[DEVELOPING SPACES FOR MULTIDISCIPLINARY COLLABORATION IN SCHOOLS: CHALLENGES AND OPPORTUNITIES]. / CREANDO ESPACIOS DE COLABORACIÓN MULTIDISCIPLINARIA EN LAS ESCUELAS: RETOS Y OPORTUNIDADES.

The main objective of this manuscript is to document our experience collaborating with professionals from various disciplines through different research projects in school and university settings, while focusing on the welfare of the school population we serve. First, we elaborate on the different projects that have served to foster this multidisciplinary collaboration. Second, we highlight the fundamental role the school social workers have played serving as links between researchers and the school community. In addition, we highlight the need to have school psychologists in the schools that make up Puerto Rico's public education system. Finally, we discuss the challenges and opportunities that this multidisciplinary effort has entailed.

[Translated Title: Participatory research to develop a school violence observation instrument]. / Estudio participativo para el desarrolllo de un instrumento de observación de violencia escolar.

School violence has been recognized worldwide as a public health problem that negatively impacts the educational process. However, in Puerto Rico official statistics and the media generally focus on isolated incidents of extreme violence in which weapons are used or property is destroyed. Little data is available about the most common forms of violence that often occur in schools on a daily basis. The Instrumento de Observación de Violencia Escolar (INOVE), developed with the input of school communities participating in Project VIAS (Violence and Asthma Health Disparity Network) of Universidad del Este (UNE), was used in this study to gather information about the characteristics of violence in two Puerto Rican schools. Among the study findings we highlight gender differences in observed violence and aggressive games and interactions between students. The data collected have served as a basis for decision-making regarding violence prevention in participating schools and have implications for the development of prevention strategies and programs.

WHY ADULT VIEWS MATTER: SCHOOL PERSONNEL PERSPECTIVES ABOUT CHILD SCHOOL PARTICIPATION.

Community-Based Participatory Research promotes the inclusion of diverse voices in the research process and in decision-making processes. However, there are very few research studies that collaborate with children, especially within the context of schools. Promoting child participation has benefits both for children as well as for schools. Nonetheless, this may depend on how adults react to such participation. The present study is part of a broader study on school violence prevention. Our objective is to explore school personnel's concept of childhood and how it relates to their opinions about child school participation. We conducted a discussion group with nineteen (19) faculty and non-faculty members of a public school to ask them questions about the topic. We categorized participants' answers and analyzed relationships among them. Results suggest that participants' concept of childhood is linked to socio-cultural and historical factors and that it impacts their opinions about child participation. Also, school personnel recognize that child participation has benefits for children, the school and the wider society. This contrasts with deficiencies on how to articulate this participation beyond traditional classroom strategies. We discuss the implications of these results for pedagogical practice and for participatory research as promoters of children voices in context.

MIRADA A LA MENTORÍA EN INVESTIGACIÓN DESDE LA PERSPECTIVA SOCIOCULTURAL DE VYGOTSKY.

In this article the authors illustrate the mentoring process through the framework of Vygotsky's sociocultural perspective regarding education and human development. To achieve this goal, they describe their experience as mentor and mentees in a research training mentoring program for undergraduate students. The authors argue that this theoretical and philosophical perspective offers a solid background to mentoring as a real option that contributes to the learning process. They recommend these programs to be encouraged by academic institutions in order for more students and professors to benefit from this process.

Endoscopic ablation of Barrett's esophagus: a multicenter study with 2.5-year follow-up.

