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How should the United States recalibrate its counterterrorism policy for an era of great power competition? With the end of unipolarity, the United States cannot fight terrorists and compete with Russia and China with equal energy, but must instead make hard choices about its priorities and resources. Among those hard choices are what to do with the web of counterterrorism partnerships with other governments that have formed in the post- 9/11 era. This article proposes three broad principles—linkages, license, and legitimacy—that the United States can use to evaluate its policy and these partnerships, with the aim of recasting U.S. counterterrorism policy for an era of great power competition. [ABSTRACT FROM AUTHOR]

Purpose: This study examined whether people who stutter would associate biological and non-biological explanations of stuttering with the endorsement of stereotypes about people who stutter, prognostic expectations for the reduction of stuttering, feelings of guilt, self-blame, and shame about stuttering, and agency for speech modification. Method: This was a cross-sectional study including 372 adults who stutter. Participants completed a web survey with scales that measured their agreement with biological and non-biological models of stuttering; their endorsement of common stereotypes for people who stutter; prognostic expectations for reduced stuttering; feelings of guilt, self-blame, and shame about stuttering; and feelings of agency in their ability to modify their speech. Result: Biological explanations for stuttering were significantly correlated with reduced stereotype endorsement about people who stutter, lower prognostic expectations for reducing stuttering, and reduced feelings of guilt and self-blame regarding stuttering. Non-biological explanations for stuttering were significantly correlated with increased endorsement of negative stereotypes about people who stutter, increased prognostic expectations for reducing stuttering, and increased feelings of guilt, self-blame, and shame about stuttering. Conclusion: It is concluded that the implications of biological framing of stuttering among people who stutter are complex and should be well thought out by professionals. Explaining stuttering as biological, but responsive to personal and environmental influences, may lead to reduced guilt and self-blame, while at the same time fostering feelings of agency for speech modification. [ABSTRACT FROM AUTHOR]

This paper explores some of the documents that provide a foundation for the Church and its ministries to deliver justice and mercy to all, including students with disabilities. First, Catholic Social Teaching (CST) traditions will be presented as the foundation to some of the documents of the American Church. A chronology of the documents of United States bishops will trace the flow of CST as the impetus for designing and delivering programs for students with disabilities in Catholic schools. Implications for Catholic schools are outlined for next steps for implementation. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to (1) document the experiences of enacted stigma (external stigma, experienced discrimination) and felt stigma (anticipation and expectation of discrimination or negative treatment by others) in adults who stutter, (2) investigate their relationships to each other, and (3) investigate their relationships to global mental health. Method Participants were 324 adults who stutter recruited from clinicians and self-help group leaders in the United States. Participants completed an anonymous web survey consisting of measures of enacted stigma, felt stigma, and global mental health. Data analysis focused on obtaining descriptive statistics for enacted stigma and felt stigma, and performing correlational analysis between these variables, and also between these variables and global mental health. Results Most participants reported experiencing several different forms of social devaluation and negative treatment from other people at some point in their lives (i.e., enacted stigma), although they rarely experienced these events during the past year. Most participants agreed that they anticipate future stigmatizing experiences (i.e., felt stigma). Enacted stigma in the past year demonstrated a significant positive relationship to felt stigma. Both enacted stigma in the past year and felt stigma demonstrated significant negative relationships with global mental health. Enacted stigma in the past year and felt stigma were unique predictors of participants’ global mental health. Conclusions People who stutter experience discrimination and social devaluation, and they anticipate future stigmatizing experiences. Both of these types of stigma, enacted and felt, are associated with reduced mental health in adults who stutter. Assessment and therapy with adults who stutter should address these aspects of stuttering. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory study was the first to obtain quantitative and qualitative data on both personal perceptions and perceived public opinion about stuttering in order to identify topics to include in anti-stigma programs for stuttering. Method: Three-hundred ten adults in the United States completed a web survey that assessed knowledge about stuttering and attitudes toward people who stutter (PWS) with questions addressing personal perceptions (direct questions) and perceived public opinion (indirect questions). Results: Many participants reported favorable personal perceptions of PWS regarding their intelligence, competence, and potential for success. However, most participants did not personally believe PWS were confident, and most believed they were shy. Perceived public opinion was more unfavorable as a majority agreed that the public is uncomfortable talking with PWS and that the public would recommend PWS avoid jobs requiring high speech demands and avoid talking to large audiences. A minority of participants agreed PWS are perceived publicly as capable or mentally healthy. Conclusions: The survey demonstrated misunderstandings and negative perceptions of PWS, especially when measured with perceived public opinion. Results can increase our understanding of content areas that should be included in anti-stigma programs for stuttering and highlight different methods for analyzing public perceptions of stuttering. [ABSTRACT FROM AUTHOR]

