Monday, May 25, 2020

Helpful Strategies For Helping With Math Anxiety - 1162 Words

Helpful Strategies to Assist with Math Anxiety In the Information Capsule from Miami-Dade county different researchers have developed strategies that a teacher can use to reduce the effects of math anxiety in a student who may be suffering from the phobia. The result of the research has found that a teacher, practice has a strong influence on students’ math anxiety. One way a teacher can reduce math anxiety is to be knowledgeable in their content when comes to math and to always exude a positive attitude towards math. The teacher needs to have more training on the subject of math so they will not lack confidence when they are teaching their students. The recommendation is for teachers to attend workshops on research-based best practices†¦show more content†¦The researchers from the Information Capsule also recommend a teacher to not put their lowest performing students in any situations that may intimidate them. Take for instance when a student is called out to answer a question on the board in front of the entir e class. These students need to be given alternative ways to participate in the classroom until their confidence is high enough to publicly answer questions in the classroom. (edgov) Parents can also do a lot of things to reduce the occurrence of math anxiety in their children. A parent should never express negative attitudes about mathematics when their child is around. A child is known to model the behaviors that their parents continuously display around them. So before a parent can help their child they have to conquer their own fears when it comes to math. A parent should always have realistic expectations of their child and should never demean a child because they do not meet a parent’s unrealistically high expectation. When a parent shows encouragement towards their child research shows it to be a positive influence a child’s performance in math. The support of a parent can make a student believe in themselves more and as a result they will become for successful. Parents should also monitor their child’s math progression. They should review the textbooks, tests, and homework that their child is bringing in the home. Another

