bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the Presence of a Dementia Special Care Unit Improve Nursing Home Quality?
Authors: Gruneir Andrea , Lapane Kate L. , Miller Susan C. , Mor Vincent
Published: September 2008

Objective: This study quantifies the effect of a new dementia special care unit (D-SCU) on the provision of care to all residents in a nursing home (NH). Method: The authors use data from the On-line Survey Certification and Reporting system to identify free-standing NHs that first reported a D-SCU between 1996 and 2003 ( N = 1,519). Fixed-effects models estimate the effect of a new D-SCU on the prevalence of each outcome (physical restraints, feeding tubes, and psychotropic medications) while controlling for secular trends. Results: For all NHs, the use of physical restraints declined, the use of antipsychotics increased, and other measures remained relatively constant. The introduction of a D-SCU was not associated with changes in trends for any measure. Discussion: Differences in care processes between NHs with and without D-SCUs are the result of differences in their underlying approach to care, not the result of care practice diffusion from the D-SCU.
School Experiences of Families of Children With Brain Tumors
Authors: Bruce Beth S. , Chapman Ann , MacDonald Allison , Newcombe Janice
Published: September 2008

Families and children often report a diverse range of academic achievements and challenges after undergoing treatment for a brain tumor. This study explores the experiences of children, youth, and their families as they seek to reintegrate into mainstream educational systems. Despite the variable experiences, there are many common strategies that could positively influence the child's success in school. Strong communication between parents, school, and health professionals is paramount. Preparing parents to advocate for their children's academic and social needs and developing an awareness of the challenges among school staff has potential to improve outcomes for these children. Equipping the children with the social skills needed to manage social situations will strengthen their ability to overcome the challenges that they face. These study findings shed light on the academic experiences of these children and can lead to the development of strategies to support families facing similar challenges.
Living Jazz, Learning Jazz
Authors: Custodero Lori A.
Published: September 2008

In this article, jazz music is used as a lens through which early childhood music pedagogy is viewed, specifically thinking about swing and improvisation—the listening and responding to what is heard and seen, and the openness to possibility. These two concepts are defined by prominent jazz musicians and are traced in the child development literature as inherent ways of relating both to both music and others. Practice that involves finding innovative and mutually supportive ways to share musical space creates opportunities for collective growth; attending to the spaces between thematic, predetermined structures creates opportunities to observe and engage with spontaneous moments of musical innovation. Such an approach to teaching and learning suggests a theoretical framework attuned to the connections between jazz and childhood development that translates to artistically authentic classroom strategies relevant to students. Direct and indirect implications are offered.
End-of-Life Care Curricula in Undergraduate Medical Education: A Comparison of Allopathic and Osteopathic Medical Schools
Authors: Rothman Margaret D. , Gugliucci Marilyn R.
Published: September 2008

End-of-life care curricula in osteopathic medical schools were compared with allopathic school offerings. An 8-question online survey of undergraduate medical education administrators at all United States osteopathic medical schools (n = 26) and 26 allopathic schools geographically closest to them was conducted in 2007. Responses from 80% (n = 21) of osteopathic schools and 77% (n = 20) of allopathic schools revealed that both osteopathic and allopathic medical schools offered end-of-life care education. Of note is that 71% of the osteopathic medical school respondents had a course that concentrates on end-of-life care compared with 37% of allopathic school respondents ( P = .03). This disparity in percentages may be due to a number of reasons, 2 of which may include course identification methods and the primary care orientation and philosophy inherent in osteopathic medical schools.
Uncovering Beliefs and Barriers: Staff Attitudes Related to Advance Directives
Authors: Bergman-Evans Brenda , Kuhnel Leslie , McNitt Denise , Myers Suzanne
Published: September 2008

Although the 1990 Patient Self-determination Act was enacted to insure that patients' wishes regarding advance directives were known and respected, it has had little impact in quality or aggressiveness of care for patients nearing death. The purpose of this descriptive study was to explore staff attitudes related to Advance Directives. A short survey was distributed to 650 hospital, home care, hospice, assisted living, and long term professional and staff members. Analysis was completed on 413 surveys (return rate 63.3%). Findings suggest that although staff members believe that Advance Directives are an important tool, they have found both logistical and process challenges to following them. The results provide needed information for improving processes for completion and utilization of Advance Directives.
Pain Management Practices by Internal Medicine Residents—A Comparison Before and After Educational and Institutional Interventions
Authors: Scott Emma , Borate Uma , Heitner Stephen , Chaitowitz Mark , Tester William , Eiger Glenn
Published: September 2008

