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Systemic Changes (systemic + change)
Selected AbstractsSoluble Interleukin-2 Receptors Increase During the Active Periods in Cluster HeadacheHEADACHE, Issue 1 2003M. Empl MD Objective.,To investigate whether cytokines are altered during the active period of cluster headache. Background.,Patients with cluster headache show activation of the hypothalamus in PET studies and via endocrinologic parameters. Data also suggest an inflammatory process occurs in cluster headache. A connection between the presumed inflammatory cause, an immunological activation, and the hypothalamus could be generated by certain cytokines. Design and Methods.,ELISA was used to determine the serum levels of soluble interleukin-2 receptors, interleukin-1, interleukin-6, and 2 soluble interleukin-6 receptors (sIL-6R and soluble gp130) in 18 patients with cluster headache (6 women and 12 men) during the cluster period and in 17 healthy controls who were headache-free (3 women and 14 men). Results.,Patients with cluster headache had significantly increased soluble interleukin-2 receptors (413.6±223 U/mL vs. 290.0±112 U/mL; P < .05) compared with controls. Serum levels of interleukin-1 (0.29±0.30 pg/mL vs. 0.13±0.13 pg/mL, n.s.), interleukin-6 (0.87±0.6 pg/mL vs. 0.91±0.7 pg/ml; n.s.), soluble interleukin-6 receptors (33,131±8,349 pg/mL vs. 35,063±7,606 pg/mL; n.s.), or soluble gp130 (289±59 pg/mL vs. 283±20 pg/mL; n.s.) did not differ between the 2 groups, although patients with cluster tended to have higher interleukin-1 values. Conclusions.,Because elevated soluble interleukin-2 receptors indicate T cell activation, our findings suggest immune activation during cluster headache. Because interleukin-2 can activate the hypothalamus and stimulate the release of Corticotropin-releasing Factor (CRF), interleukin-2 could link a putative immunological cause of cluster headache with the observed hypothalamic activation. Systemic changes of interleukin-1 or the interleukin-6 system do not seem to play a role in cluster headache, as no alterations of serum levels were observed. Even so, unchanged serum levels do not exclude limited local production. [source] The Sino,Russian Partnership and U.S. Policy Toward North Korea: From Hegemony to Concert in Northeast AsiaINTERNATIONAL STUDIES QUARTERLY, Issue 3 2005David Kerr This paper presents two sets of arguments: one theoretical and one analytical. The theoretical arguments concern the relationship between regional ordering and systemic change. The paper questions the usefulness of the unipolar conception of the contemporary system arguing that the interaction of the Great Powers cannot be understood without reference to regional dynamics. Thus, a unipolar system implies considerable potential for U.S. hegemonic intervention at the regional level but in East Asia, we find an equilibrium constructed out of both material and normative forces, defined as a concert, which presents a considerable restraint on all powers, including the U.S. The paper then proceeds to examine these claims through an analysis of the foreign policies of the U.S., Russia, and China over the North Korean nuclear problem that emerged after 2002. It finds that China and Russia have substantive common interests arising from internal and external re-ordering in which they look to strategic partnerships, regional multilateralism, and systemic multipolarization as inter-locking processes. The paper finds that they have collaborated over the Korean crisis to prevent a U.S. unilateral solution but that this should not be construed as a success for an open counterhegemonic strategy as it was only under the constraining conditions of East Asian concert, including the dynamics within the U.S. alliance systems, that this collaboration was successful. Nevertheless, the paper concludes that regional multipolarity and systemic unipolarity are contradictory: a system that exhibits multipolarization at the regional level cannot be characterized as unipolar at the global level. [source] Enacting reform-based science materials: The range of teacher enactments in reform classrooms,,JOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 3 2005Rebecca M. Schneider To promote large-scale science education reform, developers must create innovations that teachers can use to learn and enact new practices. As part of an urban systemic reform effort, science materials were designed to reflect desired reforms and to support teacher thinking by addressing necessary content, pedagogy, and pedagogical content knowledge for teachers. The goal of this research was to describe teachers' enactments in comparison to reform as instantiated in the materials. Four middle school teachers' initial enactment of an inquiry-based science unit on force and motion were analyzed. Findings indicate two teachers' enactments were consistent with intentions and two teachers' enactments were not. However, enactment ratings for the first two were less reflective of curriculum intent when challenges were greatest, such as when teachers attempted to present challenging science ideas, respond to students' ideas, structure investigations, guide