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Purpose: This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. Method: We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. Results: The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. Conclusion: Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.

398 Background: Phase III studies have shown a survival benefit for the addition of immune checkpoint inhibitors to conventional chemotherapy for patients with gastroesophageal cancer (GEC). Large scale studies of chemoimmunotherapy prior to and after surgery are under way. We sought to characterise the effects of the PDL1 inhibitor durvalumab (D) with standard neo-adjuvant chemo(radio)therapy regimens in an open label phase I/II study in patients (pts) with operable GEC (LUD2015-005, NCT02735239, EudraCT 2015-005298-19). Methods: In pts identified as suitable for potentially curative surgery we gave D (750mg q2w) alongside their standard treatment. Pts had D only at first then Oxaliplatin and Capecitabine (CapOx) q3w or fluorouracil, leucovorin, oxaliplatin and taxotere (FLOT) starting with the third cycle of D. Chemotherapy and further D were given for 6 (CapOx) or 8 (FLOT) weeks before pts had surgery and for up to 12 further infusions of D after operation. Patients on FLOT could also have more chemotherapy. Pts suitable for chemoradiotherapy (CXRT, CROSS regimen) were offered two cycles of D before starting their treatment, and were able to have up to 12 further cycles after recovering from surgery. Participants were followed for toxicity, response and survival from the time of study enrolment until death, for 3 years or until June 2022 when the study ended. Results: 11 pts received D-CapOx, 9 D-FLOT and 15 D-CXRT. All were evaluable for safety and efficacy. Treatment side effects were as expected for the agents used with diarrhoea, nausea and fatigue the most commonly reported and no new safety signals. 156 of 160 planned pre-op D doses were given. Only 2 out of 35 patients did not have surgery, both due to progressive disease on D-CXRT. 23 of the 33 patients having surgery had post-operative treatment. Amongst 33 evaluable pts 2 (5.7%) and 6 (17.1%) had complete or partial pre-op responses (RECIST) and 3 (8.6%) progression prior to surgery. Tumor regression at surgery (Mandard 1-3) occurred in 24/33 pts. Median recurrence free survival was 25.4 months (mo) (D-CapOx), 32.0 mo (D-FLOT) and not reached (D-CXRT). 2 year survival was 81.8%, 77.8% and 77.8% respectively in the 3 arms. Conclusions: Adding D to standard neo-adjuvant regimens for GEC is well tolerated. Survival times and response rates exceeded those expected for the regimens used (2 year survivals with FLOT 68% and CROSS 67%) in this non-randomised multi-centre trial. Clinical trial information: NCT02735239 .

Investigative laboratory modules (labs) can introduce undergraduates to relatively advanced statistical methods from a variety of disciplines. The labs described in this article encourage students early in their undergraduate studies to experience the role of a research scientist and to understand how statistics help advance scientific knowledge. By making students grapple with intriguing real-world problems that demonstrate the intellectual content and broad applicability of statistics as a discipline, these labs encourage students to consider a career in statistics or to incorporate statistical thinking into any career. These materials offer many potential uses: they can be combined to form a second statistics course; they can be incorporated as a final project in an introductory statistics course; or they can be used individually to demonstrate to students and researchers in other disciplines how statisticians approach the scientific process.

This paper looks at corporate social responsibility in the context of public and stakeholder dialogue and engagement. It demonstrates how this can contribute to the development of a long-term environmental management strategy. It shows how government, stakeholder and economic pressure can encourage companies to positively engage their stakeholders. Using an example from the nuclear industry the paper describes how the importance of engaging in stakeholder dialogue and consultation has been recognized and how this can contribute to more positive stakeholder relationships. In 2002, AWE plc commissioned a major independent public and stakeholder consultation exercise (Project PASCALEA). Environmental Consultants from NNC Ltd. were commissioned to manage and execute the project, together with recognized consultation specialists from the IEPPP, Lancaster University. The case study gives an insight into the consultation methodology adopted and evaluates how the outcomes from the project contributed towards the successful delivery of AWE's corporate environmental management goals. Copyright © 2004 John Wiley & Sons, Ltd and ERP Environment.

The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock’s Informed Decision Making Scale (Braddock et al., 1997; 1999; 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was “exploration of consumer preference,” with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM.

The present study used a social-cognitive model to examine the perceptions and beliefs of secondary-school students in relation to aggressive behaviour. It also investigated the effectiveness of a ...

