[A special type of psychic infantilism---disability to manage daily life in coexistence with special talent (author's transl)].
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Adult↗
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Social Security's special minimum benefit.
Social Security's special minimum primary insurance amount (PIA) provision was enacted in 1972 to increase the adequacy of benefits for regular long-term, low-earning covered workers and their dependents or survivors. At the time, Social Security also had a regular minimum benefit provision for persons with low lifetime average earnings and their families. Concerns were rising that the low lifetime average earnings of many regular minimum beneficiaries resulted from sporadic attachment to the covered workforce rather than from low wages. The special minimum benefit was seen as a way to reward regular, low-earning workers without providing the windfalls that would have resulted from raising the regular minimum benefit to a much higher level. The regular minimum benefit was subsequently eliminated for workers reaching age 62, becoming disabled, or dying after 1981. Under current law, the special minimum benefit will phase out over time, although it is not clear from the legislative history that this was Congress's explicit intent. The phaseout results from two factors: (1) special minimum benefits are paid only if they are higher than benefits payable under the regular PIA formula, and (2) the value of the regular PIA formula, which is indexed to wages before benefit eligibility, has increased faster than that of the special minimum PIA, which is indexed to inflation. Under the Social Security Trustees' 2000 intermediate assumptions, the special minimum benefit will cease to be payable to retired workers attaining eligibility in 2013 and later. Their benefits will always be larger under the regular benefit formula. As policymakers consider Social Security solvency initiatives--particularly proposals that would reduce benefits or introduce investment risk--interest may increase in restoring some type of special minimum benefit as a targeted protection for long-term low earners. Two of the three reform proposals offered by the President's Commission to Strengthen Social Security would modify and strengthen the current-law special minimum benefit. Interest in the special minimum benefit may also increase because of labor force participation and marital trends that suggest that enhancing workers' benefits may be a more effective means of reducing older women's poverty rates than enhancing spousal or widow's benefits. By understanding the Social Security program's experience with the special minimum benefit, policymakers will be able to better anticipate the effectiveness of other initiatives to enhance benefits for long-term low earners. This article presents the most recent and comprehensive information available about the special minimum benefit in order to help policymakers make informed decisions about the provision's future. Highlights of the current special minimum benefit include the following: Very few persons receive the special minimum benefit. As of December 2001, about 134,000 workers and their dependents and survivors were entitled to a benefit based on the special minimum. Of those, only about 79,000 received a higher total benefit because of the special minimum; the other 55,000 were dually entitled. (In effect, when persons are eligible for more than one type of benefit--that is, they are dually eligible--the highest benefit payable determines total benefits. If the special minimum benefit is not the highest benefit payable, it does not increase total benefits paid.) As of February 2000, retired workers who were special minimum beneficiaries with unreduced benefits and were not dually entitled were receiving, on average, a monthly benefit of $510 per month. That amount is approximately $2,000 less than the annual poverty threshold for an aged individual. Special minimum benefits provide small increases in total benefits. For special minimum beneficiaries who were not dually entitled as of December 2001, the average special minimum monthly PIA was just $39 higher than the regular PIA. Most special minimum beneficiaries are female retired workers. About 90 percent of special minimum beneficiaries are retired workers, and 77 percent of those retired workers are women. The special minimum benefit has never provided poverty-level benefits. Maximum payable special minimum benefits (unreduced for early retirement) equal 85 percent of the poverty level for aged persons, down from 96 percent at the provision's inception. Major public policy considerations raised by this analysis include the following: Social Security benefits alone do not protect all long-term low earners from poverty. Low earners with 30 years of earnings equal to the annual full-time minimum wage who retired in selected years from 1982 to 2000 received benefits that were 3.9 percent to 20.1 percent below the poverty threshold, depending on the year they retired. For 40-year earners, the range was 3.9 percent to 15.3 percent below poverty. Furthermore, in 1993, 29.2 percent of retired-worker beneficiaries who were poor had 30 or more years of coverage. The size of the universe of persistently low earners with significant attachment to the covered workforce is unknown. Available research that examines two 28-month periods suggests that only 4 percent to 6 percent of full-time, full-period earners had below-minimum wages for more than 12 consecutive months. Targeting enhanced benefits only toward long-term, regular workers who are low earners is difficult under the current Social Security program. All else being equal, if total wage-indexed lifetime covered earnings are the same for both a full-career low earner and for a high earner who has worked only occasionally, then their Social Security benefits will be identical. Social Security has no information on number of hours worked, hourly wages, or other information that could distinguish between two such persons.
