The incidence of necrotizing changes in adults with pneumococcal pneumonia

Background. Necrotizing pneumonia is generally considered a rare complication of pneumococcal pneumonia in adults. We systematically studied the incidence of necrotizing changes in adult patients with pneumococcal pneumonia, and examined the severity of infection, the role of causative serotype and the association with bacteremia. ^ Methods. We used a data base of all pneumococcal infections identified at our medical center between 2000 and 2010. Original readings of chest X-rays (CXR) and computerized tomography (CT) were noted. All images were then reread independently by 2 radiologists. The severity of disease was assessed using the SMART-COP scoring system. ^ Results. There were 351 cases of pneumococcal pneumonia. Necrosis was reported in no original CXR readings and 6 of 136 (4.4%) CTs. With re-reading, 8 of 351 (2.3%) CXR and 15 of 136 (11.0%) CT had necrotizing changes. Overall, these changes were found in 23 of 351 (6.6%, 95% CI 4.0 - 9.1) patients. The incidence of bacteremia and the admitting SMART-COP scores were similar in patients with and without necrosis (P=1.00 and P=0.32, respectively). Type 3 pneumococcus was more commonly isolated from patients with than from patients without necrotizing pneumonia (P=0.05), but a total of 10 serotypes were identified among 16 cases in which the organism was available for typing. ^ Conclusions. Necrotizing changes in the lungs were seen in 6.6% (95% CI 4.0 - 9.1) of a large series of adults with pneumococcal pneumonia. Patients with necrosis were not more likely to have bacteremia or more severe disease. Type 3 pneumococcus was commonly implicated, but 9 other serotypes were also identified.^

End -of -life planning and decision -making: Implications for adults with mental retardation

This research focused on the topic of end-of-life planning and decision-making for adults affected by mental retardation. Adults with mental retardation have unique challenges in this regard, including difficulty communicating their wishes without assistance and diminished decision-making skills. The primary research objective was to identify factors that can affect opportunities for adults with mental retardation in community-based services settings (and their advocates) to be involved in planning and deciding about their own end-of-life experience. ^ A descriptive qualitative inquiry was designed to explore issues related to death and dying, and the notion of end-of-life planning, from the perspective of adults with mental retardation who receive publicly-funded community services ("clients") and family members of individuals who receive such services. Study participants were recruited from a single mental retardation service provider in a large urban setting (the "Agency"). Sixteen clients and 14 families of Agency clients took part. Client data collection was accomplished through face-to-face interviews, focus group meetings, and record reviews; family members were involved in a face-to-face interview only. ^ An initial coding scheme was developed based upon literature and policy reviews, and themes related to the research questions. Analysis involved extracting data from transcripts and records and placing it into appropriate thematic categories, building support for each theme with the accumulated data. Coding themes were modified to accommodate new data when it challenged existing themes. ^ Findings suggest that adults with mental retardation do have the requisite knowledge, interest, and ability to participate in decisions about their end-of-life experience and handling of affairs. Siblings are overwhelmingly the chosen future surrogates and they (or their children) will likely be the end-of-life advocates for their brothers and sisters affected by mental retardation. Findings further point to a need for increased awareness, accurate information, and improved communication about end-of-life issues, both in general and particular to adults affected by mental retardation. Also suggested by the findings is a need to focus on creating accommodations and adaptations that can best uncover a person's authentic views on life and death and related end-of-life preferences. Practical implications and suggestions for further research are also discussed. ^

