Multiple Choices After School: Findings from the Extended-Service Schools Initiative

In the summer of 2002, every state became eligible to receive federal funds for after-school programs. With this opportunity came the need to make decisions about the goals, design and content of after-school programming -- decisions that will influence which youth participate, what they experience and how they may benefit. This report aims to put policymakers and program operators on firmer ground as they grapple with these decisions; it shares lessons from existing school-based after-school programs

The challenges of implementing ADHD clinical guidelines and research best evidence in routine clinical care settings: a Delphi survey and mixed-methods study

Background The landmark US Multimodal Treatment of ADHD (MTA) study established the benefits of individualised medication titration and optimisation strategies to improve short- to medium-term outcomes in attention-deficit hyperactivity disorder (ADHD). This individualised medication management approach was subsequently incorporated into the National Institute for Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78). However, little is known about clinicians’ attitudes towards implementing these medication management strategies for ADHD in routine care. Aims To examine National Health Service (NHS) healthcare professionals’ consensus on ADHD medication management strategies. Method Using the Delphi method, we examined perceptions on the importance and feasibility of implementing 103 ADHD treatment statements from sources including the UK NICE ADHD guidelines and US medication management algorithms. Results Certain recommendations for ADHD medication management were judged as important and feasible to implement, including a stepwise titration of stimulant medication. Other recommendations were perceived as important but not feasible to implement in routine practice, such as weekly clinic follow-up with the family during titration and collection of follow-up symptom questionnaires. Conclusions Many of the key guideline recommendations for ADHD medication management are viewed by clinicians as important and feasible to implement. However, some recommendations present significant implementation challenges within the context of routine NHS clinical care in England

The remodelling of patient care pathway for e-health

The interdependencies within the health care system are seldom taken into account prior to implementation of e-health projects, and there tends to be little change management as part of the plan. Our proposal offers a systems analysis model that gives e-health a framework to consider and manage the introduction, changes and outcomes. This research describes the use of a modified Patient Care Pathway as a method to design and implement e-health projects, presenting as a case study the pre-implementation phase of a teleradiology project in rural Thailand. The proposal is that a modified version of Patient Care Pathways can be used as a prospective design model for e-health services. The method adopts systems engineering principles and applies a ―whole systems approach‖ thereby providing a much richer schematic representation of the patient care pathway illustrating both the patient‘s journey through the system and also the information flow. Our method was applied to the design of a new teleradiology service that was to be established in Thailand, to connect GP‘s in a rural hospital to the radiology department in a tertiary hospital with a further connection to a specialist radiologist in a medical school in Bangkok. By comparing the pre-implementation Patient Care Pathway with the proposed pathway using the teleradiology, a systems analysis model was developed to identify critical points in the system and identify and anticipate how the system would support the changes in clinical practices. The method produced a valuable framework to better understand and thereby manage the implications of change prior to implementation of an e-health project.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Impaired receptor-mediated endocytosis by the asialoglycoprotein receptor in ethanol-fed mice: implications for studying the role of this receptor in alcoholic apoptosis

During receptor-mediated endocytosis (RME), extracellular molecules are internalized after being recognized and bound to specific cell surface receptors. In previous studies of the asialoglycoprotein receptor (ASGPR) in rats, we showed that ethanol impairs RME at multiple ASGPR sites. Ethanol administration has been shown to increase apoptosis, and we demonstrated increased sensitization to apoptotic induction in hepatocytes from ethanol-fed rats. Although a physiological role for the ASGPR has not been identified, investigators have shown its involvement in the uptake/clearance of apoptotic cells in vitvo. This suggests a potential role for the ASGPR in the removal of apoptotic cells, and the recent availability of an ASGPR-deficient mouse strain provides an excellent opportunity to examine the role of the ASGPR during ethanol impairment. In this study, we examined ethanol-impaired RME in mice and began the characterization of ASGPR-deficient mice for use in ethanol studies. Similar to our findings with rats, ligand binding, internalization, and degradation were decreased 45-50% in hepatocytes from ethanol-fed wild-type mice. In ASGPR-deficient mice, these parameters did not vary among the chow-fed, pair-fed control, or ethanol groups and were negligible compared with those of wild-type mice. TUNEL analysis of liver sections showed an ethanol-induced increase in apoptotic bodies in all mouse strains with a significant difference in the receptor-deficient mice. Further, the livers of ASGPR-deficient mice had three times more apoptotic bodies, in all feeding groups, compared with wild-type mice. These results support the use of the ASGPR-deficient mouse model for studying ethanol-induced liver injury, specifically ethanol-induced apoptosis

