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Educators, policymakers, and other concerned adults share an interest in promoting lifelong patterns of community service in youth. Practitioners and researchers alike highlight the importance of youth participation in afterschool service activities so the author's focus in this paper is on youth involved in PeaceJam, an innovative service program. PeaceJam is a community-based social action program created in the late 1990s to engage gang members in inner-city Denver in prosocial activities. Since that time, more than one million youth have participated worldwide. "PeaceJammers" study the lives of Nobel Peace laureates, identify a pressing community issue, and plan and implement a social action project. Mixed methods were employed in this study, combining results from quantitative surveys with program observations and participant interviews. Surveys were administered over three years from a sample of 781 youth (67% female, with 43% reporting an ethnicity other than Caucasian). The sample included more juniors (33%) and seniors (32%) than freshmen (15%) and sophomores (20%). Respondents averaged 1.6 years of involvement in Peace-Jam. Similarly, of the 30 interviewees, 73% were female, and 38% reported an ethnicity other than Caucasian. Analysis of our quantitative and qualitative data explored the connections between psychosocial experience and participants' sustained engagement in PeaceJam and in service to the community. In speaking of the process of participation, youth reported high levels of autonomy, belongingness, and competence. They spoke to the need to engage in intentional practices that are organized around, and sensitive to, the diverse needs that are present in youth-serving settings. Programs that facilitate social action may promote the development of shared purpose through collaborative efforts towards a common goal. Inspired by these experiences to critically analyze their own values and goals, youth may develop a sense of purpose and self-determination.

The Kalamazoo Promise was announced in the fall of 2005, offering free college tuition at any public state college or university for graduates of the district who have gained acceptance to a postsecondary institution. This program was funded through the generous support of anonymous donors, and a federally-funded evaluation is underway to examine potential changes that result from its implementation. This paper situates perceptions of school climate in this moment of punctuated equilibrium of school reform, and in the context of this universal postsecondary scholarship program. This evaluation research draws from multiple data sources including interviews with educators, and surveys and interviews with students in the school district. Findings indicate that school climate has improved since the announcement of the program. We discuss the implications of research findings and the potential of the Kalamazoo Promise as a catalyst for systemic change in the district. (Contains 1 table, 1 footnote and 3 figures.)

Involvement in social action and community service can promote the construction of prosocial identities and enduring patterns of civic behavior. This article explores this important process for youth that participate in the PeaceJam Ambassadors program. High school-aged "PeaceJammers" study the lives of Nobel Peace laureates while creating projects to affect change in their local communities. Multiple methods were used to access youth perceptions including surveys and interpretive interviews. Participants reported high levels on indicators on personal and social change. Their narratives articulated salient influences on their identities and actions. They shared how advisors promote social identity, participation, and the development of moral identities. These findings add to a growing empirical literature on moral development and youth engagement in peace education and community transformation.

Student goals and aspirations are an important determinant of success in secondary schools and promote access to post-secondary education. This paper reports on changes in student attitudes, goals, and aspirations that result from the implementation of a universal scholarship program. The Kalamazoo Promise is an innovative reform effort that provides full tuition to any state school for students that graduate from the school district. A federally-funded evaluation is examining the impacts of this program drawing from multiple data sources including student surveys and interviews with students and educators in the school district. Students and professionals in the district report that students' aspirations have been affected and describe changes in educational ambitions and the intensity with which students pursue their identified objectives. Implications of findings are discussed, as well as the potential of the Kalamazoo Promise as a catalyst for systemic change in the district. (Contains 1 table and 4 figures.)

The Kalamazoo Promise provides a scholarship for full tuition for any high school graduate from the district who's been accepted to attend a Michigan postsecondary institution. The Promise has changed the attitudes of the students, their parents, and the community and has combined with other efforts to promote successful reform and systemic change in the district. (Contains 2 figures.)

