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PubMed1994

Impact of cyanotic heart disease on school performance.

Surgical correction greatly decreases the mortality and cardiac morbidity of cyanotic congenital heart disease, but children remain at risk of long term difficulties in other areas. A historical cohort study was conducted to determine the relation between heart disease and school performance in 29 children aged 7 to 12 years old with simple transposition of the great arteries or tetralogy of Fallot. All children had surgical correction of their lesion before 2.5 years of age. Those at greater risk of school difficulties because of recognised complications of their heart disease or for reasons other than directly attributable to the heart disease were excluded. Comparison was made with 36 children who had presented with cardiac murmurs at a similar age, but who did not require treatment. Children with cyanotic disease showed significantly poorer performance in all academic areas assessed by the Wide Range Achievement Test-Revised; the difference in group mean score (adjusted for differences in maternal education, sex, and parental occupational prestige) for reading was 10.3 points (confidence interval (CI) 1.25 to 19.34), for spelling 7.8 (CI 1.11 to 14.52), and for arithmetic 6.8 (CI 0.19 to 13.39). The differences in adjusted group means for the Wechsler Intelligence Scale for Children-Revised full scale, performance and verbal IQs were significant, particularly the later at 10.1 points (CI 2.59 to 17.61). Teacher reports indicated significant differences in arithmetic when outcome was dichotomised to 'below grade' or 'not below grade'. There were no significant associations between outcome measures and the medical or perioperative parameters, however, including those related to hypoxia. It is concluded that the increased incidence of academic problems and the nature of the cognitive difficulties in children with uncomplicated corrective cardiac surgery for cyanotic heart disease are not fully explained by chronic hypoxia, or by other factors related to the cardiac surgery.

Child↗
PubMed1988

Medical school achievements as predictors of residency performance.

In this study, the authors investigated the relationships between academic achievement in medical school and performance in first-year residency. The correlations between achievement measures and residency performance ratings were low but significant. A multiple regression equation using the residents' medical specialty and the academic variables accounted for one-quarter of the variance in residency ratings. Additional analyses indicated that the residents rated as "outstanding" consistently performed better on the National Board of Medical Examiners' examinations than the residents rated as "below average." However, other factors were not found to distinguish consistently among the residents when they were grouped into four categories on the basis of overall residency performance. These results support the consideration of academic variables in the residency selection process. However, their use as a single selection factor or as a method of screening out applicants from further consideration is, at best, justified only in the case of extremely high or low medical school achievement.

Clinical Competence↗
PubMed2006

"Sleepiness" is serious in adolescence: two surveys of 3235 Canadian students.

BACKGROUND: Evidence is growing that sleep problems in adolescents are significant impediments to learning and negatively affect behaviour, attainment of social competence and quality of life. The objectives of the study were to determine the level of sleepiness among students in high school, to identify factors to explain it, and to determine the association between sleepiness and performance in both academic and extracurricular activities METHODS: A cross-sectional survey of 2201 high school students in the Hamilton Wentworth District School Board and the Near North District School Board in Ontario was conducted in 1998/9. A similar survey was done three years later involving 1034 students in the Grand Erie District School Board in the same Province. The Epworth Sleepiness Scale (ESS) was used to measure sleepiness and we also assessed the reliability of this tool for this population. Descriptive analysis of the cohort and information on various measures of performance and demographic data were included. Regression analysis, using the generalised estimating equation (GEE), was utilized to investigate factors associated with risk of sleepiness (ESS>10). RESULTS: Seventy per cent of the students had less than 8.5 hours weeknight sleep. Bedtime habits such as a consistent bedtime routine, staying up late or drinking caffeinated beverages before bed were statistically significantly associated with ESS, as were weeknight sleep quantity and gender. As ESS increased there was an increase in the proportion of students who felt their grades had dropped because of sleepiness, were late for school, were often extremely sleepy at school, and were involved in fewer extracurricular activities. These performance measures were statistically significantly associated with ESS. Twenty-three percent of the students felt their grades had dropped because of sleepiness. Most students (58-68%) reported that they were "really sleepy" between 8 and 10 A.M. CONCLUSION: Sleep deprivation and excessive daytime sleepiness were common in two samples of Ontario high school students and were associated with a decrease in academic achievement and extracurricular activity. There is a need to increase awareness of this problem in the education and health communities and to translate knowledge already available to strategies to address it.

