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This qualitative study evaluated barriers and facilitators to mobility in the homes of children with medical complexity (CMC) and the subsequent impact on CMC and their families. Eighteen caregivers of CMC were interviewed. Parents described that accessibility barriers impaired delivery of care at home and impacted the child’s participation in family life. The most inaccessible areas were stairs and bathrooms. Mobility and transfers became more difficult as children grew larger. Parents and children sustained injuries from performance of activities of daily living (ADLs). When available, durable medical equipment (DME) and home modifications improved home access and typically were funded using insurance and state Title V funds. However, parents reported that larger home modifications, such as bathroom modifications, were cost prohibitive. A pediatrician’s inquiry about mobility barriers may reveal crucial information about delivery of home care to CMC. CMC may be referred to rehabilitation specialists to address mobility needs.

From July–August, 2020, the nonprofit organization Healthy Democracy convened a seven-week pilot test of an online Citizen Assembly on the state of Oregon's response to the COVID-19 pandemic. This pilot project presented a unique research opportunity, because its organizers had ten years of experience running the Citizens’ Initiative Review, a face-to-face minipublic authorized by the State of Oregon to write voting guides for the wider electorate on ballot measures. This case study compares survey data from the Citizen Assembly pilot with the prior Citizens’ Initiative Reviews and provides analysis and recommendations that could improve the design and execution of future online assemblies.

espanolLa biomedicina en su rama de genetica, ha experimentado grandes progresos cientificos y tecnicos en los ultimos anos, especialmente a partir del descubrimiento del genoma humano. Los avances originados han sobrepasado el ambito de la patologia para continuar los estudios en materia de salud, donde se incluyen las investigaciones de actividad fisica y deporte. Los atletas cuyo objetivo es conseguir el maximo rendimiento, pueden valerse de esta herramienta ilegal de celulas geneticamente modificadas. El abuso de conocimientos y tecnicas adquiridos en el area de la terapia genica es una forma de dopaje, y esta prohibido. Hasta el momento no hay pruebas de que ese dopaje genetico se haya practicado aunque es probable su uso en un breve periodo de tiempo. En el presente trabajo de revision se abordan los aspectos relacionados con la manipulacion genetica en el rendimiento deportivo y especialmente los genes que tienen un efecto directo sobre el comportamiento muscular. Pretendemos dar a conocer la realidad actual, ademas de identificar y analizar las proteinas mas relevantes basadas en el dopaje genetico portuguesA biomedicina, em seu ramo da genetica, experimentou grande progresso cientifico e tecnico nos ultimos anos, especialmente a partir da descoberta do genoma humano. Os avancos realizados foram alem do escopo da patologia para continuar os estudos em saude, o que inclui pesquisas sobre atividade fisica e esporte. Atletas cujo objetivo e atingir o maximo desempenho, podem usar esta ferramenta ilegal de celulas geneticamente modificadas. O abuso de conhecimentos e tecnicas adquiridos na area da terapia genica e uma forma de doping e e proibido. Ate o momento nao ha evidencias de que esse doping genetico tenha sido praticado, embora seja provavel que seu uso ocorra em um curto periodo de tempo. No presente trabalho de revisao sao abordados os aspectos relacionados a manipulacao genetica no desempenho esportivo e, principalmente, os genes que tem efeito direto sobre o comportamento muscular. Pretendemos apresentar a realidade atual, alem de identificar e analisar as proteinas mais relevantes baseadas no doping genetico. EnglishBiomedicine in its genetics branch has experienced great scientific and technical progress in recent years, especially since the discovery of the human genome. The advances added have surpassed the scope of the pathology to continue the studies in the field of health, which includes the investigations of physical activity and sport. Athletes, whose goal is to achieve maximum performance, can use this banned tool of genetically modified cells. Abuse of knowledge and techniques acquired in the field of gene therapy is a form of doping, and is prohibited. So far there is no evidence that this genetic doping has been practiced although it is likely to be used in a short period of time. In the present revision are analyzed the aspects related to the genetic manipulation in the sport performance and especially the genes that have a direct effect on the muscular behavior. We like to done more information about the current reality, and identify and analyze the most relevant proteins based on genetic doping.

