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Factors affecting the school placement of children with spina bifida.

Integrating children with disabilities into mainstream schools has been an active policy in Britain since the 1981 Education Act. 26 children with spina bifida, 13 of whom were educated in mainstream schools, and 13 in special schools were assessed to clarify the relative importance of the following factors 1) IQ, 2) Mobility, 3) Hand function, 4) Bladder and bowel function, and 5) Behaviour. A marked difference was found between those attending mainstream and special schools. 11/13 of the former attained scores within the normal range as compared to only 2/13 of the latter. Neither mobility nor hand function alone were found to influence school placement and a marked correlation was found between the two. Whilst those educated in special schools had more marked problems, all children functioned poorly compared with the norms for able-bodied peers. Neither bladder nor bowel incontinence hindered attendance at mainstream school, but faecal soiling was considered the more serious problem. The frequency of behavioural problems showed a similar distribution amongst the two groups. Comments from parents highlighted their reservations about both special and mainstream schooling which indicates the policy for integration needs considerably more commitment from Government and Education Authorities in order to succeed.

Activities of Daily Living

The effects of cooperative and individualistic reward on intrinsic motivation.

The effects of cooperative versus individualistic reward on students' intrinsic motivation were investigated. The controlling aspects of extrinsic reward may be heightened or produce greater ego threat in the individualistic situation when compared with a group situation. We predicted that students in the cooperative social situation would show higher levels of intrinsic motivation. Fifth-grade students from existing cooperative groups were assigned randomly to receive a tangible reward based on either cooperative or individualistic achievement for completing pattern block designs. Cooperation affected intrinsic motivation positively. Students in the cooperative dyad solved the block designs more quickly, interacted positively, and viewed the task as easier than did those in the individualistic situation, and they reported that their peers were helpful. There was little evidence that the controlling functions of reward or ego-threat were factors in producing the outcome. Some evidence supporting the importance of the social nature of cooperation was provided.

Child

That was a good meeting!

Good meetings are rare in many organizations. The purposes of meetings include sharing information, decision making, problem solving, education, planning, evaluation, and peer support. The structure of meetings flows from the basic function(s) of the group. Consideration is given to membership, degree of formality, limits of authority, and responsibility. Suggestions for successful meetings focus on establishing an agenda, sticking to the time schedule, appropriately using visual aids, and doing necessary post-meeting follow-up. Responsible and meaningful participation in the group process is an essential aspect of meeting effectiveness and efficiency. When all the elements are managed skillfully, the meeting can be GREAT.

Audiovisual Aids

A path analysis of an adolescent drinking behavior model derived from problem behavior theory.

The interrelationships between composite variables comprised of demographics, socialization, personality, perceived environment, conventional and problem behaviors, and their combined mediational influences on adolescent drinking behavior are examined. Students randomly sampled from four suburban, metropolitan-area high schools (N = 499) were administered the 250-question Survey of Underage Drinking Styles. All 12 composite variables, derived from the survey, were arranged in a causal model and submitted to a confirmatory path analysis. Data were analyzed by multiple regression procedures. According to the present model, a powerful pathway through to drinking may begin with family interaction problems, which may lead to a reduction in the adolescent's social coping skills. A reduction in the adolescent's coping skills may lead to a compensatory belief that alcohol improves mental and physical functions and an increased affiliation with and acceptance of the peer group's attitude and behavior toward consuming alcohol as a replacement coping skill. The adolescent's drinking may then increase as a result of the affiliative need to conform to peer group pressure.

Adolescent

The sexual differentiation of social play.

Sex differences in social play are quantitative and not qualitative, referring to frequency and not the form of the behaviors. Whereas increased perinatal exposure to exogenous testosterone masculinizes social play, experimental manipulations of androgen levels after this period (i.e. following critical periods for neuronal differentiation) apparently have no effect on the expression of social play. This effect appears to involve, at least in part, androgen receptor occupancy in the amygdala. In the rat, there is a prominent sex difference in nuclear-bound androgen receptors in the amygdala during the sensitive period for the masculinization of play-fighting. Moreover, testosterone implants directly into the amygdala during this period masculinize social play in females. Progesterone exposure reduces play-fighting in male rats, as does corticosterone. This latter effect may be mediated by corticosteroid receptors in the limibic brain. Perinatal androgen exposure may also be important in humans, since girls born with congenital adrenal hyperplasia diagnosed and treated at birth still show male-like patterns of play. Theories concerning the function of sex differences in social play emphasize either the social or motor learning functions. Juvenile male primate social rank correlates with number of peer social interactions, which predominantly take the form of play-fighting. Females on the other hand appear to spend less time play-fighting and spend more time waiting and competing for interactions with infants, i.e. play-mothering, whereby they acquire the motor skills necessary for handling infants. Such differences may reflect socio-biological and developmental cascades that are, in some way, initiated by perinatal hormonal events.

