Analysis of the Litigations Pertaining to Certain Legal Rights and Responsibilities of Classroom Teachers

Educational Administratio

Environmental exposures: an underrecognized contribution to noncommunicable diseases

Previous attempts to determine the degree to which exposure to environmental factors contribute to noncommunicable diseases (NCDs) have been very conservative and have significantly underestimated the actual contribution of the environment for at least two reasons. Firstly, most previous reports have excluded the contribution of lifestyle behavioral risk factors, but these usually involve significant exposure to environmental chemicals that increase risk of disease. Secondly, early life exposure to chemical contaminants is now clearly associated with an elevated risk of several diseases later in life, but these connections are often difficult to discern. This is especially true for asthma and neurodevelopmental conditions, but there is also a major contribution to the development of obesity and chronic diseases. Most cancers are caused by environmental exposures in genetically susceptible individuals. In addition, new information shows significant associations between cardiovascular diseases and diabetes and exposure to environmental chemicals present in air, food, and water. These relationships likely reflect the combination of epigenetic effects and gene induction. Environmental factors contribute significantly more to NCDs than previous reports have suggested. Prevention needs to shift focus from individual responsibility to societal responsibility and an understanding that effective prevention of NCDs ultimately relies on improved environmental management to reduce exposure to modifiable risks

The state of the art in clinical knowledge management: An inventory of tools and techniques

Purpose To explore the need for, and use of, high-quality, collaborative, clinical knowledge management (CKM) tools and techniques to manage clinical decision support (CDS) content. Methods In order to better understand the current state of the art in CKM, we developed a survey of potential CKM tools and techniques. We conducted an exploratory study by querying a convenience sample of respondents about their use of specific practices in CKM. Results The following tools and techniques should be priorities in organizations interested in developing successful computer-based provider order entry (CPOE) and CDS implementations: (1) a multidisciplinary team responsible for creating and maintaining the clinical content; (2) an external organizational repository of clinical content with web-based viewer that allows anyone in the organization to review it; (3) an online, collaborative, interactive, Internet-based tool to facilitate content development; (4) an enterprise-wide tool to maintain the controlled clinical terminology concepts. Even organizations that have been successfully using computer-based provider order entry with advanced clinical decision support features for well over 15 years are not using all of the CKM tools or practices that we identified. Conclusions If we are to further stimulate progress in the area of clinical decision support, we must continue to develop and refine our understanding and use of advanced CKM capabilities

Incomplete Punishment Networks in Public Goods Games: Experimental Evidence

Abundant evidence suggests that high levels of contributions to public goods can be sustained through self-governed monitoring and sanctioning. This experimental study investigates the effectiveness of decentralized sanctioning institutions in alternative punishment networks. Our results show that the structure of punishment network significantly affects allocations to the public good. In addition, we observe that network configurations are more important than punishment capacities for the levels of public good provision, imposed sanctions and economic efficiency. Lastly, we show that targeted revenge is a major driver of anti-social punishment

Quality of Life and Social and Psychological Outcomes in Adulthood Following Allogeneic HSCT in Childhood for Inborn Errors of Immunity

BACKGROUND: Hematopoietic stem cell transplant (HSCT) is well established as a corrective treatment for many inborn errors of immunity (IEIs) presenting in childhood. Due to improved techniques, more transplants are undertaken and patients are living longer. However, long-term complications can significantly affect future health and quality of life. Previous research has focused on short-term medical outcomes and little is known about health or psychosocial outcomes in adulthood. OBJECTIVE: This project aimed to ascertain the long-term social and psychological outcomes for adults who underwent HSCT for IEI during childhood. METHODS: Adult patients, who had all undergone HSCT for IEI during childhood at two specialist immunology services at least 5 years previously, were invited to participate in the study. Questionnaires and practical tasks assessed their current functioning and circumstances. Information was also gathered from medical notes. Data was compared with population norms and a control group of participant-nominated siblings or friends. RESULTS: Eighty-three patients and 46 matched controls participated in the study. Patients reported significantly better physical health-related quality of life than the general population norm, but significantly worse than matched controls. Patient's self-reported physical health status and the perceived impact of their physical health on everyday life were worse than matched controls and patients reported higher levels of anxiety and lower mood than the general population. For those where their IEI diagnosis was not associated with a learning disability, cognitive function was generally within the normal range. CONCLUSIONS: Patients who have had a HSCT in childhood report mixed psychosocial outcomes in adulthood. More research is needed to establish screening protocols and targeted interventions to maximize holistic outcomes. CLINICAL IMPLICATIONS: Screening for holistic needs and common mental health difficulties should be part of routine follow-up. Information should be provided to patients and families in order to support decision-making regarding progression to transplant and the early identification of any difficulties

A multi-wavelength investigation of the radio-loud supernova PTF11qcj and its circumstellar environment

