bluuebunny/crossref_metadata_2025 huggingface dataset:
Alterations in regional vascular geometry produced by theoretical stent implantation influence distributions of wall shear stress: analysis of a curved coronary artery using 3D computational fluid dynamics modeling
Authors: LaDisa John F , Olson Lars E , Douglas Hettrick A , Warltier David C , Kersten Judy R , Pagel Paul S
Published: June 2006

Background

The success of stent implantation in the restoration of blood flow through areas of vascular narrowing is limited by restenosis. Several recent studies have suggested that the local geometric environment created by a deployed stent may influence regional blood flow characteristics and alter distributions of wall shear stress (WSS) after implantation, thereby rendering specific areas of the vessel wall more susceptible to neointimal hyperplasia and restenosis. Stents are most frequently implanted in curved vessels such as the coronary arteries, but most computational studies examining blood flow patterns through stented vessels conducted to date use linear, cylindrical geometric models. It appears highly probable that restenosis occurring after stent implantation in curved arteries also occurs as a consequence of changes in fluid dynamics that are established immediately after stent implantation.

Methods

In the current investigation, we tested the hypothesis that acute changes in stent-induced regional geometry influence distributions of WSS using 3D coronary artery CFD models implanted with stents that either conformed to or caused straightening of the primary curvature of the left anterior descending coronary artery. WSS obtained at several intervals during the cardiac cycle, time averaged WSS, and WSS gradients were calculated using conventional techniques.

Results

Implantation of a stent that causes straightening, rather than conforms to the natural curvature of the artery causes a reduction in the radius of curvature and subsequent increase in the Dean number within the stented region. This straightening leads to modest skewing of the velocity profile at the inlet and outlet of the stented region where alterations in indices of WSS are most pronounced. For example, time-averaged WSS in the proximal portion of the stent ranged from 8.91 to 11.7 dynes/cm2 along the pericardial luminal surface and 4.26 to 4.88 dynes/cm2 along the myocardial luminal surface of curved coronary arteries as compared to 8.31 dynes/cm2 observed throughout the stented region of a straight vessel implanted with an equivalent stent.

Conclusion

The current results predicting large spatial and temporal variations in WSS at specific locations in curved arterial 3D CFD simulations are consistent with clinically observed sites of restenosis. If the findings of this idealized study translate to the clinical situation, the regional geometry established immediately after stent implantation may predispose portions of the stented vessel to a higher risk of neointimal hyperplasia and subsequent restenosis.
Adjuvant Chemotherapy and Survival in Older Women With Hormone Receptor–Negative Breast Cancer: Assessing Outcome in a Population-Based, Observational Cohort
Authors: Elkin Elena B. , Hurria Arti , Mitra Nandita , Schrag Deborah , Panageas Katherine S.
Published: June 2006

Purpose

For older breast cancer patients, there is limited evidence of the efficacy of adjuvant chemotherapy from randomized clinical trials. Our goal wastoassess the relationship between adjuvant chemotherapy use and survival in a large, population-based cohort of older women with hormone receptor (HR) –negative breast cancer.

Methods

We identified women age 66 and older diagnosed with HR-negative, nonmetastatic breast cancer from 1992 to 1999 in the Surveillance, Epidemiology and End Results (SEER) cancer registries. Chemotherapy use was identified in Medicare claims linked to SEER records. Clinical and sociodemographic predictors of chemotherapy use were identified using logistic regression. The effect of chemotherapy on survival was evaluated using propensity score methods and multivariable proportional hazards regression.

Results

A total of 1,711 (34%) of 5,081 women with HR-negative breast cancer received chemotherapy within 6 months of cancer diagnosis. Chemotherapy use decreased with increasing age and comorbidity, and increased with year of diagnosis, tumor size, number of positive lymph nodes, and higher tumor grade. Adjuvant chemotherapy was associated with a mortality reduction of approximately 15% whether analyzed using propensity scores or standard multivariable methods. The greatest overall survival benefit was observed in patients with node-positive disease and in the node-negative patients most likely to receive chemotherapy.

Conclusion

This analysis suggests a survival benefit from adjuvant chemotherapy in older women with HR-negative breast cancer. The benefit of chemotherapy is most pronounced in the patients most likely to be selected for treatment, including those with involved lymph nodes or other high-risk disease characteristics.
End-of-Life Decisions Among Cancer Patients Compared With Noncancer Patients in Flanders, Belgium
Authors: Van den Block Lieve , Bilsen Johan , Deschepper Reginald , Van Der Kelen Greta , Bernheim Jan L. , Deliens Luc
Published: June 2006

Purpose

Incidence studies reported more end-of-life decisions with possible/certain life-shortening effect (ELDs) among cancer patients than among noncancer patients. These studies did not correct for the different proportions of sudden/unexpected deaths of cancer versus noncancer patients, which could have biased the results. We investigated incidences and characteristics of ELDs among nonsudden cancer and noncancer deaths.

