bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability of the Visual Analog Scale for Measurement of Acute Pain
Authors: Bijur Polly E. , Silver Wendy , Gallagher E. John 
Published: January 2008

Abstract Objective: Reliable and valid measures of pain are needed to advance research initiatives on appropriate and effective use of analgesia in the emergency department (ED). The reliability of visual analog scale (VAS) scores has not been demonstrated in the acute setting where pain fluctuation might be greater than for chronic pain. The objective of the study was to assess the reliability of the VAS for measurement of acute pain. Methods: This was a prospective convenience sample of adults with acute pain presenting to two EDs. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (95% CIs) and a Bland‐Altman analysis were used to assess reliability of paired VAS measurements obtained 1 minute apart every 30 minutes over two hours. Results: The summary ICC for all paired VAS scores was 0.97 [95% CI = 0.96 to 0.98]. The Bland‐Altman analysis showed that 50% of the paired measurements were within 2 mm of one another, 90% were within 9 mm, and 95% were within 16 mm. The paired measurements were more reproducible at the extremes of pain intensity than at moderate levels of pain. Conclusions: Reliability of the VAS for acute pain measurement as assessed by the ICC appears to be high. Ninety percent of the pain ratings were reproducible within 9 mm. These data suggest that the VAS is sufficiently reliable to be used to assess acute pain.
Effect of a δ Receptor Agonist on Duration of Survival during Hemorrhagic Shock
Authors: Summers Richard L. , Li Zizhuang , Hildebrandt Drew 
Published: January 2008

AbstractObjectives:Selective δ receptor agonists have been shown to stabilize membrane physiologic processes, reduce metabolic rates, and provide protection against ischemic insults through Katpchannel opening in a variety of organ beds. However, their potential for affecting outcomes in states of generalized ischemia has not been explored. The authors examined the effect of the nonselective δ receptor agonist, DADLE (D‐Ala2‐Leu5‐enkephalin), on hemodynamic stability and duration of survival in an animal model of severe hemorrhagic shock.Methods:Conscious Sprague Dawley rats with indwelling catheters were hemorrhaged at a rate of 3.25 mL/100 grams over 20 minutes after half of the group received 1% DADLE (1 mg/kg IV). Following the hemorrhage, all rats were continuously monitored for heart rate (HR), mean arterial pressure (MAP), and life signs for up to three hours (death defined as apnea, systolic blood pressure < 30 mm Hg without pulsations, and electroencephalographic silence). Survival rates and hemodynamic trends were compared between the control and DADLE‐treated groups.Results:In the 14 rats studied (8 DADLE; 6 controls), initial hemorrhage resulted in similar hemodynamic shock (average MAP fall: 118 to 59 vs 119 to 55 mm Hg). Analysis of survival at 3.5 hours revealed statistically significant differences between the control and DADLE groups. While 50% of the DADLE group survived past the three hours, no control animals were still alive at the end of the experimental period. The MAP trended downward and the HR increased for the control group, but all hemodynamic parameters stabilized in the rats treated with DADLE.Conclusions:Most current strategies for treating shock focus on the supply side of resuscitation. The coordinated various actions of DADLE have the potential to work in concert in the intact organism to improve overall survival during severe hemorrhagic shock. In an animal model of severe hemorrhagic shock, there was improvement in hemodynamic stability and a prolonged survival with DADLE treatment. Physiologic manipulation with DADLE appears to be a way to improve survival during shock with possible clinical implications.
Evaluation of a Structured Application Assessment Instrument for Assessing Applications to Canadian Postgraduate Training Programs in Emergency Medicine
Authors: Bandiera Glen , Regehr Glenn 
Published: January 2008

Abstract Objective: To determine the interrater reliability and predictive validity of a structured instrument for assessing applications submitted to a Fellow of the Royal College of Physicians of Canada (FRCP) emergency medicine residency program. Methods: An application assessment instrument was derived based on faculty and resident input, institutional and national documents, and previous protocols. The instrument provided a score based on objective anchors for each of four application components. Three assessors were introduced to the instrument in a detailed tutorial session. Assessors were given five applications to score and results were compared for understanding of the scoring principles. The instrument was used in a developmental pilot to assess the 2001 cohort of applications and revised again. Applications for the 2002 study cohort were submitted through a central application service. Assessors used the instrument to score each application independently. Interrater reliability was determined by calculating a two‐way mixed‐effect Cronbach's alpha. Results: Forty applications were received for the year 2002. Thirty‐eight application packages were complete and data collection was complete for all 38. The single‐rater reliabilities for the curriculum vitae, personal letter, transcript, reference letters, and overall package were 0.73, 0.52, 0.64, 0.61, and 0.72, respectively. The three‐rater reliabilities for the components were 0.89, 0.77, 0.84, and 0.82, respectively. The three‐rater reliability of the overall application score was 0.89. Conclusions: Three‐rater reliabilities for each component and the entire application package were high. Multiple assessors are required to generate acceptable reliabilities. Using strict design and implementation principles can lead to a reliable instrument for assessing complex application packages.
The structural problem of Canadian federalism
Authors: Smiley D. V. 
Published: January 2008