This paper presents the results of a systematic review of the empirical literature, reported in research journals, on Mathematics Learner Identity (MLI). In the mathematics education research field, arguments have been made that the conceptualization of Mathematics Identity (MI) is inconsistent and this makes the literature as a whole incoherent. This study aims to summarize how the concept has been employed and to develop an integrative model for analyzing concept-definitions and concept-operationalizations of MLI. An analysis of 69 papers revealed 3 main dimensions that characterized how identity is conceptually defined in any research literature (social/subjective, enacted/representational and change/stability) and 5 main categories that describe how the literature has implemented these dimensions operationally (identity as individual attributes; identity as narratives; identity as a relationship with specific practices; identity as ways of acting; and identities as afforded and constrained by local practices). An emphasis on representational aspects of identities, particularly during higher education, and enacted and practice-related identities during primary and secondary education research was found. The discussion shows how the field would be clarified if studies made their choices of conceptualization clear in terms of these dimensions and categories, and if research as a whole becomes more aware of restrictions/limitations in identity research, particularly at different points of the educational trajectory of students.

In our editorial for volume 21 issue 1 (Jones, Black, & Coles, 2019) we looked back over the previous 21 years of Research in Mathematics Education (RME) to celebrate its growth and development and...

The aim of this article is to explore the structure of social capital in peer networks and its relation to the unequal access of educational resources within mathematics classrooms. We hypothesise that learners can gain access to mathematics through friendship networks which provide more or less help from peers that might sustain (or curtail) their mathematics learning based on a Bourdieusian framework. We report a social network analysis of mutually-recognised helping within friendship groups. This is complemented by observation and interviews that illustrate how different classrooms have different network structures, positioning learners of different ethnic minorities and genders in significantly different ways regarding access to learning. We argue that friendship networks mediate social capital and access to further cultural capital, and that this may help explain structural differences in attainment. Because ethnicity and gender, inter alia, mediate friendship networks, they also mediate access to capital in the classroom.

In this editorial we explain the background to the research papers reported in this special issue, and to some extent how each paper relates to this body of work. In particular we outline the research projects and research teams that worked together between 2006 and 2014 on projects that related to the theme of transition, and we provide the knowledge base on which these papers build.

A wide body of literature has highlighted how high achievement in mathematics in secondary school does not necessarily motivate students to both choose and succeed on mathematically demanding programmes at post-compulsory level. The recent Enterprising Science project (Archer et al. (2015, J. Res. Sci. Teach., 52, 922–948)) and before that, the ASPIRES project (Archer et al. (2013, London: Kings College)), have both highlighted that access to science capital is perhaps more important than prior achievement in shaping students’ aspirations and their future trajectories in Science, Technology, Engineering and Mathematics. In this article, we critically analyse the notion of science capital and its role in mediating students’ choice of and experience of studying mathematically demanding degree programmes at university. Drawing on data from the TransMaths project, we present two cases—Stacey and Elton—who are both enrolled on the same ‘Mathematics for Physics’ course at university. We show that although both discuss access to science capital in narrating their choice of degree, they do so in different ways and this invariably interplays with different forms of identification with ‘Mathematics for Physics’. We conclude that there is a need to re-conceptualize science capital so that the dialectic relationship between its exchange and use value is theorized more fully. Whilst some students may access science capital as a means to accumulate capital (e.g. qualifications) for its own sake (exchange value), others appear to recognize the ‘use value’ of science learning and knowledge and this produces different forms of engagement with science (and mathematics). We therefore argue that authoring oneself in the name of a STEM identity is crucial in mediating how one perceives science capital. Finally, we argue that mathematics should be a central part of this framework since it significantly contributes to the exchange value of science as a form of capital (especially Physics), but it also offers use value in scientific labour (e.g. in modelling scientific problems).

There are many nonsurgical treatment options for patients with upper limb spasticity. This article presents an algorithmic approach to management, encompassing evidence-based rehabilitation therapies, medications, and promising new orthotic and robotic innovations.