We present the discovery, classification, and extensive panchromatic (from radio to X-ray) follow-up observations of PTF11qcj, a supernova discovered by the Palomar Transient Factory. PTF11qcj is located at a distance of dL ~ 124 Mpc. Our observations with the Karl G. Jansky Very Large Array show that this event is radio-loud: PTF11qcj reached a radio peak luminosity comparable to that of the famous gamma-ray-burst-associated supernova 1998bw (L_{5GHz} ~ 10^{29} erg/s/Hz). PTF11qcj is also detected in X-rays with the Chandra observatory, and in the infrared band with Spitzer. Our multi-wavelength analysis probes the supernova interaction with circumstellar material. The radio observations suggest a progenitor mass-loss rate of ~10^{-4} Msun/yr x (v_w/1000 km/s), and a velocity of ~(0.3-0.5)c for the fastest moving ejecta (at ~10d after explosion). However, these estimates are derived assuming the simplest model of supernova ejecta interacting with a smooth circumstellar material characterized by radial power-law density profile, and do not account for possible inhomogeneities in the medium and asphericity of the explosion. The radio light curve shows deviations from such a simple model, as well as a re-brightening at late times. The X-ray flux from PTF11qcj is compatible with the high-frequency extrapolation of the radio synchrotron emission (within the large uncertainties). An IR light echo from pre-existing dust is in agreement with our infrared data. Our analysis of pre-explosion data from the Palomar Transient Factory suggests that a precursor eruption of absolute magnitude M_r ~ -13 mag may have occurred ~ 2.5 yr prior to the supernova explosion. Based on our panchromatic follow-up campaign, we conclude that PTF11qcj fits the expectations from the explosion of a Wolf-Rayet star. Precursor eruptions may be a feature characterizing the final pre-explosion evolution of such stars.Comment: 43 pages, 15 figures; this version matches the one published in ApJ (includes minor changes that address the Referee's comments.

Regulation of angiogenesis by a non-canonical Wnt-Flt1 pathway in myeloid cells

Myeloid cells are a feature of most tissues. Here we show that during development, retinal myeloid cells (RMCs) produce Wnt ligands to regulate blood vessel branching. In the mouse retina, where angiogenesis occurs postnatally, somatic deletion in RMCs of the Wnt ligand transporter Wntless results in increased angiogenesis in the deeper layers. We also show that mutation of Wnt5a and Wnt11 results in increased angiogenesis and that these ligands elicit RMC responses via a non-canonical Wnt pathway. Using cultured myeloid-like cells and RMC somatic deletion of Flt1, we show that an effector of Wnt-dependent suppression of angiogenesis by RMCs is Flt1, a naturally occurring inhibitor of vascular endothelial growth factor (VEGF). These findings indicate that resident myeloid cells can use a non-canonical, Wnt-Flt1 pathway to suppress angiogenic branching

A Cognitive Model of an Epistemic Community: Mapping the Dynamics of Shallow Lake Ecosystems

We used fuzzy cognitive mapping (FCM) to develop a generic shallow lake ecosystem model by augmenting the individual cognitive maps drawn by 8 scientists working in the area of shallow lake ecology. We calculated graph theoretical indices of the individual cognitive maps and the collective cognitive map produced by augmentation. The graph theoretical indices revealed internal cycles showing non-linear dynamics in the shallow lake ecosystem. The ecological processes were organized democratically without a top-down hierarchical structure. The steady state condition of the generic model was a characteristic turbid shallow lake ecosystem since there were no dynamic environmental changes that could cause shifts between a turbid and a clearwater state, and the generic model indicated that only a dynamic disturbance regime could maintain the clearwater state. The model developed herein captured the empirical behavior of shallow lakes, and contained the basic model of the Alternative Stable States Theory. In addition, our model expanded the basic model by quantifying the relative effects of connections and by extending it. In our expanded model we ran 4 simulations: harvesting submerged plants, nutrient reduction, fish removal without nutrient reduction, and biomanipulation. Only biomanipulation, which included fish removal and nutrient reduction, had the potential to shift the turbid state into clearwater state. The structure and relationships in the generic model as well as the outcomes of the management simulations were supported by actual field studies in shallow lake ecosystems. Thus, fuzzy cognitive mapping methodology enabled us to understand the complex structure of shallow lake ecosystems as a whole and obtain a valid generic model based on tacit knowledge of experts in the field.Comment: 24 pages, 5 Figure

Performance of psychiatric hospital discharges in strict and tolerant environments

Community mental health professionals are greatly concerned with the type of social environment most conducive to helping patients remain outside psychiatric institutions and improving the quality of their lives in the community. This paper examines the tolerance of deviance characterizing significant others in the patient's environment as it relates to community tenure and selected measures of performance and quality of life of the older patient in the community. A possible role is suggested for differential tolerance of deviance in the lives of patients discharged from psychiatric hospitals. Although it would appear that patients may return to the hospital at a higher rate from low tolerance environments, it may be that for patients who remain in the community, the quality of life may be better in low tolerance environments in terms of social interaction and life satisfaction. The deviance model is of value in the continuing efforts to understand the role of the social environment in the community life of discharged patients .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44295/1/10597_2005_Article_BF01435737.pd