Characteristics of school psychology faculty in 2021

Although racial, ethnic, and linguistically minoritized school-aged students within the United States are increasing in population, school psychologists have historically been predominantly white, monolingual females. Diversity within the field of school psychology is important for improving students' achievement and postsecondary success, particularly as it relates to underrepresented students. Research shows that the diversity of school psychology faculty is important for the recruitment and retention of minoritized graduate students. However, demographic information within school psychology has only been calculated within the context of memberships to psychological organizations (e.g., the National Association of School Psychologists), which could underestimate the actual diversity of school psychology faculty currently in the profession. The purpose of this study was to collect information on the demographic characteristics of school psychology faculty as of 2021. A total of 429 school psychology trainers completed a brief web-based survey in which they self-identified their employment characteristics, gender identity, sexual orientation, racial-ethnic identity, (dis)ability status, and languages spoken. At the time of the survey, most of the sample were employed as full professors (30.5%) or assistant professors (29.4%). Results demonstrated that majority of the sample identified as white (78.6%), cisgender female (66.2%), heterosexual (87.2%), non(dis)abled (95.1%), and monolingual English speaking (83.9%). Faculty of color were more likely to report a higher percentage of time spent teaching as compared to white faculty. Implications of these findings and future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"We Already Knew What Time It Was:" HIV, COVID19, and Black Transgender Women in the South

Black transgender women in the Southeast are at the center of the modern-day HIV crisis in the U.S. This focus group study was aimed at understanding the impacts of the COVID-19 pandemic on the health and well-being of Black transgender women in the U.S. Southeast who are affected by HIV. From April-June 2022, we completed seven focus group interviews with 56 participants. Themes identified across the focus groups show: 1) the challenges that pre-dated COVID-19; 2) the challenges of managing COVID-19 risk; 3) negative consequences for mental health, physical health, and overall well-being; 4) negative trends in coping with pandemic stress; 5) the importance of self-care and social support for managing pandemic stress; and 6) the need for more community-based resources. Findings demonstrate that understanding these social determinants of health is vital to developing support resources in this ongoing health crisis and crises yet to come.

Understanding preferences of general educators for supporting classwide behavior

Innovations, such as novel evidence-based practices, are not likely to diffuse to practice without explicit effort and design (Rogers, 2003). In an effort to understand how interventions should be designed to meet teacher preferences, the present study utilized a full-profile two-alternative forced-choice experiment to examine teacher preferences when selecting a classwide intervention to address student disruptive behavior. Attributes and levels for the experiment were derived in response to four characteristics from Rogers' diffusion of innovations theory. Results from 266 general education teachers of Grades K-5 indicated that nearly all theorized characteristics influenced teacher preference, with the exception of the observability of the intervention (i.e., receiving feedback from others). Specific findings of levels within attributes suggest that, for instance, short online video trainings are preferable to full-day workshops and specific details on adaptations for inclusivity are highly preferred. Given school psychologists' roles in consultation and behavior support, knowledge of teacher preferences may be utilized to support intervention uptake and more general dissemination efforts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The weight of harm: A Response to “Editor’s Note: Societal changes and expression of concern about Rekers and Lovaas’ (1974) Behavioral Treatment of Deviant Sex-Role Behaviors in a Male Child”

In 1974, Rekers and Lovaas published an article in the Journal of Applied Behavior Analysis (JABA) wherein the authors coached a 4-year-old child’s parents to ignore and physically abuse him when he engaged in behaviors that were identified by the authors as inappropriate for a child whose sex assigned at birth was male. In October 2020, a Statement of Concern regarding Rekers and Lovaas (1974) was published in JABA (SEAB & LeBlanc, 2020), which described concerns regarding the paper and then provided justification for the journal’s decision to not retract this paper. In this current response, I provide a counterpoint to the Statement of Concern, arguing that (a) the available evidence strongly suggests that the original study was unethical and misaligned with the principles of Applied Behavior Analysis (ABA), and (b) the evidence presented to support its contemporaneous ethicality is insufficient. I end with an argument that Rekers and Lovaas (1974) should be retracted and discuss the critical role of ethics and social significance for the field of ABA.