Methods

We sampled 5,005 certificates of all deaths in 2001 (Flanders, Belgium) stratified for ELD likelihood. Questionnaires were mailed to the certifying physicians. Data were corrected for stratification and nonresponse.

Results

The response rate was 59%. Among 2,128 nonsudden deaths included, ELDs occurred in 74% of cancer versus 50% of noncancer patients (P < .001). Symptom alleviation with possible life-shortening effect occurred more frequently among cancer patients (P < .001); nontreatment decisions occurred less frequently (P < .001). The higher incidence of lethal drug use among cancer patients did not hold after correcting for patient age. Half of the cancer patients who died after an ELD were incompetent to make decisions compared with 76% of noncancer patients (P < .001). Discussion with patients and relatives was similar in both groups. In one fifth of all patients the ELD was not discussed.

Conclusion

ELDs are common in nonsudden deaths. The different incidences for symptom alleviation with possible life-shortening effect and nontreatment decisions among cancer versus noncancer patients may be related to differences in dying trajectories and in timely recognition of patient needs. The end-of-life decision-making process is similar for both groups: consultation of patients and relatives can be improved in a significant minority of patients.
Celecoxib Versus Placebo for Men With Prostate Cancer and a Rising Serum Prostate-Specific Antigen After Radical Prostatectomy and/or Radiation Therapy
Authors: Smith Matthew R. , Manola Judith , Kaufman Donald S. , Oh William K. , Bubley Glenn J. , Kantoff Philip W.
Published: June 2006

Purpose

To assess the biologic activity of celecoxib, a selective cyclooxygenase-2 inhibitor, in men with recurrent prostate cancer using change in prostate-specific antigen (PSA) doubling time (PSADT) as the primary outcome variable.

Patients and Methods

Participants had histologically confirmed prostate cancer, no recent hormone therapy, rising serum PSA after radical prostatectomy and/or radiation therapy, and no radiographic evidence of metastases. Patients were randomly assigned to celecoxib (400 mg by mouth twice daily) or placebo. Treatment continued until disease progression or until adverse effects stopped treatment. A positive outcome was defined as post-treatment PSADT of more than 200% baseline PSADT with no new metastases.

Results

The study was terminated early after information about the cardiovascular safety of celecoxib prompted review of ongoing clinical studies. Before discontinuation of the study, 78 men were assigned randomly to either celecoxib or placebo. Eight (20%) of 40 men in the placebo group and 15 (40%) of 38 men in the celecoxib group had post-treatment PSADT of more than 200% of baseline PSADT with no new metastases (P = .08). Mean PSA velocity increased by 3.0% for the placebo group and decreased by 3.4% for the celecoxib group (P = .02).

Conclusion

Although the primary efficacy objective was not met, this study provides some evidence for biologic activity of celecoxib in prostate cancer. Compared with placebo, celecoxib significantly decreased mean PSA velocity and tended to increase the proportion of men who doubled their PSADT.
Insulin Resistance Accelerates Muscle Protein Degradation: Activation of the Ubiquitin-Proteasome Pathway by Defects in Muscle Cell Signaling
Authors: Wang Xiaonan , Hu Zhaoyong , Hu Junping , Du Jie , Mitch William E.
Published: June 2006

Conditions such as acidosis, uremia, and sepsis are characterized by insulin resistance and muscle wasting, but whether the insulin resistance associated with these disorders contributes to muscle atrophy is unclear. We examined this question in db/db mice with increased blood glucose despite high levels of plasma insulin. Compared with control littermate mice, the weights of different muscles in db/db mice and the cross-sectional areas of muscles were smaller. In muscle of db/db mice, protein degradation and activities of the major proteolytic systems, caspase-3 and the proteasome, were increased. We examined signals that could activate muscle proteolysis and found low values of both phosphatidylinositol 3 kinase (PI3K) activity and phosphorylated Akt that were related to phosphorylation of serine 307 of insulin receptor substrate-1. To assess how changes in circulating insulin and glucose affect muscle protein, we treated db/db mice with rosiglitazone. Rosiglitazone improved indices of insulin resistance and abnormalities in PI3K/Akt signaling and decreased activities of caspase-3 and the proteasome in muscle leading to suppression of proteolysis. Underlying mechanisms of proteolysis include increased glucocorticoid production, decreased circulating adiponectin, and phosphorylation of the forkhead transcription factor associated with increased expression of the E3 ubiquitin-conjugating enzymes atrogin-1/MAFbx and MuRF1. These abnormalities were also corrected by rosiglitazone. Thus, insulin resistance causes muscle wasting by mechanisms that involve suppression of PI3K/Akt signaling leading to activation of caspase-3 and the ubiquitin-proteasome proteolytic pathway causing muscle protein degradation.
Decentralization, Hierarchies, and Incentives: A Mechanism Design Perspective
Authors: Mookherjee Dilip
Published: June 2006

