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identi ed as gatekeepers for special education by virtue of their expertise with psychoeducational tests. Calls for change, even reform, of the school psychologists roles permeated the Thoroughbred Years. In the early 1970s, the thrust was for school psychologists to become more system focused and to be child advocates within the system. This thrust was related to the general zeitgeist of the 1970s to change the system, whether it was the system of our schools, special education, school psychology, or government. It was a rebellious period in American history, and school psychology was no exception. The systems and organizational psychology approach to school psychology was popular (see e.g., Maher, Illback, & Zins, 1984), but the historical legacy of school psychology was reaf rmed in the service expectations required by federal legislation for children suspected of being eligible for special education. In retrospect, this legislation and its reauthorizations, although creating thousands of new school psychology jobs, pitted the eld against itself: The longtime desire to expand roles and functions clashed with the need to provide mandated traditional services for job survival. Local, state, and national surveys of how school psychologists spent their time consistently revealed that half to two-thirds of their time was devoted to psychoeducational assessment related to eligibility for special education. These results were observed even during a period of public education and school psychology reform in the last two decades of the century (Reschly, 1998). Comparisons are uncertain, but the psychoeducational assessment role during the Hybrid Years was probably more intense than recent studies have revealed. Nevertheless, it is clear that the assessment role dominated practice throughout the twentieth century. Of course, uniformity of practice was never observed. Evidence for consultation, intervention, research and evaluation, and other roles has always been available. The Thoroughbred Years were fraught with literature, expert opinion, and organizational positions that did broaden the roles of school psychologists, even if not to the extent many desired. For its part, the assessment role was broadened through improved technical adequacy of normative tests, an emphasis on criterion-referenced methods, nondiscriminatory practices, team approaches to service delivery, and mandatory reevaluations. The model of child study continued to evolve and broaden. Throughout the century, a gradual but persistent expansion of the factors involved in referrals is discernible (Fagan, 1995). In addition to the long-standing focus on the child, assessment and intervention functions expanded in the Thoroughbred Years to more consistently include classroom and teacher variables, parental and family variables, and broader theoretical perspectives on traditional testing
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Katz, 1987), more education (Apter, Reisine, Af eck, Barrows, & ZuWallack, 1998), Caucasian ethnicity (Apter et al., 1998), and higher socioeconomic status (Apter et al., 1998) have been associated with better adherence to medication regimens among patients with asthma. Adherence with medications is only one component of treatment adherence. Research has yet to focus on other components of treatment adherence, such as adherence with allergen avoidance and environmental control. Indeed, a prerequisite for patient adherence with such measures would be receiving information and education on allergen avoidance and environmental control from providers. Yet, despite practice guidelines that mandate allergy evaluations, provider adherence is low among 6,703 patients with moderate or severe asthma across the United States, less than two-thirds of patients reported ever having had an allergy evaluation (Meng, Leung, Berkbigler, Halbert, & Legorreta, 1999). There may be a number of pragmatic barriers to the consistent implementation of practice guidelines. For example, with increasing pressure for treatment providers to see more patients in less time, relatively time-consuming interventions (such as education) may be curtailed or skipped. In a managed care setting, referrals for allergy evaluations may be avoided for nancial reasons. Or, limited dissemination may result in some treatment providers being unaware of current practice guidelines. Patients who receive their asthma care from a specialist rather than a general practitioner have selfcare practices more consistent with treatment guidelines (Legoretta et al., 1998; Meng et al., 1999; Vollmer et al., 1997). The extent to which practitioners behavior is consistent with practice guidelines should be determined before assessing patients behavior; patients should not be considered nonadherent if the appropriate evaluations and treatments have not been rst established by the practitioner. However, these steps have not been taken consistently in the studies to date. Investigations on factors associated with atopic patients adherence with allergen avoidance or control (e.g., regular cleaning and washing to decrease dust mite exposure) would be a useful area for future research.
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Figure 9.8. Results of biochemical assays for the Day 0 control, 3wk + TGF, 6wk + TGF, and 6wk TGF hydrogels are depicted: DNA content (ng DNA/mg dry weight) (A), GAG content (% dry weight of construct) (B), and total collagen content (% dry weight of construct) (C). *p < 0.05, **p < 0.001. (Adapted from Williams et al., 2003).
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There appears to be a paradigm shift away from the earlier position that behavior that appears to be altruistic must, under closer scrutiny, be revealed as re ecting egoistic motives. Rather, theory and data now being advanced are more compatible with the view that true altruism acting with the goal of bene ting another does exist and is a part of human nature. (p. 27)
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Aebischer, P., Goddard, M., Signore, A.P., Timpson, R.L. (1994) Functional recovery in hemiparkinsonian primates transplanted with polymer-encapsulated PC12 cells. Exp Neurol. 126: 151 158.
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