Adolescent↗
PubMed2006

Are we ignoring youths with disabilities in foster care? An examination of their school performance.

This study examined the extent to which the academic achievement of adolescents receiving both foster care and special education services differs from the performance of youths involved in only foster care, special education, or general education. Extant school data were collected on 327 students, ages 13 through 21, who attended school in a large urban school district in Oregon. The study also collected information about students' general foster care experiences, such as length of time in care and type and number of placements. Analyses revealed that foster care youths in special education typically demonstrated lower performance on academic variables in contrast to one or more of the comparison groups. These youths also appeared to experience more restrictive special education placements than youths in special education only. Although foster care or special education status alone appears to place a student at risk of academic difficulties, the negative impact of interfacing with both systems appears multiplicative. Greater attention, commitment, and time must be given to the educational needs of foster care youths with disabilities by both education and child welfare professionals.

Adolescent↗
PubMed2003

Radiation doses in interventional radiology procedures: the RAD-IR study: part I: overall measures of dose.

PURPOSE: To determine patient radiation doses for interventional radiology and neuroradiology procedures, to identify procedures associated with higher radiation doses, and to determine the effects of various parameters on patient doses. MATERIALS AND METHODS: A prospective observational study was performed at seven academic medical centers. Each site contributed demographic and radiation dose data for subjects undergoing specific procedures in fluoroscopic suites equipped with built-in cumulative dose (CD) and dose-area-product (DAP) measurement capability compliant with International Electrotechnical Commission standard 60601-2-43. The accuracy of the dosimetry was confirmed by comprehensive measurements and by frequent consistency checks performed over the course of the study. RESULTS: Data were collected on 2,142 instances of interventional radiology procedures, 48 comprehensive physics evaluations, and 581 periodic consistency checks from the 12 fluoroscopic units in the study. There were wide variations in dose and statistically significant differences in fluoroscopy time, number of images, DAP, and CD for different instances of the same procedure, depending on the nature of the lesion, its anatomic location, and the complexity of the procedure. For the 2,142 instances, observed CD and DAP correlate well overall (r = 0.83, P <.000001), but correlation in individual instances is poor. The same is true for the correlation between fluoroscopy time and CD (r = 0.79, P <.000001). The correlation between fluoroscopy time and DAP (r = 0.60, P <.000001) is not as good. In 6% of instances (128 of 2,142), which were principally embolization procedures, transjugular intrahepatic portosystemic shunt (TIPS) procedures, and renal/visceral artery stent placements, CD was greater than 5 Gy. CONCLUSIONS: Most procedures studied can result in clinically significant radiation dose to the patient, even when performed by trained operators with use of dose-reducing technology and modern fluoroscopic equipment. Embolization procedures, TIPS creation, and renal/visceral artery stent placement are associated with a substantial likelihood of clinically significant patient dose. At minimum, patient dose data should be recorded in the medical record for these three types of procedures. These data should include indicators of the risk of deterministic effects as well as the risk of stochastic effects.

Adolescent↗
PubMed1993

Comparing medical school graduates who perform poorly in residency with graduates who perform well.

BACKGROUND: Most medical school graduates perform well as residents. However, the authors' annual surveys have shown that a few graduates from each class at their school fail to meet residency directors' expectations. METHOD: The medical school records of the 20 of the 153 graduates from the class of 1983 at the University of California, San Francisco, School of Medicine who received poor evaluations from their residency directors in the first and/or second year of residency were compared with the records of 20 of their best-received classmates. The poorly received graduates did not necessarily receive poor numerical ratings of their knowledge, skills, or overall performances, but they did receive negative or ambivalent responses to the following question: "Knowing what you now know about this resident, would select him or her again? Please explain." The two groups of graduates were matched for sex, racial-ethnic identification, and residency discipline. RESULTS: The groups were quite similar with respect to qualifications for admission to medical school, overall academic achievement, and performance on standardized national examinations. There were minor differences in performances on clinical clerkships. CONCLUSION: As indicated by residency directors' ratings and comments, most of the poorly received graduates' problems during residency appear to have been personal and motivational rather than skills- or knowledge-related. With but few exceptions, the medical school records contained little evidence that might have predicted the graduates' poor reception as residents.

