495 research outputs found

    Adolescent and young adult (AYA) oncology — An emerging discipline

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    Neo-Hamiltonian Republicans and Military Reform in the Progressive Era: 1898-1912.

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    The Spanish-American War changed the course of American history. In a few months the United States acquired a colonial empire and adopted a policy of overseas involvement that greatly altered future world events. The political victory of a few military reformers and politicians, who endorsed Social Darwinism, over those who upheld the ideas of Jefferson and Jackson, destroyed the international isolation of the American republic. No matter what successive political administrations claimed, they inherited substantial overseas commitments. The group that engineered this profound change in American foreign and defence policy were led by Elihu Root, John Hay, Leonard Wood, Alfred Thayer Mahan and Theodore Roosevelt. These men were convinced that American economic prosperity and political independence depended upon exerting influence overseas. The creation of English-speaking democracies world-wide, which endorsed free trade, would guarantee American prosperity and peace. Josiah Strong\u27s evangelism, which claimed advanced nations had a duty to help the less fortunate, provided American imperialists with moral legitimacy. American expansion required both allies and an efficient military. During the late nineteenth century top-ranking British officials decided that Britain could not maintain its industrial and naval preeminence. An informal alliance between the United States and Great Britain became increasingly attractive to key decision-makers in both countries. This decision led to poorer relations with Germany and Japan because these states resented Anglo-American imperialism and its industrial power. The American army highlighted these changes. The Spanish-American War had displayed deficiencies of command, training, and equipment that proved unacceptable to politicians wishing to influence the world. Army reform provoked political debate. Supporters of local control, volunteerism, and the ideologies of Jefferson and Jackson opposed military reform. Led by William Jennings Bryan, they challenged the view that national efficiency required a professional civil service, army, and navy responsible to federal authority. Ideas from Germany, Britain, France, and Switzerland were used to construct the new army. American business organisation, partly responsible for unparalleled economic growth, influenced the rhetoric of reform and new command structure of the army. The reforms included a General Staff structure, War College, and closer national guard-regular army cooperation; creating the basis for today\u27s American army

    Patient-focused measures of functional health status and health-related quality of life in pediatric orthopedics: A case study in measurement selection

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    The objectives of this report are to review the assessment of patient-focused outcomes in pediatric orthopedic surgery, to describe a framework for identifying appropriate sets of measures, and to illustrate an application of the framework to a challenging orthopedic problem. A detailed framework of study design and measurement factors is described. The factors are important for selecting appropriate instruments to measure health status and health-related quality of life (HRQL) in a particular context. A study to evaluate treatment alternatives for patients with neurofibromatosis type 1 and congenital tibial dysplasia (NF1-CTD) provides a rich illustration of the application of the framework. The application involves great variability in the instrument selection factors. Furthermore, these patients and their supportive caregivers face numerous complex health challenges with long-term implications for HRQL. Detailed summaries of important generic preference-based multi-attribute measurement systems, pediatric health profile instruments, and pediatric orthopedic-specific instruments are presented. Age-appropriate generic and specific measures are identified for study of NF1-CTD patients. Selected measures include the Activities Scale for Children, Gillette Functional Assessment Questionnaire Walking Scale, Health Utilities Index, and Pediatric Inventory of Quality of Life. Reliable and valid measures for application to pediatric orthopedics are available. There are important differences among measures. The selected measures complement each other. The framework in this report provides a guide for selecting appropriate measures. Application of appropriate sets of measures will enhance the ability to describe the morbidity of pediatric orthopedic patients and to assess the effectiveness of alternative clinical interventions. The framework for measurement of health status and HRQL from a patient perspective has relevance to many other areas of orthopedic practice

    A musculoskeletal model of the elbow joint complex

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    This paper describes a musculoskeletal model that represents human elbow flexion-extension and forearm pronation-supination. Musculotendon parameters and the skeletal geometry were determined for the musculoskeletal model in the analysis of ballistic elbow joint complex movements. The key objective was to develop a computational model, guided by optimal control, to investigate the relationship among patterns of muscle excitation, individual muscle forces, and movement kinematics. The model was verified using experimental kinematic, torque, and electromyographic data from volunteer subjects performing both isometric and ballistic elbow joint complex movements. In general, the model predicted kinematic and muscle excitation patterns similar to what was experimentally measured

    Classroom Experiences in an Engineering Design Graphics Course with a CAD/CAM Extension*

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    This paper reports on the development of a new CAD/CAM laboratory experience for a lower division Engineering Design Graphics (EDG) course.  The recent EDG curriculum included freehand sketching, introduction to Computer-Aided Design and Drafting (CADD), and a strong emphasis on 3-D solid modeling.  Based on an NSF-sponsored research project, the EDG curriculum paradigm has been extended to include solid model applications to design analysis and prototype manufacturing.  Specifically in the analysis lab component, students generate mass properties reports and perform finite element analysis (FEA) of solid models built in previous weeks.  In the manufacturing lab, the students build a 3-D solid model and generate an .STL file for exporting to a rapid prototyping (RP) machine.  To facilitate use and availability of laboratory resources, the students are divided into four-member teams during the analyses and prototyping exercises.  This paper reviews the project and reports on the testing of the new laboratory components which were introduced into a pilot, honors section of EDG during the Fall 1996

