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PubMed2005

Expression profiles for steroidogenic enzymes in adrenocortical disease.

CONTEXT: Excess production of aldosterone or cortisol has profound effects on cardiovascular function and impacts other major organ systems. The mechanisms leading to the autonomous hypersecretion of aldosterone or cortisol in aldosterone-producing adenoma (APA) or cortisol-producing adenoma (CPA) are unknown. OBJECTIVE: The objective of this study was to compare the expression profiles of several steroid-metabolizing enzymes and transcription factors from normal adrenal (NA), APAs, and CPAs. DESIGN: RNA from NAs, APAs, and CPAs were analyzed by microarray and real-time RT-PCR. SETTING: This study was performed at academic research laboratories. PATIENTS: At least nine normal controls and 12 patients with APA or CPA were studied. INTERVENTION: There was no intervention procedure. MAIN OUTCOME MEASURE: The main outcome measure was the expression of steroidogenic enzymes in adrenocortical disease. RESULTS: A microarray indicated a greater than 3-fold increase in the expression of CYP11B2 (aldosterone synthase) in APA, whereas 11beta-hydroxysteroid dehydrogenase type 2 (HSD11B2) and HSD17B1 had greater than 3-fold increases in expression in CPA compared with NA. Real-time RT-PCR showed that APAs produced higher levels of HSD3B2, CYP21 (21-hydroxylase), and CYP11B2 mRNA, whereas CPAs produced higher levels of CYP11A (cholesterol side-chain cleavage), CYP17 (17alpha-hydroxylase/17-20 lyase), HSD3B2, and CYP11B1 (11beta-hydroxylase) mRNA compared with normal adrenal. Steroidogenic factor-1, DAX-1 (dosage-sensitive sex reversal, adrenal hypoplasia congenita, critical region on the X chromosome gene 1), and GATA-6 were expressed at higher levels in APAs and CPAs, whereas NURR1 was expressed at higher levels in APAs than in CPAs or NAs. CONCLUSION: Elevated production of aldosterone in APAs and of cortisol in CPAs is associated with increased expression of enzymes needed for corticosteroid production along with alterations in transcription factors that enhance the expression of steroid-metabolizing enzymes.

Adenoma↗
PubMed1980

A self-instructional package for increasing attending behavior in educable mentally retarded children.

The purpose of this study was to develop a self-instructional package that would aid highly distractible children in increasing their attending behavior in a training and two generalization (a one-to-one and a classroom) situations. Three untrained subjects were monitored for general comparison and social validation purposes. One of these control subjects was distractible and the other two (criterion comparison) were evaluated as not having attentional problems. A multiple baseline design was employed in which training was sequentially introduced across subjects. During training, the experimental subjects were taught through self-instruction to focus their attention and to cope with two tasks, math and printing. After learning the self-instructions the subjects were systematically and sequentially exposed to photo-slides of distracting situations, to audio-distractors composed of noisy lunchroom verbal peer interactions, and to in vivo distractors provided by kindergarten children playing with wooden blocks in the training setting. The entire training procedure was handled in a game-like context to maintain subject interest and to facilitate generalization. The results suggested that the training package produced direct and generalized changes in self-instructional behavior. In addition, a decreae in off-task behavior occurred during math, printing, and also during a phonics program in the one-to-one and classroom situations. However, reliable changes in academic task performance were not observed. Finally, no systematic changes on any of the dependent measures occurred for the three untrained subjects.

Adolescent↗
PubMed1982

Improving classroom behavior in mentally retarded children through correspondence training.

Except for a few studies, most research investigating correspondence training procedures has been more analogue in nature. The purpose of the present set of studies was to examine whether a "say-do" correspondence training technique could be used with children in special education classes to improve classroom behavior. The specific behaviors targeted for change included: out-of-seat behavior (Experiment 1), sitting posture (Experiment 2), and on-task behavior (Experiment 3). The say-do procedure used in Experiment 1 resembled that of previous studies, whereas that in Experiment 2 was more elaborate in the specificity of verbal statements required from the children and the feedback given them. The training procedure in Experiment 3 used a format similar to the say-do approach, but stressed visual rather than verbal cuing because it was used with nonverbal children. All three studies used single-subject designs and examined maintenance and/or generalization questions. Experiments 2 and 3 also evaluated whether concomitant changes in performance on academic tasks occurred. The results of the three studies provide strong evidence that correspondence training can be effectively used with educationally handicapped children. Moreover, the successful modification of the "say-do" to a "show-do" procedure in Experiment 3 points out the flexibility of the correspondence training approach.