Adult↗
PubMed2006

Advances in treatment of acute ischemic stroke.

Stroke carries a severe toll in terms of loss of life and disability for patients and their families. Until 10 years ago, physicians, and in particular neurologists, had a conservative, non-aggressive approach to this devastating disease. The advent of thrombolytic therapy not only proved that acute ischemic stroke is treatable, but also that early reperfusion can dramatically change the outcome of acute stroke patients. As a result of these trials, intravenous (IV) tissue plasminogen activator (t-PA) has been approved for treatment of acute ischemic stroke within 3 hours after symptom onset in the United States, Canada, Australia, and the European Union. The near future is extremely promising. Imaging modalities, such as diffusion- and perfusion-weighted images, as well as CT perfusion and CT angiography, to better select patients for treatment are now routinely performed in most academic medical centers. Novel IV and intra-arterial (IA) agents have been developed and tested. Emerging therapies will soon be available to increase the therapeutic windows for thrombolysis both by better screening patients using MRI or CT and by new IV and IA treatments. Several multicenter controlled trials in both imaging-guided decisions and therapeutic agents are either completed or being performed. We review data on advancement in imaging and treatment of acute ischemic stroke, in particular focusing on pharmacologic and mechanical IA thrombolysis.

Brain Ischemia↗
PubMed2006

Advances in treatment of acute ischemic stroke.

Stroke carries a severe toll in terms of loss of life and disability for patients and their families. Until 10 years ago, physicians, and in particular neurologists, had a conservative, nonaggresive approach to this devastating disease. The advent of thrombolytic therapy not only proved that acute ischemic stroke is treatable, but also that early reperfusion can dramatically change the outcome of acute stroke patients. As a result of these trials, intravenous (IV) tissue plasminogen activator (t-PA) has been approved for treatment of acute ischemic stroke within 3 hours after symptom onset in the United States, Canada, Australia, and the European Union. The near future is extremely promising. Imaging modalities, such as diffusion- and perfusion-weighted images, as well as CT perfusion and CT angiography, to better select patients for treatment are now routinely performed in most academic medical centers. Novel IV and intra-arterial (IA) agents have been developed and tested. Emerging therapies will soon be available to increase the therapeutic windows for thrombolysis both by better screening patients using MRI or CT and by new IV and IA treatments. Several multicenter controlled trials in both imaging-guided decisions and therapeutic agents are either completed or being performed. We review data on advancement in imaging and treatment of acute ischemic stroke, in particular focusing on pharmacologic and mechanical IA thrombolysis.

Journal Article↗
PubMed2003

Future directions for academic practice plans: thoughts on organization and management from Johns Hopkins University and the University of Pennsylvania.

Academic practice plans have been challenged in recent years by increasing pressures for productivity and financial performance. Most practice plans began as relatively loose affiliations among the clinical departments associated with their respective medical schools, and such approaches were adequate in an earlier era. However, this model is not well suited to deal with the current and future challenges that face the practice plans, hospitals, and medical schools that comprise our academic medical centers. The current clinical, financial, and regulatory environment requires highly effective business management, a shared commitment to common goals, and meticulous attention to regulatory compliance. In turn, the organizational structures, daily management, and overall governance of academic practice plans must be revised to address these new expectations. The business, clinical, and academic performance of the individual practices must be aligned to meet the diverse, and sometimes conflicting, needs of the academic health center. Both Johns Hopkins Medicine and the University of Pennsylvania (Penn Medicine) have been addressing these issues independently, but their approaches share many common principles. Among others, these principles include (a) organizational alignment, (b) strong practice plan business management, (c) shared resources and strategies, (d) accountability for performance in each practice based on credible data generated by the practice plan, (e) uniform audit and compliance standards, and (f) application of market strategy principles to assure the right mix of primary and specialist physicians, and appropriate incentive-based compensation for physicians. The application of these approaches at two academic health centers, and the rationale for these approaches, are discussed in detail.