Animals

The effects of peer and parental smoking and age on the smoking careers of college women: a sex-related phenomenon.

In the United States, smoking for women has followed a different pattern for women than for men, and the literature suggests that it, as a 'masculine' behavior, may serve as a role-delineating function for women. This research examines the relationship between sex of smoking parents and peers and the smoking behavior of college women. Having a mother who smokes was significantly related to whether or not the daughter smokes, the age of onset, and the frequency of the daughter's smoking; the proportion of female friends who smoke, to the frequency and amount of the woman's smoking and to the degree of difficulty of quitting. Smoking by the father and male friends was not important. Also, the age of the woman was significantly to whether or not she ever smoked and to the age of onset of smoking. This likely reflects her experience of social norms regarding smoking by women and the publication of the first surgeon general's report on smoking and health. These findings support the notion of smoking as a role-related behavior for women. Further research is needed to extend these findings to men and other health behaviors.

Adult

Shared governance for nursing. Part I: Creating the new organization.

In Part I, the concept of shared governance is presented. I have discussed what it means to move toward a shared governance model and the way of thinking and reorganizing that supports it. Basic principles that drive the concept are discussed, and the underpinnings necessary to make it work are identified. Clearly, the move toward shared governance is not simply an organizational transition. It is a method for transforming the way we work and make decisions. Part II will examine how roles are changed. The management function, the impact of shared governance on its function, and changes in the manager's behavior will be identified. In Part II, the importance of peer processes and supports for ensuring that changes are carried out by staff leadership are discussed. A new way of composing and exercising the executive function in a professional organization also will be discussed.

Hospital Administration

Professional self-regulation: peer review.

Dentistry, in fulfilling its responsibility for self-regulation, has established a highly specific and formalized method of peer review. Its primary purpose is to mediate problems between patients, dentists, and third parties relative to the quality of treatment and appropriateness of care. It is a confidential service provided to the public and profession at no cost and accomplished with the voluntary cooperation of all parties involved. Decisions of peer review committees are advisory in nature but offer an alternative to legal resolution of misunderstandings and problems in patient care. The profession, by continually refining peer review and by educating its members and the public to its function, is providing a unique and valuable service to patients, dentists, and third parties. The objective and consistent application of this self-monitoring process is but one mechanism by which dentistry seeks to serve the public and perpetuate its high standard of care.

Dentists

Whole-cell K+ currents in type II pneumocytes freshly isolated from rat lung: pharmacological evidence for two subpopulations of cells.

The patch clamp technique was used to record whole cell K+ currents in type II pneumocytes freshly isolated from adult rats. Depolarizing voltage steps evoked outward K+ currents which were distinguished into low and high threshold types, only one type being apparent in any one cell. Low-threshold (LT) currents were activated at test potentials of -40 mV to -20 mV and were reduced in amplitude by 20 mM tetraethylammonium (TEA). High-threshold (HT) currents were activated only at test potentials positive to -20 mV and current noise was always greater than for LT currents. HT currents were also significantly more sensitive than were LT currents to block by TEA. Quinine (1 mM) blocked LT currents reversibly at all activating test potentials. HT currents were also reversibly blocked by 1 mM quinine, but in a voltage-dependent manner, the degree of block increasing with increasing test potential. 4-Aminopyridine (2 mM) further distinguished the two current types: it was virtually without effect on HT currents but caused large reductions in LT current amplitudes, apparently by acting on the open channels underlying this current. These data clearly distinguish type II pneumocytes into two subpopulations and suggest that they may play separate roles in the functioning of the intact alveolar epithelium.

4-Aminopyridine

Peer-directed communicative interactions of augmented language learners with mental retardation.

Naturally occurring peer-directed communicative interactions of 13 youth with mental retardation and little or no functional speech who used the System for Augmenting Language (SAL) as their primary means of communication were described. Findings suggest that this system was an integral component of both successful and effective conversations and may be one important means of enhancing social interactions with peer communicative partners who have and do not have mental retardation.

