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BACKGROUND: Race-specific spirometry reference equations are used globally to interpret lung function for clinical, research, and occupational purposes, but inclusion of race is under scrutiny. RESEARCH QUESTION: Does including self-identified race in spirometry reference equation formation improve the ability of predicted FEV1 values to explain quantitative chest CT abnormalities, dyspnea, or Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification? STUDY DESIGN AND METHODS: Using data from healthy adults who have never smoked in both the National Health and Nutrition Survey (2007-2012) and COPDGene study cohorts, race-neutral, race-free, and race-specific prediction equations were generated for FEV1. Using sensitivity/specificity, multivariable logistic regression, and random forest models, these equations were applied in a cross-sectional analysis to populations of individuals who currently smoke and individuals who formerly smoked to determine how they affected GOLD classification and the fit of models predicting quantitative chest CT phenotypes or dyspnea. RESULTS: Race-specific equations showed no advantage relative to race-neutral or race-free equations in models of quantitative chest CT phenotypes or dyspnea. Race-neutral reference equations reclassified up to 19% of Black participants into more severe GOLD classes, while race-neutral/race-free equations may improve model fit for dyspnea symptoms relative to race-specific equations. INTERPRETATION: Race-specific equations offered no advantage over race-neutral/race-free equations in three distinct explanatory models of dyspnea and chest CT scan abnormalities. Race-neutral/race-free reference equations may improve pulmonary disease diagnoses and treatment in populations highly vulnerable to lung disease.

Primary and secondary students in the United States are provided environmental education in their curricula due in part to national legislation, but higher education, for many U.S. citizens, is the last opportunity to educate young adults about the environment and humans' role in it in a formalized setting. Pre-college education and other life experiences or ways of learning can shape a student's mental model of the environment. While some previous research has focused on understanding environmental mental models of primary and secondary students, only one study to date has evaluated models of college students. Further, no study has evaluated potential shifts in mental models because of taking a course or what specific factors shape these models prior to college. The objectives of this study were to assess environmental models of college students and determine whether a course on "Environmental Conservation" reinforces or influences students' mental models by the end of the course. We compared environmental metal models at the start and end of our course using the Environments Task tool. Students were asked to provide pictorial and written descriptions of their mental models at both time periods. Additionally, photographs were used to explore student beliefs on environmental representations and questions were used to assess sources of prior environmental knowledge of students at the start of the semester. Results show that pictorial and written mental models differed from one another at the beginning as well as the end of the semester. More students identified humans as a part of the environment in their pictures by the end of the semester compared to the beginning, but no such shifts were noted in the written description. Students identified secondary school courses, life experiences such as growing up on a farm or ranch or hunting and fishing, and their family members as their primary sources of environmental information prior to taking the course. In total, these results indicate that mental models remain underdeveloped after this specific 16-week course and that these models may be more fixed by earlier educational experiences than previously believed. Recommendations for future environmental education are also provided.

Alternaria late blight (ALB), caused mainly by the fungal pathogen Alternaria alternata, is an important pistachio disease that causes severe tree defoliation and fruit shell staining. Its control relies on multiple fungicide sprays, including carboxamide fungicides. In 2015, we surveyed 35 orchards representing nine pistachio producing counties of California to determine the current situation of Alternaria resistance to four widely used carboxamide fungicide active ingredients. This survey showed that isolates collected in the northern (Tehama, Glenn and Colusa counties) and southern (Tulare, Kings and Kern counties) Central Valley presented higher frequencies of carboxamide resistance than isolates collected from orchards in the central region (Fresno, Madera and Merced counties). The number of carboxamide usages in a year is the main factor determining elevated resistance. By extracting the A. alternata DNA and sequencing the carboxamide target genes, we evaluated the prevalence of specific molecular alterations (mutations) associated with carboxamide fungicide resistance. Finally, we identified cross-resistance patterns among different carboxamide fungicides, leading to recommendations about combinations to avoid.