A call to action for school psychology to address COVID-19 health disparities and advance social justice

The health, economic, and social challenges associated with coronavirus disease 2019 (COVID-19) present a range of threats to students' well-being, psychoeducational experiences, and outcomes, spurring fears for a "lost generation." In this article, we present COVID-19 as a large-scale multisystemic disaster causing massive disruptions and losses, with adversities moderated by the intersectional nature of systemic inequity. We first synthesize the broad effects of COVID-19 as they relate to equity and social justice, followed by the major implications for students and schools, with a focus on intersectional systemic issues. We then propose foundational considerations and resources intended to usher a paradigm shift in how school psychologists' roles and activities are conceptualized in the years to come, ending with key imperatives for practice and graduate education in school psychology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Assessing Differential Item Functioning in a Teacher Self-Assessment of Cultural Responsiveness

The Assessment of Culturally and Contextually Relevant Supports (ACCReS) was developed in response to the need for well-constructed instruments to measure teachers’ cultural responsiveness and guide decision-making related to professional development needs. The current study sought to evaluate the presence of differential item functioning (DIF) in ACCReS items and the magnitude of DIF, if detected. With a national sample of 999 grade K-12 teachers in the United States, we examined measurement invariance of ACCReS items in relation to responses from (a) racially and ethnically minoritized (REM) youth and white teachers (teacher race), (b) teachers in schools with 0–50% and 51–100% REM youth (student race), and (c) teachers with <1–5 years of teaching experience and teachers with >5 years of experience. Findings suggested that ACCReS items exhibited negligible levels of DIF. The lack of DIF found provides additional evidence for the validity of scores from the ACCReS to assess teachers’ cultural responsiveness. Furthermore, descriptive analyses revealed that teachers were more likely to agree with items pertaining to their own classroom practice than items related to access to adequate training and support. Results inform implications for future educational and measurement research.

Using ranked survey data in education research: Methods and applications

Researchers and practitioners in education and school psychology regularly use ranked data to drive student- and systems-level decision-making. These types of data can be derived from assessments of individual preferences among researchers and practitioners, assessments of preferences among stakeholders including parents and children, and rankings of students on academic and social-emotional competency. However, the analysis of ranked data in education and psychology has typically been limited to simple approaches such as the examination of mean ranks assigned to items. This paper unifies a collection of classical methodologies, as well as proposes new techniques, for analyzing ranked data used across disciplines and applies the methods to data generated in school psychological research. The scope of the paper is to serve as a roadmap for researchers in education and school psychology who seek to more fully leverage information contained in ranked data. These methodologies include descriptive analyses, visualizations, tests of uniformity, cluster analyses, and predictive models. We demonstrate these techniques on the survey data of Fefer, DeMagistris, and Shuttleton (2016) and illustrate how using a broader set of tools can yield improved insights by researchers and practitioners.

0045 Biobehavioral Markers for Sleep/Wake Disturbance and Fatigue in Young Childhood Brain Tumor Survivors

Introduction

Survivors of childhood and adolescent brain tumors and subsequent treatment may experience many neurological processes involving the forebrain, brainstem, and hypothalamus as well as the symptom cluster of stress, sleep, and fatigue. As a result, the impact of brain tumor treatment (chemotherapy/biotherapy, radiotherapy, and surgery) may have lasting biobehavioral effects. Description of symptoms during early survivorship is not always evident in the literature.

Methods

Convenience sampling and the following inclusion criteria were utilized: brain tumor survivors ages 8–17 years; ≥6 months, &lt;6 years from completion of treatment; disease free or stable disease. Participants completed polysomnography (PSG) followed by a multiple sleep latency test (MSLT), and subjective measures of sleep, fatigue, stress, and pubertal status. Collection of salivary biomarkers for stress (cortisol) and sleep (melatonin) was completed the evening of and morning after the PSG.

Results

Analysis of the first 12 participants (5 males; 3 Hispanic/Latino; average age 14 years; 9–72 months post treatment) revealed mean (minutes) total sleep time (TST) 442, sleep latency (SL) 42 and waking (WASO) 88; sleep efficiency (SE) mean 83%, There were large magnitude correlations between several variables of interest, notably PM Cortisol with fatigue, TST (r= .472; -.453); AM Cortisol with SL (r=.479); AM Melatonin with SE, SL, WASO (r= -.459; .692; .458). Average AM melatonin level (26.6 pg/dl) was higher than PM (6.66 pg/dl). Seven participants were diagnosed with clinical sleep disorders, including one with narcolepsy and two with hypersomnia.