Thursday, May 14, 2020

WIlliam Blake, a Visionary - 1107 Words

Blake was a man active of mind and body, changing occupations without a minute of repose in between. ‘Apocalyptic’ is a word that can be used in describing William Blake’s works, whether it be a poem, artwork, or story. Although, incredibly relevant in his own time, I believe that his work resonates even more strongly in today’s society. The following stanza comes from one of Blake’s most well renowned poems â€Å"Auguries of Innocence† one of the most prolific verses’ in history; To see a world in a grain of sand And a heaven in a Wildflower, Hold infinity in the palm of your hand And eternity in an hour Blake’s capability to produce confrontational poetry is outstanding, in the above verse alone the paradox’s used are exceptional.†¦show more content†¦Ã¢â‚¬Å"Nought can deform the human race, like to the armours iron brace†, this verse conveys Blake’s strong opinion and hatred of war. Blake lived through the French revolution and bloodshed was a common element of society, and assumed by society to be a way of life. Blake expresses his outlook on war, as the epitome of human failure, which will, inevitably destroy not only the armies or countries under attack but all of human civilisation. This is epitomised in the use of the word ‘deformed’ as it has strong negative connotations of how war has disabled the human race and will continue to do so until we’re so deformed as a race that we are no longer human. An idea which is still very prominent and strongly resonates today in an age where the ‘War on Terror’ continues to cripple modern civilisation. Throughout this poem, Blake has scattered pockets of philosophical ideas and wisdom. His poetry as a whole reflects on humanity. He describes an array of mannerisms, acts of cruelty, selfishness and descriptive comparisons, all the while keeping the poem flowing and rhyming superbly. The emotion he conveys to the reader is that of frustration and desperation, as he struggles for the reader to understand his ideology and outlook on society. A Robin Red breast in a Cage Puts all Heaven in a Rage. Blake’s use of intense imagery is embodied in his use of figurative language. Blake’s love and connection to nature and animals is reflected in theShow MoreRelatedEssay William Blake: Visionary Artist and Poet770 Words   |  4 Pages William Blake The sight of an angel made William Blake the most celebrated poet of his time, it influenced in his poems and painting, which it became gothic to people and made him a spiritual person. William Blake was born over his father hosiery shop at 28 Broad Street, Golden Square, London in Nov. 28,1757. His father was James Blake a hosier, and his mother Catherine Wright Armitage Blake. (Blakearchive.org) William Blake, being mostly educated at home learned how to read and write byRead MoreWilliam Blake For this paper I choose to do a study of William Blake. I choose William Blake800 Words   |  4 PagesWilliam Blake For this paper I choose to do a study of William Blake. I choose William Blake because I really liked some of his poems and he is considered one of the most renowned poets in English literature history. He liked to write poems that could be understood by the everyday man, because most of his poem were about the everyday man, but he refused to sacrifice his visions in order to become popular. His work combines a variety of writing styles, he is an artist, a lyric poet and a visionaryRead MoreEssay on Biography of William Blake1631 Words   |  7 Pagesinspire your work and success. William Blake was a famous artist, engraver and poet. However, it was not until 1863 that he became famous when Alexander Gilchrist published his biography(Blake, William, and Geoffrey Keynes).Blake and his poetry have been compared to Shakespeare (Kathleen Raine). As an artist Blake was equated to Michelangelo. Being born during the time of both the American and French Revolution, William Blake was agai nst both the Church and the State. Blake was a Dualist, believing theRead MoreWilliam Black - I Heard an