Humans↗
[A study of children with special needs in mainstream schools and the role of nursing teachers].
OBJECTIVE: Principals of elementary schools and classroom teachers of classes for children with special needs were surveyed by questionnaire to identify the features of children with special needs in mainstream schools and the role of nursing teachers. METHODS: Subjects in Y prefecture were asked to consider several items including the following: 1) presence in class of children with special needs; 2) presence of a child with special needs who was a target of a class or a school for children with special needs; 3) presence of education for special needs experience; 4) obstacles that such children face; 5) the relation with a nursing teacher from June to August in 1998. RESULTS: 1. There was no class for children with special needs in 87 among 135 schools. Children with special needs were present in 27 out of 87 schools, and the frequency of children with special needs was about 0.3% in mainsteam classes. 2. The total number of children in classes for special needs was 177 including 142 (79.8%) with intellectual disabilities, 77 (43.3%) with complex disabilities and 61 (34.3%) requiring medical care. 3. Ninety percent of teachers of special needs classes asked a school nurse about health care for special needs and how to cope with matters relating to disabilities. 4. Ninety percent of teachers of special needs classes were concerned about matters such as the method of teaching and coping with matters relating to disabilities. CONCLUSION: The survey found that there are children with special needs in mainstream classes. The situation with the disabilities is an appreciable number of complex, so teachers of special needs classes had many concerns. Those teachers are inclined to be isolated in school. To achieve good educational outcomes for children with special needs it is important to develop a systematic network between school and experts such as medical doctors and educational professionals. Nursing teachers could play an important role in their relation, with medical specialists.
Child↗
Spontaneous or experimentally induced formation of a special zone in the adrenal cortex of the adult brush-tailed possum (Trichosurus vulpecula).
The cytology and ultrastructure of the hypertrophied special zone, which is formed spontaneously in the adrenal cortex of adult female brush-tailed possums (Trichosurus vulpecula), was compared to the adrenocortical tissue in adult males in which the special zone, normally absent, was induced following castration alone or by additional treatment with follicle-stimulating hormone (FSH). The special zone in females was situated between the zona fasciculata and the zona reticularis, the latter being a rudimentary zone in this species. Special zone tissue extended as a broad band parallel to and on one side of the adrenal medulla. In the luteal phase of the reproductive cycle, the special zone cells showed ultrastructural features commonly associated with steroidogenic tissues, with many mitochondria and compact masses of smooth endoplasmic reticulum. Cytoplasmic lipid inclusions were rarely observed. In lactating females, however, the special zone cells exhibited cytological and ultrastructural features suggestive of a transformation in their morphology broadly divided into two types of cells: (1) cells at the periphery of the special zone (closest to the zona fasciculata) showed variable quantities of lipid inclusions, mitochondria with dispersed cristae, and segregation of the smooth endoplasmic reticulum into compact masses; (2) cells within the more central regions showed an increasing abundance of lipid inclusions which in many cells became the dominant feature of the cytoplasm. These special zone cells contained very little smooth endoplasmic reticulum and their mitochondria contained few cristae together with amorphous granular material within the matrix. In castrated males, special zone tissue developed between the zona fasciculata and the zona reticularis, appearing initially as focal islands of cells (8 months postcastration) and later (11 months postcastration) expanding into a single zone, probably via the proliferation and differentiation of adjacent cells of the zona fasciculata and longitudinal growth of the special zone. Similar focal aggregations of special zone cells were induced after 14 days of FSH treatment given to 2-month castrated males. In all castrated and FSH-treated castrated males, the ultrastructure of special zone cells was similar to that of special zone cells in luteal-phase female possums. The findings suggest that the formation and cellular composition of the special zone is associated with changes in the pituitary-gonadal axis and that FSH plays a primary role in the differentiation of this tissue.
Adrenal Cortex↗
Risk of pregnancy and dropping out of school among special education adolescents.
