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PubMed1999

Drugs, heart failure and quality of life: what are we achieving? What should we be trying to achieve?

This article is a review of chronic compensated congestive heart failure (CHF), with special reference to its clinical features and pathophysiology and recent advances in pharmacotherapy, including beta-blockers, loop diuretics, ACE inhibitors and angiotensin II receptor antagonists. Clinical problems related to elderly patients and multifaceted aspects of multidisciplinary approaches of medical care to these particular patients are also discussed with special emphasis on the aspect of improved quality of life associated with reduced mortality. Concepts of CHF have greatly changed over the past decades with regard to its pathophysiology, natural progression, mechanisms, causes of death, arrhythmias and treatment goals. Although the current most frequent aetiologies of CHF include coronary heart disease and dilated cardiomyopathy, hypertension has been revisited in a different way, and has been considered of pivotal importance in most recent trends and possibly in future perspectives. Nowadays, however, with the results of improved survival, alleviation of symptoms, improvement in functional capacity and prevention of associated complications including even left ventricular remodelling through various appropriate pharmacotherapies, patients with CHF are used to being physically and psychosocially more active than ever before. Thus, improvement of patients' quality of life and reduction of mortality have become of prime importance in achieving treatment goals. Another emerging aspect of CHF is aging itself, and special features in the medical care of elderly patients with CHF always have to be taken into consideration in reduction of hospital readmission along with improvement of morbidity and mortality. Despite advances in the treatment of CHF, it remains a common disease with a poor prognosis. Therefore, this review focuses on what we should be trying to achieve in reaching goals to reduce repeated hospital readmission and mortality, and increase social activity and quality of life, especially in elderly patients with CHF. In these clinical settings, educational strategies for patients and their family members should be emphasised. Multidisciplinary interventions by nurses and possibly other contributions from a widely available social support system might be effective in preventing repeated hospital readmissions of elderly patients with CHF. In this regard, special precautions have to be paid in the management of elderly patients to achieve effective treatment goals, and any treatment strategy has to be appropriately determined through a comprehensive assessment of patient clinical profiles. Multidisciplinary approaches to these problems have to be effectively utilised to improve patients' quality of life, while possibly reducing medical expenses.

Adrenergic beta-Antagonists↗
PubMed1995

Scores of the Wechsler Individual Achievement Test and the Kaufman Test of Educational Achievement-Comprehensive Form for emotionally conflicted adolescents.

Subtest scores on the Wechsler Individual Achievement Test and the Kaufman Test of Educational Achievement-Comprehensive Form were compared for 27 emotionally conflicted adolescents. Correlations between subtests paired for assumed comparability ranged from .79 to .91 (median r = .69), and one of five mean comparisons was significant (Wechsler Mathematics Reasoning > Kaufman Mathematics Applications). The results suggest that these selected Wechsler subtests possess utility for assessing academic achievement and provide an acceptable alternative to the K-TEA.

Adolescent↗
PubMed1991

Relationship between the Kaufman Test of Educational Achievement--Brief Form and the Wide Range Achievement Test--Revised Level 2 with incarcerated juvenile delinquents.

The Kaufman Test of Educational Achievement--Brief Form and the Wide Range Achievement Test--Revised Level 2 were administered in counterbalanced order to 50 male incarcerated juvenile delinquents. The analyses showed the similar subtests on the two tests, i.e., Kaufman Reading test and WRAT-R Reading, were highly correlated. The mean standard scores of th e similar subtests were not significantly different from each other. These results contrast with the significantly lower WRAT-R scores found when scores on the WRAT-R Level 1 are compared with those on the Kaufman test.

Achievement↗
PubMed2000

Diagnosing written language disabilities using the Woodcock-Johnson Tests of Educational Achievement-Revised and the Wechsler Individual Achievement Test.