Angel Singing1404 Words   |  6 PagesWILLIAM BLAKE â€Å"I heard an angel singing† A Matter of Life an Death Abstract In this poem William Blake at the beginning speaks about an angel, who was singing in the small hours every day. An angel was singing all day about mercy, pity, peace, which is the world ´s release. Angel was positive feature. He tried to help people. His voice is really beautiful and people feel good during his singing. Devil cursed mercy, pity and peace, because he saw all men are happy in the world and they don ´tRead MoreThe Troubled Souls Of Burdened Authors In The Late Eighteenth1602 Words   |  7 PagesSamuel Taylor Coleridge s mental state and William Blake s franticness. The principle contrast amongst Shakespeare and Blake is antipodean. Blake was a visionary and thought his fancies genuine – he was frantic. Shakespeare was a thinker, and knew he was everything except creative energy, however genuine may be the truths he fashioned from them (Cooper and Dendy 1845). Researchers Cooper and Dendy takes note of that, William Shakespeare and William Blake are of no mental examination inside theirRead MoreWilliam Wordsworth And The Echoing Green905 Words   |  4 Pagesimportant events in which the literary works were published (â€Å"I Wandered Lonely as a Cloud† by William Wordsworth and â€Å"The Echoing Green† by William Blake). However these poets both use nature around them as a symbolic meaning to express their current emotions and feelings, which both sparked memories from watching nature. My thesis intends to examine the question: Why William Wordsworth and William Blake had such a symbolic meaning in their poems? This thesi s will attempt to answer this questionRead MoreWilliam Blake And William Wordsworth1099 Words   |  5 Pagesindividual uniqueness. In particular, English Romantic poets had a strong connection with mythology and nature; among those poets are William Blake and William Wordsworth. Although Blake was a contemporary of the era, he had a little in common with Wordsworth. Religion is the focus of Blake’s visionary works, which does not exist in any other Romantic poetry. William Blake uses satire in most of his work to criticize the corrupting influence of religion on imagination. For Wordsworth, nature was likeRead MoreThe Romantic Era: The Pain of Composition Romanticism allowed poets to have the world at their900 Words   |  4 Pagesemotions. William Blake, I believe, was a visionary with more of a theological or spiritual tone in both his writings and his paintings, whereas William Wordsworth used temporal viewpoints to help him describe his reality of nature. Blake and Wordsworth both used their talent for creating art and exciting passion in their readers with Blake expressing his views on morality, religion and philosophy, and Wordsworth with his ever changing views on man and nature becoming one. William Blake was bornRead MoreWilliam Blake in Contrast of Songs of Innocence and of Experience1452 Words   |  6 PagesEN 222-Intro to British Lit. II April 21, 2012 William Blake in contrast of Songs of Innocence and of Experience William Blake, an engraver, exemplified his passion for children through his many poems. Blake lived in London most of his life and many fellow literati viewed him as eccentric. He claimed to have interactions with angels and prophets, which had a great influence on his outlook of life. Blake believed all prominent entities, those being church, state, and government had become sick withRead MoreA Comparison Between William Wordsworths Upon Westminster Bridge and William Blakes London1006 Words   |  5 PagesA Comparison Between William Wordsworths Upon Westminster Bridge and William Blakes London The English Romantic period spanned between 1789 and 1824. This period was not so-called until the mid 19th century when readers began to see six different poets as part of the same movement. These poets were William Blake, William Wordsworth, Samuel Taylor Coleridge, Lord Byron, Percy Shelly and John Keats. Some aspects of Romantic poetry were; there was an increasing interest

