906 resultados para Johns Hopkins Hospital


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This study aimed to develop and validate The Cancer Family Impact Scale (CFIS), an instrument for use in studies investigating relationships among family factors and colorectal cancer (CRC) screening when family history is a risk factor. We used existing data to develop the measure from 1,285 participants (637 families) across the United States who were in the Johns Hopkins Colon Cancer Genetic Testing study. Participants were 94% white with an average age of 50.1 years, and 60% were women. None had a personal CRC history, and eighty percent had 1 FDR with CRC and 20% had more than one FDR with CRC. The study had three aims: (1) to identify the latent factors underlying the CFIS via exploratory factor analysis (EFA); (2) to confirm the findings of the EFA via confirmatory factor analysis (CFA); and (3) to assess the reliability of the scale via Cronbach's alpha. Exploratory analyses were performed on a split half of the sample, and the final model was confirmed on the other half. The EFA suggested the CFIS was an 18-item measure with 5 latent constructs: (1) NEGATIVE: negative effects of cancer on the family; (2) POSITIVE: positive effects of cancer on the family; (3) COMMUNICATE: how families communicate about cancer; (4) FLOW: how information about cancer is conveyed in families; and (5) NORM: how individuals react to family norms about cancer. CFA on the holdout sample showed the CFIS to have a reasonably good fit (Chi-square = 389.977, df = 122, RMSEA= 0.058 (.052-.065), CFI=.902, TLI=.877, GF1=.939). The overall reliability of the scale was α=0.65. The reliability of the subscales was: (1) NEGATIVE α = 0.682; (2) POSITIVE α = 0.686; (3) COMMUNICATE α = 0.723; (4) FLOW α = 0.467; and (5) NORM α = 0.732. ^ We concluded the CFIS to be a good measure with most fit levels over 0.90. The CFIS could be used to compare theoretically driven hypotheses about the pathways through which family factors could influence health behavior among unaffected individuals at risk due to family history, and also aid in the development and evaluation of cancer prevention interventions including a family component. ^

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Patients who had started HAART (Highly Active Anti-Retroviral Treatment) under previous aggressive DHHS guidelines (1997) underwent a life-long continuous HAART that was associated with many short term as well as long term complications. Many interventions attempted to reduce those complications including intermittent treatment also called pulse therapy. Many studies were done to study the determinants of rate of fall in CD4 count after interruption as this data would help guide treatment interruptions. The data set used here was a part of a cohort study taking place at the Johns Hopkins AIDS service since January 1984, in which the data were collected both prospectively and retrospectively. The patients in this data set consisted of 47 patients receiving via pulse therapy with the aim of reducing the long-term complications. ^ The aim of this project was to study the impact of virologic and immunologic factors on the rate of CD4 loss after treatment interruption. The exposure variables under investigation included CD4 cell count and viral load at treatment initiation. The rates of change of CD4 cell count after treatment interruption was estimated from observed data using advanced longitudinal data analysis methods (i.e., linear mixed model). Using random effects accounted for repeated measures of CD4 per person after treatment interruption. The regression coefficient estimates from the model was then used to produce subject specific rates of CD4 change accounting for group trends in change. The exposure variables of interest were age, race, and gender, CD4 cell counts and HIV RNA levels at HAART initiation. ^ The rate of fall of CD4 count did not depend on CD4 cell count or viral load at initiation of treatment. Thus these factors may not be used to determine who can have a chance of successful treatment interruption. CD4 and viral load were again studied by t-tests and ANOVA test after grouping based on medians and quartiles to see any difference in means of rate of CD4 fall after interruption. There was no significant difference between the groups suggesting that there was no association between rate of fall of CD4 after treatment interruption and above mentioned exposure variables. ^