We aimed to improve internal medicine residents' deficiencies in pain management and evaluate the effectiveness of our intervention, which included an interactive conference series, e-mail vignettes, and didactic sessions. An anonymous survey was administered at the beginning and at the end of an academic year, before and after the intervention, respectively. We analyzed 65 preintervention and 63 postintervention surveys. Self-perception of competency in pain management increased from 40% to 60% (P = .02). Perception of adequacy of training increased from 38.5% to 55.6% (P = .05). Opioid conversion skills improved by 25% (P = .02). Overall, knowledge did not change significantly, except in the subgroup of residents who had completed the oncology rotation from 0.60 to 0.72 (P = .003). ``Opiophobia'' improved by 20% (P = .05). Documentation of pain improved (rank correlation = 21; P = .02). We concluded that educational and institutional interventions administered over an academic year improved pain management skills and documentation and reduced ``opiophobia'' among residents.
Comorbidities in a Cancer Patient: Problems in Pain Management and Palliation
Authors: Das Subir C. , Khurana Himanshu , Gupta Deepak , Mishra Seema , Bhatnagar Sushma
Published: September 2008

Pain management and palliation face a great challenge with inclusion of the palliation teams from the earliest phases of diagnosis. The presented case report highlights that early inclusion of pain and palliative physicians in patient care demands comprehensive evaluation of the symptoms by the palliative physicians with possibly curable comorbid conditions requiring active and aggressive curative management. In summary, it is crucial for the treating palliative physician to be more proactive in the management of comorbid treatable conditions in a patient who may be an established case of advanced stage cancer.
The Early Start Denver Model
Authors: Vismara Laurie A. , Rogers Sally J.
Published: September 2008

Intervention was implemented with an infant identified at 9 months of age with a behavioral profile consistent with autistic spectrum disorder. The intervention approach, the Early Start Denver model, consisted of a 12-week, 1.5-hr-per-week individualized parent–child education program. Results of this case study demonstrated that the parent acquired multiple teaching tactics that were associated with growth in the infant's social communication behaviors. Improvements were also noted with respect to the severity of behavioral indicators related to autism between 18 and 24 months of age. Findings are discussed in relation to providing an intervention model that may equip parents with the necessary intervention skills to engage, communicate with, and teach their very young children with or at risk for autism.
Are All Precincts Created Equal?
Authors: Barreto Matt A. , Cohen-Marks Mara , Woods Nathan D.
Published: September 2008

More than forty years after passage of the 1965 Voting Rights Act, a fundamental question remains unanswered: although all citizens have an equal right to the ballot, do all citizens enjoy equal access to the ballot box? That is, are voting precincts in predominantly low-income and non-white neighborhoods less visible, less stable, harder to find, and harder to navigate than voting precincts in high-income and predominantly white neighborhoods? If so, does the lower quality result in lower levels of voting, all other things equal? The authors’ analysis indicates that the quality of polling places varies across the diverse neighborhoods of Los Angeles and that the quality of polling places influences voter turnout. Low-income and minority communities tended to have “lower quality” precincts, which tended to depress voter turnout.
Performance Matters
Authors: Miller-Day Michelle
Published: September 2008

After being told in an end-of-year job review that performances are not considered valuable research outcomes, the author argues in this essay that performance matters. This essay makes a case for recognizing performance ethnographies as research, pedagogy, and active service and concludes with guidelines for performance ethnographers who are participating in action research.
Boom, Bust, and Regional Growth Rates
Authors: Spelman William
Published: September 2008

If the primary effect of economic volatility is on consumption—requiring consumers to smooth over the rough spots—recent studies have shown that the business cycle has relatively little effect on consumer welfare. However, the primary effect of volatility may not be on consumption but on investment and productivity. If investors shift their money from volatile cities and times to stable ones, or if productivity depends on predictable demand and a stable work-force, volatility may hinder urban growth. Analysis of annual growth rates in U.S. metropolitan areas shows that short-term volatility reduced growth substantially and that these effects were larger in cities with high long-term volatility. In most metropolitan areas, volatility reduction and growth enhancement efforts would provide roughly equal improvements in consumer utility.
Test-Retest Reliability of a Theory of Mind Task Battery for Children With Autism Spectrum Disorders
Authors: Hutchins Tiffany L. , Prelock Patricia A. , Chace Wendy
Published: September 2008

This study examined for the first time the test-retest reliability of theory-of-mind tasks when administered to children with Autism Spectrum Disorders (ASD). A total of 16 questions within 9 tasks targeting a range of content and complexity were administered at 2 times to 17 children with ASD. In all, 13 questions demonstrated adequate test-retest reliability and high internal consistency. Items that did not achieve reliability violated a pragmatic convention, were ambiguous, or were associated with a response bias. No effect of verbal ability or diagnosis was found on consistency of performance. There was no effect of interval (i.e., short vs. long) on change in score although modest increases in performance occurred generally across administrations. Implications for research and practice are considered.
Redistributive Effect of U.S. Taxes and Public Transfers, 1994-2004
Authors: Kim Kinam , Lambert Peter J.
Published: September 2008

In this study, the authors derive measures of the redistributive effect of taxes and welfare expenditures for the United States using Current Population Survey data for the years 1994, 1999, and 2004. The authors find that while income inequality increased, the redistributive effect of taxes and public transfers together reduced market income inequality by approximately 30 percent. In 2004, 88 percent of the net redistributive effect resulted from public transfers and 12 percent from taxes. The total redistributive effect would have improved by 35 percent in 2004 if horizontal inequities in taxes and public transfers could have been eliminated.
Prospects for Group Processes and Intergroup Relations Research: A Review of 70 Years' Progress
Authors: Randsley de Moura Georgina , Leader Tirza , Pelletier Joseph , Abrams Dominic
Published: September 2008