Separation of ownership from management, multidivisional firm organizations, delegation of production decisions to worker teams, delegation of pricing and advertising decisions to retail franchisers, reliance on intermediaries in trade or finance, and distribution of regulatory authority across different agencies represent examples of organizations that delegate and distribute decision-making authority instead of centralizing it. This paper reviews literature on costs and benefits of delegated decision making in hierarchical organizations or contracting networks with regard to problems of incentives and coordination. It starts by describing incentive and coordination costs of delegation in simple canonical examples of hierarchies where both information and incentives of different decisionmakers differ. One class of models pertain to contexts where the classical Revelation Principle applies, i.e., where costs of contractual complexity, information processing, or communication are absent, agents do not collude, and the mechanism designer can commit to the mechanism. Delegation may conceivably entail a loss of control and coordination arising from the divergence of information and incentives. Sufficient and necessary conditions for this loss to be mitigated entirely include risk neutrality, top-down contracting, and monitoring of transfers or production assignments between subordinates. The next class of models introduces communication costs that restrict the performance of centralized arrangements relative to delegation owing to a resulting loss of flexibility, which has to be traded off against possible control losses of delegation. Finally, consequences of collusion among agents is discussed, which typically enlarge the range of circumstances under which delegation can attain optimal second-best outcomes. The paper concludes with a discussion of the relevance of this theoretical literature to recently emerging empirical studies of industrial organizations where delegated decision making plays an important role: adoption of innovative human resource management practices, new information technologies and retail franchising.
Assassinations: Evaluating the Effectiveness of an Israeli Counterterrorism Policy Using Stock Market Data
Authors: Zussman Asaf , Zussman Noam
Published: June 2006

Since the outbreak of the Intifada in September 2000, the Israeli government has extensively employed a policy of assassinating members of Palestinian terrorist organizations. Theoretically, the net effect of an assassination on future terrorism is indeterminate because it embodies two conflicting effects: the assassination of a terrorist hurts his organization's capabilities, but may increase the motivation for future attacks. Our indirect, empirical evaluation of the effectiveness of assassinations for Isreali counterterrorism is based on Israeli stock market reactions to news of such operations. We rely on the fact that terrorism has had significant adverse effects on the Israeli economy and claim that the stock market should react positively to news about effective counterterrorism measures but negatively to news about counterproductive ones. We find that the market does not react to assassinations of low-ranked members of Palestinian terrorist organizations. The market does react strongly, however, to the assassinations of senior leaders of terrorist organizations: it declines following assassinations targeting senior political leaders but rises following assassinations of senior military leaders. To the extent that these reactions reflect expectations regarding future levels of terrorism they imply that the market perceives the first type of assassinations as counterproductive, but the second as an effective measure in combating terrorism.
Predicting Tissue HER2 Status Using Serum HER2 Levels in Patients with Metastatic Breast Cancer
Authors: Kong Sun-Young , Nam Byung-Ho , Lee Keun Seok , Kwon Youngmee , Lee Eun Sook , Seong Moon-Woo , Lee Do Hoon , Ro Jungsil
Published: June 2006

Background: Immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH) are reliable ways to identify overexpression or amplification of the HER-2/neu (HER2, symbol ERBB2) gene, but each technique requires a high-quality tissue sample, which may not be available. We investigated whether serum concentrations of the HER2 extracellular domain (ECD) can be used as an alternative to tissue HER2 status in metastatic breast cancer, and we defined an optimal decision-level concentration of serum HER2 for prediction of tissue HER2 status.

Methods: In 195 patients with metastatic breast cancer, we determined HER2 expression by IHC and performed FISH analysis on tumors for which IHC staining was graded as 2+. We measured serum HER2 by immunoassay and used ROC curve analysis to determine optimal serum HER2 ECD concentrations for differentiation between positive and negative HER2 status.

Results: IHC results were 0/1+ for 30 (15%) of the patients, 2+ for 89 (46%), and 3+ for 76 (39%). FISH revealed HER2 amplification in 19 (21%) of the IHC 2+ tumors. Mean (SE) serum HER2 ECD was 22.2 (5.1) μg/L in the tissue HER2-negative group, significantly lower than the concentration of 363 (96) μg/L in the tissue HER2-positive group (P <0.0001). ROC curve analysis showed 95% specificity and 62% sensitivity for tissue HER2 positivity at 37 μg/L of serum HER2.

