularly in the areas of academic achievement, regular school attendance, and social competency. Vulnerabilities in achieving each of these three goals have been documented among students with special health care needs (SSHCN), and ascribed to the influence of their health-related disabilities. Despite recognition of these vulnerabilities, barriers still exist to successful integration of SSHCN into educational settings. A key barrier to successful integration involves poor linkages between the health and education systems. This article describes a model linkage system--the School Liaison Program at Texas Children's Hospital, developed as a U.S. Dept. of Health and Human Services Maternal and Child Health Bureau Special Project of Regional and National Significance. The program provides educational liaison services between the largest pediatric hospital in the United States and school districts in the fourth largest city. A description of the linkage system emphasizes interdisciplinary staffing by both special educators and health providers. The model for educational liaison service delivery presented includes the elements of eligibility, assessment of the educational implications of illness, plan development and referral, involvement in educational placement, and monitoring. Resources for integrating SSHCN into educational settings are suggested.

Adolescent↗
PubMed2025

Defining the networks that connect RNase III and RNase J-mediated regulation of primary and specialized metabolism in Streptomyces venezuelae.

UNLABELLED: RNA metabolism involves coordinating RNA synthesis with RNA processing and degradation. Ribonucleases play fundamental roles within the cell, contributing to the cleavage, modification, and degradation of RNA molecules, with these actions ensuring appropriate gene regulation and cellular homeostasis. Here, we employed RNA sequencing to explore the impact of RNase III and RNase J on the transcriptome of Streptomyces venezuelae. Differential expression analysis comparing wild-type and RNase mutant strains at distinct developmental stages revealed significant changes in transcript abundance, particularly in pathways related to multicellular development, nutrient acquisition, and specialized metabolism. Both RNase mutants exhibited dysregulation of the BldD regulon, including altered expression of many cyclic-di-GMP-associated enzymes. We also observed precocious chloramphenicol production in these RNase mutants and found that in the RNase III mutant, this was associated with PhoP-mediated regulation. We further found that RNase III directly targeted members of the PhoP regulon, suggesting a link between RNA metabolism and a regulator that bridges primary and specialized metabolism. We connected RNase J function with translation through the observation that RNase J directly targets multiple ribosomal protein transcripts for degradation. These findings establish distinct but complementary roles for RNase III and RNase J in coordinating the gene expression dynamics critical for S. venezuelae development and specialized metabolism. IMPORTANCE: RNA processing and metabolism are mediated by ribonucleases and are fundamental processes in all cells. In the morphologically complex and metabolically sophisticated Streptomyces bacteria, RNase III and RNase J influence both development and metabolism through poorly understood mechanisms. Here, we show that both ribonucleases are required for the proper expression of the BldD developmental pathway and contribute to the control of chloramphenicol production, with an interesting connection to phosphate regulation for RNase III. Additionally, we show that both RNases have the potential to impact translation through distinct mechanisms and can function cooperatively in degrading specific transcripts. This study advances our understanding of RNases in Streptomyces biology by providing insight into distinct contributions made by these enzymes and the intriguing interplay between them.

Streptomyces↗
PubMed1989

Students' time on learning tasks in special education.

The purpose of this study was to measure, through naturalistic observation procedures, the use of time among handicapped students in four special education alternatives--regular class, resource room, special class, and special school. The sample included 230 elementary age students enrolled in 58 classes in 16 schools. ANOVA comparisons revealed that the least restrictive alternatives, particularly the resource room, made more in-class learning time available. Discussion includes recommendations for increasing learning time.

Child↗
PubMed1994

Places of change: special education's power and identity in an era of educational reform.

Special education is in danger of disintegration due to (a) justified criticisms of implementational failures, and (b) unjustified criticisms from reformers and detractors, mostly having to do with its conceptualization and the separate placement of some students with disabilities. Needed reforms in special education include (a) constructing defensible rival philosophies, (b) improving the preparation and support of special education teachers, and (c) putting educational methods on a sound scientific footing.

Adolescent↗
PubMedDate not supplied

Preparing students with special needs for reintegration: curriculum-based measurement's impact on transenvironmental programming.

The original intent of special education pull-out services was to remove students from general education temporarily for intensive, individualized instruction in deficit areas. In many school districts, however, it seems that once students participate in pull-out services, there is little effort to return them to general education. One explanation for this is that not much is known about how best to prepare students for movement up the cascade of services, including reintegration into the mainstream. A promising reintegration approach is transenvironmental programming (TP). Research suggests that supplementing TP with continuous progress monitoring, specifically via curriculum-based measurement (CBM), better prepares students for reintegration than either TP or CBM alone. Findings from the present study provide a possible explanation: Results suggest that special educators using TP who receive CBM information about their students' academic progress are more likely to plan and implement academic interventions in preparation for students' transition than are those special educators who do not receive this information. This supports the hypothesis that the relatively greater success of TP + CBM is due to increased attention to academic preparation. Implications for practice and future research are discussed.