Achievement↗
PubMed1983

Technology in the education of multiply-handicapped children.

The number of technical aids now available has allowed severely multiply-handicapped children to better participate in their education. Project TEACH (Technical-Educational Aids for Children with Handicaps), a 3-year early childhood demonstration project of the Federal Office of Education, provided ten children with seating systems, mobility aids, feeding devices, and augmentative communication aids. The children's performance of academic, motor, daily living, and communication skills as they relate to their educational program is reported as well as the model used to deliver technical services in an educational environment.

Activities of Daily Living↗
PubMed2005

Incidental stromal-predominant mixed epithelial-stromal tumors of the kidney: a mimic of intraparenchymal renal leiomyoma.

CONTEXT: Mixed epithelial-stromal tumor of the kidney is a recently recognized benign renal tumor that usually occurs in adult women and typically forms a sizable lesion with solid and cystic areas. The recognized morphologic spectrum of this recently described entity is evolving. OBJECTIVE: To review the clinicopathologic features of 3 small mixed epithelial-stromal tumors of the kidney that were incidental findings in kidneys removed for other reasons. DESIGN: The clinical presentation and morphologic findings of the 3 cases were reviewed. A panel of immunohistochemical stains was performed. SETTING: Academic medical center. RESULTS: All 3 lesions contained predominantly fascicles of smooth muscle mimicking leiomyoma, but they also had cellular subpopulations of smaller, müllerian-appearing stromal cells. Tubules present within the lesion were most abundant at the periphery, suggesting that they might be entrapped. Although only the spindled smooth muscle cells were immunoreactive for muscle markers desmin and actin, both the spindled smooth muscle cells and the cellular müllerian-appearing stromal cells demonstrated diffuse nuclear labeling for estrogen and progesterone receptors. CONCLUSIONS: Mixed epithelial-stromal tumor of the kidney may present as an incidental stromal-predominant lesion within the kidney. Such lesions are easily confused with leiomyomas or stromal-predominant angiomyolipomas.

Adult↗
PubMed2004

Replantation: past, present, and future.

The reattachment of completely severed parts has only been a clinical reality for 40 years. During that time there has been a shift in focus from refining technical aspects and improving success rates to assessing functional outcomes and better defining the indications for replantation. Although replantations are most frequently performed in academic environments, all practitioners should understand the basic indications for replantation as well as the principles of preservation of tissue. The advances in microsurgery and replantation over the past four decades have revolutionized the way reconstructive surgeons restore form and function to the body, and have laid the groundwork for new advances in composite tissue allotransplantation and tissue engineering.

Decision Making↗
PubMedDate not supplied

[Fifty years of impact factor: pros and cons].

BACKGROUND: The Impact Factor (IF) was thought up 50 years ago, and it is currently the best available bibliometric index. Despite its shortcomings, the IF is widely used and offers, at present, the best simple tool to help libraries decide which journals to purchase. DISCUSSION: The use of the term "impact factor" has gradually evolved, especially in Europe, to include both journal and author impact. With this meaning, it has become the most used tool in evaluating scientific quality in decisions regarding funding and academic career. This ambiguity and use of IF to compare authors may be misleading. There is poor correlation between the citation frequency of a certain article and the IF of the journal in which it is published. There is a marked bias towards the English language journals compared with those in other languages. Even within the field of Occupational Medicine, the distribution of IF exhibits a wide spread between specialty subsets. CONCLUSION: The IF is a flawed measure of quality of academic staff performance. Searching for the highest IF is not equal to searching for the truth. There is still much work to be done to develop truly objective measures of scientific quality. Like all measures, the use of IF has to be tempered with knowledge of its limitations and common sense.

Bibliometrics↗
PubMed1988

Short- and long-term academic predictors of medical student performance.

The relationship between entry qualifications and performance throughout the medical course was studied in individual cohorts of students admitted in the years 1977 to 1981. A modest but significant relationship with overall initial qualifications was found throughout the course. Students without biology showed a marked disadvantage in the first year but the effect did not persist. There were quite marked variations in all these effects between cohorts; studying only a single cohort could lead to inappropriate conclusions.

Achievement↗
PubMed1988

Long-term follow-up and complications of infants with vulvovaginal embryonal rhabdomyosarcoma treated with surgery, radiation therapy, and chemotherapy.