Primary objective: This paper examined the use of an atypical neuroleptic medication, risperidone, in reducing the excessive motor activity of an adolescent with an anoxic brain injury following cardiac arrest from a lightning strike. Lower extremity restlessness caused the patient to develop skin breakdown and interfered with healing of existing burns. Research design: Single-blind, placebo-controlled single-subject experimental design. Experimental intervention: Escalating doses of risperidone up to 1 mg and in combination with methylphenidate (10 mg) and amantidine (100 mg). Main outcomes and results: The patient demonstrated a reduction in restlessness in response to the use of risperidone, which permitted wound healing. The addition of methlphenidate to risperidone led to a slight increase in attention to task. Conclusions: The use of the atypical neuroleptic medication, risperidone, may be considered as part of the armamentarium available to physicians treating restlessness in severe brain injuries.

The tombs at Vergina in Macedonia continue to produce more questions than answers. At the 1990 Annual Meeting of the Archaeological Institute in San Francisco a colloquium entitled ‘The royal tombs at Vergina: continuing issues’ was presented on these tombs, their dating, and their possible inhabitants. The participants in this colloquium were not in agreement about the identity of those laid to rest in the tombs, or when these burials took place, or the nature of the grave goods which accompanied the funerary rituals. We must continue to anticipate and hope for progress in the debate over these crucial questions.

A randomized controlled trial compared recovery characteristics after selective spinal anaesthesia (SSA) or propofol general anaesthesia (GA) for short-duration outpatient laparoscopic surgery. Forty women were randomized to receive either SSA (1% lidocaine 10 mg, sufentanil 10 microg and sterile water 1.8 ml) or GA (propofol and nitrous oxide 50% in oxygen). Compared with the GA group, times to leaving the operating room, performing a straight leg raise, performing deep knee-bends and achieving an Aldrete score9 and the time in Phase II recovery were significantly shorter (P0.05) in the SSA group.

To apply a population pharmacodynamic model to small-dose hypobaric spinal anesthesia for outpatient laparoscopy.The level of spinal analgesia after spinal blockade with small-dose (20-25 mg) hypobaric lidocaine was assessed by means of pinprick in patients undergoing outpatient laparoscopy. In 57 patients, 385 measurements were available for analysis. We first modelled the data for each patient with a mixed-effects model described by Schnider (Model 1). The population mean parameters, inter-individual variance, and residual variance were estimated. Clinically important endpoints (time to reach T10 (onset), time to maximal level, duration and maximally attained level) of each patient were calculated based on the estimated time course of analgesia level for each patient. The model was used to predict the later data with respect to level of spinal analgesia of each patient from fits based on the observed data in the first 75 min.The mean +/- SD onset time was 8.3 +/- 1.9 min, time to maximal level was 20.8 +/- 5.3 min, duration of effect was 37.9 +/- 13.1 min, and mean maximal level was T5. There was a good correlation (R2 = 0.90) between the observed levels of analgesia and those predicted from the model. Data from the first 75 min predicted the later observed data for each patient moderately well (R2 = 0.38).A population pharmacodynamic model was applied to low-dose hypobaric lidocaine spinal anesthesia. Clinically important endpoints were determined and forecasting of later data with respect to level of spinal analgesia was attempted. Such an approach may be useful in the management of low-dose spinal anesthetic techniques in outpatients.

To compare intubating conditions and postoperative myalgias in outpatients after intubation with propofol/alfentanil compared with propofol/alfentanil/succinylcholine with and without precurarisation with d-tubocurarine.144 ASA I-II ambulatory patients for dental extraction under anesthesia were studied. Subjects received either 3 mg d-tubocurarine (Group II) or saline (Groups I, III) i.v. prior to induction of anesthesia with 20 microg x kg(-1) alfentanil and 2.5 mg x kg(-1) propofol followed by 1.5 mg x kg(-1) succinylcholine (II and III) or saline 0.9% (I) for muscle relaxation. The ease of airway management and the postoperative incidence, severity and distribution of muscle pains were examined.Intubation was successful in all patients and there were no differences in jaw mobility, ease of bag-mask ventilation, visualization of the vocal cords or cord position. Limb movement was more common during intubation in Group I (37.5%) than in Group III (8.3%) or Group II (2%), P0.05. At home, VAS scores for myalgia were higher in Group III than in Group I and II. Neck myalgia was more common in Group II (72%) than in Groups II (44%) and I (41%), P0.05. Myalgias were also more common in Group III patients (P0.05).Acceptable intubating conditions were achieved with propofol and alfentanil alone. Succinylcholine reduced limb movement during intubation but was associated with postoperative myalgias for up to five days. Precurarisation with tubocurarine reduced the severity of succinylcholine myalgia.

leges, the system's mission is complex: we offer general education and the two-year associate degree, prepare students who plan to transfer to four-year colleges or universities, and serve students seeking occupational education and certification, a single class to upgrade a skill, or simply enrichment. Among those 2.5 million students are many who need to do further precollegiate work and a large contingent one in five who are recent immigrants or English-language learners. Most of our students are older than those in traditional four