Pennsylvania Folklife Vol. 18, No. 3

• The End of the Horse and Buggy Era • Moravian Architecture and Town Planning: A Review • Humor in a Friendly World • Chickens and Chicken Houses in Rural Pennsylvania • Eighteenth-Century Emigrants to America from the Duchy of Zweibrucken and the Germersheim District • Horse-Drawn Transportation: Folk-Cultural Questionnaire No. 11https://digitalcommons.ursinus.edu/pafolklifemag/1035/thumbnail.jp

Health Impacts of Estrogens in the Environment, Considering Complex Mixture Effects

PublishedResearch Support, Non-U.S. Gov'tBACKGROUND: Environmental estrogens in wastewater treatment work (WwTW) effluents are well established as the principal cause of reproductive disruption in wild fish populations, but their possible role in the wider health effects of effluents has not been established. OBJECTIVES: We assessed the contribution of estrogens to adverse health effects induced in a model fish species by exposure to WwTW effluents and compared effects of an estrogen alone and as part of a complex mixture (i.e., spiked into effluent). METHODS: Growth, genotoxic, immunotoxic, metabolic, and endocrine (feminized) responses were compared in fathead minnows (Pimephales promelas) exposed for 21 days to a potent estrogenic effluent, a weakly estrogenic effluent before and after spiking with a steroidal estrogen [17 alpha-ethinyl-estradiol (EE2)], and to EE2 alone. RESULTS: In addition to endocrine disruption, effluent exposure induced genotoxic damage, modulated immune function, and altered metabolism; many of these effects were elicited in a sex-specific manner and were proportional to the estrogenic potencies of the effluents. A key finding was that some of the responses to EE2 were modified when it was present in a complex mixture (i.e., spiked into effluent), suggesting that mixture effects may not be easily modeled for effluent discharges or when the chemicals impact on a diverse array of biological axes. CONCLUSION: These data reveal a clear link between estrogens present in effluents and diverse, adverse, and sex-related health impacts. Our findings also highlight the need for an improved understanding of interactive effects of chemical toxicants on biological systems for understanding health effects of environmental mixtures.This work was funded by the Environment Agency to C.R.T. (project no. SC040078). T.N. was supported by a Fundação para a Ciência ea Tecnologia (FCT) fellowship (BPD/18192/04)

The Vehicle, 1966, Vol. 8

Vol. 8 Table of Contents CommentaryBill Moser & Avis Eaglestonpage 3 The Vengeance of the DeadStephen W. Gibbspage 5 Ode To A MeadowKathleen McCormackpage 12 Row OnDavid Helmpage 13 Sonnet 63R.L. Hudsonpage 14 UntitledKathleen McCormackpage 14 The Pure GoldDavid Helmpage 15 CommunionDavid Helmpage 15 PreludeMichael Baldwinpage 15 The AlbatrossKaren Cooleypage 16 The Albatross (photo)DeWittpage 17 Ruff and the VaseDavid Helmpage 18 LaBelleKathleen McCormackpage 19 Not Quite SoR.L. Hudsonpage 20 Feeling (no number)David Reifpage 21 Song at DuskDavid Helmpage 21 Arcadia RuminationsR.L. Hudsonpage 22 The BarWayne Johnsonpage 25 HelloWilliam Framepage 26 The ProcessJerry DeWittpage 27 The KillingAdrian Beardpage 30 The Amusement Park GameStephen W. Gibbspage 38 DamnMel Tylerpage 40 PainWilliam Framepage 40 UntitledSusan Champlinpage 41 Portrait of A Scholar As A Young ManStephen W. Gibbspage 42 The TimesW.D.Mpage 46 ParadoxW.D.M.page 46 MankindDavid Helmpage 47https://thekeep.eiu.edu/vehicle/1014/thumbnail.jp

