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The present literature is conflicting regarding the management of microinvasive ductal carcinoma in situ (miDCIS) as to following recommendations for DCIS (margin status, surgical axillary staging, and possible observation) versus invasive breast cancer. We hypothesize that miDCIS represents more aggressive disease than pure DCIS.We performed a retrospective review of female miDCIS patients compared with age-matched cohorts of DCIS and T1b/c patients with invasive breast cancer. We collected demographic, clinicopathologic, treatment, and outcome information. Analysis of variance or Kruskal-Wallis tests were used to analyze continuous variables and chi-square or Fisher's exact tests for categorical variables. Survival outcomes were analyzed using Kaplan-Meier curves.We included 375 patients (125 in each group) with median age 59 y (range 33-91 y). miDCIS tumors were more likely to be hormone receptor negative and human epidermal growth factor receptor 2 positive compared with DCIS or invasive ductal carcinoma (IDC; all P 0.001). Subgroup analysis by miDCIS focality demonstrated no significant differences. The number of involved lymph nodes was not significantly different from DCIS patients but was significantly fewer than invasive cancer patients. Of 115 miDCIS patients (88%) staged with sentinel lymph node biopsy, eight (7%) had nodal metastases. Six miDCIS patients (5%) were treated with adjuvant chemotherapy. Over a median follow-up of 23.3 mo, there were no significant differences in local or distant recurrence.Based on our results, miDCIS has more aggressive pathologic features compared with DCIS and warrants surgical treatment and nodal staging similar to the management of IDC. In addition, similar to IDC, nodal and receptor status may influence medical management.

The Northern Wedge Failure (NWF) is a complex failure mass within Whitehall Quarry, Cambridge, New Zealand. Initiation of failure of the c. 500 000 m 3 mass occurred during spring of 1988. Complete failure was expected following displacement recordings of 2.3–5.6 m a −1 ; however, this did not eventuate. By the mid 1990s, the failure mass was deemed stable. In 2010, an engineering geological investigation was conducted to assess the stability of the NWF at that time. The rock mass that failed comprises moderately dipping interbedded feldspathic sandstone and argillaceous mudstone below a thin alluvial cover. It is bound by two fault planes, both exhibiting up to 100 mm of gravelly clay fault gouge. X-ray diffraction analysis of the gouge indicated the presence of kaolinite and montmorillonite, and Atterberg Limit tests showed the plastic and liquid limits to be 31% and 51%, respectively. Electronic distance monitoring (EDM) was carried out over 12 months. Recorded velocities increased by 17% above the 21 mm/month baseline over the wetter months. Limit equilibrium analysis carried out using historic and recent field and laboratory observations input to the computer software SWedge estimated a Factor of Safety (FOS) of 0.97. Complete failure of the NWF could be initiated at any time by an extended period of heavy rainfall and/or unloading of the toe or the stripping of overburden.

In late 2013, Trinidad and Tobago Police Service (TTPS) conducted the first randomized experiment ever to test a hot spots patrol strategy (HSPS) across large areas, as distinct from testing extra patrols one hot spot at a time. The HSPS experiment required, and helped to refine, a formal theory of both the causes and effects of directed patrols in hot spots. This article presents an integrated theory of how to implement an HSPS in ways that maximize the preventive effects of patrol on crime. It then describes the HSPS experimental protocol used to test the theory in Trinidad. The key elements of HSPS are scaling up from specific hot spot locations to a district-wide focus on all its hot spots and feeding back to the constables who provide hot spots patrols data on what they have done and with what effect—presented every 2 weeks, at a district-level “COP-stat” meeting with the people actually doing the patrols.