This chapter examines how gendered and classed positions are co-constructed and accessed through participation in whole class discussions in the primary mathematics classroom. Using Holland and Bourdieu, we highlight how forms of participation mark out gendered and classed positions in education and how this is mediated through the exchange of capital which takes place locally in whole class discussions. We present evidence regarding the experiences of two girls, Sian and Erica, who appear to take up/enact the contrasting positions of ‘domestique’ and ‘in need of help’, which we argue, are mediated by their perceived ability and gender. Our aim is to highlight the concept of ‘position’ as a means to understand how local participation (classroom level) is structurally mediated by the educational field – thus giving more or less access to the symbolic capital that success in mathematics affords.

A common theme in accounts of choosing mathematics is that of persistence in the face of troubles or difficulties which are often associated with the structuring effects of gender, class, culture and ethnicity. Centring on an analysis of one woman’s account of becoming a mathematician, we build on our understanding of multiple and developing identities with the aim of capturing the nature of individual challenge to structuring discourses and its implications for choice and participation in mathematics more generally. Inspecting how she talks about events in the past, present, and future, we expand on Leont’ev’s (1978, 1981) notion of leading activity to explore how we organise and prioritise activities (and their related identities) within the context of Holland et al.’s (1998) theory of identity in practice, hybridity and world-making. We interrogate the part played by contradiction in creating a space for individual agency through its resolution in hybrid practices and its relation to social change, exploring how our informant narrates taking up mathematics “against the odds” as part of an ongoing process of “re-writing” herself into new imagined worlds. In providing an insight into how one individual envisages and enacts a different mathematics culture in which she can have a place, our analysis suggests ways forward in creating new, more inclusive, mathematics education.

Mathematics has long been known to be problematic for university engineering students and their teachers, for example, Scanlan.[1] This paper presents recent data gathered from interviews with engineering students who experienced problems with mathematics and their lecturers during their transition through the first year in different programme contexts. Our interviews with the students reveal how they understand the relation between engineering and mathematics and we draw on the concept of ‘use- and exchange-value’ to explore this relationship more fully. This paper challenges both the pedagogical practice of teaching non-contextualized mathematics and the lack of transparency regarding the significance of mathematics to engineering. We conclude that the value of mathematics in engineering remains a central problem, and argue that mathematics should be a fundamental concern in the design and practice of first-year engineering.

Inhalant abuse is the intentional inhalation of a volatile substance for the purpose of achieving an altered mental state. As an important, yet underrecognized form of substance abuse, inhalant abuse crosses all demographic, ethnic, and socioeconomic boundaries, causing significant morbidity and mortality in school-aged and older children. This review presents current perspectives on epidemiology, detection, and clinical challenges of inhalant abuse and offers advice regarding the medical and mental health providers' roles in the prevention and management of this substance abuse problem. Also discussed is the misuse of a specific "over-the-counter" dissociative, dextromethorphan.

This study was a pilot which sought to establish whether or not sleep disturbance was an issue for inpatient mentally disordered offenders in a medium secure forensic psychiatric unit. Implications for clinical practice are discussed.

We address the current concerns about teaching‐to‐the‐test and its association with declining dispositions towards further study of mathematics and the consequences for choice of STEM subjects at university. In particular, through a mixed study including a large survey sample of over 1000 students and their teachers, and focussed qualitative case studies, we explored the impact of ‘transmissionist’ pedagogic practices on learning outcomes. We report on the construction and validation of a scale to measure teachers’ self‐reported pedagogy. We then use this measure in combination with the students’ survey data and through regression modelling we illustrate significant associations between the pedagogic measure and students’ mathematics dispositions. Finally, we discuss the potential implications of these results for mathematics education and the STEM agenda.

We examine the transition from school (compulsory education) to college (post-compulsory/pre-university) of students who are continuing their mathematical education. Previous work on transition between institutions suggests that transitional problems can be critical, and students often regard mathematics as ‘difficult’ during transitional periods. However, our analysis of students' interviews showed a more positive discourse, one of reported challenge, growth and achievement; transition was not seen as an obstacle but as an opportunity to develop a new identity. Particularly in relation to mathematics, this was reflected in a need for a better understanding of the subject, and for being more responsible for their learning. Thus, we propose to re-think transition as a question of identity in which persons see themselves developing due to the distinct social and academic demands that the new institution poses. Conceptualising transition in this way could have important practical implications for the way tha...

