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Physical and psychosocial aspects of the learning environment in information technology rich classrooms.

This paper reports on a study of environments in emerging Internet classrooms. At issue for this study is to what extent these 'technological classrooms' are providing a positive learning environment for students. To investigate this issue, this study involved an evaluation of the physical and psychosocial environments in computerized school settings through a combination of questionnaires and inventories that were later cross-referenced to case studies on a subset of these classrooms. Data were obtained from a series of physical evaluations of 43 settings in 24 school locations in British Columbia, Canada and Western Australia. Evaluations consisted of detailed inventories of the physical environment using the Computerised Classroom Environment Inventory (CCEI): an instrument developed specifically for this study. Data on psychosocial aspects of the environment were obtained with the What is Happening in this Class? (WIHIC) questionnaire administered to 1404 high school students making routine use of these computerized classrooms. Potential deficiencies in the physical environment of these locations included problems with individual workspaces, lighting and air quality, whereas deficiencies in the psychosocial environment were confined to the dimension of Autonomy. Further analysis of these classroom environment data indicated that student Autonomy and Task orientation were independently associated with students' Satisfaction with learning and that many physical (e.g. lighting and workspace dimensions) and psychosocial factors (e.g. students' perceptions of Co-operation and Collaboration) were also associated. The results provide a descriptive account of the learning environment in 'technology-rich' classrooms and, further, indicate that ergonomic guidelines used in the implementation of IT in classrooms may have a positive influence on the learning environment.

Adolescent↗

Conventional wisdom is a poor predictor of the relationship between discipline policy, student misbehaviour and teacher stress.

Will an effective discipline policy improve student misbehaviour and result in a reduction of teacher stress? It is commonly believed that student misbehaviour is a major cause of teacher stress, and that the degree of student misbehaviour is reflected in student suspension rates. Moreover, it is believed that student misbehaviour can be reduced by improving a school's discipline policy through the collaborative efforts of whole school communities. As a result of growing concern about student misbehaviour and teacher stress, a Whole School Approach to Discipline and Student Welfare programme was implemented throughout the Australian state of Victoria. This paper reports on the evaluation studies that were conducted to assess the effectiveness of the programme and examine the assumptions which underpinned its implementation. Data were obtained from 4,072 primary and secondary school teachers. Although longitudinal analyses suggested that the programme was effective in reducing teacher stress, there was no mean change in student misbehaviour. Structural equation analyses showed that there was little relationship between a school's discipline policy and the perceived level of student misbehaviour. It was also found that student suspension rates were not related to student misbehaviour, but could be predicted on the basis of a school's discipline policy and the self-esteem of teachers. Two and three wave causal analyses also demonstrated the problems associated with using cross-sectional research to support major policy decisions. Overall, these studies showed that there is little point in trying to reduce teacher stress by reducing student misbehaviour. Rather, it is more appropriate to develop a supportive organisational climate that enables teachers to cope with the student misbehaviour that confronts them.

Adolescent↗

Evaluation of student attitudes and knowledge in a new program in international health and medicine.

Ben-Gurion University (BGU) in collaboration with Columbia University inaugurated a medical school in 1998, with the expressed purpose of training physicians in International Health and Medicine (IHM). The Beer-Sheva Survey of Attitudes and Knowledge in International Health and Medicine was given to the first graduating class and three control groups. The graduates of the new program retained their positive attitudes toward IHM and increased their knowledge of the subject. Further studies are necessary to document the effect of the program on the clinical practice of its graduates.

Academic Medical Centers↗

Respirators, recommendations, and regulations: the controversy surrounding protection of health care workers from tuberculosis.

Recent nosocomial outbreaks of tuberculosis have increased concern about the occupational acquisition of tuberculosis by health care workers. The Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, and the Occupational Safety and Health Administration, Department of Labor, have issued recommendations and regulations in an effort to decrease health care workers' risk for exposure to patients with infectious tuberculosis. Within the CDC, the National Center for Infectious Diseases, the National Center for Prevention Services, and the National Institute for Occupational Safety and Health collaborated to produce the 1994 Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities. As stated in the Draft Guidelines, the major components of health care worker protection from Mycobacterium tuberculosis infection include administration or source controls, engineering controls, and respiratory protective devices. We review the evolution of the seemingly conflicting recommendations for respiratory protective devices made by these Centers of the CDC and explain how the recommendations in the current CDC Guidelines were reached.

Centers for Disease Control and Prevention, U.S.↗

Factor solution of the BPRS-expanded version in schizophrenic outpatients living in five European countries.