The long-term follow-up is presented of three infants with vulvovaginal rhabdomyosarcoma treated at 10, 11, and 15 months of age by radical surgery, pelvic radiation therapy, and chemotherapy. Two patients developed colonic stricture requiring operative repair. One of these two patients also has urinary incontinence secondary to severe bladder contraction. Pelvic radiation did not significantly affect stature. Lateral transposition of the ovaries at the time of surgery preserved endocrine function in one patient with a normal puberty. The other two patients developed normal secondary sexual characteristics with hormonal replacement therapy. These patients perform well academically and socially. They have adapted 14, 14, and 16.5 years after their therapy.

Adolescent↗
PubMed1979

Training sensory awareness and spatial organization in people with right brain damage.

Building on a methodology to improve scanning and academic skill performance behavior in persons with acquired right brain damage due to stroke, this study presents 2 additional treatment methods: training in sensory awareness and spatial organization. The 53 patients studied were divided into two groups, experimental (N = 30) and control (N = 23). The experimental group received a treatment program incorporating the 2 new methods as well as a condensed version of the original program. The controls received standard rehabilitation. Both groups were retested after 1 month. Analyses revealed that the performance of those in the experimental group exceeded that of the controls, that those patients in the experimental group with severe impairments improved more than those with mild impairments, and that combined multiple-treatment produces greater generalization than the original single treatment program.

Activities of Daily Living↗
PubMedDate not supplied

[An update on the treatment of otitis media with effusion in children. The indications for transtympanic drainage].

Otitis media with effusion (O.M.E.) is a frequent child's condition, with generally spontaneous recovery. Only a few cases, with some complications and chronic-O.M.E., present hearing loss and later verbal and academic delayed performances. We report our experience on treatment by tympanostomy tubes for O.M.E., at the Clinic of otolaryngology of the University of Pisa, since 1981 to 1993, resulting a progressively reduced number of these operations in the last period. We believe that both the inflamed upper airways care, and first choice adenoidectomy can explain the trend. Ventilation tubes must be placed only for persistent picture of O.M.E. and possibility of invalidity.

Adolescent↗
PubMed1996

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↗
PubMed1997

Facial nerve monitoring among graduates of the Ear Research Foundation.

OBJECTIVE: This study aimed to evaluate the patterns of facial nerve monitoring among graduates of an otology fellowship in which monitoring is emphasized throughout training. STUDY DESIGN: This study involved a questionnaire administered to graduates of the Ear Research Foundation, Sarasota, Florida, U.S.A. (otology/neurotology fellowship). SETTING: The study was performed in academic and private practices of surveyed physicians. MAIN OUTCOME MEASURES: These included patterns of facial nerve monitor use and surgical results after facial nerve injuries. RESULTS: Nearly 100% of the graduates of the Ear Research Foundation continue to use facial nerve monitoring routinely in otologic surgery. Five cases of facial nerve injury in surgery for long-term disease were reported for all 15 neurotologists surveyed. CONCLUSION: Routine facial nerve monitoring is not considered the standard of care in most communities; however risk of facial nerve injury appears to be greatly reduced when this adjunctive technique is employed.

Adult↗
PubMedDate not supplied

The accuracy of academic self-evaluations in adolescents with learning disabilities.

The purpose of this study was to document the degree of overestimation of academic skills among students with learning disabilities (LD) and to evaluate the role of reference group and metacognitive awareness in such overestimation. High school students with (n = 52) and without (n = 49) LD in Grades 9 through 12 completed a self-concept scale and a survey requiring them to rate their own academic skills in 17 specific skill areas. Students were further asked to predict their performance on two academic tasks prior to actually performing the tasks. The students' mothers or fathers, their English teachers or academic advisors, and (in the case of the students with LD) their special education case managers also completed the skill rating inventory and predicted student performance on the two tests. Despite reporting significantly lower academic self-concepts, students with LD overestimated their academic skills relative to the ratings of others and to their actual test performance. Such overestimation was less pronounced among the students without LD. All participants reported using similar reference groups in making their judgments. Analyses of item-by-item accuracy judgments from the two tests revealed evidence of group differences in metacognitive awareness that may be related to the overestimation. These findings have implications for realistic goal setting and effective self-advocacy.

Adolescent↗
PubMed1998

Family capital and Hong Kong adolescents' academic achievement.

This study examined relationships between the economic, human, social, and cultural capital of families and adolescents' academic achievement. Data were collected from 387 14-yr.-old Hong Kong students (187 girls, 200 boys), who completed questionnaires to assess their perceptions of the various dimensions of family capital. Academic achievement was measured by performance in Chinese language, English language, and mathematics. The findings indicated that different combinations of the dimensions of family capital combined to contribute to moderate amounts of variance in adolescent girls' academic performance, whereas social capital was the only family measure to have a meaningful and significant modest association with adolescent boys' academic achievement.

Achievement↗