We seek to illuminate reasons why undertaking mathematics coursework assessment as part of an alternative post-compulsory, pre-university scheme led to higher rates of retention and completion than the traditional route. We focus on the students’ experience of mathematical activity during coursework tasks, which we observed to be qualitatively different to most of the other learning activities observed in lessons. Our analysis of interviews found that these activities offered: (i) a perceived greater depth of understanding; (ii) motivation and learning through modelling and use of technology; (iii) changes in pedagogies and learning activities that supported student-centred learning; and (iv) assessment that better suited some students. Teachers’ interviews reinforced these categories and highlighted some motivational aspects of learning that activity during coursework tasks appears to provide. Thus, we suggest that this experience offered some students different learning opportunities, and that this is a...

The purpose of the study was to re-examine the efficacy of Tuckman’s (1965) model of group development in adventure programming. More specifically, the researchers were interested in comparing Tuckman’s traditional sequential model to more contemporary non-sequential and integrative models that have emerged as alternative ways to conceptualize the process of group development. The researchers used a case study approach (Merriam, 2001) and techniques characteristic of naturalistic inquiry (Lincoln & Guba, 1985) to explore the nature of group development among participants in a weeklong sea kayaking expedition. The researchers concluded that more contemporary models of group development more accurately explained the process of group development in this case study than Tuckman’s (1965) traditional model of group development.

The construct of identity has been used widely in mathematics education in order to understand how students (and teachers) relate to and engage with the subject (Kaasila, 2007; Sfard & Prusak, 2005; Boaler, 2002). Drawing on cultural historical activity theory (CHAT), this paper adopts Leont’ev’s notion of leading activity in order to explore the key ‘significant’ activities that are implicated in the development of students’ reflexive understanding of self and how this may offer differing relations with mathematics. According to Leont’ev (1981), leading activities are those which are significant to the development of the individual’s psyche through the emergence of new motives for engagement. We suggest that alongside new motives for engagement comes a new understanding of self—a leading identity—which reflects a hierarchy of our motives. Narrative analysis of interviews with two students (aged 16–17 years old) in post-compulsory education, Mary and Lee, are presented. Mary holds a stable ‘vocational’ leading identity throughout her narrative and, thus, her motive for studying mathematics is defined by its ‘use value’ in terms of pursuing this vocation. In contrast, Lee develops a leading identity which is focused on the activity of studying and becoming a university student. As such, his motive for study is framed in terms of the exchange value of the qualifications he hopes to obtain. We argue that this empirical grounding of leading activity and leading identity offers new insights into students’ identity development.

This paper reports how students talk about their aspirations in regard to higher education (HE) and their mathematics, what ‘repertoires’ they use to mediate this discourse, and how students’ predominant ‘repertoire style’ relates to their cultural background. Our analyses draw on an interview sample (n=40) of students selected because they are ‘on the cusp’ of participation or non‐participation in mathematically demanding programmes in further and higher education. The interviews explored the students’ aspirations for their future in general and HE in particular, influences on these choices, and the place of mathematics in these. Thematic analysis revealed four interpretative repertoires commonly in use, which we call ‘becoming successful’, ‘personal satisfaction’, ‘vocational’, and ‘idealist’ repertoires. Most of the sample was found to use a single, predominant repertoire, which we call their repertoire ‘style’: what is more, this style is found to be strongly related to background factors independentl...

Recently, classroom talk has re-emerged within educational policy as instrumental in delivering standards-based reform in several counties. In England, both the National Numeracy and Literacy Strategies and the National Strategy for Key Stage 3 emphasised the importance of interactive whole class teaching' (IWT) where pupils are expected to play an active part by answering questions, contributing points to discussions, and explaining and demonstrating their methods and solutions to others in the class' (DfEE, 2001: 26). The aim is to increase the quality of teaching and learning in both the primary and secondary classroom by engaging pupils and demanding active participation. This paper explores the pedagogic value of interactive forms of whole class teaching from a sociocultural standpoint and considers whether policy guidelines (such as those referred to above) incorporate an understanding of teacher - pupil talk which is likely to be effective in terms of promoting children's learning. It also consider...