We used ethnographic methods in the tradition of Spradley (1979) and constant comparative analysis to explore case manager resource allocation decision making. We interviewed, observed, and shadowed 11 case managers within a children's home care program in a regional health authority in western Canada as they went about their daily work over a 5-month period. Our findings provide knowledge about the little-understood set of processes at the micro level of resource allocation. Although the case manager considers many factors, reported elsewhere (Fraser, Estabrooks, Allen, & Strang, 2009), they balance and weigh these factors within a relational context. The purpose of this article is to use Jenna's story as a case example to illustrate how the case manager balances and weighs the factors that influence their resource allocation decisions within this context. Jenna's story demonstrates the complex and multidimensional processes that are embedded in the relational nature of resource allocation decisions. We discuss home care case manager resource allocation decisions as viewed through the lens of relational ethics. Keywords: home care; service authorization; relational ethics; care planning Everything affects everything else. The case manager keeps the wheels turning. They are all wheels that work together and all the little cogs need to be in order for everything to function. (case manager) It takes a lot of work to maintain a healthy family life. That work is exponentially increased in families living with chronically ill and medically fragile children who have complex care needs. Families provide much of the sophisticated and heavy care to these children (Peter et al., 2007). Home care programs provide care that supports these families in keeping their children at home within the family unit. Case managers working within home care programs are charged with making resource allocation decisions regarding the type and amount of services to be provided for these chronically ill children. To many people, decisions are choices between competing alternatives, but to home care case managers, their decisions are much more complex and are embedded within relationships in a multidimensional decision-making context. Case managers work closely with clients and their families as they intricately balance and weigh various influencing factors within system constraints so that children with complex medical needs can be cared for at home. The factors that case managers use are reported in detail elsewhere (Fraser, Estabrooks, Allen, & Strang, 2008). In this article, we share a case that resonated with us as we conducted the previously mentioned ethnographic study. Our purpose in telling Jenna's story, as told to us primarily through Rosie, her case manager, is to illustrate how case managers balance and weigh the factors that influence them in making resource allocation decisions through the lens of relational ethics. We use Jenna's case to highlight the relational nature of the process that surround case manager resource allocation decisions in the midst of complexity. METHODS Our research study was approved by the Health Ethics Review Board at the University of Alberta. We received administrative approval from the health region in which it was conducted. We used ethnographic methods, specifically ethnoscience (Spradley, 1979), to uncover the factors that influence case managers in making resource allocation decisions for home care clients in the main study. Ethnoscience is used to study language and, in particular, how people use language to categorize their world. Specific data collection and analysis procedures for the main ethnographic study are fully described elsewhere (Fraser et al., 2008). In addition to ethnoscience, we used constant comparative analysis to analyze the process date that arose in the study. This case arose out of the constant comparative analysis. An overview of the research context, participants, and methods is provided here to help situate this case in the overall study. …

Social networks and social support are recognized as important determinants of health. Relocation is a common transition in older adults’ lives that can disrupt existing social networks and challenge seniors to reconstitute these networks. Social engagement is a required component of the process of reconstituting social relationships and of feeling connected. The purpose of this focused ethnographic study was to develop an understanding of the experience of social engagement in relocated residents of a senior-designated apartment building. Data generation included interviews with 19 older adults. Transcribed interviews were analyzed using thematic analysis. Seniors developed four types of relationships for provision of feelings of security, casual interactions, opportunity to be supportive, and friendship. The findings of this research provide a better understanding of the relationships seniors developed in a new community as a result of the process of social engagement.

In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family—staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of “Everybody Knows Your Name,” “Loss and Laundry,” “It's the Little Things That Count,” and “The Chasm of Us Versus Them.” Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family— staff relationships in traditional continuing care settings in Canada.

Background Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care. Methods Using Spradley's methodology, we designed an ethnographic study of a children's home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis. Results One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the team's role been reported as an influencing factor. Conclusion The findings of this study are examined in light of Daniels and Sabin's Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.

This study’s purpose was to explore family caregivers’ experiences while they waited placement of family members with dementia in long-term care and how they coped during this period of waiting and transition. In this exploratory descriptive qualitative study, interviews were conducted with 29 caregivers at entry to the placement wait-list and at 3 to 4-month intervals thereafter. Final interviews, with 15 caregivers, were conducted shortly after admission to long-term care. When “the waiting begins,” the themes of crisis as initiator, synchronicity, control, and reciprocity emerged. “After placement” included the themes of deeply bonded relationships, attempting continuity, and sorting out the change. The findings provide new insight into family caregiver experiences during and after placement of a family member with dementia in long-term care. Clinicians must recognize that wherever services are provided, at home before placement or in institutions after placement, family caregivers must be incorporated as full partners in care.