Three archival analyses are presented substantially extending empirical reviews of the progress of group-related research. First, an analysis of social psychological research from 1935 to 2007 (cf. Abrams & Hogg, 1998) showed that group-related research has a steadily increasing proportion of titles in the principal journals and currently accounts for over a sixth of all the research in our list of social psychological journals. Second, analysis of the most cited papers from a set of principal social psychology journals from 1998 to 2007 showed that a third of high-impact articles in social psychology focus on groups. Third, analysis of the content of two major specialist journals in the field, Group Processes & Intergroup Relations and Group Dynamics: Theory, Research, and Practice, showed that together these journals cover a broad range of group-related research, and that the only keyword common to both journals was social identity. These findings demonstrate the health and major contributions of research into group processes and intergroup relations to social psychology as a whole.
Interethnic Interactions: Expectancies, Emotions, and Behavioral Intentions
Authors: Ashby Plant E. , Butz David A. , Tartakovsky Margarita
Published: September 2008

Two studies examine Hispanic and non-Hispanic White people's responses to interethnic interactions. Consistent with previous findings regarding White/Black interactions, participants who had negative expectations about intergroup interactions reported more anger and anxiety about interethnic interactions. These negative emotional responses, in turn, were associated with negative behavioral intentions such as the desire to avoid interethnic interactions and the externalization of blame if an interethnic interaction did not go well. Across the studies, White participants who were angry about interethnic interactions wanted to avoid these interactions, whereas anxiety was the key predictor of avoidance for the Hispanic participants. Results are discussed in terms of their implications for developing models of intergroup interactions and designing approaches to improve these interactions.
Mistletoe in Conventional Oncological Practice: Exemplary Cases
Authors: Legnani Walter
Published: September 2008

Mistletoe therapy, a cancer treatment suggested by Rudolf Steiner in 1920, is a typical and specific anthroposophic therapy, but could become more important today in the field of mainstream medicine. This article analyzes some of the most typical effects of mistletoe therapy based on the experience of more than 100 cases. A few patients were chosen who appear exemplary of the opportunities offered by mistletoe therapy. Their clinical history demonstrates an improvement in clinical condition and performance status, better quality of life, improved psychological status, reduction of infective events, better tolerance of concomitant chemoradiotherapy, and even a direct reduction of tumor size. The conclusion is that the patients may be indicative for future prospective clinical studies designed to confirm a real efficacy of mistletoe in cancer therapy.
Granulosa Cell Tumor of the Ovary: Tumor Review
Authors: Koukourakis Georgios V. , Kouloulias Vasilios E. , Koukourakis Michael J. , Zacharias Georgios A. , Papadimitriou Christos , Mystakidou Kyriaki , Pistevou-Gompaki Kyriaki , Kouvaris John , Gouliamos Athanasios
Published: September 2008

Granulosa cell tumors of the ovary are rare neoplasms that originate from sex-cord stromal cells. The long natural history of granulosa cell tumors and their tendency to recur years after the initial diagnosis are the most prominent of their characteristics. The secretion of estradiol is the reason for signs at presentation such as vaginal bleeding and precocious puberty. Abdominal pain and hemoperitoneum, which occasionally can occur, are attributable to tumor rupture. The most common finding in pelvic examination is a tumor mass, which is subsequently confirmed with imaging techniques. Surgery is the mainstay of initial management for histological diagnosis, appropriate staging, and debulking. A more conservative unilateral salpingo-oophorectomy is indicated in patients with stage I disease and patients of reproductive age. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is the appropriate surgical treatment for postmenopausal women and those with more advanced disease. The stage of disease is the most important prognostic factor associated with the risk of relapse. There are no clear conclusions regarding the role of postoperative chemotherapy or radiotherapy in stage I disease and in those with completely resected tumor. The use of adjuvant chemotherapy or radiotherapy has sometimes been associated with prolonged disease-free survival and possibly overall survival. Chemotherapy is the treatment of choice for patients with advanced, recurrent, or metastatic disease, and BEP (bleomycin, etoposide, and cisplatin) is the preferred regimen. Although the overall rate of response to treatment is high, the impact of treatment on disease-free or overall survival is unknown. Prolonged surveillance is mandatory because tumors tend to recur years after the initial diagnosis.
Role of Religiosity and Spirituality in Complementary and Alternative Medicine Use Among Cancer Survivors in California
Authors: Hsiao An-Fu , Wong Mitchell D. , Miller Melissa F. , Ambs Anita H. , Goldstein Michael S. , Smith Ashley , Ballard-Barbash Rachel , Becerra Lida S. , Cheng Eric M. , Wenger Neil S.
Published: September 2008

