Teachers are constantly assessing their students, whether it is formally or informally. They use screening, diagnostic, and outcome assessments to determine areas of concern and then monitor the progress of the students based on the interventions given. They are called upon to intervene with prevention in mind, helping students catch up as they begin to fall behind. The Response to Intervention model offers three tiers of service for students. Professionals should question the interventions they deliver in response to their students' needs.This Literacy Leaders column offers a series of questions for reflection that may guide teachers or administrators in determining the effectiveness of applied interventions. Also offered is a suggested model for literacy leaders to follow that will help align what interventions and progress monitoring tools are available at the individual campus and district level.يقيّم المعلمون طلابهم باستمرار سواء أكان رسميا أو غير رسمي ويستخدمون تقييمات باختلاف أنواعها بما فيها الرشح والفحص والنتائج كي يحددوا مجالات الاهتمام وثمة يراقبون تقدّم الطلاب على أساس التدخلات المفترضة وهي مستخدمة لتتدخل من أجل الوقاية وهذا يساعد الطلاب في ملاحقة الدرس عند تأخّرهم به. إذ يقدم نموذج استجابة للتدخل ثلاث مراحل الخدمة للطلاب. وينبغي على المحترفين أن يتأملوا التدخلات التي يستخدمونها لوفاء بحاجات الطلاب.ويقدّم عمود قادة التعلم هذا سلسلة الأسئلة للتأمل التي قد توجّه معلمين أو مديرين نحو تحديد فعالية التدخلات المنطبقة وكذلك يقدّم نموذجاً مقترحاً لقادة التعلم ليتبعوه سيساعد في تصفيف أدوات التدخّل والتقدّم المتاحة على مستويّ الجامعة والمحافظة.教师持续不断地评估他们的学生，无论是正式的或非正式的评估。他们使用筛检式评估、诊断式评估和结果评估以测定所关注的领域，然后根据所给予的一些干预去监察学生的进度。当学生的学习出现落后时，为了制止问题恶化，教师被要求予以干预，以帮助学生迎头赶上。「对干预的反应」这模型提供三层给予学生的服务。教育专业人员应就他们对学生的需要作出的回应而质疑他们所提供的干预的效能。本期的《读写教学领导者》专栏提供一系列的反思问题，指导教师或行政人员如何确定所应用的干预的效能；亦建议一个模型给读写教育领导者遵循，帮助他们在各自的校园和地区层面上，调准可利用的干预和监察其进度的工具的一致性。Les enseignants évaluent continuellement leurs élèves, que ce soit de façon formelle ou informelle. Ils scrutent, diagnostiquent, et mesurent les effets pour identifier les secteurs préoccupants, puis pilotent la progression des élèves à partir de ces données. Ils sont appelés pour intervenir en termes de prévention, pour aider à rattraper les élèves qui commencent à prendre du retard. Le modèle Réponse à l'intervention offre aux élèves une aide en trois parties. Les professionnels devraient s'interroger sur les interventions qu'ils effectuent pour répondre aux besoins des élèves.La rubrique Pilotes en littératie offre à la réflexion une série de questions susceptibles d'aider les enseignants ou les responsables administratifs à déterminer l'efficacité des interventions qu'ils réalisent. Elle offre également un modèle à suivre conseillé aux pilotes en littératie qui les aidera à organiser les interventions avec les outils de pilotage des progressions disponibles au niveau local et régional.Учителя постоянно оценивают учеников – на формальном и неформальном уровне. Они делают срезы и диагностику, по их результатам определяют моменты, вызывающие беспокойство, осуществляют учебное вмешательство, а затем проверяют, насколько оно помогло. Цель оценивания в этом случае – вовремя вмешаться, чтобы предотвратить необратимое отставание учащихся. Модель Ответ на вмешательство предлагает три уровня поддержки учеников. Профессионалы должны уметь оценить то вмешательство, которые они осуществляют для помощи учащимся.В этой рубрике обсуждается ряд значимых вопросов, которые могут помочь учителям и руководителям образовательных учреждений в определении эффективности применяемых вмешательств. Кроме того, в данном выпуске предлагается модель, которая поможет руководителям и учителям определить, какие формы вмешательства и инструменты контроля можно получить в местном университете или образовательном округе.Los maestros están constantemente evaluando a sus estudiantes, ya sea formal o informalmente. Usan evaluaciones de filtración, de diagnosis y de resultados para determinar las áreas que les incumben y entonces supervisan su progreso basado en la intervención proveída. Se les pide que intervengan con la intensión de prevenir, ayudando a los estudiantes a ponerse al día cuando empiezan a retrasarse. El modelo de Respuesta a la Intervención ofrece tres niveles de servicio a los estudiantes. Los profesionales deben cuestionar las intervenciones que hacen como resultado de las necesidades de los estudiantes.Esta columna de Líderes de Alfabetización ofrece una serie de preguntas de reflexión que podrían guiar a los maestros o administradores determinar si las intervenciones aplicadas han sido efectivas. También se ofrece una sugerencia de un modelo que los líderes de alfabetización pueden seguir para ayudarles a emparejar los instrumentos de intervención y supervisión que tengan disponibles al nivel de sus recintos individuales y del distrito.