small-group discussions, or make adaptations. Overall, findings suggest that purposefully using materials with detailed lesson descriptions and specific, consistent supports for teacher thinking can help teachers with enactment. However, materials alone are not sufficient; reform efforts must include professional development and efforts to create systemic change in context and policy to support teacher learning and classroom enactment. © 2005 Wiley Periodicals, Inc. J Res Sci Teach 42: 283,312, 2005 [source] Dealing with uncertainty: adaptive approaches to sustainable river managementAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 4 2002M.J. CLARKArticle first published online: 5 AUG 200 Abstract 1.Sustainable river management is the proclaimed aim of many agencies and institutions, but it remains challenging to bring this worthy ideal from the level of political rhetoric to that of practical river management. 2.Amongst the many drivers that already pressure the river manager, from internal institutional goals, through political aspirations to systemic change within the biophysical process system, one common element emerges, that of prevailing uncertainty. 3.Once it has been accepted that conventional science and engineering approaches to uncertainty (risk) minimization may be sub-optimal in a truly holistic (biophysical, socio-economic, political) system, the challenge emerges of developing a more appropriate framework without destroying over-burdened managers and management systems in the process. 4.It is argued that the necessary components are often already in place or under consideration. A linked model is proposed comprising practical measures of sustainability, robust approaches to uncertainty (if necessary, involving attitude change), responsive (adaptive) management frameworks, and an important underpinning of fuzzy decision support. Copyright © 2002 John Wiley & Sons, Ltd. [source] INCLUSION: Confusion about inclusion: patching up or system change?BRITISH JOURNAL OF SPECIAL EDUCATION, Issue 3 2008Klaus Wedell In this article, Klaus Wedell, Emeritus Professor at the Institute of Education, University of London, looks back over 35 years of developments in the worlds of special and inclusive education. He engages directly with the complexities , for example, the tensions between the standards agenda and policy on inclusion , that have led some commentators to adopt controversial positions and that have engendered heated debate. Klaus Wedell also discusses a dilemma that is emerging as a key issue in the field , the relationships between ,difference', stigma, equality of opportunity and ,special' or separate provision. The response provided here takes, as a starting point, the notion of a flexible education system that could recognise diversity among learners while making provision for all. Klaus Wedell explores this possibility in terms of the curriculum, pedagogy, school structures and local authorities. He indicates points at which policies contradict one another and where practice has not evolved to address the challenges raised by innovative thinking. He provides evidence of the need for systemic change. He argues that all young people should be valued as individuals so that the differences between them can be acknowledged without prejudice. Only in this way, suggests Klaus Wedell, can the artificial separation of special educational needs policy and mainstream thinking be ended. [source] The Abortion Debate in Mexico: Realities and Stalled Policy ReformBULLETIN OF LATIN AMERICAN RESEARCH, Issue 1 2007ANDRZEJ KULCZYCKI Over 500,000 clandestine abortions occur annually in Mexico, many under unfavourable health conditions. An uneasy silence about this situation has long prevailed. Since the 1970s, abortion has appeared periodically in public discourse and on the decision-making agenda, only for action to be repeatedly postponed. Mobilisation around the abortion issue grew slowly, but debate and controversy became nationwide as the country began to experience systemic change in 2000. Despite increasing political pluralism and growing awareness of the existing problems, for now in Mexico, as elsewhere in Latin America, the question of abortion is not judged sufficiently pressing to merit major policy change. However, improved contraceptive use and the institution of new technologies and post-abortion care are helping to make abortions safer and rarer. [source] Reflections on training in child abuse and neglect prevention: Experiences in BrazilCHILD ABUSE REVIEW, Issue 6 2007Victoria Gabrielle Lidchi Abstract In cooperation with an international partner, Brazilian professionals based in Rio de Janeiro designed a training programme in child protection to respond to the particular challenges to effective practice posed by the local environment and to address obstacles to its achievement in the existing child protection system. Training participants used a structured process to identify and address such external challenges and internal obstacles. The use of the framework included an exploration of beliefs held by Brazilian child protection professionals. The training was itself envisaged as an intervention