This study examined the temporal relationship between dropping out of school and teen-age pregnancy, and whether or not teens in special education programs are at greater risk for pregnancy and dropping out than non-special education teens. Cumulative Student Records and case files were reviewed on a random sample of 135 already pregnant girls served by the San Diego Adolescent Pregnancy and Parenting (SANDAPP) program. A comparison was made of ages at time of dropping out and conception of the first live birth between special education and non-special education groups. The overall prevalence of special education teens in the program was compared with the prevalence rate of 10% in the San Diego Unified School District. Results indicated 20% of SANDAPP adolescents were in special education compared to 10% for the overall school district. Special education teens dropped out of school significantly earlier than non-special education teens. No significant evidence supported the hypothesis that teens dropped out of school first, then became pregnant. Nor was there significant evidence to suggest special education teens experience their first live birth at younger ages than their non-special education counterparts. No relationship was found between mean grade point average and age at conception. The researchers concluded that special education teens are at higher risk for pregnancy and dropping out of school than non-special education teens.
Adolescent↗
Special education for students with disabilities: analysis and recommendations.
Twenty years ago, the educational rights of students with disabilities were dramatically and firmly established in law and practice. Prior to that time, many students were refused enrollment or special educational services. As recently as 1973, at least one million students were denied enrollment in public schools solely on the basis of their disabilities, and at least two million others were not receiving an education appropriate to their needs. Although every state has provided some form of special education throughout this century, these services were largely at the discretion of local school districts. Only since a federal court case in 1972 and the passage of federal legislation in 1975 have all states been mandated to provide a free, appropriate public education to all students with disabilities. Today, as Parrish and Chambers point out in this journal issue, special education for students with disabilities is the largest categorical program in public schools, costing an estimated $32 billion. Since the passage of Public Law 94-142 in 1975 (later retitled the Individuals with Disabilities Education Act, or the IDEA), the number of elementary and secondary students receiving special education has increased from 3.7 million to 4.6 million, increasing also from 8% to 11% of all students in public schools. According to Parrish and Chambers, the population of students eligible for special education is expected to continue to rise. The IDEA governs the educational rights of individuals from birth to age 21, though only students in elementary and secondary school are addressed in this journal issue. The IDEA allowed access to the public schools for many students who had previously been denied enrollment. The IDEA has also been given partial credit for decreasing the rate of institutionalization of individuals with disabilities. Before the IDEA, many parents had the sole responsibility of meeting all the needs of their severely disabled children 24 hours per day; once schools began to provide extensive services to students with severe disabilities, more families were able to avoid institutionalization. Under the IDEA, states and local districts were given a mandate to provide specialized educational programs to students with special needs, and students and parents were given a mechanism for enforcement of their rights. In a 1989 survey, 94% of parents of students with disabilities agreed that services for these students had improved since the implementation of the IDEA. Yet special education today is widely criticized as expensive, ineffective, inadequately coordinated with regular education, and/or culturally biased. The National Association of State Boards of Education has recommended radical reduction in the size of special education. Special education also has its champions, who argue that many students perform better academically and have better self-esteem when provided with special services, often in a separate setting. This analysis addresses five questions concerning special education under the IDEA: (1) Why are so many students considered disabled? (2) What are the educational needs of students with disabilities? (3) How should appropriate, individualized services be funded? (4) Are the IDEA's procedural protections necessary? (5) Can regular education meet the needs of more students?
Adolescent↗
A profile of recyclers making special trips to recycle.
The aims of the research were to: (1) establish a profile of 'special recyclers', i.e. those who make special trips by car to recycle their household waste; and (2) establish whether the environmental burden resulting from their activities presents a significant environmental problem than needs pro-active management. The research was undertaken through surveys of recyclers at supermarket recycling centres and at civic amenity sites in Glasgow and across Ayrshire in south-west Scotland. Twenty-two percent of civic amenity recyclers made special trips to recycle, whilst at supermarkets less than 10% made special journeys. Those making special journeys tended to make shorter journeys than those combining recycling with another activity. Special recyclers also tended, on average, to recycle more items and bring greater weights of recyclable material per trip. No demographic difference was found between the special recyclers and the 'non-specials'. The environmental impact of consumer journeys to recycle was estimated from the statistic: 'The total distance travelled by car by special recyclers/the total weight deposited by all recyclers'. For the sites of this survey, this statistic ranged in value from 9 km tonne-1 to 106 km tonne-1. The lowest impacts of 9 km tonne-1 were at a supermarket site in a small town with a predominantly local catchment. The highest impacts were at a civic amenity site, in a major town, also used by residents from satellite communities. Over 50% of special recyclers cited nearness as their prime reason for choosing a particular site, compared with 32% of non-specials. Although special recyclers in Ayrshire did appear to act reasonably responsibly (environmentally), their activities produced additional environmental burden. Simulation studies demonstrate that up to 34% reduction in this burden may be possible through encouraging longer intervals between recycling trips. Three quarters of the environmental burden was attributable to less than 5% of the overall recycling population.