Objective:We examined the incidence and predictors of peritraumatic distress and dissociation after one of the most common forms of civilian trauma exposure: motor vehicle collision (MVC).Method:In this study, patients presenting to the emergency department after MVCs who were without serious injury and discharged to home after evaluation (n= 935) completed an emergency department interview evaluating sociodemographic, collision-related, and psychological characteristics.Results:The incidence and predictors of distress (Peritraumatic Distress Inventory score ≥23) and dissociation (Michigan Critical Events Perception Scale score >3) were assessed. Distress was present in 355 of 935 patients (38%), and dissociation was present in 260 of 942 patients (28%). These outcomes showed only moderate correlation (r= .45) and had both shared and distinct predictors. Female gender, anxiety symptoms prior to the MVC, and vehicle damage severity predicted both distress and dissociation. Higher socioeconomic status (higher education, higher income, full-time employment) had a protective effect against distress but not dissociative symptoms. Better physical health and worse overall mental health were associated with increased risk of dissociation but not distress. Distress but not dissociation was associated with lower patient confidence in recovery and a longer expected duration of recovery.Conclusion:There are unique predictors of peritraumatic distress and dissociation. Further work is needed to better understand the neurobiology of peritraumatic distress and dissociation and the influence of these peritraumatic outcomes on persistent psychological sequelae. [ABSTRACT FROM PUBLISHER]

BACKGROUND The annual cost of caring for the 80,000 patients who develop venous catheter-associated bloodstream infections (CA-BSIs) each year in the US is estimated to be between US$296 million and $2.3 billion, and every year 28,000 patients die of these infections. Despite these alarming statistics, there are few programs currently in place to reduce the rate of infection. OBJECTIVE To assess the efficacy of an intervention to decrease the incidence of CA-BSIs in intensive care units (ICUs) for up to 18 months after implementation. DESIGN AND INTERVENTION This was a prospective cohort study carried out as part of the Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality Keystone ICU Project. In October 2003, all of the hospitals in Michigan, USA, were invited to participate in the study. At least one physician and one nurse in each participating ICU received training on the science and safety of the intervention and were responsible for passing this information on to their colleagues. The intervention was implemented between March 2004 and September 2005, and comprised the use of daily goal sheets designed to improve staff communication in the ICU, and a program to improve safety culture; both initiatives commenced during the first 3 months of the study. These protocols were followed during the subsequent 6-month period by the implementation of a 5-step procedure to be adhered to when inserting a central venous catheter (CVC). This procedure involved hand washing, cleaning the patient's skin with chlorhexidine gluconate, using barrier precautions when inserting the catheter, avoiding catheter insertion at the femoral site, and removing unnecessary catheters. OUTCOME MEASURE The rate of CA-BSIs in each 3-month period. RESULTS The study enrolled 108 ICUs, but four were excluded because they did not monitor or report infection rates. One further unit was excluded because it merged with another ICU; therefore, 103 ICUs in 67 hospitals were included in the analysis, representing 85% of the ICU beds in Michigan. Data were collected for a total of 375,757 catheter-days. At baseline, the median rate of CA-BSIs was 2.7 (mean 7.7) per 1,000 catheter-days (95% CI 0.6-4.8); the rate decreased to 0 infections (mean 2.3) per 1,000 catheter-days (95% CI 0-3.0) up to 3 months after the intervention had been implemented (P ≤ 0.002). A median rate of 0 infections (mean 1.4) per 1,000 catheter-days was maintained for the entire follow-up period. At 16-18 months after implementation, the rate of infection had been reduced by 66% compared with the baseline rate. Although the decrease in infection rate was observed for both teaching and nonteaching hospitals of all sizes, the intervention was more successful in facilities with fewer than 200 beds, with an incidence-rate ratio of 0.97 for each 100-bed decrease (P < 0.001). CONCLUSION The implementation of an inexpensive, evidence-based intervention in the ICU can reduce the rate of CA-BSIs over an extended period of time. [ABSTRACT FROM AUTHOR]

