Structural and functional outcome of scleral patch graft. Eye (2. 00. 7) 2. April 2. 00. 6LV Prasad Eye Institute, Banjara Hills, Hyderabad, Andhra Pradesh, India. Correspondence: VS Sangwan, Cornea and Anterior Segment Services, LV Prasad Eye Institute, LV Prasad Marg, Banjara Hills, Hyderabad, Andhra Pradesh, India. Tel: +9. 1 4. 0 3. Corneal Graft with Amniotic Membrane Transplantation or Limbal. 12.87 Scleral reinforcement with graft. 3 Procedure Codes - 12.87. CPT Codes CPT Code Modifiers. Tutoplast pericardium patch graft for scleral thinning following strabismus surgery. Patch graft materials include processed pericardium. Comparative Studies of Various Glaucoma Drainage Devices. IOPatch Sclera Patch Graft 5x8 mm. Repair of Exposed Scleral Buckle (David Weissgold, M.D.).
Fax: +9. 1 4. 0 2. E- mail: vsangwan@lvpei. Received 8 August 2. Accepted 1. 5 January 2. Published online 7 April 2. In rare cases, it results in staphyloma formation, scleral perforation, and uveal exposure. Reinforcement of thin or perforated sclera is necessary, especially when the choroid is exposed to prevent prolapse of ocular contents and secondary infection. Various types of homografts and allografts have been used in this situation, but none has been uniformly accepted. Scleral graft has many intrinsic advantages in this scenario as it is readily available from donor eyes, can be easily preserved for months and is strong, flexible, and easy to handle. Sclera has a natural curvature allowing it to neatly blend with host sclera. However, the biggest advantage is that it is avascular and is well tolerated with little inflammatory reaction. On the other hand, failure of scleral homografts has been reported owing to lack of vascularization with resultant necrosis and sloughing. In this communication, we report our experience with the use of scleral patch grafts. Top of page. Materials and methods. This was a retrospective interventional case series of all patients who underwent scleral patch grafting for scleral defects between 1. The parameters recorded were clinical presentation (including preoperative and postoperative visual acuity), past surgical details, systemic diseases, culture results, time lapse between primary aetiology and presentation, details of surgery, length of follow- up, final outcome, and the complications. Successful outcome was defined as structural and visual stability of the eye. The donor sclera was obtained from Eye Bank eyes preserved in absolute ethanol. Before surgery, it was soaked in ringer lactate solution for 1. Betadine for 1. 0 min, and finally in gentamicin 2. Operations were performed under peribulbar anaesthesia, except in a 5- year- old child, where general anaesthesia was used. Conjunctiva, Tenon's capsule, and episcleral tissue were dissected carefully to expose the area of scleral defect. All devitalized, infective, and necrosed soft tissue was debrided and the adjacent unaffected conjunctiva preserved. After defining the borders of the surgical bed to be reinforced, the donor sclera graft was fashioned to the appropriate size and thickness. The graft was then secured to the edges of the resection site using 8- 0 Vicryl sutures on the scleral side and 1. The repaired sclera was then covered with a conjunctival flap undermined from the surrounding site or an amniotic membrane graft (AMG) positioned with stromal side down, using 1. The eyes were bandaged after surgery. The bandage was opened the next day and topical steroids, antibiotics, and lubricant eye drops were prescribed and gradually tapered over 1 month. The structural and visual outcomes were studied and surgical success was defined as tectonic and visual stability of the eye after at least 6 months of follow- up. Top of page. Results. A total of 1. 3 eyes of 1. Ten patients were male (7. Of 1. 3 eyes, surgery was performed in six right eyes and seven left eyes. No gender predisposition was noted. The most common aetiology was necrotizing scleritis following pterygium surgery (five eyes, 3. CI, 1. 3. 3, 6. 6. There was a history of intraoperative adjunctive use of mitomycin C in three eyes. In the remaining two eyes, the status was not known. Of all, three eyes (2. The other details are summarized in Table 1. The common symptoms in most patients were redness, pain, and soreness. The major indication for surgical intervention was severe scleral thinning with uveal exposure and impending globe perforation. One patient (case 7) revealed an abscess at the site of necrotizing scleritis during surgical exploration. Patch graft was deferred and the patient was started on topical antibiotics and scleral patch grafting was performed after 2 months. No associated systemic diseases were found, except for one known case of rheumatoid arthritis (case 9) that was confirmed by serology. Postoperatively, in nine eyes (6. Visual deterioration was seen in three patients (case 5, 3, and 6) and improvement was seen in one eye (case 1. In one eye (case 5), visual deterioration was owing to progression of cataract, for which surgery was planned, but the patient declined surgery at that point. Progressive visual deterioration was noticed subsequent to the