SummaryPulmonary hypertension is a frequent complication of sickle cell disease that is associated with haemolysis, impaired nitric oxide bioavailability and high mortality. We sought to evaluate the safety and efficacy of selective pulmonary vasodilators and antiproliferative agents in this at‐risk population. After optimising sickle cell disease therapy to stabilise haemoglobin and fetal haemoglobin levels, we evaluated the safety and efficacy of sildenafil in 12 patients with sickle cell disease and pulmonary hypertension. Sildenafil therapy (mean duration 6 ± 1 months) decreased the estimated pulmonary artery systolic pressure [50 ± 4 to 41 ± 3 mmHg; difference 9 mmHg, 95% confidence interval (CI): 0·3–17, P = 0·043] and increased the 6‐min walk distance (384 ± 30 to 462 ± 28 m; difference 78 m, 95% CI: 40–117, P = 0·0012). Transient headaches occurred in two patients and transient eye‐lid oedema in four patients. No episodes of priapism occurred in the three men in the study; two of them were on chronic exchange transfusions and one had erectile dysfunction. In conclusion: (1) sickle cell disease patients with anaemia and pulmonary hypertension have significant exercise limitation; (2) the 6‐min walk distance may be a valid endpoint in this population; (3) therapy with sildenafil appears safe and improves pulmonary hypertension and exercise capacity. Additional phase I studies in males with sickle cell disease followed by phase II/III placebo controlled trials evaluating the safety and efficacy of sildenafil therapy in sickle cell disease patients with pulmonary hypertension are warranted.
The Web-based tutorial is an attractive mode of delivery for information literacy instruction, but do we know that it is effective? A pre-and posttest study compared student learning from use of an online tutorial with learning from a traditional lecture/demonstration for basic information literacy instruction in freshman English composition classes. Measures of both student learning and student satisfaction were comparable for online tutorial and in-class instruction. The authors have implemented the tutorial for these classes and continue to improve it based on student and faculty feedback.here is a long tradition of library instruction at the State University of New York (SUNY) at Oswego, and the instructional program is well developed. The library has concentrated its efforts on offering course-related instruction, with particular emphasis on freshmen students taking English 102: Composition II. During English 102 sessions, students are taught basic library research and information literacy skills. The authors focused on these classes for the purposes of this project.
In-depth case studies of the research experiences of university students gave rise to a conceptual framework for understanding the students' behaviors related to reading, writing, and thinking as well as information seeking, the fundamental components of information literacy. The 3 Directions refer to the students' movements toward (1) a product-Actions and Products Direction; (2) learning about their subject-Cognition Direction; and (3) participation in a scholarly or professional community-Participation Direction. Situated cognition offers a full explanation of the 3 Directions. This model is applied to the assessment of advanced-level information literacy in the disciplines and to the design of a basic level online tutorial.he complete scope of information literacy reaches beyond the information-seeking skills with which librarians are most familiar and reaches into domains in which librarians typically have no in-depth preparation. Consider what information literacy means for juniors and seniors in higher education: accomplishment of some kind in reading, writing, and critical thinking as well as information seeking, within particular disciplines of practice or scholarship. Most librarians would rightfully be reluctant to claim anything more than basic competence in critical thinking, for instance, in areas outside their own undergraduate studies.One response, however unsatisfactory, is to focus on information seeking and closely related basic skills. This would result in putting a wall up around library and information use instruction and never venturing beyond that known and familiar territory. This leads to isolation of library activities from the related activities that give meaning and value to the use of the library.A more productive and proactive response is to try to understand the information literacy experiences of our students and the situations in which they will need to seek and use information. Then we can think more creatively about how we can help our students and faculty and also offer to our students more of what we as information professionals know about the production, organization, and use of information. To promote this situated understanding, this article presents the 3 Directions Model, a framework that the author developed from an empirical base, and then reports on the author's experiences using the 3 Directions in program assessment and instructional design. The
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