Adolescent

Manuscript peer review at the AJR: facts, figures, and quality assessment.

Concern by the government, funding institutions, and the public for quality assurance in all aspects of medical endeavors mandates critical examination of various professional activities. Although peer review is generally regarded as the best system for selecting and improving scientific papers for publication, the efficacy of this process has never been proved. Moreover, the administrative functions of the editorial staff are often poorly understood. The purpose of this article is to make peer review a the AJR less esoteric and more understandable by quantifying some of its activities. This information is then assessed as it relates to the quality of this important step in scientific publication.

Peer Review, Research

The overtures of preschool social skill intervention agents. Differential rates, forms, and functions.

The purpose of this study was to examine the differential topographies and functions of social behaviors directed by normally developing preschoolers to their playmates with autism. Social interaction data from intervention phases of a study by Kohler, Strain, Hoyson, DeCesare, Donina, and Rapp were analyzed in three different ways. First, the frequency of four behaviors commonly included in social interaction training or assessment procedures (i.e., play organizer suggestions, share offers or requests, assistance offers or requests, and general statements) was examined. Second, the effects of each peer behavior on the immediate response of 3 children with autism were examined. Finally, the impact of each behavior that led to a positive response on the duration of subsequent target child-peer social interactions was examined. The four social behaviors had differential topographical and functional properties. Shares and play organizers occurred most frequently and generated the highest proportion of positive responses from all 3 children with autism. Conversely, assistance offers or requests occurred less often and received a lower percentage of positive responses. However, assistance behaviors consistently led to the longest social interactions. Implications of these results for future social skills training and research are discussed.

Autistic Disorder

The case conference approach to teaching clinical pharmacology.

This article analyzes the development of the small group case conference format, historically, elsewhere, and at the authors' institution, as a way of introducing second-year medical students enrolled in a basic pharmacology course to the practicalities, nuances, and challenges of contemporary drug therapy. A number of goals and purposes for these conferences have been identified and incorporated into the development and execution of a plan carried out over the past 14 years. Two examples of the conferences were presented, including an analysis of their teaching features. A listing of the general topics of 40 individual conferences used by the authors was provided. The authors reviewed evidence based on several methods of evaluation that the conferences are enthusiastically accepted by second-year medical students as an adjunctive approach to teaching both basic and applied clinical pharmacology. In addition, the authors find that the conferences subserve a number of other teaching functions such as problem-solving, information retrieval and presentation, and peer co-instruction. The conferences provide a mechanism for faculty-student interaction and an additional way to evaluate student knowledge and performance beyond the more conventional examination approaches.

Diabetes Mellitus

Communications and aging. A case for understanding African Americans who are elderly.

It is important to recognize that the samples drawn of African American elders in the preceding studies were drawn from nationally represented populations as well as from smaller groups of subjects drawn from specific cities. However, these samples, despite their intragroup regional heterogeneity, share similar cultural experiences that are expressed in the differences found in four significant areas from their white peers. These culturally related differences should not be overlooked in either functional assessment or in rehabilitation strategies nor should these differences remain unrecognized in future research. Wallace and Freeman (1991) go further to say that culturally sensitive approaches to clinical and academic preparation of clinicians, through an infusion approach, are needed to provide information about cultural diversity in adults including health/environmental issues that determine health status and consequences on communication competence in multicultural communities, such as poverty, access to health care, genetics, stress, living environments, and diet. One clear approach to sharpening clinician cultural sensitivity to diversity among people who are elderly is to include aging cultural differences in the speech-language pathology curricula of colleges and universities and to begin to explore these issues more fully in our research and professional forums.

Black or African American

Interpersonal relations during simulated space missions.

The present article derives from two isolation studies performed for the European Space Agency (ESA) as simulations of space travels, lasting for 4 and 9 weeks. The aim was to study how interpersonal relations were affected by time, and how individual characteristics related to conflicts and tension among crewmembers. A broad battery of methods was used, including video-recording, peer-ratings and self-reports. In both studies, group-functioning declined in the middle of the isolation and towards the end of the stay. Dominance and task motivation seemed to be important characteristics for compatibility between crewmembers, and negative relations established early in the isolation remained stable over time. These findings have implications for composition, training, and support of crews for extended spaceflights.

Adult

Pre- and postnatal low-level lead exposure and children's dysfunction in school.