The writing portions of the Woodcock-Johnson Tests of Educational Achievement-Revised and the Wechsler Individual Achievement Test are often administered when establishing eligibility for special education services due to learning disabilities. The scores on these measures are typically regarded as equivalent although little is known about how scores on the two measures differ for the same students. Differences of only a few points, however, may affect eligibility for special education services. These tests were administered to 25 sixth grade students previously diagnosed with learning disabilities in written expression only. Students' Wechsler scores were consistently higher on the overall writing composite, while there was no difference in the mean scores on the language mechanics subtests. The WIAT Written Expression subtest mean, however, was significantly higher than the Woodcock-Johnson Writing Samples subtest mean. Use of the Wechsler test would be less likely to identify children for special education services in written expression when point discrepancy criteria are utilized for eligibility. Clinicians should be cognizant of the effect of the specific test chosen on eligibility outcome.

Achievement↗
PubMed2006

Effect of individualizing starting doses of a statin according to baseline LDL-cholesterol levels on achieving cholesterol targets: the achieve cholesterol targets fast with atorvastatin stratified titration (ACTFAST) study.

AIMS: To investigate whether selecting the starting dose of atorvastatin according to baseline and target (<2.6 mmol/L) LDL-cholesterol (LDL-C) values would allow high-risk subjects to achieve target LDL-C concentration within 12 weeks, with the initial dose or a single uptitration. METHODS AND RESULTS: Twelve-week, prospective, open-label trial that enrolled 2117 high-risk subjects (statin-free [SF] or statin-treated [ST]). Subjects with LDL-C >2.6 mmol/L (100mg/dL) but <or=5.7 mmol/L (220 mg/dL) were assigned a starting dose of atorvastatin (10, 20, 40 or 80 mg/day) based on LDL-C and status of statin use at baseline, with a single uptitration at 6 weeks, if required. There was no washout for ST subjects. At study end, 80% of SF (82%, 82%, 83% and 72% with 10, 20, 40 and 80 mg, respectively) and 59% of ST (60%, 61% and 51% with 20, 40 and 80 mg, respectively) subjects reached LDL-C target. In the ST group, an additional 21-41% reduction in LDL-C was observed over the statin used at baseline. Atorvastatin was well tolerated. CONCLUSION: This study confirms that individualizing the starting dose of atorvastatin according to baseline and target LDL-C values (i.e. the required LDL-C reduction), allows a large majority of high-risk subjects to achieve target safely, within 12 weeks, with the initial dose or with a single titration.

Aged↗
PubMed2005

Monetary incentives in support of academic achievement: results of a randomized field trial involving high-achieving, low-resource, ethnically diverse urban adolescents.

Significant resources have been directed at understanding and alleviating the achievement gap in education. Most programs focused on this aim rely on a top-down approach, including funding for infrastructure improvement, curriculum development, class size, and teacher salaries. This article presents findings from a randomized field trial that evaluates a bottom-up approach in which high-achieving students of diverse racial and ethnic backgrounds from poor families are given monetary incentives to maintain their academic standing. The evaluation was designed to explore the role of monetary incentives as a mechanism for promoting resiliency in the face of poverty-related challenge. Discussion of what motivates students to learn is framed as a function of normal cognitive and socioemotional development in challenging environments. Evaluation findings indicate that monetary incentives are effective in promoting academic success to different degrees and for different reasons depending on students' perception of the meaning of the incentive in relation to their emergent identity.

Adolescent↗
PubMed2005

Achievement by proxy distortion in sports: a distorted mentoring of high-achieving youth. Historical perspectives and clinical intervention with children, adolescents, and their families.

This article describes potentially pathogenic behavior in youth sports. It delineates the four stages of achievement by proxy distortion (ABPD) behavior and attempts to raise awareness of that behavior and to facilitate communication among sports medicine and psychiatry professionals of the potential for exploitation and abuse of children and adolescents by parents, mentors, coaches, and the systems that nurture and develop these children. Information is presented to distinguish motivations behind normal parenting from those that lead to risky sacrifice, objectification of the child, and potential abuse. Distinct abuse stages of ABPD are described. The authors identify "red flags" that indicate distorted views and potentially harmful behavior toward children.

