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Background and Objective: Most evidence about difficult‐to‐treat and severe asthma (DTTA) comes from clinical trials and registries. We aimed to identify people with DTTA from a large nationally representative asthma population and describe their characteristics and healthcare utilization compared with people whose asthma was not 'difficult‐to‐treat'. Methods: We conducted a cross‐sectional survey of Australians aged ≥18 years with current asthma from large web‐based survey panels. Enrolment was stratified by gender, age‐group and state/territory based on national population data for people with asthma. Difficult‐to‐treat or severe asthma was defined by poor symptom control, exacerbations and/or oral corticosteroid/biologic use despite medium/high‐dose inhaled therapy. Outcomes included exacerbations, healthcare utilization, multimorbidity, quality of life and coronavirus disease of 2019 (COVID‐19)‐related behaviour. Weighted data were analysed using SAS version 9.4. Results: The survey was conducted in February–March 2021. The weighted sample comprised 6048 adults with current asthma (average age 47.3 ± SD 18.1 years, 59.9% female), with 1313 (21.7%) satisfying ≥1 DTTA criteria. Of these, 50.4% had very poorly controlled symptoms (Asthma Control Test ≤15), 36.2% were current smokers, and 85.4% had ≥1 additional chronic condition, most commonly anxiety/depression. More than twice as many participants with DTTA versus non‐DTTA had ≥1 urgent general practitioner (GP) visit (61.4% vs. 27.5%, OR 4.8 [4.2–5.5, p < 0.0001]), or ≥1 emergency room visit (41.9% vs. 17.9%, OR 3.8 [3.3–4.4, p < 0.0001]) in the previous 12 months. Conclusion: Our findings emphasize the burden of uncontrolled symptoms, current smoking, multimorbidity and healthcare utilization in people with DTTA in the community, who may be under‐represented in registries or clinical trials. In this cross‐sectional study of a nationally‐representative population of 6048 adults with current asthma, 21.7% had difficult‐to‐treat asthma. Burden for patients and health system was seen in poor general health status, poor asthma symptom control, frequent urgent GP and emergency department (ED)/hospital visits and high prevalence of multimorbidity, particularly anxiety and/or depression. See relatededitorial [ABSTRACT FROM AUTHOR]

Simple Summary: Congenital malformations of the equine caudal cervical vertebrae (C6 and C7) were first reported in the 1800s. However, by the 21st century these findings were no longer incidental, especially with studies reporting breed percentages as high as 38%. Therefore, this study examined the association between C6 osseous specimens (n = 85) demonstrating the congenital malformation of either a partial unilateral or bilateral absent ventral process and the transposition on the ventral surface of sequential C7s (44/85). The aim was to determine if the absent morphology on C6 corresponded to the transposition on C7 and in some cases replication of a transverse foramen (33/44). Findings revealed the larger morphological absence on C6 generated a stronger dependency for transposition on C7 that included the replication of a transverse foramen. The transposition on C7 was characterized by either a complete or incomplete likeness of the C6 ventral process. Complete transpositions on C7 appeared as a normal C6 ventral process, while incomplete transpositions appeared in most as a cranial ventral tubercle (CrVT). When complete bilateral transpositions were demonstrated, the morphology of C7 resembled C6. These findings are relevant to the reading of radiographic images and potential clinical findings. In recent years, equine complex vertebral malformation (ECVM) has been of concern in the equine community, with studies identifying numerous associative morphological variations. Here, we examine the morphological association between C6 and C7 for dependency in ECVM cases, where the partially absent ventral process of C6 transposes on the ventral surface of C7. A C6 ventral process presents two tubercles, one cranial (CrVT) and one caudal (CVT). In this study, the C6 osseous specimens (n = 85) demonstrated a partial or completely absent CVT (aCVT) graded 1–4 that often extended cranially creating a partially absent cranial ventral tubercle (aCrVT) graded 1–3. In the 85 C6 osseous specimens examined, the corresponding C7s demonstrated either a complete or incomplete transposition of the ventral process from C6 in 44/85, with 30/44 replicating a transverse foramen. A strong statistical dependency existed between C6 grade 4 aCVTs and grades 1–3 aCrVTs and C7 transpositions with replicated transverse foramen. Sidedness was also demonstrated, where a left sided absent C6 associated with transposition on the left ventral surface of C7. This likewise applied to right sidedness and most bilateral cases. These findings might benefit practitioners when radiographing the extent of the ECVM configuration in patients presenting caudal cervical pain. [ABSTRACT FROM AUTHOR]

Introduction: Pharmacovigilance programs protect patient health and safety by identifying adverse event signals through postmarketing surveillance of claims data and spontaneous reports. Electronic health records (EHRs) provide new opportunities to address limitations of traditional approaches and promote discovery-oriented pharmacovigilance. Methods: To evaluate the current state of EHR-based medication safety signal identification, we conducted a scoping literature review of studies aimed at identifying safety signals from routinely collected patient-level EHR data. We extracted information on study design, EHR data elements utilized, analytic methods employed, drugs and outcomes evaluated, and key statistical and data analysis choices. Results: We identified 81 eligible studies. Disproportionality methods were the predominant analytic approach, followed by data mining and regression. Variability in study design makes direct comparisons difficult. Studies varied widely in terms of data, confounding adjustment, and statistical considerations. Conclusion: Despite broad interest in utilizing EHRs for safety signal identification, current efforts fail to leverage the full breadth and depth of available data or to rigorously control for confounding. The development of best practices and application of common data models would promote the expansion of EHR-based pharmacovigilance. [ABSTRACT FROM AUTHOR]