Wednesday, May 6, 2020

Mentorship Assessment and Student Essay - 5901 Words

Preparation for mentorship portfolio of learning. Introduction. Within this assignment I aim to demonstrate achievement of the five identified learning area and the ensuing ability to use these to act as an effective mentor and role model for nursing students within my clinical area. In order for me to show my capability in applying the theories to practice I am going to use the Gibb cycle of reflection as stated in beginning reflective practice (jasper 2003), I feel that this will help me further understand and enhance my knowledge and theory behind the clinical practice I currently undertake and how to keep improving this with each new student nurse I come to work with in the future. The concept of mentorship dates back to the†¦show more content†¦Following this meeting the student and I came up with a clear and concise plan as to what the student had to do to meet his required learning outcomes and had put things in place to ensure that these were reasonable and obtainable. At the end of the meeting I was happy with the proposed action plan, also as my student had never worked within a community setting before I reassured him that should he feel that he needs to talk about something to approach me and we can sit and discuss this is a constructive way so that it will not impede his learning. I was initially hesitant about becoming a mentor, as I had only just moved into my current job and was still getting used to the nature of the work, also my work environment had only just been approved for nursing students, and this was the second student to come to the team, therefore as a multidisciplinary team of nurses, Social workers and Occupational therapists we were concerned about the nature of the experience the students would receive as it was not clear as to if the clients would allow the students access to the visits and participate in these, and should this happen they would not be able to gain the knowledge needed to pass the unit. However I had confidence in my communication and interpersonal skills, and hoped that the clients within the community would allow my student access to the visits. BailleShow MoreRelatedEssay The Concept of Mentorship1074 Words   |  5 PagesIn the following assignment the author will critically explore, discuss, reflect upon and evaluat e mentorship within clinical nursing placements. With particular reference to learning disabilities and respite care, the author will look at the needs and benefits of mentorship, as well as the problems and constraints, especially being in such a specialised service. The author will explore the area of orientation, looking at why it is such an important aspect of the whole placement area. Once theseRead MoreStudent Mentorship Program For The Community College Essay1463 Words   |  6 PagesStudent Mentoring in the Community College Student Population Served Student Success is now considered a vital element in the community college role. We must teach our students, and equipped them with skills to achieve their educational goal, as well as their career goals thereby, surviving in the workplace. Therefore, I am proposing a student mentorship program that targets all students enrolling at Mohave Community College (MCC). The program will encourage participation from the concurrent enrolledRead MoreAssess and Workplace as a Learning Environment Essay1330 Words   |  6 PagesMENTORSHIP PREPARATION | Assess and critically analysis your workplace as a learning environment and identify any changes you could make | | | Appendix 1 SWOT analysis of my work place. A SWOT is an acronym for strength, weaknesses; Opportunities and Threats). A SWOT analysis is a successful way of examing your own mentorship role and helping you grow and move forwards. Strengths a) Good communication skills b) Good timekeeping c) Good team player d) OrganisationRead MoreA Short Note On External Mentorship For Employers1451 Words   |  6 PagesExternal Mentorship for Employers How to Begin as a Mentor To determine if you are ready as a mentor, the minimum requirements to establish a mentor and mentee relationship are: ïÆ'Ëœ Three or more years of professional experience in the related field of student study or industry that aligns with program learning outcomes ïÆ'Ëœ Expertise in any of the following areas: o Leadership o Communication Skills o Strategic Decision Making o Organization Skills o Resource Management How to Apply CompleteRead MoreHow Teacher Development Influence The Self Confidence For The Beginning Mentees Teachers Essay933 Words   |  4 Pagesthe change of self-worth on novice teachers who have gone through the professional mentoring development? Significance of Study The purpose of this quantitative quasi-experimental pre-post, test study is to test to what degree teacher mentorship development influence the self-confidence of beginning mentees teachers. The potential outcomes of mentor teachers mentoring novice have shown to be successful in research. Garmston (2015) mentioned that peer coaching will develop the beginningRead MoreSchool Based Mentoring Programs ( Sbmp )919 Words   |  4 PagesUndoubtedly, SBMP have been shown to improve students: attitudes, confidence, school engagement, school performance, behaviour, vocational skills, and emotional and social skills (Converse Lignugaris/Kraft, 2009; Miller et al., 2013; Schwartz, Rhodes, Herrera, 2012). Contrarily, these promising outcomes are equally met with many studies that show: no, or only little, improvements; only short-lived results; or only effectiveness with certain types of students (Converse Lignugaris/Kraft, 2009; McQuillinRead MoreNew Teacher Orientation And Mento ring1096 Words   |  5 Pagesthe direct needs of the new employee. The is allotted for these meets cannot extend over 7.5 hours due to the current union contract (D. Gaffney, personal communication, January 28, 2016). In additional to induction meetings, a well established mentorship program is at work for MCIU employees. Each newly hired candidate is linked with a â€Å"VIP† or Volunteer Induction Profession (This name is somewhat ironic as mentors do receive a stipend for their participation.). After receiving training and beingRead MoreCreating A Crisis Management Plan For Mentorship Academy Athletic Department1476 Words   |  6 Pagesmanagement plan for Mentorship Academy Athletic Department. Mentorship Academy host several athletic events throughout the school year for high school athletes to participate. Students that participates in any athletic events are at a risk for injuries than any other student and causes each sport to have a higher standard of caution and safety to protect the students’ safety. Therefore I will be completing a crisis management plan for Mentorship Academy Football Team. Currently, Mentorship Academy hasRead MoreGraduation Gap Between Minority Students And White Students Essay1311 Words   |  6 Pagesdiverse students entering and graduating from post-secondary institutions is increasing at rapid rates (Education Trust, 2015; Georgetown University Center, 2012). Between the years 2003 and 2013, 77% of public institutions improved graduation rates for underrepresented groups, including African-American, Hispanic, and Native American students (Education Trust, 2015). Despite this increase, there continues to be a graduation gap between underrepresented minority students and White students. NationallyRead MoreThe Role Of The Mentor1525 Words   |  7 Pagesmentor is shown to significantly influence how students perceive their placement. Students expressed that when they are supported and have a mentor who actively engages with them, this leads to a positive experience regardless of the specific clinical area (Tastan et al, 2015; Plushford, Boit and Ow en, 2002). Equally, when students felt like they had a mentor who did not engage with them, facilitate their learning, support them or fully understand what students were able to participate in care wise, it

