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This research focused on individual responses to organizational change by exploring the relationships among individual resistance, organizational justice, and commitment to change following organizational change implementations in three organizations. To accomplish this, Web-based questionnaires were used to gather individual-level quantitative data from 218 employees within three organizations located in the United States. The previously validated measures used included Oreg's (2003) resistance to change scale, Colquitt's (2001) four-factor organizational justice scale, and the Herscovitch and Meyer (2002) commitment to change scale. The survey data were analyzed with the use of structural equation modeling to test for relationships among constructs, and results demonstrated that organizational justice was strongly associated with commitment to organizational change, the strongest relationship being between procedural justice and affective commitment to change. In addition, resistance to change was not significantly related to justice or commitment to change. These findings on resistance to change support recent conceptual arguments that conventional views of resistance to change are not useful for informing organizational change implementation efforts. (Contains 11 tables and 1 figure.)

This article outlines an approach for teaching law students about advocacy beyond the judicial branch, with particular emphasis on legislative advocacy. Given the long and well-documented shift away from the judicial branch as the primary source of original public law, it is critical to teach law students that legislative advocacy is more than just an "alternative" or "non-traditional" legal career option and, instead, is one which regularly involves "real lawyering." Just as law students learn practical trial skills through moot court, shouldn't they learn practical legislative advocacy skills through simulated legislative hearings? Further, can law students move beyond traditional approaches for drafting legislative proposals in a classroom, setting to vetting and advancing student-developed legislative proposals in a legislative body ? This article outlines an effort to determine the limits of how far, and under what circumstances, law students can both develop original legislation and engage in actual legislative advocacy. [ABSTRACT FROM AUTHOR]

Background: Propofol for colonoscopy is largely administered by anesthesiologists or anesthesiology nurses in the United States (US) and Europe. Endoscopist-directed administration of propofol (EDP) by nonanesthesiologists has recently been proposed, with potential savings of anesthetist reimbursement costs. We aimed to assess potential EDP-related benefit in a screening setting. Methods: In a Markov model the total number of screening and follow-up colonoscopies in a cohort of 100000 US subjectswere estimated. Anesthetist- assisted colonoscopy was compared with an EDP strategy. Model outputs were projected onto the 50-80-year-old US population, assuming 27% as the current uptake for colonoscopy screening. Anesthetist costs were estimated using the mean reimbursement for the corresponding Medicare code (=65-year-olds) and from commercial insurance information (50-64-yearolds). The proportion of colonoscopies with anesthesiologist assistance was estimated from the Medicare database. Mean nurse salary was used to estimate the cost of a 2-week EDP training. The absolute number of US endoscopists was estimated by inflating by 33% the number of boardcertified gastroenterologists. No EDP mortality was assumed in the reference scenario, and 0.0008% mortality in the sensitivity analysis. US census data were adopted. Analogous inputs were used for France to assess EDP-related benefit in a European country. Results: EDP training for 17166 nurses (one for each US endoscopist) showed a cost of $ 47 million. Cost estimates for anesthesiologist assistance for colonoscopy were $95 (Medicare) and $450 (non-Medicare commercial insurance), with 34.8% of colonoscopies requiring anesthesiologist assistance. US implementation of an EDP policy showed a 10-year saving of $3.2 billion (Monte Carlo analysis 5-95% percentiles $2.7-$11.9 billion). In the sensitivity analysis, assuming 50% of colonoscopies were anesthetist- assisted showed an EDP benefit of $4.6 billion. Assuming a 0.0008% mortality rate, the incremental cost-effectiveness of anesthetist-assisted colonoscopy versus an EDP policy was $1.5 million per life-year gained, supporting EDP as the optimal choice. A 31-fold increase of EDPrelated mortality or a 17-fold cost reduction for anesthetist-assisted colonoscopy was required for EDP to become not cost-effective in this scenario. Implementation of an EDP policy in France, within a guaiac-fecal occult blood test (g-FOBT) screening program, was estimated to save €0.8 billion in 10 years. Conclusions: The absolute economic benefit of EDP implementation in a screening setting is probably substantial with 10-year savings of $3.2 billion in the US and €0.8 billion in France. The impact of an eventual EDP-related mortality on EDP cost-effectiveness seems marginal. The huge economic and medical resources entailed by anesthetist-assisted colonoscopy could be more efficiently invested in other clinical fields. [ABSTRACT FROM AUTHOR]