Simple Summary: Specialized bony structures in the cervical spine are conservative traits in Equus ferus caballus with the ventral process of C6 being deemed one of the most significant structures relative to posture and locomotion. However, studies have identified an anomalous variation in the ventral process of C6 where its caudal ventral tubercle (CVT) is either unilaterally or bilaterally absent (aCVT). Consequently, the aim of this study is to describe the morphology and provide a grading system that identifies the extent of the absence in equal quarterly increments. Only osseous specimens with congenital variants of the ventral process were examined, totaling 76 (unilateral n = 47; bilateral n = 29). Observational grading identified four levels of absence—1/4, 2/4, and 3/4, with 4/4 representing complete absence of the CVT. Fifty-six osseous specimens with aCVTs had a grade 4/4 with 41/56 extending the absent morphology cranial, thus involving the caudal aspect of the cranial ventral tubercle (CrVT). This combined morphology effectively diminished the attachment sites for the cranial, and thoracal portions of the longus colli muscle, a primary fixator, flexor, rotator, and stabilizer of the cervical vertebrae. A study comparing radiographic images with gross specimens may provide information to facilitate accurate radiological descriptions of C6 variants. This study examined the anomalous variations of the ventral process of C6 in modern E. ferus caballus. The aim was to provide an incremental grading protocol measuring the absence of the caudal ventral tubercle (CVT) in this ventral process. The findings revealed the most prevalent absent CVT (aCVT) was left unilateral (n = 35), with bilateral (n = 29) and right unilateral (n = 12). Grading was determined in equal increments of absence 1/4, 2/4, 3/4, with 4/4 representing a complete aCVT in 56/76, with a significance of p = 0.0013. This also applied to bilateral specimens. In those C6 osseous specimens displaying a 4/4 grade aCVT, 41/56 had a partial absence of the caudal aspect of the cranial ventral tubercle (CrVT). Here, grading absent CrVTs (aCrVT) followed similarly to aCVTs, though 4/4 was not observed. The significance between 4/4 grade aCVTs and the presentation of an aCrVT was left p = 0.00001 and right p = 0.00018. In bilateral specimens, C6 morphologically resembled C5, implying a homeotic transformation that limited the attachment sites for the cranial and thoracal longus colli muscle. This potentially diminishes function and caudal cervical stability. Therefore, it is recommended that further studies examine the morphological extent of this equine complex vertebral malformation (ECVM) as well as its interrelationships and genetic code/blueprint. [ABSTRACT FROM AUTHOR]

Simple Summary: The mammalian body plan is like a 'blueprint' that supports the survival and procreation of a species. This plan includes specialized bony structures for muscle attachment such as the ventral process of C6, a two-part bony projection divided into cranial and caudal ventral tubercles (CVT). In modern horses, muscles such as the longus colli attach to the ventral process of C6 and aid in the flexion, stabilization, fixation, and force redirection of cervical vertebrae. Recent studies identified an anomalous variation where the CVT was either unilaterally or bilaterally absent. Therefore, the purpose of this study is to determine if anomalous variations of the CVTs, as described in modern horses, is a post-domestication congenital abnormality or a normal presentation throughout evolution. For this purpose, the ventral processes of C6 in extinct and extant Equus specimens in museums and research/educational facilities were examined. The findings revealed the CVT of C6 was present in those extinct and extant specimens examined, and that its absence was only evident in modern horses. This implies that the absent CVT manifested post-domestication. Although the clinical significance is unknown, the relevance might be considered when reporting on diagnostic images of C6, and especially, for potential buyers in pre-purchase cases. In this study, we examined the ventral process of C6 in extinct and extant Equus (sister taxa to Equus ferus caballus only) with the purpose of describing normal morphology and identifying anomalous variations relevant to recent studies describing a congenital malformation in E. ferus caballus. Overall, 83 specimens from 9 museums and 3 research/educational facilities were examined, totalling 71 extinct specimens from 12 species and 12 extant specimens from 5 species. The lateral view revealed that a large convexity exists in the ventral process between the cranial ventral tubercle (CrVT) and the caudal ventral tubercle (CVT) in the earliest ancestor, Hyracotherium grangeri, from 55 mya, which receded throughout the millennia to become a smaller convexity in E. ferus caballus and the sister taxa. The CrVT is visibly shorter and narrower than the CVT, with a constricted section directly ventral to the transverse process, essentially demarcating the CrVT and CVT. No congenital malformations were evident. As the ventral process of C6 is an integral component for muscle attachment in supporting the head/neck during posture and locomotion, this would indicate that the caudal module in the cervical column might be compromised when a partial or complete absence of the CVT is detected via radiographs in modern E. ferus caballus. [ABSTRACT FROM AUTHOR]

Background: Validating new algorithms, such as methods to disentangle intrinsic treatment risk from risk associated with experiential learning of novel treatments, often requires knowing the ground truth for data characteristics under investigation. Since the ground truth is inaccessible in real world data, simulation studies using synthetic datasets that mimic complex clinical environments are essential. We describe and evaluate a generalizable framework for injecting hierarchical learning effects within a robust data generation process that incorporates the magnitude of intrinsic risk and accounts for known critical elements in clinical data relationships. Methods: We present a multi-step data generating process with customizable options and flexible modules to support a variety of simulation requirements. Synthetic patients with nonlinear and correlated features are assigned to provider and institution case series. The probability of treatment and outcome assignment are associated with patient features based on user definitions. Risk due to experiential learning by providers and/or institutions when novel treatments are introduced is injected at various speeds and magnitudes. To further reflect real-world complexity, users can request missing values and omitted variables. We illustrate an implementation of our method in a case study using MIMIC-III data for reference patient feature distributions. Results: Realized data characteristics in the simulated data reflected specified values. Apparent deviations in treatment effects and feature distributions, though not statistically significant, were most common in small datasets (n < 3000) and attributable to random noise and variability in estimating realized values in small samples. When learning effects were specified, synthetic datasets exhibited changes in the probability of an adverse outcomes as cases accrued for the treatment group impacted by learning and stable probabilities as cases accrued for the treatment group not affected by learning. Conclusions: Our framework extends clinical data simulation techniques beyond generation of patient features to incorporate hierarchical learning effects. This enables the complex simulation studies required to develop and rigorously test algorithms developed to disentangle treatment safety signals from the effects of experiential learning. By supporting such efforts, this work can help identify training opportunities, avoid unwarranted restriction of access to medical advances, and hasten treatment improvements. [ABSTRACT FROM AUTHOR]

This article reports findings from a study that examines the factors which influence early childhood and care (ECEC) early career teachers' confidence in teaching Religious Education (RE) and how it impacts their teaching of RE in Catholic primary schools in Western Australia. Teachers' confidence is a teacher's belief in their ability to accomplish a goal and refers to strength of belief. Research in this area has shown that confidence is correlated with the sense of teaching efficacy and responsibility for student learning. Whilst there has been some research into teacher confidence, there has been insufficient research into early childhood teachers' confidence to teach RE in Catholic schools in an Australian context. Literature supports the notion that if early childhood teachers have a strong teacher confidence for a subject, they are more motivated to teach the subject and this has a positive correlation with positive student outcomes. The epistemological approach underpinning the research is constructivist in nature; therefore, it is based on understanding the constructed realities of what humans know of the world and themselves as produced by communications and systems of meaning. Three case studies follow teachers from their early career to second-year experience in Catholic schools. This study investigates support structures and aspects that contribute to teacher confidence in the teaching of RE. The main themes identified by the data that contributed to confidence or lack of confidence included training, family and religious backgrounds, teaching and learning, mentoring and support in the first year of teaching. The implications of the results for pre-service teacher training and support for graduate teachers are discussed and some suggestions are offered about the courses provided by universities and what schools and education systems can do to support early career teachers to teach RE effectively in Catholic schools. [ABSTRACT FROM AUTHOR]