Tuesday, May 5, 2020

Apple Capability and Core Competencies

Question: Discuss about the Apple Capability and Core Competencies. Answer: Introduction For a long period of time Apple has been the best worldwide in the manufacture of electronic devices. The production of quality products like iPhones, iMac, and iPod has always been the bottom line of the success (Meyer,2006). In 2008, the company clinched position 24 in the word-wide rank of the best companies with the best brand (Basu and Wright, 2008). The success of Apple company is as a result of its uniqueness and competency to understand the customer needs, change in taste and adjust accordingly keeping in mind to listen to clients and do as the clients request. These core competencies facilitated a great campaign for Apple hence making it gain a competitive edge in the global market. According to Sliber and Kearny (2009) core competencies are the driving force that make the company unique and most importantly gaining a larger market share than its competitors. One of the key competencies of Apple company is its ability to design software and electronic gadgets that are of top value. For instance, since Steve Jobs took the job at Apple as the Chief Executive Officer, apple started integrating robust technology in the design of Apple Product hence it started attracting customers who had initially stopped purchasing their products because then, innovation was minimal. For the past decade, Apple has released quite a batch of products that include, iPhones, iPod, iWatch, Apple television, iTunes, movies among other products. The products are built with n top notch features and colors that make customers to purchase their products (Lehman, Haslam, 2013, p.12). Evaluation of the company`s record reveals Apple is a financially stable company. According to the research of De Wit and Meyer (2010), since 2003 to 2008 the company has tripled its profit from $24 million to $3.5 billion. Therefore, with the suitable financial base Apple is able to pays its worker and research team reasonable wages and salaries for the great job they do to ensure the gadgets developed are of high quality. Another competency is that Apple has a strong and dynamic capability. Apple is always willing to adjust and be ahead of its market rivals. Especially the changes brought in by competitors Apple is the best company to outdo its rivals. For example, when the market rivals launch a new product, Apple immediately launches an advanced gadget within no time. Remember, when Dell launched its tablet in the market Apple launched its iPad 2. In another scenario, Samsung company launched Samsung S3 phone immediately Apple unleashed a powerful iPhone 5 just to prove to the competitors and the rest of the market that they are always the best innovators. Maybe another key competency that is overlooked is the range of products that Apple offers to its customers. The innovativeness in Apple is incredible and I think no other company can compete with apple in terms of products. Take an example of Nokia company, their android phones require the user to create their own backup but for the case of Apple`s iPhones the iCloud is their backup. These are some of the comparisons that justify Apple as a competent company and is likely to maintain in performance because its naturally responsive and sensitive to the dynamics existing in the industry. Apple has robustness in ensuring their business secret is not concealed to their competitors. In this case, Apple has deployed a closed proprietary system that ensures the techniques and secrets of their innovations are withheld by the company only. As a result, this makes other rival in the market to be unable to make duplicates or counterfeit gadgets to cause confusion in the market. On the other end of the spectrum, Apple is a company that has consistency in their product portfolio development. Usually, Apple releases one product at a time so that they avoid losing. Those companies that tend to diversify too much in their line of production there are high chances of losing their competitive edge. Notably, the organization structure of this company is vibrant. The organization structure is contributing immensely to innovation and easy distribution of roles. A firm`s organizational structure creates room for other opportunities hence business growth is realized. In Apple`s case, as much as their organizational structure adopts the old hierarchy, the structure is much flexible and gives support to other levels of leadership. Th success of Apple can be realized the results and the performance of Apple and its ability to suit the market and meet the customer demands. Cross-examination and analysis of the company portfolio, goals, and objectives reveals that Apple is incorporating other aspects other than technology to develop its competency. More especially, it is noted that the management thrives to combine technical forces and customer orientation to keep their reputation at the top level. The company CEO initiated a differentiated approach to manufacture their products hence, the volume of production went high so does the profitability. Above all, due to the company`s competency, customers have developed a habitual purchase behavior of their products. The customers have developed the notion in their mind that the products of Apple are of good quality hence they have created a unique taste that no other competitor can produce a product of the same kind. That is the reason why, even if the products of Apple are so expensive, consumers still dig deeper in their pocket to purchase the product. Just because they feel there is value out of what they purchase, the customers don`t mind engaging with the company again and again. How does Competition Impact on the Apple and its Ability to Serve itsMarkets? To a great extent, Apple does not face tough competition from the market rival because it is always informed in terms of technology and innovation, However, the little competition that comes from companies like Dell, in the line of computer manufacture, Nokia and Samsung in the line of phone manufacturing have always behind Apple in terms of innovation. Therefore, it is difficult for them to take the huddle from Apple. Apple has always differentiated itself from the market rivals. In the production process of Apple, Apple manufactures differentiated products that allows them to create premium products that attract premium prices for people of social class over the globe. Apple enjoys high profits than competitors that means although their products are sold at a premium price, hence, the customer perceives the value of the products as the most important. Consider Potential CustomerMarkets-that the OrganizationMay Try and Serve? Apple understands its audience by producing iPhones with feature that suite the Social class individuals. Studies have shown that social class people are extravagant