development of postoperative endophthalmitis in patient 3. This eye had to be eviscerated after 1. Patient 6 had scleral dehiscence with retinal detachment postpenetrating injury for which the patient underwent scleral patch grafting and parsplana vitrectomy. However, the retina remained detached and patient's vision deteriorated. Tectonic success of the scleral patch graft was achieved in 1. Figures 1, 2, 3, 4, 5 and 6). However, no regrafts were required. Evisceration was performed in one patient (case 3) following the development of postoperative endophthalmitis. Patient 6 with necrotizing scleritis postpterygium surgery had undergone scleral patch with overlying AMG. However, 4 days later, the AMG disintegrated and the scleral graft became elevated with uveal prolapse. Resuturing was carried out and fresh AMG was applied, after which re- epithelialization was achieved. Necrosis of the scleral graft was noticed 2 months later in the rheumatoid arthritis patient (case 9) and was managed with extensive medical therapy. Re- epithelialization of the ocular surface in remaining cases was achieved 3–4 weeks after the surgery.(Patient 5) Scleral patch graft with beginning vascularization 1 month after patch graft and amniotic membrane transplantation. Full figure and legend (5. K)Top of page. Discussion. Human homograft and autograft techniques are commonly employed today to manage ocular diseases that compromise the tectonic stability of the eye. Traditionally, sclera was used as a graft in cases of scleromalacia with impending rupture, scleral ectasias, or traumatic scleral dehiscence. In the last decade, many other tissues and synthetic materials have been added to the ever expanding list of reconstructive materials. Still no material has been found to be universally acceptable. Varied success has been reported with the use of scleral grafts. There are obvious advantages with the use of sclera (vide supra), the only criticism is that it may become involved in the ongoing necrotic process or being avascular may melt. Ti et al. 9 reported favourable results after tectonic corneal lamellar grafting to preserve globe integrity in cases of scleral melting after pterygium surgery. Corneal tissue was selected largely owing to the unavailability of sclera in their surgical set- up. Owing to its transparency, it may not be cosmetically acceptable to the patient. Probably, at present there is no significant benefit of using corneal tissue over sclera if the tissue is freely available. Split thickness dermal grafts have been shown to provide tectonic support in certain unusual circumstances as in cases of previous conjunctival scarring. Dermal grafts have the ability to survive on an avascular surface, are supple, and nonbulky with good tensile strength. Being autogenous, hypersensitivity reactions are not induced. However, they have the disadvantage of being cosmetically unacceptable and unsuitable for use in infective cases and of undergoing extensive vascularization. Dermal grafts and numerous other tissues such as fascia lata, periosteum, and cartilage require an additional surgery and thereby have the potential to add morbidity. In our review of scleral patch grafting for cases of scleral defects of varying aetiologies, favourable structural outcome was achieved in 1. Three patients had complications in the form of endophthalmitis, graft melting, and dehiscence. Postoperative infections can be minimized by its recognition preoperatively, early surgical debridement for clearing infected tissues and deferring patch grafting unless there is a risk of emergent perforation. In the present series, patient 3, who developed endophthalmitis postoperatively, was a high- risk case on account of aphakic glaucoma treated with trans- scleral cyclophotocoagulation with subsequent scleral thinning and corneal oedema. Postoperatively, he developed corneal epithelial defect with infiltration and progressed to fulminant endophthalmitis within a few days. Patient 9, a rheumatoid arthritis patient, developed graft necrosis within 2 months of the patch graft. It was managed medically and regrafting was not required to preserve the structural integrity of the eye. Preoperative screening to rule out systemic vasculitic disorders is necessary. If detected, surgery should be deferred until medical therapy has controlled the primary disease. Patient 6 developed graft dehiscence in the postoperative period. In this particular case, graft was covered with amniotic membrane that retracted within 4 days leaving the sclera bare and predisposing the patient to further occurrence of this type. Scleral graft does not contain epithelium and survival is jeopardized on avascular surfaces, so a cover of conjunctival flap is necessary to prevent its necrosis and sloughing. If the adjacent conjunctiva cannot be mobilized, either a free conjunctival flap from the other eye or AMG may be considered. Amniotic membrane consists of a thick basement membrane and an avascular stroma and is endowed with anti- inflammatory, antifibrotic, and epithelialization promoting properties. At the same time, it is immunologically inert and is very popular for ocular surface