Conclusion: To use serum HER2 concentration as an alternative to direct determination of tissue HER2 status, we suggest 37 μg/L as a cutoff for predicting positive tissue HER2 with 95% specificity. Sensitivity, however, is low.
Establishment of detailed reference values for luteinizing hormone, follicle stimulating hormone, estradiol, and progesterone during different phases of the menstrual cycle on the Abbott ARCHITECT® analyzer
Authors: Stricker Reto , Eberhart Raphael , Chevailler Marie-Christine , Quinn Frank A. , Bischof Paul , Stricker René
Published: June 2006

During a normal menstrual cycle, serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and progesterone can vary widely between cycles for the same woman, as well as between different woman. Reliable reference values based on the local population are important for correct interpretation of laboratory results. The purpose of our study was to determine detailed reference values for these hormones throughout the menstrual cycle using the Abbott ARCHITECT system. From 20 volunteers (age 20–36years) with normal cycles and no use of oral contraceptives, samples were taken every day during their cycle. Volunteers received three vaginal ultrasound examinations (days 10 and 13, and 1 or 2days after ovulation) to measure follicular and corpus luteum development. Hormone levels were measured using the corresponding ARCHITECT assay and were synchronized to the LH peak. Median, and 5th and 95th percentile values were determined for each day of the cycle, as well as for early follicular (days −15 to −6), late follicular (days −5 to −1), LH peak (day 0), early luteal (+1 to +4), mid-luteal (days +5 to +9), and late luteal (days +10 to +14) phases of the cycle. Based on our data, we were able to establish detailed reference values for LH, FSH, estradiol, and progesterone, which should aid in the interpretation of results for these reproductive hormones in a variety of circumstances.

Clin Chem Lab Med 2006;44:883–7.
The Economics of Global Food Security
Authors: Tweeten Luther
Published: June 2006

This article outlines a food security synthesis: that food insecurity traces to poverty, that poverty must be addressed by economic development, and that economic development flows from application of the standard model that is now mainstream economics. Food‐insecure countries do not follow the standard model; their policies for agriculture and other sectors deter development. Reasons lie in institutions such as government and in attitudes. The economics of food security is straightforward. The challenge of food security for our time is for economists to work with others regarding socioinstitutional changes essential for proven policies and practices to supply adequate diets.
Differences between Farmer and Agency Attitudes Regarding Policies to Reduce Phosphorus Pollution in the Minnesota River Basin
Authors: McCann Laura M. J. , Easter K. William
Published: June 2006

Farmers and agency staff were surveyed regarding their opinions on alternative policies to reduce agricultural nonpoint source pollution in the Minnesota River. Farmers were also asked about their land and nutrient management practices. The information was used to examine determinants of policy preferences. For agency staff, farmer resistance and administrative or transaction costs were more important than farmer costs. Both agency staff and farmers indicated that their preferred policy was a requirement for conservation tillage on highly erodible land. Changes in how soil test results are reported may have potential to reduce phosphorous applications, as would improved manure management.
How Quality Management Metasystems Are Affecting the Food Industry
Authors: Caswell Julie A. , Bredahl Mary E. , Hooker Neal H.
Published: June 2006

The future competitiveness of the U.S. food industry depends on its ability to deliver high‐quality products at competitive prices to domestic and international markets. Recent developments in the establishment and operation of quality management metasystems are having important effects on this competitiveness. Their use has the potential to enhance product quality, simplify contractual relationships, demonstrate compliance with regulations, and improve responsiveness to customers. Their use is also requiring novel internal organization and market linkages between firms.
On the way to understand biological complexity in plants: S-nutrition as a case study for systems biology
Authors: Hesse Holger , Hoefgen Rainer
Published: June 2006

The establishment of technologies for high-throughput DNA sequencing (genomics), gene expression (transcriptomics), metabolite and ion analysis (metabolomics/ionomics) and protein analysis (proteomics) carries with it the challenge of processing and interpreting the accumulating data sets. Publicly accessible databases and newly development and adapted bioinformatic tools are employed to mine this data in order to filter relevant correlations and create models describing physiological states. These data allow the reconstruction of networks of interactions of the various cellular components as enzyme activities and complexes, gene expression, metabolite pools or pathway flux modes. Especially when merging information from transcriptomics, metabolomics and proteomics into consistent models, it will be possible to describe and predict the behaviour of biological systems, for example with respect to endogenous or environmental changes. However, to capture the interactions of network elements requires measurements under a variety of conditions to generate or refine existing models. The ultimate goal of systems biology is to understand the molecular principles governing plant responses and consistently explain plant physiology.
Orphan nuclear hormone receptor NR4A1 interacts with HPV16 E2 regulatory protein
Authors: Olejnik-Schmidt Agnieszka , Schmidt Marcin , Goździcka-Józefiak Anna
Published: June 2006