RATIONALE: The expanded version of the Brief Psychiatric Rating Scale (BPRS-E) has improved the instrument's coverage and interrater reliability, but there is little knowledge on its subsyndromes. OBJECTIVES: To assess: (1) whether there are common underlying BPRS-E subscales in patients living in different countries and (2) if this is the case, whether these subscales behave the same in all populations and, if not, what are the differences over these populations. METHODS: Data are part of the EPSILON study, a collaborative project carried out in Denmark, England, Holland, Italy and Spain. A random representative sample of 404 adult patients with a ICD-10 diagnosis of schizophrenia who have been in contact with mental health services of a defined catchment area in each site were assessed. Simultaneous component analysis (SCA) was used to find component weights that optimally explain the variance of the variables in different populations simultaneously. RESULTS: Symptom severity differed significantly among the five EPSILON sites in 12 out of 24 BPRS-E items, but a common component solution could be found. It explained 48.8% of the variance and gave four well-interpretable components: manic excitement/disorganization, depression/anxiety, negative and positive symptoms. Each component's internal consistency and intercomponent correlation matrix differed significantly among sites. The four components mean score differed significantly among sites for negative symptoms and depression/anxiety. CONCLUSIONS: In spite of the heterogeneity of symptom's severity in the various countries, the way symptoms cluster in schizophrenia is rather stable cross-culturally. Data demonstrate that to explore schizophrenia a third component, including mania/disorganization items, is necessary beside the positive-negative symptom dimensions. The subscales derived from these analyses can be readily used in clinical trials and epidemiological studies.

Adult↗

A point mutation in the constant region of Ig lambda1 prevents normal B cell development due to defective BCR signaling.

Surface expression of B cell antigen receptors (BCRs) containing Ig and Igalpha/Igbeta generates signals required to transit discrete developmental checkpoints. The mechanism by which BCR components collaborate to initiate signals is still unclear. The expression of Iglambda1 in SJL mice is 50-fold lower than in other strains. Here, we demonstrate by gene targeting that a point mutation, which changes a glycine to a valine in the lambda1 constant region, is responsible for this defect. In vitro experiments show that Ig receptors bearing this mutation, while expressed normally, are deficient in signaling. These findings reveal a direct involvement of the Ig light chain (IgL) in B cell signaling and development beyond the requirement of light chains for BCR assembly.

Animals↗

Epidemiology of paediatric cancer in Hong Kong, 1982 to 1991. Hong Kong Cancer Registry.

OBJECTIVE: To review the data of paediatric cancer that had been collected by the Hong Kong Cancer Registry from 1982 through 1991. DESIGN: Cross-sectional retrospective study. SETTING: Hong Kong. PATIENTS: Children aged 15 years or younger. MAIN OUTCOME MEASURES: The types of cancer were classified into 12 diagnostic groups according to morphology (following the International Classification of Diseases for Oncology M-code). The incidences of the different types of cancer were obtained with reference to the Hong Kong population aged 15 years or younger. Data collected between 1989 and 1991 were checked by paediatric oncologists from the Hong Kong Paediatric Haematology and Oncology Study Group. RESULTS: A total of 1756 cases of paediatric cancer were registered during the 10-year period. The incidence of cancer was 144.3 new cases per million children. Leukaemia was the most common form of childhood cancer (40.0%), followed by brain tumour (16.3%), and lymphoma (10.8%). The relative frequencies of neuroblastoma (2.4%) and Wilms' tumour (3.5%) were lower than those reported from western countries. CONCLUSION: The incidences and types of paediatric cancer in Hong Kong are similar to those in western countries. Collaboration with paediatric oncology groups should provide more accurate information on the incidence and survival rates of children with cancer in Hong Kong.

Journal Article↗

John Bowlby and James Robertson: theorists, scientists and crusaders for improvements in the care of children in hospital.

AIMS: John Bowlby and James Robertson, two men who were extremely influential in the latter part of the 20th Century, combined scientific theory with evangelism to bring about changes in the way in which children were cared for in hospitals and other institutions. This paper discusses their work together, their theories and their influence on the care of children and paediatric nursing. BACKGROUND: Bowlby and Robertson collaborated early in their working relationship on research about separation of mother and child. Bowlby was the scientist who developed classic theories about maternal separation. Robertson focused his research on separation of mother and child due to hospital admission. Between the two of them, they derived a classic theory about the phases of 'protest', 'despair' and 'denial' (Bowlby called this last stage 'detachment') through which small children pass when isolated from their mothers for a length of time. DISCUSSION: Bowlby became an internationally recognized theorist, widely acclaimed and considered an expert in the field of maternal care and child development. Robertson, with his wife, Joyce, not only continued Bowlby's work investigating children separated from their mothers, but also took on the role of campaigner for the welfare of children in hospital. James Robertson, with his impressive speaking powers, established an international reputation proselytizing the need to admit parents to hospital with their children. The work of Bowlby and Robertson coincided with new knowledge about cross-infection, which had been one of the reasons for excluding parents from hospital wards. At the same time, and influenced by their work, community groups, which championed the idea of admitting parents with their children, developed. The combination of these factors provided a catalyst for changes within the health systems of many developed countries. Because of the theoretical work of Bowlby and Robertson's missionary zeal, government policies, staff attitudes and parents' expectations changed. Children's wards and hospitals in developed countries today admit parents as part of normal routine and actively involve them in the planning and implementation of their child's care.