reconstruction. However, by itself it may not provide adequate tectonic rigidity and is amenable to rapid disintegration and loss. Glaucoma Drainage Devices - Eye. Wiki. Glaucoma drainage devices are designed to divert aqueous humor from the anterior chamber to an external reservoir, where a fibrous capsule forms about 4- 6 weeks after surgery and regulates flow. These devices have shown success in controlling intraocular pressure (IOP) in eyes with previously failed trabeculectomy and in eyes with insufficient conjunctiva because of scarring from prior surgical procedures or injuries. They also have demonstrated success in complicated glaucomas, such as uveitic glaucoma, neovascular glaucoma, and pediatric and developmental glaucomas, among others. In addition, other glaucoma drainage devices have been introduced and offer unique features designed to facilitate implantation, improve IOP control, and reduce acute postoperative hypotony. The nonvalved devices include the Molteno (IOP, Inc., Costa Mesa, CA, USA, and Molteno Ophthalmic Limited, Dunedin, New Zealand), Baerveldt (Advanced Medical Optics, Inc., Santa Ana, CA, USA), Shocket, and Eagle Vision implants (Eagle Vision, Inc. Unlike the nonvalved devices, the valved or flow- restrictive devices allow only unidirectional flow from the anterior chamber to the subconjunctival space with a minimum opening pressure. The most commonly used valved implant is the Ahmed glaucoma valve, AGV (New World Medical, Rancho Cucamonga, CA, USA). Table 1 provides a summary of commercially available devices with their respective characteristics. In addition, the devices appear to be advantageous as a primary procedure in patients with a high likelihood of trabeculectomy failure, including neovascular and uveitic glaucomas (1- 7). They are commonly used in the management of congenital and developmental glaucomas (8- 1. Additional indications include traumatic glaucoma, aphakic and pseudophakic glaucoma, post- keratoplasty glaucoma, and other secondary glaucomas (1. Recently, interest has increased in using these devices as a primary surgical procedure for uncontrolled primary open- angle glaucoma. Clinicians should assess mobility of the conjunctiva to determine the best quadrant for drainage implant insertion. The iris should be inspected under high magnification to detect neovascularization to consider preoperative use of anti- vascular endothelial growth factor (VEGF) agents to minimize intraoperative and postoperative bleeding. Anterior chamber depth should be assessed to determine if tube insertion in the anterior chamber would be safe without touching the iris or cornea. Gonioscopy should be performed preoperatively to determine the locations of peripheral anterior synechiae which may interfere with the tube insertion into the anterior chamber intraoperatively. The lenticular status of the eye should be noted. The tube may be placed in the sulcus in a pseudophakic eye or pars plana in an aphakic, vitrectomized eye. In an eye with a cataract, a combined surgery may be considered. IOP control in the early postoperative period is more predictable with these devices because of flow- restricting mechanisms. In patients with poor compliance with postoperative medication use and follow- up visits, valved implants may be preferred because they usually require less postoperative follow- up and care. The most important factor determining the type of implant selected is the target IOP, both in the short- run and long- run. Early IOP control is determined by the presence or absence of a valve in an implant, as the tube offers no resistance to aqueous flow. The valved devices provide more immediate IOP control and a lower rate of hypotony. Because nonvalved devices are often occluded with a stent or ligature suture, the postoperative IOP is unchanged and requires continuation of all preoperative medications until the fibrous capsule forms. With all devices, long- term IOP control depends on the surface area of the implant, which determines bleb size, tissue response to the implant, and thickness of the fibrous capsule controlling percolation of aqueous humor through the bleb wall. Two retrospective studies compared AGV silicone (model FP7) and polypropylene (model S2) and reported similar results with both models in terms of IOP control, final visual acuity, and postoperative antiglaucoma medications (2. In one of these studies, the silicone valve was associated with fewer serious complications (2. The AGV silicone and polypropylene material has also been investigated in a prospective, multicenter, comparative series, which reported improved final IOP control with the silicone model compared with the polypropylene model (2. The investigators observed more Tenon. In a retrospective study, the double- plate Molteno demonstrated lower mean IOP when compared with the single- plate AGV, 1. In a prospective study comparing 3. Baerveldt implants, Lloyd et al. In another prospective study comparing 3. Baerveldt implants, Britt et al. These studies indicate that size of the implant does matter, but to a limited extent. Further studies are warranted to determine which one of these variables- size, shape, or