Rationale: In a prior study, lumacaftor/ivacaftor treatment (≤28 d) in patients with cystic fibrosis (CF) heterozygous for F508del-CFTR did not improve lung function.Objectives: To evaluate an optimized lumacaftor/ivacaftor dosing regimen with a longer duration in a cohort of patients heterozygous for F508del-CFTR.Methods: Patients aged 18 years or older with a confirmed CF diagnosis and percent predicted FEV1 (ppFEV1) of 40 to 90 were randomized to lumacaftor/ivacaftor (400 mg/250 mg every 12 h) or placebo daily for 56 days. Primary outcomes were change in ppFEV1 at Day 56 and safety. Other disease markers were evaluated.Measurements and Main Results: Of 126 patients, 119 (94.4%) completed the study. Lumacaftor/ivacaftor was well tolerated, although chest tightness and dyspnea occurred more frequently with active treatment than with placebo (27.4% vs. 14.3% and 14.5% vs. 6.3%, respectively). Mean (SD) ppFEV1 values at baseline were 62.9 (14.3) in the active treatment group and 60.1 (14.0) in the placebo group. Absolute changes in ppFEV1 (least squares mean [SE]) at Day 56 were -0.6 (0.8) percentage points in the active treatment group and -1.2 (0.8) percentage points in the placebo group (P = 0.60). CF respiratory symptom scores in the active treatment group improved by a mean of 5.7 points versus a decrease of -0.8 in the placebo group (P < 0.01). No changes in body mass index occurred. Changes from baseline in sweat chloride (least squares mean [SE]) at Day 56 were -11.8 (1.3) mmol/L in the active treatment group and -0.8 (1.2) mmol/L in the placebo group (P < 0.0001).Conclusions: Sweat chloride and respiratory symptom scores improved with lumacaftor/ivacaftor, though no meaningful benefit was seen in ppFEV1 or body mass index in patients heterozygous for F508del-CFTR. Clinical trial registered with www.clinicaltrials.gov (NCT01225211). [ABSTRACT FROM AUTHOR]

Purpose: In this study, the author examined the relationship of social support, empowerment, self-help support group participation, and group identification to quality of life in adults who stutter. Method: Two-hundred forty-nine adults who stutter completed a web-based survey, including measures of social support, empowerment, self-help support group participation, group identification, and quality of life. Results: After controlling for demographic and stuttering parameters, both empowerment in the self-esteem / self-efficacy domain and social support from family significantly predicted quality of life in adults in the sample. Conclusions: Increased self-esteem/self-efficacy and social support from family relates to improved quality of life in adults who stutter, independent of stuttering severity. Treatments that increase feelings of self-esteem /self-efficacy and strengthen social support from the family should be considered for individuals who struggle to cope with stuttering in order to enhance their quality of life. [ABSTRACT FROM AUTHOR]

The article discusses the U.S.'s military strategic policy of utilizing drone aircraft in warfare under U.S. President Barack Obama, including against the terrorist organization Al Qaeda in Pakistan and the Islamic fundamentalism organization the Taliban. The role that the U.S.'s use of drone aircraft plays in terrorist recruitment is discussed.

