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The European Veterinary Immunology Group (EVIG) was founded under the auspices of the European Federation of Immunologic Societies (EFIS) in 2001, and held its first meeting in autumn 2003 in Berlin. Here, we summarize the short history of this group, report on the workshop in Berlin and outline some future perspectives up to the next meeting scheduled for 2006 in Paris.
An abbreviated version of a behavioral weight loss program for obese retarded adults was provided for two groups of eight moderately retarded, obese adults working in a sheltered workshop. The program involved ten weeks of treatment, five weeks of maintenance and included a one-year follow-up check. Pictured materials were developed to facilitate the subject's comprehension and practice of the behavioral weight loss strategies. subjects in one treatment group were also paired to assess the impact of a buddy reinforcement program on their weight loss. Following ten weeks of treatment, significant weight loss was observed (mean percent weight loss = 6.2); weight loss continued during five weeks of maintenance (additional mean percent weight loss = 1.8). No differences in weight loss or percent weight loss were found between the buddy reinforcement group and the other treatment group at the end of treatment of maintenance and during follow-up. At one year follow-up, 37.5% of the sample maintained a weight loss. Discussion centers around the issues of developing efficient weight loss strategies for obese retarded adults, high inter-individual variability observed in weight loss during treatment, and relatively low long-term maintenance of weight loss after treatment terminated.
BACKGROUND & AIMS: The diagnosis and management of Barrett's esophagus (BE) are controversial. We conducted a critical review of the literature in BE to provide guidance on clinically relevant issues. METHODS: A multidisciplinary group of 18 participants evaluated the strength and the grade of evidence for 42 statements pertaining to the diagnosis, screening, surveillance, and treatment of BE. Each member anonymously voted to accept or reject statements based on the strength of evidence and his own expert opinion. RESULTS: There was strong consensus on most statements for acceptance or rejection. Members rejected statements that screening for BE has been shown to improve mortality from adenocarcinoma or to be cost-effective. Contrary to published clinical guidelines, they did not feel that screening should be recommended for adults over age 50, regardless of age or duration of heartburn. Members were divided on whether surveillance prolongs survival, although the majority agreed that it detects curable neoplasia and can be cost-effective in selected patients. The majority did not feel that acid-reduction therapy reduces the risk of esophageal adenocarcinoma but did agree that nonsteroidal antiinflammatory drugs are associated with a cancer risk reduction and are of promising (but unproven) value. Participants rejected the notion that mucosal ablation with acid suppression prevents adenocarcinoma in BE but agreed that this may be an appropriate strategy in a subgroup of patients with high-grade dysplasia. CONCLUSIONS: Based on this review of BE, the opinions of workshop members on issues pertaining to screening and surveillance are at variance with published clinical guidelines.
PURPOSE: To bring together multidisciplinary experts to discuss primary central nervous system lymphoma (PCNSL) and primary intraocular lymphoma (PIOL). METHODS: NIH campus workshop discussion focusing on future work in both clinical and basic lymphoma research. RESULTS: The discussion lead to recommendations on elucidating disease pathobiology, improving diagnostic accuracy and sensitivity, and novel therapeutic strategies. CONCLUSIONS: Approaches which have been successfully applied to other neoplasms, such as microarray, may be applied to improve diagnostic accuracy and sensitivity of PCNSL and PIOL and should be systematically incorporated into clinical trials of both. Development of animal models of PCNSL and PIOL may be useful in understanding the unique ocular and CNS milieu. Disease detection by radiological, nuclear medicine, molecular and flow cytometric approaches should be systematically studied to improve early diagnosis, accurate staging, and response evaluation. Improved therapy remains the ultimate goal. Efforts in these arenas should be coordinated on a national and international level.
On 3-4 June 2004, in Washington, DC, the Forum for Collaborative HIV Research convened experts from academia, community and private practices, US government agencies, and industry to develop recommendations for increased uptake of buprenorphine integrated into human immunodeficiency virus (HIV) primary care, with special emphasis on Ryan White CARE Act-funded programs. Workshop participants evaluated knowledge gaps requiring research; barriers to integration at the patient, clinic, and systems level; policy and financing issues; and program impacts. Recommendations were developed for training, including medical school and post-medical school training of clinical teams as well as training of patients; for improving programs and services, including integration of opioid dependence and HIV infection into chronic disease models, providing flexible access to core and support services, and monitoring and evaluation of programs; for changes in policy supportive of program and services goals; for financing buprenorphine treatment by use of existing models of integrated treatment and merging funding streams at the local level; and for addressing research gaps, including cost-effectiveness research.