In this rejoinder we take up some issues raised in the two responses. We go on to offer four questions for an agenda for educational research on subjectivity within the sociocultural and CHAT traditions.

This paper illustrates how classroom discourse demands a multi-layered analysis. The first analysis focuses on classroom discourse and provides a picture of pupil participation in teacher–pupil interactions: who is inducted into discourse and who is not. However, this local micro-analysis does not afford interpretation at the level of the teachers’ intentions, and hence of the way that ideology (e.g. of social class, gender and policy) is mediated by the discourse. Thus, interview data, inter alia, is used to develop themes such as ‘time pressure’, which can then be applied to a second interpretation of the discourse. A final layer of analysis establishes the extent to which such themes can be defined in terms of ‘cultural models’ which are aligned/disaligned with policy and institutional discourses. Thus, the paper illustrates how dialogue can be situated within a socio-cultural framework in which macro-concepts enter the data through discussion of the teacher's intentions.

In this introduction we (i) explain the significance of the concept of subjectivity for educational researchers today, (ii) provide a minimal background literature that the papers draw on, and (iii) introduce each paper of the double issue. We finally somewhat anticipate the rejoinder in the second volume of the double issue.

Background Botulinum toxin type B (BTX-B, Myobloc™, San Francisco, CA, USA) was FDA-approved for the treatment of cervical dystonia in December 2000. It has since been used off-label for the treatment of axillary hyperhidrosis. However, there are sparse data in the medical literature evaluating the safety and efficacy of Myobloc™ (botulinum toxin type B) for this indication. Objective To assess the safety, efficacy and duration of action of Myobloc™ (botulinum toxin type B) in the treatment of bilateral axillary hyperhidrosis. Methods This study was a double-blinded, randomized, pilot study conducted in an outpatient office setting at a private academic medical center beginning in November 2001. Twenty-three male and female volunteers between the ages of 18 and 80 were screened for participation; 20 participants with primary axillary hyperhidrosis were enrolled. Participants were injected subcutaneously with either Myobloc™ (botulinum toxin type B) (2500 U, or 0.5 ml, per axilla) or 0.5 ml vehicle (100 mM NaCl, 10 mM succinate, and 0.5 mg/ml human albumin) into bilateral axillae. Participants who received placebo were rolled over and received Myobloc™ (botulinum toxin type B) at subsequent visits. All participants were followed until sweating returned to baseline levels. This trial was initially conceived as a placebo-controlled study; however, owing to the insufficient size of the placebo group, the placebo arm of this trial was dropped during data analysis. The main outcome measures were safety, efficacy, and duration of effect. Results According to participant assessment of axillary hyperhidrosis improvement (A-HI) and quality of life (A-HQOL) scores and the physician assessment scores, a significant difference was observed in treatment response at Day 30 in the participants receiving Myobloc™ (botulinum toxin type B) injections. Duration of action ranged from 2.2 to 8.1 months (mean 5.0 months). The adverse event profile included bruising, flu-like symptoms, and dry eyes. Conclusion Myobloc™ (botulinum toxin type B) proved to be safe and efficacious for the treatment of bilateral axillary hyperhidrosis. More studies are needed to assess the duration of response using different doses of Myobloc™ (botulinum toxin type B).

The shape and form of effective teacher–pupil talk has recently become the focus of attention within policy guidelines such as the National Numeracy and Literacy Strategies. Prior to this, research on classroom discourse has established that social context plays an important role in determining the quality of teacher–pupil talk since it directs teachers' and pupils' interpretations of what is said. This paper presents a multi-layered approach to the analysis of whole-class discussions which highlights the impact of wider, institutional and historical aspects of the classroom context on the meanings relayed within interactions. Video and audio data, collected over a five-month period of participant observation in a primary school mathematics classroom, highlights how issues such as teacher expectations and time pressure influence the quality of interactions pupils experience. The paper concludes that teacher–pupil interactions play an instrumental role in determining the social positioning of pupils within...