Business schools continue to grapple with the issue of curriculum integration. Although faculty are encouraged to work conjointly and students are told that theories, concepts, and techniques learned in one course will be used in future courses, the challenge of integrationfrom course to course remains elusive. This article presents a model for curriculum integration developed by the business school at the State University of New York at Geneseo. The model uses a comprehensive case based on a real-world insurance company. Incoming business students will be presented with a synopsis of the case in their first year of business school. The same case with the relevant topical additions will continue to be used in all subsequent primary business courses. The article presents the rationale, methodology, and curriculum development of the case. The article also outlines how the school plans to integrate the case into the upper-level business courses.

For more than 20 years, joint appointments between nursing education and nursing service have been recommended as a strategy to foster excellence in nursing education and nursing practice, bridge the theory-practice gap, and promote clinically relevant research. This article discusses the termination of a joint-appointment initiative after research that had demonstrated its success in terms of benefits to both agencies and satisfaction for the incumbents in the positions. It presents the value and vulnerability of joint academic-clinical agency joint appointments based on critical analysis of the academic literature juxtaposed with our research and subsequent experience with four joint appointments between a faculty of nursing and a home-care agency. Top-level administrative support and understanding of the potential of such positions are crucial for the nurses involved, and the positions themselves become vulnerable in times of change and fiscal restraint.

Decision-making related to resource allocation in home care case management practice is addressed from the unique perspective of nursing. The case management process stipulates the adherence to both client-centered and system-centered goals. Issues that emerge from this process include the ethical dilemma of deciding the equitable and fair distribution of resources related to the provision of appropriate levels of service; economic factors as they relate to limited financial resources; and the variance among case managers in their decision-making. Moderate realism, as compared to critical and feminist theory, provides a philosophical perspective that allows a practical interpretation of these issues.

The findings from a qualitative study of bow caregivers coped while they cared for a dying family member at home are presented. Fifteen family caregivers were interviewed twice following The death of their family member. Although it was not one of the original objectives of the research, coping emerged as a category needing further analysis. There were factors that either facilitated or interfered with caregiver coping. Those factors that facilitated their coping included characteristics of the caregivers themselves; contributions made by the dying person; and supportive networks, both formal and informal, available to the caregivers. Interfering factors related to caregiver experiences with informal and formal systems. From the more distant Perspective of post-death reflections, the caregivers Provided insight into how their coping was grounded in the meaning associated with their experiences.

In recent years, fluorescence-based optical methods for detecting dental caries have been examined with some success. However, these methods do not explicitly assess the lesion depth, which may prove to be a useful indicator of the progression/regression of dental caries. The purpose of this study was to apply a newly developed fibre optic-based confocal microscope to the characterisation of artificial enamel lesions in their initial stages. Lesions were found to produce characteristic back-scattering signals, with an initial peak indicating the sample surface and a smaller secondary peak indicating the base of the lesion. Analysis of these signals showed that lesions from as little as 20 to over 100 μm deep could be detected. As the technique incorporates fibre optics to deliver the excitation light and collect the back-scattered light, it is suited to clinical application. Further work is needed to show that this method is applicable to detecting natural lesions in vivo.

(2002). Bibliotherapy in the Classroom Using Literature to Promote the Development of Emotional Intelligence. Childhood Education: Vol. 79, No. 2, pp. 74-80.

The purpose of this qualitative interpretive study was to explore the experience of respite during home-based family caregiving for persons with advanced cancer. Fifteen caregivers were interviewed twice after the death of their family member. Three main themes emerged from the data analysis. First, caring for a dying family member at home is an emotionally intense, exhausting, and singular experience, set in a world apart from everyday life patterns. Second, the caregivers differentiated between cognitive breaks and physical (getting away from) breaks of respite. To achieve a cognitive break and yet remain within the caregiving environment was viewed as important, whereas the physical separation from it was significant only if it contributed in some meaningful way to the caregiving. Third, the meaning of respite is rooted in the desire to bring a measure of quality and normalcy to the life of the dying person. Respite means staying engaged in living life with the dying family member.