Conclusion

During early survivorship after pediatric brain tumor treatment, survivors may be at high risk for sleep/wake disturbance (SWD). Morning melatonin and biomarker correlations with sleep and fatigue in this sample warrant further exploration and may be related to first night effect versus circadian rhythm differences or clinical sleep disorder. Recommendations for future practice include developmentally matched protocols and routine screening of biobehavioral markers to assess risk for stress, SWD, and fatigue.

Support

1. Center for Oncology Education and Research Harris College of Nursing & Health Sciences Texas Christian University 2. Neuro-Oncology Program Hematology/Oncology Center Cook Children’s Health Care System 3. Nursing Research and Evidence-Based Practice James A. “Buddy” Davidson Endowed Fund

Gender Disparities in Financial Relationships Between Industry and Orthopaedic Surgeons

BACKGROUND

Recent studies in a number of surgical subspecialties have demonstrated that financial relationships with industry differ between men and women. This study aimed to determine if gender disparities exist in industry relationships with orthopaedic surgeons.

METHODS

This retrospective study utilized publicly available data from the Centers for Medicare & Medicaid Services (CMS) at OpenPayments.cms.gov. Data were extracted for payments made to orthopaedic surgeons from industry for royalties, licensing, or consulting fees from 2016 to 2017. A physician's profile was used to determine name, gender, practice location, and subspecialty. Years of experience were recorded from publicly available websites. Total number of payments and amounts were compared among men and women, subspecialties, and locations. Multivariable linear regression models were used to determine predictors of total payments and number of payments.

RESULTS

Royalties and consulting fees were paid to 3,418 individual physicians (11% of 29,996 physicians in the American Academy of Orthopaedic Surgeons [AAOS] census) and accounted for 88% of total payments. The majority of the total payment amount (99.6%) was made to men, while only 0.4% went to women. Male gender was a predictor of total number of payments (β = 5.17, p < 0.001), as were years of experience (β = 0.15 [95% confidence interval (CI): 0.10 to 0.20], p < 0.001), Mountain region (β = 2.77 [95% CI: 0.37 to 5.17], p = 0.02), and adult reconstructive subspecialty (β = 4.07 [95% CI: 1.89 to 6.25], p < 0.001). Years of experience (β = 0.046 [95% CI: 0.039 to 0.052], p < 0.001), male gender (β = 1.09 [95% CI: 0.67 to 1.51], p < 0.001), Mountain region (β = 0.35 [95% CI: 0.020 to 0.68], p = 0.04), and adult reconstructive subspecialty (β = 0.33 [95% CI: 0.030 to 0.63], p = 0.03) were associated with higher payments.

CONCLUSIONS

Male gender, years of experience, Mountain region, and adult reconstructive subspecialty are independent predictors of a higher number of industry payments and payment amount. These disparities in industry payments may contribute to continued inequities in scholarship, academic rank, and leadership opportunities.

Common barriers to healthcare for transgender people in the U.S. Southeast

Background: Transgender and non-binary people are more likely to face barriers to healthcare than their cisgender counterparts. The majority of work in this area centers on the experiences of transgender people in northern cities and urban enclaves, yet over 500,000 transgender people live in the U.S. Southeast. Aims: The purpose of this study is to explore barriers to healthcare among transgender people in the U.S. Southeast. Methods: The research team conducted four 120-minute focus groups (eligibility criteria: 18 years or older, self-identify as transgender, live in the U.S. Southeast). Participants completed a demographic questionnaire prior to the start of the focus group. Each focus group explored access to and experiences of receiving basic healthcare as a transgender person in the U.S. Southeast. Established qualitative methods were used to conduct the focus groups and data analysis. Results: Participants (n = 48) ranged in age from 19 to 65, with the majority identifying as trans women (43.8%) and non-binary (33.3%). The sample was racially diverse: White (50%), Black (37.5%), and Latinx or Multiracial (12.5%). Multiple barriers to care were identified: (1) fear and mistrust of providers; (2) inconsistency in access to healthcare; (3) disrespect from providers; and, (4) mistreatment due to intersecting experiences of gender, race, class, and location. Discussion: Transgender Southerners face barriers to care at the structural, cultural, and interpersonal levels. The study results have implications for researchers, as well as providers, practices, and health care systems throughout the region.