Research shows that news coverage of protest groups that challenge the status quo treats them relatively critically. To develop a more precise understanding of such coverage, this study content analyzes an international set of newspapers (N = 220) to explore the relationships between a protest group’s goals and tactics on resulting news coverage. The findings indicate that a group’s tactics—more than its goals—play a substantial role in affecting coverage. Furthermore, the findings also show that the protest issue and location indirectly affect coverage through their relationship to a group’s tactics. Implications for journalists and protesters alike are discussed. [ABSTRACT FROM AUTHOR]

One of the underlying assumptions of the contemporary debate over Afghanistan is that counterterrorism objectives can be achieved through counterinsurgency methods. The recent decision by President Barack Obama to deploy 30,000 extra troops to Afghanistan is premised on the idea that to disrupt Al Qaeda and prevent it from forming training camps in Afghanistan it will be necessary to first reverse the momentum of the Taleban insurgency. This approach—which places the US and UK on the offensive to disrupt terrorist plots before they arrive on their shores—assumes that the threats from Al Qaeda and the Taleban are intertwined and thus the strategy of response must seamlessly comprise elements of counterterrorism and counterinsurgency. In fact, counterterrorism and counterinsurgency are very different—often contradictory—models of warfare, each with its own associated assumptions regarding the role of force, the importance of winning support among the local population, and the necessity of building strong and representative government. Rather than being mutually reinforcing, they may impose tradeoffs on each other, as counterterrorism activities may blunt the effectiveness of counterinsurgency approaches and vice versa. The last four years in Afghanistan provide evidence that when employed in the same theatre counterterrorism and counterinsurgency strategies can offset one another. To be in a position to begin the withdrawal of US troops before July 2011, the Obama administration will need to find a way to manage the tradeoffs between its counterterrorism and counterinsurgency strategies in Afghanistan. [ABSTRACT FROM AUTHOR]

The article examines how poverty is addressed in contemporary political debate in the U.S. and how concern for the non-working poor can once again be made central to progressive politics. It argues that contrary to conventional wisdom there is a coded language employed by progressives when talking about poverty, particularly among the unemployed poor. Poverty is not a generalised phenomenon in the U.S., according to the author, but rather concentrates on particularly disadvantaged racial and ethnic groups. The three reasons why Americans are squeamish about talking about poverty are given, including the ideology of the American Dream.

The 9/11 attacks made the war on terror the central plank of American grand strategy. Yet despite its importance in shaping US policy choices, there has been considerable confusion over how the war on terror relates to foreign policy goals. This article attempts to locate the war on terror within American grand strategy and makes three claims. First, it argues that the Bush administration's approach to the war on terror rests on a false analogy between terrorism and fascism or communism. This has led to misinterpretations of the goals of the war on terror and to a persistent misuse of American power. Second, it suggests that the central purpose of the war on terror should be to de-legitimize terror as a tactic and to induce states to assume responsibility for controlling terrorists within their borders. American grand strategy should be focused on creating a normative anti-terror regime with costly commitments by linchpin states—defined as great powers and crucial but endangered allies such as Pakistan and Saudi Arabia—rather than on conducting regime change against rogue states on the margins of the international system. Success in the war on terror should be measured not by the perceived legitimacy of discrete US policy choices, but by the number of these crucial states who accept the de-legitimation of terrorism as a core foreign policy principle and act accordingly. Third, it argues that bilateral enforcement of an anti-terror regime imposes high costs for US power and puts other elements of American grand strategy— including the promotion of democracy and the promotion of human rights—at risk. To reduce these costs and to preserve American power over the long-term, the US should attempt to institutionalize cooperation in the war on terror and to scale back ambitious policy choices (such as achieving a democratic revolution in the Middle East) which increase the risks of state defection from the anti-terror regime. [ABSTRACT FROM AUTHOR]

This paper examines newspaper coverage of protests from 1960 to 1999. Initial findings indicated protests received consistent levels of support over that time. In light of this, we expected little change in the extent to which these protests challenged the status quo. However, there was a steady decline, with protest coverage becoming less deviant throughout this study. Further analyses suggest disparities in coverage of different protest-types were apparent during the Vietnam War. The most drastic change in treatment of different protest-types was directly after the height of the anti-war movement followed by gradual change thereafter. [ABSTRACT FROM AUTHOR]