Temperate bacterial viruses (phages) may enter a symbiosis with their host cell, forming a unit called a lysogen. Infection and viral replication are disassociated in lysogens until an induction event such as DNA damage occurs, triggering viral-mediated lysis. The lysogen-lytic viral reproduction switch is central to viral ecology, with diverse ecosystem impacts. It has been argued that lysogeny is favoured in phages at low host densities. This paradigm is based on the fraction of chemically inducible cells (FCIC) lysogeny proxy determined using DNA-damaging mitomycin C inductions. Contrary to the established paradigm, a survey of 39 inductions publications found FCIC to be highly variable and pervasively insensitive to bacterial host density at global, within-environment and within-study levels. Attempts to determine the source(s) of variability highlighted the inherent complications in using the FCIC proxy in mixed communities, including dissociation between rates of lysogeny and FCIC values. Ultimately, FCIC studies do not provide robust measures of lysogeny or consistent evidence of either positive or negative host density dependence to the lytic-lysogenic switch. Other metrics are therefore needed to understand the drivers of the lytic-lysogenic decision in viral communities and to test models of the host density-dependent viral lytic-lysogenic switch.

Background: Skin cancer, the most common cancer in the United States, accounts for over one million cases per year. Risk can be mediated by limiting UV radiation exposure, yet efforts to increase adoption of protective measures have met with limited success. Purpose: This study compares the results of surveys conducted in 1990 and 2007 assessing the knowledge, attitudes and behaviors of college students regarding intentional sun exposure. Methods: The 44-item "Sun and Skin Inventory" was administered to students enrolled in personal health classes during the fall semesters in 1990 and 2007. Results: Mean knowledge scores were no different in 2007 than 1990 and knowledge scores were not related to sunbathing frequency in either survey. Risk perception was negatively related to sunbathing frequency and students reporting greater perceived risk had more positive attitudes toward protective behaviors. Overall, sunbathing behavior was unchanged over 17 years, but students did report more frequent sunscreen use in the latter survey. Discussion: Despite educational efforts regarding risks related to intentional UV exposure, high risk behavior continues among adults. Translation to Health Education Practice: Comprehensive prevention initiatives that include education as well as policy and environmental strategies integrated across state, regional and local levels need to be implemented. (Contains 5 tables.)

In 1979 Aaron Antonovsky introduced the concept of salutogenesis as the study of health development. This approach contrasted with the concept of pathogenesis or the study of disease development. Pathogenesis works retrospectively from disease to determine how individuals can avoid, manage, and/or eliminate that disease. Salutogenesis works prospectively by considering how to create, enhance, and improve physical, mental, and social well-being. Salutogenesis provides a framework for researchers and practitioners to help individuals, organizations, and society move toward optimal well-being. This article reviews the development and benefits of the salutogenic approach to health, how it complements pathogenesis, and suggests how to use the salutogenic model to develop a science for positive health. The article also suggests using salutogenesis as a basis for the new health care system in America. (Contains 1 table.)

The natural beauty of coral reefs attracts millions of tourists worldwide resulting in substantial revenues for the adjoining economies. Although their visual appearance is a pivotal factor attracting humans to coral reefs current monitoring protocols exclusively target biogeochemical parameters, neglecting changes in their aesthetic appearance. Here we introduce a standardized computational approach to assess coral reef environments based on 109 visual features designed to evaluate the aesthetic appearance of art. The main feature groups include color intensity and diversity of the image, relative size, color, and distribution of discernable objects within the image, and texture. Specific coral reef aesthetic values combining all 109 features were calibrated against an established biogeochemical assessment (NCEAS) using machine learning algorithms. These values were generated for ∼2,100 random photographic images collected from 9 coral reef locations exposed to varying levels of anthropogenic influence across 2 ocean systems. Aesthetic values proved accurate predictors of the NCEAS scores (root mean square error < 5 for N ≥ 3) and significantly correlated to microbial abundance at each site. This shows that mathematical approaches designed to assess the aesthetic appearance of photographic images can be used as an inexpensive monitoring tool for coral reef ecosystems. It further suggests that human perception of aesthetics is not purely subjective but influenced by inherent reactions towards measurable visual cues. By quantifying aesthetic features of coral reef systems this method provides a cost efficient monitoring tool that targets one of the most important socioeconomic values of coral reefs directly tied to revenue for its local population.