Objectives. Cancer survivors often turn to religion, spirituality, and complementary and alternative medicine (CAM) because they perceive these areas as being more holistic and patient-centered than conventional medicine. Because increased religiosity and spirituality have been found to be associated with higher CAM use in the general population, it was hypothesized that these factors would be important predictors of CAM use in cancer survivors. Design and Subjects. The study included a subsample of 1844 people with cancer or a history of cancer from the 2003 California Health Interview Survey of CAM, a cross-sectional survey of a population-based sample of adults in California. Prevalence and predictors of religious/spiritual forms of CAM (R/S CAM) and nonreligious/nonspiritual forms of CAM (non-R/S CAM) were compared. Multivariate logistic regression was used to identify the predictors of R/S CAM and non-R/S CAM. Results. Nearly two thirds of participants reported using at least 1 type of R/S CAM, and 85% reported ever using non-R/S CAM. The majority of cancer survivors reported that they were very/moderately religious or spiritual. Both religiosity and spirituality were strongly related to non-R/S CAM use, but in opposite directions. Very or moderately religious cancer survivors were less likely (odds ratio = 0.30; 95% confidence interval, 0.12-0.40) than nonreligious cancer survivors to use non-R/S CAM. In contrast, very or moderately spiritual cancer survivors were more likely (odds ratio = 2.42; 95% confidence interval, 1.16-6.02) than nonspiritual cancer survivors to use non-R/S CAM. Conclusions. The use of R/S CAM and non-R/S CAM is very high in cancer survivors. It may be helpful for clinicians to ascertain their patients' use of these types of CAM to integrate all forms of care used to managing their cancer.
Acute Exercise Protects Against Doxorubicin Cardiotoxicity
Authors: Wonders Karen Y. , Hydock David S. , Schneider Carole M. , Hayward Reid
Published: September 2008

Numerous methods have been used to minimize the cardiotoxic effects of the chemotherapeutic agent doxorubicin (DOX), and most have had limited success. Chronic endurance exercise has been shown to protect against DOX cardiotoxicity, but little is known regarding the effects of acute exercise on DOX-induced cardiac dysfunction. Purpose. The purpose of this study was to determine the effects of a single bout of acute endurance exercise on the cardiac dysfunction associated with DOX treatment. Methods. Male Sprague-Dawley rats either performed an acute exercise bout on a motorized treadmill for 60 minutes at a maximal speed of 25 m/min with a 5% grade (EX) or remained sedentary (SED) 24 hours before receiving either a 15-mg/kg DOX bolus dose or saline (SAL). Cardiac function was then analyzed 5 days post injection using a Langendorff isolated perfused heart model. In addition, myocardial lipid peroxidation was analyzed as an indicator of oxidative stress. Results. Doxorubicin treatment alone (SED+DOX) promoted a significant decline in end-systolic pressure (—35%), left ventricular developed pressure (—59%), and the maximal rate of left ventricular pressure development (—43%) as well as a 45% increase in lipid peroxidation products when compared with SED+SAL ( P < .05). Acute exercise 24 hours before DOX treatment, however, had a cardioprotective effect, as end-systolic pressure, left ventricular developed pressure, and the maximal rate of left ventricular pressure development were significantly higher in EX+DOX compared with SED+DOX ( P < .05) and EX+DOX had similar levels of lipid peroxidation products as SED+SAL Conclusions. An acute exercise bout performed 24 hours before DOX treatment protected against cardiac dysfunction, and this exercise-induced cardioprotection may partly be explained by a reduction in the generation of reactive oxygen species.
Amelioration of Radiation-induced Hematological and Biochemical Alterations by Alstonia scholaris (a Medicinal Plant) Extract
Authors: Gupta Uma , Jahan Swafiya , Chaudhary Ranu , Pradeep Kumar Goyal
Published: September 2008

The radioprotective efficacy of a hydro-alcoholic extracted material from the bark of Alstonia scholaris (ASE) was studied in mice against radiation-induced hematological and biochemical alterations. Swiss albino mice were administered ASE (100 mg/kg body weight/d for 5 consecutive day) orally prior to whole-body gamma irradiation (7.5 Gy). Radiation exposure resulted in a significant decline ( P < .001) in erythrocytes and hemoglobin until the third day, following a gradual recovery (ie, day 7), but these values did not reach normal values during the remainder of the animals' life span. Hematocrit percentage declined significantly ( P < .001) until day 15. In contrast, ASE-pretreated irradiated animals had significantly higher erythrocyte, hematocrit, and hemoglobin values than the irradiated controls. Furthermore, a significant elevation in lipid peroxidation level over normal was recorded in gamma-irradiated mice, whereas this increase was considerably lower in ASE-pretreated animals. Pretreatment with ASE caused a significant increase in glutathione levels in serum as well as in liver in comparison to irradiated animals. This study showed that ASE protects against radiation-induced hematological and biochemical alterations in Swiss albino mice.
Nonadherence Increases the Risk of Hospitalization Among HIV-Infected Antiretroviral Naïve Patients Started on HAART
Authors: Fielden Sarah J. , Rusch Melanie L. A. , Yip Benita , Wood Evan , Shannon Kate , Levy Adrian R. , Montaner Julio S. G. , Hogg Robert S.
Published: September 2008