It is a reasonable generalisation that most doctors aim to be skilled in the practice of medicine; they try to be ‘good’ doctors. Also, despite frequent news stories illustrating the shortcoming of doctors, surveys show that contemporary society holds the medical profession in high regard;1 doctors are generally considered to be ‘good’ people despite obvious exceptions such as Dr Harold Shipman. But what do we mean by ‘goodness’ in medical practice? This essay uses sources from the arts and the humanities to explore this concept of ‘goodness’ and to consider the qualities of a ‘good’ doctor in a contemporary medical context. Let us start with a consideration of a picture of a ‘good’ doctor. Van Gogh (1853–1890), produced several portraits of his own physician, Dr Paul-Ferdinand Gachet. Van Gogh was a prolific artist, producing more than two thousand paintings, drawings, and sketches, also leaving detailed descriptions of his colourful life in letters and diaries. In a letter to his sister, Wilhemina Van Gogh, he wrote that in this painting he had tried to portray Gachet's ‘sad but gentle, yet clear and intelligent’ expression.2 A foxglove on the table represents Gachet's medical status and, possibly, the digitalis he prescribed for Van Gogh's mania. (It has been proposed that xanthopsia caused by digoxin poisoning explains Van Gogh's preoccupation with the colour yellow, though this seems unlikely.) Van Gogh started painting in Belgium moving to Paris in 1886 where he met the impressionist artists Pissarro, Monet, and Gauguin. Although his paintings now sell for millions of pounds he failed to make any money in his own lifetime, his penury a constant preoccupation. He was a heavy drinker with a taste for absinthe and had bursts of manic activity followed by periods of depression. To improve his health he moved south to …

This longitudinal audit aimed to determine the ethnic groups and other characteristics of patients referred to a Low Secure Unit in South East London over a period of 9 years between 1997 and 2005. The data provide a picture of the characteristics of those most likely to be referred to a Low Secure Unit, and highlights an over-representation of Black Caribbean and Black African people. Discussion is provided for this latter finding.

PurposeThe purpose of this paper is to undertake a survey of the level and quality of service user involvement in clinical audit in NHS trusts currently, in order to identify perceived drivers and barriers, and factors to increase meaningful involvement.Design/methodology/approachA cross‐sectional descriptive survey was conducted with clinical audit leads in NHS trusts in two Strategic Health Authority regions (South East Coast and London).FindingsThere has been an increase in the presence of relevant policies and structures related to user involvement in clinical audit since previous research a decade ago. However, similar barriers are identified and the role of users is still mainly providing feedback, with little meaningful involvement in the audit cycle, and few examples of improvements to clinical care.Practical implicationsAn organisational culture of user involvement needs to continue to be developed in the NHS generally, and the rationale and benefits of this need to be fully understood by all health professionals. Support needs to be provided at a national and trust level.Originality/valuePrevious research on this topic was conducted ten years ago and there is no evidence to demonstrate how practice has changed since. This paper provides contemporary evidence regarding the implementation of user involvement in clinical audit.

Teaching is a complex profession that involves grappling with a variety of management styles; federal, state, and local mandates; local policies and agendas; and informed curriculum practices that affect pedagogy. Teachers work in increasingly diverse schools, and they must be reflective practitioners to deal with the many social and educational issues that converge in such places. A reflective practitioner is better able to grow and defend teaching practices.