Based on uncertainty reduction theory, this paper argues that individuals were motivated to seek information and learn about the September 11 terrorist attacks to reduce uncertainty about what happened. Results from a panel survey indicate that negative emotional response was a strong predictor of efforts to learn. Analyses also show that relative increases in newspaper, television, and Internet use from Wave 1 to Wave 2 were positively related to efforts to learn about the attacks. The findings extend uncertainty reduction theory to the mass media context thereby contributing to our understanding of uses and gratifications. [ABSTRACT FROM AUTHOR]

This research examined the relationship between the nature of newspaper coverage of social protests and the level of deviance and type of protest. A content analysis of 280 protest news stories from the Milwaukee Journal. Wisconsin State Journal. Sauk Prairie Star. Watertown Times, and Park Falls Herald from, 1960 to 1499 was conducted to compare indicators of the protest paradigm between protests that either support the status quo, endorse moderate reform, or seek radical reform. Additional analyses looked at the role that the type of protest played in adherence to the protest paradigm. Results of analyses indicate that moderate reform and radical reform protests were more likely to be treated critically in both the headline and main body of the article as well as have greater emphasis plated on specific events rather than themes end goals. [ABSTRACT FROM AUTHOR]

Research on print and broadcast media shows differences in cognitive and affective responses. We extend that research by combining content analysis and survey methods to examine medium differences in the emotional tone of coverage concerning the September 11 terrorist attacks, and audience differences in emotional reactions to the attacks. A computer aided content analysis of national television and newspaper transcripts demonstrates that television news was consistently more emotional than print news. Further, a panel survey found use of television news was more strongly related to positive and negative emotional responses to the attacks than use of newspapers. [ABSTRACT FROM AUTHOR]

• Board Certified Specialists in Fluency Disorders reported their self-efficacy for providing treatment. • Self-efficacy for providing multidimensional therapy for children who stutter was high. • Self-efficacy was correlated with several cognitive, affective, and behavioral variables. • Specialists reported that seeking and maintaining specialty certification increased their self-efficacy. The purpose of this study was to document fluency specialists' self-efficacy beliefs for providing multidimensional treatment to children who stutter and to identify cognitive, affective, and behavioral correlates of self-efficacy. Sixty-six Board Certified Specialists in Fluency in the United States completed an online survey measuring self-efficacy in providing multidimensional stuttering therapy, perceived importance of multidimensional aspects of therapy, feelings of comfort in providing therapy, perceived treatment success, and employment and demographic questions. Open-ended questions were also asked for participants to describe why they chose to specialize and what benefits they received from it. Participants reported high levels of self-efficacy (averages above 9 on a scale from 0 to 10) in speech-related, cognitive, emotional, and social domains of stuttering therapy, as well as high levels of comfort and clinical success. Higher ratings of overall self-efficacy were significantly correlated with beliefs about the importance of multidimensional treatment, τ = 0.27, treatment comfort, τ = 0.25, and self-reported treatment success, τ =.49. Responses indicated that many participants believed that their self-efficacy grew because of specialty certification. Although not the same as treatment outcome data, self-efficacy among clinical service providers is an important variable to consider. Board Certified Specialists in Fluency in the United States report very high levels of self-efficacy for school-age stuttering treatment. The process of certification helps to increase self-efficacy and provides a means for advertising competence in stuttering treatment. This information could help in recruiting the next generation of fluency specialists. [ABSTRACT FROM AUTHOR]

Objective: Many people with psychiatric disability have educational goals. In this paper, we survey a sample to describe the frequency of academic interests, specific goals related to this interest, and barriers that undermine education. Methods: One hundred and four people from a large Midwestern mental health center completed the Educational Goals Survey (EGS) which was developed with feedback from two consumer focus groups. Results:Almost two thirds of respondents never got beyond high school education. Of this group, 54.5% wanted to go back to school. Reasons for returning to school included improving one's job status and enhancing personal growth. Conclusions: Two sets of barriers emerged from the data; those which are consistent with any adult student and those which must be addressed because of disability. We make sense of these data by comparing results with the U.S. Census where appropriate. [ABSTRACT FROM AUTHOR]