Survey of living conditions of Arctic indigenous peoples

Major findings of the Survey of Living Conditions in the Arctic (SLiCA) are: (1) A combination of traditional activities and cash employment is the prevailing lifestyle of Arctic indigenous peoples; (2) family ties, social support of each other, and traditional activities have a lot to do with why indigenous people choose to remain in Arctic communities; (3) well-being is closely related to job opportunities, locally available fish and game, and a sense of local control. Well-being and depression (and related problems like suicide) are flip sides of the same coin. Improving well-being may reduce social problems; and, (4) health conditions vary widely in the Arctic: three-in-four Greenlandic Inuit self-rate their health as at least very good compared with one-in-two Canadian and Alaska Inuit and one-in-five Chukotka indigenous people. Findings are based on 7,200 interviews in a probability sample of Inupiat settlement regions of Alaska, the four Inuit settlement regions of Canada, all of Greenland, and the Anadyrskij, Anadyr, Shmidtovs, Beringovskij, Chukotskij, Iujl'tinskij, Bilibinskij, Chaunskij, Providenskij, Uel'Kal' districts of Chukotka. Indigenous people and researchers from Greenland, Russia, Canada, the United States, Denmark, Norway, Sweden, and Finland collaborated on all phases of the study.

Foctors that prevent children from gaining access to schooling : a study of Delhi Slum households

This paper examines the factors that prevent slum children aged 5 to 14 from gaining access to schooling in light of the worsening urban poverty and sizable increase in rural-to-urban migration. Bias against social disadvantage in terms of gender and caste is not clearly manifested in schooling, while migrated children are less likely to attend school. I argue that the lack of preparation for schooling in the pre-schooling ages and school admission procedures are the main obstacles for migrated children. The most important implication for universal elementary education in urban India is raising parental awareness and simplifying the admission procedures.

Communication peculiarities of early-aged children from speech risk group with close grownups

More children with different versions of speech disorders appear in Russia last decades. This situation reflects general tendency of national health deterioration. Our practical experience shows that close grownups can?t communicate to children with limited health capacity. As a result there arise social disabilities in child development. Speech communication is one of the forms of global communicative interaction process between close grownups and young child in the course of which there is a redistribution of knowledge and ignorance (Nikas Luman,2005). Within a framework of sociocultiral theory of mental growth we consider the appearance of speech communication under any cases of physical illness is possible only under conditions of correctly- organized communication between grownups and young children. (L.S. Vigotski ,2000). The special value in this aspect acquires the study of communication between grownups and young children. For five years we have been conducting the surveys on the problem of communicative contacts between parents and non-verbal children. Analysis of received data gave us the opportunity to systematize peculiar communicative interaction of adults and children who have some lapses in acquiring speech form communication. We have revealed four versions of situational- business communication between close grownups and young children with disabilities in acquiring speech. We have assumed that four versions of situational- business communication negatively affect speech form communication formation.

VOLTAR À ESCOLA: O PERFIL SOCIAL E AS EXPECTATIVAS DE ALUNOS DA EDUCAÇÃO DE JOVENS E ADULTOS

A idéia de voltar a estudar, buscando uma escolarização considerada como perdida, ganha sentido quando se apresenta não apenas como uma forma reparadora para aqueles que não tiveram acesso a escola na idade certa, mas também como uma necessidade de inserção ao espaço contemporâneo do trabalho e da sociedade, vinculado a um grau mais elevado de escolarização que estimule o prosseguimento dos estudos na busca de ascensão social e profissional. Essa verificação mostra-se contrária a muitos estudos já apresentados, pois normalmente vemos a Educação de Jovens e Adultos como um bálsamo que suprirá todos os problemas sociais e econômicos de uma clientela desfavorecida e insegura de sua capacidade de aprendizagem e com históricos frustrantes de escolarização. Este trabalho objetiva apresentar uma pesquisa empírica sobre a trajetória escolar de 88 alunos da Educação de Jovens e Adultos (EJA) do ensino fundamental II (5ª a 8ª série) e do ensino médio, realizada em uma escola da periferia da cidade de São Bernardo do Campo, no estado de São Paulo, mostrando as relações existentes entre o fracasso e o sucesso que a volta à escola pode propiciar, assim como a análise dos ascendentes e descendentes em relação à escolarização e a escolha profissional. A pesquisa apresenta-se dividida em duas partes, sendo a primeira constituída de informações sobre os alunos, seus pais, filhos e irmãos e a segunda compreendida por duas partes, em que se vêem quantitativamente os motivos do abandono e do retorno à escola e por textos descritivos (redações) dos alunos pesquisados, seus desejos e aspirações, frustrações e sonhos, propondo análises sobre a escolarização e a continuidade de estudos e a necessidade desse retorno à escola. O corpo teórico desta pesquisa foi norteado pelos estudos sobre alfabetização e escolarização de jovens e adultos, sobre as políticas públicas e os movimentos de educação popular, assim como pelas leis que regem essa modalidade de ensino e suas aplicabilidades. Como instrumentos metodológicos, foram utilizados técnicas de análise das leis vigentes, questionários e redações dos alunos. A apresentação e interpretação dos dados coletados sugerem a viabilidade da trajetória escolar dos alunos.(AU)