This research reports an exploratory study of 22 pre-service teachers involved in the Religious Education courses offered by The University of Notre Dame Australia, as part of the university's accreditation to teach religious education. The study examined the influence of key factors on how confident these pre-service teachers perceived themselves to be to engage with the necessary knowledge to effectively teach religious education in a Catholic school. The pre-service teachers were surveyed pre and post their final-year internship, and subsequently, six of these were interviewed at the end of their first term of employment. Results indicated that out of the five compulsory courses, the two teaching method courses were found to be most influential in developing confidence to teach. Family, religious background, schooling, and mentoring were found to be influential in confidence development. In addition, confidence improved across the timeframe. [ABSTRACT FROM AUTHOR]

There are three major social issues that are identified and discussed as major contributors to the new normal and the redefinition of deviance. They include: 1) the political rise of the extreme right; 2) the renewed urgency to address issues of social, political, and environmental justice, including and racial inequalities and inequities; and 3) COVID and its effects on society and culture. Sociologists must be key players in the identification and resolution of these issues. In so doing, we impact the reframing and redefinition of what is deviant and what constitutes the new normal. [ABSTRACT FROM AUTHOR]

Educational practices to reduce negative attitudes toward persons with substance use disorders (SUD) are urgently needed for undergraduate nursing students, but few studies have examined their long term effectiveness. In this pilot, consenting students completed the Drug and Drug Problems Perception Questionnaire (DDPPQ) anonymously online, before and 1 year after integrated curricular content about SUD. Pretest scores were significantly higher than posttest, indicating higher negative attitudes toward persons with SUD before the integrated content. Time main effect was statistically significant. To our knowledge, this is the first report examining long-term effects of an educational intervention with reinforcement in multiple courses over time upon the attitudes of undergraduate nursing students toward persons with SUD. [ABSTRACT FROM AUTHOR]

Objective: This pilot aimed to test the engagement, acceptability, and usefulness of a goal-setting smartphone app, Kiss myAsthma, in young people with asthma. Methods: Young people aged 15–24 years old were invited to trial a smartphone app for asthma management. A mixed-methods approach combined quantitative analysis of self-report questionnaires and app usage log data with qualitative thematic analysis of open-ended questions at baseline and six weeks after downloading the app. App log data (pages visited, frequency of use and content of participants interaction, e.g.goals set, symptoms recorded) were analyzed. Results: Nine of 12 participants completed both baseline and six-week questionnaires. Participants reported high satisfaction with app content and usability (median score 5 out of 6 [range 4–6]) and rated the app highly on "feeling confident in my ability to manage my asthma." At six weeks there was a clinically significant change in asthma quality of life (e.g. Emotional Function domain score baseline: 4.7 [2.7–6.3], follow-up: 5.7 [4.7–6.7]; p = 0.043). Participants logged information about asthma severity, flare-ups and mood and tracked their symptoms with the app's History functionality. Five participants (42%) nominated goals and strategies and 3 participants (25%) entered data in the Inspiration section, a tool to support intrinsic motivation to manage asthma. Qualitative data aligned with quantitative results. Conclusions: This six-week pilot of the Kiss myAsthma app showed its potential to support self-management, quality of life and health behavior change in young people with asthma. [ABSTRACT FROM AUTHOR]

Since its founding in 1929, the Pacific Sociological Association (PSA) has undergone a variety of changes as it has adapted to shifts in society, developments in the discipline, and an increasingly diverse membership. The panelists in this session highlighted several ways in which the PSA has evolved over time and discussed a number of attempts to address the challenges facing millennials and millennial sociologists (the theme of the 90th Annual Meeting). Suggestions regarding ways in which the PSA can continue to offer support to this generation in the future were also discussed. [ABSTRACT FROM AUTHOR]

Background: Methods to increase treatment compliance in adolescents with cystic fibrosis (CF) is of utmost importance to improve outcomes and survival. Motivational interviewing (MI) has gained momentum as an effective strategy to address ambivalence to change in a variety of chronic health conditions and remains a promising strategy to facilitate treatment adherence in adolescents with CF. Methods: The project utilized the Plan-Do-Study-Act cycle of quality improvement (QI). A repeated measure pretest-posttest design was used to evaluate the effectiveness of a MI training. An interactive, 4-hour MI workshop was executed within a single CF center. CF care providers (N = 12) from a single CF team completed surveys evaluating knowledge, perceived importance, usage, and confidence in using MI with adolescents before and after the training. Following the MI training, care providers engaged high-risk adolescent patients using MI techniques. To determine the effect of MI on patient adherence (N = 32), markers of lung function and weight were measured before and after MI exposure. Results: Quantitative analysis of provider surveys indicated enhanced MI-related knowledge and confidence after the training. Provider usage, perception of the usefulness, and importance of using MI was unchanged. Patient-specific outcomes indicated no significant change in patient-forced expiratory volume in 1 second (FEV1), a marker of lung function, or body mass index (BMI), five months after exposure of MI in the CF clinic setting. Conclusions: This QI project demonstrates the effectiveness of a brief MI training on CF care providers' knowledge and confidence in engaging adolescents using MI techniques. Though no statistically significant differences were found in patient-specific outcomes during this brief intervention period, it is critical that longer-term exposure to MI be explored further in adolescents with CF. This study adds to a growing body of evidence supporting team-based MI trainings for CF providers. Future research focusing on patient experience and perceived benefit of MI counseling is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Before performing a surgical procedure, informed consent (IC) is obtained. Parents may exhibit anxiety and/or a desire for more knowledge during the IC process for their child. The purpose of this study was to measure the impact of a multimedia intervention (MMI) versus conventional discussion on parental understanding and anxiety during the IC process for infants undergoing surgery for hypertrophic pyloric stenosis.Methods: A time-interrupted series design was employed over a 9-month period. In the first phase, conventional discussion for IC was performed. In the second phase, a MMI was utilized. In both phases, anxiety scores and post-consent knowledge tests were collected.Results: 31 participants were included in the study, 17 in the conventional consent and 14 in the MMI phase. Parental anxiety around the IC discussion was measured. There was a significant decrease in anxiety noted with use of the MMI (p = 0.046) but no significant difference in knowledge (p = 0.84).Conclusion: The MMI significantly reduced parental anxiety during the IC process. Providers may consider applying this type of MMI to other surgical procedures. Securing IC in a manner that improves knowledge and decreases anxiety may improve long-term understanding and parental satisfaction with the health care process. [ABSTRACT FROM AUTHOR]