BACKGROUND: For patients with Barrett's esophagus (BE), life-long surveillance endoscopy is recommended because of an elevated risk for developing dysplasia and esophageal adenocarcinoma. Various endoscopic therapies have been used to eradicate BE. Recently circumferential radiofrequency ablation has been used with encouraging short-term results. OBJECTIVE: To provide longer follow-up and to assess the long-term safety and efficacy of step-wise circumferential ablation with the addition of focal ablation for BE. DESIGN: Prospective, multicenter clinical trial (NCT00489268). SETTING: Eight U.S. centers, between May 2004 and February 2007. PATIENTS: Seventy subjects with 2 to 6 cm of BE and histologic evidence of intestinal metaplasia (IM). INTERVENTIONS: Circumferential ablation was performed at baseline and repeated at 4 months if there was residual IM. Follow-up biopsy specimens were obtained at 1, 3, 6, 12, and 30 months. Specimens were reviewed by a central pathology board. Focal ablation was performed after the 12-month follow-up for histological evidence of IM at the 12-month biopsy (absolute indication) or endoscopic appearance suggestive of columnar-lined esophagus (relative indication). Subjects received esomeprazole for control of esophageal reflux. MAIN OUTCOME MEASUREMENTS: Complete absence of IM per patient from biopsy specimens obtained at 12 and 30 months, defined as complete remission-IM (CR-IM). RESULTS: At 12 months, CR-IM was achieved in 48 of 69 available patients (70% per protocol [PP], 69% intention to treat [ITT]). At 30 months after additional focal ablative therapy, CR-IM was achieved in 60 of 61 available patients (98% PP, 97% ITT). There were no strictures or buried glandular mucosa detected by the standardized biopsy protocol at 12 or 30 months, and there were no serious adverse events. LIMITATIONS: This was an uncontrolled clinical trial with 2.5-year follow-up. CONCLUSION: Stepwise circumferential and focal ablation resulted in complete eradication of IM in 98% of patients at 2.5-year follow-up.

Long-term results of radiofrequency energy delivery for the treatment of GERD: sustained improvements in symptoms, quality of life, and drug use at 4-year follow-up.

BACKGROUND: The Stretta endoscopic antireflux procedure has effectively controlled symptoms of patients with GERD refractory to proton pump inhibitor (PPI) medication up to 1 year. OBJECTIVE: The aim of this study was to evaluate the efficacy of the Stretta procedure for patients with GERD based on symptom control, quality of life (QOL), and medication use. DESIGN: Prospective single-center case series. SETTING: Academic endoscopy referral center. PATIENTS: Adults with GERD symptoms and partial response to daily antisecretory medication. INTERVENTION: We have used the Stretta procedure for patients with GERD diagnosed by endoscopic or pH testing since 2000. Our primary assessment was a validated health-related QOL score for heartburn and regurgitation and GERD symptoms index performed at baseline, 12, 36, and 48 months after treatment. A secondary outcome measure was the dose and the frequency of antisecretory pharmaceutical use. RESULTS: We performed the Stretta procedure in 83 consecutive patients with persistent GERD symptoms. Complete matched data for follow-up evaluations are reported at 12, 36, and 48 months. The mean GERD QOL score was 2.4 (baseline), 4.6 (36 months), and 4.3 (48 months, P < .001). The mean GERD symptom score was 2.7 (baseline), 0.3 (36 months), and 0.6 (48 months P < .001). Daily medication usage was 100% (baseline) and 13.6% (48 months, P < .001). LIMITATIONS: Nonrandomized study design, lack of control arm, and lack of 24-hour pH. CONCLUSIONS: For these GERD patients followed to 4 years, the Stretta procedure was a safe, effective, and durable treatment, with significant and sustained improvements in GERD symptoms, QOL, and PPI elimination.

Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett's esophagus: 1-year follow-up of 100 patients.

OBJECTIVE: To assess the dose-response, safety, and efficacy of circumferential endoscopic ablation of Barrett's esophagus (BE) by using an endoscopic balloon-based ablation device (HALO360 System). DESIGN: This study was conducted in 2 serial phases (dosimetry phase and effectiveness phase) to evaluate a balloon-based ablation device that delivers a pre-set amount of energy density (J/cm2) to BE tissue. The dosimetry phase evaluated the dose-response and the safety of delivering 6 to 12 J/cm2. The effectiveness phase used 10 J/cm2 (delivered twice [x2]) for all patients, followed by EGD with biopsies at 1, 3, 6, and 12 months. A second ablation procedure was performed if BE was present at 1 or 3 months. Patients received esomeprazole 40 mg twice a day for 1 month after ablation, and 40 mg every day thereafter. Postablation symptoms were quantified by using a 14-day symptom diary (scale, 0-100). A complete response (CR) was defined as all biopsy specimens negative for BE at 12 months. SETTING: Eight U.S. centers, between September 2003 and September 2005. PATIENTS: Patients were 18 to 75 years of age, with a diagnosis of BE (without dysplasia), with histopathology reconfirmation of the diagnosis within 6 months of enrollment. RESULTS: In the dosimetry phase, 32 patients (29 men; mean age, 56.8 years) were enrolled. Median symptom scores returned to a score of 0 of 100 by day 3. There were no dose-related serious adverse events, and the outcomes at 1 and 3 months permitted the selection of 10 J/cm2 (x2) for the subsequent effectiveness phase of the study. In the effectiveness phase, 70 patients (52 men, 18 women; mean age, 55.7 years) were enrolled. Median symptom scores returned to a score of 0 of 100 by day 4. At 12 months (n = 69; mean, 1.5 sessions), a CR for BE was achieved in 70% of patients. There were no strictures and no buried glandular mucosa in either study phase (4306 biopsy fragments evaluated). CONCLUSIONS: Circumferential ablation of nondysplastic BE by using this balloon-based ablation device can be performed with no subsequent strictures or buried glands and with complete elimination of BE in 70% of patients at 1-year follow-up.