Cost Sharing↗
PubMed2003

Postponing or rejecting parenthood? Results of a survey among female academic professionals.

The current surge in childlessness is often seen as an alternative lifestyle amidst growing pluralism and individualism. The results of this study indicate that several subgroups of childless women need to be differentiated: those who actively decide to forgo children in favour of other life pursuits and those who merely defer the decision. Both have accumulated a high degree of human capital in their education or career-building paths. Thus, the increase of a woman's time invested in education or career formation takes its toll on the time available for childrearing. A survey performed among female academics (N = 193) brought to light that among childless women, many merely mean to postpone motherhood until their career prospects are established. Differences between those who outwardly reject motherhood and those who defer the decision can be seen in a variety of job- and career-related aspects. However, due to misconceptions about fertility, many of those who merely intended to postpone children may inevitably end up 'involuntarily childless'. As this trend is most likely to increase in the near future, the resolution of this conflict will be an important milestone in the development of modern industrialized countries. As can be seen from this survey, financial benefits will not induce women to enter into motherhood. Rather, societal and infrastructural changes have to be brought about in order to induce women to enter into motherhood.

Adult↗
PubMed2004

Antithrombotic trials in acute ischaemic stroke: a selective review.

Stroke is a common cause of morbidity and mortality throughout the US and the world. Given the highly disabling nature of this disease, it is important to provide acute therapy when indicated to improve individual outcomes. Recombinant tissue plasminogen activator (rt-PA) is, at present, the only approved drug for the treatment of acute strokes due to cerebral ischaemia. It can be given intravenously within a 3-h window of the onset of neurological deficits. Intra-arterial administration of rt-PA within a 6-h window is performed at several academic centres in patients with middle cerebral and other intracranial artery occlusions based on results of a randomised clinical trial. Other thrombolytic agents are being studied in randomised trials. Although acute therapy of ischaemic stroke has received much attention since the approval of rt-PA, only a small percentage of individuals actually receive rt-PA. This article will review the main thrombolytic agents and the trials performed thus far, as well as examine some important ongoing trials. How administration of acute thrombolytic therapy may evolve in the future will also be addressed.

Abciximab↗
PubMed1996

Defining collegiality within the academic setting.

Faculty development and performance are important issues within colleges of nursing. Collegiality is a performance requirement for promotion and tenure, but the behaviors synonymous with collegiality are frequently unwritten within the academic community as well as being poorly defined in the literature. The ambiguity that this situation produces is often experienced by faculty seeking tenure and promotion. Faculty at a midwestern university used the Delphi technique to determine behaviors synonymous with collegiality. Results of the Delphi rounds yielded specific behavioral indicators for the four broad statements that describe collegiality in the governance document of the university. Those statements include willingness to serve on committees and perform work necessary to departmental operations, willingness to provide guidance and help colleagues in their professional duties, respect for the ideas of others, and conduct of one's professional life without prejudice toward others. Findings revealed that while the area of collegiality is ambiguous, indicators of collegial behavior can be identified. Limitations and benefits of using the Delphi technique are discussed.

Career Mobility↗
PubMed1991

Partial zona dissection or subzonal sperm insertion: microsurgical fertilization alternatives based on evaluation of sperm and embryo morphology.