In the United States, youth involvement in delinquent and criminal acts remains persistent and increasingly violent. For at-risk youth, key demographics include poverty and distressed communities. Since traditional interventions have had limited success in addressing the needs of and issues experienced by these youths, millennials must seek new and creative techniques and programs to serve them. One such program that currently exists and provides inspiration for the future is Destiny Arts Youth Performance Company, a nonprofit, community dance group based in Oakland, CA, that offers competitive scholarships to deserving, at-risk youth in lower class, largely ethnic communities. In the ethnographic documentary, FREE: The Power of Performance, the lives of five at-risk youths are affected and transformed through the creative medium of dance. It shows that for at-risk, diverse teens, collaborative art can be a foundation for personal strength, liberation, and hope. [ABSTRACT FROM AUTHOR]

The Dutch Konik is valued from a genetic conservation perspective and also for its role in preservation of natural landscapes. The primary management objective for the captive breeding of this primitive horse is to maintain its genetic purity, whilst also maintaining the nature reserves on which they graze. Breeding selection has traditionally been based on phenotypic characteristics consistent with the breed description, and the selection of animals for removal from the breeding program is problematic at times due to high uniformity within the breed, particularly in height at the wither, colour (mouse to grey dun) and presence of primitive markings. With the objective of identifying an additional non-invasive selection criterion with potential uniqueness to the Dutch Konik, this study investigates the anatomic parameters of the distal equine limb, with a specific focus on the relative lengths of the individual splint bones. Post-mortem dissections performed on distal limbs of Dutch Konik (n = 47) and modern domesticated horses (n = 120) revealed significant differences in relation to the length and symmetry of the 2nd and 4th Metacarpals and Metatarsals. Distal limb characteristics with apparent uniqueness to the Dutch Konik are described which could be an important tool in the selection and preservation of the breed. [ABSTRACT FROM AUTHOR]

Objective: The underlying model of the genetic determinant of a trait is generally not known with certainty a priori. Hence, in genetic association studies, a dominant model might be erroneously modelled as additive, an error investigated previously. We explored this question, for candidate gene studies, by evaluating the sample size required to compensate for the misspecification and improve inference at the analysis stage. Power calculations were carried out with (1) the true dominant model and (2) the incorrect additive model. Empirical power, sample size and effect size were compared between scenarios (1) and (2). In each of the scenarios the estimates were evaluated for a rare (minor allele frequency < 0.01), low frequency (0.01 ≤ minor allele frequency < 0.05) and common (minor allele frequency ≥ 0.05) single nucleotide polymorphism. Results: The results confirm the detrimental effect of the misspecification error on power and effect size for any minor allele frequency. The implications of the error are not negligible; therefore, candidate gene studies should consider the more conservative sample size to compensate for the effect of error. When it is not possible to extend the sample size, methods that help mitigate the impact of the error should be systematically used. [ABSTRACT FROM AUTHOR]

BACKGROUND: Detecting volatile organic compounds (VOCs) could provide a rapid, noninvasive, and inexpensive screening tool for detecting cancer. OBJECTIVE: In this systematic review, we identified specific exhaled breath VOCs correlated with lung, colorectal, and breast cancer. METHODS:We identified relevant studies published in 2015 and 2016 by searching Pubmed andWeb of Science. The protocol for this systematic review was registered in PROSPERO and the PRISMA guidelines were used in reporting. VOCs and performance data were extracted. RESULTS: Three hundred and thirty three records were identified and 43 papers were included in the review, of which 20 were review articles themselves. We identified 17 studies that listed the VOCs with at least a subset of statistics on detection cutoff levels, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and gradient. CONCLUSIONS: Breath analysis for cancer screening and early detection shows promise, because samples can be collected easily, safely, and frequently. While gas chromatography-mass spectrometry is considered the gold standard for identifying specific VOCs, breath analysis has moved into analyzing patterns of VOCs using a variety of different multiple sensor techniques, such as eNoses and nanomaterials. Further development of VOCs for early cancer detection requires clinical trials with standardized breath sampling methods. [ABSTRACT FROM AUTHOR]

The study examined potential psychosocial determinants of male condom use in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota in two sequential phases: the elicitation (Phase I) and cross-sectional quantitative studies (Phase II). Information from Phase I was used to develop the instrument for Phase II. Study participants who self-identified as Somali and Ethiopian immigrants (n = 205) responded to questions on demographic characteristics, attitudes (affective and instrumental), norms (subject and descriptive), perceived behavioral control, self-efficacy, and intention to use male condoms. Hierarchical regression models were used to assess the relationship between the main independent variables (attitude norms, perceived behavioral control, and self-efficacy, and the dependent variable, the intention to use male condoms. Overall, participants showed low intention and slightly favorable (affective and instrumental) attitudes toward condom use; had experienced weak, but positive social influence as measured by injunctive and descriptive norms. Moreover, study participants had shown slight perceived behavioral control, but had fairly moderate positive self-efficacy. The Theory of Planned Behavior was moderately effective in predicting condom use; however, the Integrated Behavioral Model, explained nearly 40% of the variations in the intention to use male condoms. Among men, self-efficacy had the strongest influence (β = .44, p < .001) on behavioral intention. Among women, descriptive norms (β = .22,p < .05) exerted the strongest effect (model 3). Improving self-efficacy, specifically, among older men, and fostering desirable normative influence among women, are suggested as main components of public health interventions to promote condom use among Somali and Ethiopian immigrants. [ABSTRACT FROM PUBLISHER]

Objective: Immigrants, specifically African‐born black persons, are affected by the HIV epidemic in the U.S. The low level of condom use among immigrants is a risk factor for contracting HIV and STIs. Immigrants go through acculturation process in their new adopted countries—a process reported to influence many health risks and protective factors; however, the mechanism through which acculturation influences health behaviors is not well understood. Thus, study examined the mediating role of attitude in the relationship between acculturation and the intention to use male condoms in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota. Design and Sample: The study was a regression analysis and the method of data collection cross‐sectional. Participants were (n = 205) Somali and Ethiopian immigrants in Minnesota who volunteered for the study. Measures: Study participants responded to questions on attitudes, behavioral intention, and acculturation levels. Results: The indirect effect of acculturation through the mediator, attitude, was not significant, product coefficient (a × b) = 0.04, 95% CI: [0.00, 0.11]; hence attitude did not mediate the relationship between acculturation and the intention to use condoms in the study population. However, there were significant direct and total effects of acculturation (c′ = .27, p < .05; c = .31, p < .05), respectively, on intention to use condoms. Conclusion: Results of the study may suggest that public health intervention strategies targeting condom use among immigrants should incorporate programs that improve English language training tailored to the cultural practices and values of the immigrants, and consider the effect of acculturation on condom use. [ABSTRACT FROM AUTHOR]

