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Describes how to teach rock climbing to elementary school students using balance dome cones, which are small, cylindrical- shaped cones that are rounded at the top, seven inches in diameter, and four inches high. Students step on the cones as they explore and discover their balance limits in various unnatural movement positions. Individual and team activities are described. (SM)

Discusses the need for the chief development officer (CDO) to have a good working relationship with the college or university chief executive officer (CEO). CDOs need to make sure that their CEOs are well prepared for meetings with alumni and donors, build the CEO's confidence, make work fun, and downplay the stress involved in fund raising. (MDM)

Techniques that reduce donors' resistance to college fund-raising requests, either direct mail or telephone solicitations, are offered. These include: respecting the prospects' concerns about privacy; offering nonintrusive giving options; honesty and clarity of communication; reinforcing donor sense of control; connecting with prospects' interests; and generally enhancing interpersonal communication. (MSE)

The institutional memory of a college or university depends largely on staff continuity and student memory. By encouraging graduates to tell their stories about the institution, advancement professionals can foster alumni desire to give to the institution. Topics and themes might include faculty and curricular experiences, social/extracurricular experiences, or institutional character. (MSE)

Written by professional psychologists, the 10 articles collected in this bulletin focus on stressful experiences that, when inappropriately responded to, can result in developmental problems for children. Stress factors are conceptualized as being either direct or indirect, or internal or external. Articles are organized in terms of these four dimensions. Two of the articles discuss direct, internal factors associated with stress: organically based learning disabilities and children's self-defeating misperceptions of self and others. Seven articles focus on direct, external stress factors, including hospitalization, death, divorce, child abuse, birth or adoption of a sibling, school problems, and disastrous international and natural events. The remaining article, examining a type of indirect, external stress, indicates developmental stress points associated with increasing levels of exposure to media. Generally, all 10 articles, as well as the introduction, attempt to present the specific nature of the stress factor discussed, describe children's perceptions of and reactions to specific stressful life experiences, and delineate internal and external resources available for helping children cope with stress. Frequently, specific suggestions for intervention are provided for parents and teachers. (RH)

This document discusses methods of calibration for chemical sprayers to insure proper control of the target plant or insect. Both granular and spray application techniques are presented with special emphasis given to computing chemical mixes properly. (CS)

Background Cognitive behaviour therapy (CBT) and exercise have been shown to result in improved outcomes for patients with fibromyalgia or chronic widespread pain (CWP), although whether they can deliver long-term benefit is unknown. Objectives To determine the long-term health effects of telephone-delivered CBT (tCBT), exercise, and combined treatments compared with treatment as usual (TAU) among patients with CWP. Methods The MUSICIAN Trial was a 2x2 factorial randomized controlled trial. Patients with CWP were identified from a screening survey sent to patients over 25 years old registered at 8 UK general practices. Eligible individuals were patients meeting the ACR definition of CWP, reporting disability, who had consulted their family physician in the last year and with no cause for their pain identified requiring alternative treatment. They were randomly assigned to one of four study arms: tCBT, exercise, combined tCBT and exercise, or TAU. Participants receiving tCBT had 8 telephone sessions provided weekly with a therapist involving techniques to manage pain, and had follow-up calls at 3 and 6 months. Patients in the exercise group followed a 6 month exercise program to improve cardiovascular fitness individually designed for them by a fitness instructor with whom they had monthly reviews. Patients assigned to combined treatment received both interventions concurrently, while the TAU group received usual care from their family physician. Participants were followed up at 30 months post-randomisation with a postal questionnaire or by telephone (in case of non-response). The primary outcome (change in health since entering study) was considered positive if a subject scored at least 6 (“I feel much better“) on a 7 point scale from 1 (“I feel very much worse “) to 7 (“I feel very much better “). Analysis was by logistic regression which adjusted for age, gender, centre and baseline predictors of outcome, to obtain measures of improvement in the active treatment g

Background Chronic kidney disease (CKD) is a long-term condition and has been described as the gradual loss of kidney function over time. Early in the disease process, people with CKD often experience no symptoms. For a long time, CKD has been an underdiagnosed condition. Even in the absence of symptoms, CKD appears to add significantly to the burden of cardiovascular disease and death and, for an important minority, can progress to kidney failure. Objective To systematically review the evidence of the clinical effectiveness and cost-effectiveness of early referral strategies for management of people with markers of renal disease. Data sources Electronic searches of 12 major databases (such as MEDLINE, EMBASE, CINAHL, etc.) were conducted for the time period of 1990 to April 2008 to identify studies comparing early referral to other care options for people with CKD. Additional searching was performed in the NHS Economic Evaluation Database to support the cost-effectiveness literature review. Review methods Two authors reviewed all titles, abstracts and full papers to select relevant literature. A Markov model was constructed to represent the natural history of CKD. The model allowed cohorts to be tracked according to estimated glomerular filtration rate (eGFR) status and the presence of other complications known to influence CKD progression and the incidence of cardiovascular events. Results From 36 relevant natural history studies, CKD was found to be, despite marked heterogeneity between studies, a marker of increased risk of mortality, renal progression and end-stage renal disease. Mortality was generally high and increased with stage of CKD. After adjustment for comorbidities, the relative risk of mortality among those with CKD identified from the general population increased with stage. For clinical populations, the relative risk was higher. All three outcomes increased as eGFR fell. Only seven studies, and no randomised controlled trials, were identified as re