Rejecting, reframing, and reintroducing: trans people's strategic engagement with the medicalisation of gender dysphoria

This article uses ethnographic methods to explore how transgender people engage the medicalisation of transgender experience in a U.S. context under the purview of the American Psychiatric Association. Building on sociological literature related to medicalisation, this paper argues that the lived experience of medicalisation is a non-linear, complex process whereby individual engagement with medical authority is both empowering and constraining in the lives of trans people. Inductive qualitative analysis of 158 hours of participant observation and 33 in-depth interviews with members of a transgender community organisation revealed that transgender individuals (i) reject a medical frame for gender dysphoria, (ii) embrace and stress the importance of gender-affirming medical technologies for individual identity development and social interaction and (iii) strategically reintroduce medical logics and embrace medical authority in order to facilitate medical and social recognition, validation and acceptance.

"I Can Never Be Too Comfortable": Race, Gender, and Emotion at the Hospital Bedside

In this article, we examine how race and gender shape nurses' emotion practice. Based on audio diaries collected from 48 nurses within two Midwestern hospital systems in the United States, we illustrate the disproportionate emotional labor that emerges among women nurses of color in the white institutional space of American health care. In this environment, women of color experience an emotional double shift as a result of negotiating patient, coworker, and supervisor interactions. In confronting racist encounters, nurses of color in our sample experience additional job-related stress, must perform disproportionate amounts of emotional labor, and experience depleted emotional resources that negatively influence patient care. Methodologically, the study extends prior research by using audio diaries collected from a racially diverse sample to capture emotion as a situationally emergent and complex feature of nursing practice. We also extend research on nursing by tracing both the sources and consequences of unequal emotion practices for nurse well-being and patient care.

A systematic evidence review of school-based group contingency interventions for students with challenging behavior

The purpose of this review was to synthesize the research underlying group contingency interventions to determine whether there is sufficient evidence to support their use for managing the classroom behavior of students with behavioral difficulties. An application of the What Works Clearinghouse (WWC) procedures for evaluating single-subject research revealed that the research investigating group contingencies demonstrated sufficient rigor, evidence, and replication to label the intervention as evidence-based. These findings were further supported across five quantitative indices of treatment effect. The results associated with the application of the WWC procedures and quantitative evaluations were supplemented with additional systematic coding of methodological features and study characteristics to evaluate the populations and conditions under which the effects of the group contingency best generalize. Findings associated with this coding revealed that the lack of detailed reporting across studies limited our ability to determine for whom and under what conditions group contingencies are best suited.

Climate and red spruce growth and decline in the northern Appalachians

Between the mid-1960s and mid-1980s, red spruce (Picea rubens Sarg.) died at unusual rates on the mountains of New York and western New England. We determined the relationship between standardized tree ring widths and monthly climate data for calibration and verification periods from 1856 to 1981 and found that after about 1960, there was a distinct shift in the temperature variables related to standardized ring widths in vigorous spruce. The beginning of widespread spruce mortality, regionwide growth decreases, and the shift in response to climate in the early 1960s corresponds to the onset of a decade of unusually cold winters and several consecutive years when severe winter damage was noted across the Northeast in this species. We suggest that the episodes of winter damage are an important initiating and synchronizing factor in the red spruce decline.

HLA type of EBV-transformed human B cell lines

This appendix lists reference Epstein-Barr virus (EBV)-transformed B lymphoblastoid cell lines (B-LCL) and the HLA types expressed by these cell lines. These B-LCL are useful for studies of cellular immunity (e.g., restriction of antigen-specific responses), biochemical characterization of histocompatibility molecules, and as controls for DNA-based typing methods.

Randomised trial of high frequency oscillatory ventilation or conventional ventilation in babies of gestational age 28 weeks or less: respiratory and neurological outcomes at 2 years

BACKGROUND

The long term outcome of children entered into neonatal trials of high frequency oscillatory ventilation (HFOV) or conventional ventilation (CV) has been rarely studied.

OBJECTIVE

To evaluate respiratory and neurodevelopmental outcomes for children entered into the United Kingdom Oscillation Study, which was designed to evaluate these outcomes.

METHODS

Surviving infants were followed until 2 years of age corrected for prematurity. Study forms were completed by local paediatricians at routine assessments, and parents were asked to complete a validated neurodevelopmental questionnaire.

RESULTS

Paediatricians' forms were returned for 73% of the 585 surviving infants. Respiratory symptoms were common in all infants, and 41% had received inhaled medication. Mode of ventilation had no effect on frequency of any symptoms. At 24 months of age, severe neurodevelopmental disability was present in 9% and other disabilities in 38% of children, but the prevalence of disability was similar in children who received HFOV or CV (relative risk 0.93; 95% confidence interval 0.74 to 1.16). The prevalence of disability did not vary by gestational age, but boys were more likely to have overall disability. Developmental scores were unaffected by mode of ventilation (relative risk 1.13; 95% confidence interval 0.78 to 1.63) and were lower in infants born before 26 weeks gestation compared with babies born at 26-28 weeks.