Adolescent↗

Lessons learned in a European-Latin American collaboration for developing postgraduate education in public health.

BACKGROUND: New funding from the European Union (EU) allowed the collaborative development of postgraduate education in public health between five countries in South America and Europe. METHODS: A planning meeting, two workshops, a final meeting and the use of e-mail and faxes for discussing curricula were employed. RESULTS: One new master of public health in Argentina has begun, plans for new masters in Chile have been developed. A new collaborative module using the Internet was started and is now in its third year, new European plans for distance learning are being developed. Possibilities for collaborative research have been identified and those involved developed a broader horizon and international contacts. The planned grant from the EU was 72,040 Euros. Staff time spent administering the project was much greater than time spent discussing curricula. This is the only publication. CONCLUSION: Although the aims were achieved, the opportunity costs were great, as methods of assessing European research do not value such work highly and the administrative burden of small EU grants is high. Once a network is established greater efforts should be put into electronic communication, but European programmes currently do not fund such 'remote' support.

Argentina↗

Liaison psychiatry in general practice: the comprehensive collaborative model.

A model of liaison psychiatry in general practice is described and its impact assessed using data from the Nottingham psychiatric case register. The model incorporates a comprehensive network of general practice psychiatric clinics for both psychiatrists and other mental health professionals, associated with mainly informal liaison with general practitioners and others in the primary care team, and a reduction in psychiatric outpatient clinics. Following the introduction of this model, the proportion of new and referred patients seen in primary care settings rose from 1% to 18% in Nottingham over an 8-year period. Over this period admission rates significantly fell in Nottingham compared with the rest of England and evidence is given that the growth of primary care psychiatry contributed significantly to this reduction.

Adolescent↗

The European Atherosclerosis Research Study (EARS): design and objectives.

The European Atherosclerosis Research Study--EARS--is a multicentre collaborative project sponsored by the European Community. Its main objective is to study, in young people, the biological expression of a paternal history of premature acute myocardial infarction (AMI) and the relative share of heredity and environment in this expression. In 14 centres in 11 European countries, the offspring of fathers who suffered from a documented AMI before the age of 55 years (cases) are compared with age- and sex-matched control individuals. Genetic variables (restriction fragment length polymorphisms of candidate genes), lifestyle variables and biochemical variables that are known or suspected to play a role in the development of coronary heart disease (CHD), are studied. The cultural and ethnic diversity within Europe allows a thorough investigation of the relative importance and the potential interactions of genetics and environment in the pathogenesis of CHD. A standardized core methodology and centralized storage of blood samples with particular types of analyses systematically carried out in one or a few specialized laboratories, from a strong basis for valid cross-cultural analyses. The results of this study will offer new clues for the modelling of individual risk for developing CHD.

Adolescent↗

The ECLW Collaborative Study: III. Training and reliability of ICD-10 psychiatric diagnoses in the general hospital setting--an investigation of 220 consultants from 14 European countries. European Consultation Liaison Workgroup.

A comprehensive training program for reliable use of the ICD/10 in Consultation-Liaison (C-L) psychiatry was conducted with 220 psychiatrists and psychologists from 14 European countries. The training included rating of written test cases and development of a coding manual to avoid diagnostic pitfalls not addressed in the ICD-10 manual. Following this training, all consultants rated 13 written case histories. One hundred sixty-seven consultants (76%) had a kappa (kappa) of at least 0.70. Only 13 (6%) had a kappa 0.40. The percentage of high reliability raters was evenly distributed among the different countries. Consultants had some problems in the differentiation between adjustment disorders and depressive disorders, and in the classification of disorders where ICD-10 differs from the DSM-III-R system. National biases in diagnostic practice were found with regard to the "case" concept and the role of alcohol in confusional states. Finnish consultants coded "no psychiatric disorder" significantly more often, whereas German and Italian consultants attributed delirious state more often to alcohol than consultants from other European countries. The study demonstrates that it is possible to achieve acceptable interrater reliability in applying the ICD-10 guidelines, through training programs designed for C-L psychiatrists and psychologists. Nevertheless, this first cross-national study shows the importance of addressing differences in national diagnostic practice.