The study examined correlates of consistent condom use in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota. Study participants (n = 205) responded to questions on attitudes, social norms, perceived behavioral control, self-efficacy, behavioral intention, and self-reported male condom use. Participants were neither for, nor against using condoms, and the same was true for social influence and self-efficacy; however, reported moderately favorable attitude toward condom use and little difficulties in using condoms. Self-efficacy emerged as the factor with the strongest direct influence on behavioral intention to use condoms. In turn, behavioral intention was a significant predictor of self-reported condom use. Increasing male condom use self-efficacy among Somali and Ethiopian immigrants is suggested as a main component of public health intervention seeking to curb the spread of HIV and other STIs in Minnesota. [ABSTRACT FROM AUTHOR]

Background: Recent emphasis has been placed on elucidating the biologic mechanism linking socioeconomic status (SES) to cardiovascular disease (CVD). Positive associations of inflammatory biomarkers provide evidence suggestive of a biologic pathway by which SES may predispose to CVD. African Americans have disproportionately lower SES and have a higher prevalence of CVD risk factors compared to most ethnic/racial groups. Adiponectin (an anti-inflammatory marker) is also lower. The objective of this study was to assess the association of adiponectin with SES among African American men and women using the Jackson Heart Study.Methods: Study sample included 4340 participants. Linear regression was performed separately by SES and stratified by sex. Annual household income and level of education was used as proxies for SES. Crude, age, health behavior and health status adjusted models were analyzed. The main outcome was log-transformed adiponectin.Results: Men in the lowest income group had significantly higher adiponectin than those in the highest income group in the fully adjusted model (ß/standard error [se], p value = .16/.08, p = .0008. Men with < high school level of education had significantly higher adiponectin in the crude and age adjusted models than those with ≥ college degree (.25/.05, p < .0001; .14/.05/ p = .005, respectively). Women with some college or vocational training in the crude and age adjusted models had lower adiponectin compared to women with ≥ college degree (-.09/.03, p = .004; -.06/.03, p = .04, respectively).Conclusion: Findings suggest a potential inverse biologic pathway between annual household income and adiponectin among African American men. There was no such finding among women. Findings suggest interventions should be targeted for higher SES African American men to improve adiponectin levels. [ABSTRACT FROM AUTHOR]

Objective: This aim of this study was to assess inhaler technique of people with intellectual disability (ID), and evaluate the effectiveness of teaching with respect to their individual ability to adopt correct technique.Methods: Seventeen people with ID were recruited through existing networks of general practitioners and disability support organisations. Inhaler technique was assessed using validated checklists and placebo devices, followed by provision of individualised training. The educational interaction between participant and researcher was captured via video recording and analysed qualitatively.Results: Seventeen people with ID participated; females comprised 65%. At baseline, no participants correctly used any device. Pressurised metered dose inhalers, with or without accessory devices, were the most poorly used devices. Inhalation steps were poorly performed across all devices. Following training, the proportions of assessed participants that were able to master inhaler technique were 100% of Accuhaler users, 40% of Turbuhaler users, 25% of pressurised metered dose inhaler users and 0% of Handihaler users. Barriers identified included poor comprehension of breathing processes, the lack of attentiveness and poor dexterity. Facilitators for educator delivery of inhaler technique education included the use of analogies and being patient.Conclusions: This is the first study to examine inhaler technique mastery in people with ID. Results show that with education that addresses the unique patient barriers inherent in this group, some individuals can be trained to mastery. Structured modules of inhaler technique training tailored for people with ID, but which can be individualised, are recommended. [ABSTRACT FROM AUTHOR]

Background: African Americans experience disproportionately higher prevalence of type 2 diabetes and related risk factors. Little research has been done on the association of ADIPOQ gene on type 2 diabetes, plasma adiponectin, blood glucose, HOMA-IR and body mass index (BMI) in African Americans. The objective of our research was to assess such associations with selected SNPs. The study included a sample of 3,020 men and women from the Jackson Heart Study who had ADIPOQ genotyping information. Unadjusted and adjusted regression models with covariates were used with type 2 diabetes and related phenotypes as the outcome stratified by sex. Results: There was no association between selected ADIPOQ SNPs with type 2 diabetes, blood glucose, or BMI in men or women. There was a significant association between variant rs16861205 and lower adiponectin in women with minor allele A in the fully adjusted model (β(SE) p = -.13(0.05), 0.003). There was also a significant association with variant rs7627128 and lower HOMA-IR among men with minor allele A in the fully adjusted model (β(SE) p = -0.74(0.20), 0.0002). Conclusions: These findings represent new insights regarding the association of ADIPOQ gene and type 2 diabetes and related phenotypes in African American men and women. [ABSTRACT FROM AUTHOR]

BackgroundRespiratory disease is common in people with intellectual disability (ID). The inhaled route is preferred for medication administration in treating respiratory diseases, including asthma. People with ID often need assistance with taking medicines due to cognitive, physical, and sensory impairments; in supported accommodation this assistance is provided by direct support professionals (DSPs). MethodA qualitative study design was used to explore DSPs’ experiences with asthma medication management. Data were collected via in-depth, semistructured, face-to-face or telephone interviews. ResultsKey findings included the complex balance of duties undertaken by DSPs, and a lack of consistency in asthma management processes across sites. ConclusionsThis exploratory research suggests that DSPs are involved in asthma management and required to use clinical judgement, but are not provided with education and tools to manage asthma in, and foster correct inhaler use by, their clients. This highlights the need for tailored guidelines that integrate with the principles of the National Disability Insurance Scheme. [ABSTRACT FROM PUBLISHER]

Background Correct inhaler technique is vital in the management of asthma and chronic obstructive pulmonary disease. However, inhaler misuse is ubiquitous and patients seldom receive effective education on how to use inhalers. Prisoners may have additional contributing factors for inhaler misuse, i.e. low health literacy and intellectual disability. Consequently, health professionals within correctional service facilities have a unique opportunity, and arguably an even more critical role, in the training of inmates in inhaler use. Aim To evaluate correctional services health professionals' baseline inhaler techniques; to assess the impact of training on inhaler techniques; and to evaluate the impact of the training on service delivery to inmates. Method Nurses working in a correctional services hospital complex were recruited. Their baseline inhaler technique (i.e. prior to training) was assessed using inhaler technique checklists. An education intervention was then delivered, following which participants' inhaler technique was reassessed. Results A total of 23 nurses participated in the study. At baseline, proportions demonstrating correct technique were 42, 0 and 5% for metered dose inhalers, Turbuhaler and Accuhaler, respectively. Following training, there was a statistically significant increase in the proportion of participants demonstrating correct inhaler techniques (84% (p = 0.008), 84% (p < 0.001) and 90% (p < 0.001)). Conclusions Nurses in correctional care are expected to check inmates' inhaler techniques as part of clinical care, but were unable to use inhalers correctly and needed training in this regard. Pharmacists are well placed to provide this training. [ABSTRACT FROM AUTHOR]

