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The study of deaf users of signed languages, who often experience delays in primary language (L1) acquisition, permits a unique opportunity to examine the effects of aging on the processing of an L1 acquired under delayed or protracted development. A cohort of 107 congenitally deaf adult signers ages 45-85 years who were exposed to American Sign Language (ASL) either in infancy, early childhood, or late childhood were tested using an ASL sentence repetition test. Participants repeated 20 sentences that gradually increased in length and complexity. Logistic mixed-effects regression with the variables of chronological age (CA) and age of acquisition (AoA) was used to assess sentence repetition accuracy. Results showed that CA was a significant predictor, with increased age being associated with decreased likelihood to reproduce a sentence correctly (odds ratio [ OR ] = 0.56, p = .010). In addition, effects of AoA were observed. Relative to native deaf signers, those who acquired ASL in early childhood were less likely to successfully reproduce a sentence ( OR = 0.42, p = .003), as were subjects who learned ASL in late childhood ( OR = 0.27, p < .001). These data show that aging affects verbatim recall in deaf users of ASL and that the age of sign language acquisition has a significant and lasting effect on repetition ability, even after decades of sign language use. These data show evidence for life-span continuity of early life effects. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Global Initiative for Asthma (GINA) was launched in 1993 under the auspices of the National Heart, Lung, and Blood Institute, National Institutes of Health, USA, and the World Health Organization to produce a global strategy on asthma management and prevention. Now constituted as a non-profit entity, it continues to produce, on an annual basis, the most widely cited evidence-based report on the optimal management of asthma in both adults and children intended for global use. Although the GINA Report is often viewed and used as an asthma treatment guideline, it is designed to be a clinically oriented strategy document that supports the development of practice guidelines in different countries and regions.Other GINA products, including the report's pocket guides, teaching slide kits and implementation tools, are also offered free of charge for public use. The GINA Scientific Committee comprises recognised international experts from primary, secondary and tertiary centres of care who are actively involved in both the care of patients and research in asthma. The GINA Assembly is a forum for exchange of scientific information and discussions on initiatives to improve asthma care in various countries, focusing on implementation strategies. GINA plays a role in shaping research on the diagnosis and treatment of asthma and informs the development of point of care practice guides and decision support tools. GINA supports the objectives of raising awareness of asthma and improving access to therapy and quality of care for asthmatic patients, in addition to presenting and promoting continuously updated evidence-based treatment approaches for global use., Competing Interests: Conflict of interest: L-P. Boulet reports the following: research grants for participation in multicentre studies from AstraZeneca, Boston Scientific, GlaxoSmithKline, Hoffman La Roche, Novartis, Ono Pharma, Sanofi and Takeda; support for research projects introduced by the investigator from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck and Takeda; consulting fees and advisory board membership for AstraZeneca, Novartis and Methapharm; royalties as co-author of “Up-To-Date” (occupational asthma); non-profit grants for the production of educational materials from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck Frosst and Novartis; conference fees from AstraZeneca, GlaxoSmithKline, Merck and Novartis; and support for participation in conferences and meetings from Novartis and Takeda. He is the past president and a member of the Canadian Thoracic Society Respiratory Guidelines Committee and Chair of the Board of Directors of the Global Initiative for Asthma (GINA). Conflict of interest: H. Reddel reports grants and personal fees from AstraZeneca and Novartis; grants, personal fees and non-financial support from GlaxoSmithKline; and personal fees from Merck, Teva, Mundipharma and Boehringer Ingelheim; outside the submitted work. She is Chair of the GINA Scientific Committee. Conflict of interest: E. Bateman is a member of the Science Committee and Board of GINA. He reports personal fees from Novartis, Cipla, Vectura, Menarini, ALK, ICON, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca, and grants from GlaxoSmithKline, Hoffmann le Roche, Sanofi-Aventis, Novartis, AstraZeneca and Teva, outside the submitted work. Conflict of interest: S. Pedersen reports personal fees from AstraZeneca, ALK and Thermo Fisher, outside the submitted work. Conflict of interest: J.M. FitzGerald reports personal fees for advisory board membership from GSK, AstraZeneca, Boehringer Ingelheim, Novartis, Pfizer, Sanofi-Regeneron and Theravance, peer-reviewed funding from CIHR, AllerGen and BC Lung Association, research funding from GSK, AstraZeneca, Amgen, Sanofi-Regeneron and Novarits, all paid directly to UBC; and is a member of the steering committee for the International Severe Asthma Registry and PI for the Canadian Severe Asthma Registry, and a member of the GINA Science and Executive Committees. Conflict of interest: P.M. O'Byrne has received consultancy fees from AstraZeneca, GSK and Chiesi; has received grants/patents pending from AstraZeneca, Genetech and Novartis; and is a board member for the Joint Oversight Board for LABA safety study., (Copyright ©ERS 2019.)