This study aimed to determine the contribution of the underlying dentine and the enamel-dentine junction to measurements of mineral loss from enamel recorded using quantitative light fluorescence (QLF). Sixteen square blocks (5 × 5 mm) were cut from the labial surfaces of extracted bovine incisor teeth. A dental drill was used to remove dentine and the enamel-dentine junction from half of each specimen. All specimens were embedded in epoxy resin and ground to produce a smooth, flat enamel surface. Half of the enamel surface of the block, perpendicular to where the dentine had been removed, was demineralised for 72 h prior to undertaking QLF measurements from the enamel surface to compare fluorescence loss from different areas of the block. QLF readings taken from lesions with no underlying dentine or enamel-dentine junction were very similar to readings from lesions with underlying dentine. A comparison of the two data sets demonstrated a linear relationship with a gradient of 0.95 and a y intercept of –1.24 (r2 = 0.936). From these data, the underlying dentine and enamel-dentine junction did not influence mineral loss in enamel measured using QLF.

Large numbers of family members, particulary women, find themselves in the stressful roles of caring for their frail elders with dementia. Although caregiver respite is seen as one way to mitigate the negative consequences of care giving, many caregivers are reluctant to use services which offer them respite opportunities. By focusing on the similarities between respite and leisure experiences from a feminist perspective, this caregiver hesitancy will be explored. Interpreting the stories of eight women caregivers participating in a qualitative study which examined the experience of respite for family caregivers of persons with dementia, convergence between the experiences of leisure an of respite occur in at least four areas. These included: the experience of freedom, the getting away from obligatory routine, the pursuit of personally satisfying activities, and bothe as an ‘attitude of the mind’.

Laser Doppler flowmetry is a non-invasive electrooptical technique which allows the semi-quantitative recording of pulpal blood flow. This study aimed to determine the reliability (measured as the sensitivity and specificity) of laser Doppler flowmetry as a method of assessing the vitality of traumatised anterior teeth, and to compare it with standard pulpal diagnostic tests. Recordings of pulpal blood flow were taken from 67 non-vital anterior teeth (55 patients), where the pulpal status was confirmed by pulpectomy. For comparison, recordings were also taken from 84 vital anterior teeth (84 patients). Analysis of the recordings allowed diagnostic criteria to be developed which gave the technique a sensitivity and specificity of 1.0 for this sample. None of the other standard pulpal diagnostic methods tested was as reliable. This was usually due to low sensitivities, which ranged between 0.92 for sensibility testing with ethyl chloride down to 0.36 for periapical radiolucency and 0.16 for a history of pain. Laser Doppler flowmetry was found to be a reliable method of assessing the pulpal status of traumatised anterior teeth, although it is technique-sensitive and time-consuming to use.

Demographic trends indicate a growth in the older adult population, and in turn, are affecting the availability and use of health services. Although placement of an older adult charge into nursing home care is often described as a logical progression through the continuum of available services, informal caregivers often view placement as a last resort or as an indication of failure. This qualitative study used grounded theory methods to explore the experiences of caregivers actively involved in the process ofplacing an older adult in a long-term carefacility upon discharge from acute care. Four themes (uncertainty, surrendering to the system, urgency, and validating) were interwoven throughout caregivers'perspectives of the conflictive decision to use nursing home care after hospitalization.

For the caregiver, a respite experience is one way to mitigate the negative consequences of caregiving. In this interpretive study, based on narrative inquiry and using grounded theory analytical methods, 10 caregivers described the respite experience as a cognitive process of getting out of the caregiver world and into their own world. In this world, theyfeelfreefrom the responsibilities and the worries of caregiving-the quintessential meaning of respite to these caregivers. Factors influencing the caregivers'abilities to experience this respite include the nature of the pre-illness relationship between the caregivers and their dependentfamily members, role expectations, the attributes of the available respite services, and time. Thesefindings provide a criticalfirst step in understanding why the respite experience may be so difficultfor some caregivers to achieve and their continuing hesitancy to use respite services even when these services are available.