CONCLUSIONS

Initial mode of ventilation in very preterm infants has no impact on respiratory or neurodevelopmental morbidity at 2 years. HFOV and CV appear equally effective for the early treatment of respiratory distress syndrome.

The mechanical joint score: a new clinical index of joint damage in rheumatoid arthritis

OBJECTIVES

To evaluate the mechanical joint score (MJS) in terms of its reliability between observers and over time, its ease of use and its relationship with conventional measures of rheumatoid arthritis (RA) disease activity, severity and functional outcome.

METHODS

The MJS was evaluated in 103 patients with reference to the following joints: total proximal interphalangeal (PIP) joints, total metacarpophalangeal (MCP) joints, wrists, elbows, shoulders, hips, knees, ankles and total metatarsophalangeal (MTP) joints. The score was based on the appearance of the joints on a scale of 0-3, 0 representing no abnormality and 3 severe abnormality or previous surgery. The MJS was evaluated in terms of its intra- and inter-observer variability and its content, construct and criterion validities. A subset of 29 patients were re-evaluated after 5 yr to examine change in MJS over time.

RESULTS

The MJS performed well in terms of inter-observer and intra-observer reliability. The MJS showed strong correlation with the Larsen X-ray score of hands and feet (Spearman correlation coefficient 0.74) and with the modified Health Assessment Questionnaire (Spearman correlation coefficient 0.56) and only weak correlation with indices of disease activity, such as the Ritchie index and erythrocyte sedimentation rate. The MJS showed highly significant positive change over time.

CONCLUSION

The MJS is a reliable clinical index of joint damage and may be a useful new outcome measure in RA.

A Dendroctonus bark engraving (Coleoptera: Scolytidae) from a middle Eocene Larix (Coniferales: Pinaceae): early or delayed colonization?

An engraving made by a scolytid bark beetle, assigned to the genus Dendroctonus of the tribe Tomicini, has been identified on a mummified, middle Eocene (45 Ma) specimen of Larix altoborealis wood from the Canadian High Arctic. Larix altoborealis is the earliest known species of Larix, a distinctive lineage of pinaceous conifers that is taxonomically identifiable by the middle Eocene and achieved a broad continental distribution in northern North America and Eurasia during the late Cenozoic. Dendroctonus currently consists of three highly host-specific lineages that have pinaceous hosts: a basal monospecific clade on Pinoideae (Pinus) and two sister clades that consist of a speciose clade associated exclusively with Pinoideae and six species that breed overwhelmingly in Piceoideae (Picea) and Laricoideae (Pseudotsuga and Larix). The middle Eocene engraving in L. altoborealis represents an early member of Dendroctonus that is ancestral to other congeneric species that colonized a short-bracted species of Larix. This fossil occurrence, buttressed by recent data on the phylogeny of Pinaceae subfamilies and Dendroctonus species, indicates that there was phylogenetically congruent colonization by these bark-beetle lineages of a Pinoideae + (Piceoideae + Laricoideae) host-plant sequence. Based on all available evidence, an hypothesis of a geochronologically early invasion during the Early Cretaceous is supported over an alternative view of late Cenozoic cladogenesis by bark beetles onto the Pinaceae. These data also suggest that host-plant chemistry may be an effective species barrier to colonization by some bark-beetle taxa over geologically long time scales.

The current status of Balint groups in US family practice residencies: A 10-year follow-up study, 1990-2000

BACKGROUND AND OBJECTIVES

In 1990, the first and, to date, only objective study of Balint groups in US family practice residencies was conducted to measure their prevalence, composition, leadership, and function. The study reported here collected similar information about Balint groups.

METHODS

Surveys were sent to all 464 US family practice residency program directors, with a 1-month follow-up to nonrespondents. The survey included questions about the existence, leadership, meeting frequency, and objectives of Balint training.

RESULTS

A total of 298 (64%) residencies responded. Almost half (48%) of US responding residences reported conducting Balint groups, and 40% of those residencies have more than one group. The frequency of Balint group meetings has shifted in the past 10 years. In 1990, 55% of groups met weekly; in 2000, only 15% of groups met weekly. Sixty-five percent of residencies require Balint participation. One third of Balint groups are conducted without a coleader and the number of physicians leading groups is 22%, a decrease of 10% from 10 years ago. Forty-four percent of groups are led by psychologists, an increase of 19% from 10 years ago. Respondents indicated uncertainly about whether their groups were true Balint groups or simply resident support groups.