Abstract. A federal system must attempt to deal with diversities which are territorially based. It can do this through two procedures: (i) conferring the power over some of these most pervasive diversities on the states or provinces; (ii) giving the constituent regional units a permanent voice in the central government. It is the argument of this paper that Canadian federalism has come to rely too exclusively on the first method to the neglect of the second. Thus from time to time important geographically‐based attitudes and interests find they have little influence in the federal government and turn to the provinces instead. Thus the price of the survival of Canadian federalism may be the radical restructuring of the central government to make it more effectively representative of these territorially‐based diversities. Several tentative suggestions are made to this end ‐ measures to decrease the dominance of the Prime Minister over Parliament, a federal bureaucracy based deliberately on representative lines, the reorganization of the cabinet and several of the departments of government to make them more representative of geographically‐based interests, reforms in the electoral system. In general, the survival of Canadian federalism requires some method to obstruct the growing power of the provinces and this method may well be that central institutions come to act in terms of Calhoun's rule of concurrent majorities.Sommaire. Tout systène fédéral doit essayer de s'occuper des situations diverses dont la base est géographique. Cela peut se faire de deux façons: (i) endonnant aux états ou aux provinces le pouvoir de traiter de certaines des particularités les plus courantes; (ii) en donnent aux groupes représentant les régions une voix permanente au sein du gouvernement central. Cette communication soutient que le fédéralisme canadien en est arrivéà utiliser presque exclusivement la premiere méthode au détriment de la seconde. De temps à autre, des attitudes et intérêts d'inspiration géographique se trouvent exercer peu d'influence dans le gouvernement fédéral et tendent à sa manifester au niveau provincial. Ainsi le prix de la survive du fédéralisme canadien pourrait être la restructuration radicale du gouvernement central pour qu'il représente mieux les diversités à base territoriale. On a offert différentes suggestions à cette fin ‐ des mesures pour diminuer l'emprise du premier ministre sur le parlement, une bureaucratie fédérate établie de facon délibérée d'après le principe de la représentation, la réorganisation du cabinet et de plusieurs ministères du gouvernement pour qu'ils représentent mieux les intérêts géographiques, des réformes du système électoral. D'une façon générale, la survie du fédéralisme canadien dépend d'une méthode permettant d'enrayer le pouvoir croissant des provinces et il se pourrait que cette méthode demande que les institutions centrales se conforment à la règie de Calhoun des majorités coexistantes.
Pour une politique de stabilisation régionale
Authors: Raynauld André 
Published: January 2008

Abstract. Regional unemployment disparities in Canada are sensitive to changes in aggregate demand. It would be desirable to find ways to stimulate the economy in one region while restraining it in another. Provincial governments having taxing and spending powers should be able to implement anticyclical fiscal policies. For this purpose they should have an indirect access to an ultimate source of liquidity which can be provided only by the Bank of Canada. It is proposed to set up a regional stabilization fund which would acquire short‐term provincial bonds up to a limit determined by the desirability of deficit financing in any one province for stabilization purposes. The fund would issue its own bonds and the Bank of Canada would be asked to purchase these bonds in the same manner as she does with respect to federal securities. In as much as provincial deficit financing is effective, the federal deficit would be proportionately reduced.The major argument against such a course of action is high regional leakages through imports. Recent evidence shows that leakages are much lower than is generally assumed. The conclusion is that regional stabilization is indeed possible; the proposed fund would increase considerably the effectiveness of stabilization policies in Canada.Sommaire. Les disparités régionales quant aux emplois varient au Canada en fonction de la demande globale. Il serait souhaitable de trouver des moyens de stimuler l'économie dans une région et en même temps, de la modérer dans une autre. Les gouvernements provinciaux ayant le pouvoir de taxer et de dépenser devraient pouvoir mettre en vigueur des politiques fiscales anticycliques. A cet fin, ils ont besoin d'un acoès indirect à une source ultime de liquidité qui ne peut être fournie que par la Banque du Canada. Nous suggérons la création d'un fonds de stabilisation régionale qui acquerrait des effets provinciaux à court terme jusqu'à concurrence du financement déficitaire souhaitable pour une province donnée, aux fins de stabilisation. Le fonds émettrait ses propres effets et l'on demanderait à la Banque du Canada de les acheter de la même façon qu'elle le fait pour les effets fédéraux. Le déficit fédéral serait réduit dans la mesure où le financement déficitaire provincial donnerait les résultats escomptés.Le principal argument contre ce genre de mesure, c'est l'effet adverse produit par les importations dans la région, mais on a prouvé récemment que cet effet était beaucoup moins important qu'on ne l'avait pensé précédemment. La conclusion, c'est que la stabilisation régionale est possible et la création de ce fonds augmenterait considérablement l'efficacité des politiques de stabilisation au Canada.
Understanding and handling the linguistic causes of communications failure
Authors: Vollmer H. F. 
Published: January 2008