such that they go for products that are expensive and can only be afforded by few people. Thus, the marketers of Apple company target such an audience. For example, people use Apple iPhones because they have high security features and they have large memory and RAM. Apple company has done a one-to-one relationship with their target audience and they use their customers to brand the name by offering incredible and high value iPhones. What are the Likely Impacts of the External Environment Effective marketing incorporates micro and macro environmental factors. The concepts are relevant to marketing when applied in the right manner and can contribute positively to the performance of the business. Therefore, even other small companies should learn to keep into considerations to keep the performance at the top. For the case, of Apple there are quite a number of external forces that we can say have contributed to its performance and those others that are restraining the company. External factors are known to affect the business from the outside environment such that the business has little control over them. There are a couple of factors in external environment that influence decision of not only Apple but also other companies. The factors include demographic change, government regulation, trade barriers and other tribunals. Therefore, in all the decisions made by Apple management these factors have to be put into consideration. Political factors are the prevailing conditions that exist in the United States for the case of Apple. The political atmosphere should be friendly for apple to carry out its marketing mix segmentation and peacefully do advertisements without fear or lose of property (Giroux et.al. 2016). Of which the United States government as prostrated a stable political stand that encourages economic growth and development by combating wars, crimes, and ethnicity to create a conducive business environment for all the companies. Nonetheless, the government has also adjusted on political stability, deliberations on employment policies, taxation, and other regulations. Notably, US has trade agreement with many countries and trade unions which enable free trade between the countries and the border countries. Economic factors are the prevailing conditions that determine the value of money in the economy. Such economic factors can be exchange rates, taxation policies, the rate of inflation, the standards of living, and per capita income among other factors. The factors are important because Apple manufactures and targets middle class and high class individuals. For the company to experience high returns, the conditions should be favorable to motivate the customers to purchase the Apple`s products. Also, the exchange rates and value of currency play a major in the economy. A wide range of customers for Apple products come from international market (Communication strategies. n.d.) As a result, the trade regulations that have been implemented must be favorable to ensure the company continues to serve their clients with minimal or no interference and stringent restrictions. Social-cultural factors have influenced the performance of Apple. Factors like advancement in technology, change in lifestyle, living standards, and demographic factors have boosted the performance and their sales (Marengo Pasquali,2012). Most people are interested to move at the same pace technology is changing. Therefore, the young educated people, business men are the first targets of Apple. The target market is expected to develop demand for the gadgets manufactures by Apple. Hence, those countries within a population structure that has more youths is likely to be a suitable hub for Apple to invest. Besides environmental factors can circumvent the operation of Apple is they are not properly addressed. Every country has its own rules are regulations of conserving the environment. As pointed earlier on, Apple operates on an international market therefore, they have to adhere to the underpinned environments rules as specified by the particular country Apple is willing or already it has penetrated. If Apple is able to operate in any standards then it would be easy for them to operate in any region as long as there is a trade agreement with the trade union or respective country. Make Recommendations on how These Factors above will Impact on the OverallMarketing Strategy of the Organization As we know Apple is very responsive to changes in technology and a s a result they should continue to be unique and probably the company should keep on improving the value of the product by introducing an element of change to convince the client the company is innovative and is offering improvised products every time. In those countries that have legislations that allow compulsory recycling of products, Apple should ensure in such target markets produce recyclable products that are environmental friendly. Another example is that Legal factors requires Apple to operate under special rules and regulations just like consumers, health and safety laws which safeguard the well-being of individuals. As well, Apple should be observant of intellectual property and patent laws as pertains the requirements of a particular country. References Basu,R., Wright,J.N. (2008). Supply chain in emerging markets. Total Supply Chain Management, 164-180. doi:10.1016/b978-0-7506-8426-2.50015-0 Communication strategies. (n.d.). Marketing Communication Policies, 117-131. doi:10.1007/978-3-540-37323-0_7 DAMANPOUR,F. (1988). Innovation Type, Radicalness, and the Adoption Process. Communication Research, 15(5), 545-567. doi:10.1177/009365088015005003 De Wit. (2010). Law and Visual Arts. Law and policy review. doi:10.5349/lpr7 Dedication. (2006). Search Marketing Strategies, vi. doi:10.1016/b978-0-7506-6618-3.50002-8 Giroux,M., Pons,F., Maltese,L. (2016). Sustainability Marketing Strategies: How Self-Efficacy and Controllability Can Stimulate Pro-environmental Behaviors for Individuals. Celebrating Americas Pastimes: Baseball, Hot Dogs, Apple Pie and Marketing?, 731-732. doi:10.1007/978-3-319-26647-3_152 Giroux,M., Pons,F., Maltese,L. (2016). Sustainability Marketing Strategies: How Self-Efficacy and Controllability Can Stimulate Pro-environmental Behaviors for Individuals. Celebrating Americas Pastimes: Baseball, Hot Dogs, Apple Pie and Marketing?, 731-732. doi:10.1007/978-3-319-26647-3_152 Lehman,G., Haslam,C. (2013). Accounting for the Apple Inc business model: Corporate value capture and dysfunctional economic and social consequences. Accounting Forum, 37(4), 245-248. doi:10.1016/j.accfor.2013.08.001 Marengo,L., Pasquali,C. (2012). How to Get What You Want When You Do Not Know What You Want: A Model of Incentives, Organizational Structure, and Learning. Organization Science, 23(5), 1298-1310. doi:10.1287/orsc.1110.0705 Meyer,H.S. (2006). Apple Lounge. JAMA, 295(11), 1313. doi:10.1001/jama.295.11.1313-a