Adult↗
PubMed2004

School-based mental health services in Baltimore: association with school climate and special education referrals.

This study investigated the association between school-based mental health services and two proposed but untested outcomes of these services: (a) school climate and (b) patterns of referrals to special education. Results from a climate survey found that teachers and staff in eight elementary schools with expanded school mental health (ESMH) services gave higher ratings on the survey's mental health climate subscale than respondents from schools in a matched comparison group. No differences were found for the General Climate subscale of the survey. Results also indicated that teachers in ESMH schools referred fewer students to the special education eligibility process because of emotional and behavioral issues and that fewer students in ESMH schools were found eligible for special education for emotional and behavioral disabilities. Results of this study provide beginning evidence for the positive impact of ESMH programs on these two schoolwide indicators of functioning.

Adolescent↗
PubMed2004

Increasing self-efficacy and knowledge through a seizure education program for special education teachers.

Since the passage of the 1975 Education for All Handicapped Children Act and the 1986 PL99-457 amendment, many children aged birth to 3 years with special health care needs are enrolled in early intervention programs. Educators working in early intervention services often need to respond to and manage seizure activity and medical emergencies for special needs children. To do so, they need to have knowledge and confidence in their ability to intervene effectively. This intervention study was designed to address the knowledge and self-efficacy of 28 special needs educators on seizure management. The intervention resulted in increased knowledge, skills, and self-efficacy related to seizure management and their ability to interact supportively with families.

California↗
PubMed1990

A comparison of male admissions to a special hospital 1970-71 and 1987-88.

Characteristics of 109 male patients admitted over a two-year period to a Special Hospital are described and discussed. Comparison is made with the results from a previous study conducted in another Special Hospital (Broadmoor) some fifteen years ago. Admissions still originate mainly from the courts, the penal system, and the NHS. However, the pattern of admissions has changed, influenced in part by the advent of the Regional Secure Unit programme, and the 1983 revision of the Mental Health Act. Very few admissions were diagnosed as suffering from a primary affective disorder. Patients suffering from psychopathic disorder had committed few crimes of murder and manslaughter. Possible reasons for these and other findings are discussed. It is concluded that the Special Hospitals continue to play a distinct and essential role.

Admitting Department, Hospital↗
PubMed1994

Managing special education needs: helping and involving parents.

This paper reviews a period of enormous change and flux in the English education service. It notes that a number of the supports and sources of advice traditionally available to parents of young people with special educational needs and to the young people themselves are now reduced, are being changed or are in the process of being removed. It proposes a new emphasis for service professionals, administrators and the voluntary bodies working in the area of special educational needs. The central premise is that the work and role of the voluntary bodies, in supporting young people with special needs and their parents, should be welcomed and confirmed as a vital element within the educational process. A range of practical service strategies is proposed which is intended to sustain a user friendly educational service during a time of massive change. A model for confirming the potentially significant role of the voluntary bodies in this important area of educational need is offered.

Education, Special↗
PubMed1998

Criminal conviction after discharge from special (high security) hospital. Incidence in the first 10 years.

BACKGROUND: The aim was to measure the criminal convictions received by people who leave special hospital and to test previously identified correlates of conviction. METHOD: A cohort study design was used and the subjects were all 425 patients discharged from the special hospitals in 1982 and 1983. The outcome measure was a criminal conviction received within 10.5 years of discharge. RESULTS: Five and a half years after discharge 26% of ex-patients had been convicted of any offence, 9% of a violent offence, 5% of a sex offence and 10% of any serious offence. Ten and a half years after discharge 34% of patients had been convicted of any offence, 15% of a violent offence, 7.5% of a sex offence and 15% of any serious offence. When other variables are controlled for, gender and destination on discharge do not predict conviction. Age, a legal category of psychopathic disorder and prior criminal record do predict, but the effect is small. CONCLUSION: The rate of conviction of patients leaving special hospital has fallen over the past 20 years; this is the case for crime in general and for serious crimes in particular. The change in rates of conviction over time for patients of different legal categories, previously thought to be different, is the same. The low predictive power of the variables examined here suggests that actuarial methods are of limited value in predicting offending in this group.

Adult↗
PubMed2000

Trends in special (high-security) hospitals. 1: Referrals and admissions.