This critical review of the published literature on dental materials for the year 1996 has been compiled by the Dental Materials Panel of the UK. It continues the series of annual reviews started in 1973 and published in the Journal of Dentistry. Emphasis has been placed upon publications which report upon the materials science or clinical performance of the materials. The review has been divided by accepted materials classifications (fissure sealants, glass polyalkenoate cements, dentine bonding, dental amalgam, endodontic materials, casting alloys, resin-bonded bridges and ceramo-metallic restorations, ceramics, denture base resins and soft lining materials, impression materials, implants materials, orthodontic materials, biomechanics and image processing, resin composites and casting investment materials and waxes). Three hundred and thirteen articles have been reviewed.

Secondary analysis of qualitative data is a valid mode of clinical inquiry. However, there is limited information available on its use in nursing. This article describes the use of secondary analysis for a study of family caregivers of relatives with dementia. The advantages, limitations, and application of secondary analysis are outlined; data management, analysis, and rigor are also discussed. The article concludes that this method is cost-effective, decreases respondent burden, and is a useful research method for students. However, the secondary analyst must be aware of the limitations of using secondary analysis of qualitative data.

This paper describes a novel application of transverse microradiography for the detection and quantification of mineral loss due to acid erosion in thin tooth sections. Sixty-four specimens were randomly divided into eight equal-sized groups and exposed to an orthophosphoric-acid-based erosive fluid (pH = 3) for 0, 0.25, 0.5, 1, 2, 5, 12, or 24 hrs. We made microdensitometric scans separately across both enamel and dentin to derive data for the total mineral loss and the minimum mineral content within the eroded area. We then analyzed specimens using a profilometer to determine (1) the area above a plot of penetration depth against distance and (2) the maximum depth of penetration. Correlation coefficients for comparisons between microradiographic and profilometric data for both enamel and dentin specimens varied between 0.87 and 0.96. Two-sample t tests demonstrated that the microradiographic technique could detect early erosion, i.e., discriminate between erosion times of less than 1 hr. It was concluded that this application of transverse microradiography was a useful and acceptable method for the measurement of early mineral loss in vitro, occurring as a result of acid erosion.

Summary A Neodyminium-yttrium aluminium garnet (Nd–YAG) pulsed laser was used in vitro to determine whether various laser energy levels from 0.75 W to 1.7 W at 15 pulses s−1 (pps) were able to (i) remove debris from the walls of prepared root canals (ii) remove pulpal tissue from unprepared canals and (iii) create a fused apical plug from dentine chips, hydroxyapatite (HAP) or low-fusing dental porcelain. Single-rooted teeth were sectioned at the amelocemental junction and the crowns discarded. The root canals of 50 teeth were prepared chemomechanically and allocated to four groups of 10 teeth for laser treatment. One group was left unlased as a control. After lasing, the teeth were split longitudinally, stained and examined for residual debris. Results showed that there was no statistically significant difference between the groups (P < 0.05). A further 20 teeth were not prepared and lased in the coronal one-third of the root canal at different energy levels; five teeth were not lased. The teeth were split and examined as previously. The results showed that lasing cleaned the coronal part of the root canal almost completely of pulpal tissue. In the final part of the study laser energy was applied to dentine chips, HAP and low-fusing procelain in an attempt to produce a fused apical plug. The laser was unable to melt the dentine chips but some hardening of HAP occurred when combined with blue food-colouring, with or without glycerine, at energy levels of 1.0 W, at 15 pps for 30 s. Superficial hardening of low-fusing porcelain occurred at 1.0 W, 15 pps for 30 s which increased when 1.5 W was applied at 15 pps for 30s.

Abstract: With increasing emphasis on outcome research in health care, there is concern about the poor utilization of evaluative research findings at the organizational level. This article examines the factors that influence utilization of results at a local agency and program level. The selected findings of an evaluation of one small adult day-care program will be used as a case study to illustrate the issues associated with these utilization factors. Three broad categories will be addressed in the discussion: structural factors, factors associated with the research process itself, and factors related to the organizational climate of the agency.