The socioeconomic, demographic, and educational characteristics of 24 pregnant and 24 non-pregnant adolescents, 17 years and under, living in Travis County, Texas, were deter mined. The objectives of phase 1 of an ongoing longitudinal study were to initiate the study, to obtain base line data, and to define the descriptive data. Findings in the population studied in cluded the following: 38 percent of the pregnant adolescents were Mexican-American; 38 per cent of the pregnant adolescents had a gynecologic age of 3 or less; the grade level discrepancy ranged from 1 to 3 years for all subjects, both controls and pregnant adolescents; and 63 per cent of the students planned to place their child in the school nursery while completing their education. Socioeconomic and demographic data included age, age at menarche, home environment, parents' occupation and educational level, number of children living at home, and percentage of students working while they are pregnant.

Treatment of Dexter-type long-term bone marrow cultures with the antibiotic mycophenolic acid (MPA) eliminates all hemopoietic cells from the cultures, while a morphologically intact, adherent stromal cell layer is retained. The ability of these MPA treated stromal cell cultures to support long-term hemopoiesis was tested by seeding them with fresh bone marrow cells that had been passed through nylon wool. This procedure yields a relatively stromal cell depleted population of hemopoietic cells. An aliquot of 5 X 10(5) or 2.5 X 10(5) nylon wool passed bone marrow cells bearing the T6 chromosomal marker was seeded onto replicate MPA-treated stromal cell layers. The stromal cells stimulated the proliferation of the bone marrow cells, and nonadherent cells were present for up to 8 weeks of culture. Progenitors of granulocytes and macrophages (CFU-GM) were also present for this period of time despite weekly demi-depopulation, during culture feeding. Karyotypic analysis confirmed that the CFU-GM were derived from the reseeded population. Nylon wool-passed bone marrow cells seeded alone into empty flasks under identical conditions did not survive past 1 week. Cells from the reseeded cultures were also tested for early myeloid precursors (CFU-S) and injected into immunodeficient CBA/N mice to test for the presence of primitive B cell precursors. CFU-S were present in mice killed 11 days following injection of cells, and high levels of B cell colony-forming units (CFU-B) were present in mice 4 weeks post reconstitution. Further studies demonstrated that factors present in medium conditioned by the stromal cells could support the growth of CFU-GM. These data indicate that treatment of long-term bone marrow cultures with MPA results in a population of functional stromal cells.

Two kitteens with progressive neurologic disease had increased concentrations of GM2 ganglioside in their cerebral cortex. Examination under the light microscope revealed cytoplasmic vacuolation of neurons and hepatocytes. Transmission and scanning electron microscopy demosntrated cytoplasmic inclusions encompassed by membranes in various central nervous system cell types and in hepatocytes. Beta-D-N-acetyl-hexosaminidase activity was reduced to about 1.0 percent of normal in brain, liver, and cultured skin fibroblasts of the diseased kittens; both major electrophoretic forms, A and B, of the enzyme were deficient. In fibroblasts from the parents of the diseased kittens, this enzyme activity was intermediate between that of affected and normal cats, suggesting an autosomal recessive mode of inheritance of the enzyme defect. Histopahtological and ultrastructural lesions, glycolipid storage, enzyme defect, and pattern of inheritance are similar to those of human GM2 gangliosidosis type 2.

The morphologic changes of viral leukoencephalomyelitis of goats (VLG), an afebrile paralytic disease of 2–4 month old kids, were studied in 13 naturally infected goats: 11 during the first 5–22 days of clinical disease and two that survived 8 months and 3 years after onset of clinical signs. Lesions in the early clinical phase of the disease included interstitial pneumonia and widely disseminated myelinoclastic perivascular lesions in the brain and spinal cord. In the central nervous system, hypertrophied and hyperplastic reticulin fibers of the vascular sheath encompassed an inflammatory cell infiltrate composed of lymphocytes, plasma cells, and macrophages. Occasionally, malacia occurred, and several animals had transverse myelitis. Neuronal necrosis and neuronophagia were not features of the disease. Lesions were most frequent in the subpia and subependyma. Pulmonary lesions were not present in goats that survived the initial clinical phase of the disease, but myelin had disappeared from large areas of the spinal cord and from small foci in the brain. Nodular accumulations of mononuclear cells and small perivascular cuffs were also present in the central nervous system. VLG resembles visna in the topographic distribution and myelinoclastic nature of its lesions. Like visna, it bears some resemblance to post-infectious encephalitis of man.