    Development and evaluation of a musculoskeletal model of the elbow joint complex

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    This paper describes the development and evaluation of a musculoskeletal model that represents human elbow flexion-extension and forearm pronation-supination. The length, velocity, and moment arm for each of the eight musculotendon actuators were based on skeletal anatomy and position. Musculotendon parameters were determined for each actuator and verified by comparing analytical torque-angle curves with experimental joint torque data. The parameters and skeletal geometry were also utilized in the musculoskeletal model for the analysis of ballistic elbow joint complex movements. The key objective was to develop a computational model, guided by parameterized optimal control, to investigate the relationship among patterns of muscle excitation, individual muscle forces, and movement kinematics. The model was verified using experimental kinematic, torque, and electromyographic data from volunteer subjects performing ballistic elbow joint complex movements

    Stress, relationship satisfaction, and health among African American women: Genetic moderation of effects

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    We examined whether romantic relationship satisfaction would serve as a link between early and later stressors which in turn would influence the Thyroid Function Index (TFI), an indicator of physiological stress response. Using the framework of genetic susceptibility theory combined with hypotheses derived from the vulnerability-stress-adaptation and stress-generation models, we tested whether the hypothesized mediational model would be conditioned by 5-HTTLPR genotype, with greater effects and stronger evidence of mediation among carriers of the “s” allele. In a sample of African American women in romantic relationships (n = 270), we found that 5-HTTLPR moderated each stage of the hypothesized mediational model in a “for better or for worse” manner. That is genetic polymorphisms function to exacerbate not only the detrimental impact of negative environments (i.e. “for worse effects”) but also the beneficial impact of positive environments (i.e. “for better effects”). The effect of early stress on relationship satisfaction was greater among carriers of the “short” allele than among those who did not carry the short allele, and was significantly different in both the “for better” and “for worse” direction. Likewise, the effect of relationship satisfaction on later stressors was moderated in a “for better” or “for worse” manner. Finally, impact on physiological stress, indexed using TFI level, indicated that the impact of later stressors on TFI level was greater in the presence of the short allele, and also followed a “for better” or “for worse” pattern. As expected, the proposed mediational model provided a better fit for “s” allele carriers

    La tempête de verglas : une occasion d’étudier les effets du stress prénatal chez l’enfant et la mère