Diagnosis, Differential↗

Digitalis for treatment of congestive heart failure in patients in sinus rhythm.

BACKGROUND: Digitalis glycosides have been in clinical use in the treatment of congestive heart failure for more than 200 years. In recent years several trials have been conducted to address concerns about efficacy and toxicity. Although a systematic review of the literature was recently published, an update is required to include more current trials. OBJECTIVES: To examine the effectiveness of digitalis glycosides in treating congestive heart failure in patients with normal sinus rhythm. To examine the effect of digitalis in patients taking diuretics, ACE inhibitors, and beta blockers; patients with varying severity and duration of disease; patients with prior exposure to digitalis vs. no prior exposure; and patients with diastolic vs. systolic dysfunction. SEARCH STRATEGY: Electronic databases were searched between 1966 and 2000. Dissertation Abstracts and annual meeting abstracts of the American Heart Association, American College of Cardiology, and European Society of Cardiology were searched from 1996-2000. In addition, reference lists provided by the pharmaceutical industry (Glaxo Wellcome Inc.) were searched. SELECTION CRITERIA: Included were randomized placebo-controlled trials of 20 or more adult patients of either sex with symptomatic congestive heart failure who were studied for seven weeks or more. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of heart failure such as acute ischemic heart disease or myocarditis was present. DATA COLLECTION AND ANALYSIS: Articles selected from the searches described above were reviewed by one of the coauthors, and validated by staff from the central office of the Heart Collaborative Review Group in Bristol, UK. MAIN RESULTS: Eleven articles meeting the defined criteria were identified, and major endpoints of mortality, hospitalization, and clinical status, based respectively upon on 8, 4, and 10 of these selected studies, were recorded and analyzed. The data show that there is no difference in mortality between treatment and control groups, whereas digitalis therapy is associated with a lower rate of hospitalization and of clinical deterioration. REVIEWER'S CONCLUSIONS: The literature indicates that digitalis has a useful role in the treatment of patients with congestive heart failure who are in normal sinus rhythm.

Cardiotonic Agents↗

Plasma cholesterol response to a change in dietary fat intake: a collaborative twin study.

The rise of plasma cholesterol in response to an increase from 8 to 22.3% in saturated fatty acid of total intake was studied by comparing the concordance of change in pairs of young English and Italian monozygotic (33 pairs) and dizygotic (22 pairs) twins. LDL and total cholesterol rose about 0.6 mmol/l. All methods of analyses showed a marked genetic component influencing total and LDL cholesterol level. However, the genetic component of the increase in LDL and total cholesterol levels was small in Italy and absent in England. These results suggest that the response of plasma cholesterol to this dietary change is largely determined by environmental factors rather than inheritance.

Adolescent↗

Bone mineral density in pre-and post-menopausal women with affective disorder treated with long-term L-thyroxine augmentation.

BACKGROUND: Augmentation with TSH-suppressive L-thyroxine (T4) has been shown to improve the course of illness in otherwise refractory affective disorders. This collaborative study investigates whether T4 augmentation for a minimum of 12 months decreases bone mineral density (BMD) in 26 pre- and post-menopausal women with affective disorder. METHODS: We measured BMD at the femoral neck, Ward's triangle, trochanter and lumbar vertebrae (L1-L4) in 13 premenopausal and 13 postmenopausal women with affective disorder using dual energy X-ray absorptiometry. BMD was expressed as g/cm(2) and as a Z-score, calculated using bone density data from the international reference population standard. RESULTS: The Z-scores for the pre- and post-menopausal women were within the reference range of the age and sex matched population standard. BMD for the composite group also did not differ either from the population standard. BMD in the lumbar spine and hip did not differ significantly between the pre- and post-menopausal groups. However, there were a relatively high number of postmenopausal patients with BMDs one S.D. lower than the population standard. LIMITATIONS: This is a cross-sectional study with a relatively small sample size. CONCLUSIONS: The study demonstrates that T4 augmentation treatment does not reduce BMD to a clinically significant degree in many women with affective disorder. However, the resilience of bone structure to T4 treatment may vary with site and menopausal status. This study underscores the need for regular assessment of BMD during adjunctive thyroid treatments for affective disorder, especially in postmenopausal women.

