Policy and planning implications of home-based infant stimulation programs for native Indians in North America

Multidisciplinary infant stimulation programs for native Indian children and their parents in North America have been developed in response to serious health, educational and social conditions. The common characteristics of the programs typically include local initiation and development in response to local needs, a preventive rather than compensatory focus, multidisciplinary content, use of para-professional staff, and the active involvement of parents and community elders. The implications of these programs and their development for policy-making and early childhood program planning are discussed in terms of the use of community initiation and involvement, the problem of conflicting administrative jurisdiction, the need for adequate funding, the difficulty in disseminating information about the programs, and the nature and role of evaluation. Locally-initiated multidisciplinary programs for Native Indian children are one option for fostering the optimal development of children in their earliest years.     

The chemopreventive agent oltipraz possesses potent antiangiogenic activity in vitro, ex vivo, and in vivo and inhibits tumor xenograft growth.

Angiogenesis plays a pivotal role in tumor growth and represents a key target for chemopreventive intervention. On the basis of the structural features and lack of target organ specificity of the synthetic dithiolethione oltipraz, inhibition of angiogenesis was assessed as a potential mechanism for its broad-based chemopreventive activity. The effects of oltipraz on the development and maturation of a vascular network was determined in vitro using two-dimensional capillary tube formation assays with human umbilical vein endothelial cells plated on Matrigel and ex vivo using primary rat aortic ring explant cultures in three-dimensional collagen gels, respectively. The antiangiogenic and antitumor efficacy of oltipraz administration in vivo in nude mice was evaluated by determining its effects on neovascularization in s.c. Matrigel implants seeded with vascular endothelial growth factor and basic fibroblast growth factor-stimulated porcine aortic endothelial cells and on tumor growth and angiogenesis in SVR murine angiosarcoma xenografts implanted s.c. A dose-dependent reduction (0.4-100 microM) in microvessel formation was observed in both human and rodent bioassays after oltipraz exposure, with inhibition approaching 100% in the rat aortic ring assay at the highest concentration (P < 0.01). Similarly, oltipraz (40 microM) inhibited complete capillary tube formation by human umbilical vein endothelial cells by 62% (P < 0.05) relative to control cultures. p.o. administration of oltipraz (250 mg/kg/day for 6 days) to nude mice implanted with porcine aortic endothelial cell-Matrigel plugs resulted in a 42% reduction in neovascularization (P < 0.05) relative to vehicle-treated control mice. Administration of the same dose of oltipraz to athymic mice bearing established s.c. SVR angiosarcoma xenografts for 10 days resulted in a significant inhibition of tumor growth as early as day 4 of dosing (P < 0.005), with a maximum inhibition of tumor growth (81%, P < 0.001) relative vehicle-treated mice by day 10. The observed efficacy of oltipraz in this model is comparable with that of SU 5416 and TNP-470, known antiangiogenic agents currently under clinical development. Plasma levels of oltipraz at the termination of in vivo efficacy studies were 66.4 +/- 7 microM as determined by reversed phase high-performance liquid chromatography, a concentration range associated with significant antiangiogenic activity of oltipraz in vitro and ex vivo. These data suggest that the chemopreventive agent oltipraz may be effective in the treatment of advanced stage cancers and metastases, in part, because of its antiangiogenic activity in vivo.     

A developmental model for identifying and serving young gifted children

Recent literature on the nature of intelligence, young children's learning, affective characteristics of the gifted, and the needs of diverse learners has implications for identifications and instruction of young gifted children. A Developmental Model is proposed that integrates this knowledge with the Developmental Curriculum approach supported by The National Report on Identification #opRichert, Alvino, & McDonnel, 1982#cp. The model serves as both an approach to identification and appropriate practice for preschool and primary-age gifted children. Suggestions are offered for implementation.     

Trichothiodystrophy and Associated Anomalies: A Variant of SIBIDS or New Symptom Complex?