A self-instruction manual to develop a production supervisory strategy (PSS) was studied as an aid for staff responsible for supervising production of 80 retarded persons working on contract assembly tasks in sheltered work settings. The manual was introduced in a multiple-baseline across three groups of staff and clients. Subsequently, at the request of the first author, the PSS developed via the manual was withdrawn in a multiple-baseline across the three groups. Average hourly production increased for 77 of the 80 clients under the PSS as compared to the mean production during baseline, with an average percentage increase for all clients of 68%. The error rates were not affected by the changes in production rates. Mean production rates decreased when the PSS was withdrawn. A preference test showed that all of the clients were in favor of the PSS. A staff questionnaire indicated that all the staff recommended the use of the PSS for the benefit of the clients and as a personal preference for work conditions. Following the completion of data collection, staff in all settings voluntarily reintroduced the PSS. Many components of the PSS were still in effect with all three groups at an 11-month follow-up, and with two of the groups at a 20-month follow-up. Failure to maintain the PSS in a group coincided with complete staff turnover for that group. It was concluded that the PSS can be effectively implemented by workshop staff on the basis of a self-help manual.
This workshop examined the opportunities for translational research directed at immune and inflammatory mechanisms. This summary presents the background data in 3 general areas: (1) inflammation and hemostasis in cerebrovascular and cardiovascular disease, (2) immune interactions in the central nervous system and heart, and (3) translation of immune modulation in the brain and heart, all of which supported a consensus derivation of the opportunities for future research in these areas. The summary concludes with 11 recommendations.
Mental hospitals with large numbers of inactive chronic patients often have a history of hospital farms and shops that provided meaningful, though unpaid, occupation to hundreds of patients. The reforms of work programs brought about by the Souder v. Brennan decision were long overdue, the author says, but the resulting termination of work programs in many hospitals means many benefits to patients have been lost. At one state hospital, many of the jobs eliminated by the Souder decision were replaced by an expansion of the hospital's sheltered workshop, which operates under a work activities center certificate. A project in which patients made and assembled parts for unpainted wooden toys was responsible for much of the expansion.
The Workshop Behavior Checklist is a standardized assessment instrument to assess the work performance of people with severe mental illness using the situational assessment approach. It is modified from the Behavior Identification Form developed by the Material Development Center. The modification process was conducted by enlisting input from mental health professionals (n = 150) and potential employers of discharged patients with mental illness (n = 31) by questionnaires specially designed for this purpose. The results of these questionnaires were then analyzed by an expert panel consisting of 10 therapists and one psychiatrist working in relevant fields. Altogether 14 items in general behaviors, vocational behaviors, and social behaviors were selected. In addition, a new version of the checklist together with its rating guidelines were designed. Exploratory factor analysis (n = 112) shows that all 14 items fit well into a four-factor model explaining 67.2% of total variance, which is in line with the original design of the revised checklist. Cronbach alpha analysis shows that the revised checklist has acceptable to very good internal consistency (.51 to .84) and intraclass correlation coefficients indicate that it has good to excellent inter-rater (.57 to .81) and test-retest (.86 to .94) reliability. Clinical implications and further research are discussed.
The identification, quantification, and characterization of T-cells reactive with the islet autoantigens GAD65, proinsulin (PI), and tyrosine phosphatase-like molecules IA-2 and phogrin are major research goals in type 1 diabetes. In the Immunology of Diabetes Society First Workshop on Autoreactive T-Cells, the quality of recombinant preparations of these autoantigens was identified as a significant weakness, a finding that may account for much of the inconsistency in published studies of peripheral blood T-cell reactivity to islet autoantigens. Poor antigen quality has also hampered the development of novel technologies for the detection of islet-reactive T-cells. For these reasons, in the present study, several preparations of GAD65, PI, and IA-2 were collected and evaluated for endotoxin content, ability to stimulate a panel of relevant T-cell clones, and inhibitory effects on proliferation to unrelated third-party antigens. Through this process, we have been able to identify preparations of GAD65 and IA-2, generated in insect cells using the baculovirus expression system, that stimulate relevant clones and display low inhibitory effects on third-party antigens. In addition, we characterized a PI preparation generated in bacteria as being free of effects on proliferation to third-party antigens and low in endotoxin content. These preparations are important to promote the development of robust and sensitive assays of islet-reactive T-cells in patients with type 1 diabetes or patients at high risk for developing the disease.
Voices, Opportunities & Choices Employment Club (VOCEC) is a non-profit "umbrella" corporation that facilitates the development of affirmative businesses to create jobs for consumers of mental health services. To date, 5 independent businesses have been developed by transforming the resources of sheltered workshops within Kingston Psychiatric Hospital and 2 businesses have been established in collaboration with a local public library. This paper provides a description of VOCEC, including an overview of the affirmative business approach, the structure of the organization, and the process of business development. Personal reflections provide insights into the experiences of consumers, staff, and Board members associated with the corporation.
Production times of high and low retarded adults in a sheltered workshop were analyzed in terms of actual time working as opposed to actual time not working and under conditions of standard and high motivation. Under standard conditions, low productivity was primarily the result of more time spent not working. High motivation attenuated this effect. The results were discussed in terms of cognitive vs. motivational interpretations of individual differences in work performance.