The human NR4A1 orphan receptor is a member of the TR3 steroid receptor superfamily, which binds DNA at the NBRE and NurRE responsive elements. The TR3 receptors are involved in the regulation of differentiation, proliferation and apoptosis. We report that NR4A1 interacts with human papillomavirus type 16 (HPV16) E2 protein — a key papillomavirus regulatory factor. This interaction might be involved in the transcription regulation of the HPV16 genes and the regulation of infected cell homeostasis.
The breakdown of bilayer lipid membranes by dendrimers
Authors: Shcharbin Dzmitry , Drapeza Alexander , Loban Valeri , Lisichenok Alexej , Bryszewska Maria
Published: June 2006

The BLM-system for studying the electrophysical properties of bilayer lipid membranes (BLM) was applied to investigate interactions between polyamidoamine (PAMAM) dendrimers and lipid bilayers. The cationic PAMAM G5 dendrimer effectively disrupted planar phosphatidylcholine membranes, while the hydroxyl PAMAM-OH G5 and carboxyl PAMAM G4.5 dendrimers had no significant effect on them.
Self-Determination for Individuals with the Most Severe Disabilities: Moving beyond Chimera
Authors: Brown Fredda , Gothelf Carole R. , Guess Doug , Lehr Donna H.
Published: June 2006

Individuals with the most severe disabilities may be unsuccessful in effecting changes in their environment for various reasons. Because of limitations in cognitive and expressive language skills, their attempts at communicating may be overlooked or misunderstood, or may be knowingly or inadvertently obstructed. Consequently, self-determination is often dependent on our interpretation of what people with the most severe disabilities are communicating. This article explores the implications of making interpretations, the need for such interpretations, and the dangers. Current progress in supporting and promoting self-determination are acknowledged. It is suggested that although these procedures may be intended to increase self-determination, they do not automatically do so. In fact, they may function to limit self-determination. Strategies and methodologies must be critically evaluated to ensure that such efforts reflect the tenets and spirit of self-determination.
A Comparison of Supported Work versus Center-Based Program Services on Selected Outcomes for Individuals with Multiple Severe Disabilities
Authors: Reid Dennis H. , Green Carolyn W. , Parsons Marsha B.
Published: June 2006

The effects of supported work versus center-based program services were evaluated with four individuals who have multiple severe disabilities. Each week the individuals participated in supported work placements in a publishing company and in a center-based program within an adult education department at a residential center. Systematic observations were conducted in multielement fashion of the degree to which the individuals displayed alert and active behavior, were involved in purposeful activity, and exhibited indices of happiness in both programs. Results indicated that most individuals displayed more alert and active behavior and were involved in more purposeful activity during supported work than during the center-based program. Two of the individuals also displayed more indices of happiness during supported work, whereas two individuals showed no consistent differences in happiness indices across the two types of programs. Possible reasons for the beneficial effects of supported work are discussed, with an emphasis on potentially different expectations for the participants and staff in supported work versus center-based services, as well as differences in the proficiency with which staff performed their duties. Areas for future research are offered to provide more detailed determinations of the relative benefits of supported work for people with multiple severe disabilities.
Building a Future: A Study of Student Participation in Person-Centered Planning
Authors: Whitney-Thomas Jean , Shaw Deirdre , Honey Katherine , Butterworth John
Published: June 2006

This study used qualitative methodology to understand the participation of young people as they plan for their transition from school to adult life by using a person-centered planning process, specifically Whole Life Planning. Given the dynamic, interpersonal nature of person-centered planning, the study also examined the roles that others play in the process and how facilitators, family members, and other members of the young person's social network influence the focus person's participation. Findings revealed that student participation ranged from highly active to nonexistent across the observed planning meetings. The level of student participation was influenced by the student's conversational style, the size of the meeting, the level of abstraction in the planning discussions, and the expectations and behaviors of others.
“He Can't Really Play”: An Ethnographic Study of Sibling Acceptance and Interaction
Authors: Harry Beth , Day Monimalika , Quist Faustina
Published: June 2006

This article reports the findings of a case study of sibling interaction between a young man with Down syndrome and his three brothers. The case study was conducted as part of a larger study of the social relationships of 10 students with moderate to severe disabilities. Data were collected by ethnographic interviews with family members and key personnel in the student's school and community, and by participant observation of a range of home, school, and community activities. Data from the case study of sibling relationships are compared to data on the target student's interactions with nonfamily peers. Findings indicate that, within the family context, a range of sibling roles and of activities for the target student seemed to compensate for the target student's limited participation in sibling play activities. Outside of the family, the need for peer facilitation and advocacy was essential for the target student to be included successfully. The discussion offers a consideration of how schools can foster a sense of belonging that will encourage peer accommodations without creating unrealistic demands on students, both with and without disabilities.
Integrating Choice-Making Opportunities within Teacher-Assigned Academic Tasks to Facilitate the Performance of Children with Autism
Authors: Moes Doug R.
Published: June 2006