Background. Since the advent of highly active antiretroviral therapy (HAART), AIDS-related hospitalizations have decreased. The objective of this study was to assess the impact of adherence on hospitalization among antiretroviral-naïve HIV-infected persons initiating HAART. Methods. Analysis was based on a cohort of individuals initiating HAART between 1996 and 2001. The primary outcome was hospitalization for one or more days. Survival methods were used to assess the impact of adherence on hospitalization. Results. Of 1605 eligible participants, 672 (42%) were hospitalized for one or more days after initiating HAART. Median adherence levels were 92 (IQR: 58, 100) and 100 (IQR: 83, 100) among those ever and never hospitalized, respectively. After controlling for confounders, those with <95% adherence had 1.88 times (95% CI: 1.60, 2.21) higher risk for hospitalization. Conclusions. Suboptimal adherence among HIV-infected patients taking HAART predicts hospitalization. Identifying and addressing factors contributing to poor adherence early in treatment could improve patient care and lower hospitalization costs.
Hyper Interleukin-10 in an HIV-Positive Child With T-Cell Lymphoma and Candidal Sepsis
Authors: Lighter Jennifer , Tse Doris B. , Kaul Aditya , Borkowsky William
Published: September 2008

We describe a case in which a human immunodeficiency virus (HIV)-positive child presented in severe metabolic acidosis secondary to his candidal sepsis and T-cell lymphoma, a rare finding in pediatric AIDS. Significantly elevated levels of Interleukin-10 (IL-10) were found in the patient's serum, which may have played a role in acute demise.
Lateral Trunk Displacement and Stability During Sit-to-Stand Transfer in Relation to Foot Placement in Patients With Hemiparesis
Authors: Duclos Cyril , Nadeau Sylvie , Lecours Julie
Published: September 2008

Background. In hemiparetic individuals, sit-to-stand (STS) transfer is characterized by asymmetric weight-bearing and altered trunk kinematics that can be improved by positioning the affected foot behind the nonaffected one. Objective. To examine the influence of frontal trunk kinematics on medio-lateral displacements of the center of pressure (CP) during STS performed with the feet placed in 2 different positions, as well as relationships between these parameters, medio-lateral stability, and clinical scores of the participants. Methods. Eighteen patients with chronic stroke and 15 control individuals were evaluated during sit-to-stand transfers either in spontaneous foot position or with their affected or dominant foot placed behind, respectively. Medio-lateral CP, pelvis, and shoulder displacement were analyzed using 3D kinematic and kinetic data recordings of the whole task. Motor and sensory impairment, spasticity, muscle strength, and equilibrium were evaluated by standard scales. The possible time during which a participant could prevent a fall (minimal time-to-contact) was used as a stability index. Results. Spontaneously, the deviation of the CP of stroke participants paralleled the tilt of the trunk toward the nonaffected side, as early as the first third of the task. With the affected foot placed behind, trunk position did not differ from those of control participants who executed the transfer spontaneously. Hemiparetic participants were less stable than control participants. Placement of the feet had no significant effect on the stability of either group. Stability was strongly associated with better motor scores on the Chedoke-McMaster Stroke Assessment. Conclusions. In hemiparetic individuals, improving STS symmetry by positioning the affected foot behind the nonaffected one did not decrease medio-lateral stability, which was associated with the level of stroke-related motor impairments.
Design for the Everest Randomized Trial of Cortical Stimulation and Rehabilitation for Arm Function Following Stroke
Authors: Harvey Richard L. , Winstein Carolee J. ,   for the Everest Trial Group
Published: September 2008

Background. Cortical stimulation (CS) combined with rehabilitation may improve upper limb motor function after stroke. Objective. Describe the study design for the Everest Clinical Trial, a randomized single-blinded pivotal device trial, testing safety and efficacy of epidural CS delivered during rehabilitation for upper limb motor function in patients with ischemic stroke. Method . A total of 174 participants from 21 centers with hemiplegia at least 4 months after acute ischemic stroke are randomized in a 2:1 ratio to investigational or control groups. Investigational patients undergo implantation of cortical electrode and pulse generator and receive 6 weeks of upper limb rehabilitation with subthreshold CS delivered only during therapy. Control group patients receive the same therapy without device implantation or stimulation. Primary outcome measures include the upper extremity Fugl-Meyer (UEFM) score and the arm motor ability test (AMAT) measured at baseline and 1, 4, 12, and 24 weeks following rehabilitation treatment with primary endpoint at 4 weeks following treatment. A successful outcome is defined as an improvement in UEFM of at least 4.5 points and in AMAT of at least 0.21 points from baseline to primary endpoint. A 20% better success rate between investigational and control groups will be considered clinically meaningful. Adverse events occurring during the study will be identified. Results. Not applicable. Conclusions . The Everest Clinical Trial is the first randomized pivotal trial on the safety and efficacy of direct CS delivered during rehabilitation for recovery of upper limb motor function in patients with ischemic stroke.
A Novel Functional Electrical Stimulation Treatment for Recovery of Hand Function in Hemiplegia: 12-Week Pilot Study
Authors: Knutson Jayme S. , Hisel Terri Z. , Harley Mary Y. , Chae John
Published: September 2008