Two independent cross-over studies have now been carried out to evaluate the effect of a regime of chewing sucrose-containing gum on enamel lesion remineralization. The first study has been reported in detail elsewhere. This further study aimed to increase the data set with an additional 13 volunteers. Similar protocols were followed in both studies. Weighted averages from the two studies showed delta z values corresponding to 16.8% remineralization for the gum versus 11.6% remineralization for the control (p = 0.046, two-sided). A significant difference between test and control was evident for lesion body (p = 0.0004, two-sided) but not for surface zone (p = 0.32, two-sided).

Pulsed Nd-YAG laser irradiation of bacteria has been suggested as a possible means of treating contaminated intra-oral sites although relatively few studies have been conducted. In this investigation, the antimicrobial activity of a pulsed Nd-YAG laser was assessed in vitro for a range of oral bacteria using several pulse energies and exposure durations. Pure cultures of each organism were lased in saline suspensions followed by standard colony counting techniques for test and control samples. Microbial inhibition was found to be organism-dependent and varied with energy dose and pulse energy. For all nine test species 120-mJ laser pulses proved more efficient than 80-mJ pulses, with 99.9% kills compared with around 90% kills after exposure to 1800 pulses. These killing activity levels compare favourably with those achieved with other lasers in vitro.

This paper describes a study designed to define the principal techniques that pre‐service teachers apply as they address the challenges encountered in completing the current Curry Teaching Simulations. Factor analysis of simulation performance scores yielded three clearly identifiable performance factors. The three factors addressed the techniques which defined teachers’ misbehavior intervention, instructional delivery, and activity sequencing, respectively. Regression analyses were employed to assess the relationship of each of the three factors to personality and demographic variables.

The aims of this study were firstly to investigate the fluoride-releasing characteristics of five commercial glass ionomer materials: Ketac Fil, Chemfil Superior, Fuji II LC, Aquacem and Vitrebond. The second aim was to assess the fluoride uptake and subsequent release from the same range of materials. In both tests, ten discs, 6 mm in diameter with a thickness of 1.5 mm, were made for each material. The initial fluoride release was assessed over a 60-day period for all materials. Each disc was immersed in 2 ml of de-ionised water within a plastic vial. The solutions were changed daily up to day 15, and thereafter every 3 and 4 days until the end of the test. All of the materials released measurable amounts of fluoride throughout the test period, with a considerable range on day 1 (15.3-155.2 ppm F). The concentration of fluoride released on the 2nd day fell sharply for all materials (range 6.3-44.3 ppm F). By day 60 all materials continued to release fluoride, albeit to a lesser extent (range 0.9-3.99 ppm F). With regard to the uptake and release of fluoride, a similar protocol was employed, although all samples were immersed in 1 litre of de-ionised water for 60 days to allow the majority of the fluoride to leach out from the materials. The ten pellets for each material were divided into two groups, five samples as control and five samples as test. Each day over a 20-day period all test samples were exposed to a 1000-ppm F solution for 2 min.(ABSTRACT TRUNCATED AT 250 WORDS)

The objective of this work was to identify suitable methods for personal sampling of formaldehyde in ambient air at sub-ppm levels. Experiments were conducted to survey several of the commercially available monitors and to compare them to the more established “active” methods, which are based on a variety of different chemistries: chromotropic acid, 2-(hy-droxymethyl)piperidine, and 2,4-dinitrophenylhydrazine. Experiments were conducted in a laboratory plexiglas exposure chamber. Stable formaldehyde concentrations were generated by heating alpha-polyoxymethylene in a refillable, high-permeation rate diffusion tube. The experiments were designed to determine the suitability of the monitors for short-term and time weighted average (TWA) monitoring for formaldehyde. Short-term sampling was performed at nominal concentrations of 0.3 and 2 ppm. TWA sampling was performed at nominal concentrations of 0.3, 0.5, and 1 ppm. A total of 6 passive and 5 active methods were evaluated. Several devices were capable of m...