The contributions of pre- and postnatal low-level lead exposures to the risk of learning problems were evaluated among 1923 children who were born in one Boston hospital in 1979-1980 and followed to age 8 years. In this relatively privileged group, more than 20% of the children had a mother with some formal postgraduate education. Prenatal lead exposure was estimated with a measurement of umbilical cord blood lead content, and postnatal lead exposure was approximated with measurement of lead in the dentin of an exfoliated deciduous tooth. Information about potential confounders and effect modifiers was obtained from maternal interview shortly after delivery and from a mailed questionnaire completed and returned when the child was approximately 6 years old. An assessment of each child's function in school was provided by the teacher, who completed a questionnaire near the end of the school year in which the child reached the age of 8 years. We considered a learning problem to be related to lead exposure if its adjusted prevalence increased with each loge increase in lead, and if the adjusted prevalence was elevated among children with high levels (i.e., approximating the highest decile) of umbilical cord blood lead (i.e., > or = 10 micrograms/dl) or dentin lead (i.e., > or = 5 micrograms/g). Girls with elevated umbilical cord blood lead levels were more likely than their peers to be dependent and inpersistent and to display an inflexible and inappropriate approach to tasks (defined as the "tasks" cluster). Boys with elevated umbilical cord blood lead levels were more likely than others to have difficulty with both simple directions and sequences of directions. Among girls, elevated deciduous tooth dentin lead content was associated with reading and spelling difficulties, the tasks cluster, and with "not functioning as well as peers." Elevated dentin lead levels were not overrepresented among boys with any of the assessed learning clusters. These findings are consistent with the inference that lead levels still prevalent among children (i.e., blood < 15 micrograms/dl) are associated with some learning problems in girls.

Child

Long-term quality of life after kidney transplantation in childhood.

Transplantation is the treatment of choice for children with end-stage renal disease. However, the long-term quality of life and socioprofessional outcome for those with successful transplants have not previously been reported. We studied these factors in patients transplanted when less than 18 years old who currently have greater than or equal to 10 years of graft function. A total of 57 questionnaires were sent out; 57 (100%) responded [24 female and 33 male patients; average (+/- SD) age at tx = 10 +/- 5 years (0.9-17.7); average f/u = 15.6 +/- 3 years (10-26); current age = 26 +/- 5 years (12-38); 26 had greater than 1 transplant]. Of the 57 respondents, 9 are less than 18 (all are in school); 48 are greater than or equal to 18 (7 in school, 37 employed, 4 unemployed); 12 are married, 1 engaged, and 2 divorced; and 9 have children. While in school, 43 (75%) had participated in sports, 37 (65%) in other extracurricular activities; 7 (12%) were A and 33 (58%) B students; 15 (26%) received awards or scholarships. For those working, the range of occupations is broad (average work week = 41 +/- 5 hr). Health-related absence from work has been nonexistent for 93%. Health is rated as good to excellent by 91% and fair by 9%. The future is regarded as hopeful or promising by 80%. Similarly, 89% are satisfied with life in general; 95% said health never or seldom interferes with family life; 95% feel health and drug side effects are of no or minor concern in sexual relationships. Only 3% feel health is a problem in maintaining a sexual relationship (41% are not sexually active). Only 4% stated that health often interferes with social life; 98% meet with friends on a regular basis; 76% are satisfied with personal relationships and 8% dissatisfied; 91% are satisfied with their ability to perform at work or school and 5% dissatisfied. Of note, 32% are dissatisfied with body appearance. Major concerns are short stature and brittle bones. Major suggestions include education/support groups to deal with teasing at school and peer problems. We conclude that transplanted children with long-term graft function have a favorable social and professional outcome. Overall, quality of life seems excellent.

Adolescent

Effects of early alcohol use on adolescents' relations with peers and self-esteem: patterns over time.

Strain or problem-solving models posit that deviance persists because it enhances youths' psychosocial properties and is therefore functional for adolescents. However, empirical tests of this assumption have been limited to determining whether a moderately social activity like delinquency produces time-ordered changes in self-esteem. This research examines whether a highly social activity like alcohol use improves adolescents' relations with peers and self-esteem over time. The results of a four-year panel study show that the effects of early alcohol use are limited to enhancing peer relations only among adolescents who use alcohol in order to be part of the group. Early alcohol consumption also has a delayed effect on boosting self-esteem, but this effect is restricted to youths who equate drinking with sophistication. The lack of generality of these findings and how the psychological functions of drinking might cancel these effects are discussed.

Adolescent