Background. Loss of finger extension is common after stroke and can severely limit hand function. Contralaterally controlled functional electrical stimulation (CCFES) is a new treatment aimed at restoring volitional finger and thumb extension. A previous pilot study showed reductions in hand impairment after 6 weeks of CCFES, but the effect did not persist after end of treatment. Objective. This study aimed to evaluate the feasibility of achieving greater and more persistent gains with CCFES by increasing the treatment period to 12 weeks. Methods. CCFES uses neuromuscular electrical stimulation to open the paretic hand in direct proportion to the degree of volitional opening of the unimpaired contralateral hand, which is detected by an instrumented glove. Three subjects with chronic hemiplegia participated in a 12-week CCFES treatment, which consisted of daily CCFES-assisted active repetitive hand-opening exercises and twice weekly functional task practice with CCFES. Results. Maximum voluntary finger extension increased by 101° and 68° for subjects 1 and 2, respectively, but subject 3 had no improvement in finger extension. Box and Block score increased by 6, 15, and 7 blocks, and upper extremity Fugl-Meyer score increased by 11, 15, and 7 points for subjects 1, 2, and 3, respectively. The finger extension gains declined at the 1-month and 3-month follow-up for subjects 1 and 2, but the gains in Box and Block and Fugl-Meyer scores persisted at follow-up. Conclusions. Greater reductions in hand impairment were achieved by extending the treatment period. The effect and its longevity may be related to baseline impairment level.
Success with Men's Educational Group Appointments (MEGA): Subjective Improvements in Patient Education
Authors: Campbell Bruce B. , Shah Sunny , Gosselin Daniel
Published: September 2008

Men have a higher age-adjusted death rate from many of the leading causes of death, compared with women. Avoidance of health care and unhealthy behavior contribute to premature death among men. The Lahey Clinic recently initiated a program, the Men's Educational Group Appointment (MEGA), which capitalizes on the potential benefits of group dynamics in an effort to educate men about preventative health. We hypothesized that putting men into a group setting for the educational portion of the visit would improve information exchange and patient learning. During 12 months, 261 men between the ages of 22 and 67 were evaluated. A survey designed to address both patient satisfaction and patients' perceptions regarding how much they learned was administered to all patients following the MEGA session. We identified high patient satisfaction with the MEGA model. This study illustrates the potential utility of the group model for improving patient education regarding health maintenance among men.
Medical Treatment for Men Who Have Sex With Men and Are Living With HIV/AIDS
Authors: Beckerman Adela , Fontana Leonard
Published: September 2008

This study focuses on a sample of men who have sex with men (MSM) living with HIV/AIDS in a south Florida community. The study uses a mixed-method, quantitative, and qualitative research design. The purpose of the study was to identify individual and service system characteristics that impact access, retention, and adherence to an HIV/AIDS medical treatment regimen. The study identified many men who were not likely to seek treatment after their initial HIV/AIDS diagnosis. Compared with the general population living with HIV/AIDS in the same south Florida community many of these men were less likely to maintain a regimen of medical care for their HIV/AIDS. The study indicated that the following issues affected medical treatment and treatment adherence: treatment readiness, presence of support networks, availability of “MSM-friendly” health providers, and the cultural competency of substance abuse providers.
Instructional Leadership for Quality Learning
Authors: Pansiri Nkobi Owen
Published: September 2008

A descriptive study using questionnaires was conducted in 2004 to assess the effectiveness of instructional leadership displayed by primary school management teams following the implementation of the Primary School Management Project in Botswana. Leadership skills, Coordination of instructional activities, management of curriculum and quality of learners were key variables that guided the study. Respondents were 240 primary school teachers including school heads and 575 learners. Data were analyzed descriptively through the use of the Statistical Package for Social Sciences (SPSS) program using frequencies and percentages. The results reveal school management teams' lack of interpersonal skills necessary for classroom supervision, inability to mobilize parents to participate in school instructional improvement activities, teachers' unauthorized use of corporal punishment and lack of creativeness and innovativeness for management of curriculum change. Regarding quality of learning, the study identifies learners' inability and lack of freedom for self-expression and inadequate acquisition of basic literacy skill at varying degrees between rural and urban schools.
School Principals' Assumptions about Human Nature
Authors: Sabanci Ali
Published: September 2008

This article considers principals' assumptions about human nature in Turkey and the relationship between the assumptions held and the leadership style adopted in schools. The findings show that school principals hold Y-type assumptions and prefer a relationship-oriented style in their relations with assistant principals. However, both principals and teachers reported that principals hold X- and Y-type assumptions, and prefer a task-oriented leadership style in their relations with teachers. The findings are concordant with the related literature that (1) a manager who holds theory Y assumptions may tend to adopt a `democratic' leadership style, (2) theory X assumptions may lead a manager to adopt an autocratic style and (3) a leader can adopt different types of assumptions and leadership styles.
Manitoba Superintendents
Authors: Crippen Carolyn , Wallin Dawn
Published: September 2008