Some practical ideas for teachers and literacy coaches are put forth in this column. These suggestions can make any school a more collaborative environment.

Background: Chronic vesicular hand dermatitis is a chronic disease that can be debilitating for patients, and many treatment options do not provide lasting remission.Objective: We attempted to determine the efficacy of megavoltage irradiation in the treatment of this disease.Methods: Between July 2001 and March 2005, 9 patients with severe chronic vesicular hand dermatitis had megavoltage radiation therapy to their sites of disease. Eight pairs of hands and seven pairs of feet were irradiated (15 total sites).Results: All patients had an improvement in their disease during the course of radiation therapy. Patients were followed after radiation therapy for a median follow-up time of 20.2 months (range, 1 to 45 months). The disease completely resolved in 7 of the 15 (47%) sites irradiated. There was a decrease in the severity or frequency of flare-ups at the other 8 sites (53%).Conclusion: Megavoltage radiation therapy may be effective in the treatment of chronic vesicular hand dermatitis and may provide durable remissions in some patients.

The purpose of this study was to quantify the level of serum DNA in different groups of primary breast cancer patients and in healthy controls using real-time quantitative PCR in order to determine whether such measurements have diagnostic or prognostic value. A total of 96 serum samples of patients with primary breast cancer before surgery (with positive or negative lymph nodes and with high or low relapse-free survival) as well as 24 healthy controls were analysed. DNA concentrations in the serum of the patients differed significantly from the concentration of serum DNA in the controls (medians were 221 and 63 ng ml −1 , respectively, P <0.001 M–W test). However, no statistically significant difference was observed between the patient groups ( P =0.87, M–W test). The serum DNA levels were elevated independently of the size of primary tumour or lymph node metastases. The overall survival of patients with serum DNA concentrations >221 ng ml −1 was better than patients with serum DNA concentration ⩽221 ng ml −1 (Kaplan–Meier, P =0.028).

Objectives Active support was implemented in three community houses (active support houses), with 11 service users with severe learning disabilities. Methods This was evaluated with reference to changes in levels of engagement, challenging behaviour (major and minor) and staff contact, measured against three comparison services (non‐active support houses). Results All measures increased for the active support houses. Significant increases in activity levels were found in one house. Statistically significant increases in activity and minor challenging behaviour were also found when all active support houses were compared with all non‐active support houses. In the non‐active support houses, all measures decreased, with the exception of mean level of staff contact in one house. Conclusions Unlike previous research findings, those service users who were less able did not receive comparatively more support from staff post‐training and changes appeared unrelated to staff contact.

Objective To evaluate transvaginal and transabdominal ultrasound scanning, with or without Doppler, as a diagnostic test for the accurate diagnosis of pelvic endometriosis.Methods The MEDLINE (1966-2001) and EMBASE (1980-2001) databases were searched for relevant studies, published in English. Only studies fulfilling predefined criteria were selected. An assessment of quality was made for each study, and data were then reanalyzed using likelihood ratios to determine the usefulness of the test.Results In total, 67 papers were identified using the search strategy, of which 17 described relevant studies. Of these, seven fulfilled the inclusion criteria. All seven related to the use of transvaginal gray-scale imaging in the diagnosis of ovarian endometriomata specifically, rather than endometriosis. The positive likelihood ratios ranged from 7.6 to 29.8, and the negative likelihood ratios ranged from 0.1 to 0.4. Confidence intervals were wide. One paper addressed the use of conventional color Doppler with ultrasound: the positive likelihood ratio was 1.2, with a negative likelihood ratio of 0.4. One paper assessed the use of color Doppler energy imaging, and showed a positive likelihood ratio of 33.5 and a negative likelihood ratio of 0.1.Conclusions Transvaginal ultrasound appears to be a useful test both to make and to exclude the diagnosis of an ovarian endometrioma.