A continuously mixed series of microbial communities inhabits various points of the respiratory tract, with community composition determined by distance from colonization sources, colonization rates, and extinction rates. Ecology and evolution theory developed in the context of biogeography is relevant to clinical microbiology and could reframe the interpretation of recent studies comparing communities from lung explant samples, sputum samples, and oropharyngeal swabs. We propose an island biogeography model of the microbial communities inhabiting different niches in human airways. Island biogeography as applied to communities separated by time and space is a useful parallel for exploring microbial colonization of healthy and diseased lungs, with the potential to inform our understanding of microbial community dynamics and the relevance of microbes detected in different sample types. In this perspective, we focus on the intermixed microbial communities inhabiting different regions of the airways of patients with cystic fibrosis.

Extramammary Paget's disease (EMPD) is an uncommon cutaneous neoplasm almost exclusively located in the vulvar, perianal, and male genitalia regions. Evaluation and management are complicated given the average delay in diagnosis is two years and approximately 30% of cases are associated with underlying malignancies. The axilla is a unique location for EMPD. We report a rare case of a 78-year-old male with axillary EMPD associated with an underlying adenocarcinoma. A 1-cm tender and pruritic erythematous plaque with surrounding erythema appeared in the patient's axilla. An irritated seborrheic keratosis secondarily impetiginized along with irritant contact dermatitis was suspected. Treatment of cefdinir and topical hydrocortisone failed and a biopsy was taken. Microscopic and immunohistochemical examination showed ulceration with an underlying proliferation of atypical glands (Figure 2A) and a nested intraepidermal proliferation with pagetoid spread (Figure 2B). The atypical cells were positive for gross cystic disease fluid protein 15 (Figure 2C), epithelial membrane antigen (Figure 2D), cytokeratin 5/6, and cytokeratin 7. These findings were supportive of an apocrine adenocarcinoma arising in association with EMPD. Wide location excision was performed. Screening for associated malignancies or lymphatic spread is the primary goal during evaluation. Outcomes are favorable when the primary neoplasm is of limited distribution. The accepted treatment for primary lesions is wide local excision, although anatomic tissue constraints necessitate further research into other treatment modalities. To our knowledge, this is the 14th reported case of axillary EMPD with an underlying adenocarcinoma which may help with identification and management of future cases. [ABSTRACT FROM AUTHOR]

Background: As of 2019, South Dakota had only 32 registered dermatologists, one per 27,569 people. Wait times for dermatologic care are affected by factors such as socioeconomic status, provider distribution, and patient to provider ratios. This inaccessibility to care or prolonged wait times may lead to diagnosis and treatment delays as well as disease progression. We hypothesized wait times to see a dermatologist would be longer in rural areas than urban areas in South Dakota. Methods: Dermatology clinics throughout South Dakota were contacted to obtain wait times. An internet search was conducted to develop a list of dermatology providers. A population of 50,000 or greater defined an urban area and a ratio of four dermatologists per 100,000 people was used as an ideal patient to provider ratio. Results: Overall, 75% of South Dakota's dermatology clinics participated with an equal rural to urban distribution. There was no difference in wait times for new (p=0.787) or established patients (p=0.461) comparing rural and urban clinics. All South Dakota cities with clinics met the goal patient to dermatologist ratio except for Dakota Dunes (included as part of the Sioux City, Iowa, metro population). Conclusions: The data does not support the hypothesis that wait times for dermatologists would be longer in rural locations than urban locations. Despite adequate dermatologist to patient ratios throughout most of South Dakota, wait times of over six weeks were found at both urban and rural locations, indicating the need for future studies to assess potential solutions for improving timely access to dermatologic care. [ABSTRACT FROM AUTHOR]