Racial, ethnic and economic disparities in cancer rates, outcomes, and clinical trials participation persist despite significant research. We examined barriers to clinical trials enrollment among Chinese patients, and developed a navigation program for Chinese gynecologic and breast cancer patients. Six bilingual navigators were trained and a navigator assigned to each patient for at least 2 months. All patients received a clinical trials booklet in Chinese and English. Data collection included pre-and post-navigation surveys, intake forms, and documentation of navigation encounters. Between July 2010 and May 31, 2011, we recruited 28 breast and gynecologic cancer patients. Patients averaged 317 min of navigation (range 63-1,852) during 8 sessions (range 3-28). They improved in 4 of 10 true-false knowledge statements about clinical trials. A patient navigation program for Chinese-speaking cancer patients is feasible. It results in high patient satisfaction rates and modest improvements in clinical trials knowledge and participation. [ABSTRACT FROM AUTHOR]

The survey was completed by 12 152 people of which 7285 (61%) reported a history of doctor-diagnosed asthma.5 People with asthma were particularly vulnerable to the impacts of smoke exposure, with 93.6% experiencing respiratory symptoms compared to 70.2% in those without asthma (Fig. Notably, people with asthma reported significantly higher rates of serious health outcomes including attending the ED (5.9%), hospitalization (2.4%) and requiring corticosteroid medication (16.3%) compared to those without asthma (1.4%, 0.6% and 2.4%, respectively). Keywords: asthma; bushfire; impact EN asthma bushfire impact 296 297 2 03/22/21 20210401 NES 210401 The impact of bushfire, particularly on those with chronic lung diseases, is now recognized.1,2 Individuals with asthma are among the most vulnerable groups.3 As bushfires are anticipated to be longer and more intense in many regions of the world, their adverse impact, particularly in asthmatic individuals, will impose a significant burden. [Extracted from the article]

Australian data suggest up to 15% of people with intellectual disability (ID) have asthma. The inhaled route of administration is optimal for the management of obstructive airways diseases; however, correct inhaler use requires dexterity and particular breathing patterns and potentially represents a problem in this population due to physical and cognitive deficits. Understanding the nature and extent of inhaler use in persons with ID is important, as correct inhaler technique is imperative for optimal clinical outcomes; however, currently no evidence base exists to inform health professionals. This study describes respiratory medication use, reported prevalence of asthma, and asthma management practices undertaken in a clinic sample of Australian adults with ID. Results showed a prevalence of retrospectively reported asthma of 6%, with 86% of asthma patients prescribed inhaled medication. A review of patient records also indicated omission of some recommended asthma management strategies. [ABSTRACT FROM AUTHOR]

Many factors can be attributed to successful substance abuse treatment completion. The purpose of this research is to examine employment status as a factor that contributes to successful treatment outcomes. Traditional substance abuse treatment is discussed and shown to lack an employment component to counseling. Research is discussed and illustrates the benefits employment has on not only successful treatment completion but also reduction in substance use as well as many other benefits. This study utilized extant data from a rural substance abuse treatment program. Data was collected from the program using the Government Results and Performance Act (GPRA) tool. A binary logistic regression analysis was used to determine the relationship between the predictor variable of employment and the dichotomous dependent variable of treatment completion while controlling for the variables of gender, criminal justice status, and educational level. The Omnibus Tests of Model Coefficients for Block One was not significant (p > .05). The Omnibus Tests of Model Coefficients of Block Two was significant (p < .05) as was employment status (p < .05). Implications and suggestions for further research are discussed. [ABSTRACT FROM AUTHOR]

The quality of delivery of health education services is connected to landmark events in the history of health education. Quality assurance is one type of professional development in which practicing health education specialists engage. This article presents the steps of an accreditation/approval process, brief overviews of the major accreditation/approval systems, and the opportunities within the accreditation/approval process for professional development. [ABSTRACT FROM PUBLISHER]

Objective-To evaluate the presence of a dominance rank in a group of cats and the relation between agonistic behavior and the use of resources, including environmental enrichment, in these cats. Design-Observational analytic study. Animals-27 neutered cats in a shelter in Sao Paulo, Brazil. Procedures-The cats were video recorded for 4 consecutive days to obtain baseline data. Subsequently, a puzzle feeder was added as an enrichment device every other day over 8 days, for a total of 4 days with enrichment. Cats were also video recorded on these days. All pretreatment and posttreatment agonistic behaviors and interactions with the puzzle feeder were recorded by reviewing the videotapes. Results-i 43 agonistic encounters were recorded, of which 44 were related to resources and 99 were not. There were insufficient agonistic interactions to determine a dominance rank. Presence or absence of the puzzle feeder did not affect the rate of aggression. There was no significant effect of weight, sex, or coat color on the rate of aggression, and aggressive behavior did not correlate with time spent with the puzzle feeder. Twenty-three of the 27 cats interacted with the puzzle feeder. Conclusions and Clinical Relevance-In a stable group of communally housed cats, environmental enrichment did not cause increased aggression as a result of competition for the source of enrichment. Because environmental enrichment increases the opportunity to perform exploratory behaviors, it may improve the welfare of groups of cats maintained long-term in shelters, sanctuaries, or multicat households. [ABSTRACT FROM AUTHOR]

Mental health disorders and suicide occur in persons with HIV/AIDS at higher rates than the general population. Rehabilitation professionals need to be aware of risk factors for suicide in this population and should be prepared to manage situations involving potential suicide. For this study 71 individuals living with HIV/AIDS were interviewed using the Global Appraisal of Individual Needs (GAIN). Rates of depressive symptoms and anxiety were found to be prevalent among the participants. Depressive symptoms and low life satisfaction were significantly associated with suicide risk. [ABSTRACT FROM AUTHOR]