Mary Wollstonecraft was born in 1759. She was largely self-educated and worked as a school teacher, governess and editor. She made contact with the circle of radicals and artists which included Blake, Paine, Fuseli and Godwin. She went to Paris in 1792, met Gilbert Imlay and gave birth to their child. She married Godwin in 1797 but died after the birth of their daughter Mary (later Mary Shelley). The inner life of Mary Wollstonecraft is remarkably displayed in her personal letters, both in those from her early years to her friends and sisters and in those pathetic later ones to her lover Gilbert Imlay. Current biographies, all dating from the 1970s, as the times demanded, show the formation of the feminist and the genesis of the public works, especially of A Vindication of the Rights of Woman. Each biography used the letters copiously but none dwelt on them or quoted them at length. Indeed Claire Tomalin, whose biography is now the most accessible in Britain, was clearly embarrassed by the pleading approaches to Imlay and played down an episode which was central to Wollstonecraft's life and intellectual development. Janet Todd's biography will connect, for the first time, Mary Wollstonecraft's published works with her letters and discuss the psychological revelations, the desires and fears revealed in them. It will show how printed and private writings together reveal the divided nature of Wollstonecraft and the personal motivations of many of her general political themes. It will capture the emerging character of the woman who never ceased to reveal herself in all her writings.

Primary care literature emphasises the importance of agreement and shared models in the consultation. This study compared general practitioners' (GPs') and patients' models of obesity. Questionnaires concerning beliefs about the causes, consequences and solutions to obesity were completed by 89 general practitioners (GPs) and 599 patients from practices across UK. In terms of causes, the results showed that the patients were more likely to attribute obesity to a gland/hormone problem, slow metabolism and stress than the GPs, whereas the GPs were more likely to blame eating too much. In terms of consequences, the patients rated difficulty getting to work more highly whereas the GPs regarded diabetes as more important. For the solutions to obesity, the two groups reported similar beliefs for a range of methods, but whereas the patients rated the GP and a counsellor as more helpful, the GPs rated the obese person themselves more highly. It is argued that patients show a self serving model of obesity by blaming internal uncontrollable factors for causing obesity yet expecting external factors to solve it. In contrast, GPs show a victim blaming model by attributing both cause and the solution to internal controllable factors. Such differing models have implications regarding the form of intervention likely to be used in primary care and indicate that whereas patients would prefer a more professional based approach, GPs would prefer a more patient-led one. Further, the results suggest that even if an intervention could be negotiated, success rates would be low as either the patient or the GP would be acting in contradiction to their beliefs about the nature of obesity.

Vascular endothelial growth factor (VEGF) is known to occur as at least six differentially spliced variants, giving rise to mature isoforms containing 121, 145, 165, 183, 189 and 206 amino acids. However, little is yet known concerning the in vivo activities of this differential splicing. Stably transfected MCF-7 breast carcinoma cells were constructed that secreted comparable amounts of the 121, 165 or 189 isoforms. Rabbit corneal angiogenesis assays showed the VEGF121 transfectant to have much greater angiogenic activity than the 165 or 189 expressing MCF-7 cells. While the VEGF121-expressing MCF-7 cells were reproducibly more tumorigenic than the control transfectants, this was not the case with the VEGF165- or VEGF189-expressing cells. More surprising was the observation that VEGF189 located to the nucleus, consistent with the presence of a highly conserved nuclear localization sequence in exon 6a that is expressed in VEGF189 but not 121 or 165. It was concluded that the VEGF121 isoform is both more angiogenic and tumorigenic than are the 165 and 189 isoforms. This is probably due to the ability of the 121 isoform, unlike the 165 and 189 isoforms, to freely diffuse from the cells producing it. © 2000 Cancer Research Campaign

This paper describes the development and formative evaluation of a media literacy, media based intervention for high-risk adolescents. The program described, Flashpoint, was developed to (1) moderate the influence of media presentations of violence, substance abuse and prejudice on adolescents; and t (2) teach participants cognitive skills which would enable them to resist impulses to engage in behavior involving violence, substance abuse or prejudice. The evaluation described studied the pilot testing of the program with three groups of adolescents (N=33) involved in the juvenile justice system: adolescents in a diversion program (first time, nonviolent offenders); adolescents on probation; and adolescents in residential custody of the Department of Youth Services. Qualitative findings are reviewed in detail.