Attitude↗
Sertoli cell ectoplasmic specializations: a type of actin-associated adhesion junction?
In this paper we provide evidence that ectoplasmic specializations are a form of intercellular adhesion junction. Ectoplasmic specializations, found at basal junctions between adjacent Sertoli cells and at sites of adhesion between Sertoli cells and germ cells, consist of actin filament bundles sandwiched between the plasma membrane and a cistern of endoplasmic reticulum. The actin filaments in each bundle are unipolar and are hexagonally packed. The bundles are coupled to the adjacent membranes and to each other. Because ectoplasmic specializations are associated with junctional sites, they may play a role in intercellular adhesion. In this study, we report a procedure for obtaining samples enriched for ectoplasmic specializations and identify polypeptides that may be associated with ectoplasmic specializations. On SDS-polyacrylamide gels, an 83K (K = 10(3) Mr) polypeptide is specific to the ectoplasmic specialization-enriched sample, suggesting that it may be a component of ectoplasmic specializations. Other polypeptides at 38, 53, 56 and 69K also may be associated with ectoplasmic specializations. Immunoblots further indicate that fimbrin and vinculin are present in the ectoplasmic specialization-enriched fraction. In addition, immunofluorescence indicates that vinculin is associated with spermatid-Sertoli cell and Sertoli-Sertoli cell junctions. We suspect that fimbrin, an actin-bundling protein, may be involved in cross-linking the hexagonally packed actin filaments in ectoplasmic specializations while vinculin may be associated with actin-membrane linkages. If so, ectoplasmic specializations may be a new class of actin-associated junctional site. Moreover, the presence of vinculin in testicular fractions enriched for ectoplasmic specializations and at junctional sites supports the view that these structures may play a role in intercellular adhesion, possibly by stabilizing an adhesive membrane domain.
Actins↗
The prevalence and clinical characteristics of short segments of specialized intestinal metaplasia in the distal esophagus on routine endoscopy.
OBJECTIVE: To prospectively determine the prevalence and clinical characteristics of short segments of specialized intestinal metaplasia in the distal esophagus. Short segment is defined as extending less than 2 cm proximal to the esophagogastric junction. This has been referred to by some investigators as "short segment Barrett's esophagus." METHODS: One hundred and seventy two patients undergoing elective esophagogastroduodenoscopy were consecutively enrolled. Patients with known Barrett's esophagus were excluded. All study patients completed a symptom questionnaire. At endoscopy, the presence of esophagitis and locations of the diaphragmatic hiatus, esophagogastric junction, and the squamocolumnar junction were recorded. Biopsy specimens were obtained at the squamocolumnar junction to identify specialized intestinal metaplasia and 2 cm above the squamocolumnar junction to evaluate for histological esophagitis. RESULTS: Two patients (1.2%) had at least 2 cm of columnar-lined esophagus. Of the 170 patients without 2 cm of columnar-lined esophagus, 16 (9.4%) patients had short segments of specialized intestinal metaplasia. Twelve (7.0%) of these patients had specialized intestinal metaplasia limited to the esophagogastric junction. All patients with specialized intestinal metaplasia were Caucasian, and there was a slight male predominance. Patients without specialized intestinal metaplasia (n = 154, 90.6%) did not differ statistically with respect to age, gender, use of acid-suppressing drugs, alcohol, or smoking history. Pyrosis and regurgitation were significantly more common in patients with specialized intestinal metaplasia involving the distal 2 cm of the esophagus or the esophagogastric junction. Cough was more common in the group with specialized intestinal metaplasia limited to the esophagogastric junction. The groups were similar in frequency of dysphagia, globus sensation, nocturnal pyrosis, eructation, early satiety, nausea, and abdominal pain. CONCLUSIONS: Specialized intestinal metaplasia less than 2 cm proximal to the esophagogastric junction is common in Caucasian patients undergoing routine esophagogastroduodenoscopy. Pyrosis and regurgitation are significantly more common in patients with short segments of specialized intestinal metaplasia, whether involving the distal 2 cm of the esophagus or the esophagogastric junction alone. Alcohol and tobacco use are no more common in patients with specialized intestinal metaplasia than in those without metaplasia. The presence of specialized intestinal metaplasia did not correlate with either endoscopic or histological esophagitis.