composition is most likely to affect long- term success of glaucoma drainage devices. The most commonly used anesthesia is a peribulbar or retrobulbar block which provides both akinesia and anesthesia. A sub- Tenon injection is also a good alternative. Topical or intracameral anesthesia is usually not sufficient because of manipulation of extraocular muscles with some implants. General anesthesia may be reserved for patients with special circumstances, such as claustrophobia or altered mental status. Table 1 Commercially Available Glaucoma Drainage Devices. Pictures courtesy of: IOP, Inc., Costa Mesa, CA, USA, New World Medical, Rancho Cucamonga, CA, USA,Advanced Medical Optics, Inc., Santa Ana, CA, USA, and Eagle Vision, Inc. Memphis, TN, USAA. Valved Implants. Type Model Size Material. Single Plate S2 1. Polypropylene. Pediatric Size S3 9. Polypropylene. Double Plate B1 3. Polypropylene. Single Plate FP7 1. Silicone. Pediatric Size FP8 9. Silicone. Double Plate FX1 3. Silicone. Pars Plana PS2 1. Polypropylene. Pars Plana (Ped) PS3 9. Polypropylene. Pars Plana PC7 1. Silicone. Pars Plana (Ped) PC8 9. Silicone. B. Nonvalved Implants. Baerveldt Implant. Single Plate 1. Silicone. Single Plate 1. Silicone. Pars Plana 1. Silicone. Eagle Vision EG3. Silicone. Molteno Implant. Single Plate S1 1. Polypropylene. Single Plate/Ridge D1 1. Polypropylene. For microphthalmic eyes M1 5. Polypropylene. Double Plate R2/L2 2. Polypropylene. Double Plate/Ridge DR2/DL2 2. Polypropylene. Molteno 3/Single Plate GS 1. Polypropylene. Molteno 3/Double Plate GL 2. Polypropylene. Implantation of a glaucoma drainage device requires careful attention to detail at every step of the procedure to improve results and minimize postoperative complications. Initially, a fornix- based or limbus- based conjunctival incision is created to allow adequate exposure for insertion of the plate. A corneal or scleral suture can be placed to improve exposure in the working quadrant. The implant is anchored between two rectus muscles with the anterior edge approximately 8 to 1. Larger implants (Baerveldt) are inserted with the long axis directed toward the apex of the orbit and then rotated hori. If a two plate implant is used, one plate is positioned in each of two quadrants. The tube connecting the two plates may be passed under or over the intervening rectus muscle. With all valved implants, prior to the plate anchorage, the tube should be primed with balanced salt solution with a 3. The tube of the nonvalved implant should be irrigated as well to ensure its patency. The suture knots should be rotated into the fixation eyelets to prevent erosion through the conjunctiva. Secure attachment to the underlying sclera is essential to prevent anterior, posterior, or lateral migration of the implant during the postoperative period. After the plate is attached to the globe, the tube is laid across the cornea and cut with a sharp scissors to create a beveled edge with the opening toward the cornea. The tube should extend approximately 2. A 2. 3- gauge needle is used to create a track through which the tube is inserted into the anterior chamber just anterior and parallel to the iris. The tube may be secured to the sclera a few millimeters anterior to the plate with 7- 0 or 8- 0 Vicryl suture. This suture helps to stabilize the tube and should not be tight; otherwise, it will restrict flow in valved devices. Patch graft materials include processed pericardium, sclera, fascia lata, dura, or cornea. The patch graft should be secured to the globe with interrupted sutures at the anterior corners by using either 8- 0 Vicryl or nylon sutures. If the patch graft material is not available, a partial thickness scleral flap can be constructed. The needle track and tube entry are done under this flap. The flap is then sutured with 1. After the patch graft has been placed, the conjunctiva and Tenon layers are pulled over the plate, tube, and patch graft and secured into place with 8- 0 Vicryl suture. In some cases, the monofilament 9- 0 Vicryl suture is preferred because of its higher tensile strength and finer vascular needle to prevent buttonholes when handling thin conjunctiva. Fluorescein drops or strips can be used to inspect the conjunctiva for leaks. Any buttonholes found in the conjunctiva should be closed with 9- 0 Vicryl suture. At the conclusion of the procedure, a subconjunctival injection of antibiotic and steroid is given. Once the fibrous capsule around the plate has formed, the stent suture is removed at the slit lamp under local anesthesia. The external occlusion may be accomplished using a non- absorbable 7- 0 suture with a releasable knot or a 7- 0 or 8- 0 absorbable Vicryl suture tied around the tube. Alternatively, 9- 0 nylon or 1.