Purpose The purposes of this study were to examine the self-efficacy of school-based speech-language pathologists (SLPs) in conducting multidimensional treatment with children who stutter (CWS) and to identify correlates of self-efficacy in treating speech-related, social, emotional, and cognitive domains of stuttering. Method Three hundred twenty randomly selected school-based SLPs across the United States responded to an online survey that contained self-efficacy scales related to speech, social, emotional, and cognitive components of stuttering. These ratings were analyzed in relation to participants' beliefs about stuttering treatment and their comfort level in treating CWS, perceived success in therapy, and empathy levels, in addition to their academic and clinical training in fluency disorders as well as demographic information. Results Overall, SLPs reported moderate levels of self-efficacy on each self-efficacy scale and on a measure of total self-efficacy. Significant positive associations were observed between SLPs' self-efficacy perceptions and their comfort level in treating CWS, self-reported success in treatment, beliefs about the importance of multidimensional treatment, and self-reported empathy. There were some discrepancies between what SLPs believed was important to address in stuttering therapy and how they measured success in therapy. Conclusions Among school-based SLPs, self-efficacy for treating school-age CWS with a multidimensional approach appears stronger than previously reported; however, more progress in training and experience is needed for SLPs to feel highly self-efficacious in these areas. Continuing to improve clinician self-efficacy for stuttering treatment through improved academic training and increased clinical experiences should remain a high priority in order to enhance outcomes for CWS. Supplemental Material https://doi.org/10.23641/asha.12978194.

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative adult samples. To address these limitations, the current study investigated the relationship between individual-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. The objectives of the present study were to: 1) compute the prevalence of mental health indicators by child maltreatment types, 2) estimate the prevalence of overall good, moderate, and poor mental health by child maltreatment types; and 3) examine the relationship between individual-level factors and overall mental health status of adolescents with and without a history of maltreatment. Data were from the National Comorbidity Survey of Adolescents (NCS-A; n = 10,123; data collection 2001-2004); a large, cross-sectional, nationally representative sample of adolescents aged 13-17 years from the United States. All types of child maltreatment were significantly associated with increased odds of having poor mental health (adjusted odds ratios ranged from 3.2 to 9.5). The individual-level factors significantly associated with increased odds of good mental health status included: being physically active in the winter; utilizing positive coping strategies; having positive self-esteem; and internal locus of control (adjusted odds ratios ranged from 1.7 to 38.2). Interventions targeted to adolescents with a history of child maltreatment may want to test for the efficacy of the factors identified above., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Benchmarking is the process of using outcome data to identify high-performing centres and determine practices associated with their outstanding performance. The US Cystic Fibrosis Foundation (CFF) Patient Registry contains centre-specific outcomes data for all CFF-certified paediatric and adult cystic fibrosis (CF) care programmes in the USA. The CFF benchmarking project analysed these registry data, adjusting for differences in patient case mix known to influence outcomes, and identified the top-performing US paediatric and adult CF care programmes for pulmonary and nutritional outcomes. Separate multidisciplinary paediatric and adult benchmarking teams each visited 10 CF care programmes, five in the top quintile for pulmonary outcomes and five in the top quintile for nutritional outcomes. Key practice patterns and approaches present in both paediatric and adult programmes with outstanding clinical outcomes were identified and could be summarised as systems, attitudes, practices, patient/family empowerment and projects. These included: (1) the presence of strong leadership and a well-functioning care team working with a systematic approach to providing consistent care; (2) high expectations for outcomes among providers and families; (3) early and aggressive management of clinical declines, avoiding reliance on 'rescues'; and (4) patients/families that were engaged, empowered and well informed on disease management and its rationale. In summary, assessment of practice patterns at CF care centres with top-quintile pulmonary and nutritional outcomes provides insight into characteristic practices that may aid in optimising patient outcomes.

