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PubMed2001

The Interdisciplinary Generalist Curriculum (IGC) project: an overview of its experience and outcomes.

The Interdisciplinary Generalist Curriculum (IGC) Project was a competitive, seven-year demonstration project funded by the Health Resources and Services Administration (HRSA). It was established to determine whether specific interdisciplinary innovations in preclinical medical school curricula could affect students' selection of careers in family medicine, general internal medicine, or general pediatrics. Through collaboration among the three generalist disciplines, the IGC innovation exposed all preclinical students in ten demonstration schools to a new or significantly enhanced preclinical curriculum that included a direct supervised clinical experience with a generalist physician preceptor. The project was managed by an interdisciplinary executive committee that was codirected by one representative each from family medicine, general internal medicine, and general pediatrics. A national advisory committee with representation from the academic and professional organizations of family medicine, internal medicine, pediatrics, and osteopathy provided input to the executive committee in guiding the project. The project was externally evaluated. Major outcomes of the IGC Project include sustained curricular changes in ten institutions, prompted by relatively few dollars and demonstration of models for collaboration at institutional and national levels. This supplement describes the IGC Project's experience and outcomes so that others may draw pertinent information to apply to their own efforts in medical education.

Curriculum↗
PubMed2001

Lessons learned from a distance-based consulting program to assist faculty development projects.

Changes in faculty roles and demographics necessitate a re-examination of the types of professional development opportunities offered in academic institutions. A distance-based consulting program was designed to assist faculty development projects as they progress through all stages of faculty development: needs assessment, project design, implementation, and, in particular, program evaluation and dissemination of results (i.e., presentations and published articles). The progress of 17 faculty development projects in primary care educational sites that received assistance in the United States and Canada was tracked over two years. Three factors were identified as having the most impact on the success of faculty development projects: (1) funds committed to and designated for faculty development; (2) funded, protected time for at least one person to implement the faculty development initiative; and (3) an environment capable of supporting faculty development initiatives (e.g., no major budget shortfall, few faculty transitions, a strong mission, no threat of mergers). Only a few of the participating sites reached the stage of evaluating and publishing articles about the outcomes of their projects within the designated 15-month time frame, with many sites reporting environmental impediments to project success. The authors describe the institutional characteristics that facilitated project success, assess the usefulness of distance-based consulting efforts, and offer recommendations for future distance-based consulting programs. They conclude by noting that the personal touch (i.e., one-on-one contact with consultants) is what is most appreciated, and that excellent one-on-one, in-person assistance may be inherently more effective than even the best-run distance-based consulting.

Canada↗
PubMed2002

Into work, through tailored paths: a two-year follow-up of the return-to-work rehabilitation and re-employment project.

Between the years 1996 and 2000, over 2000 projects were carried out in Finland with the aim of finding innovative measures for crossing the job threshold. Among them was the Pathway-to-Work Project, which aimed at tailoring return-to-work plans for 140 middle-aged, long-term unemployed participants with various disabilities and getting half of them into work or training. This study of the Pathway-to-Work Project had two research objectives. First, to evaluate the outcomes of the return-to-work rehabilitation project and second, to determine what combination of different measures seemed necessary and effective in the rehabilitation of long-term unemployed people with disabilities. The research design comprised three parts: a quantitative quasi-experimental part with a matched control group, a register follow-up and the collection of qualitative data. The main variables used to evaluate the outcomes were (1) the changes in the labour market situation during the 2-year register follow-up, (2) the changes in distress (measured by the General Health Questionnaire-12), perceived competence (measured by Wallston's Self-Performance Survey) and sense of coherence (measured by Antonovsky's SOC-13) during the intervention and (3) the description of the process in the project. In the 1-year follow-up, 31% of the participants were found to be at work and 37% unemployed. In the 2-year follow-up, 14% were at work and 59% unemployed. The jobs seemed to be subsidized for a period of half a year to a year. The difference between the project group and the matched control group was remarkable: at the end of the project, only 9% of the control group were at work and 86% unemployed. The participants' distress level decreased remarkably and their perceived competence increased, but their sense of coherence did not change. The results showed that even carefully tailored client work enables only some of the long-term unemployed people with disabilities to cross the job threshold and that other means of policy, strategy and intervention are needed to link the return-to-work interventions more closely with work, work places and enterprises.

Adult↗
PubMed2004

The reality of returning to work and training: experiences from a long-term unemployment project.