There is a need for a simple, quickly applied tool which can correlate performance of the handicapped individual with that of the able-bodied worker and be easily utilized by nontechnical personnel. Efforts at both the Cerebral Palsy Center and the Rehabilitation Center in Atlanta demonstrated that the third generation of Methods-Time-Measurement (MTM-3) satisfies these criteria. As every motion involved in an operation is detailed and a corresponding time value applied, the over-all result reflects a normal rate of accomplishment more accurately than the usual methods and is especially useful in bidding jobs for the workshop. MTM-3 also has a place in the evaluation section to verify or correct existing standards on bench-type work samples and to develop more meaningful time distribution charts relating to a specific population at a center. In studies of disabled individuals, MTM-3 yields a more accurate determination of the actual degree of disability than the American Medical Association's existing estimated percentages in regard to motor skills.
The paper provides the results of the examination of 112 convalescents of different age using the method of determining the class of ability to work according to the response to the active orthostatic test. A comparative analysis was conducted of different methods of occupational rehabilitation under conditions of workshop medical unit of a large industrial enterprise. It was found that the most effective method is the transfer of convalescents to a more easy work for physiologically substantiated periods of time. Validated criteria of assessing the efficacy of rehabilitation measures are proposed.
The possibility that there is an increased risk of melanoma in patients with psoriasis treated with psoralen-UV-A (PUVA) therapy has raised concern on the part of physicians and patients about the long-term safety of this treatment. In response to this concern, the National Psoriasis Foundation sponsored a workshop at which invited participants with expertise in PUVA therapy, psoriasis treatment, melanoma and nonmelanoma skin cancer, and epidemiological and clinical trials were asked to develop a consensus on the following 3 issues: the risk of long-term adverse effects of PUVA therapy with emphasis on nonmelanoma and melanoma skin cancer; the guidelines for physicians and patients for selection and use of PUVA therapy with consideration of the risk-benefit ratio of this treatment compared with the risk-benefit ratios of alternative treatments; and the directions for further evaluation of the long-term effects Of PUVA therapy.
To provide a venue for a comprehensive multidisciplinary review of the current state of knowledge regarding the human immunodeficiency virus-associated peripheral neuropathies and to provide the institute with guidance in formulating future research initiatives, the National Institute of Neurological Disorders and Stroke (Bethesda, Md) convened a workshop on September 18 through 19, 2000. The participants were chosen from various disciplines and included clinicians, pathologists, neurobiologists, neurophysiologists, virologists, and neuroimmunologists. The present article summarizes the highlights of the meeting and includes the recommendations developed by the participants for future research. As might be expected in a rapidly evolving scientific field, the meeting was characterized by a lively and far-ranging discussion of data interpretation, experimental approaches, and priorities for future research. However, the recommendations presented at the end of this article constitute a consensus judgment reached by all of the participants of the most important areas for future research.
OBJECTIVE: To evaluate the effectiveness of a training program using standardized parents (SPs) to improve the performance of pediatric intensive care fellows in communicating bad news to parents. DESIGN: Self-controlled crossover design. SETTING: Tertiary pediatric intensive care unit in a university-affiliated children's hospital. PARTICIPANTS: Seven pediatric intensive care fellows and 4 trained volunteers (2 sets of SPs) participated in the study. METHODS: Two case scenarios of children admitted to the intensive care unit with a near-fatal diagnosis were used for the fellow's interactions with the SPs. The SPs had received 15 hours of training in role playing, performance evaluation, and giving feedback to the physicians. At the end of the first session, SPs provided feedback to the physicians under each of the 5 following categories: communication skills, content issues, support systems, interventions, and parent perceptions. During the second session, the parent meeting was repeated with a new but similar case scenario and a different set of SPs. Both sessions were videotaped, and a rater blinded to the order of the sessions used a weighted scale based on a checklist to score changes in physician performance. RESULTS: The performance by the fellows showed a significant mean (+/-SEM) improvement in scores of 18.1 (+/-5.2) points (P = .007) between the first and the second sessions. Ranking of session scores revealed that physician performance improved significantly during the second session (Wilcoxon signed rank test, P = .002). CONCLUSIONS: To our knowledge this is the first study that demonstrates short-term improvement in physician performance in conveying bad news in a pediatric intensive care setting using SPs in a 1-day workshop.
At a recent workshop sponsored by the National Institute of Child Health and Human Development, Bethesda, Md, injury and child behavior researchers recommended continued expansion of both directed research on control of specific injuries and basic research on mechanisms that underlie many or all injuries. Prevention of injuries that are not amenable to environmental control will require change in human behavior. Important research questions to address this goal include the following: How do identified risk factors influence the occurrence of injuries? How do children learn behaviors that alter the rate of injury? How do child developmental factors contribute to safety and injury? Innovative methods are needed, such as measure of environmental hazards, exposure to risk, and precursors of serious injuries. These approaches expanded by a broadened base of investigators should help reduce childhood mortality and morbidity due to injuries.