VOLTAR À ESCOLA: O PERFIL SOCIAL E AS EXPECTATIVAS DE ALUNOS DA EDUCAÇÃO DE JOVENS E ADULTOS

A idéia de voltar a estudar, buscando uma escolarização considerada como perdida, ganha sentido quando se apresenta não apenas como uma forma reparadora para aqueles que não tiveram acesso a escola na idade certa, mas também como uma necessidade de inserção ao espaço contemporâneo do trabalho e da sociedade, vinculado a um grau mais elevado de escolarização que estimule o prosseguimento dos estudos na busca de ascensão social e profissional. Essa verificação mostra-se contrária a muitos estudos já apresentados, pois normalmente vemos a Educação de Jovens e Adultos como um bálsamo que suprirá todos os problemas sociais e econômicos de uma clientela desfavorecida e insegura de sua capacidade de aprendizagem e com históricos frustrantes de escolarização. Este trabalho objetiva apresentar uma pesquisa empírica sobre a trajetória escolar de 88 alunos da Educação de Jovens e Adultos (EJA) do ensino fundamental II (5ª a 8ª série) e do ensino médio, realizada em uma escola da periferia da cidade de São Bernardo do Campo, no estado de São Paulo, mostrando as relações existentes entre o fracasso e o sucesso que a volta à escola pode propiciar, assim como a análise dos ascendentes e descendentes em relação à escolarização e a escolha profissional. A pesquisa apresenta-se dividida em duas partes, sendo a primeira constituída de informações sobre os alunos, seus pais, filhos e irmãos e a segunda compreendida por duas partes, em que se vêem quantitativamente os motivos do abandono e do retorno à escola e por textos descritivos (redações) dos alunos pesquisados, seus desejos e aspirações, frustrações e sonhos, propondo análises sobre a escolarização e a continuidade de estudos e a necessidade desse retorno à escola. O corpo teórico desta pesquisa foi norteado pelos estudos sobre alfabetização e escolarização de jovens e adultos, sobre as políticas públicas e os movimentos de educação popular, assim como pelas leis que regem essa modalidade de ensino e suas aplicabilidades. Como instrumentos metodológicos, foram utilizados técnicas de análise das leis vigentes, questionários e redações dos alunos. A apresentação e interpretação dos dados coletados sugerem a viabilidade da trajetória escolar dos alunos.(AU)

Invariance and restriction toward a limited set of self-antigens characterize neonatal IgM antibody repertoires and prevail in autoreactive repertoires of healthy adults.

Analysis of the reactivity of IgM with self-antigens in tissues by a quantitative immunoblotting technique showed striking invariance among newborns in the human and in the mouse. The self-reactive repertoire of IgM of adults was also markedly conserved; it comprised most anti-self reactivities that prevailed among neonates. Multivariate analysis confirmed the homogeneity of IgM repertoires of neonates toward self- and non-self-antigens. Multivariate analysis discriminated between newborn and adult repertoires for reactivity with two of five sources of self-proteins and with non-self-antigens. Our observations support the concept that naturally activated B lymphocytes are selected early in development and throughout life for reactivity with a restricted set of self-antigens.