Myobloc, known as Neurobloc in Europe, is a member of the botulinum toxin family. It has been used for a myriad of problems since its approval in the United States in December 2000. It is currently not approved for cosmetic use but has been used for this purpose. This article reviews what is currently known about botulinum toxin type B and its efficacy and safety.

Crow's feet develop with age and are one of the earliest signs of the normal aging process. Botulinum toxin type A, approved by the Food and Drug Administration for the treatment of glabellar wrinkles in April 2002, has been used off-label to treat facial wrinkles since 1981. Botulinum toxin type B (BTX-B, Myobloc) was Food and Drug Administration-approved for use in cervical dystonia in the United States in December 2000 and has subsequently been used in an off-label indication to treat facial wrinkles. There are sparse data in the literature evaluating the safety and efficacy of BTX-B for the treatment of facial wrinkles. In this pilot study, participants with moderate or severe crow's feet wrinkles were treated with Myobloc versus placebo. The duration of correction and side effect profile are reported.

This ex vivo human percutaneous absorption study evaluated a set of six model drugs (ketamine hydrochloride, bupivacaine hydrochloride, diclofenac sodium, gabapentin, orphenadrine citrate, pentoxifylline) from two popular formulations for topically applied compounding preparations. The compounded preparations used in this study were Versatile cream and a reference cream. Each formulation was applied to human trunk skin mounted on Franz Diffusion Cells, 50 mg/chamber (or 28.2 mg/cm2). Serial dermal receiver solutions were collected for 48 hours. Analysis of the resultant data supports the concept that the Versatile base formulation provides improved characteristics relative to the reference base. This is of key importance where the patient does not show clinical improvement when a conventional topical delivery vehicle is used in the formulation. From the results, it is reasonable to anticipate that, relative to the reference formulation, the Versatile formulation provides enhanced transdermal delivery of some analgesic medications.

Recent legislation by the Department for Education and Employment requires schools to produce written home-school agreements, which should be signed by teachers and parents. Among the benefits expected from this initiative is the creation of a greater sense of partnership between home and school, especially with regard to difficult pupil behaviour. However, research has shown that teachers view parents as being the major cause of pupil misbehaviour, thus creating a potential barrier to a genuine partnership around agreed strategies involving home and school. There is also a belief among teachers that strategies devised for one pupil will lead to negative reactions on the part of classmates. This study examines various aspects of the classroom culture (the belief systems of teachers and pupils) concerning interventions with individual pupils, their teachers and parents. A vignette incorporating elements from two real and successful home-school interventions set up with, and mediated by, educational psychol...

This paper investigates treatment for anger and aggression using a variety of methods. Assessments include direct observation, self-recording of frequency of aggressive incidents, self-recording of feelings of aggression, provocation role-plays, and provocation inventories. Treatment approaches include two forms of relaxation (BRT and APR), discussions and exercises on the understanding of emotion, role-plays to develop skills for dealing with feelings of anger, and exercises in the way in which individuals construe various situations. Three participants illustrate how these assessment and treatment methods can be used to tailor treatment to suit the particular problems displayed by individuals. The reasons for choosing particular methods are discussed as are the ways in which individuals respond to the programmes of therapy.

Purpose. Despite increasing evidence that anger may play a contributing role in the violent behaviour of psychiatric patients, as yet there is a dearth of evidence concerning the utility of anger control treatment procedures with this population. This paper describes the development and preliminary evaluation of an anger treatment protocol modified to meet the needs of secure hospital patients. Method. Four patients having recurrent problems of anger and aggression were provided with anger control treatment based on the new protocol. Evaluation of the intervention was based on clinical assessments and by quantified structured interviews obtained post-treatment with each patient's psychiatrist, key worker, and day-care worker. Results. Therapist assessment and clinical staff ratings testifiy to modest but significant treatment gains for patients. Experience from clinical implementation highlights key issues in treatment process and institutional system integration for achieving efficacy. Conclusions. The results support the application of anger control treatment procedures to severely disordered psychiatric patients in a forensic institution. Given the preliminary nature of this evidence, and in the absence of a controlled clinical trial, continued work is needed on treatment and research protocols.