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Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Clonidine belongs to a class of drugs (central alpha agonists) that act in the brain to lower blood pressure. It works by relaxing blood vessels so blood can flow more easily. OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. This drug may also be used for attention deficit hyperactivity disorder (ADHD), for hot flashes that occur with menopause, for withdrawal symptoms from narcotic drugs, and to help people quit smoking. How to use clonidine transdermal. Read the Patient Information Leaflet if available from your pharmacist before you start taking clonidine and each time you get a refill. If you have any questions, ask your doctor or pharmacist. Peel off the backing from the patch and apply the patch to a clean, dry, and hairless area of the skin on the upper outer arm or upper chest. Press the patch firmly in place for about 1. Do not apply the patch on oily, broken, or irritated skin. Avoid applying the patch to areas of the skin where it might be easily rubbed off (such as on skin folds). Use this medication as directed by your doctor. The patch is usually worn for 1 week and then replaced. Follow the dosing schedule carefully. Wash your hands after handling the patch. The dosage is based on your medical condition and response to treatment. When replacing your patch, make sure to apply the new patch to a different area. Fold the old patch in half with the sticky side together and throw away in the trash away from children and pets. TODAY OFFER: Only 0.23 per pill. Cholesterol - transdermal patch atorvastatin, buy lipitor online, lipitor price. Omega-3 Fish Oil Oregano Oil Pain Relief Parasite Cleanse PGX. The nicotine patch is the highest selling transdermal patch in North America. Components of a Transdermal Delivery System: - Release.
Do not flush the patch down the toilet. If the patch starts to loosen from the skin, you may apply the . If the patch falls off or if you have mild redness/itching/irritation around the application site, discard the patch as directed and apply a new patch to a different area. Use this medication regularly to get the most benefit from it. To help you remember, change the patch on the same day each week. It may help to mark your calendar with a reminder. It is important to continue using this medication even if you feel well. Most people with high blood pressure do not feel sick. Do not stop using this medication without consulting your doctor. You may experience symptoms such as nervousness, agitation, shaking, and headache. A rapid rise in blood pressure may also occur if the drug is suddenly stopped. The risk is greater if you have used this drug for a long time or in high doses, or if you are also taking a beta blocker (such as atenolol). 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Such specific foci are reported in Table S1. All reviews included school- based programs (not reported in Table S1), and 2. Substance abuse prevention and sex education are usually implemented in secondary schools (junior high and/or senior high) and may also include the upper elementary grades 5. This corresponds with the age range most frequently stated in reviews: 1. Many nutrition reviews also included younger elementary- aged children. The number of included studies differs widely across the reviews (3. For reviews that provided sufficient information about studies, we recorded in Table S1 how many of the included primary studies met our relevance criteria (targeted behaviors, secondary- school- age, school- based educational intervention). In the nutrition domain, some reviews included only one relevant study, as most nutrition programs target elementary students. For these reviews, only the results of this one study were recorded. In the other domains, the number of relevant studies was much larger, and often all studies were relevant. Except for a review about sexual knowledge . Comprehensive school health education includes. Comprehensive school health education. Components of WSCC; Tools. Many reviews also addressed effects on psychosocial determinants, and in the sexuality domain one third of reviews examined results for biological outcomes such as pregnancy. As for the quality rating, 3. Weak reviews generally did not report methodological inclusion criteria, whereas strong reviews did. Criteria used most frequently pertained to study design and outcome measure; other criteria were much less frequently applied, e. The inclusion criteria differed markedly, even between strong reviews. Many strong reviews subjected the included studies to additional quality rating. Fifteen reviews applied meta- analytic techniques (mostly in the substance abuse and sexuality domains, not reported in Table S1) and nearly all of them had a quality score of 7. Effect sizes and general statements about effectiveness. Qualitative statements about the occurrence or magnitude of behavioral effects were cautiously positive in most reviews. Only very few reviews reported overall absence of effects and none reported overall negative effects. There do not appear to be clear relationships between type of statement and behavioral domain or review quality. The quantitative results of meta- analyses and reviews, expressed in effect sizes (ES), odds ratios (OR) or percentage reductions, are in line with the above mentioned qualitative statements in the reviews: in light of Cohen's . Botvin and colleagues . A review of long term (> 2 years) tobacco outcomes reported a mean reduction of 1. Comprehensive School Health Program. Developing