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Multiple dietary deficiencies and high rates of infectious illness are major health problems leading to malnutrition and limitation of growth of children in developing countries. Longitudinal studies which provide information on illness incidence and growth velocity are needed in order to untangle the complex interrelationship between nutrition, illness and growth. From 1967 to 1973, researchers led by Dr. Bacon Chow of the Johns Hopkins University School of Hygiene undertook a quasi-experimental prospective study in Suilin Township, Taiwan to determine the effects of a nutritional supplement to the diets of pregnant and lactating women on the growth, development and resistance to disease of their offspring. This dissertation presents results from the analysis of infant morbidity and postnatal growth.^ Maternal nutritional supplementation has no apparent effect on the postnatal growth or morbidity of infants. Significant sex differences exist in growth response to illness and in illness susceptibility. Male infants have more diarrhea and upper respiratory illness. Respiratory illness is positively associated with growth rate in weight in the first semester of life. Diarrhea is significantly negatively associated with growth in length in the second semester. Small-for-date infants are more susceptible to illness in general and have a different pattern of growth response than large-for-date infants.^ Principal components analysis of illness data is shown to be an effective technique for making more precise use of ambiguous morbidity data. Multiple regression with component scores is an accurate method for estimating variance in growth rate predicted by indepenent illness variables. A model is advanced in which initial postnatal growth rate determines subsequent susceptibility to nutritional stress and infection. Initial growth rate is a function of prenatal nutrition, but is not significantly affected by maternal supplementation during gestation or lactation. Critical evaluation is made of nutritional supplementation programs which do not afford disease control.^

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Background Emergency contraception can prevent pregnancy when taken after unprotected intercourse.Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision could circumvent some obstacles to timely use. Objectives To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. Search strategy In November 2009, we searched CENTRAL, EMBASE, POPLINE,MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. Selection criteria We included randomized controlled trials comparing advance provision and standard access (i.e., counseling whichmay ormay not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy). Data collection and analysis Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 5.0.23. Main results Eleven randomized controlled trials met our criteria for inclusion, representing 7695 patients in the United States, China, India and Sweden. Advance provision did not decrease pregnancy rates (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.76 to 1.25 in studies for which we included twelve-month follow-up data; OR 0.48, 95% CI 0.18 to 1.29 in a study with seven-month follow-up data; OR 0.92, 95% CI 0.70 to 1.20 in studies for which we included six-month follow-up data; OR 0.49, 95% CI 0.09 to 2.74 in a study with three-month follow-up data), despite reported increased use (single use: OR 2.47, 95% CI 1.80 to 3.40; multiple use: OR 4.13, 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -12.98 hours, 95% CI -16.66 to -9.31 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 1.01, 95% CI 0.75 to 1.37), increased frequency of unprotected intercourse, or changes in contraceptive methods.Women who received emergency contraception in advance were equally likely to use condoms as other women. Authors’ conclusions Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Results from primary analyses suggest that advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy.However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

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O objetivo dessa tese é aprofundar, a partir do discurso pós-colonial, uma crise na perspectiva teológica da libertação. Esta promoveu, na década de 1970, uma reviravolta nos estudos teológicos no terceiro mundo. Para tanto, leremos um conto de Gabriel García Márquez chamado “El ahogado más hermosodel mundo” (1968) analizando e avaliando as estratégias políticas e culturais ali inscritas. Para levar a frente tal avaliação é preciso ampliar o escopo de uma visão que divide o mundo em secular/religioso, ou em ideias/práticas religiosas e não religiosas, para dar passo a uma visão unificada que compreende a mundanalidade, tanto do que é catalogado como ‘religioso’ quanto do que se pretende ‘não religioso’. A teologia/ciências da religião, como discurso científico sobre a economia das trocas que lidam com visões, compreensões e práticas de mundo marcadas pelo reconhecimento do mistério que lhes é inerente, possuem um papel fundamental na compreensão, explicitação, articulação e disponibilização de tais forças culturais. A percepção de existirem elementos no conto que se relacionam com os símbolos sobre Jesus/Cristo nos ofereceu um vetor de análise; entretanto, não nos deixamos limitar pelos grilhões disciplinares que essa simbologia implica. Ao mesmo tempo, esse vínculo, compreendido desde a relação imperial/colonial inerente aos discursos e imagens sobre Jesus-Cristo, embora sem centralizar a análise, não poderia ficar intocado. Partimos para a construção de uma estrutura teórica que explicitasse os valores, gestos, e horizontes mundanos do conto, cristológicos e não-cristológicos, contribuindo assim para uma desestabilização dos quadros tradicionais a partir dos quais se concebem a teologia e as ciências da religião, a obra de García Márquez como literatura, e a geografia imperial/colonial que postula o realismo ficcional de territórios como “América Latina”. Abrimos, assim, um espaço de significação que lê o conto como uma “não-cristologia”, deslocando o aprisionamento disciplinar e classificatório dos elementos envolvidos na análise. O discurso crítico de Edward Said, Homi Bhabha e GayatriSpivak soma-se à prática teórica de teólogas críticas feministas da Ásia, da África e da América Latina para formular o cenário político emancipatório que denominaremos teologia crítica secular.

