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The authors conducted a diabetes quality improvement project in 5 privately owned primary care practices serving at least 25% minority patients. Interventions included group-specific and practice-specific training on an electronic patient registry, cultural competency practices and tools, and selected quality improvement strategies. The authors conducted a comprehensive evaluation involving quantitative and qualitative data to assess project impact. Although overall clinical performance did not improve over the 14- to 20-month project time frame, other practice structural characteristics and processes did show improvement: successful implementation of the registry and clinician reminders in all practices, institution of team care and patient reminders in 4 practices, and collection of patient race/ethnicity data in 4 practices. These results highlight the difficulty of bringing about clinical improvement in this subset of practices and also the importance of conducting comprehensive evaluations to fully understand and interpret multicomponent quality improvement projects. © 2012 by the American College of Medical Quality.

Superintendents have the responsibility to engage in the act of teaching their colleagues what they have learned about the most important work of school districts-ensuring high student achievement. They also must provide strong leadership that will foster and nurture powerful learning communities.

In the developing nervous system, neurotrophin 3 (NT3) and brain-derived neurotrophic factor (BDNF) have been shown to interact with each other and with different parts of a neuron or glia and over considerable distances in time and space. The auditory system provides a useful model for analyzing these events, insofar as it is subdivided into well-defined groups of specific neuronal types that are readily related to each other at each stage of development. Previous work in our laboratory suggested that NT3 and its receptor TrkC in the mouse cochlear nucleus (CN) may be involved in directing neuronal migration and initial targeting of inputs from cochlear nerve axons in the embryo. NT3 is hard to detect soon after birth, but TrkC lingers longer. Here we found NT3 and TrkC around P8 and the peak around P30. Prominent in ventral CN, associated with globular bushy cells and stellate cells, they were localized to different subcellular sites. The TrkC immunostain was cytoplasmic, and that of NT3 was axonal and perisomatic. TrkC may be made by CN neurons, whereas NT3 has a cochlear origin. The temporal pattern of their development and the likelihood of activity-dependent release of NT3 from cochlear axons suggest that it may not be critical in early synaptogenesis; it may provide long-term trophic effects, including stabilization of synapses once established. Activity-related regulation could coordinate the supply of NT3 with inner ear activity. This may require interaction with other neurotrophins, such as BDNF.

To study the mechanisms of noise-induced hearing loss and the phantom noise, or tinnitus, often associated with it, we used a mouse model of noise damage designed for reproducible and quantitative structural analyses. We selected the posteroventral cochlear nucleus, which has shown considerable plasticity in past studies, and correlated its changes with the distribution of neurotrophin 3 (NT3). We used volume change, optical density analysis, and microscopic cluster analysis to measure the degeneration after noise exposure. There was a fluctuation pattern in the reorganization of nerve terminals. The data suggest that the source and size of the nerve terminals affect their capacity for regeneration. We hypothesize that the deafferentation of ventral cochlear nucleus is the structural basis of noise-induced tinnitus. In addition, the immunofluorescent data show a possible connection between NT3 and astrocytes. There appears to be a compensatory process in the supporting glial cells during this degeneration. Glia may play a role in the mechanisms of noise-induced hearing loss. © 2011 Wiley Periodicals, Inc.

The Peruvian writer Mario Vargas Llosa, one of the most prolific and distinguished Spanish American novelists of the twentieth century and the winner of the 2010 Nobel Prize in Literature, is also the author of eight plays, which have frequently been overshadowed by his narrative production. Going beyond the relationship traced by critics between his novels and his plays, this essay underscores the prevalence in his theatrical work of a tug of war between biographical and autobiographical voices as part of a fundamental exploration of real and fictional memory. From Vargas Llosa's early plays of the 1980s to his most recent ones, he has frequently dramatized the life of both real and imaginary, famous and infamous others and selves, creating the illusion that the audience is witnessing someone's life trajectory. This is the analytical angle from which this essay approaches not only Vargas Llosa's first play, La seorita de Tacna (1981), but in particular one of his most recent ones, Odiseo y Penélope (2007). In both analyses, the definitions of biographical and autobiographical discourses are interpreted in light of theatrical representation, underscoring in this way the subjective, dramatic, and metaphorical perspectives of these expressions. © 2012 Taylor and Francis Group, LLC.

iPrompts® is a software application for handheld devices that provides visual support to individuals with Autism Spectrum Disorders (ASDs). Caregivers use the application to create and present visual schedules, visual countdown timers, and visual choices, to help individuals with ASDs stay organized, understand upcoming events, and identify preferences. The developer of the application, HandHold Adaptive, LLC, initially introduced iPrompts on the iPhone and iPod Touch in May of 2009. The research team from the Center of Excellence on Autism Spectrum Disorders at Southern Connecticut State University conducted a study of iPrompts in 2010, investigating its use by educators working with students with ASDs. Among other findings, educators indicated a desire to present visual supports on a larger, "tablet"-sized display screen, leading the developer to produce an iPad-specific product, iPrompts® XL. Described in this paper are the research effort of iPrompts and subsequent development effort of iPrompts XL. © 2012 Springer-Verlag.

Objectives: Increasing evidence suggests that deficits in mindfulness (awareness, attentiveness, and acceptance of the present moment) play a role in a range of disorders involving behavioral dysregulation. This paper adds to that literature by describing a transdiagnostic psychotherapy (Mindfulness & Modification Therapy; MMT) developed to target behavioral dysregulation. Design: An open-treatment pilot-trial investigated the feasibility, acceptability, and pre-post effects of MMT targeting women (N = 14) court-referred for alcohol abuse/dependence and aggression. Results: Pre-post comparisons revealed significant decreases in alcohol use, drug use, and aggression. In addition, the retention rate was 93%. Conclusion: Preliminary evidence suggests that MMT is a feasible and acceptable treatment that decreases dysregulated behaviors such as substance use and aggression, while also potentially increasing retention. (c) 2011 Wiley Periodicals, Inc. J Clin Psychol 67:117, 2011.