A project called Pathway-to-Work was carried out in northern Finland between 1995 and 1998. In the course of this project, tailored return-to-work paths were planned for 140 long-term unemployed people with disabilities. The present study, based on that project, had three research objectives: (i) to describe how the participants experienced and defined their opportunities of employment and training at the beginning of the project and how the opportunities were eventually realized; (ii) to form a model of the issues that influenced the participants' decision making on the basis of their descriptions of their life situation; and (iii) to look for elements in the progression of the project that could explain the outcome in terms of the participants' situation in the labour market. The research design was composed of three parts: eight in-depth interviews, a register follow-up, and comparison with a matched control group. Comparative content analysis was used to process the in-depth interviews. The outcome was evaluated according to the following variables: (i) the changes in the participants' labour market situation during the 2-year follow-up; (ii) the changes in the participants' distress level, perceived competence, and sense of coherence during the intervention. We found that the participants had not decided whether to return to work but had left this decision to the professional working on the project. The way participants described their life situations and opportunities made it clear that they placed high expectations on the project. However, although they could realistically estimate their own potential, the labour-market situation was beyond their predictive vision. We conclude that, when targeting services to groups such as described here, more attention should be paid to understanding the clients' behaviour and the social circumstances in which they live.

Adult↗
PubMed1999

Organize for success: seven steps to a successful building project.

Intended for ambulatory care administrators considering a building project, the article discusses seven key steps to a successful project: Avoid common pitfalls: allow enough time, avoid over-delegation, focus staff on issues rather than egos, require staff "buy-ins" to project concepts and design, and understand the realties of construction. Select the right team: how to interview, assess qualifications, and make a sound decision. Understand all the project costs; construction cost is only one of many. Understand the various construction methods and pricing alternatives; become a sophisticated consumer. Understand the nature and scope of the risks inherent in building projects. Understand all the management issues. Start your project off right through producing. Identify strategic goals and needs, then quantify and qualify your project's intent, scope, and basic financial assumptions.

Ambulatory Care Facilities↗
PubMed1999

Performance analysis of maximum intensity projection algorithm for display of MRA images.

The maximum intensity projection (MIP) is a popularly used algorithm for display of MRA images, but its performance has not been rigorously analyzed before. In this paper, four measures are proposed for the performance of the MIP algorithm and the quality of images projected from three-dimensional (3-D) data, which are vessel voxel projection probability, vessel detection probability, false vessel probability, and vessel-tissue contrast-to-noise ratio (CNR). As side products, vessel-missing probability, vessel receiver operating characteristics (ROC's), and mean number of false vessels are also studied. Based on the assumptions that the intensities of vessel, tissue, and noise along a projection path are independent Gaussian, these measures are derived and obtained all in closed forms. All the measures are functions of explicit parameters: vessel-to-tissue noise ratio (VTNR) and CNR of 3-D data prior to the MIP, vessel diameter, and projection length. It is shown that the MIP algorithm increases the CNR of large vessels whose CNR prior to the MIP is high and whose diameters are large. The increase in CNR increases with projection path length. On the other hand, all the proposed measures indicate that the small vessels that have low CNR prior to the MIP and small diameters suffer from the MIP. The performance gets worse as projection path length increases. All measures demonstrate a better performance when the vessel diameter is larger. Other properties and possible applications of the derived measures are also discussed.

Algorithms↗
PubMed2006

3-D shape estimation of DNA molecules from stereo cryo-electron micro-graphs using a projection-steerable snake.

We introduce a three-dimensional (3-D) parametric active contour algorithm for the shape estimation of DNA molecules from stereo cryo-electron micrographs. We estimate the shape by matching the projections of a 3-D global shape model with the micrographs; we choose the global model as a 3-D filament with a B-spline skeleton and a specified radial profile. The active contour algorithm iteratively updates the B-spline coefficients, which requires us to evaluate the projections and match them with the micrographs at every iteration. Since the evaluation of the projections of the global model is computationally expensive, we propose a fast algorithm based on locally approximating it by elongated blob-like templates. We introduce the concept of projection-steerability and derive a projection-steerable elongated template. Since the two-dimensional projections of such a blob at any 3-D orientation can be expressed as a linear combination of a few basis functions, matching the projections of such a 3-D template involves evaluating a weighted sum of inner products between the basis functions and the micrographs. The weights are simple functions of the 3-D orientation and the inner-products are evaluated efficiently by separable filtering. We choose an internal energy term that penalizes the average curvature magnitude. Since the exact length of the DNA molecule is known a priori, we introduce a constraint energy term that forces the curve to have this specified length. The sum of these energies along with the image energy derived from the matching process is minimized using the conjugate gradients algorithm. We validate the algorithm using real, as well as simulated, data and show that it performs well.