CONCLUSIONS

About half of US family practice residencies operate groups described as Balint groups. They meet less frequently then 10 years ago and are less likely to have a physician involved in group leadership. Some of the groups may actually be support groups rather than Balint groups.

Gastric antral vascular ectasia in systemic sclerosis: complete resolution with methylprednisolone and cyclophosphamide

A case of severe, transfusion dependent anaemia in a 72 year old woman, which on endoscopy was found to be due to gastric antral vascular ectasia (GAVE), is reported. Repeated endoscopic sclerotherapy was ineffective. She subsequently developed Raynaud's phenomenon and on further investigation was found to have classical systemic sclerosis with lung involvement. Treatment with pulses of intravenous methylprednisolone and cyclophosphamide resulted in significant improvement in her pulmonary function tests and skin score. Coincidentally, her haemoglobin stabilised and further endoscopic examinations were normal. This is the first report of cyclophosphamide and methylprednisolone leading to complete and sustained resolution of GAVE in association with systemic sclerosis.

HLA-DR and -DQ polymorphism in Cameroon

HLA-DRB1, -DQA1 and -DQB1 allele frequencies were determined by high-resolution polymerase chain reaction using sequence-specific oligonucleotide probes (PCR-SSOP) and/or DNA sequencing in 126 healthy individuals in Cameroon. Eighteen DRB1, 11 DQA1, and 18 DQB1 alleles were observed. The most common alleles at each locus were DRB1*1503 (29%), DRB1*1301 (13%); DQA1*0102 (38%), DQA1*0302 (11%), DQA1*0401 (11%); and DQB1*0602 (31%), DQB1*0301 (13%), DQB1*0501 (12%). Forty-four different haplotypes were identified including 12 novel haplotypes demonstrating the HLA class II diversity resulting from allele combinations in this population. A single predominant DRB1*1503-DQA1*0102-DQB1*0602 haplotype was observed with a frequency of 27%. In summary, this study of HLA class II polymorphism in Cameroon demonstrates the extent of diversity in this population.

HLA-B allele frequencies in Côte d'Ivoire defined by direct DNA sequencing: identification of HLA-B*1405, B*4410, and B*5302

Direct automated DNA sequencing was used to analyze exons 2 and 3 of HLA-B alleles present in forty-four unrelated individuals residing in the village of Adiopodoume, Côte d'Ivoire (Ivory Coast). Of the 23 HLA-B alleles observed, the most frequently detected allele was HLA-B*5301 (22.7%), which is believed to confer resistance to severe Plasmodium falciparum malaria. B*4501 (9.1%), B*1503 (8.0%), B*0705 (5.7%), B*1510 (5.7%) and B*3501 (5.7%) occurred frequently in the population. A second allele of B53 was identified; B*5302 contains a single amino acid variation at residue 171 (Y-->H). Two additional novel alleles, B* 1405 (a single amino acid variant of B*1402) and B*4410 (a five amino acid variant of B*4403) were characterized.

The Balint movement in America

Michael Balint's (1896-1970) career evolultion from general practitioner (1918) to psychoanalyst (1926) and subsequently to general practitioner educator (1950) began at his home in Budapest and then moved from London to sites in the United States. His frequent visits to America, together with his wife Enid, were an influential force in promoting and training US-based Balint group leaders. Michael and Enid Balint's influence, together with the support of US physicians, South African physicians who became US citizens, and behavioral scientists, laid the foundation for the formation of an American Balint Society in 1990. The Society's educational and research efforts occurred primarily in family practice residencies and have grown over the past 10 years. The Society, is presently working to standardize credentialing of Balint group leaders to assure continued quality growth in the American Balint movement.