An important issue in the measurement of health status concerns the extent to which an instrument displays lack of sensitivity to changes in health status at the extremes of the distribution, known as floor and ceiling effects. Previous studies use relatively simple methods that focus on the mean of the distribution to examine these effects. The aim of this paper is to determine whether quantile regression using longitudinal data improves our understanding of the relationship between quality of life instruments. The study uses EQ-5D and SF-36 (converted to SF-6D values) instruments with both baseline and follow-up data. Relative to ordinary least least-squares (OLS), a first difference model shows much lower association between the measures, suggesting that OLS methods may lead to biased estimates of the association, due to unobservable patient characteristics. The novel finding, revealed by quantile regression, is that the strength of association between the instruments is different across different parts of the health distribution, and is dependent on whether health improves or deteriorates. The results suggest that choosing one instrument at the expense of another is difficult without good prior information surrounding the expected magnitude and direction of health improvement related to a health-care intervention.

Background: Prevention of disability (POD) is one of the key objectives of leprosy programmes. Recently, coverage and access have been identified as the priority issues in POD. Assessing the cost-effectiveness of POD interventions is high

Aims To assess the cost-effectiveness of an improved automated grading algorithm for diabetic retinopathy against a previously described algorithm, and in comparison with manual grading. Methods Efficacy of the alternative algorithms was assessed using a reference graded set of images from three screening centres in Scotland (1253 cases with observable/referable retinopathy and 6333 individuals with mild or no retinopathy). Screening outcomes and grading and diagnosis costs were modelled for a cohort of 180 000 people, with prevalence of referable retinopathy at 4%. Algorithm (b), which combines image quality assessment with detection algorithms for microaneurysms (MA), blot haemorrhages and exudates, was compared with a simpler algorithm (a) (using image quality assessment and MA/dot haemorrhage (DH) detection), and the current practice of manual grading. Results Compared with algorithm (a), algorithm (b) would identify an additional 113 cases of referable retinopathy for an incremental cost of £68 per additional case. Compared with manual grading, automated grading would be expected to identify between 54 and 123 fewer referable cases, for a grading cost saving between £3834 and £1727 per case missed. Extrapolation modelling over a 20-year time horizon suggests manual grading would cost between £25 676 and £267 115 per additional quality adjusted life year gained. Conclusions Algorithm (b) is more cost-effective than the algorithm based on quality assessment and MA/DH detection. With respect to the value of introducing automated detection systems into screening programmes, automated grading operates within the recommended national standards in Scotland and is likely to be considered a cost-effective alternative to manual disease/no disease grading.

Aim: To assess the efficacy of automated “disease/no disease” grading for diabetic retinopathy within a systematic screening programme. Methods: Anonymised images were obtained from consecutive patients attending a regional primary care based diabetic retinopathy screening programme. A training set of 1067 images was used to develop automated grading algorithms. The final software was tested using a separate set of 14406 images from 6722 patients. The sensitivity and specificity of manual and automated systems operating as “disease/no disease” graders (detecting poor quality images and any diabetic retinopathy) were determined relative to a clinical reference standard. Results: The reference standard classified 8.2% of the patients as having ungradable images (technical failures) and 62.5% as having no retinopathy. Detection of technical failures or any retinopathy was achieved by manual grading with 86.5% sensitivity (95% confidence interval 85.1 to 87.8) and 95.3% specificity (94.6 to 95.9) and by automated grading with 90.5% sensitivity (89.3 to 91.6) and 67.4% specificity (66.0 to 68.8). Manual and automated grading detected 99.1% and 97.9%, respectively, of patients with referable or observable retinopathy/maculopathy. Manual and automated grading detected 95.7% and 99.8%, respectively, of technical failures. Conclusion: Automated “disease/no disease” grading of diabetic retinopathy could safely reduce the burden of grading in diabetic retinopathy screening programmes.

The QACTIS system has been tested in previous years at the TREC Question Answering Evaluations. This paper describes new enhancements to the system specific to TREC-2006, including basic improvements and thresholding experiments, filtered and Internet-supported pseudo-relevance feedback for information retrieval, and emerging statistics-driven question-answering. For contrast, we also compare our TREC-2006 system performance to that of our top systems from TREC-2004 and TREC-2005 applied to this year's data. Lastly, we analyze evaluator-declared unsupportedness of factoids and nugget decisions of "other" questions to understand major negative changes in performance for these categories over last year., Presented at the Text Retrieval Conference (15th) (TREC 2006) held in Gaithersburg, MD on 14-17 Nov 2006. Published in the Proceedings of the Text Retrieval Conference (15th), 2006.

Using four detailed and complex simulation models we derive a framework for predicting behavior of any defoliating insect/forest system. The framework uses simple and easily gathered biological information on four sets of state variables, each with a characteristic temporal scale, to predict presence, absence or form of key ecological processes acting on or between the variables. The combination of these key processes enables prediction of system equilibrium structure and this structure can be used to derive the temporal behavior of the system. Four qualitatively different classes of system behavior arise from the equilibrium structures. The framework is tested against twelve other systems and field invalidation experiments are outlined. Forest defoliator research and management implications are discussed.