In this paper we describe the validation of two scales constructed to measure pre-university students' changing disposition (i) to enter Higher Education (HE) and (ii) to further study mathematically-demanding subjects. Items were selected drawing on interview data, and on a model of disposition as socially- as well as self- attributed. Rasch analyses showed that the two scales each produce robust one-dimensional measures on what we call a 'strength of commitment to enter HE' and 'disposition to study mathematically-demanding subjects further' respectively. However, the former scale was initially found to suffer psychometrically from a ceiling effect, which we 'corrected' by adding some harder items at a later data point, and revised the scale according to our interpretation of subsequent results. We finally discuss the potential significance of the constructed measures of learning outcomes, as variables in monitoring or even explaining students' progress into different subjects in HE.

Vorapaxar is an orally active protease-activated receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet aggregation. This open-label study assessed the pharmacokinetics and pharmacodynamics of single-dose warfarin in the presence/absence of multiple-dose vorapaxar in 12 healthy men.Subjects received two treatments separated by ≥ 7-day washout: Treatment A warfarin 25 mg (Day 1); Treatment B vorapaxar 2.5 mg/day on Days 1-6 and vorapaxar 40 mg coadministered with warfarin 25 mg (Day 7). R-warfarin, S-warfarin, and prothrombin time (PT) were assayed predose and up to 120 h postdose.The geometric mean ratio (GMR) as a percentage (warfarin + vorapaxar/warfarin) was calculated. The GMR (90 % CIs) estimates of C(max) were 105 (99, 111) and 105 (99, 112) for R- and S-warfarin, respectively. The GMR (90 % CIs) estimates of AUC(0-∞) were 108 (101, 116) and 105 (96, 115) for R- and S-warfarin, respectively. The GMR (95 % CIs) estimates of AUC(0-120 h) for PT and INR were 97 (95, 98) and 96 (94, 98), respectively.Results of this study indicate that vorapaxar has no meaningful effect on the pharmacokinetics or pharmacodynamics of warfarin, suggesting that the coadministration of these two drugs or vorapaxar coadministered with other CYP2C9/CYP2C19 substrates is unlikely to cause a clinically significant pharmacokinetic drug interaction.

This book brings together scholars working in the field of mathematics education to examine the ways in which learners form particular relationships with mathematics in the context of formal schooling. While demand for the mathematically literate citizen increases, many learners continue to reject mathematics and experience it as excluding and exclusive, even when they succeed at it. In exploring this phenomenon, this volume focuses on learners' developing sense of self and their understanding of the part played by mathematics in it. It recognizes the part played by emotional responses, the functioning of classroom communities of practice, and by discourses of mathematics education in this process. It thus blends perspectives from psychoanalysis, socio-cultural theory and discursive approaches in a focus on the classic issues of selection and assessment, pedagogy, curriculum, choice, and teacher development.

Whole-class discussions have long been the focus of much research. They are a dominant practice in many classrooms and are, potentially, key sites for fostering children’s learning (Barnes, 1976; Cazden, 2001; Edwards & Mercer, 1987; Wells, 1999). In England, we have seen the endorsement of whole-class teaching within educational policy (Department for Education and Employment (DfEE), 1998, 1999, 2001), not only as a pedagogic tool for standards-based educational reform (Reynolds & Muijs, 1999), but also as a means to achieving inclusivity within an increasingly diverse classroom environment. For example, the National Literacy Strategy Framework for Teaching introduced the notion of interactive whole class teaching, stating that it benefits children who need help to access the curriculum for example low attainers, those with special needs or limited fluency in English, by introducing them to challenging work, teaching them skills in a highly supportive context and raising their expectations and self esteem. (DfEE, 1998, p. 96)

1. Although nurses are at considerable risk for assaults, there are few practical and specific guidelines for controlling anger and aggression. 2. A training course was developed to give staff the necessary skills and knowledge to cope with clients who have the potential to become angry and assaultive, or those who have already become violent. 3. Participants in the training course felt more confident in managing potentially violent situations, and they reported relying on methods to de-escalate the situation to halt a sequence that would ultimately lead to violence.