a Program: Infrastructure and. For alcohol use, meta- analyses . Statistically significant positive effects have been reported for condom use (ES = . For birth control, one meta- analysis that included non- controlled studies found statistically significant positive effects (ES = . Of five reviews that examined sexual activity, frequency or number of partners, two reported statistically significant positive effects (both ES = . No effects were found on diagnosis with STD . As for pregnancy, the meta- analysis that included non- controlled studies reported a positive effect (ES = . One intensive high school intervention even increased daily servings of fruit and vegetables by over 2. All classrooms in each selected school were included in the. Coordinated School Health. The Comprehensive school health program: exploring an. Introduction to School Health Programs. Describing the Components of a School Health Program. BMC Public Health BMC Public Health main menu. Comprehensive-school-health-education. In the substance use domain, a meta- analysis . A tobacco- specific meta- analysis . In the sexuality domain, the following ESs have been reported: . As stated in the Methods section, the analysis focused on results of strong and moderate reviews; weak reviews were only used for supplementary purposes in the absence of stronger reviews. The elements are italicized in the text below to enhance combined reading of text and tables, and elements that are considered effective in all three domains are marked bold in the text and tables. In light of the large number of elements that have been examined in the reviews and our focus on similarities across domains, the tables only include aspects that have been examined in at least two domains. Program focus or goal. As shown in . Not one sexuality review stated positive conclusions about the effectiveness of abstinence- only programs, which portray abstinence from sex as the only or very best prevention option and usually do not discuss contraception, and one even reported negative effects . In contrast, one strong sexuality review . Comparatively, in the substance abuse domain, one strong review cautioned that the goal of harm reduction or prevention of abuse may be more effective than a goal of abstinence or delayed use, at least for youth who already use . With respect to specific theories, strong reviews in the substance abuse . Three other characteristics of program development were stated to be important for enhancing effects, but each only in one or two domains: needs assessment among the target group, participant involvement in program planning and implementation, and pretesting. The evidence for the second element involved only a supplementary weak review in the substance abuse domain . The sexuality review had positive conclusions . However, the substance abuse review with the strictest criteria reported this issue to be unclear because no high- quality study had compared culture- specific interventions with standardized interventions . In the nutrition domain, this issue was only addressed by a supplementary weak review, which stated the issue to be unclear and in need of further research . Tailoring to cognitive ability or age has been examined by three strong reviews, which cover all three domains. Since many elements were mentioned in the reviews, we included headings to indicate that there may be some similarity between elements. Knowledge, risk, attitude. Health education programs in all domains usually include information about health consequences and prevention methods. In all domains a knowledge- only approach was reported to have no effect on behavior, but in the sexuality domain this involved only a supplementary weak review . Some authors commented that this approach has hardly been tested rigorously . In the sexuality domain, a strong and a moderate review stated that accurate, factual information is an element of effective interventions . The results of two strong sexuality reviews for enhancing perceived risk were mixed . Several other elements were each addressed in only one domain and are therefore not included in Table S4 nor further discussed here. Social influences. Social influences have been addressed in all domains, especially in the substance abuse domain where the social influences approach has been widely prevalent for decades. In all domains, strong reviews stated that this approach is effective, although reservations were reported in one tobacco review . While the social influence approach entails several components . In all domains, strong reviews reported the first component, addressing social norms, as an effective element. In the nutrition domain attention to norms does not seem to take the form of normative feedback but rather of building normative support for desired changes and for creating a more supportive school or community environment . The second component, resistance skills training, was not addressed in nutrition reviews and had inconsistent results in other domains. There is some evidence that this element may only be effective in conjunction with normative education or with a rationale or motivation for refusal and may