What is "the right to dignity"? Even though the role of human dignity within the framework of legal rules has attracted scholarly attention for some time, it is only relatively recently that courts in the United States have shown a similar interest in exploring the existence and scope of dignity rights. Unfortunately, those judicial opinions that have explicitly or implicitly evoked the idea of a right to dignity have done so in an ad hoc manner, without explaining the contours of dignity rights. This Article presents four possible meanings of the invocation of dignity rights in judicial opinions. It notes that each of these possibilities is founded in a very different theoretical understanding of dignity rights. The Article then concludes by exhorting courts to coalesce around one of these possibilities, so that a more secure legal foundation can be built for the development of dignity rights in the United States. [ABSTRACT FROM AUTHOR]

This Article seeks to clarify the current debate concerning the use of non-U.S. persuasive authority within the context of constitutional interpretation. It begins by noting that commentary on comparative constitutional law often fails to make any distinction between foreign domestic sources and international law used comparatively, and thus risks evoking parallels between different systems of law that lack context and plausibility. It then draws on various normative theories and underpinnings of both domestic and international legal regimes to show that a proper comparative enterprise must take this distinction into account. The Article concludes by explaining that only when those policy goals of international law and domestic law coincide should international law materials be called upon as sources of persuasive authority for domestic constitutional interpretation. [ABSTRACT FROM AUTHOR]

THIS ESSAY investigates the changing provisions concerning church membership in relationship to pastoral authority in The United Methodist Church and its directly antecedent bodies from the formation of the Methodist Episcopal Church in 1784 down to the present. It does so primarily by examining the conditions and requirements for church membership, and the mechanism of admission to church membership, that are stated in the Disciplines and Rituals of those bodies. By doing so, it seeks to help illumine the process by which Methodism in America evolved from being a group of voluntary societies existing within the context of a church to being a church (or family of churches). The general trajectory of the historical development of Methodism traced in this essay seems clear: from an association of relatively small voluntary religious societies of self-selected individuals with a high degree of mutual accountability, to a church which understands itself as a large and increasingly inclusive global covenant community with a comparably large and increasingly complex global infrastructure. In the course of this historical development, the role of the pastor has undergone significant change, as has the nature of pastoral authority, and provisions relating to church membership have been repeatedly reconsidered and revised. Throughout most of this history, pastoral authority in regard to church membership has been qualified by a specific role for local church laity in the membership process. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and efficacy of two reduced dosing regimens of sodium phosphate tablets (Visicol, InKine Pharmaceutical Co. Inc., Blue Bell, PA, USA) for colon cleansing prior to colonoscopy. Methods: In a randomized, multicentre, endoscopist-blinded clinical study, adults undergoing colonoscopy received either 28 tablets (42 g) or 32 tablets (48 g) of sodium phosphate for colon cleansing. The endoscopist used a validated four-point scale to rate the overall quality of colon cleansing, as well as cleansing in the ascending colon. Adverse events were collected and evaluated. Results: The quality of overall colon cleansing was `excellent' or `good' in 84% or more of both groups, with no significant difference between the two doses. No patient had a preparation rated as `inadequate' or required a repeat procedure. All patients were able to complete the assigned dose of tablets, and there were no deaths, serious adverse events or dropouts from the study. Conclusions: A reduced tablet regimen for sodium phosphate tablets, using either 28 or 32 tablets, is well tolerated and effective for colon cleansing prior to colonoscopy. [ABSTRACT FROM AUTHOR]

The authors reflect on the use of colonoscopy as modality for colorectum cancer screening in the U.S. They are critical on the lack of sufficient evidence to support the effective and safe use of colonoscopy in the screening. They note some studies which suggest that the magnitude of colonoscopy's protection in adenoma cohorts may not be as efficient as previously perceived.

1962-1963 gave promise of being a good year for the Committee on International Cooperation. The President of the incoming administration was active on the international level and interested in the work of the Committee. He sought to make the personnel of the Committee representative of its tasks by appointing people from various countries who were also specialists in various areas. Shortly after the Washington meetings the Chairman communicated with the members of the Committee, providing them with background materials, an agenda of work for the year in which special attention was called to the proposal to establish a Registry, requesting comments on matters contained in the documents forwarded to them, and asking for suggestions. This memorandum elicited enthusiastic and thoughtful responses from four colleagues. Nevertheless, the Chairman remains convinced that there are significant tasks for the Committee, especially in view of the increasingly international outreach of the membership and the activities of the American Sociological Association. It is felt, too, that at least a beginning has been made on the development of a program of work to be undertaken by successive committees.