Aim: To create a database of refrigerated medications along with comprehensive data on their stability when stored outside the recommended conditions; and to develop an educational tool for managing cold chain emergencies at the hospital. Method: Phase 1: a searchable database was created with fields on product stability, stored temperatures and storage conditions. Phase 2: the database was populated with the products' stability data from various sources, such as literature searches, approved product information and pharmaceutical companies. Phase 3: focus groups were held with the hospital's stakeholders (nurses, pharmacists, pharmacy technicians) to develop an educational tool for managing cold chain emergencies. Results: Of the 36 pharmaceutical companies contacted, 29 responded (response rate 81%) and provided 'extra' stability data for 28 products (n = 150; 19%). Pursuant to issues raised by the pharmaceutical companies about concerns of breaching the registration conditions of their products and misinterpretation of the provided in-house stability data, a stakeholder meeting was held with the Therapeutic Goods Administration. At the meeting, the need for short-term 'end of shelf life' real-time stability studies for refrigerated products was discussed. An educational tool was designed based on a survey of local practices at the hospital pertaining to monitoring refrigerators used to store medications. Conclusion: Creation of the database has resulted in a critical analysis of the existing stability data on refrigerated medications. Hospital staff lack guidance on the selection, monitoring and maintenance of refrigerators used to store medications, and to manage cold chain emergencies. There is an opportunity for professional pharmacy organisations to provide this guidance. [ABSTRACT FROM AUTHOR]

The article discusses the guiding principles in oneness of humankind that can lead to the healing of racism and discrimination. It notes that healing racism takes a lot of personal reflection and acceptance of all race and culture. It details on the healing process of racism which entails cognitive and emotional understanding of people and culture and what sets each one apart. It explains how racism is linked with poverty and socioeconomic backgrounds. It adds that school systems are dealing with stability of multiple races and diverse cultures.

Abstract: The mare is seasonally polyestrus, having an anovulatory period during the short light days of late fall and early winter, and beginning to ovulate as the days become longer during the winter. The complete estrus cycle is typically about 3 weeks, with 5 to 7 days of estrus and approximately 2 weeks of diestrus. When a mare lives within the natural social structure of the horse, i.e. a family band with several adult mares and one or more stallions, estrus is characterized by repeatedly approaching the stallion, frequent urination, deviating the tail away from the perineum, and standing still with the hind limbs spread apart. Diestrus is characterized by avoidance of an approaching stallion, and aggression toward the stallion, such as squealing, striking, and kicking, if he persists in attempting to court the diestrus mare. However, mares and stallions with long-term social relationships will often rest together, graze together and groom each other, all without sexual interactions. Hormonally, estrous behavior in the mare is initiated by estradiol that is secreted by the follicle, while estrous behavior is suppressed by progesterone, secreted by the corpus luteum. Mares are unusual among the ungulates in that they periodically exhibit estrous behavior during the anovulatory period. This is probably due to the release of estrogenic steroids secreted by the adrenal cortex. The display of sexual behavior by the mare throughout the year is thought to facilitate maintenance of the horse''s social structure, in which the male remains with a group of females year round, in contrast with most ungulates in which the females and males only come together during the mating season. [Copyright &y& Elsevier]

The article outlines the natural behaviors of pet rabbits and the ways to prevent or manage common problem behaviors. The association of rabbits' behaviors to the lifestyles of their ancestors is addressed. The origin of domestic rabbits and their social organization are discussed. The significance of an appropriate housing to a rabbit's quality of life and development of interesting behaviors is also tackled.

This Special Issue on "Millennials/Gen Zs: Engaging, Researching and Teaching about Power, Diversity and Change" is designed to bring scholarly attention to our younger generations. As a whole, these Special Issue manuscripts aim to demonstrate the relevance of the PSA today and to advance our understanding of a generation considered to be the largest living, most progressive generation since the 1960s and the most racially and diverse generation in American history. [Extracted from the article]

Objective--To investigate the relationship of litter box location as it relates to cats' use of space in the house, elimination problems, and certain behaviors associated with elimination. Sample Population--40 cats in single-cat households with or without elimination behavior problems (20 cats/group). Procedures--Camcorders were used to record the cats' behaviors at the litter box and other areas in which they eliminated during a 72-hour period. Use of space in the house was recorded by direct observation during 400 minutes of the 72 hour period. Elimination behaviors and other cat- and litter box associated variables were compared between groups; litter box location with respect to inappropriate elimination was assessed. Results--Litter box location did not differ between cats with and without elimination behavior problems. An inverse correlation was found between time spent sniffing and the distance of the litter box from the central core area. Cats with elimination problems spent significantly less time digging at the litter box than cats without elimination problems. There was no significant difference in the time spent pawing in litter box, sniffing, or covering excreta after elimination between the 2 groups of cats. Conclusions and Clinical Relevance--Times spent digging in litter boxes by cats with and without elimination problems have been determined, and data suggest that actual digging times could be used as a means to test for litter preference and litter aversion. This information may also be used to identify cats with litter aversion prior to the development of an elimination problem. [ABSTRACT FROM AUTHOR]

The predictors of drop-out from a group cognitive behaviour therapy (CBT) program were examined. In Study 1, 6 years of archival data of Perth Clinic's group CBT program were examined to determine the predictors of treatment drop-out. The predictors identified were low self-esteem at admission and a poor relationship status. These predictors were used to generate an algorithm for use by clinicians in identifying patients who may be likely to drop out. In Study 2, a controlled trial was conducted to determine if a brief self-esteem module delivered prior to a group CBT program might enhance outcomes and reduce drop-out rates. Day-patients who received the self-esteem module reported small additional reductions in depression scores but there were no noticeable effects upon drop-out rates. Suggestions are made for other ways to reduce drop-outs in CBT programs. [ABSTRACT FROM AUTHOR]

Background. Results are reported from a randomized trial designed to increase the accuracy of perceived breast cancer risk among callers to the NCI''s Cancer Information Service (CIS) (n = 392).Methods. CIS callers assigned to the intervention group (n = 200) received a brief educational intervention and an estimate of breast cancer risk over the telephone at the end of usual service. Follow-up interviews were completed by telephone at 1 month (n = 367).Results. On average, women overestimated their risk by 25 percentage points. Eighty percent of the respondents rated their risk of breast cancer higher than did the assessment tool. Women rated their risk higher if they were under age 50 (P =0.025) or had a first-degree family history of breast cancer (P = 0.0001), and rated their risk lower if they were Latina (P = 0.050) or Asian/other race/ethnicity (P = 0.013). Women with a first-degree family history of breast cancer in the intervention group significantly reduced their risk overestimate compared to those in the control group (-12.5 vs. 2.8 percentage points, P = 0.006).Conclusions. This intervention was unique because it was delivered in an ongoing service setting. It should be further tested in diverse populations. [Copyright &y& Elsevier]