Alitretinoin (9-cis-retinoic acid) is an FDA-approved topical therapy for the treatment of Kaposi sarcoma. Alitretinoin is a naturally occurring endogenous retinoid that binds to and activates all known intracellular retinoic acid receptor (RAR) subtypes alpha, beta, and gamma and retinoic X receptor (RXR) subtypes alpha, beta, and gamma. Photoaging of the skin is the result of accumulated exposure to solar UV radiation. Several topically applied retinoids have been proven clinically effective for treating the appearance of photoaging. Tretinoin and tazarotene, which have been shown to improve photodamaged skin, bind RAR subtypes only. The theoretic benefit of alitretinoin gel 0.1% (Panretin) in the treatment of photoaged skin stems from the binding and activation of both RARs and RXRs, which promote the repair mechanisms in damaged skin. The objective of this study was to evaluate the safety and efficacy of topical alitretinoin gel 0.1% in the treatment of photodamaged skin. The treatment was well tolerated by participants (N=20) and subjectively showed improvement of benign skin lesions (eg, seborrheic keratoses) and precancerous lesions (eg, actinic keratoses). Larger, blinded, controlled trials are needed to investigate the role of this novel retinoid in the treatment of photoaging.

Background Palmar hyperhidrosis is a problem of unknown etiology that affects patients both socially and professionally. Botulinum toxin type B (Myobloc), approved by the Food and Drug Administration for use in the treatment of cervical dystonia in the United States in December 2000, has subsequently been used effectively in an off-label indication to treat hyperhidrosis. There are sparse data, however, in the literature evaluating the safety and efficacy of BTX-B for the treatment of palmar hyperhidrosis. Objective We evaluated the safety and efficacy of Myobloc in the treatment of bilateral palmar hyperhidrosis. This was a double-blind, randomized, placebo-controlled study to report on the safety and efficacy of Myobloc. Methods Twenty participants (10 men, 10 women) diagnosed with palmar hyperhidrosis were injected with either Myobloc (5,000 U per palm) or a 1.0 mL vehicle (100 mM NaCl, 10 mM succinate, and 0.5 mg/mL human albumin) into bilateral palms (15 Myobloc, 5 placebo). The participants were followed until sweating returned to baseline levels. The main outcome measures were safety, efficacy versus placebo, and duration of effect. Results A significant difference was found in treatment response at day 30, as determined by participant assessments, between 15 participants injected with Myobloc and 3 participants injected with placebo. The duration of action, calculated in the 17 participants who received Myobloc injections and completed the study, ranged from 2.3 to 4.9 months, with a mean duration of 3.8 months. The single most reported adverse event was dry mouth or throat, which was reported by 18 of 20 participants. The adverse event profile also included indigestion or heartburn (60%), excessively dry hands (60%), muscle weakness (60%), and decreased grip strength (50%). Conclusion Myobloc proved to be efficacious for the treatment of palmar hyperhidrosis. Myobloc had a rapid onset, with most participants responding within 1 week. The duration of action ranged from 2.3 to 4.9 months, with a mean of 3.8 months. The adverse event profile included dry mouth, indigestion or heartburn, excessively dry hands, muscle weakness, and decreased grip strength. MYOBLOC WAS PROVIDED FOR THIS STUDY BY ELAN PHARMACEUTICALS.

Therapeutic interventions for anger and aggression have progressed significantly in the past decade, yet the treatment of this very problematic emotion/action complex remains neglected among seriously disordered populations. Recent work by Howells and his colleagues (Howells, 1989; Howells & Hollin, 1989; Levey & Howells, 1991) has certainly provided an impetus to addressing problems of anger, aggression, and violence among institutionalized patients.1 Most assuredly, the management of patients’ aggressive behavior presents formidable challenges to clinical staff who must be concerned with risks to themselves and to the welfare of other patients. Moreover, a patient’s inability to control aggressive behavior will certainly forestall discharge and perpetually remain a liability for social adaptation. Because assaultive behavior is often mediated by anger, treatment procedures that aim to provide clients with anger-control capabilities are important therapeutic resources, especially be-cause they seek to promote anger regulatory competency through the development of coping skills that have larger implications for psychosocial adjustment.