Evaluation of health care programs is a complex process which presents many challenges. A case study of a small-scale adult day care program evaluation is presented to illustrate these issues. The rationale for developing the program and the findings from the evaluation study are discussed. Several evaluation issues including the use of multiple methods, levels of analysis, characteristics of the sponsoring agency, political influences, methodological issues and influences on utilization of findings are addressed.

An enamel-section-carrying intra-oral appliance to predict the results of double-blind anti-caries studies has been developed. Initial validation was against the F concentration effect attained in a clinical trial where three sodium monofluorophosphate (SMFP) dentifrices were used. Original appliance-based work showed significant differences in remineralization between non-F and F dentifrices, but not between different F dentifrices. However, it was shown later that acidified gel-prepared lesions were not as responsive as solution-prepared lesions to de- and remineralizing processes, and lesion remineralization rates were found to be dependent on initial lesion size. An in situ cross-over study was then repeated with use of acid-solution-created lesions, and seven volunteers completed the project. Each brushed twice daily × 2 min with either 0,1000, or 2500 ppm F, as SMFP dentifrice. After a two-week wash-out, subjects wore the appliances for four weeks. Enamel mineral content was assessed at 0, two, and four weeks via microradiography/microdensitometry, and a statistically significant dose-response was obtained between non-F and F as well as between 1000 and 2500 ppm F pastes, i.e., as per the three-year clinical trial data. Hence, the model's suitability for pre-clinical screening was confirmed. It has also been used in caries microbiological studies, in root caries investigations, and currently in chewing gum cariogenicity experiments.

Shortened hospital stays have necessitated examination of alternative approaches for pre and postoperative teaching. An investigation of one alternative became a study in which a home care preoperative teaching programme for older adults undergoing cataract extractions with lens implants was implemented and evaluated. The findings indicated that the teaching programme was effective and resulted in positive benefits.

The clinical application of computerized continuous-infusion pressure-monitored sialography using an aqueous contrast medium during the investigation of 296 salivary glands is described. A comparison between the pressure changes and the sialographic features revealed a significant (P less than 0.001) correlation between raised filling pressure (greater than 60 mmHg) and the presence of an obstructive lesion (stricture, mucous plug, sialolith). Occasionally a raised filling pressure was observed although the associated sialography films were normal. The sensitivity of the technique was 86.4%. It is concluded that the monitoring of pressure changes occurring during sialography can alert the clinician to the presence of high filling pressure and may also provide additional evidence of obstructive changes within salivary glands.

This paper uses a sample of 425 students from 4 large sections of Introductory Microeconomics during the period 2005 – 2007 to examine the impact of using the Personal Response System (PRS or Clickers) on class attendance and exam performance. The evidence suggests that the use of PRS has led to improved attendance. The exam scores are similar to classes that used online quizzes instead of the PRS. A survey of student attitudes towards the PRS indicates that the use of PRS helps with student learning and reinforcing important concepts. Based on the results of this study the authors believe that the PRS is a useful tool for all instructors, particularly those faced with large sections.

Respite care can be considered an illness prevention and health promotion intervention for both caregivers and the older people dependent on them. By maintaining clients' level of functioning, the process of deterioration is delayed and a degree of health promotion is achieved. Similarly, the relief of caregivers' burden, although minimal, sustains them in their role. A community-based mode of providing adult day care is supported in the literature. It seems logical to combine the services of a community-based organization and a long-term care institutional setting whenever possible.

An in vitro pH-cycling experiment was carried out to investigate the effect of fluoride concentration on enamel demineralization and remineralization. Artificial caries lesions were formed in an acid-buffered solution and subjected daily to a 3-hour acid attack, a 5-min immersion in the test NaF solution (0, 1, 250, 500, 1,000, 1,750 and 2,500 ppm F), and to 21 h in an artificial saliva. Changes in mineral content were assessed weekly for 5 weeks using microradiography/microdensitometry. The lesions in the control group (0 ppm F) and the 1-ppm F group demineralized. Remineralization was significantly higher in the 500-ppm F group compared to the 250-ppm F group. However, higher fluoride concentrations did not produce any further significant increase in remineralization. Laminations were apparent in lesions subjected to the 250- and 500-ppm F solutions.