BACKGROUND: Special hospitals in England provide psychiatric care and treatment in high security. Their future is often questioned. AIMS: To test for variation in demand for high-security psychiatric services over one 10-year period. METHOD: This study was from the special hospitals' case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by health region; admission episodes; legal category of detention; admission source and type of offence. RESULTS: Referrals to special hospitals showed no decrease during the 10 years; an apparent increase may reflect underrecording before 1992. Admissions fell by about 16% over the 10 years, but with regional variation. Women, civil cases, admissions under the MHA classifications of psychopathic disorder or mental impairment and directly from a court on a hospital order were most affected. There was an increase in admissions of pre-trial and sentenced male prisoners, and of transferred hospital order patients from other hospitals. CONCLUSIONS: There is continuing demand from all parts of the country for high-security hospital beds. The smaller numbers admitted appear to include more demanding cases.

Commitment of Persons with Psychiatric Disorders↗
PubMed2000

Trends in special (high-security) hospitals. 2: Residency and discharge episodes, 1986-1995.

BACKGROUND: It has been argued that many patients in special hospital beds do not need to be there. In the 1990s there were initiatives to discharge women and people with learning difficulties. AIMS: To test for trends in special hospital discharges and to examine annual resident cohorts. METHOD: This study was from case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by region; admission episodes; legal category of detention; admission source and type of offence. RESULTS: The median annual number of residents was 1859 (range 1697-1910), with an 8% fall for the period. This particularly affected people in mental impairment categories. Numbers were sustained in the male mental illness groups. Discharges, mainly to other institutions, increased. There was no overall change over the 10 years in length of stay for treatment, but successive admission cohorts from 1986 did show some reduction, even with solely remand order cases excluded. CONCLUSIONS: Service planners need a longitudinal perspective on service use. Trends over 10 years to both fewer admissions and more discharges have reduced the special hospital population, but despite new treatments for schizophrenia, men under mental illness classification, as well as transfer from other secure settings, have gone against this trend.

Female↗
PubMed2004

Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care.

OBJECTIVE: Large provider caseloads are associated with better patient outcomes after many complex surgical procedures. Mortality rates for pediatric brain tumor surgery in various practice settings have not been described. We used a national hospital discharge database to study the volume-outcome relationship for craniotomy performed for pediatric brain tumor resection, as well as trends toward centralization and specialization. METHODS: We conducted a cross sectional and longitudinal cohort study using Nationwide Inpatient Sample data for 1988 to 2000 (Agency for Healthcare Research and Quality, Rockville, MD). Multivariate analyses adjusted for age, sex, geographic region, admission type (emergency, urgent, or elective), tumor location, and malignancy. RESULTS: We analyzed 4712 admissions (329 hospitals, 480 identified surgeons) for pediatric brain tumor craniotomy. The in-hospital mortality rate was 1.6% and decreased from 2.7% (in 1988-1990) to 1.2% (in 1997-2000) during the study period. On a per-patient basis, median annual caseloads were 11 for hospitals (range, 1-59 cases) and 6 for surgeons (range, 1-32 cases). In multivariate analyses, the mortality rate was significantly lower at high-volume hospitals than at low-volume hospitals (odds ratio, 0.52 for 10-fold larger caseload; 95% confidence interval, 0.28-0.94; P = 0.03). The mortality rate was 2.3% at the lowest-volume-quartile hospitals (4 or fewer admissions annually), compared with 1.4% at the highest-volume-quartile hospitals (more than 20 admissions annually). There was a trend toward lower mortality rates after surgery performed by high-volume surgeons (P = 0.16). Adverse hospital discharge disposition was less likely to be associated with high-volume hospitals (P < 0.001) and high-volume surgeons (P = 0.004). Length of stay and hospital charges were minimally related to hospital caseloads. Approximately 5% of United States hospitals performed pediatric brain tumor craniotomy during this period. The burden of care shifted toward large-caseload hospitals, teaching hospitals, and surgeons whose practices included predominantly pediatric patients, indicating progressive centralization and specialization. CONCLUSION: Mortality and adverse discharge disposition rates for pediatric brain tumor craniotomy were lower when the procedure was performed at high-volume hospitals and by high-volume surgeons in the United States, from 1988 to 2000. There were trends toward lower mortality rates, greater centralization of surgery, and more specialization among surgeons during this period.

Adolescent↗
PubMedDate not supplied

Providing a healthcare input to children in special schools.

The education of children with special educational needs is often accompanied by a requirement for medical or healthcare provision. If this cannot be done safely then the child's access to education is limited. No standardized template for the delivery of a healthcare input to children in special schools is apparent. This study sought to explore, through the use of an indepth needs assessment exercise and focus group interviews, what the most appropriate healthcare role was for delivering health care in a special school catering for children with a broad range of severe learning disabilities. While an overwhelming viewpoint of participants in focus groups perceived that a nurse was the only suitable person to undertake the role, the evidence gathered prompted the research steering group to suggest to the contrary, i.e. that the role of a healthcare worker with a national vocational qualification (NVQ) level 3 in care was the more appropriate person to maximize both the role of the nurse and the quality of care provided to these children.

Child↗