Background: The Communities Putting Prevention to Work: Chronic Disease Self-Management Program (CDSMP) Initiative funded grantees in 45 states, the District of Columbia and Puerto Rico to implement and expand delivery of CDSMP to older adults. We examine whether there are differences in the enrollment and completion rates of members of racial and ethnic minority groups and what sites have done to enhance their delivery of the CDSMP to such groups., Method: This study used a multi-method approach including: site visits to 6 states, telephone interviews with the 47 program grantees and delivery sites, review of program reports, and analysis of administrative data on participants, completers, workshops and leaders., Results: Grantees served 89,861 participants, including 56.3% who self-identified as White, 17.3% as Black, 5.0% as other/multi-racial, 3.2% as Asian/Asian Americans, 1.4% as American Indian/Alaskans, .8% as Native Hawaiian/Pacific Islanders, and 16.0% individuals of unknown race. Overall, completion rates averaged 74.5%, with Native Hawaiian/Pacific Islanders completing workshops at a higher rate (90.6%) than other groups. Completion rates for participants aged > or = 75 were higher than for younger participants. Senior centers, health care organizations, and residential facilities served 63.1% of the participants., Conclusions: Grantees have successfully delivered CDSMP to racially and ethnically diverse participants in a range of settings. As the Administration for Community Living/Administration on Aging (ACL/AoA) grantees have demonstrated, CDSMP can be brought to scale by community organizations, partnerships and networks to reach diverse populations in diverse settings. The program can be a significant tool for addressing health disparities and empowering racial/ethnic minorities to take charge, promote better health and self-management of chronic conditions.

Background: The Rockwood Clinic in Spokane, Washington, participated in the Washington State Diabetes Collaborative, which promoted spread of the Chronic Care Model. Eleven participating providers managed care for 698 patients with diabetes, while 19 non-participating providers had 1,300 patients. IMPLEMENTING THE CHRONIC CARE MODEL: Rockwood upgraded its clinical information system to allow for creation of a patient registry to track clinical measures and generate performance reports. Components included a referral mechanism to facilitate more frequent use of diabetes educators, monthly reports, and sharing of results and updated clinical information from consulting specialists. Rockwood created a self-management tool kit and implemented patient goal setting and group visits., Outcome Measures: Seven of the 12 patient outcomes were significantly better for participating providers (p < .05). Two favorable outcomes, eye examinations and blood pressure < 130/85 mm Hg, were significantly associated with greater participation levels at p < .05., Discussion: Implementing the Chronic Care Model to improve care, using quality improvement staff and administrative support, required fundamental changes in the system of care delivery. These changes were designed to refocus diabetes care efforts at Rockwood on prevention rather than acute care episodes.

Maintenance of the interactive Child and Adolescent Trial for Cardiovascular Health (CATCH) third- to fifth-grade curricula was studied in the 56 original intervention schools and 20 of the original control schools 5 years postintervention in four regions of the United States. Target grade teachers completed a self-administered survey that included questions regarding use of the CATCH materials, training in CATCH or other health education, barriers and perceived support for health education, and amount of health education currently taught. Percentage of teachers who continued to teach CATCH in the classroom was low; however, percentages were significantly higher in former intervention compared with control schools, even though control schools received training and materials following the main field trial. The results of this study can provide useful information for future development of classroom health promotion materials with a higher level of sustainability.

Telemedicine is likely to adopt rather than create most of its protocols and standards as it becomes an integral part of medical practice. To optimize this process, it will be necessary to understand how to use existing protocols and standards, and influence the development, evaluation, and modification of new ones. We have identified key participants in standards setting activities under the titles of international government, United States government, professional certifying organizations, and independent institutes. We have reviewed their roles in establishing standards for identification of patients and providers, content and structure of patient records, terminology and codes of medical information and records, and transfer of messages and data. We have addressed requirements for storing and viewing images, the impact of image resolution on accuracy of clinical interpretation, the choice of communications protocols to satisfy transmission requirements, the need to link images and text data, and the evaluation of telemedicine systems.