Geografia Escolar: crianças e infâncias no primeiro ano do ensino fundamental em Juiz de Fora (MG)

Esta pesquisa tem como objetivo compreender as vivências da Geografia Escolar pelas crianças no primeiro ano do Ensino Fundamental a partir do seu protagonismo. Inspirada em princípios qualitativos, tem na Etnografia sua base metodológica, enfocando especialmente o trabalho realizado em duas escolas públicas de Juiz de Fora (MG). Assim, busca aproximar-se dos significados que as crianças atribuem a este campo de saber nas práticas escolares, colocando-os em diálogo com alguns discursos adultos constituintes da Geografia Escolar. Tomando como referencial teórico os estudos da infância e, em especial, a Geografia da Infância, traz as vozes das crianças, sujeitos centrais no processo de antecipação do ingresso obrigatório no Ensino Fundamental para os seis anos de idade. Os achados da investigação foram organizados em três campos interpretativos que reorientam o olhar sobre a política de antecipação do ingresso obrigatório no Ensino Fundamental, bem como a Geografia Escolar com crianças.

Voters and Candidates of the Future

Within the literature there is a growing concern about lower voter turnout rates among young age cohorts. In this article we investigate the reported willingness to vote among 72,466 14-year old adolescents from 22 European countries, taking part in the International Citizen and Civic Education Survey (ICCS, 2009). Results indicate that the willingness to vote remains quite high among this age group, but with a clear gender division. While girls are more likely to state that they will vote, boys are more likely to see themselves as a future election candidate. An open classroom climate at school contributes to the willingness to vote in future elections. The elements that are known to have an effect on the turnout level of adults, however, do not have a significant impact on the intention to vote among adolescents. This would suggest that the observed low turnout rate among young age groups cannot just be attributed to an alleged lack of political motivation among adolescents.

Systematic review of outcome domains and instruments used in clinical trials of tinnitus treatments in adults

BACKGROUND: There is no evidence-based guidance to facilitate design decisions for confirmatory trials or systematic reviews investigating treatment efficacy for adults with tinnitus. This systematic review therefore seeks to ascertain the current status of trial designs by identifying and evaluating the reporting of outcome domains and instruments in the treatment of adults with tinnitus. METHODS: Records were identified by searching PubMed, EMBASE CINAHL, EBSCO, and CENTRAL clinical trial registries (ClinicalTrials.gov, ISRCTN, ICTRP) and the Cochrane Database of Systematic Reviews. Eligible records were those published from 1 July 2006 to 12 March 2015. Included studies were those reporting adults aged 18 years or older who reported tinnitus as a primary complaint, and who were enrolled into a randomised controlled trial, a before and after study, a non-randomised controlled trial, a case-controlled study or a cohort study, and written in English. Studies with fewer than 20 participants were excluded. RESULTS: Two hundred and twenty-eight studies were included. Thirty-five different primary outcome domains were identified spanning seven categories (tinnitus percept, impact of tinnitus, co-occurring complaints, quality of life, body structures and function, treatment-related outcomes and unclear or not specified). Over half the studies (55 %) did not clearly define the complaint of interest. Tinnitus loudness was the domain most often reported (14 %), followed by tinnitus distress (7 %). Seventy-eight different primary outcome instruments were identified. Instruments assessing multiple attributes of the impact of tinnitus were most common (34 %). Overall, 24 different patient-reported tools were used, predominantly the Tinnitus Handicap Inventory (15 %). Loudness was measured in diverse ways including a numerical rating scale (8 %), loudness matching (4 %), minimum masking level (1 %) and loudness discomfort level (1 %). Ten percent of studies did not clearly report the instrument used. CONCLUSIONS: Our findings indicate poor appreciation of the basic principles of good trial design, particularly the importance of specifying what aspect of therapeutic benefit is the main outcome. No single outcome was reported in all studies and there was a broad diversity of outcome instruments. PROSPERO REGISTRATION: The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): CRD42015017525 . Registered on 12 March 2015 revised on 15 March 2016.

Is socioeconomic position early in life associated with physical activity during adulthood following the accumulation of risk model with additive effects?