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A pesquisa tem por objetivo trabalhar o evento da Revolta de Jeú, em conjunto com a Estela de Dã, tendo como ponto de partida para tal, a exegese da perícope de 2 Reis 10-28,36. A história Deuteronomista apresenta o ato da Revolta de Jeú como sendo um feito demasiadamente importante, na restauração do culto a Javé em Israel, a partir de um contexto onde o culto a outras divindades, em Israel Norte, estava em pleno curso. No entanto, a partir da análise conjunta da Estela de Dã, que tem como provável autor o rei Hazael de Damasco, somos desafiados a ler esta história pelas entrelinhas não contempladas pelo texto, que apontam para uma participação ativa de Hazael, nos desfechos referentes a Revolta de Jeú, como sendo o responsável direto que proporcionou a subida de Jeú ao trono em Israel, clarificando desta forma este importante período na história Bíblica. Para tal análise, observar-se-á três distintos tópicos, ligados diretamente ao tema proposto: (1) A Revolta de Jeú e a Redação Deuteronomista, a partir do estudo exegético da perícope de 2 Reis 10,28-36, onde estão descritas informações pontuais sobre período em que Jeú reinou em Israel; (2) Jeú e a Estela de Dã, a partir da apresentação e análise do conteúdo da Estela de Dã, tratando diretamente dos desdobramentos da guerra em Ramote de Gileade, de onde se dá o ponto de partida à Revolta de Jeú; e por fim (3) O Império da Síria, onde a partir da continuidade da análise do conteúdo da Estela de Dã, demonstraremos a significância deste reino, além de apontamentos diretamente ligados ao reinado de Hazael, personagem mui relevante no evento da Revolta de Jeú.

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Peer reviewed

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Although it may sound reasonable that American education continues to be more effective at sending high school students to college, in a study conducted in 2009, The Council of the Great City Schools states that "slightly more than half of entering ninth grade students arrive performing below grade level in reading and math, while one in five entering ninth grade students is more than two years behind grade level...[and] 25% received support in the form of remedial literacy instruction or interventions" (Council of the Great City Schools, 2009). Students are distracted with technology (Lei & Zhao, 2005), family (Xu & Corno, 2003), medical illnesses (Nielson, 2009), learning disabilities and perhaps the most detrimental to academic success, the very lack of interest in school (Ruch, 1963). In a Johns Hopkins research study, Building a Graduation Nation - Colorado (Balfanz, 2008), warning signs were apparent years before the student dropped out of high school. The ninth grade was often referenced as a critical point that indicated success or failure to graduate high school. The research conducted by Johns Hopkins illustrates the problem: students who become disengaged from school have a much greater chance of dropping out of high school and not graduating. The first purpose of this study was to compare different measurement models of the Student School Engagement (SSE) using Factor Analysis to verify model fit with student engagement. The second purpose was to determine the extent to which the SSE instrument measures student school engagement by investigating convergent validity (via the SSE and Appleton, Christenson, Kim and Reschly's instrument and Fredricks, Blumenfeld, Friedel and Paris's instrument), discriminant validity (via Huebner's Student Life Satisfaction Survey) and criterion-related validity (via the sub-latent variables of Aspirations, Belonging and Productivity and student outcome measures such as achievement, attendance and discipline). Discriminant validity was established between the SSE and the Appleton, Christenson, Kim and Reschly's model and Fredricks, Blumenfeld, Friedel and Paris's (2005) Student Engagement Instruments (SEI). When confirming discriminant validity, the SSE's correlations were weak and statistically not significant, thus establishing discriminant validity with the SLSS. Criterion-related validity was established through structural equation modeling when the SSE was found to be a significant predictor of student outcome measures when both risk score and CSAP scores were used. The third purpose of this study was to assess the factorial invariance of the SSE instrument across gender to ensure the instrument is measuring the intended construct across different groups. Conclusively, configural, weak and metric invariances were established for the SSE as a non-significant change in chi-square indicating that all parameters including the error variances were invariant across groups of gender. Engagement is not a clearly defined psychological construct; it requires more research in order to fully comprehend its complexity. Hopefully, with parental and teacher involvement and a sense of community, student engagement can be nurtured to result in a meaningful attachment to school and academic success.

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Mode of access: Internet.

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Mode of access: Internet.

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Federal Highway Administration, Structures and Applied Mechanics Division, Washington, D.C.

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Federal Highway Administration, Structures and Applied Mechanics Division, Washington, D.C.

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Federal Highway Administration, Structures and Applied Mechanics Division, Washington, D.C.