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    Depuis plusieurs années, des études ont démontré que les événements stressants pendant la grossesse affectent le niveau de développement neurologique, de même que le fonctionnement cognitif et psychologique ultérieurs de l'enfant. Par exemple, Mednick (1997) a examiné l'impact d'un important séisme survenu en Chine sur le développement intellectuel et psychologique d'enfants à naître. Vingt-trois ans plus tard, des différences significatives dans le fonctionnement intellectuel, la dépression et la taille de certaines régions du cerveau ont été constatées chez ce groupe en comparaison aux enfants du groupe témoin. Des événements de moindre envergure, tels un divorce ou la perte d'emploi durant la grossesse, peuvent également augmenter l'incidence des complications obstétricales et avoir un impact sur le fonctionnement neurologique du bébé, son poids à la naissance et la circonférence de sa tête. Le décès du père ou l'exposition à un désastre naturel durant la grossesse ont été associés à la dépression, à la schizophrénie et à la criminalité à l'âge adulte. Divers effets adverses reliés aux événements stressants ont aussi été notés chez les primates. L'ensemble de ces études suggèrent que le second trimestre de la grossesse constitue une période critique pendant laquelle les événements stressants peuvent affecter le développement du foetus. Des contraintes méthodologiques nuisent actuellement à la recherche sur le stress prénatal maternel. Les études sur des animaux offrent d'excellents contrôles des environnements prénatal et postnatal. Cependant, les résultats de ces études sont difficilement applicables à l'humain à cause de la présence chez ce dernier, de nombreux facteurs de risque ou de protection absents chez les animaux. De plus, on ne peut assigner les stresseurs de façon aléatoire, dans les études sur les effets des événements de vie pendant la grossesse humaine. En effet, les traits de personnalité de la mère peuvent être transmis certes génétiquement mais également au niveau du développement. Par ailleurs, les enfants d'une mère avec de telles difficultés de personnalité sont exposés à plus d'événements de vie prénatale. D'autre part, la majorité des études sur l'humain ont une variance restreinte car il faut un très vaste échantillon de femmes enceintes pour garantir un nombre suffisant de sujets ayant vécu des événements de vie majeurs. Finalement, les études rétrospectives démontrant un lien entre un risque élevé de schizophrénie ou de dépression et des événements prénataux n'incluent pas de mesures prises sur le champ de la gravité objective ou de la manifestation biologique du stress. Nous présentons ici une revue de littérature portant sur le stress prénatal suivie d'une discussion sur comment la tempête de verglas de 1998 pourrait être utilisée pour faire la lumière sur des questions telles que les mécanismes par lesquels le stress prénatal exerce une influence sur la santé mentale du foetus.Over the last several years, studies have shown that stressful experiences during the pregnancy can predict levels of neurological development, as well as cognitive and psychological functioning, during childhood and adulthood. For example, Mednick (1997) has been studying the effects of a major earthquake in China on the psychological and intellectual development of the unborn child. Twenty-three years after the quake, significant differences have been found between the earthquake group and a control group born one year later in terms of intellectual functioning, depression, and the size of certain brain regions. Less severe events, such as a divorce or job loss during the pregnancy, may also increase the risk of obstetric complications and may have an effect on the baby's neurological well being, weight and head circumference at birth. Death of the baby's father during the pregnancy and natural disasters have both been associated with increased rates of depression, schizophrenia and criminality in adulthood. Several of these same effects have been found in studies of prenatal stress in non-human primates. Many of these studies suggest that the second trimester of pregnancy is a particularly critical period during which stressful events may compromise development of the fetus. Methodological constraints limit research on prenatal maternal stress. Animal studies are able to control for pre- and postnatal environments. However, animal studies have limited generalizability to humans for whom numerous risk and protective factors are in operation. Studies of human pregnancies cannot randomly assign subjects to stress conditions. Maternal personality and temperament may be associated with characteristics of a woman's child not only through genetic transmission of personality, but possibly also through differential exposure to difficult life conditions which may, in part, be self-imposed. In addition, studies of prenatal life events in humans have severely restricted variance; very large samples of women must be screened to identify even small numbers of women who have experienced major life events during the pregnancy. Finally, follow-back studies which show an association between prenatal events and later rates of mental illness, do not include timely evaluations of actual rates of exposure to the event, nor the pregnant woman's subjective or biological reactions to the event. In this paper, we present a review of the literature on prenatal maternal stress followed by a discussion of how the January 1998 Québec ice storm could be used to study the mechanisms by which prenatal stress may influence mental health outcomes in the unborn child.Desde hace varios años, estudios han demostrado que los hechos estresantes durante el embarazo afectan el grado de desarrollo neurológico, como posteriormente el funcionamiento cognoscitivo y psicológico del niño. Por ejemplo, Mednick (1997) examinó el impacto de un terremoto importante occurrido en China en el desarrollo intelectual y psicológico del futuro niño. Veintitres años después, diferencias significativas fueron constatadas en en funcionamiento intelectual, la depresión y la dimensión de ciertas regiones del cerebro en este grupo, comparativamente a un grupo testigo. Hechos de menor envergadura como el divorcio o la pérdida del empleo durante el embarazo pueden igualmente aumentar la incidencia de las complicaciones obstétricas y tener un impacto en el funcionamiento neurológico del bebé, su peso en el nacimiento y la circunferencia de la cabeza. La muerte del padre o la exposición a un desastre natural durante el embarazo han sido asociados a la depresión, la esquizofrenia y la criminalidad en la edad adulta. Diversos efectos adversos ligados a hechos estresantes también han sido notados en los primates. El conjunto de estos estudios sugieren que el segundo trimestre del embarazo constituye un período crítico durante el cual los eventos estresantes pueden afectar el desarrollo del feto. Impedimentos metodológicos afectan actualmente la investigación sobre el estrés perinatal materno. Los estudios con animales ofrecen excelentes controles del medio perinatal y postnatal. Sin embargo los resultados de estos estudios dificilmente son aplicables al ser humano a causa de la presencia de numerosos factores de riesgo o de protección, ausentes en los animales. Además, en los estudios sobre los efectos de los eventos de vida durante el embarazo no se puede asignar estresores de forma aleatoria. En efecto, los rasgos de personalidad de la madre pueden ser transmitidos genéticamante, pero también en el curso del desarrollo. Entre otras, los niños de una madre con determinadas dificultades de personalidad están expuestos a más hechos perinatales de vida. Por otra parte, la mayoría de los estudios sobre el humano varían poco puesto que se necesita un amplio muestreo de mujeres embarazadas que garantice un número suficiente de sujetos que hayan vivido eventos de vida mayores. Para terminar, los estudios retrospectivos demuestran una relación entre el alto riesgo de esquizofrenia o de depresión y los hechos perinatales no incluyen la toma rápida de medidas sobre la gravedad objetiva o sobre la manifestación biológica del estres. Nosotros presentamos aquí una revista de la literatura que aborda el estres perinatal, seguida de una discusión sobre cómo la tempestad de hielo de 1998 podría se utilizada para aclarar sobre interrogantes tales los mecanismos por los cuales el estres perinatal ejerce una influencia en la salud mental de feto
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