As levels of immigration and ethnic diversity continue to rise in most Western societies, the social demography of schools is changing rapidly. Although schools represent a prominent developmental context, relatively little is known about the extent to which the racial/ethnic composition of schools influences mental health outcomes in students. The objective of the present study is to examine the association between immigrant and racial/ethnic congruence in school-the numerical representation of a student's immigrant generational status and race/ethnicity in the student body-and levels of emotional and behavioral problems. This study also examines the extent to which the association between congruence and emotional-behavioral problems differs across racial/ethnic immigrant sub-groups and is accounted for by individual perceptions of school belonging. Data come from the in-school survey of the Longitudinal Study of Adolescent Health (Add Health) conducted in the United States. The sample is nationally representative, and includes 128 schools and 77,150 adolescents in grades 7-12 (50 % female, M age = 14.9 years, SD = 1.78). After controlling for school and family socio-demographic characteristics, immigrant and racial/ethnic congruence in school exhibited a negative association with emotional and behavioral problems for most sub-groups examined. School belonging was associated negatively with emotional and behavioral problems, and partially accounted for the effects linked to congruence in schools. The immigrant and racial/ethnic composition of schools and perceptions of belonging have strong links with emotional and behavioral problems and may represent important targets for intervention.

The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system.To gauge the addiction treatment field's readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback.On a scale of "Needs to Begin," "Early Stages," "On the Way," and "Advanced," the mean scores for respondents (n = 276) ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of < $5 million (n = 193) were less likely than those with budgets > $5 million to have information technology (patient records, patient health technology, and administrative information technology), evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA.The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.

The heart is increasingly recognized as a target for toxicity. As studies in laboratory rodents are commonly used to investigate the potential toxicity of various agents, the identification and characterization of lesions of cardiotoxicity is of utmost importance. Although morphologic criteria have been established for degenerative myocardial lesions in rats and mice, differentiation of spontaneously occurring lesions from toxin-induced or toxin-related lesions remains difficult. A retrospective light microscopic evaluation was performed on the hearts of F344 rats and B6C3F(1) mice from National Toxicology Program (NTP) studies of six chemicals identified in the NTP database in which treatment-induced myocardial toxicity was present. Two previously defined myocardial lesions were observed: "cardiomyopathy" that occurred spontaneously or as a treatment-related effect and "myocardial degeneration" that occurred as a treatment-related effect. Both lesions consisted of the same basic elements, beginning with myofiber degeneration and necrosis, with varying amounts of inflammation, interstitial cell proliferation, and eventual fibrosis. This observation is indicative of the heart's limited repertoire of responses to myocardial injury, regardless of the nature of the inciting agent. A prominent differentiating factor between spontaneous and treatment-induced lesions was distribution and lesion onset. Once the respective lesions had undergone fibrosis, however, they generally appeared morphologically indistinguishable.

Context: The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the respiratory tract of individuals with cystic fibrosis (CF) has increased dramatically; however, its impact on outcomes in CF is unclear. Because the time between infection with bacteria in CF and death can be decades, observational studies with long periods of follow-up are well suited to address the current gap in knowledge., Objective: To determine whether isolation of MRSA from the respiratory tract of CF patients is associated with worse survival compared with patients who never have a culture positive for MRSA., Design, Setting, and Participants: Cohort study of 19,833 CF patients aged 6 to 45 years seen at centers accredited by the Cystic Fibrosis Foundation in the United States. Patients entered between January 1996 and December 2006 and were followed up through December 2008. Cox regression models with time-varying covariates were used to compare survival between CF patients with and without respiratory tract MRSA., Main Outcome Measure: Time from age at entry until age at death from any cause., Results: In 137,819 patient-years of observation (median, 7.3 years/patient), 2537 CF patients died and 5759 patients had MRSA detected. The mortality rate was 18.3 deaths (95% confidence interval [CI], 17.5-19.1) per 1000 patient-years in patients without MRSA and 27.7 deaths (95% CI, 25.3-30.4) per 1000 patient-years in those with MRSA. Among those with MRSA, the attributable risk percentage of death associated with MRSA was 34.0% (95% CI, 26.7%-40.4%). The unadjusted hazard ratio associated with MRSA was 1.47 (95% CI, 1.32-1.62). After adjustment for time-varying covariates associated with severity of illness, MRSA remained associated with a higher risk of death (1.27; 95% CI, 1.11-1.45)., Conclusion: Detection of MRSA in the respiratory tract of CF patients was associated with worse survival.