Providing opportunities to make choices has received increasing support as an antecedent intervention to improve the performance of students with disabilities. Additional research in this area is needed to determine under what circumstances the application of choice making as a curricular intervention is appropriate and produces meaningful outcomes. The present study extended this line of research and investigated how providing choice opportunities to children with autism impacted their performance during teacher-assigned homework activities. An ABAB design was utilized to evaluate the effects of choice making (student vs. tutor) on the academic performance of four children with autism. Results showed that providing students with opportunities to make choices regarding the order of task completion and use of stimulus materials improved participants' accuracy, productivity, affect, and reduced their disruptive behaviors. These findings support the use of child choice as a teaching strategy to improve the academic performance of children with autism during curricular activities. The functional properties of choice making and considerations for its use as a curricular-based antecedent intervention are discussed.
Identifying Work Preferences Prior to Supported Work for an Individual with Multiple Severe Disabilities Including Deaf-Blindness
Authors: Parsons Marsha B. , Reid Dennis H. , Green Carolyn W.
Published: June 2006

We evaluated a pre-work assessment for predicting task preferences during supported work with an individual who has profound mental retardation as well as deafness and blindness. The assessment method included specific components for familiarizing an individual with visual and auditory impairment with available work tasks. The individual's task selections were compared for three work tasks drawn from his future job duties. Results of the worker's choices, once he began his supported job in a publishing company, indicated the pre-work assessment predicted tasks that the worker preferred to perform during his routine job. Results are discussed regarding the benefits of determining work preferences prior to beginning supported work. Areas for future research are also noted, focusing on developing additional procedures for matching individuals with deaf-blindness with preferred work activities.
Newborn Infants and the Moral Significance of Intellectual Disabilities
Authors: Vehmas Simo
Published: June 2006

This article presents moral philosophical arguments regarding life-saving medical treatment that may be more available to infants without disabilities than to infants with intellectual disabilities. The ideas are that children with disabilities are a burden to their families and to society and that a happy life may not be attainable for these children and their families. I argue that human well-being is not based merely on individual characteristics, but is a result of the individual's relation to other people. Further, children with disabilities are not inevitably a burden to their families or society. Accordingly, intellectual disability is not a sufficient reason for withholding life-saving treatment.
A Functional Developmental Approach to Autism Spectrum Disorders
Authors: Greenspan Stanley I. , Wieder Serena
Published: June 2006

Historically, severe developmental disabilities, including autism, have been approached from the point of view of presenting symptoms as well as the overall syndrome. Although individual practitioners, such as speech pathologists, occupational and physical therapists, and educators have worked with the child's individual capacities, a developmentally based functional approach has not been sufficiently articulated and systematized to guide assessment, intervention, and research efforts. In this article, we describe a dynamic, developmental model that conceptualizes the child's functional emotional developmental capacities, individual differences in sensory processing and modulation, motor planning and sequencing, as well as child/caregiver and family interaction patterns. Because each child with developmental challenges is unique, the functional developmental approach will capture the child's special strengths and challenges, as well as provide a more comprehensive and individualized framework for clinical work with a child and his or her family.
Paraprofessionals in Job Coach Roles
Authors: Rogan Patricia M. , Held Mary
Published: June 2006

The purpose of this article is to examine issues related to paraprofessionals in job coach roles for students with disabilities. Postschool outcomes of students with disabilities are partially dependent on the nature and quality of supports they receive during this critical time of transition in their lives. Although schools are increasingly relying on paraprofessionals to support students in school and community settings, including workplaces, there is growing concern about their lack of preparation and support. This article describes issues related to recruitment, retention, orientation, and training of paraprofessionals in job coach roles. In addition, roles and responsibilities, supervision, support, evaluation, and compensation issues are discussed in relation to school job coaches. Recommendations for improving practice are offered, which require an investment on the part of schools to ensure the provision of quality services and supports.
The Tip of the Iceberg: Determining Whether Paraprofessional Support is Needed for Students with Disabilities in General Education Settings
Authors: Giangreco Michael F. , Broer Stephen M. , Edelman Susan W.
Published: June 2006

Paraprofessionals represent an important and growing segment of the personnel support used in American schools to provide inclusive educational opportunities to students with disabilities. When and how to utilize paraprofessionals effectively persists as an ongoing challenge in the schools. After presenting selected issues associated with employing paraprofessionals, this article extends the discussion on paraprofessional issues by exploring guidelines to assist teams in making decisions about paraprofessional supports. This includes both considerations for the appropriate use of paraprofessionals when assigned, as well as alternative support solutions. Our discussion is intended to advance dialogue on this important topic and to support the appropriate involvement of paraprofessionals in the education of students with disabilities as valued participants on collaborative teams whose roles are clearly defined and supported.
Reducing Individualized Job Coach Assistance Provided to Persons with Multiple Severe Disabilities in Supported Work
Authors: Parsons Marsha B. , Reid Dennis H. , Green Carolyn W. , Browning Leah B.
Published: June 2006