The role of the school superintendent is complex and challenging. The type of leadership exemplified by school superintendents is crucial to their ability to respond appropriately and adequately to growing diversity issues and economic, social and community influences. Because individuals learn from the styles and/or characteristics of others whom they would like to emulate, this localized qualitative study asked superintendents to elaborate on the nature and characteristics of the people who have most influenced their leadership style. Who were these mentors? What specific characteristics were identified in the mentors? In what ways are these characteristics evident in superintendents' own leadership styles? A critical lens of servant-leadership was used to analyze the information gathered from Manitoba superintendents.
A Comparative Analysis of the Educational Priorities and Capacity of Rural School Districts
Authors: Wallin Dawn
Published: September 2008

This article outlines a comparative analysis of three studies (one provincial, and two school division) that examined the congruence between the priorities of the Manitoba government's Kindergarten to Senior 4 (K-S4) Education Agenda for Student Success and priorities identified by stakeholders in a rural Manitoba (Canada) school division, as well as the capacity of the division to achieve them. Capacity was defined utilizing a model developed out of rural sociology termed entrepreneurial social infrastructure which includes three components for success: (1) Legitimization of Alternatives; (2) Diverse Networks; and (3) Resource Mobilization. The findings of the study suggest that (1) rural areas are dynamic and unique in their economic, social and demographic characteristics, and (2) that theoretical conceptualizations of how rural areas develop and/or thrive have yet to be refined, particularly as they relate to rural education. School reform efforts have a tendency to essentialize schooling across contexts, which provides many challenges to rural school divisions when they do not reflect local purposes, interests and/or capacities. A more localized and responsive conceptualization of school improvement strategies is therefore necessary, as well as research that is tailored to the particular needs of rural communities.
Blue Rubber Bleb Nevus Syndrome
Authors: Having Karen , Bullock Stephani
Published: September 2008

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by the presence of cutaneous and gastrointestinal (GI) hemangiomas. These BRBNS-associated hemangiomas, possibly numbering into the hundreds, may also be identified in multiple visceral locations.

Although the presence of benign cutaneous lesions is of small concern, GI lesions are cause for bleeding. Heavy visceral organ involvement can lead to intravascular coagulation, consumptive coagulathopy, and organ failure. Therefore, GI-related complaints, anemia, the visual identification of a cutaneous blue-colored lesion located on the upper extremity or trunk, and multiple visceral hemangiomas involving a large portion of the organ may indicate the presence of BRBNS. It is important that this unusual combination of patient signs, symptoms, and sonographic findings be presented to the interpreting physician to facilitate inclusion of this rare condition as a possible differential diagnosis to be considered.
A newly identified isoform of Slp2a associates with Rab27a in cytotoxic T cells and participates to cytotoxic granule secretion
Authors: Ménasché Gaël , Ménager Mickaël M. , Lefebvre Juliette M. , Deutsch Einat , Athman Rafika , Lambert Nathalie , Mahlaoui Nizar , Court Magali , Garin Jérôme , Fischer Alain , de Saint Basile Geneviève
Published: September 2008

Cytotoxic T lymphocytes (CTLs) and natural killer cells help control infections and tumors via a killing activity that is mediated by the release of cytotoxic granules. Granule secretion at the synapse formed between the CTL and the target cell leads to apoptosis of the latter. This process involves polarization of the CTL's secretory machinery and cytotoxic granules. The small GTPase Rab27a and the hMunc13-4 protein have been shown to be required for both granule maturation and granule docking and priming at the immunologic synapse. Using a tandem affinity purification technique, we identified a previously unknown hematopoietic form of Slp2a (Slp2a-hem) and determined that it is a specific effector of the active form of Rab27a. This interaction occurs in vivo in primary CTLs. We have shown that (1) Rab27a recruits Slp2a-hem on vesicular structures in peripheral CTLs and (2) following CTL-target cell conjugate formation, the Slp2a-hem/Rab27a complex colocalizes with perforin-containing granules at the immunologic synapse, where it binds to the plasma membrane through its C2 domains. The overexpression of a dominant-negative form of Slp2a-hem markedly impaired exocytosis of cytotoxic granules—indicating that Slp2a is required for cytotoxic granule docking at the immunologic synapse.
Management of acute promyelocytic leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet
Authors: Sanz Miguel A. , Grimwade David , Tallman Martin S. , Lowenberg Bob , Fenaux Pierre , Estey Elihu H. , Naoe Tomoki , Lengfelder Eva , Büchner Thomas , Döhner Hartmut , Burnett Alan K. , Lo-Coco Francesco
Published: September 2008