We report on the use of a blue laser diode to excite natural fluorescence from a range of dentalsamples. Sixty teeth with naturally occurring lesions were examined. The lesions were classified onvisual inspection as falling into three classes as shiny lesions, dull lesions and brown lesions. Theresulting fluorescence was then examined using a fibre optically coupled spectrometer in a series ofwavelength bands. By examining the intensity ratios in the two wavelength bands 480-500nm and620 to 640nm we were able to classify the lesion types and thus provide a quantifiable measurementof lesion types. This method has application for detection of dental caries as well as demonstratingpotential application to evaluate lesions which may represent different degrees of caries activity.

The findings from a qualitative study of how caregivers coped while they cared for a dying family member at home are presented. Fifteen family caregivers were interviewed twice following the death of their family member. Although it was not one of the original objectives of the research, coping emerged as a category needing further analysis. There were factors that either facilitated or interfered with caregiver coping. Those factors that facilitated their coping included characteristics of the caregivers themselves; contributions made by the dying person; and supportive networks, both formal and informal, available to the caregivers. Interfering factors related to caregiver experiences with informal and formal systems. From the more distant perspective of post-death reflections, the caregivers provided insight into how their coping was grounded in the meaning associated with their experiences.

The purpose of this qualitative interpretive study was to explore the experience of bereavement following home-based family caregiving for persons with advanced cancer. The research question addressed by this research was: How do family caregivers of patients with advanced cancer perceive the effects of home-based caregiving on their bereavement? Fifteen caregivers were retrospectively interviewed twice after the death of their family member. Caregivers reported both positive (e.g., feelings of accomplishment, improved family relationships) and negative (e.g., haunting images, feelings of failure) outcomes that they attributed to having cared for their family member. Overall, positive outcomes predominated and bereaved family members reported satisfaction with having provided care for their loved one who had died.

The purpose of this study was to examine the relationship between knowledge and practice of lifestyle behaviors in healthy older adults related to the prevention of vascular dementia. Data were derived from a convenience sample of 281 Canadian participants 55 years of age and older. Lifestyle was measured using the health-promoting lifestyle profile (HPLP). Seven knowledge sub-scales were developed consistent to the HPLP. Multivariate analysis found that four independent variables accounted for 26% of the variance of a healthy lifestyle score and included those who reported a lower level of stress, indicated a higher knowledge of interpersonal relations, had a better general health self-assessment and higher medical knowledge. These Canadian results were compared with those from a study conducted in Australia and found to be similar. The study argues that health professionals and health education programs can better promote and increase awareness of healthy lifestyle behaviors by assisting older adults to apply this knowledge in their daily lives. Specifically, the study discusses policy and practice implications with regards to lifestyle issues relating to health responsibility, physical activity, spirituality, stress management, interpersonal relationships and nutrition.

Respite services are seen as one key formal support intervention mitigating the negative consequences of family caregiving. The purpose of this paper is to examine how the caregivers' respite experience influenced their return to the responsibilities of caring for their family members. The discussion is based on a qualitative interpretative study with 20 caregivers exploring the meaning of respite to family caregivers of persons with dementia. Although the beneficial effect of the emotional and physical refreshment and renewal was evident throughout, there were notable variations in how caregivers experienced their return to caregiver responsibilities. Some experienced short-term despondency and feelings of 'let-down' while others felt guilty and emotionally devastated when they returned. Three factors emerged which related to the differential caregiver experiences: the amount of time and quality of the respite interval; the nature and quality of the respite help that was used for the dependent family member; and the condition of their dementia family member when the caregiver resumed the caregiver role. Clinicians must recognize that these factors strongly influence how the responsibilities of caregiving are resumed. Researchers must explore for additional factors which detract from the anticipated positive effects of the caregiver respite experience. Clarification of these factors can provide guidance to service providers to develop respite services that are more attuned to the caregivers' perceptions of benefit for themselves and for their dependent family members.