Although technology exists for supporting people with disabilities in a variety of work situations, demonstrations of the technology's utility generally have not involved individuals with multiple severe disabilities in community jobs. We evaluated a program for reducing job coach assistance provided for three individuals with multiple severe disabilities who worked in a publishing company. Initially, observations were conducted to determine the job steps for which each worker received assistance in terms of a job coach completing aspects of the steps for the worker. Each job step receiving assistance was then reviewed to determine if the assistance could be reduced by teaching the worker additional skills or by modifying the environment to compensate for physical disabilities. Once the instruction and modifications were initiated, reductions occurred in the amount of work completed by the job coaches for each worker. Work activity and quality continued at a high level for each worker, although productivity decreased. The latter results appeared due to reductions in work completed by job coaches and not to changes in each worker's work rate. Results are discussed regarding the possible impact of reducing job coach assistance on work opportunities for this population of potential workers. Suggestions for future research focus on developing additional means of increasing independence of workers with multiple severe disabilities.
Increasing Early Social-Communicative Skills of Preverbal Preschool Children with Autism through Social Interactive Training
Authors: Hwang Bogseon , Hughes Carolyn
Published: June 2006

We evaluated the effects of a social interactive training program on early social-communicative skills (i.e., eye contact, joint attention, motor imitation) of three preverbal preschool children with autism. Training was conducted in the children's classroom during naturally occurring daily activities. Findings indicated that implementation of social interactive training components (i.e., contingent imitation, use of naturally occurring reinforcement, expectant look, environmental arrangement) was associated with increases in target behaviors across participants. In addition, generalization of eye contact and motor imitation behavior were found across an additional setting and different interactive partners, although joint attention rarely generalized. Social validation measures provided by 30 raters indicated that perceived positive changes in performance had occurred in child behaviors and that training procedures were considered acceptable. Results are discussed in terms of implications for research and practice.
Valued Member or Tolerated Participant: Parents' Experiences in Inclusive Early Childhood Settings
Authors: Soodak Leslie C. , Erwin Elizabeth J.
Published: June 2006

The present qualitative investigation explored the perspectives of parents of young children with severe disabilities to understand the factors that shape their participation in their child's inclusive education. Ten parents of children in early childhood inclusive settings were interviewed. A conceptual framework of factors that influence parent participation was developed based on the themes that emerged from the data. Findings indicated that parent participation is influenced by a number of factors, including the school's beliefs about inclusion, receptivity to parents, and willingness to change. Parent-professional partnerships were facilitated by trust, shared philosophies about children and schooling, and open communication. Achieving effective parent-professional partnerships in inclusive settings appears to be a complex process that involves commitment and understanding. Most importantly, the findings suggest that meaningful participation for children as well as parents is an important and necessary component of inclusive education.
Portraits of Three Adolescent Students with Asperger's Syndrome: Personal Stories and How They Can Inform Practice
Authors: Marks Susan Unok , Schrader Carl , Longaker Trish , Levine Mark
Published: June 2006

This article presents three portraits of adolescent students with Asperger's syndrome. These portraits include descriptive details about these students as young children, their schooling experiences, their interests, and their social life experiences. To construct these portraits, we conducted a series of focus groups with professionals who provide direct services to these students. We also conducted interviews with the students and parents. The purpose of these three portraits is to serve as a starting point for those in the field to further examine possible solutions for better meeting the needs of these students. The role of these portraits (or personal stories) in helping to inform critical areas of need and important directions for meeting the needs of adolescent students with Asperger's syndrome conclude our article.
Comparison of the Instructional Contexts of Students with Severe Disabilities and Their Peers in General Education Classes
Authors: McDonnell John , Thorson Nadine , McQuivey Camille
Published: June 2006

This study examined the instructional contexts of six students with severe disabilities and six peers without disabilities enrolled in the same general education classes. The two groups of students were compared on (a) the extent to which they were the exclusive focus of instruction; (b) the amount of one-to-one, small group, and whole group instruction that they received and the amount of independent work they were asked to complete; (c) who delivered instruction; and (d) the types of instructional interactions that were directed toward them. Data were collected using The Code for Instructional Structure and Academic Response — Mainstream Version (MS-CISSAR; Carta, Greenwood, Schwartz & Miller, 1990). The results indicate that students with severe disabilities were much more likely than their typically developing peers to have instruction focused exclusively on them and to receive one-to-one instruction. The results are discussed in terms of the implications for educational programs for this group of students and future research.
Challenges Facing Institutions of Higher Education Preparing Inclusive Educators
Authors: Smith Anne
Published: June 2006