Abstract. If verbal meaning is that which words represent whenever they arecommunicated, it follows that practical communication is effective only if there is agreement as to what is represented. Communication is therefore not merely a matter of transmitting familiar words (or of translating unfamiliar words into familiar) ‐ it is a process of achieving agreement about something other than words.This paper attempts to show that communications failure can be caused bycertain symbolic, grammatical and abstracting characteristics of language, which, in conjunction with the nature of its interface with the non‐linguistic world, tend autocratically to hide or distort that world. People cannot communicate effectively unless they learn, not only the words and structuring techniques of language (whether it be English or French), but also the mannerin which the autocratic processes superimpose themselves upon the realities to be communicated. The paper concludes by suggesting that this knowledge could be acquired through suitable instruction given within the formal systems of education and in supplementary courses provided by all public and private organizations. Organizations should not overlook the extent to which inadequate assumptions about the nature and use of language could be increasing their costs and reducing their effectiveness. Public administrators in particular have a heavy responsibility to communicate effectively and efficiently.Sommaire. Si les mots, lorsqu'ils sont prononcés, ont une signification verbale, il s'en suit que les communications commerciales ne sont efficaces que lorsque l'on s'est entendu sur cette signification. La communication pratique n'est done pas simplement la transmission de mots familiers (et la transformation de mots nonfamiliers en mots familiers), c'est un processus pour conclure un accord sur quelque chose d'autre que des mots.Cette dissertation tente de montrer que l'échec des communications peut être dûà certaines caractéristiques symboliques, grammaticales et « abstrayantes » de la langue qui, en conjonction avec la nature de son contact avec le monde non linguistique, tendent à cacher ou à déformer autocratiquement ce monde. Les gens ne peuvent pas communiquer efficacement s'ils n'apprennent pas, outre les mots et les techniques de structuration de la langue (qu'il s'agisse du français ou de l'anglais), la façon dont les processus autocratiques se surimposent sur les réalités à communiquer. L'auteur de la dissertation conclut en proposant l'acquisition de ces connaissances par des cours adéquats donnés dans le cadre des systèmes d'éducation officiels et par des cours complémentaires fournis par le secteur commercial de la communauté. Les affaires commerciales ne devraient pas ignorer la mesure dans laquelle des postulats inadéquats, quant à la nature et l'usage de la langue, peuvent augmenter leurs coûts et réduire leur efficacité. Les administrateurs publics, en particulier, ont la lourde responsabilité de communiquer de façon effective et efficace.
Indicative planning: failure or success?
Authors: Holloway Ronald G. 
Published: January 2008

Abstract. Two forms of national economic planning are distinguished imperative planning (planning with controls) and indicative (persuasive) planning. The trend away from controls in the Soviet Union is briefly treated. The French planning machinery and the factors determining the initial success of the French method of planning by inducement, its subsequent decline, and its anticipated recovery are outlined. Greater attention is paid to the more democratic British experiment in planning by consensus, with particular emphasis on the structure and evolution of the planning institutions and their strengths and weaknesses. Reasons for the British attempt at national economic planning and for its failure are also indicated while the aborted move towards greater intervention in the private sector is analysed in depth. The author concludes that the new emphasison planning the public sector, using both central policy reviews and annual five‐year expenditure projections linked with economic assessments, is likely to prove more effective than earlier methods and that the deliberate retreat from planning the entire economy will prove a sound basis for a subsequent advance.Sommaire. L'auteur distingue deux sortes de planifications de l'économie nationale‐ la planification imposée (planification avec contrôles) et la planification suggérée (par persuasion). Puis il traite rapidement de la tendance en Union Soviétique d'abandonner les contrôles. L'auteur explique ensuite le mëcanisme français de planification, les facteurs qui ont déterminé le succès initial de la méthode française de planification par encouragement, son déclin subséquent et l'anticipation de son renouveau. Il examine ensuite plus en détail l'expérience britannique, d'un caractère plus démocratique, qui consiste à planifier par accordg général en insistant particulièrement sur la structure et l'évolution des institutions de planification, sur leurs points forts et sur leurs points faibles. Il expose les raisons des efforts britanniques de planification de l'économie nationale et pourquoi ils ont échoé et analyse en profondeur la tentative avortée d'une plus grande intervention dans le secteur privé. L'auteur conclut que la nouvelle importance accordée à la planification du secteur public en se servant à la fois de révisions des politiques‐clés et d'estimations annuelles des dépenses quinquennales par rapport aux évaluations économiques, risque de se montrer plus efficace, comme méthode, que les précédentes et que l'abstention délibéreé d'une planification totale de l'économie permettra de faire un pas en avant.
Conditional grants and provincial government budgeting
Authors: Strick J. C. 
Published: January 2008

