Visions of a cure. Visualization, clinical trials, and controversies in cardiac therapeutics, 1968-1998

In the early 1970s physicians engaged in fierce debates over the most appropriate method of evaluating the efficacy of coronary artery bypass grafting (CABG). With millions of patients and billions of dollars at stake, CABG sparked fierce controversy. Skeptics demanded that randomized controlled trials (RCTs) be performed, while enthusiasts argued that they already had visual proof of CABG's efficacy. When RCTs appeared, they did not settle the controversy. Participants simply reasserted their preconceptions, defending a trial's strengths or exploiting its flaws. The debate centered on standards of knowledge for the evaluation of therapeutic efficacy. Specifically, cardiologists and cardiac surgeons struggled to assess the relevance of different measures of therapeutic success: physiological or clinical, visual or statistical. Many factors contributed to participants' decisions, including disciplinary affiliation, traditions of research, personal experience with angiography, and assessments of the history of cardiac therapeutics. Physicians had to decide whether angiography provided a meaningful representation of the disease and its treatment or whether demonstrations of therapeutic success could come only from long-term statistical evaluation of mortality data.     

The initiation of distance learning at Thomas Jefferson University: the library as integral partner

In 1998 Thomas Jefferson University offered its first entirely online course. Librarians and library staff were integral in the development, support, evaluation, and refinement of this course. While staff members may have taken non-traditional roles in this effort, their roles generally fell within the broad guidelines of assisting University faculty with information and knowledge management. The development and support of distance course offerings will continue to be a focus at Scott Memorial Library.     

The effect of two different 18-week walking programmes on aerobic fitness, selected blood lipids and factor XIIa

Forty-nine previously sedentary or low active individuals aged 40-71 years were allocated to three groups. The long walking group participated in an 18-week walking programme which consisted of walks lasting 20-40 min; the repetitive short walking group completed walks of between 10 and 15 min, up to three times a day, with no less than 120 min between each walk; and the control group maintained their low level of activity. Both walking programmes began at a prescribed 60 min x week(-1), which increased steadily up to 200 min x week(-1) by week 12. During the study, the long walking group walked for an estimated 2514 min (139 min x week(-1)), expending an estimated 67.5 MJ (3.72 MJ x week(-1)) at an estimated 73% of their age-predicted maximum heart rate and 68% of their estimated VO2max. The repetitive short walking group walked for an estimated 2476 min (135 min x week(-1)), expending an estimated 58.5 MJ (3.17 MJ x week(-1)) at an estimated 71% of their age-predicted maximum heart rate and 65% of their estimated VO2max. The results showed a statistically significant reduction in heart rate during a standardized step test (pre- vs post-intervention) in both walking groups, indicating an improvement in aerobic fitness, although the control group showed a higher average heart rate during the post-intervention test, indicating reduced fitness. When compared with the male subjects pre-intervention, the females possessed more favourable levels of high-density lipoprotein (HDL) cholesterol (P< 0.001), apolipoprotein (apo) AI (P < 0.001) and ratios of total cholesterol:HDL cholesterol (P< 0.02) and low-density lipoprotein (LDL) cholesterol: HDL cholesterol (P< 0.02). Compared with the controls post-intervention, the walking groups showed no statistically significant changes in total cholesterol, LDL cholesterol, HDL cholesterol, apo AI, apo AII, apo B, or the ratios of total cholesterol: HDL cholesterol, LDL cholesterol: HDL cholesterol, apo AI: apo B or apo AI: apo AII (P > 0.05). Relative to the walking groups, factor XIIa increased in the control group (P < 0.05). We conclude that, although both walking programmes appeared to improve aerobic fitness, there was no evidence of improvements in the blood lipids or associated apolipoproteins of the walking groups. Further analysis indicated that this apparent lack of change may have been related to the subjects' relatively good pre-intervention blood lipid profiles, which restricted the potential for change. The implications of the observed changes in the coagulation/fibrinolytic factors remain unclear.     

Using the Ecosystemic Approach to Change Chronic Problem Behaviour in Primary Schools

This paper describes a small‐scale study of what the authors describe as the ecosystemic approach to changing chronic problem behaviour. The study was undertaken with a group of twelve Leicestershire primary teachers. The technique is briefly described and then teachers' responses to it and its effectiveness are discussed. Four case study examples are presented and finally its potential is considered. Although in this case the work was undertaken with primary teachers, this is an approach which could also be useful at secondary level.