Our schools will need to hire more than two million teachers in the next decade for classrooms that already face shortages of qualified teachers, particularly in high-poverty communities. Many districts hire teachers on substandard licenses. New teachers often enter classrooms underprepared for the challenges they will face and are given insufficient support in their first years. For teachers in the classrooms, opportunities to strengthen their skills and knowledge remain largely disjointed, unfocused, and unconnected to classroom practice. (Riley, 2000, p. iii).
Teaching Communication Book Use to a High School Student Using a Milieu Approach
Authors: Rodi Michael S. , Hughes Carolyn
Published: June 2006

This study combined communication book training, a milieu approach (Warren & Kaiser, 1986), and systematic vocabulary selection to teach a nonspeaking adolescent to communicate in three settings. Specifically, we conducted a systematic replication of Hamilton and Snell's (1993) instructional procedures to teach a high school student from a Spanish-speaking home to use a communication book to initiate conversation and respond to teachers, peers, and work supervisors. The student had mental retardation and was deaf and nonverbal Results indicated rapid learning of communication book use in two settings (i.e., meal preparation and employment training) and more delayed increases in a third setting (i.e., small group communication). Based on these findings, we make suggestions for future research and practice.
Community Placement for Persons with Significant Cognitive Challenges: An Outcome Analysis
Authors: Spreat Scott , Conroy James W.
Published: June 2006

Outcome indices were compared across groups of individuals who either remained in institutional settings or transferred from an institutional setting to various community living arrangements. All individuals included in the analysis had been labeled as having profound mental retardation. The community group exceeded or matched institution groups with respect to service hours, community integration, and adaptive behavior. Greater productivity, in terms of vocational activity, was noted in the two institution settings. Persons in the community had slightly greater difficulty in obtaining medical services. Nonmedical unmet needs were greater in the community programs.
Mexican Immigrant Families' Beliefs and Goals for Their Infants in the Neonatal Intensive Care Unit
Authors: Denney Maria K. , Singer George H. S. , Singer Joanne , Brenner Mary E. , Okamoto Yukari , Fredeen Rosy M.
Published: June 2006

This article presents a study of Mexican immigrant families' beliefs and goals about caregiving and development for their infants with prematurity, low birth weight, and/or intensive health care needs, as well as their experiences with neonatal intensive care services. Interviews with six families were conducted primarily in Spanish, transcribed, and analyzed in a structured procedure following one major tradition of qualitative research. The study revealed that the Mexican immigrant families had distinct caregiving beliefs for their infants, and certain hospital practices were different from their beliefs and customs. Communication and cultural barriers were identified stressors for families in the neonatal intensive care unit. Extended family members were described as a valuable source of support and information about health and infant caregiving practices. Implications for neonatal intensive care service delivery and suggestions for further research are discussed.
Differences between High School Students Who Do and Do Not Volunteer to Participate in a Peer Interaction Program
Authors: Carter Erik W. , Hughes Carolyn , Copeland Susan R. , Breen Catherine
Published: June 2006

We examined the differences between two groups of general education high school students: Those who volunteered to participate in a peer buddy program designed to increase their social interactions with their peers with severe disabilities ( n = 30), and those who chose not to volunteer ( n = 30). Differences were examined using the Social Distance Questionnaire for Attitudes of High School Students Toward Handicapped Persons. Analyses indicated that, at pre-test, peer buddies reported significantly greater willingness to interact with people with severe disabilities and more previous contact with these individuals than did nonvolunteers. There were no differences between the scores of the groups on knowledge of disability or affect toward persons with disabilities. After one semester of enrollment in the program, social willingness, knowledge, and contact scores of peer buddies increased significantly, whereas the scores of nonvolunteers remained the same as at the pre-test. In addition, students' self-reported previous contact with individuals with disabilities positively correlated with their scores indicating their social willingness to interact with their peers with disabilities. Implications of the study are discussed with respect to benefits of and recommendations for peer interaction programs.
A Deweyan Perspective on Democracy and Inquiry in the Field of Special Education
Authors: Danforth Scot
Published: June 2006

On what basis do special educators working in the area of severe disabilities make decisions? This article provides an exploration of the practice of social inquiry in professional work that draws from the democratic ethics of John Dewey. Dewey emphasizes the need for knowledge to contribute to the daily challenge of fostering equality in human interactions and relationships. His philosophy supports the free development of many forms of social inquiry and the cultivation of a pluralistic dialogue valuing diverse perspectives. This article concludes with a description of advisory work within the self-advocacy movement as an example of Deweyan democracy in action.