L'activité physique améliore la santé, mais seulement 4.8% des Canadiens atteignent le niveau recommandé. La position socio-économique est un des déterminants de l'activité physique les plus importants. Elle est associée à l’activité physique de manière transversale à l’adolescence et à l’âge adulte. Cette thèse a tenté de déterminer s'il y a une association à long terme entre la position socio-économique au début du parcours de vie et l’activité physique à l’âge adulte. S'il y en avait une, un deuxième objectif était de déterminer quel modèle théorique en épidémiologie des parcours de vie décrivait le mieux sa forme. Cette thèse comprend trois articles: une recension systématique et deux recherches originales. Dans la recension systématique, des recherches ont été faites dans Medline et EMBASE pour trouver les études ayant mesuré la position socio-économique avant l'âge de 18 ans et l'activité physique à ≥18 ans. Dans les deux recherches originales, la modélisation par équations structurelles a été utilisée pour comparer trois modèles alternatifs en épidémiologie des parcours de vie: le modèle d’accumulation de risque avec effets additifs, le modèle d’accumulation de risque avec effet déclenché et le modèle de période critique. Ces modèles ont été comparés dans deux cohortes prospectives représentatives à l'échelle nationale: la 1970 British birth cohort (n=16,571; première recherche) et l’Enquête longitudinale nationale sur les enfants et les jeunes (n=16,903; deuxième recherche). Dans la recension systématique, 10 619 articles ont été passés en revue par deux chercheurs indépendants et 42 ont été retenus. Pour le résultat «activité physique» (tous types et mesures confondus), une association significative avec la position socio-économique durant l’enfance fut trouvée dans 26/42 études (61,9%). Quand seulement l’activité physique durant les loisirs a été considérée, une association significative fut trouvée dans 21/31 études (67,7%). Dans un sous-échantillon de 21 études ayant une méthodologie plus forte, les proportions d’études ayant trouvé une association furent plus hautes : 15/21 (71,4%) pour tous les types et toutes les mesures d’activité physique et 12/15 (80%) pour l’activité physique de loisir seulement. Dans notre première recherche originale sur les données de la British birth cohort, pour la classe sociale, nous avons trouvé que le modèle d’accumulation de risque avec effets additifs s’est ajusté le mieux chez les hommes et les femmes pour l’activité physique de loisir, au travail et durant les transports. Dans notre deuxième recherche originale sur les données canadiennes sur l'activité physique de loisir, nous avons trouvé que chez les hommes, le modèle de période critique s’est ajusté le mieux aux données pour le niveau d’éducation et le revenu, alors que chez les femmes, le modèle d’accumulation de risque avec effets additifs s’est ajusté le mieux pour le revenu, tandis que le niveau d’éducation ne s’est ajusté à aucun des modèles testés. En conclusion, notre recension systématique indique que la position socio-économique au début du parcours de vie est associée à la pratique d'activité physique à l'âge adulte. Les résultats de nos deux recherches originales suggèrent un patron d’associations le mieux représenté par le modèle d’accumulation de risque avec effets additifs.

Voters and Candidates of the Future

Within the literature there is a growing concern about lower voter turnout rates among young age cohorts. In this article we investigate the reported willingness to vote among 72,466 14-year old adolescents from 22 European countries, taking part in the International Citizen and Civic Education Survey (ICCS, 2009). Results indicate that the willingness to vote remains quite high among this age group, but with a clear gender division. While girls are more likely to state that they will vote, boys are more likely to see themselves as a future election candidate. An open classroom climate at school contributes to the willingness to vote in future elections. The elements that are known to have an effect on the turnout level of adults, however, do not have a significant impact on the intention to vote among adolescents. This would suggest that the observed low turnout rate among young age groups cannot just be attributed to an alleged lack of political motivation among adolescents.

Principles of education : drawn from nature and revelation and applied to female education in the upper classes /

Photocopy.

The Indiana survey of religious education.

"Made under the direction of Walter S. Athearn."