Abstract. The conditional grant has become an important instrument of federal government assistance to the provinces in the last decade. But while the federal government has increased its use of conditional grants, the grants have been subjected to increasing criticism by the provincial governments. The primary complaint of the provinces is that these grants interfere with provincial expenditure priorities and cause a reallocation of provincial resources. Provinces have charged that major programs, such as Medicare, were initiated by the federal government without meaningful consultation and that the provinces were forced to participate or forego the federal contribution. The provinces have claimed that in order to participate they have to substitute or divert funds from existing or planned programs to the shared‐cost program, resulting in a substitution effect in their budgets.The Ontario government has been particularly critical of conditional grants on these grounds. An analysis of shared‐cost programs in the case of Ontario, however, indicates that conditional grants have not produced relatively significant substitution effects in the budget of that province.While provincial dissatisfaction with the conditional grant system continues, the two parties have been unable to find a mutually acceptable alternative.Sommaire. Dans les derniers dix ans, le gouvernement fédéral s'est beaucoup servi des subventions conditionnelles pour accorder de l'aide aux provinces. Mais, au fur et à mesure que le Gouvernement fédéral utilisait de plus en plus ce mécanisme, les gouvernements provinciaux intensifiaient leur critique des subventions conditionnelles. Le principal grief des provinces, c'est que ces subventions affectent les priorités provinciales concernant les dépenses et causent une réalocation des resources provinciales. Les provinces se plaignent que le gouvernement fédéral mette en Æuvie des programmes importants, tels que Médicare, sans vraiment les consulter préalablement, les forçant ainsi à participer ou à renoncer à la contribution fédérale. Les provinces ont prétendu qu'il fallait qu'elles substituent ou qu'elles soustraient, au bénéfice du programme à coûts partagés, des fonds prévus pour des programmes existants à créer, effectuant ainsi des substitutions au sein de leur budget.Le gouvernement de l'Ontario, en particulier, a critiqué les subventions conditionnelles pour ces raisons. Néanmoins une analyse des programmes à coüts partagés révèle que les subventions conditionnelles n'ont pas produit de substitution importante dans le budget de cette province.Les provinces continuent à se plaindre du système des subventions conditionnelles mais les dew parties n'ont pas réussi à trouver d'alternative qui convienne à l'une et à l'autre.
The legislative role of parliamentary committees in Canada: the case of the Joint Committee on the Public Service Bills1
Authors: Mallory J. R. , Smith B. A. 
Published: January 2008

Abstract. This paper examines the legislative role of committees in the Canadian parliament folloing from changes in the role of committees since 1965, and relates the topic to recent studies on the role of parliament. The particular committee under study as unusual in several respects: it as a joint committee of the to houses; it dealt ith three separate but related bills hich had been the result of long prior discussion and general party consensus; and the civil servants in attendance ere permitted to play an unusually open and prominent role in negotiating significant amendments to the bills. In spite of these unusual factors, it is submitted that this case study thros ne light on the differences beteen the behaviour of legislators on the floor of the House as contrasted ith the ‘small group’ situation in committees. It is argued that more flexible relationships among the government, parliament, and the bureaucracy are possible than either past practice or a rigid theory of responsible government ould suggest. Sommaire. Les auteurs de cet exposé examinent le rôle 1égislatif des comités au sein du parlement canadien à la suite des changements survenus depuis 1965 et ils considèrent ce sujet à la lumière d'études récentes portant sur le rôle du parlement. Le comitéétudiéétait exceptionnel à plusieurs points de vue: c'était un comité conjoint des deux chambres; il s'occupait de trois projets de loi distincts mais connexes qui avaient bénéficié de longues discussions préalables et d'un assentiment général au sein des partis; les fonctionnaires préents purent jouer un rôle exceptionnel et de premier plan dans la négociation d'amendements im‐portants. En dépit de ces caractéristiques inusitées, les auteurs déclarent que ce cas illustre bien la différence de comportement des législateurs à la chambre et en petits groupes au sein du comité. Ils en concluent que les relations entre le gouverenement, le parlement et la bureaucratie peuvent être plus souples que la pratique passée ou une théorie rigide du gouvernement ne le laisserait supposer.