In March 1961, the Executive Committee of the American Sociological Association voted to change the name of the Committee on Relations with Foreign Sociologists to Committee on International Cooperation. Following through on recommendations of the 1960 Committee, the Committee undertook the development, with the aid of the Executive Office, of a roster of foreign sociologists visiting the United States. Department chairmen were asked to list visitors, and effective continuing contacts were established with the U.S. Department of State and the Institute of International Education. Copies of the roster were forwarded to department chairmen and to program chairmen of regional sociological societies. Next steps taken were the mailing of a welcoming letter to visitors, and a survey of their views on measures the Association might initiate to enhance the professional value of a stay within the United States. Cordial invitations to attend the 1961 Annual Meetings were issued, and in a number of instances accepted.

This article presents the report of the Committee on Relations With Latin America of the American Sociological Society. Because only three members of the present Committee have declared themselves willing to be responsible for these three things, each for specific Latin American countries, and because these countries are a minority of all Latin American countries, it is not deemed advisable to project these activities until complete coverage is possible. Complete coverage can probably be attained by the canvassing of prospective participants. The present Committee assume the responsibility of securing a group of persons who will do these three things for all South American countries and that once such a list of persons has been obtained that these persons constitute the Committee on Relations With Latin America. Such a Committee would in effect become a standing committee, though it need not be designated as such. Unless, however, it is practically a standing committee the work proposed would not be carried out, and had better not be carried out than to be spotted, and thus unrepresentative.

Background and Aim: Recently, the BLI Adenoma Serrated International Classification (BASIC) system was developed by European experts to differentiate colorectal polyps. Our aim was to validate the BASIC classification system among the US-based endoscopy experts., Methods: Participants utilized a web-based interactive learning system where the group was asked to characterize polyps using the BASIC criteria: polyp surface (presence of mucus, regular/irregular and [pseudo]depressed), pit appearance (featureless, round/non-round with/without dark spots; homogeneous/heterogeneous distribution with/without focal loss), and vessels (present/absent, lacy, peri-cryptal, irregular). The final testing consisted of reviewing BLI images/videos to determine whether the criteria accurately predicted the histology results. Confidence in adenoma identification (rated "1" to "5") and agreement in polyp (adenoma vs non-adenoma) identification and characterization per BASIC criteria were derived. Strength of interobserver agreement with kappa (k) value was reported for adenoma identification., Results: Ten endoscopy experts from the United States identified conventional adenoma (vs non-adenoma) with 94.4% accuracy, 95.0% sensitivity, 93.8% specificity, 93.8% positive predictive value, and 94.9% negative predictive value using BASIC criteria. Overall strength of interobserver agreement was high: kappa 0.89 (0.82-0.96). Agreement for the individual criteria was as follows: surface mucus (93.8%), regularity (65.6%), type of pit (40.6%), pit visibility (66.9%), pit distribution (57%), vessel visibility (73%), and being lacy (46%) and peri-cryptal (61%). The confidence in diagnosis was rated at high ≥4 in 67% of the cases., Conclusions: A group of US-based endoscopy experts have validated a simple and easily reproducible BLI classification system to characterize colorectal polyps with >90% accuracy and a high level of interobserver agreement., (© 2021 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background and Aims: Endoscopic prediction of polyp histology is rapidly improving to the point where it may not be necessary to submit all polyps for formal histologic assessment. This study aimed to quantify the expected costs and outcomes of removing diminutive polyps without subsequent pathologic assessment., Methods: Cross-sectional analysis of a colonoscopy database for polyp histology; decision models that quantify effects on guideline-recommended surveillance and subsequent costs and consequences. The database was composed of consecutive colonoscopies from 1999 to 2004 at a single-institution tertiary care center. Patients were those found to have at least one diminutive polyp removed during colonoscopy, irrespective of indication. The main outcome measurements include up-front cost savings resulting from forgoing pathologic assessment; frequency and cost of incorrect surveillance intervals based on errors in histologic assessment; number needed to harm (NNH) for perforation and/or interval cancer., Results: Incorrect surveillance intervals were recommended in 1.9% of cases when tissue was submitted for pathologic assessment and 11.8% of cases when it was not. Based on the annual volume of colonoscopy in the US, the annual up-front cost savings of forgoing the pathologic assessment would exceed a billion dollars. An upper estimate on the downstream costs and consequences of forgoing pathology suggests that less than 10% of the up-front savings would be offset and the NNH exceeds 11000., Conclusion: Endoscopic diagnosis of polyp histology during colonoscopy and forgoing pathologic examination would result in substantial up-front cost savings. Downstream consequences of the resulting incorrect surveillance intervals appear to be negligible., (© Georg Thieme Verlag KG Stuttgart · New York.)