Algorithms↗
PubMed2003

Sovereign cat bonds and infrastructure project financing.

We examine the opportunities for using catastrophe-linked securities (or equivalent forms of nondebt contingent capital) to reduce the total costs of funding infrastructure projects in emerging economies. Our objective is to elaborate on methods to reduce the necessity for unanticipated (emergency) project funding immediately after a natural disaster. We also place the existing explanations of sovereign-level contingent capital into a catastrophic risk management framework. In doing so, we address the following questions. (1) Why might catastrophe-linked securities be useful to a sovereign nation, over and above their usefulness for insurers and reinsurers? (2) Why are such financial instruments ideally suited for protecting infrastructure projects in emerging economies, under third-party sponsorship, from low-probability, high-consequence events that occur as a result of natural disasters? (3) How can the willingness to pay of a sovereign government in an emerging economy (or its external project sponsor), who values timely completion of infrastructure projects, for such instruments be calculated? To supplement our treatment of these questions, we use a multilayer spreadsheet-based model (in Microsoft Excel format) to calculate the overall cost reductions possible through the judicious use of catastrophe-based financial tools. We also report on numerical comparative statics on the value of contingent-capital financing to avoid project disruption based on varying costs of capital, probability and consequences of disasters, the feasibility of strategies for mid-stage project abandonment, and the timing of capital commitments to the infrastructure investment. We use these results to identify high-priority applications of catastrophe-linked securities so that maximal protection can be realized if the total number of catastrophe instruments is initially limited. The article concludes with potential extensions to our model and opportunities for future research.

Journal Article↗
PubMed1991

Projections from the Cerebral Cortex to the Red Nucleus of the Guinea-pig. A Retrograde Tracing Study.

The origin and the topographic distribution of corticorubral (CR) projections in the guinea-pig were studied by using the retrograde axonal transport of a tracer, colloidal gold-labelled, enzymatically inactive horseradish peroxidase conjugated to wheat-germ agglutinin (WGAapoHRP - Au), which was injected in the red nucleus (RN). It was found that the bulk of the CR projections arise from layer V neurons of the agranular frontal cortex in both its medial (Agm) and lateral (Agl) subdivisions; in the Agm labelled neurons are preferentially located in the upper part of layer V, whereas in the Agl they are more concentrated in the central band of the layer. Fewer projections originate from areas of the granular parietal and the agranular cingulate and retrobulbar cortices. CR projections have a bilateral origin, with a large ipsilateral predominance. The pattern of retrograde cortical labelling observed after injection of WGAapoHRP - Au in different portions of the RN indicates that CR projections are distributed throughout the entire rostrocaudal extent of the nucleus, but are slightly more concentrated in the rostral parvocellular area. The morphological arrangement of CR projections in the guinea-pig, as demonstrated in the present study, shows several analogies with other mammals. The functional characteristics of the cortical areas in which CR neurons are located indicate that CR projections may play a significant role in the central organization of movement.

Journal Article↗
PubMed1993

Retinal projections to the pretectum, accessory optic system and superior colliculus in pigmented and albino ferrets.