Age Distribution↗
Congruity of acetylcholine receptor, acetylcholinesterase, and Dolichos biflorus lectin binding glycoprotein in postsynaptic-like sarcolemmal specializations in noninnervated regenerating rat muscles.
Noninnervated regenerating muscles are able to form focal postsynaptic-like sarcolemmal specializations either in places of the former motor endplates ("junctional" specializations) or elsewhere along the muscle fibers (extrajunctional specializations). The triple labeling histochemical method was introduced to analyse the congruity of focalization in such specializations of 3 synaptic components: acetylcholinesterase (AChE), acetylcholine receptor (AChR), and a specific synaptic glycoprotein which binds Dolichos biflorus lectin (DBAR). Noninnervated regenerating soleus and extensor digitorum longus (EDL) muscles of the rat were examined and compared with denervated muscles of neonatal and adult rats. All junctional sarcolemmal specializations in noninnervated regenerating muscles accumulated AChE and AChR. Localization of the 2 components was identical within the limits of resolution of the method. DBAR could not be demonstrated in junctional specializations in 17-day-old regenerating muscles. It seems that an agrin-like inducing substance in the former junctional basal lamina invariably triggers the accumulation of both AChE and AChR in the underlying sarcolemma of the regenerating muscle fiber. However, accumulation of DBAR would probably require the presence of the motor nerve. In most of the extrajunctional sarcolemmal specializations in 8-day-old regenerating soleus and EDL muscles, both AChE and AChR accumulated. However, about 10 percent of AChE accumulations lacked AChR and about 35% of AChR accumulations lacked AChE. Even greater variability was observed in 17-day-old regenerating muscles. The presence of DBAR in the extrajunctional postsynaptic-like sarcolemmal specializations could not be demonstrated. Similar extrajunctional sarcolemmal specializations were observed in denervated postnatal rat muscles. About 70% contained both AChE and AChR, and 30% contained only AChR, but none contained DBAR. In denervated mature muscles, sparse extrajunctional AChR accumulations did not contain detectable amounts of AChE. The ability to form complex postsynaptic-like sarcolemmal specializations in the absence of nerve, which is probably inherent to noninnervated immature muscle fibers, may be reduced with muscle maturation. Variable accumulation of individual components in the postsynaptic-like specializations indicates that different triggering factors may be involved in their accumulation or, at least, the mechanisms of their accumulation can function relatively independently.
Acetylcholinesterase↗
Bullying and peer victimization among children with special health care needs.
BACKGROUND: Dr Van Cleave's current address is Department of Pediatrics, Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, 50 Staniford St, Room 901, Boston, MA 02114. The association between bullying, being bullied, or being a bully/victim and having a special health care need has not been well described in a national sample of children with a broad variety of special needs. OBJECTIVE: We aimed to determine the prevalence of bullying, being bullied, or being a bully/victim in children with special health care needs and associations of behaviors with particular types of special needs. DESIGN: We performed a secondary data analysis using the National Survey of Children's Health, a nationally representative telephone survey conducted by the National Center for Health Statistics of >102,000 US households. METHODS: We measured associations between having a special health care need and being a victim of bullying, bullying other children, and being a bully/victim in children and adolescents aged 6 to 17 years. Multiple logistic-regression models were used to examine the association of children with special health care needs overall, and of particular special needs, with the bullying measures. RESULTS: Overall, children with special health care needs were 21% of the population. In multivariate models adjusting for sociodemographic factors, being a child with special health care needs was associated with being bullied but not with bullying or being a bully/victim. Having a chronic behavioral, emotional, or developmental problem was associated with bullying others and with being a bully/victim. CONCLUSIONS: Having a special health care need generally is associated with being bullied, and having a behavioral, emotional, or developmental problem is associated with bullying others and being a bully/victim. These findings may help pediatricians, mental health providers, and schools use targeted screening and interventions to address bullying for children with special health care needs.
Adolescent↗
Children with special health care needs enrolled in the State Children's Health Insurance Program (SCHIP): patient characteristics and health care needs.