OBJECTIVE: To establish guidelines for application of partial zona dissection, subzonal sperm insertion, and regular in vitro fertilization (IVF) in severe male factor patients. DESIGN: Two studies were performed: partial zona dissection and IVF was applied in 57 couples during the first period, and subzonal sperm insertion was also applied in a second group of 47 couples. SETTING: Procedures were performed in an academic research environment. PATIENTS, PARTICIPANTS: Couples who failed fertilization previously, others not acceptable for IVF, and a third group in whom IVF was expected to fail. INTERVENTIONS: Oocytes were micromanipulated with either partial zona dissection or subzonal sperm insertion, or the zona pellucida was left intact. Embryos were replaced in patients prophylactically treated with methylprednisolone and antibiotics. MAIN OUTCOME MEASURES: Because several microsurgical fertilization techniques are now available, this study was performed to compare sperm parameters, embryo morphology, fertilization, and implantation rates after application of two successful micromanipulation procedures. RESULTS: Twenty-one pregnancies were established in 104 patients, 5 definitely from subzonal sperm insertion and 4 from partial zona dissection. Patients who failed IVF before had a similar chance of pregnancy after the use of micromanipulation, as first time patients (9/53 versus 12/51). In a subgroup of 15 patients who failed IVF with insufficient numbers of motile sperm, fertilization was significantly higher after subzonal sperm insertion. Partially zona-dissected embryos from couples with severe teratozoospermia (less than or equal to 5% normal forms; strict criteria) had significantly more morphological abnormalities than those from patients with moderate teratozoospermia (6% to 10% normal forms). In severely teratozoospermic patients, significantly fewer partially zona-dissected than subzonally inserted embryos implanted. CONCLUSIONS: The decision of which micromanipulation method to perform can possibly be based on careful analysis of sperm morphology.

Embryo Implantation↗
PubMed2003

Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome.

OBJECTIVE: The role of the lateral pharyngeal muscular walls in the pathogenesis of obstructive sleep apnea hypopnea syndrome (OSAHS) is crucial. My objective is to describe a surgical procedure for splinting the lateral pharyngeal walls in patients with OSAHS and report the initial results. STUDY DESIGN: Prospective randomized pilot study performed in an academic tertiary center as part of a doctoral thesis. PATIENTS AND METHODS: Ten adults with OSAHS, originally selected for treatment with uvulopalatopharyngoplasty, underwent the lateral pharyngoplasty procedure, which consists of a microdissection of the superior pharyngeal constrictor muscle within the tonsillar fossa, sectioning of this muscle, and suturing of the created laterally based flap of that muscle to the same-side palatoglossus muscle. In addition, a palatopharyngeal Z-plasty is performed to prevent retropalatal collapse. RESULTS: Lateral pharyngoplasty improved sleep and daytime symptoms related to OSAHS. After at least 6 months of follow-up, the median apnea-hypopnea index decreased from 41.2 to 9.5 (P =.009) and the median total sleep time spent in rapid eye movement (REM) sleep and in stages 3 plus 4 non-REM sleep increased from 14.1% to 22.1% (P =.059) and from 5.3% to 16.3% (P =.037), respectively. Also, there was statistically significant improvement in snoring, daytime sleepiness, and overall impact of the disease on quality of life. Swallowing disturbances lasted a median of 14.5 days after the surgeries, and all patients returned to normal subjective swallowing function in the follow-up. CONCLUSIONS: Lateral pharyngoplasty is a safe and straightforward approach to lateral pharyngeal muscles and has produced appreciable benefits for OSAHS patients.

Adult↗
PubMed1997

Academic effects of providing peer support in general education classrooms on students without disabilities.

We studied the academic effects on peers without disabilities of serving as peer supports for students with disabilities in general education classrooms. Three peers were studied using a range of indicators, including academic engagement, coursework performance, and social validity assessments. Peers assisting a student with disabilities via curricular adaptation, assignment completion, and social facilitation constituted the multicomponent independent variable. We used withdrawal or multiple baseline designs to demonstrate positive benefits for peers for all measures used. In addition, follow-up data for 2 peers indicated that the positive changes associated with serving as a peer support were maintained for up to 2 months. Our results are discussed in relation to the possible academic and social effects of providing peer supports in general education classrooms for students with and without disabilities.

Achievement↗
PubMed2001

Radioligand binding assays in the drug discovery process: potential pitfalls of high throughput screenings.