Balloon-based electrode for the ablation of non-dysplastic Barrett's esophagus: ablation of intestinal metaplasia (AIM II Trial).

INTRODUCTION: Barrett's esophagus (BE) is a condition in which an abnormal intestinal-type epithelium called specialized intestinal metaplasia (SIM) replaces the stratified squamous epithelium that normally lines the distal esophagus. This occurs as a consequence of chronic gastroesophageal reflux disease (GERD) which is present in more than 20% of adults. It is present in 1-2% of the United States population with an estimated prevalence as high as 25% in white males older than 50 yrs without GERD. This intestinal metaplasia predisposes patients to esophageal adenocarcinoma, the most rapidly rising tumor incidence over the last 30 years, with an annual incidence of 0.5% in patients with BE and a survival rate less than 10% in 5 years. The objective of the study was to assess the safety and efficacy of circumferential endoscopic ablation of Barrett's esophagus using the HALO360 System. METHODS: Patients with non-dysplastic Barrett's esophagus confirmed within the previous year were treated twice per session with a balloon-based, bipolar radiofrequency ablation device with a pre selected energy of 10 J/ cm2 at 260 W for 10 secs, achieving full thickness ablation of epithelium followed by Omeprazole 40 mg PO BID for 1 month and then, daily. Patients were followed at 1, 3, 6 and 12 months with EGD with biopsy and a 2nd re treatment at 4 month if IM persisted. RESULTS: A total of 21 Hispanic patients underwent treatment with a gender distribution of 9 female and 10 male, at a mean age of 59.6 years old (SD +/- 12.9) and a mean weight of 161 Lbs (SD +/- 26.1). There was a complete response of 66.7%, 61.9%, 76.2%, 76.2% at 1, 3, 6, and 12 month respectively and a biopsy clearance rate (BCR) of 84.6% and 92.3% at 6 and 12 mo with single treatment and of 62.5% and 50.0% at 6 and 12 month in retreated patients. No complications from the procedure such as strictures or ulcers were reported at 1 year after treatment. CONCLUSIONS: In spite of the multiple treatment options for BE, especially among ablation techniques, radiofrequency ablation therapy is achieving promising results with a full thickness ablation of Barrett's epithelium in 76.2% of patients without direct injury to the submucosa, avoiding formation of strictures and minimal side effects from treatment.

Intestinal digestive resistance of immunodominant gliadin peptides.

Two recently identified immunodominant epitopes from alpha-gliadin account for most of the stimulatory activity of dietary gluten on intestinal and peripheral T lymphocytes in patients with celiac sprue. The proteolytic kinetics of peptides containing these epitopes were analyzed in vitro using soluble proteases from bovine and porcine pancreas and brush-border membrane vesicles from adult rat intestine. We showed that these proline-glutamine-rich epitopes are exceptionally resistant to enzymatic processing. Moreover, as estimated from the residual peptide structure and confirmed by exogenous peptidase supplementation, dipeptidyl peptidase IV and dipeptidyl carboxypeptidase I were identified as the rate-limiting enzymes in the digestive breakdown of these peptides. A similar conclusion also emerged from analogous studies with brush-border membrane from a human intestinal biopsy. Supplementation of rat brush-border membrane with trace quantities of a bacterial prolyl endopeptidase led to the rapid destruction of the immunodominant epitopes in these peptides. These results suggest a possible enzyme therapy strategy for celiac sprue, for which the only current therapeutic option is strict exclusion of gluten-containing food.