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Objective. Studies have shown that platelets play an important role in the pathophysiology of vaso-occlusive crises (VOC) in sickle cell disease. This study investigates whether changes in platelet indices from baseline can be predictive of complications during acute pain crisis. Methods. Data were obtained from pediatric sickle cell patients in the well-clinic setting and compared with data gathered during VOC (n = 67). Primary outcome was complicated (admission, acute chest syndrome, transfusion, etc) versus uncomplicated (discharge from emergency department without subsequent return) course. Results. Patients with uncomplicated courses had larger platelet declines (53.7) than those with complicated courses (14.8, P = .005). Conclusions. The study suggests that patients with uncomplicated VOC are more likely to experience a larger decline in platelets. The predictive value is limited by the need to have preexisting steady-state data and relatively small decline. Ongoing studies are needed to identify useful laboratory data to help predict severity of VOC. [ABSTRACT FROM PUBLISHER]

Currently school reform discourse encourages states to adopt college readiness standards. Meanwhile, federal and state accountability and related mandated reforms remain a policy concern. As such, it is important to examine the interplay between accountability and the establishment of a college-going culture in high "minority", high poverty high schools. This qualitative case study integrated critical ethnographic approaches to examine how a high "minority", high poverty enrollment high school negotiated the politics of implementing a college-going culture in the midst of responding to state accountability sanctions. In-depth interviews with faculty and students as well as observations revealed that the state accountability sanctions were not the only stressors that conflicted with the establishment of a college-going culture. Multiple sociopolitical factors precipitated a negative academic climate as well. For instance, pressures to improve the high school's poor accountability rating led to a school-wide instructional focus on the state exit exam, which interfered with the school's college-going culture. Finally, while the school offered programs and supports that provided college information, this information was not disseminated in a systematic way that would reach all students. [ABSTRACT FROM AUTHOR]