Objectives. We compared trends in prevalence rates of preventable cardiovascular-and diabetes-related hospitalizations between African Americans and members of other major US racial/ethnic groups. Methods. Standardized rates for 1991 to 1998 were derived from hospital and US census data for California. Results. African Americans had significantly higher hospitalization rates in 1991, and discrepancies in rates continued to widen through 1998. Overall male and female rates were approximately 3 times higher for angina, 7 times higher for hypertension, between 7 and 8 times higher for congestive heart failure, and 10 times higher for diabetes. Conclusions. Widening disparities in cardiovascular- and diabetes-related health conditions were observed in this study, possibly owing to racial inequalities in provision of effective primary care. (Am J Public Health. 2003;93:447-455) [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Chronic pain is a global public health problem that negatively impacts individuals' quality of life and imposes a substantial economic burden on societies. The use of medicinal cannabis (MC) is often considered by patients to help manage chronic pain as an alternative or supplement to more conventional treatments, given enabling legalization in a number of countries. However, healthcare professionals involved in providing guidance for patients related to MC are often doing so in the absence of strong evidence and clinical guidelines. Therefore, it is crucial to understand their perspectives regarding the clinical use and relevance of MC for chronic pain. As little is known about attitudes of HCPs with regard to MC use for chronic pain specifically, the aim of this review was to identify and synthesize the published evidence on this topic. Methods: A systematic search was conducted across six databases: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and PubMed from 2001 to March 26, 2021. Three authors independently performed the study selection and data extraction. Thematic analysis was undertaken to identify key themes. Results: A total of 26 studies were included, involving the United States, Israel, Canada, Australia, Ireland, and Norway, and the perspectives of physicians, nurses, and pharmacists. Seven key themes were identified: MC as a treatment option for chronic pain, and perceived indicated uses; willingness to prescribe MC; legal issues; low perceived knowledge and the need for education; comparative safety of MC versus opioids; addiction and abuse; and perceived adverse effects; Conclusion: To support best practice in the use of MC for chronic pain, healthcare professionals require education and training, as well as clinical guidelines that provide evidence‐based information about efficacy, safety, and appropriate dosage of products for this indication. Until these gaps are addressed, healthcare professionals will be limited in their capacity to make treatment recommendations about MC for people/patients with chronic pain. [ABSTRACT FROM AUTHOR]

Racial residential segregation has been deemed a fundamental cause of health inequities. It is a result of historical and contemporary policies such as redlining that have created a geographic separation of races and corresponds with an inequitable distribution of health-promoting resources. Redlining and racial residential segregation may have contributed to racial inequities in COVID-19 vaccine administration in the early stages of public accessibility. We use data from the National Archives (historical redlining), Home Mortgage Disclosure Act (contemporary redlining), American Community Survey from 1940 (historical racial residential segregation) and 2015–2019 (contemporary racial residential segregation), and Washington D.C. government (COVID-19 vaccination administration) to assess the relationships between redlining, racial residential segregation, and COVID-19 vaccine administration during the early stages of vaccine distribution when a tiered system was in place due to limited supply. Pearson correlation was used to assess whether redlining and racial segregation, measured both historically and contemporarily, were correlated with each other in Washington D.C. Subsequently, linear regression was used to assess whether each of these measures associate with COVID-19 vaccine administration. In both historical and contemporary analyses, there was a positive correlation between redlining and racial residential segregation. Further, redlining and racial residential segregation were each positively associated with administration of the novel COVID-19 vaccine. This study highlights the ongoing ways in which redlining and segregation contribute to racial health inequities. Eliminating racial health inequities in American society requires addressing the root causes that affect access to health-promoting resources. [ABSTRACT FROM AUTHOR]

Most of the benefit of asthma preventer inhalers is seen with low doses. However, many Australian patients are prescribed doses of inhaled corticosteroids that are higher than necessary to control their asthma. Prescribing unnecessarily high preventer doses increases the patient's risk of adverse effects. They may also increase the patient's out-of-pocket costs. Asthma guidelines recommend considering a step-down in preventer treatment after asthma has been well controlled for two to three months in adults and for six months in children. The stepdown process should be individualised for each patient. Preventive therapy should not be stopped completely. [ABSTRACT FROM AUTHOR]

The article discusses legislation in the United States that affect the vocational education and future employment of students with disabilities. It is examined where Public Law 94-142, the Education for All Handicapped Children Act, and Section 504 of the Rehabilitation Act of 1973 mandate that opportunity for vocational education should be provided for handicapped students. It also discusses the most important areas of the final regulations of Public Law 94-482, the Vocational Education Act of 1963, which explain why vocational education is being made accessible to students with disabilities.

Part VII. Presents a survey which was conducted to determine the caller's satisfaction on the information services rendered by the Cancer Information Service (CIS) in the United States and to determine if the information provided by CIS facilitates decisionmaking and subsequent reduction actions. Methodology; Measures used; Results.

Part V. Presents the telephone service user survey which was conducted to assess the satisfaction and impact of the assistance and information provided by the Cancer Information Services (CIS) to callers in the United States. Methodology; Role of CIS cancer information specialists; Statistics on the results of the survey.

Obesity is associated with age-related health conditions and telomere attrition - a marker of cellular aging. Obesity is attributable to adverse modifiable lifestyle factors. Little is known about the mediation effect of lifestyle factors associated with the relationship between obesity and telomere length. Our objective was to examine this association in the US. Pack years smoked, drinking level per day, physical activity (PA) per week and diet based on Healthy Eating Index (HEI) were assessed as mediators associated with the relationship between adiposity measures and leukocyte telomere length (LTL); adiposity measures included body mass index (BMI), % total body fat (TBF) and waist circumference (WC). Separate adjusted linear regressions and mediation analysis were conducted on a total of 4919 respondents aged 20-84 years using cross-sectional 1999-2002 data from the US National Health and Nutrition Examination Survey. Inadequate PA correlated with 1.28% shorter LTL and was a factor accounting for 35% of the relationship between BMI and LTL (β = -0.0128, 95% CI = 0.0259, 0.0004, p = .05). Smoking 30-≥59 pack years correlated with 4% shorter LTL and accounted for 21% of the relationship between %TBF and LTL (β = -0.0386, 95% CI = -0.0742, -0.0030, p = .03). Improvement in diet correlated with 0.11% longer LTL and contributed 25% of the association between %TBF and LTL (β = 0.0011, 95%CI =0.0004, 0.0018, p = .01). Diet correlated with 0.11% longer LTL and correspond to 28% of the relationship between WC and LTL (β = 0.0011, 95%CI = 0.0004, 0.0018, p = .03). Interventions to improve modifiable behaviors may ameliorate cellular aging and aging related health conditions due to obesity among US adults. [ABSTRACT FROM AUTHOR]