Retinal projections to the pretectal nuclei, accessory optic system and superior colliculus in pigmented and albino ferrets were studied using anterograde tracing techniques. Both Nissl- and myelin-stained material was used to identify the pretectal nuclei, nuclei of the accessory optic system and the layers of the superior colliculus. Following monocular injection of either horseradish peroxidase or rhodamine-B-isothiocyanate, four pretectal nuclei, including the nucleus of the optic tract, posterior pretectal nucleus, anterior pretectal nucleus and the olivary pretectal nucleus, could be identified to receive direct retinal input in both pigmented and albino strains. In the accessory optic system, retinal terminals were observed in the dorsal, lateral and medial terminal nuclei as well as in the interstitial nucleus of the superior fasciculus, posterior fibres. The retinal projection to the superior colliculus was found to innervate the three superficial layers. The retinal projections to the pretectal nuclei and nuclei of the accessory optic system in the pigmented animals were bilateral, although the label was most dense contralateral to the injected eye. Ipsilateral retinal projections to the pretectal nuclei and nuclei of the accessory optic system appeared to be absent in albino ferrets, i.e. they were invisible with our methods. In both pigmented and albino ferrets retinal terminals in the contralateral superior colliculus densely innervated the three superficial layers. In both strains the ipsilateral projection appeared as clusters which were absent in rostral and caudal poles. In pigmented animals the ipsilateral projection was much denser and more extensive than in albinos. Following injection of retrograde tracers into the brainstem at the level of the dorsal cap of the inferior olive, retrogradely labelled neurons in the pretectum were found in the ipsilateral nucleus of the optic tract. Their somata overlapped mainly with scattered retinal terminals close to the pretectal surface and rarely or not all with the deeper prominent terminal clusters. In the accessory optic system, inferior olive projecting neurons were observed in all four ipsilateral nuclei and fully coincided with the retino-recipient zones. In the superior colliculus, retrogradely labelled neurons were found contralateral to the injection site in the deep layers.

Albinism↗
PubMed1995

Corticothalamic projections from the cortical barrel field to the somatosensory thalamus in rats: a single-fibre study using biocytin as an anterograde tracer.

This study investigated the pattern of axonal projections of single corticothalamic neurons from the cortical barrel field representing the vibrissae in the rat. Microiontophoretic injections of biocytin were performed in cortical layers V and VI to label small pools of corticothalamic cells and their intrathalamic axonal projections. After a survival period of 48 h, the animals were perfused and the tissue was processed for biocytin histochemistry. On the basis of the intrathalamic distribution of axonal fields and of the types of terminations found in the thalamus, four types of corticothalamic projections were identified. (i) Cells of the upper part of layer VI projected exclusively to the ventral posteromedial (VPm) nucleus, where they arborized in long rostrocaudally oriented bands or 'rods'. (ii) All cells of the lower part of layer VI projected to the medial part of the thalamic posterior group (Pom) but the vast majority of them also collateralized in VPm where they participated in the formation of rods. (iii) A minority of corticothalamic cells in the lower portion of layer VI, possibly located under the interbarrel spaces (septae), arborized exclusively in Pom. (iv) The corticothalamic projection of layer V cells originated from collaterals of corticofugal cells whose main axons ran caudally towards the brainstem. These collaterals arborized exclusively in Pom or in the central lateral nucleus. All corticothalamic cells from layer VI displayed the same type of axonal network, made of long branches decorated by terminal buttons emitted en passant at the tip of fine stalks. Corticothalamic fibres arising from layer V pyramids, however, remained smooth as they ran across the lateral thalamus and they generated in Pom one or two clusters of large boutons. All corticothalamic axons derived from layer VI cells, but not those derived from layer V cells, gave off collaterals as they traversed the thalamic reticular complex. These observations are discussed in the light of previous studies bearing on the topological organization and function of corticothalamic projections to VPm and Pom in rats. The possibility that a similar cellular specificity and a similar organizational plan may characterize corticothalamic relationships in other sensory systems is also considered.

Animals↗
PubMed1995

Physiological characterization of pretectal neurons projecting to the lateral posterior-pulvinar complex in the cat.

Pretectal neurons projecting to the lateral posterior-pulvinar complex (LP-P) in cats were electrophysiologically identified by their antidromic activation from the LP-P. Their responses to various visual stimuli and to electrical stimulation of the optic chiasm and the lateral geniculate nucleus (LGN) were characterized. In retrograde double-labelling experiments, the pretectal projections to the LP-P and to the LGN were tested for possible overlap. Forty-five neurons were antidromically activated from the LP-P; 55% of them could also be activated orthodromically from the optic chiasm. Most antidromically activated neurons responded to rapid movements of large textured visual stimuli as well as to 'on' or 'off' visual stimulation with short bursts. When stimulated with a slowly moving, large, structured visual stimulus, most cells showed a slight but significant activity increase. None of the neurons projecting to the LP-P was also activated antidromically from the LGN. Thus, the two populations are separate. This is supported by the results from the retrograde double-labelling experiments. None of the LP-P projecting neurons showed any directional selectivity to slow movements of large visual stimuli, a property by which pretectal neurons projecting to the inferior olive are characterized. Thus, neurons projecting to the LP-P do not bifurcate to the inferior olive. Response properties of neurons projecting to the LP-P were very similar to those of the 'jerk' neurons described by Schweigart and Hoffmann (Exp. Brain Res., 91, 273-283, 1992); therefore we believe them to be identical.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2004

Thalamic innervation of striatal and subthalamic neurons projecting to the rat entopeduncular nucleus.