BACKGROUND: Children with special health care needs (CSHCN) often require more extensive services than children without special needs. The State Children's Health Insurance Program (SCHIP) in many states typically provides less extensive benefits and services than do state Medicaid programs. To design SCHIP to address the needs of CSHCN adequately, it is important to measure the degree to which children who enroll in SCHIP have special health care needs and to assess their health status and unmet health care needs. Little is known about the characteristics or preenrollment experience of CSHCN who enroll in SCHIP. OBJECTIVES: To use data from the Child Health Insurance Research Initiative to measure the prevalence of CSHCN in SCHIP in 4 states, describe their demographic and health care features at enrollment, and compare their sociodemographic characteristics, health status, prior health care experiences, and unmet needs versus children without special health care needs. METHODS: Children (0-18 years old) newly enrolled in SCHIP in 4 states were eligible for the study: New York, Florida (adolescents only), Kansas, and Indiana (CSHCN only). Telephone interviews were conducted shortly after enrollment and identified CSHCN by using the Child and Adolescent Health Measurement Initiative CSHCN screener. A common set of core questions assessed demographic characteristics, health status, special health care need status, insurance experience, access, use, quality of health care, and unmet needs during the year before enrollment. Bivariate and multivariate analyses were used to compare characteristics of CSHCN with characteristics of children without special needs. RESULTS: Interviews were completed for parents of 5296 children enrolled in SCHIP in the 4 states. By using the Child and Adolescent Health Measurement Initiative CSHCN screener, the prevalence of CSHCN among SCHIP enrollees was 17% (New York), 18% (Florida), and 25% (Kansas), higher than the prevalence of CSHCN reported in the general population in those states. More than half of CSHCN reported the use of a chronic medication. Demographic characteristics of CSHCN were similar to those of children without special needs, although CSHCN were more likely to reside in single-parent households. Although CSHCN had poorer health status than children without special needs, many CSHCN were reported to be in good health, suggesting a wide spectrum of severity of illnesses within the CSHCN group. Although CSHCN were more likely than children without special needs to have been insured before SCHIP, a large proportion of CSHCN were nevertheless uninsured for at least 12 months before SCHIP (New York, 56%; Florida, 68%; Kansas, 24%; Indiana, 25%). Although most SCHIP enrollees had a usual source of care (USC) before SCHIP and there was some variation across states, between 4% and 13% of CSHCN lacked a USC on enrollment, and 23% to 38% of CSHCN changed their USC after enrollment in SCHIP. The majority of all SCHIP enrollees (including CSHCN) had used some health care during the year before SCHIP including preventive, acute, or specialty care. A high proportion of all SCHIP enrollees, including >30% to 40% of CSHCN, were reported to have unmet health care needs at enrollment in SCHIP. A variety of unmet needs were reported by CSHCN including specialty care, mental health care, dental care, and prescription medications. Nevertheless, the vast majority of CSHCN as well as children without special needs rated the quality of their medical care before SCHIP highly on several specific quality measures. Findings from multivariate analyses were similar to bivariate results with CSHCN in several states having higher use of care and more unmet health care needs before enrollment. CONCLUSIONS: SCHIP is enrolling many CSHCN, with the prevalence of these children occurring at least as high as the prevalence of CSHCN in the general population. CSHCN enrolled in SCHIP represent a heterogeneous population with a wide range of health status and health care needs. Although most CSHCN were already already connected to the health care system with a USC and prior health care visits, many had unmet health care needs before enrolling in SCHIP. IMPLICATIONS FOR MONITORING AND IMPROVING SCHIP FOR CSHCN ENROLLEES: 1) SCHIP benefit packages need to adequately cover services required by CSHCN such as prescription medications and specialty, mental health, developmental, and home services; 2) because utilization of care will be high among this large group of children, alternative methods of financing and managing care should be considered such as risk adjustment and special programs that involve case management and care coordination; 3) coordination of care across programs (such as between SCHIP and the state Title V Maternal and Child Health Services program, a component of which serves CSHCN) and ensuring adequate access to primary care and specialty providers might improve access to services for CSHCN; and 4) it is critical to monitor the quality of care for CSHCN enrolled in SCHIP, because these children are among the most vulnerable children covered by public health insurance programs and many of them are enrolling in SCHIP.
Adolescent↗
Physiotherapy specialization in Canada: an update.