opportunity for participants to promote ,bottom up' processes of local systemic change. The programme aimed to provide training that accessed the experience of the international partner's ,community of expertise', but mitigated the risk to effectiveness of a ,transplant' programme that fails to engage with the surrounding social reality and culture. As part of a nine-country international training project initiative (ITPI, International Training Project Initiative by ISPCAN) sponsored by the International Society for the Prevention of Child Abuse and Neglect (ISPCAN), standardised tools were adopted to monitor and evaluate the training process. Copyright © 2007 John Wiley & Sons, Ltd. [source] Field evidence for indirect interactions between foliar-feeding insect and root-feeding nematode communities on Nicotiana tabacumECOLOGICAL ENTOMOLOGY, Issue 2 2009IAN KAPLAN Abstract 1.,As herbivory often elicits systemic changes in plant traits, indirect interactions via induced plant responses may be a pervasive feature structuring herbivore communities. Although the importance of this phenomenon has been emphasised for herbivorous insects, it is unknown if and how induced responses contribute to the organisation of other major phytoparasitic taxa. 2.,Survey and experimental field studies were used to investigate the role of plants in linking the dynamics of foliar-feeding insects and root-feeding nematodes on tobacco, Nicotiana tabacum. 3.,Plant-mediated interactions between insects and nematodes could largely be differentiated by insect feeding guild, with positive insect,nematode interactions predominating with leaf-chewing insects (caterpillars) and negative interactions occurring with sap-feeding insects (aphids). For example, insect defoliation was positively correlated with the abundance of root-feeding nematodes, but aphids and nematodes were negatively correlated. Experimental field manipulations of foliar insect and nematode root herbivory also tended to support this outcome. 4.,Overall, these results suggest that plants indirectly link the dynamics of divergent consumer taxa in spatially distinct ecosystems. This lends support to the growing perception that plants play a critical role in propagating indirect effects among a diverse assemblage of consumers. [source] Integrating education into primary care quality and cost improvement at an academic medical centerTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2006R. Van Harrison PhD Abstract Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical clinical guidelines for common medical conditions; measure and provide feedback on physicians' performance; and facilitate systemic changes to support appropriate care. Various methods are used to improve care, including evidence reviews, formal education, informal clinical "opinion leaders," feedback, reminders, and procedure changes. Twenty-four common medical conditions have been addressed through this process. More than 30 measures of clinical performance have been developed and reported. Methods: This case study describes a systematic, multifaceted program to improve the quality and cost-effectiveness of primary care. Results: Illustrative results for clinical performance are presented for 2 measures of chronic care, 2 measures of preventive care, and 2 measures of acute care. All 6 measures show general improvement in performance across years, with performance near or above the National Committee for Quality Assurance's 90th percentile for Health Plan Employer Data and Information Set measures. Discussion: A systematic approach involving all relevant components of a health system integrates the synthesis of information, education about the information and how to implement it, and addressing operational barriers. Benefits include a curriculum that is shared across faculty, residents, and medical students and more uniform quality of care that faculty model for physicians-in-training. [source] Hospital-Physician Collaboration: Landscape of Economic Integration and Impact on Clinical IntegrationTHE MILBANK QUARTERLY, Issue 3 2008LAWTON ROBERT BURNS Context: Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P). Methods: This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration. Findings: The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians. Conclusions: Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously. [source] Tobacco Screening Multicomponent Quality Improvement Network Program: Beyond EducationACADEMIC EMERGENCY MEDICINE, Issue 11 2009Sharon Kimmel PhD Abstract Objectives:, Due to the addictive nature of the disease and interrelated societal influences on the behavior of tobacco use, repeated interventions are often required before people successfully stop using tobacco. Our objective was to implement a multicomponent clinical intervention initiative enabling health care providers to effectively screen for tobacco use. We also sought to describe changes in emergency medicine providers' documentation of cessation advice to tobacco users. Methods:, The intervention was conducted at three emergency departments (EDs) and four clinics at a community-based teaching hospital and health network. Health care