Unlabelled: Bullying in school-age children is a global epidemic. School personnel play a critical role in eliminating this problem. The goals of this study were to examine speech-language pathologists' (SLPs) perceptions of bullying, endorsement of potential strategies for dealing with bullying, and associations among SLPs' responses and specific demographic and practice-oriented variables. A survey was developed and mailed to 1000 school-based SLPs. Six vignettes describing episodes of physical, verbal, and relational bullying of hypothetical 10-year students who stutter were developed. Three vignettes described bullying specifically mentioning stuttering behaviors, while three described bullying without mentioning stuttering behavior. The data from 475 SLPs were analyzed. SLPs rated physical bullying as most serious and in need of intervention, followed by verbal bullying. Relational bullying was rated as not serious or in need of intervention. SLPs also responded to the likelihood of using strategies for dealing with bullying. Physical and verbal bullying elicited the use of "talking with the teacher", "working with school personnel", and "reassuring the child of his safety" strategies. Relational bullying elicited "ignore the problem" and "be more assertive" strategies. Correlations among variables are reported. The seriousness of physical and verbal bullying, likelihood of intervention, and the lack of knowledge about relational bullying is discussed., Educational Objectives: Readers should be able to: (1) summarize the research describing the negative effects of three major types of bullying, (2) summarize the research describing bullying and children with communication disorders, especially stuttering, (3) report results of a survey of speech-language pathologists' (SLPs) perceptions of bullying in school-age children, (4) explain the perceived seriousness of the problem by SLPs and likelihood of intervention, and (5) describe the need for continued prevention and intervention activities for children who stutter., (Copyright 2010 Elsevier Inc. All rights reserved.)

Rationale: The prevalence in cystic fibrosis (CF) of respiratory cultures with methicillin-resistant Staphylococcus aureus (MRSA) has dramatically increased over the last 10 years, but the effect of MRSA on FEV(1) decline in CF is unknown., Objectives: To determine the association between MRSA respiratory infection and FEV(1) decline in children and adults with CF., Methods: This was a 10-year cohort study using the Cystic Fibrosis Foundation patient registry from 1996-2005. We studied individuals who developed new MRSA respiratory tract infection. Repeated-measures regression was used to assess the association between MRSA and FEV(1) decline, adjusted for confounders, in individuals aged 8-21 years and adults (aged 22-45 yr). Two different statistical models were used to assess robustness of results., Measurements and Main Results: The study cohort included 17,357 patients with an average follow-up of 5.3 years. During the study period, 1,732 individuals developed new persistent MRSA infection (> or =3 MRSA cultures; average, 6.8 positive cultures) and were subsequently followed for an average of 3.5 years. Even after adjustment for confounders, rate of FEV(1) decline in individuals aged 8-21 years with persistent MRSA was more rapid in both statistical models. Their average FEV(1) decline of 2.06% predicted/year was 43% more rapid than the 1.44% predicted/year in those without MRSA (difference, -0.62% predicted/yr; 95% confidence interval, -0.70 to -0.54; P < 0.001). Effect of MRSA on FEV(1) decline in adults was not clinically significant., Conclusions: Persistent infection with MRSA in individuals with CF between the ages of 8 and 21 years is associated with a more rapid rate of decline in lung function.