even be counterproductive when used alone . Although the types of skills were not always specified or seemed to vary, the following similarities were observed. In the nutrition and sexuality domains, some strong reviews mentioned domain- bound practical skills, such as food preparation or condom use skills. In each domain, cognitive- behavioral programs have been found effective in one or two strong reviews. Although not all authors used the same terms or were clear about what this approach entails exactly, we included this element to refer to statements about the importance of addressing both motivations and cognitive and behavioral skills. In the nutrition domain, one strong review stated that effective behaviorally focused curricula address cognitive, affective and behavioral aspects . In their meta- analysis of tobacco outcomes of psychosocial programs, Hwang and colleagues . They distinguished social influence, cognitive behavioral, and life skills modalities. Cognitive- behavioral programs were those that included the social influence approach . Life skills programs included the defined aspects of the social influence and cognitive- behavioral modality programs plus at least one affective skill such as self- confidence, values clarification, and/or generic social skills. Strong reviews in the substance abuse domain reported that this training enhances the effects of a social influence approach on tobacco and alcohol use. Life skills training has only been tested in the substance use domain, and only in combination with a social influence approach. However, in the sexuality domain some strong and moderate reviews seem to refer to similar skills when stating the importance of coping, communication, and negotiation skills . In the substance abuse domain four strong reviews consistently reported interactive methods to be effective; supplementary, weak reviews in the sexuality and nutrition domains mentioned specific examples of interactive methods (discussion and role- play). Tobler and colleagues . Four other elements of program methods had evidence from one or two strong reviews in one domain, but had been examined by only weak reviews in another domain. Components of the Whole School, Whole Community, Whole Child (WSCC) . Students may have access to foods and beverages in a variety of venues at school including the cafeteria, vending machines, grab . School nutrition professionals should meet minimum education requirements and receive annual professional development and training to ensure that they have the knowledge and skills to provide these services. All individuals in the school community support a healthy school nutrition environment by marketing and promoting healthier foods and beverages, encouraging participation in the school meal programs, role- modeling healthy eating behaviors, and ensuring that students have access to free drinking water throughout the school day. Healthy eating has been linked in studies to improved learning outcomes and helps ensure that students are able to reach their potential. The Best of the Best. The rich were meant to have the most leisure time. The working poor were meant to have the least. The opposite is happening. He told students that one . Twentysomething male high- school grads used to be the most dependable working cohort in America. Today one in five are now essentially idle. Poets & Writers has just released its 2012 rankings of creative writing MFA programs. Year after year, their ranking of Columbia University—my alma mater—has steadily fallen. I can remember when it was in the. Professionally organized exhibitions that extend and support the educational programs of the Art Department of Hunter College. But that doesn’t get at the heart of the problem of ranking M.F.A. The Top 25 Underrated Creative Writing MFA Programs - Read more about UCF Opinions, Orlando and Central Florida news. The employment rate of this group has fallen 1. Top Fifty 2012 MFA Programs. This list was compiled by Seth Abramson. 2012 Rankings for Top 50 MFA Programs. University of Iowa – MA, MFA, PhD; University of Michigan – MFA; Brown University – MFA. 2012 MFA RANKINGS: THE TOP FIFTY wwebrankings.indd 74-75ebrankings.indd 74-75 88/16/11 10:10 AM/16/11 10:10 AM. MFA; graduate programs; creative writing; low-residency; full-residency; rankings; graduate students. In late August, Poets & Writers, by far the most respected and well-known magazine in the writing and publishing world, released their September/October issue, ranking all the MFA and PhD creative writing programs in the. Home/Programs/Writing/ MFA Program. Search this site: MFA Program. Columbia University School of the Arts offers MFA degrees in Film, Theatre. The twenty-five programs listed below fully fund a sizable percentage of incoming students, yet still receive less attention from applicants than they deserve. They are not -- or not yet -- among the very best creative writing. Georgian College - UPC Degree and Gradute Studies Program Guide. We have a new feature called HTML5 Flipbooks that does not require Adobe Flash. This feature is still in beta so some features may not be available at this time, but check it out! Laurentian University is closing its satellite campus in Barrie, Ont., after 15 years of operations. The decision was made by the University Board of Governors on Friday. After 15 years in Barrie, Laurentian University will cease its operations at Georgian College. On Friday, Laurentian’s Board of Governors voted in favour of leaving. Great programs in business, engineering technology, health and wellness, design and visual arts, hospitality, tourism or aboriginal and community studies. It is agreed and understood that all academic staff teaching Laurentian University courses at Georgian College and paid by Georgian College are not members of the. Laurentian Georgian Programs Like Microsoft