The epidemiology of Plasmodium falciparum malaria in two Cameroonian villages: Simbok and Etoa

In support of ongoing immunologic studies on immunity to Plasmodium falciparum, demographic, entomologic, parasitologic, and clinical studies were conducted in two Cameroonian villages located 3 km apart. Simbok (population = 907) has pools of water present year round that provide breeding sites for Anopheles gambiae, whereas Etoa (population = 485) has swampy areas that dry up annually in which A. funestus breed. Results showed that individuals in Simbok receive an estimated 1.9 and 1.2 infectious bites per night in the wet and dry season, respectively, whereas individuals in Etoa receive 2.4 and 0.4 infectious bites per night, respectively. Although transmission patterns differ, the rate of acquisition of immunity to malaria appears to be similar in both villages. A prevalence of 50-75% was found in children < 10 years old, variable levels in children 11-15 years old, and 31% in adults. Thus, as reported in other parts of Africa, individuals exposed to continuous transmission of P. falciparum slowly acquired significant, but not complete, immunity.

Diversity is demonstrated in class I HLA-A and HLA-B alleles in Cameroon, Africa: description of HLA-A*03012, *2612, *3006 and HLA-B*1403, *4016, *4703

To examine the genetic diversity in west Africa, class I HLA-A and HLA-B alleles of 92 unrelated individuals from two areas in the Cameroon, the capital Yaoundé and the village of Etoa, were identified by direct automated DNA sequencing of exons 2 and 3 of the HLA-B locus alleles and sequence-specific oligonucleotide probe (SSOP) and/or sequencing of the HLA-A locus alleles. HLA-A*2301 (18.7%), A*2902 (10.4%), B*5301 (10.9%), and B*5802 (10.9%) were the most frequently detected alleles, present in at least 10% of the population. A total of 30 HLA-A locus and 33 HLA-B locus alleles, including six novel alleles, were detected. The novel alleles were HLA-A*03012, A*2612, A*3006 and HLA-B*1403, B*4016, and B*4703. HLA-B*4703 contains a novel amino acid sequence that is a combination of the first 5 amino acids of the Bw6 epitope and the last 2 residues of the Bw4 epitope. The addition of 6 alleles to the ever-expanding number of known class I HLA alleles supports our hypothesis that extensive genetic diversity, including previously undescribed alleles, would be observed in this African population. In the Yaoundé population, the allele frequency distribution at the HLA-A locus is consistent with distributions indicative of balancing selection. Extensive HLA-A-B haplotypes were observed in this population suggesting that only a fraction of the Cameroon HLA-A-B haplotype diversity has been observed.

Characterization of conserved T- and B-cell epitopes in Plasmodium falciparum major merozoite surface protein 1

Vaccines for P. falciparum will need to contain both T- and B-cell epitopes. Conserved epitopes are the most desirable, but they are often poorly immunogenic. The major merozoite surface protein 1 (MSP-1) is currently a leading vaccine candidate antigen. In this study, six peptides from conserved or partly conserved regions of MSP-1 were evaluated for immunogenicity in B10 congenic mice. Following immunization with the peptides, murine T cells were tested for the ability to proliferate in vitro and antibody responses to MSP-1 were evaluated in vivo. The results showed that one highly conserved sequence (MSP-1#1, VTHESYQELVKKLEALEDAV; located at amino acid positions 20 to 39) and one partly conserved sequence (MSP-1#23, GLFHKEKMILNEEEITTKGA; located at positions 44 to 63) contained both T- and B-cell epitopes. Immunization of mice with these peptides resulted in T-cell proliferation and enhanced production of antibody to MSP-1 upon exposure to merozoites. MSP-1#1 stimulated T-cell responses in three of the six strains of mice evaluated, whereas MSP-1#23 was immunogenic in only one strain. Immunization with the other four peptides resulted in T-cell responses to the peptides, but none of the resulting peptide-specific T cells recognized native MSP-1. These results demonstrate that two sequences located in the N terminus of MSP-1 can induce T- and B-cell responses following immunization in a murine model. Clearly, these sequences merit further consideration for inclusion in a vaccine for malaria.

The chest radiograph appearances of very premature infants at 36 weeks post-conceptional age