The introduction of all-trans retinoic acid (ATRA) and, more recently, arsenic trioxide (ATO) into the therapy of acute promyelocytic leukemia (APL) has revolutionized the management and outcome of this disease. Several treatment strategies using these agents, usually in combination with chemotherapy, but also without or with minimal use of cytotoxic agents, have provided excellent therapeutic results. Cure of APL patients, however, is also dependent on peculiar aspects related to the management and supportive measures that are crucial to counteract life-threatening complications associated with the disease biology and molecularly targeted treatment. The European LeukemiaNet recently appointed an international panel of experts to develop evidence- and expert opinion–based guidelines on the diagnosis and management of APL. Together with providing current indications on genetic diagnosis, modern risk-adapted front-line therapy and salvage treatment, the review contains specific recommendations for the identification and management of most important complications such as the bleeding disorder, APL differentiation syndrome, QT prolongation and other ATRA- and ATO-related toxicities, as well as for molecular assessment of response to treatment. Finally, the approach to special situations is also discussed, including management of APL in children, elderly patients, and pregnant women.
Immunotransplantation preferentially expands T-effector cells over T-regulatory cells and cures large lymphoma tumors
Authors: Brody Joshua D. , Goldstein Matthew J. , Czerwinski Debra K. , Levy Ronald
Published: September 2008

Ex vivo–expanded tumor-infiltrating lymphocytes infused into lymphodepleted recipients has clear antitumor efficacy. More practical sources of such antitumor lymphocytes would broaden the application of this approach. Previously, we described an in situ vaccination combining chemotherapy with intratumoral injection of CpG-enriched oligonucleotides, which induced T-cell immunity against established lymphoma. An ongoing clinical trial of this maneuver has demonstrated clinical responses in lymphoma patients. Here, we use this vaccine maneuver to generate immune cells for transfer into irradiated, syngeneic recipients. Transferred tumor-specific T-effector (Teff) cells preferentially expanded, increasing the Teff/T-regulatory (Treg) ratio in these “immunotransplantation” recipients and curing large and metastatic tumors. Donor T cells were necessary for tumor protection, and CD8 T-cell immune responses were enhanced by posttransplantation booster vaccination. Hematopoietic stem cell transplantation is a standard therapy for lymphoma. Therefore, in situ tumor vaccination followed by immunotransplantation of harvested tumor-specific T cells could be directly tested in clinical trials to treat otherwise resistant malignancies.
In vivo proliferation advantage of genetically corrected hematopoietic stem cells in a mouse model of Fanconi anemia FA-D1
Authors: Río Paula , Meza Néstor W. , González-Murillo África , Navarro Susana , Álvarez Lara , Surrallés Jordi , Castella Maria , Guenechea Guillermo , Segovia José C. , Hanenberg Helmut , Bueren Juan A.
Published: September 2008

Fanconi anemia (FA) is an inherited recessive DNA repair disorder mainly characterized by bone marrow failure and cancer predisposition. Studies in mosaic FA patients have shown that reversion of one inherited germ-line mutation resulting in a functional allele in one or a few hematopoietic stem cells (HSCs) can lead to the proliferation advantage of corrected cells, thus over time normalizing the hematologic status of the patient. In contrast to these observations, it is still unclear whether ex vivo genetic correction of FA HSCs also provides a similar proliferation advantage to FA HSCs. Using an FA mouse model with a marked hematopoietic phenotype, the FA-D1 (Brca2Δ27/Δ27) mice, we demonstrate that the lentivirus-mediated gene therapy of FA HSCs results in the progressive expansion of genetically corrected clones in mild-conditioned FA-D1 recipients. Consistent with these data, hematopoietic progenitors from FA recipients progressively became mitomycin C resistant and their chromosomal instability was reverted. No evidence of myelodysplasia, leukemias, or abnormal clonal repopulation was observed at multiple time points in primary or secondary recipients. Our results demonstrate that ectopic expression of BRCA2 confers a beneficial in vivo proliferation advantage to FA-D1 HSCs that enables the full hematopoietic repopulation of FA recipients with genetically corrected cells.
Trisomy 21 enhances human fetal erythro-megakaryocytic development
Authors: Chou Stella T. , Opalinska Joanna B. , Yao Yu , Fernandes Myriam A. , Kalota Anna , Brooks John S. J. , Choi John K. , Gewirtz Alan M. , Danet-Desnoyers Gwenn-ael , Nemiroff Richard L. , Weiss Mitchell J.
Published: September 2008

Children with Down syndrome exhibit 2 related hematopoietic diseases: transient myeloproliferative disorder (TMD) and acute megakaryoblastic leukemia (AMKL). Both exhibit clonal expansion of blasts with biphenotypic erythroid and megakaryocytic features and contain somatic GATA1 mutations. While altered GATA1 inhibits erythro-megakaryocytic development, less is known about how trisomy 21 impacts blood formation, particularly in the human fetus where TMD and AMKL originate. We used in vitro and mouse transplantation assays to study hematopoiesis in trisomy 21 fetal livers with normal GATA1 alleles. Remarkably, trisomy 21 progenitors exhibited enhanced production of erythroid and megakaryocytic cells that proliferated excessively. Our findings indicate that trisomy 21 itself is associated with cell-autonomous expansion of erythro-megakaryocytic progenitors. This may predispose to TMD and AMKL by increasing the pool of cells susceptible to malignant transformation through acquired mutations in GATA1 and other cooperating genes.