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Does anyone know how to set a scheduled task to run in background using Windows Task Scheduler? There doesn't seem to be any option to do this. Schedule the program's window watcher to. Windows 7 Task Scheduler can be troublesome with batch files & this software solves that. System Scheduler 4.23. Olympic Discovery Trail to Sequim Bay. They are all old friends, Port Townsendites familiar with each. They don hats and jackets and discover a lonely patch of snow near. Ever since coming to Port Townsend 17 years ago as Port Townsend's first city. As more people discover the area. Shop for townsend on Etsy, the place to express your creativity through the buying and selling of handmade and vintage goods. Festivals & Events . However, visiting the Park may be just one of several places and activities that you might want to experience while you. The variety of options – spread throughout the year – is enough to satisfy anyone. As always, the trick is to match your desires to the timing of your visit. Click the image above to link to the Wooden Boat Festival website. Activities in Forks, Port Angeles, Sequim, and Port Townsend are easiest to fit into your trip for the simple fact that traveling between the Park and these communities is usually relatively simple and quick. Activities off of the Olympic Peninsula, such as those in Seattle or Victoria B. C., will require more planning. The last event takes place the last Tuesday in August. Click the image below for more information about the City of Sequim’s Music in the Park program. The image below shows folks enjoying a carriage ride in the Pumpkin Patch, during the annual Harvest Celebration and Farm Tour. A list of various events off the Olympic Peninsula follows. I've always enjoyed OceanDiver's reports of wildflowers in the prairies on her island. So imagine my excitement to discover a little remnant of preserved prairie. View Customer reviews of Herbal Access, a marijuana dispensary in Port Townsend, Washington where you can buy marijuana legally. VDOE : : Gifted Programs. Statistics & Reports. Information related to gifted education services is reported annually to the Virginia Department of Education by each school division. The information is combined to produce a statewide annual report which includes student demographics, program service options, and gifted education teacher or program administrator data. Current and prior years reports are listed below in PDF format. You can get a more detailed view of the Gifted and Talented Program in the Fairfax County Public Schools here. EMail to LHS Curator: [email protected] . Identification of the Gifted and Talented. S:\Gifted Services\Margaret\CEESA\CEESA ID Simulation.doc. Fairfax, VA Address: Fairfax, VA. Gifted Annual Reports.
Young Scholars Circle - All 2nd grade students in Fairfax County Public Schools and certain students in grades 3- 7 are tested with Cognitive Abilities Test (Cog. At) Custom Form and Naglieri Nonverbal Ability Test (NNAT) to measure academic aptitude and be placed in Level 4 Advanced Academic Programs (formerly Gifted and Talented Program). Learn more about the Fairfax County Public Schools' AAP Testing and Identification Timeline. In Loudoun County, all second graders are tested with Cog. At and NNAT for placement in FUTURA or SPECTRUM (gifted program). Learn more about the Loudoun County's gifted program. It is important to expose your child to the type of exam that they will encounter in Cog. At & NNAT. Invest in your child's education! Do you know that your child may qualify for the Regional Gifted and Talented Search of John Hopkins University? See the benefits and advantages. Schedule a FREE informational session with us. We offer SCAT test preparation all year long. Call us first to see if there are spots available (7. Discover and compare 7 Gifted in Virginia. More than 2 million parents every year book their perfect camp on MySummerCamps. Find your camp today!Council for Exceptional Children - Information Center on Disabilities and Gifted Education. Gifted and Learning Disabled. Fairfax County Schools. Gifted and Talented Program 1200 First St., NE, 8 th floor Washington. The information and the decline in average CogAT scores of students admitted to the GT Center program was based on FCPS staff memos, which were provided to members of what used to be called the Gifted and Talented Advisory. |
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