The present study analyses the anatomical arrangement of the projections linking the Wistar rat parafascicular thalamic nucleus (PF) and basal ganglia structures, such as the striatum and the subthalamic nucleus (STN), by using neuroanatomical tract-tracing techniques. Both the thalamostriatal and the striato-entopeduncular projections were topographically organized, and several areas of overlap between identified circuits were noticed, sustaining the existence of up to three separated channels within the Nauta-Mehler loop. Thalamic afferents arising from dorsolateral PF territories are in register with striatofugal neurons located in dorsolateral striatal areas, which in turn project to dorsolateral regions of the entopeduncular nucleus (ENT). Medial ENT regions are innervated by striatal neurons located within medial striatal territories, these neurons being the target for thalamic afferents coming from medial PF areas. Finally, afferents from neurons located in ventrolateral PF areas approached striatal neurons in ventral and lateral striatal territories, which in turn project towards ventral and lateral ENT regions. Efferent STN neurons projecting to ENT were found to be the apparent postsynaptic target for thalamo-subthalamic axons. The thalamo-subthalamic projection was also topographically organized. Medial, central and lateral STN territories are innervated by thalamic neurons located within medial, ventrolateral and dorsolateral PF areas, respectively. Thus, each individual PF subregion projects in a segregated fashion to specific parts of the striato-entopeduncular and subthalamo-entopeduncular systems. These circuits enabled the caudal intralaminar nuclei to modulate basal ganglia output.

Animals↗
PubMed2005

Both oral and caudal parts of the spinal trigeminal nucleus project to the somatosensory thalamus in the rat.

Recent evidence has been accumulated that not only spinal trigeminal nucleus caudalis (Sp5C) neurons but also spinal trigeminal nucleus oralis (Sp5O) neurons respond to noxious stimuli. It is unknown, however, whether Sp5O neurons project to supratrigeminal structures implicated in the sensory processing of orofacial nociceptive information. This study used retrograde tracing with Fluorogold in rats to investigate and compare the projections from the Sp5O and Sp5C to two major thalamic nuclei that relay ascending somatosensory information to the primary somatic sensory cortex: the ventroposteromedial thalamic nucleus (VPM) and the posterior thalamic nuclear group (Po). Results not only confirmed the existence of contralateral projections from the Sp5C to the VPM and Po, with retrogradely labelled neurons displaying a specific distribution in laminae I, III and V, they also showed consistent and similar numbers of retrogradely labelled cell bodies in the contralateral Sp5O. In addition, a topographic distribution of VPM projections from Sp5C and Sp5O was found: neurons in the dorsomedial parts of Sp5O and Sp5C projected to the medial VPM, neurons in the ventrolateral Sp5O and Sp5C projected to the lateral VPM, and neurons in intermediate parts of Sp5O and Sp5C projected to the intermediate VPM. All together, these data suggest that not only the Sp5C, but also the Sp5O relay somatosensory orofacial information from the brainstem to the thalamus. Furthermore, trigemino-VPM pathways conserve the somatotopic distribution of primary afferents found in each subnucleus. These results thus improve our understanding of trigeminal somatosensory processing and help to direct future electrophysiological investigations.

Animals↗
PubMed2006

Sleep-active neurons in the preoptic area project to the hypothalamic paraventricular nucleus and perifornical lateral hypothalamus.