For the past decade, we have been developing techniques for monitoring pre- and postharvest diseases of tree fruit, nuts and vines at the UC Kearney Research and Extension Center (KREC). We have also advanced new methods to monitor pathogen resistance to fungicides, which growers can now use to make decisions on disease management. Although accurate, the conventional techniques are time-consuming and only provide results after 5 to 21 days. Molecular methods offer the possibility of faster, more reliable and efficient tests. We have developed such methods to monitor, diagnose and quantify crop pathogens. We have also used these new molecular techniques to answer complex questions on the biology of tree fruit and nut pathogens, the origin of their inoculum sources, changes in their population structures and the epidemiology of the diseases they cause. We are now working on molecular techniques that could supplement the conventional ones we have developed for vine diseases. Private diagnostic laboratories have been using a number of these conventional techniques and plan to adopt some of the molecular ones in the near future.

Kimbel Library launched its mobile environment and ran it in full production for several months yet usage patterns were quite low and flat. The library only saw a substantial increase in usage when new, value-added services were integrated into this platform. Upon implementing and integrating discovery services, chat and SMS capabilities, and computer availability maps into our mobile environment the library witnessed and continues to see a steady and significant increase in usage. These services, any issues encountered in their integration, and solutions to resolve these issues are identified, and usage trends and overall increases in mobile platform usage are revealed. Web vs. native app usage trends, devices used, and other metrics and statistical information will be assessed. This article will also explore possible future enhancements to our mobile services, such as geolocation and location-based services for enhancing library instruction, tutorials, library tours, and the possible development of an augmented reality environment for bridging the gap between physical and online resources and services.

The Sleep Quality Index (SQI) and the Centers for Disease Control's National College Health Risk Survey (NCHRS) were administered to 859 undergraduates at a large southeastern university. Results indicated that 76.6% reported occasional sleep problems and 11.8 % experienced poor sleep quality. Among the problems reported, "general morning tiredness" (82%) and "insomnia" (28%) were the most common. Certain health risk behaviors appear to be associated with poor sleep quality including fighting, suicide ideation, smoking, and alcohol use. Implications and limitations of the study are identified. (Contains 1 table.)

In this study, we explore how specific individual, family, and family-within-community characteristics, as well as aspects of in-home family therapy, relate to responses to treatment. The Child and Adolescent Functional Assessment Scale scores and Global Assessment of Functioning scores were used as outcome measures. Results revealed significant differences between pre- and post-scores for clients receiving in-home family therapy services, providing an initial indicator of treatment success. In addition, primary family caregiver social support, role performance in school/work, and self-harmful behavior were indicative of successful outcomes. Clients with higher problem levels had the greatest rates of change, and clients receiving more hours of services fared better in therapy.

In the spring of 2003, three Atlanta area high school art teachers implemented constructivist lessons to see how students would accept responsibility for their own learning and peer-teaching situations. Each teacher selected at least one class in which to implement a variety of constructivist strategies. The teachers then selected a goal in their district art curriculum that required students to develop skills in a specific artistic area. Brooke Richards selected collage; Janet Felts chose video; and Neda Abghari decided on printmaking. Led by these teachers, students generated their own lesson objectives and evaluation criteria. All of the teachers planned both small and large cooperative group activities within each lesson. Although admitting that the planning and preparation for these lessons is not easy, Richards, Felts, and Abghari say they will continue to develop constructivist lessons. It was learned that each learning-community or classroom has its own dynamic, and teachers need to select practices that they believe are most beneficial for each group of students. These teachers facilitated a framework with components similar to those suggested by Dever and Hobbs (2000) in which students actively engage, investigate, share, and assess their own performance. Using this model, students successfully integrated inquiry learning with skill development.

Data from the 1990 North Carolina Youth Risk Behavior Survey were used to examine adolescents' perceptions of relative weight and the relationship of these perceptions to physical activity levels, weight loss efforts, and television viewing time. About 25 percent (860) considered themselves too fat and reported little physical activity. (SM)

Presents a primer for health educators about blood donation and transfusion, examining the nature of human blood, the background of blood transfusion, blood donation criteria, risks related to homologous blood transfusion, directed blood donation, potential alternatives to homologous transfusion, and resources for education on the subject. (SM)