Background: Motor vehicle collisions (MVCs) are the second most common injury mechanism resulting in emergency department (ED) visits by older adults. MVCs result in substantial pain and psychological distress among younger individuals, but little is known about the occurrence of these symptoms in older individuals. We describe the frequency of and characteristics associated with pain, distress, and anticipated time for physical and emotional recovery for older adults presenting to the ED after MVC in comparison to younger adults., Methods: In-person interviews were conducted for adults presenting to one of eight EDs after MVC without an obvious fracture or injury requiring admission as part of two prospective studies. Pain severity was assessed using a 0-10 verbal scale. Distress was assessed using the Peritraumatic Distress Inventory (range 0-52). Patients were asked to estimate their expected time for physical and emotional recovery; these responses were dichotomized to <30 or ≥30 days. ED pain and distress and associations between patient and collision characteristics and ED pain and distress were examined for patients age 65 years and older and patients age 18 to 64., Results: Older (n = 96) and younger (n = 943) adults had the same mean pain scores (5.5, SD 2.5 vs. 5.5, SD 2.4). Distress scores were lower in older than in younger adults (15.5, SD 9 vs. 19.2, SD 10). A higher percentage of older adults than younger adults had an anticipated time to physical recovery ≥30 days (41%, 95% confidence interval [CI] 28%-55% vs. 11%, 95% CI 9%-13%). Similarly, older adults were more likely to have an anticipated time for emotional recovery ≥30 days (45%, 95% CI 35%-55% vs. 17%, 95% CI 15%-20%). Older adults were less likely than younger adults to have moderate or severe neck pain (score ≥4) (25%, 95% CI 23% to 41% vs. 54%, 95% CI 48% to 60%) or back pain (31%, 95% CI 23% to 46% vs. 56%, 95% CI 51 to 62%) but more likely to have moderate or severe chest pain (42%, 95% CI 32% to 50% vs. 20%, 95% CI 16 to 23%). Pre-MVC depressive symptoms and pain catastrophizing were positively associated with pain and distress in both older and younger adults., Conclusions: In our cohort, older adults who presented to the ED after MVC experienced similar pain severity as younger patients and less distress but were more likely to estimate their times for physical and emotional recovery to be 30 days or more. Increased emergency provider awareness of acute pain and distress symptoms among older patients experiencing MVC may improve outcomes for these patients.

Study Objective: Physical abuse of older women, including reports of sexual assault, has risen rapidly for the last decade. The purpose of this study was to compare a group of postmenopausal victims of sexual assault with younger adult women (18-39 years old) by examining patient demographics, assault characteristics, and patterns of physical injury., Methods: We conducted a retrospective cohort analysis to assess epidemiology and anogenital injuries in consecutive female victims presenting to sexual assault clinics and/or emergency departments within 3 counties of Western Michigan. All patients were examined by forensic nurses trained to perform medicolegal evaluations using colposcopy with nuclear staining. Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system. Data from 2 patient groups (women aged 18-39 years vs postmenopausal women >or=50 years) were compared using chi(2) and t tests., Results: During the 5-year study period, 1917 adult sexual assault victims met the inclusion criteria and comprised the study population as follows: 84% of the victims were 18 to 39 years old, and 4% were postmenopausal women at least 50 years old. The 72 postmenopausal victims were more likely to be assaulted by a single assailant, typically a stranger (56% vs 32%, P = .008), in their own home (74% vs 46%, P < .001) and experienced more physical coercion (72% vs 36%, P < .001). In comparison, the younger control group was more likely to have used alcohol or illicit drugs before the assault (53% vs 18%, P < .001) and have a history of sexual assault (51% vs 15%, P < .001). Postmenopausal victims had a greater mean number of nongenital (2.3 vs 1.2, P < .001) as well as anogenital injuries (2.5 vs 1.8, P < .001). The localized pattern and type of physical injuries were similar in both groups, although postmenopausal women tended to have more anogenital lacerations and abrasions., Conclusion: The postmenopausal woman is not immune from sexual assault. The epidemiology of sexual trauma in this age group is uniquely different when compared to younger women, which may be useful in planning intervention and prevention strategies.

To determine the incidence of toluidine blue positive findings after speculum examination of sexual assault victims, we performed a prospective before and after study of 27 female patients presenting after sexual assault to a free-standing nurse examiner clinic. Before the insertion of a speculum, a 1% aqueous solution of toluidine blue was applied to the posterior fourchette and photographs were taken using colposcopy with digital imaging (16 x magnification). After the forensic examination was completed, dye was reapplied. Photographs taken before and after speculum examination were reviewed by three EM physicians for superficial lacerations or abrasions. Before speculum examination, genital injuries from sexual assault were documented in 67% of the patients (mean number of genital injuries, 1.4). After speculum examination, one patient (3.7%) demonstrated a new genital injury-an abrasion to the labia. Until further studies are performed, use of a speculum should be delayed until after toluidine dye application.