Achievement↗
PubMed1989

Assessing gender-related differences in achievement orientation using two different achievement scales.

The consistent finding that the achievement scales of the Adjective Check List (ACL) and Edwards Personal Preference Schedule (EPPS) are not correlated has led researchers to question the validity of both of these measures. This article presents evidence indicating that although these measures are independent, they can predict the same performance criteria. Of interest is that the EPPS predicts outcomes for men, whereas the ACL predicts performance for women. A topical examination of each measure's relationships to other scales provides a tentative rationale for these scales' orthogonality that does not call into question the validity of either measure.

Achievement↗
PubMed2002

Perceptions of competence, implicit theory of ability, perception of motivational climate, and achievement goals: a test of the trichotomous conceptualization of endorsement of achievement motivation in the physical education setting.

To test and extend the conceptualization of the endorsement of achievement goals in the physical education setting Mastery, Performance-approach, and Performance-approach goals, Perception of the physical education competence, Implicit theory about sport ability, and Perception of the motivational climate were assessed among 682 boys attending five French schools. Analysis indicated that (1) Performance-approach goals were positively associated with perception of physical education Competence, Entity beliefs about sport ability, the Performance dimension of the motivational climate, and negatively associated with Incremental beliefs about sport ability. (2) Mastery goals were positively associated with perception of physical education Competence, Incremental beliefs about sport ability, the Mastery dimension of the motivational climate, and negatively associated with the Performance dimension of the motivational climate. Also, (3) Performance-avoidance goals were positively associated with Entity beliefs about sport ability and the Performance dimension of the motivational climate; these goals were negatively associated with Incremental beliefs about sport ability and perception of physical education Competence. These results clearly attested to the validity of the trichotomous model in the physical education setting.

Achievement↗
PubMed1998

The achievement by proxy spectrum in youth sports. Historical perspective and clinical approach to pressured and high-achieving children and adolescents.

This article, with examples of the descriptively defined three stages of achievement by proxy distorted (ABPD) behavior, should increase awareness of this field by facilitating communication, enabling child psychiatrists and other professionals to identify the "red flags" that can lead to abuse and exploitation of children and adolescents, and further contributing toward psychoeducation of self-help skills in parents and other adults with the goal of understanding motivations for ABPD behaviors and risky rationalizations, in addition to creating prevention strategies.

Achievement↗
PubMed1996

Receptors coupled to pertussis toxin-sensitive G-proteins traffic to opposite surfaces in Madin-Darby canine kidney cells. A1 adenosine receptors achieve apical and alpha 2A adrenergic receptors achieve basolateral localization.

The alpha 2A adrenergic receptor (alpha 2AAR) previously was shown to be directly delivered to and retained on the lateral subdomain of renal epithelial cells. The present studies demonstrate that, in contrast, wild-type and epitope-tagged canine A1 adenosine receptors (A1AdoR) are apically enriched (65-83%) in Madin-Darby canine kidney (MDCKII) and porcine renal epithelial (LLC-PKI) cells, based on surface biotinylation strategies detecting photoaffinity-labeled A1AdoR. Confocal microscopy corroborated the apical enrichment of the epitopetagged A1AdoR. Metabolic labeling studies revealed that this steady-state polarization is achieved by direct delivery to both the apical (60-75%) and basolateral surface. Growth of A1AdoR-expressing cells as monolayers presence of A1AdoR antagonists, which decreased cell growth, suggesting that A1AdoR elicit MDCKII cell proliferation. The preferential apical but detectable basolateral localization of A1AdoR provides a molecular understanding of published reports that functional responses can be elicited following apical as well as basolateral delivery of adenosine agonists in varying renal preparations. These findings also suggest that receptor chimeras derived from the Gi/Go-protein-coupled alpha 2AAR and A1AdoR will be informative in revealing structural features critical for basolateral versus apical targeting.

Amino Acid Sequence↗