Because of a perceived need for specialization within the profession, the Canadian Physiotherapy Association (CPA) accepted the concept of specialization for physiotherapists, during its Annual General Meeting (AGM) in June 1985. A proposal concerning the implementation of specialization (termed the "Specialization Document"), will be presented to the 1986 AGM for approval by the Association's voting delegates. This paper provides a brief outline of the document's contents, including: the structure of the proposed Canadian College of Physiotherapy, which will oversee the certification process; the role of the CPA Divisions in establishing specialty councils; and the mechanism whereby certification will be granted, touching on such factors as eligibility for certification, evaluation of competence, recertification, and cost. The specialization document makes provision, in the initial stages of specialization, for an Implementation Committee, whose task will be to define the criteria necessary for the establishment of the College's standards for specialization and certification. Specialization does not mean that all therapists must become certified specialists; certification will neither prohibit nonspecialists from practising in a specified area nor relegate certified specialists to practising only in special areas in which they are certified. The CPA Board of Directors supports certification because it is designed to promote the highest quality of health care by physiotherapists, while promoting the growth of physiotherapy theory and practice through a critical evaluation of current and potential treatment methodology. Because of the many steps necessary for a careful and logical development of the specialization methodology, it is expected that final approval of the certification process will require many years to achieve.
Canada↗
Evidence that vinculin is co-distributed with actin bundles in ectoplasmic ("junctional") specializations of mammalian Sertoli cells.
Ectoplasmic specializations of Sertoli cells are actin containing structures found at sites of attachment to spermatids and to neighboring Sertoli cells. We suspect that these cytoskeletal structures are a form of actin-associated adhesion junction. If this is true, then molecular components, such as vinculin, that characterize actin-associated adhesion junctions in general should be present in ectoplasmic specializations. In this paper we have used two approaches to verify the prediction that vinculin is a component of ectoplasmic specializations. First, we have used fluorescence microscopy to probe immunologically for vinculin in ectoplasmic specializations associated with spermatids of the ground squirrel. Second, we have used immunogold techniques to probe for vinculin in ectoplasmic specializations of rat testis. Our results indicate that the immunological probe for vinculin was reactive with ectoplasmic specializations. In single label fluorescence experiments, linear patterns obtained with the vinculin probe were similar to those obtained with probes for filamentous actin. In double label experiments, the vinculin probe was co-distributed with the actin probes. In immunogold studies, specific labelling with the probe for vinculin occurred in ectoplasmic specializations both at sites of attachment to spermatids and adjacent to basal Sertoli cell junctions. Moreover, gold particles were concentrated adjacent to filament bundles within each ectoplasmic specialization. Our results support the conclusion that vinculin is present in ectoplasmic specializations. Further, they indicate that vinculin is co-distributed with actin bundles within each ectoplasmic specialization.
Actins↗
Sound recognition and localization in man: specialized cortical networks and effects of acute circumscribed lesions.
Functional imaging studies have shown that information relevant to sound recognition and sound localization are processed in anatomically distinct cortical networks. We have investigated the functional organization of these specialized networks by evaluating acute effects of circumscribed hemispheric lesions. Thirty patients with a primary unilateral hemispheric lesion, 15 with right-hemispheric damage (RHD) and 15 with left-hemispheric damage (LHD), were evaluated for their capacity to recognise environmental sounds, to localize sounds in space and to perceive sound motion. One patient with RHD and 2 with LHD had a selective deficit in sound recognition; 3 with RHD a selective deficit in sound localization; 2 with LHD a selective deficit in sound motion perception; 4 with RHD and 3 with LHD a combined deficit of sound localization and motion perception; 2 with RHD and 1 with LHD a combined deficit of sound recognition and motion perception; and 1 with LHD a combined deficit of sound recognition, localization and motion perception. Five patients with RHD and 6 with LHD had normal performance in all three domains. Deficient performance in sound recognition, sound localization and/or sound motion perception was always associated with a lesion that involved the shared auditory structures and the specialized What and/or Where networks, while normal performance was associated with lesions within or outside these territories. Thus, damage to regions known to be involved in auditory processing in normal subjects is necessary, but not sufficient for a deficit to occur. Lesions of a specialized network was not always associated with the corresponding deficit. Conversely, specific deficits tended not be associated predominantly with lesions of the corresponding network; e.g. deficits in auditory spatial tasks were observed in patients whose lesions involved to a larger extent the shared auditory structures and the specialized What network than the specialized Where network, and deficits in sound recognition in patients whose lesions involved mostly the shared auditory structures and to a varying degree the specialized What network. The human auditory cortex consists of functionally defined auditory areas, whose intrinsic organization is currently not understood. In particular, areas involved in the What and Where pathways can be conceived as: (1) specialized regions, in which lesions cause dysfunction limited to the damaged part; observed deficits should be then related to the specialization of the damaged region and their magnitude to the extent of the damage; or (2) specialized networks, in which lesions cause dysfunction that may spread over the two specialized networks; observed deficits may then not be related to the damaged region and their magnitude not proportional to the extent of the damage. Our results support strongly the network hypothesis.