The lamina terminalis consists of the organum vasculosum of the lamina terminalis (OVLT), median preoptic nucleus (MnPO) and subfornical organ. The MnPO and ventrolateral preoptic area (vlPOA) are known to contain high densities of neurons that are sleep active. The prevalence of sleep-active neurons in the OVLT and subfornical organ is unknown. The vlPOA and subdivisions of the lamina terminalis project to hypothalamic regions involved in the control of behavioral, electrographic or autonomic arousal, including the lateral hypothalamic area (LHA) and paraventricular nucleus (PVN). The extent to which projection neurons are active during sleep is unknown. We quantified c-Fos protein immunoreactivity (IR) in the lamina terminalis and vlPOA in sleeping and awake rats that received injections of retrograde tracer into either the LHA or PVN. Fos IR was also examined in lamina terminalis neurons following tracer injections into the vlPOA. Significantly more projection neurons from the MnPO, OVLT and vlPOA to the LHA were Fos-immunoreactive in sleeping vs. awake animals. Waking Fos IR was more prevalent in lamina terminalis neurons projecting to the PVN although a subset of MnPO projection neurons in sleeping rats was Fos-immunoreactive. Almost 50% of vlPOA-PVN projection neurons expressed Fos IR during sleep, compared with 3% during waking. Significantly more neurons in the OVLT and MnPO projecting to the vlPOA were Fos-immunoreactive in sleeping vs. awake rats. Inhibition of LHA and PVN neurons arising from OVLT, MnPO and vlPOA neurons may contribute to suppression of behavioral, electroencephalographic and sympathetic nervous system activation during sleep.

Animals↗
PubMed1999

Assessment of the "scholarly project" requirement for emergency medicine residents: report of the SAEM Research Directors' workshop. SAEM Research Directors' Interest Group.

OBJECTIVES: Differences in interpretation of the residency review committee (RRC) directive concerning resident scholarly activity have resulted in inconsistencies in the practical fulfillment of this responsibility among the various training programs in emergency medicine. During a workshop organized by the SAEM Research Directors' Interest Group (RDIG), a consensus statement was developed regarding the scope, definition, and purpose of the scholarly project requirement. METHODS: During the workshop, the NIH model of consensus building was used to develop statements pertaining to specific questions of the goals, definition, and endpoints of the scholarly project. The program consisted of an overview of the history and issues related to the scholarly project and presentations of varying viewpoints from interested parties. A final consensus of answers to the defined questions was then developed by the workshop participants during roundtable discussions and further refined through interactive debate using the RDIG e-mail list server. RESULTS: By consensus it was agreed that the primary role of the scholarly project is to instruct residents in the process of scientific inquiry, to teach problem-solving skills, and to expose the resident to the mechanics of research. To realize these goals, the project should include the general elements of hypothesis formulation, data collection, analytic thinking, and interpretation of results. It was also thought that these elements should be documented in some written form with a literature review. CONCLUSIONS: While each residency program must implement the RRC residency requirements in a manner that best suits the needs and culture of its individual environment, a concurrence of definition and approach to satisfying the scholarly project requirement would provide better consistency in resident training. Guidelines developed by consensus during the SAEM RDIG workshop may serve as a general recipe that can be used to fulfill the goals of the scholarly project and the spirit of the RRC directive.

Decision Making↗
PubMedDate not supplied

Evaluation of different projections for radiographic detection of tarsal degenerative joint disease in Icelandic horses.

Radiographs from 196 tarsi in 98 Icelandic horses were evaluated to compare the accuracy of four different projections in detecting radiographic signs of degenerative joint disease in the distal tarsus. The extent and localization of tarsal degenerative joint disease found in one projection when reading all four projections of the same tarsus together was compared with the combined findings from all four projections. The results of reading individual radiographic projections without knowledge of the other three projections was also evaluated. Degenerative joint disease was detected most frequently in the plantarolateral-dorsomedial oblique (P1L-DMO) projection. The location with the highest relative frequency of radiographic findings was the dorsolateral aspect of the centrodistal and tarsometatarsal joints respectively. Radiographic signs of active bone remodelling was detected in 30 (33%) and periarticular osteophytes in 51 (56%) of 91 tarsi with degenerative joint disease.

Animals↗
PubMed1995

A review of selected school-based conflict resolution and peer mediation projects.

Many U.S. schools are implementing curricula and other activities to reduce interpersonal violence among students. Most involve conflict resolution or peer mediation (CR/PM) training. Little is known about the effectiveness or manner of implementing these projects. This paper examines nine projects supported by four state health departments. Available data suggest some projects may modify youths' self-reported attitudes about violent behavior, improve school discipline, and reduce absenteeism. The review also revealed considerable variation in implementation, especially in the role of professionally trained consultants and amount of teacher and student training. More attention should be paid to evaluating CR/PM projects. Some data suggest they may contribute positively to community efforts to reduce violence among youth, but insufficient information exists to know which projects best serve which students, and how projects should be implemented. Until consensus emerges, project personnel should carefully assess the implementation and impact of their activities. Routinely collected data, such as disciplinary actions, can be used for evaluation, often with only minor modification.

Adolescent↗