Oral sodium phosphate (NaP) solution has been withdrawn from the market in the United States but remains available for over-the-counter purchase for bowel preparation for colonoscopy in Canada. The present review summarizes recent data regarding the renal toxicity of oral NaP as well as its efficacy and tolerability relative to other preparations. Given the availability of effective alternatives to NaP solution, its use for colonoscopy preparation in Canada should be limited. Candidate patients for oral NaP solution should be assessed for eligibility and preparation instructions should adhere to the current recommendations for maximizing the safety of oral NaP.

Background: Recent data indicate that colorectal cancer incidence and mortality in white Americans have been declining since 1985 at a rate of 2% to 3% per year. In African Americans, however, mortality from colorectal cancer appears to be increasing. We sought to evaluate the prevalence of colonic neoplasia in asymptomatic African Americans., Methods: We performed a cross-sectional colonoscopy screening study to determine the prevalence of colonic neoplasia in asymptomatic African Americans older than 50 years of age., Results: One hundred sixty-six subjects were evaluated for the study of whom 121 (69 women) were deemed to be asymptomatic average-risk persons and completed colonoscopy. Forty-two individuals (35%) had a total of 72 adenomas (67 tubular and 5 tubulovillous); 47 (65.3%) of these were proximal to the splenic flexure. Three subjects had an adenoma 1 cm or greater in diameter and none had severe dysplasia., Conclusions: The overall prevalence of adenomas in asymptomatic average-risk African Americans was comparable to that of previously described populations. The predominance of right-sided adenomas in this study confirms previous findings and is an area requiring further study. Until this issue is resolved, we suggest the use of colonoscopy rather than sigmoidoscopy for screening for colorectal neoplasia in asymptomatic, average-risk African Americans.

Retrospective analysis of the Surveillance Epidemiology and End Results (SEER) program database for the period 1974 through 1995 identified 101,734 white and African-American women, age > or = 25 yr, with prior cervical, endometrial, or ovarian cancer. Subsequent follow-up demonstrated no increased risk of colorectal cancer in women with cervical cancer. For endometrial cancer patients, increased risk of colorectal cancer was confined to women whose diagnosis of endometrial cancer was before age 50, but the increased risk was substantial in this group (RR 3.39; 95% CI 2.73-4.17). For ovarian cancer patients, increased risk for colorectal cancer was substantial for those diagnosed with ovarian cancer before age 50 (RR 3.67; 95% CI 2.74-4.80), and there was some increased risk for women diagnosed at ages 50-64 yr (RR 1.52; 95% CI 1.25-1.83).

Objective: The prevalence of colonic angiodysplasia (AD) among healthy asymptomatic people is unknown, and the natural history of these lesions has not been clearly defined. The purpose of our study was to determine prevalence and to review and assess the natural history of AD., Methods: Each of the authors had previously published his own prospective study that involved screening colonoscopy for the detection of neoplasia in asymptomatic adult men and women who had never bled. All pathological lesions diagnosed by endoscopy were recorded, but only data pertaining to polyps were published. We pooled and analyzed the endoscopic findings (raw data) from those studies and assessed the natural history of the lesions by reviewing the medical charts of affected subjects to determine whether bleeding had occurred. Nine hundred sixty-four patients were evaluated (mean age, 62 yr). All were > or = 50 yr old (range, 50-79 yr), not anemic, Hemoccult negative, asymptomatic, and had full colonoscopy to the cecum., Results: Eight subjects had AD (prevalence, 0.83%). Lesions in affected individuals were usually small (mean size, 4.0 mm) and most often were located in the right colon (62%). No subject bled, and all maintained a stable hemoglobin (mean, 14.6 g%) with a mean follow-up of 3 yr., Conclusions: We conclude that 1) colonic AD is uncommon among healthy asymptomatic people (prevalence, 0.83%), 2) lesions are usually small (< 10 mm) and are located proximal to the hepatic flexure, 3) the natural history for AD in these people is benign, and the risk of bleeding over a 3-yr period is low (0% in 3 yr), and 4) because of this low risk, endoscopic treatment for incidental (nonbleeding) AD is unnecessary.