Acute Disease↗
Surface specializations of neurites in embryonic mouse spinal cord.
Focal surface specializations occur upon axons, axon growth cone filopodia and, somewhat less frequently, upon dendrites as well as dendritic growth cones in embryonic mouse spinal cord. These surface specializations are observed during the early synaptogenic period (embryonic days 12-16) when the axons of the marginal zone are forming synaptic junctions with motor neuron dendrites growing into their domain. At relatively low electron microscopic magnifications, the specializations appear as discrete patches of electron-dense material located just outside the plasma membrane. Higher resolution and an optimum section plane reveal the following ultrastructural characteristics of these specializations. There is a narrow (approximately 5 nm) less dense layer between the outer surface of the plasms membrane and the thicker (approximately 11.5-15 nm) electron-dense, distal layer of the specializations. The dense layer contains spherical profiles (approximately 10-15 nm in diameter) which have relatively clear centers and non-laminar, opaque perimeters. The surface specializations are commonly associated with an accumulation of dense, fibrillar cytoplasmic material that undercoats the cytoplasmic surface of the plasma membrance directly opposite to the external specializations. Furthermore, some of these surface specializations appear to be forming or merging with the cleft material of protosynaptic junctions and primitive puncta adhaerentia-like contacts. We have also examined the pattern of concanavalin A-peroxidase staining on the cell surfaces in embryonic spinal cord. At embryonic day 13, the earliest stage examined in the concanavalin A-peroxidase experiments, there is already an ubiquitous staining around all the cellular processes in the marginal zone as well as around the perikarya and processes of cells located in the intermediate and ventricular zones. No selective enhancement of neurite surfaces occurred which might have correlated with the surface specializations described above. Finally, the possibility is discussed that the neurite surface specializations might play some role in intercellular recognition phenomena leading to the formation of synaptic junctions and puncta adhaerentia.
Age Factors↗
Evaluation of a general practitioner with special interest service for dermatology: randomised controlled trial.
OBJECTIVE: To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a hospital dermatology clinic. DESIGN: Randomised controlled trial. SETTING: General practitioner with special interest dermatology service and hospital dermatology clinic. PARTICIPANTS: Adults referred to a hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest. INTERVENTIONS: Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual hospital outpatient care. MAIN OUTCOME MEASURES: Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment. RESULTS: 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to hospital outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service. CONCLUSIONS: The general practitioner with special interest service for dermatology was more accessible and preferred by patients than hospital outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
Adolescent↗
Allied health deans' and program directors' perspectives of specialized accreditation effectiveness and reform.
Criticisms, calls for change, and recommendations for specialized accreditation improvement have been made by individuals or groups external to the daily operations of allied health educational programs, frequently as opinion pieces or articles lacking a research foundation. While there is a great deal of concern related to specialized accreditation, little input has been provided from those within, and integral to, allied health educational programs affected by specialized accreditation standards. The purpose of this study was to explore the perspectives of selected allied health deans and program directors regarding specialized accreditation effectiveness and reform. Survey research was used to study perspectives of allied health deans and program directors located in four-year colleges and universities and in academic health centers and medical schools. Surveys were mailed to program directors offering-programs in clinical laboratory sciences and medical technology, nuclear medicine technology, occupational therapy, physical therapy, radiation therapy, and radiography. Simultaneously, allied health deans located within these institutions were surveyed. A total of 773 surveys were mailed and 424 valid responses were received, yielding a response rate of 55%. The results affirmed the role of accreditation as an effective system for assuring quality in higher education. The role of specialized accreditation in improving the quality of allied health programs was clearly articulated by the respondents. Respondents voiced strong opposition to governmental or state-level requirements for accountability and emphasized the vital role of peer evaluators. Significant differences in deans' and program directors' perspectives related to specialized accreditation were evident. Whereas deans and program directors agreed with the purposes of specialized accreditation, they expressed less support for the process and effectiveness, and critique and reform, of specialized accreditation. Within those categories, deans were in greater support of critique and reform efforts related to specialized accreditation, while program directors were more supportive of the purpose, process, and effectiveness of specialized accreditation.
Accreditation↗