This systematic review presents both the physiological and symptom-based studies which. have explored gastrointestinal variation across the menstrual cycle. Understanding this variation may be helpful in identifying the origin of pelvic pain, particularly as the symptoms associated with causes, such as endometriosis, also vary across the cycle. One-third of otherwise asymptomatic women may experience gastrointestinal symptoms at the time of menstruation, and almost 50% of women with irritable bowel syndrome report a perimenstrual increase in symptoms.

Contemporary feminist scholarship has read the Vindication of the Rights of Woman as a paradigm of the anti-eroticism present in all of Wollstonecraft's works, but which is less discernible in her private life and letters. As a result, it is not unusual to find the letters and the life being cited as contradictory departures from the sexual ideology of the Vindication. Against received feminist critical opinion, this essay argues that secrecy rather than pleasure in sexual relations that is the target of the text's negative polemic. In other words, I propose that the focus of a Vindication's anti-eroticism is the art of secrecy which fashionable male conduct-book writers encouraged women to practise. In the context of the Vindication's outrage over the cultural injunction to women to cloak sexual emotion in enigmatic self-reserve, the frankness with which Wollstonecraft later declares her passion in the Letters to Imlay appears less of a contradiction than a consolidation of her theoretical position. The concluding section of the paper re-examines Wollstonecraft's ideal of mutual love based on honesty in the light of the failed relationship with Imlay. By looking at similar disappointments suffered by contemporary fictional heroines, I close with the suggestion that the texts of Enlightenment feminism paradoxically reveal secrecy to be a constituent component of heterosexual desire.

This Protocol is directed towards Health Authorities, Local Authorities, Community Health Councils, provider units and other organisations with an interest in mental distress and illness. Interventions with proven health gain potential are listed for a range of mental health problems. The main section on health gain is balanced by the following section which collates and clarifies the views of the users of mental health services. The final sections focus upon ways of driving forward a change towards a community service which uses resources as effectively as possible.

1. We have determined the membrane and firing properties of fifty‐six jaw‐elevator motoneurones in rats that were anaesthetized with pentobarbitone, paralysed and artificially ventilated. 2. Forty‐two neurones were identified as masseter motoneurones and fourteen as masseter synergist motoneurones. The membrane potentials for the sample ranged from ‐60 to ‐86 (mean = ‐68; S.D. = 7.3; n = 56), and spike amplitudes from 50 to 95 mV. The duration of the after‐hyperpolarization following antidromic spikes in masseter motoneurones ranged from 15 to 50 ms (mean = 30; S.D. = 12.8) and their amplitudes from 1.0 to 4.5 mV (mean = 2.7; S.D. = 2.2; n = 42). 3. The mean input resistance for the total sample was 2.3 M omega (S.D. = 0.9; n = 56), membrane time constant 3.9 ms (S.D. = 0.9; n = 48) and rheobase 4.2 nA (S.D. = 2.6; n = 56). The distribution of these parameters was independent of membrane potential. We found no significant interrelationships between the membrane properties and one interpretation of this is that our sample may be drawn from a homogenous population of motoneurones. We also suggest that elevator motoneurones may have a lower Rm (specific membrane resistivity) value than cat hindlimb motoneurones because they have a similar range of input resistance values but only half the total surface area. 4. Forty‐six out of forty‐nine neurones fired repetitively to a depolarizing current pulse at a mean threshold of 1.6 x rheobase. Current‐frequency plots were constructed for thirteen neurones and all but one showed a primary and secondary range in the firing of the first interspike interval. The mean slope in the primary range was 31 impulses s‐1 nA‐1 and 77 impulses s‐1 nA‐1 for the secondary range. The mean minimal firing frequency for steady firing was 26 impulses s‐1 and, in response to an increase of stimulation, the rate increased monotonically with a slope of 11 impulses s‐1 nA‐1. 5. The dynamic sensitivity of twelve neurones was assessed from their response to ramp waveforms of current of constant amplitude but varying frequencies (0.2‐2 Hz). Firing initially increased along a steep slope up to a frequency of between 40 and 60 impulses s‐1 and then increased along a much shallower slope. Both the threshold for eliciting firing and the firing at the transition point of the two slopes remained constant with changes in ramp frequency.(ABSTRACT TRUNCATED AT 400 WORDS)