Development and Pilot Assessment of the PACE Tool: Helping Case Managers Identify and Respond to Risk Factors in Workers' Compensation Case Management.

Purpose The aim was to develop a tool to be applied by workers' compensation case managers to guide intervention and avoid delayed return to work. Methods The Plan of Action for a CasE (PACE) tool was developed based on a review of existing literature, focus groups with case managers and analysis of existing claims data. Combined with analysis of existing case manager practice, these sources were used to determine key constructs for inclusion in the tool to be aligned with the demands of case manager workload. Mapping of existing interventions was used to match risk identified by the tool with appropriate intervention. Results The final PACE tool consisted of 41 questions divided into Ready (worker), Set (employer) and Go (treating practitioner) categories. Questions in the tool were linked to appropriate case manager actions. Data collection was completed by case managers for 524 claims within the first 2 weeks of the claim being accepted. The most commonly identified risks for delayed RTW included both worker and employer expectations of RTW, as well as certification of capacity. Factor analysis identified two factors operating across the tool categories. Case managers reported benefits in using the tool, but reported it also increased their workload. Conclusions The PACE tool is a unique example of the implementation of risk identification in case management practice. It demonstrates that case managers are ideally placed to collect information to identify risk of delayed RTW. Future work will establish the impact of case-manager led intervention based on identified risks on outcomes for injured workers.

Career dreams among health care students: I want to make a difference.

There is a continuous increase in demand for health services in most countries because people who are older are living longer. Health care for people who are older is not, generally, an attractive career option for undergraduate health professionals. This study investigated career dreams among undergraduates studying a variety of health care subjects to understand what motivates them. Eighteen focus groups were conducted with 90 students, and template analysis was performed within a sociological framework. Four themes emerged from the analysis: no plans to work with people who are older, dreaming of making a difference, seeking variety, and the impact of clinical placements on stimulating or reducing interest in working with people who are older. Geriatrics and gerontology do not offer the opportunities that students are looking for in their future careers. There is a need to change the way we talk about adults who are older everywhere, not just in health care training. However, health care educators should also help students to understand the value of care provided to adults who are older.

Children's Doctor Games and Nudity at Danish Childcare Institutions.

This article presents the first Danish study of the acceptance of children's nudity and sexuality at Danish childcare institutions. The study revealed an important cultural shift in the attitude toward children's nudity and sexual games, the so-called doctor games. Although these were quite accepted at Danish childcare institutions until the beginning of this century, the study showed that new, pervasive regulations had been established to control the child's body and its sexuality. A new discourse revealed that fear of child sexual abuse, in particular, had influenced views of children's sexual games and nudity and that, at times, the child itself was viewed as a potential threat to other children. This marks a new development in Denmark, internationally known for its broadmindedness, and this article discusses the background to this cultural shift in the institutions, and possible implications for the children.

Molecular phylogeny of Plagiothecium and similar hypnalean mosses, with a revised sectional classification of Plagiothecium.

We investigated the systematic relationships within the pleurocarpous moss genus Plagiothecium, based on cladistic analyses of sequence data from one nuclear (ITS) and two plastid (trnK-psbA (matK) and rpl16 intron) DNA regions for 110 specimens of Plagiothecium and similar hypnalean mosses. Plastid and nuclear trees were mostly similar, but differed in the placement of several species of Plagiothecium, and in the relationships among other genera. The phylogenetic hypotheses based on plastid markers were well resolved; in contrast, nuclear data were insufficient to resolve some of the lowest-level relationships within the genus. In the main Plagiothecium is natural, includes more taxa than are often recognized, and is most closely related to Isopterygiopsis and Herzogiella. Nine sections are recognized within Plagiothecium, four new: Section Pseudo-Neckera to accommodate P. neckeroideum and its allies, Section Ortholimnobium for P. handelii and P. paleaceum, Section Struckia for P. argentatum and P. enerve, and Section Rectithecium for P. piliferum. The geographical distribution of the sections suggests that Plagiothecium originated in Asia. The derived, mainly autoicous sections Plagiothecium and Leptophyllum may have spread to the Southern Hemisphere through long distance dispersal. Three new species in section Leptophyllum (P. funale, P. pacificum and P. rhizolucidum) and two new taxa in section Pseudo-Neckera (P. decoratum and P. neckeroideum fo. exile) are described. A limited phylogenetic hypothesis for the superficially similar hypnalean genus Taxiphyllum, which was used as outgroup, is included. A related genus (Longiella) is described, with a single species (L. plagiothecioides). The aquarium species T. barbieri is transferred to Ectropothecium.

Consequences of combined herbivore feeding and pathogen infection for fitness of Barbarea vulgaris plants.

Plants are often attacked by pathogens and insects. Their combined impact on plant performance and fitness depends on complicated three-way interactions and the plant's ability to compensate for resource losses. Here, we evaluate the response of Barbarea vulgaris, a wild crucifer, to combined attack by an oomycete Albugo sp., a plant pathogen causing white rust, and a flea beetle, Phyllotreta nemorum. Plants from two B. vulgaris types that differ in resistance to P. nemorum were exposed to Albugo and P. nemorum alone and in combination and then monitored for pathogen infection, herbivore damage, defence compounds, nutritional quality, biomass and seed production. Albugo developed infections in the insect-resistant plants, whereas insect-susceptible plants were scarcely infected. Concentrations of Albugo DNA were higher in plants also exposed to herbivory; similarly, flea beetle larvae caused more damage on Albugo-infected plants. Concentrations of saponins and glucosinolates strongly increased when the plants were exposed to P. nemorum and when the insect-susceptible plants were exposed to Albugo, and some of these compounds increased even more in the combined treatment. The biomass of young insect-susceptible plants was lower following exposure to flea beetles, and the number of leaves of both plant types was negatively affected by combined exposure. After flowering, however, adult plants produced similar numbers of viable seeds, irrespective of treatment. Our findings support the concept that pathogens and herbivores can affect each other's performance on a host plant and that the plant reacts by inducing specific and general defences. However, plants may be able to compensate for biomass loss from single and combined attacks over time.

Negative thoughts and health: associations among rumination, immunity, and health care utilization in a young and elderly sample.

OBJECTIVE: In the present study, it was tested whether rumination-negative, recurrent thoughts-would be associated with immune parameters and health care utilization. Because rumination has been associated with sadness and subjective sleep quality, it was tested whether these factors mediated the possible effects of rumination. A young sample and an elderly sample were included to test for age differences in the association between rumination and health-related measures. METHODS: A representative sample of 196 young subjects (20 to 35 years) and 314 elderly subjects (70 to 85 years) completed questionnaire measures of rumination, sadness, and subjective sleep quality. Immune measures included leukocyte counts, lymphocyte subsets, natural killer cell activity, and T-cell proliferation. Contacts with primary care physicians were registered for 1 year through central registers. RESULTS: Rumination displayed a positive association with total leukocyte count, total lymphocyte count, and number of B cells among the elderly, and this was not mediated by sadness or subjective sleep quality. Rumination was also positively associated with number of telephone consultations during the follow-up for the elderly, and this was partly mediated by sadness and subjective sleep quality. Although total leukocyte counts correlated with number of telephone consultations at the follow-up, none of the immune parameters mediated the association between rumination and health care utilization. No significant associations were found for the young participants. CONCLUSION: The results suggest that rumination may be associated with health-related measures in the elderly. Thus, negative thoughts may be detrimental to health, independently of negative affect.