Absorptiometry, Photon↗

Cincinnati Lipid Research Clinic.

A major limitation of the Collaborative Lipid Research Clinic's Family Study and hence, the Princeton School District's Family Study, was the insufficient data gathering relative to environmental influences, particularly nutrient intake, alcohol intake, smoking, habitual physical activity, recent weight gain and loss, etc. (Laskarzewski 1983c). In addition, inadequacies of quantitation of family history further represented major problem areas (Laskarzewski 1982c). Nevertheless, the Princeton School District Family Study had major utility in documenting within-family aggregation of CHD risk factors in children and their young adult parents in an economically variegated, biracial cohort.

Adolescent↗

European collaborative study of luteinizing hormone assay: 1. Epitope specificity of luteinizing hormone monoclonal antibodies and surface mapping of pituitary and urinary luteinizing hormone.

This report describes the results of the first part of the collaborative study organized by a working group sponsored by the Community Bureau of Reference of the European Community Commission. The whole study was designed to understand the causes of discrepancy among LH immunoassay methods. In the parent work, we studied the characteristics of 55 monoclonal antibodies to LH which allowed us to establish a detailed map of the antigenic surface of the hormone. In the present report we used this information to interpret the discrepancy in LH concentrations assayed with 12 different methods in 300 sera from subjects with various clinical conditions. The 55 monoclonal antibodies provided by 11 commercial companies were tested in various experiments: the apparent affinity of the antibodies was, generally but not always, higher for LH presented by a second antibody coated to plastic than for LH directly coated to plastic; 26% of the antibodies recognized the alpha subunit, 26% the beta subunit and 48% reacted only with the holomolecule (anti-alpha beta); only 28% of the antibodies were strictly specific for LH. Criss-cross experiments allowed us to distinguish 13 antigenic regions on the surface of LH: 6 were located on the alpha subunit, 3 on the beta subunit and 4 on the holomolecule. The monoclonal antibodies to the alpha beta regions further separated into 12 clusters of reactivity. Accordingly, LH appeared to exhibit at least 21 epitopes. Comparison of the immunoreactivity of various LH preparations indicated that highly purified pituitary LH and immunoaffinity purified urinary LH reacted similarly with the monoclonal antibodies and strongly differed from crude urinary LH. These data indicated that the immunoreactivity of an LH preparation depends mainly upon the degree of purification and not that much upon the origin of the preparation. The epitope specificity of the monoclonal antibodies used in 11 commercially available LH assay kits was also determined: 10 kits used at least one anti-alpha beta monoclonal antibody associated with an anti-beta monoclonal antibody in 7 cases or another anti-alpha beta monoclonal antibody in 3 cases; one kit used an anti-alpha monoclonal antibody associated with an anti-beta monoclonal antibody. None of the kits were strictly identical with regards to the epitope specificity of the monoclonal antibodies used.

Antibodies, Monoclonal↗

Work, career satisfaction, and the position of general internists in the south of Spain.

BACKGROUND: A progressive dissatisfaction has been noted among many internists, and the future of the specialty represents a matter of concern. The objectives of this study were to analyze career satisfaction among 182 internists from 34 hospitals in the south of Spain and to assess the opinion of 47 other health care professionals who frequently interact with internists on the present and future role of the specialty. METHODS: Ours was a multi-institutional, cross-sectional survey of internists that focused on demographics/practice characteristics, education/research, career satisfaction, and opinions regarding the future of internal medicine. Also included were interactive, interdisciplinary focus groups of family physicians, sub-specialists, and managers. The internists were asked to complete a questionnaire that contained items and factors that were measured on a 5-point Likert scale and quantitatively analyzed; the opinions of the focus groups were qualitatively analyzed. RESULTS: The internists surveyed dedicated most of their time to treating hospitalized patients rather than to diagnostic procedures and technical assessment. Some 54% and 57% of the internists pursued continuing medical education and research, respectively, in their free time. The internists were satisfied with the content of their work and with their interpersonal relationships, but they were dissatisfied with their physical/instrumental environment, management policies, and degree of work stability. No differences were detected in relation to age, gender, community factor, or professional category. With regard to the future of the specialty, the main opportunity detected by internists was a closer collaboration with primary care. An analysis of the strengths, weaknesses, future opportunities and threats to internal medicine expressed by the seven focus groups was highly concordant and added worthwhile information and clear proposals for the development of the specialty. CONCLUSIONS: Internists in the south of Spain were satisfied with the content of their work and dissatisfied with health care management and job stability. The future of internal medicine was felt to lie in a deeper collaboration between internists and their colleagues in primary care.

Journal Article↗