Abstract: Trichothiodystrophy is characterized by sparse, short, sulfur-deflclent hair. Numerous symptom complexes have been described in which the hair abnormaiity represents a constant feature. We report a boy with trichothiodystrophy, ichthyotic skin changes, onychodystrophy, chronic neutropenia, osteoscierosis, hypothyroidism, nystagmus, growth and mentai retardation, and microcephaiy, who developed a progressive encephalopathy with ataxia and optic atrophy at 2.5 years of age. in addition to a deficient cystine ievei identified on a hair sampie, a disturbance in the composition of other amino acids was present. Ai-though features were reminiscent of osteoscierosis, ichthyosis, brittie hair due to trichothiodystrophy, impaired inteliigence, decreased fertiiity, and short stature (SIBIDS) and couid represent a variant of this disorder, findings in our patient may refiect a new trichothiodystrophy symptom compiex that carries a poor prognosis for survivai beyond chiidhood.     

Role perception and role enactment of the nurse and their determinants in a teaching hospital in Nigeria

This study was conducted to compare nurses' perception of their role with the perception which physicians and patients have of the role of nurses in a teaching hospital incorporating a school of nursing and midwifery; to explore the underlying reasons for the discrepancies found; to examine the effects of discrepancies in role perception on the effectiveness of patient care and to discuss the findings in the light of nursing education curricula in Nigeria.

Questionnaires, listing ten technical/instrumental and expressive/humanitarian nursing functions were administered to three groups of respondents (nurses, physicians and patients). They were requested to select any five statements that best described what nurses did, and to rank them according to how often the functions described were seen being practised.

A second questionnaire, administered only to the nurse respondents, elicited a number of background parameters related to nursing career.

The results from the first questionnaire show that nurses did not seem to agree with patients and physicians on the perception and enactment of their role. Nurses saw their role as equally technical/instrumental and expressive/humanitarian, whereas patients and physicians saw it as more expressive/humanitarian, the patients being particularly more inclined to this perception. Most significant was the disagreement between patients and nurses. Nurses whose perception of their role agreed most closely with that of physicians and patients, were found to be older, and to have had longer experience. A significant proportion of them had only basic nursing qualifications, and they perceived their functions to be more appreciated by patients.     

STUDIES ON THE PATHOGENESIS OF ACUTE INFLAMMATION : III. THE FAILURE OF ANTICOAGULANTS TO PREVENT THE LEUCOCYTIC STICKING REACTION AND THE FORMATION OF SMALL THROMBI IN RABBIT EAR CHAMBERS DAMAGED BY HEAT

Vigorous anticoagulation with heparin sodium and sodium warfarin singly and in combination did not prevent the margination and endothelial sticking reaction of leucocytes in rabbit ear chambers damaged by heat. The general inflammatory reaction observed in this preparation was similarly uninfluenced by the anticoagulants. An unexpected finding after administration of heparin was the enhanced formation of platelet and fibrin-like thrombi within damaged ear chambers. Sodium warfarin did not induce or prevent this heparin effect. Production of these heparin-associated thrombi was minimized in animals subjected to defibrinogenation in vivo whereas leucocytic sticking was not modified. Although defibrinogenation was not absolute, these experiments represent additional proof that the sticking of white blood cells to vascular endothelium is not causally related to the fibrinogen-fibrin system.     

Resource planning for patient-centered, collaborative care

In this article, we use self-reported information from 13,271 older adults and the results from several controlled trials to construct a planned-care management strategy that cuts across diseases and conditions and also addresses health disparities attributed to low socioeconomic status. Three strata result from the interaction of patients' financial status, the presence or absence of bothersome pain and psychosocial problems, and their confidence with self-care. A majority of ambulatory patients generally fall in the first stratum. More resources are required in the 2 remaining strata to attain patient-centered, collaborative care. Because the planned-care management strategy is behaviorally sophisticated, it is likely to be more efficient and effective than strategies based on concepts of disease management that focus on either a single disease or groupings of patients who are "high utilizers" of healthcare. We conclude that modern technologies and related approaches make resource planning for patient-centered, collaborative care feasible and desirable.