The chest radiograph of very premature infants at 36 weeks post-conceptional age (PCA) was evaluated with regard to the degree of hyperinflation and cardiomegaly, and the presence of fibrosis/interstitial shadowing, cystic elements, air bronchograms and opacification. The evolution of abnormalities was assessed by comparing the radiograph appearance at 36 weeks PCA with that at 28 days post-natal age (PNA). Three scoring systems were used to determine how any abnormalities present could be best quantified to reflect disease severity as determined by chronic dependency upon supplementary oxygen status. Chest radiographs at 36 weeks PCA from 60 infants (median gestational age 26 weeks (range 24-28)) were studied. 47 infants also had radiographs at 28 days PNA. Only three infants had no chest radiograph abnormalities at 36 weeks PCA, although 24 infants were not dependent upon supplementary oxygen. The most common abnormalities were interstitial shadowing and hyperinflation, while cystic elements and cardiomegaly were rare. The radiographic appearance had deteriorated from 28 days PNA to 36 weeks PCA (p < 0.05); more infants at 36 weeks PCA were hyperinflated (p < 0.01). The chest radiograph appearances of infants who were dependent upon supplementary oxygen scored higher than those who were not (p < 0.01) using all three scoring systems. The system that assessed only the presence of interstitial shadowing, cystic elements and hyperinflation had the highest specificity in identifying oxygen dependency beyond 36 weeks PCA and had the highest area under the respective receiver operator characteristic curve. In conclusion, the majority of very immature infants have an abnormal chest radiograph appearance at 36 weeks PCA. The appearance can, however, be meaningfully scored by evaluating only three abnormalities.

Assessing the binding of four Plasmodium falciparum T helper cell epitopes to HLA-DQ and induction of T-cell responses in HLA-DQ transgenic mice

A subunit vaccine for Plasmodium falciparum malaria will need to contain well-defined T helper cell epitopes that induce protective immune responses to the parasite. One major barrier to the use of subunit vaccines is the requirement for T helper cell epitopes to be presented by the HLA class II molecules that are present in the population being vaccinated. Since the majority of malaria studies have focused on HLA-DR, little information on the role of HLA-DQ in the binding and immune response to malarial epitopes is available. This study used an in vitro peptide-binding assay to predict the extent of HLA-DQ binding of four conserved T helper cell epitopes identified from asexual-stage malaria vaccine candidate antigens. Epstein-Barr virus (EBV)-transformed human B-cell lines expressing 14 different DQ molecules (DQ2.1, -2.2, -4.1, -4.2, -5.1 to -5.3, -6.1, -6.2, -6.4, -7.1, -7.3, -8, and -9) representing all broad serological specificities, including common DQ molecules present in populations in areas where malaria is endemic, were used in the binding assay. Moreover, an HLA-DQ transgenic mouse model was employed to evaluate the correlation between the in vitro DQ binding of the peptides and the generation of in vivo immune responses following peptide immunization. This study identified two broad DQ-binding peptides, ABRA#14 and SERA#9. ABRA#14 also induced T-cell proliferation and Th1-associated cytokine production in DQ8(+) transgenic mice. The combination of peptide binding to EBV-transformed cell lines and DQ transgenic mice provides a method for identifying additional T-cell epitopes for inclusion in a vaccine.

Balint group observations: the white knight and other heroic physician roles

BACKGROUND

This article reports a typology of five roles that resident family physicians on occasion assume when relating to troubling patients presented in Balint group seminars. The five roles include the white knight (my way or no way), the Pogo look-alike (I feel your pain), the missing link (you made me do it), the surrogate (I can help), and the revolutionary (let me show you). Each role reflects a particular physician's coping behavior in the context of a specific troubling relationship and is driven, in large part, by unrealistic professional expectations. The roles intend to perform a heroic function in rescuing or protecting the patient, the family, or the physician from a distressing medical situation. Balint group work provides participants with the opportunity to derive clinically useful meaning from their presentations. Residents begin to imagine a variety of therapeutic (helpful) roles to replace the ones they were induced to fill. This process has implications for practicing physicians and physician teachers for improving patient and doctor satisfaction and well-being.

A simple chest radiograph score to predict chronic lung disease in prematurely born infants

A simple scoring system has been evaluated with regard to its ability to characterize the pre-term infant's chest radiograph appearance at 28 days and predict oxygen dependency beyond 36 weeks post-conceptional age (PCA). Chest radiographs taken at approximately 1 month of age in 42 infants (median gestational age 28 weeks) were assessed by the scoring system for the presence of fibrosis/interstitial shadows, cystic elements and degree of hyperinflation (maximum score 8). The system's results were then compared with those obtained using two previously published scoring systems. Using all three systems, there were significant differences in the scores of infants who were and were not oxygen dependent at 28 days (p < 0.001) and 36 weeks PCA (p < 0.001). For the three systems, the positive predictive values of a score of 3 or more to predict oxygen dependency at 36 weeks (PCA) were between 67% and 80% and similar receiver operating characteristic curves were obtained. We conclude that scoring only three abnormalities of the 28 day chest radiograph appearance of pre-term infants gives useful predictive information.