Radioligand binding assays evaluating directly the ability of a drug to interact with a defined molecular target is part of the drug discovery process. The need for a high throughput rate in screening drugs is actually leading to simplified experimental schemes that increase the probability of false negative results. Special concern involves voltage-gated ion channel drug discovery where a great care is required in designing assays because of frequent multiplicity of (interacting) binding sites. To clearly illustrate this situation, three different assays used in the academic drug discovery program of the authors were selected because they are rich of intrinsic artifacts: (I) (20 mmol/l caffeine almost duplicated [3H]ryanodine binding (89% higher than control) to rat heart microsomes at 0.3 mumol/l free calcium but did not exert any effect when using a high (107 mumol/l) free calcium, as mostly used in ryanodine binding assays; (II) An agonist for the ionotropic glutamate receptor of the kainate type can distinctly affect [3H]kainate binding to chicken cerebellum membranes depending on its concentration: unlabelled kainic acid per se either stimulated about 30% (at 50-100 nmol/l), had no effect (at 200 nmol/l) or even progressively decreased (at 0.3-2 mumol/l) the binding of 5 nmol/l [3H]kainate, emphasizing the risk of using a single concentration for screening a drug; (III) in a classical [3H]flunitrazepam binding assay, the stimulatory effect of a GABA (gamma-aminobutyric acid) agonist was only observed when using extensively washed rat brain synaptosomes (10 mumol/l GABA increased flunitrazepam binding by 90%). On the other hand, the inhibitory effect of a GABA antagonist was only observed when using crude synaptosomes (10 mumol/l bicuculine reduced [3H]flunitrazepam binding by 40%). It can be concluded that carefully designed radioligand assays which can be performed in an academic laboratory are appropriate for screening a small number of drugs, especially if these are potential hits because of their rational design. Therefore, the low throughput rate could be partially balanced by a higher performance when compared to what is done in a robotic high throughput screening where simplification of assay conditions can lead to false negative results.

Animals↗
PubMed1994

Gloomy but smarter: the academic consequences of attributional style.

The social psychological literature concerning the relationship between attribution and performance has documented the detrimental effects of particular types of attributional pattern on performance, expectancies and mood. The present paper reports three studies in which there was a consistent relationship between attributional style and actual performance. Undergraduate students who tended to attribute achievement-orientated failure to stable, and to some extent global, causes actually performed well on subsequent academic and ability tasks. These findings are new and constitute a challenge to the prevailing assumptions in the literature.

Adolescent↗
PubMedDate not supplied

Declining immune function in children and adolescents with hemophilia and HIV infection: effects on neuropsychological performance. Hemophilia Growth and Development Study.

OBJECTIVE: To determine whether declines in immune functioning are associated with changes in neuropsychological performance in children and adolescents with hemophilia who are infected with the human immunodeficiency virus (HIV). METHODS: Participants were 333 males with hemophilia, ages 6-19 years at entry. A baseline and four annual neuropsychological evaluations were given. A longitudinal growth curves analysis of data was performed to detect changes associated with declining immune function. The cohort was stratified into four groups: (1) HIV- (n = 126); (2) HIV+, average of first two and last two CD4 counts > or = 200, (n = 106; High CD4 group); (3) HIV+, average first two counts > or = 200, average last two counts < 200 (n = 41; CD4 Drop group); and (4) HIV+, average first two and last two counts < 200 (n = 60; Low CD4 group). RESULTS: There were significant differences among the four groups over time in nonverbal intelligence, perceptual/performance skills, nonverbal memory, academic achievement, and language. The Low CD4 group consistently showed the greatest decrement in performance. On measures showing a practice effect for repeated measurements, the Low CD4 group participants' scores remained stable over time, suggesting opposing effects of practice and HIV-related declines. Lowered academic performance relative to IQ was found in all groups. CONCLUSIONS: Declines in neuropsychological functioning are directly related to declines in immune functioning in HIV+ children, adolescents, and young adults with hemophilia. Hemophilia itself may be a risk factor for academic underachievement.

Adolescent↗