Objectives: More than 500,000 adolescents with special health care needs age into adulthood each year in the United States, and there is growing recognition of the need for support of their transition to adult-oriented health care. Because of improved survival, cystic fibrosis has experienced this increasing transition need, and cystic fibrosis policy leaders responded by mandating the transition of adults with cystic fibrosis to adult-focused cystic fibrosis care programs by 2000. The primary objective of this study was to characterize in detail recent transition practices at US cystic fibrosis programs, to identify areas for improvement and to serve as a model for other diseases. A secondary objective of this study was to develop and validate a survey for formal assessment of transition practices., Methods: A 105-question survey on key aspects of transition was administered to cystic fibrosis care team members from all 195 US Cystic Fibrosis Care programs. Rates of adherence to recommended components of transition care were measured., Results: A total of 448 surveys were obtained from 170 (87%) of 195 cystic fibrosis programs. Although transfer of care occurs at a median age of 19 years, initial discussion of transition does not occur until a median age of 17 years, limiting time to foster self-care skills. Only half of programs consistently perform a transition readiness assessment, 28% of centers offer visits focused on transition, and <10% have a written list of desirable self-management skills., Conclusions: There is significant variability in transition support provided to young adults with cystic fibrosis, but there are simple steps that may lead to more consistent delivery of transition services. Methods of assessment and lessons learned from transitioning young adults at US cystic fibrosis programs may serve to improve transition for individuals with other childhood diseases.

Background: Infection with multiple antibiotic-resistant Pseudomonas aeruginosa (MARPA) in individuals with cystic fibrosis (CF) has caused much concern among caregivers, yet little is known about the risks associated with acquiring resistance. The main objective of the study was to estimate the incidence and identify risk factors for the acquisition of MARPA among individuals with CF., Methods: Five-year cohort study of individuals followed in the Cystic Fibrosis Foundation Registry from 1998 through 2002., Results: Demographics, anthropometrics, spirometry, respiratory culture results, comorbidities, antibiotic usage, and hospitalizations were collected. Of the 4,293 patients with P aeruginosa infection during the study period, MARPA developed in 341. The overall incidence of MARPA was 1.8%/yr. Independent risk factors for MARPA included CF-related diabetes mellitus (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.11 to 2.43), long-term inhaled tobramycin usage (HR, 2.08; 95% CI, 1.56 to 2.77), and care at a CF center with a baseline MARPA prevalence in the top quartile (HR, 2.00; 95% CI, 1.31 to 3.04). Frequent courses of IV antibiotics and repeated hospitalizations were also found to independently increase the risk for MARPA., Conclusions: Infection with MARPA is common among patients with CF. Diabetes, long-term inhaled tobramycin usage, and frequent acute pulmonary exacerbations requiring hospitalization or IV antibiotics increase the risk for MARPA. Receiving CF care at a center with a high prevalence of resistant Pseudomonas also increases the risk for MARPA in patients with CF. Further study is needed to investigate the mechanisms of acquiring resistant strains and the clinical impact of MARPA on CF outcomes.

This article reviews the research on intensive case management (ICM) programs as a jail diversion intervention for people with a serious mental illness (SMI). The review includes two types of ICM programs: (a) general ICM programs that included an assessment of arrests and incarceration rates for people with an SMI and (b) ICM programs specifically implemented as a component of a jail diversion intervention for people with an SMI. Results indicate that general ICM programs (19) rarely led to reductions in jail or arrest rates over time, and these rates were similar to those found in standard mental health services. General ICM programs that included an integrated addiction treatment component (8) had mixed results but a trend toward reductions in rates of arrests and incarceration over time for individuals with an SMI and a co-occurring substance use disorder. Results were mixed for jail diversion interventions with an ICM program, but most ICM programs (8) led to significant reductions in arrests and incarcerations over time. Specific elements of effective ICM jail diversion programs are discussed.

The mental health system has realized significant metamorphoses in the standards and practices of quality care for people with psychiatric disability during the past decade. Now change agents are wrestling with effective strategies that help real-world systems to adopt programs reflecting these metamorphoses. Two fundamental approaches to systems change are compared and contrasted here: evolution and revolution. First, the authors compare the different ways in which evolution and revolution might approach change in the mental health system. They do this by showing how they might influence the transformation of day treatment into supported employment programs. Then, the authors present the two approaches as naturally occurring change processes that work in tandem to affect real-world adaptations. Finally, they summarize practical strategies that change agents might adopt to realize evolution and revolution. Clearly, all stakeholder groups need to become strategic about system change so that real-world practices keep up with the ideals emerging in practice guidelines and evidence-based practice reviews.