providers with the opportunity to identify and counsel tobacco-using patients in ambulatory health care settings were the study population. The authors initiated a quality improvement initiative for tobacco screening that employed a multicomponent strategy to facilitate systemic changes that support 100% tobacco use identification, documentation, and counseling. Baseline, posteducation, and post,wrap-around documented screening rates were compared within each site across the intervention. Cumulative ED baseline, posteducation, and post,wrap-around rates of provider advice to tobacco users were compared across the intervention. Percentage of possible available gain was calculated in consideration of a 100% ceiling effect. Statistical analysis was performed using SPSS and MetStat. Descriptive statistics and Pearson's chi-square cell frequency were used to analyze and compare sites. Fisher's exact test was used to compare those tests with a chi-square cell frequency of five or less. The statistical tests used for pre-/postintervention percentage comparisons by site had power between 80% and 90%, detecting differences of 10% and 20% or more at a 0.05 level of significance. Results:, Significant increases in posteducation screening rates for all ED sites complemented significant increases in ED post,wrap-around intervention screening rates. Significant increases in ED provider documented cessation advice were also noted. Conclusions:, This initiative successfully changed tobacco screening behavior of health care providers at all sites. It was particularly successful in the ED, typically an environment less likely to be conducive to preventive health interventions. [source] The In Vivo Response of Novel Buprenorphine Metabolites, M1 and M3, to Antiretroviral Inducers and Inhibitors of Buprenorphine MetabolismBASIC AND CLINICAL PHARMACOLOGY & TOXICOLOGY, Issue 3 2009David E. Moody The identification of two, M1 and M3, in urine suggests that they may be quantitatively significant metabolites. To further understand the in vivo regulation of this mode of metabolism, we evaluated 24-hr urine from subjects (10 per treatment group) on buprenorphine alone or with the antiretroviral agents: efavirenz, delavirdine, nelfinavir, ritonavir, and lopinavir/ritonavir. Quantitative analysis for buprenorphine and traditional metabolites and semi-quantitative analysis of M1 and M3 in urine were performed by liquid chromatography-electrospray ionization-tandem mass spectrometry. The renal clearance of buprenorphine and traditional metabolites were similar for all treatments except for lopinavir/ritonavir, suggesting that urine amounts of M1 and M3 would adequately reflect systemic changes (except lopinavir/ritonavir). Efavirenz decreased M1 and increased M3 consistent with its ability to induce cytochrome P450 (CYP) 3A. Delavirdine increased M1 and decreased M3 consistent with its ability to inhibit CYP3A. Both nelfinavir and ritonavir decreased both M1 and M3, consistent with their ability to inhibit CYP3A and 2C8. These results provide further information on the in vivo response of novel secondary metabolites of buprenorphine to metabolic inhibitors and inducers. [source] Activation of the coagulation system occurs within rather than outside cutaneous haemangiomasACTA PAEDIATRICA, Issue 10 2001J Antovic Haemangiomas are the commonest tumours of infancy. They can become even more serious if followed by consumption coagulopathy and even life-threatening in cases of Kasabach,Merritt syndrome, with thrombocytopenia and haemorrhage. Data exist concerning systemic coagulation abnormalities in children with haemangiomas but to our knowledge there are no data on local consumption coagulopathy in haemangioma per se. We examined blood coagulation and fibrinolysis parameters in blood withdrawn from haemangioma blood vessels and blood withdrawn from the systemic vein in 14 children with cutaneous haemangiomas (3M, 11F; age range 3 mo to 10 y). Compared with controls, significant decreases in fibrinogen levels, FVII activity, antithrombin and plasmin inhibitor levels and increases in international normalized ratio (INR) and D-dimer levels were observed in the blood samples withdrawn directly from haemangioma blood vessels. Fibrinogen and antithrombin levels in samples withdrawn from systemic veins were reduced in relation to control values whilst INR values increased, but within normal ranges. D-dimer levels were increased in peripheral blood. The fibrinogen level was significantly lower and the INR and D-dimer levels were significantly higher in blood samples from haemangiomas compared to systemic blood. Clinical signs of systemic disseminated intravascular coagulation were not observed. Conclusions: Our results suggest a strong local activation and local consumption coagulopathy in haemangioma, along with less conspicuous but observable systemic changes in coagulation and fibrinolysis parameters, although without signs of consumptive coagulopathy. These systemic changes could be a reflection of intra-lesion coagulation activation although there is no evidence to suggest truly systemic disseminated intravascular coagulation. [source] | |||||||||||||||||||