The Vehicle, 1966, Vol. 8

Vol. 8 Table of Contents CommentaryBill Moser & Avis Eaglestonpage 3 The Vengeance of the DeadStephen W. Gibbspage 5 Ode To A MeadowKathleen McCormackpage 12 Row OnDavid Helmpage 13 Sonnet 63R.L. Hudsonpage 14 UntitledKathleen McCormackpage 14 The Pure GoldDavid Helmpage 15 CommunionDavid Helmpage 15 PreludeMichael Baldwinpage 15 The AlbatrossKaren Cooleypage 16 The Albatross (photo)DeWittpage 17 Ruff and the VaseDavid Helmpage 18 LaBelleKathleen McCormackpage 19 Not Quite SoR.L. Hudsonpage 20 Feeling (no number)David Reifpage 21 Song at DuskDavid Helmpage 21 Arcadia RuminationsR.L. Hudsonpage 22 The BarWayne Johnsonpage 25 HelloWilliam Framepage 26 The ProcessJerry DeWittpage 27 The KillingAdrian Beardpage 30 The Amusement Park GameStephen W. Gibbspage 38 DamnMel Tylerpage 40 PainWilliam Framepage 40 UntitledSusan Champlinpage 41 Portrait of A Scholar As A Young ManStephen W. Gibbspage 42 The TimesW.D.Mpage 46 ParadoxW.D.M.page 46 MankindDavid Helmpage 47https://thekeep.eiu.edu/vehicle/1014/thumbnail.jp

The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle

Background: Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research). Methods: With the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013. Results: The findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user. Conclusions: The findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers

Galaxy Zoo: dust and molecular gas in early-type galaxies with prominent dust lanes

We study dust and associated molecular gas in 352 nearby early-type galaxies (ETGs) with prominent dust lanes. 65% of these `dusty ETGs' (D-ETGs) are morphologically disturbed, suggesting a merger origin. This is consistent with the D-ETGs residing in lower density environments compared to the controls drawn from the general ETG population. 80% of D-ETGs inhabit the field (compared to 60% of the controls) and <2% inhabit clusters (compared to 10% of the controls). Compared to the controls, D-ETGs exhibit bluer UV-optical colours (indicating enhanced star formation) and an AGN fraction that is more than an order of magnitude greater (indicating higher incidence of nuclear activity). The clumpy dust mass residing in large-scale features is estimated, using the SDSS r-band images, to be 10^{4.5}-10^{6.5} MSun. A comparison to the total (clumpy + diffuse) dust masses- calculated using the far-IR fluxes of 15% of the D-ETGs that are detected by the IRAS- indicates that only ~20% of the dust resides in these large-scale features. The dust masses are several times larger than the maximum value expected from stellar mass loss, ruling out an internal origin. The dust content shows no correlation with the blue luminosity, indicating that it is not related to a galactic scale cooling flow. No correlation is found with the age of the recent starburst, suggesting that the dust is accreted directly in the merger rather than being produced in situ by the triggered star formation. Using molecular gas-to-dust ratios of ETGs in the literature we estimate that the median current and initial molecular gas fraction are ~1.3% and ~4%, respectively. Recent work suggests that the merger activity in nearby ETGs largely involves minor mergers (mass ratios between 1:10 and 1:4). If the IRAS-detected D-ETGs form via this channel, then the original gas fractions of the accreted satellites are 20%-44%. [Abridged]Comment: 11 pages, 18 figures, 1 table, MNRAS (Accepted for publication- 2012 March 19