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Lifestyle medicine (LM) is an emerging specialty that is gaining momentum and support from around the world. The American Medical Association passed a resolution to support incorporating LM curricula in medical schools in 2017. Since then, the American College of Lifestyle Medicine Undergraduate Medical Education Task Force has created a framework for incorporating LM into medical school curricula. This article provides competencies for medical school LM curriculum implementation and illustrates how they relate to the Association of American Medical College’s Core Entrustable Professional Activities and the LM Certification Competencies from the American Board of Lifestyle Medicine. Finally, standards are presented for how medical schools may receive certification for integrating LM into their curriculum and how medical students can work toward becoming board certified in LM through an educational pathway.

Chapter 6, “The ASCA National Model as a Supervisory Guide,” summarizes the ASCA National Model and the school counselor’s role in leading a comprehensive school counseling program. Although it is likely that you have already been introduced to the ASCA National Model, the revised model is summarized in this chapter with a description of empirically based studies that support this type of programming. Furthermore, the school counselor standards are discussed and the recommended percentages of time school counselors are to spend on various direct and indirect activities are outlined.

Chapter 8, “Understanding How to Manage Your School Counseling Program Using the ASCA National Model,” contains practical suggestions for organizing and administering school counseling tasks throughout the academic year. Considerations such as the school counselor’s office arrangement and space, assessments, and tools that facilitate these tasks such as management agreements, the advisory council, the use of data, action and lesson plans, and calendars are discussed to aid in your understanding of how the school counseling program can be best organized.

The Geostationary Operational Environmental Satellite (GOES)-16 observatory was launched on 19 November 2016. During daily on-orbit operations, shadowing of the inboard magnetometer sensor unit occurs due to spacecraft geometry and solar angle. Throughout the shadowing periods of the inboard magnetometer, anomalous excursions of 20 nT are observed. In addition to the excursions during shadow events, the measurement difference between the inboard and outboard magnetometer varies over the day, indicating erroneous measurements by one or both magnetometers. Another immediate on-orbit observation was that based on the deployment rotations, the zero offsets of the X and Y axes were found to be significantly different, ∼30 nT, from ground calibration data. Because of these observables, an extensive root cause investigation was undertaken to correct the magnetometer system for the next spacecraft in the GOES-R series. This paper documents the efforts of that activity and the lessons learned as a result of the investigation.

Background: : Pneumocystis jirovecii is an opportunistic pathogen that causes pneumonia, particularly in immunodeficient hosts. Materials and Methods: : We retrospectively compared the results obtained by two staining methods (toluidine blue and calcofluor white) and two quantitative (q) real time PCR assays for the detection of P. jirovecii in bronchoalveolar lavage (BAL) specimens. For the qPCR assays, we used newly selected probes and primers targeting the Kex-1 gene, which codes for a serine endoprotease, and compared the results to those from the published assay targeting the β-tubulin gene. Results: : A total of 1,843 BAL specimens were analyzed microscopically in parallel, and 74 (4.0%) were found to be positive with both stains, 23 (1.2%) were positive only with the toluidine blue stain, and six (0.3%) only with the calcofluor stain (p = 0.003). Of these, a selection of 186 consecutive BAL fluid samples were tested by qPCR using the respective different primer pairs. 21 of the 186 samples (11.3%) were microscopically positive with both stains as well as qPCR positive after 18-31 cycles (corresponding to 5.24 × 106 copies/ml to 640 copies/ml of native BAL) using the Kex-1 primer pair and between 21-33 cycles using the β-tubulin assay. A good correlation between semi-quantitative microscopy and the number of PCR cycles needed for a positive signal was noted. Of the remaining 165 samples, 153 (82%) were both microscopically and PCR negative (PCR with the two sets of primers); the remaining 12 samples (7%) were Kex-1-based PCR positive (from cycles 33 to 41, corresponding to 160 copies/ml of BAL or less) but microscopically negative. Of these latter samples, ten (6%) were also positive (from cycles 34 to 38) with the primers targeting the β-tubulin gene. Taking microscopy as a reference, the sensitivity of qPCR targeting the Kex-1 gene was 100%, and the specificity was 92.4%. Conclusion: : The sensitive qPCR analysis proved to be a rapid and reliable method to detect P. jirovecii in BAL

Collaborative, proactive anti-bullying interventions and policies that strive to create and sustain a safe environment for all adolescents.IntroductionSchool bullying reaches across all ages and grades, and is associated with serious mental health issues such as suicide, homicide, and other acts of violence. According to the U.S. Department of Education and Justice (2011), 37% of middle school students reported being victims of bullying. Bullying is a subtype of aggression, but is different from other types of altercations in that it is characterized as an unequal relationship between the bully and the victim (Olweus, 1993); consists of a series of repetitive behaviors as opposed to a specific, isolated incident (MacNeil 8c Newel, 2004); and is intentional. For instance, the bully's intention is to hurt another by repetitively engaging in harmful behaviors based on a perceived imbalance of power (Kowalski, Limber, & Agatston, 2008).There are several different types of bullying that are classified as physical, verbal, relational, and cyber bullying. Physical bullying may involve hitting, punching, threatening acts, and kicking. Verbal bullying includes such actions as name-calling or teasing. Relational bullying (also known as social aggression) involves spreading rumors or excluding someone from others or events (Espelage 8c Swearer, 2003), ignoring others, spreading nasty rumors, leaving hurtful messages on desks, making prank phone calls, and/or giving "death stares." Finally, cyber bullying is using technology to harass, exclude, or degrade another through such means as instant messaging, e-mail, chat rooms, and videos using cell phones, social networking sites, etc. (Espelage, 2004).Although similarities exist between each of these types of bullying, there are subtle distinctions, such as gender differences. Males tend to engage in more physical types of aggression, whereas females use more relational types of aggression (Carbone-Lopez, Esbensen, 8c Brick, 2010). Males who bully are often taller and/or stronger than their victims (McMaster, Connolly, Pepler, 8c Craig, 2002), and tend to choose victims that are physically weaker and shorter or based on friend choice or another's clothing. Females tend to choose victims based on looks, affect, weight, or good grades (Harris, 2004). Furthermore, females are more likely than males to be victims of sexual bullying such as sexual innuendos and unwanted sexual attention. This type of aggression usually begins during the middle-school years, and bridges the gap between bullying and dating violence with the potential to worsen into other forms of abuse (Fredland, 2008) throughout adulthood.Bullying behaviors are most often experienced between sixth and eighth grades, with a decline in upper grade levels (U.S. Department of Education and Justice, 2011). Yet, it is speculated that this decline is not necessarily due to a decrease in bullying, but rather due to a reduction in reporting of incidents, and/or a transformation into more adult forms of aggression such as sexual harassment (Fredland, 2008). Peers usually view these more adult forms of bullying as more socially acceptable.Aggressive behaviors can be seen along a continuum with the bully at one end of the scale, the victim at the other end, with bully-victims and spectators somewhere in between (Espelage, 2004). Despite the role one plays in a bullying incident-whether it is the victim, bully, bullyvictim, or bystander-all are impacted by this aggressive act.Both school counselors and teachers share the goal of nurturing student development, yet each professional strives to reach this goal through different paradigms. Studies reveal a positive association amongst classroom guidance, academic achievement, and personal/social growth, yet collaboration is rare (Stringer, Reynolds, 8c Simpson, 2003) despite school counselors' unique education to integrate school counseling goals with those of the school curriculum. …

A fundamental goal of cognitive radar is to sense, learn and adapt (SLA) to a complex environment. A further goal of cognitive fully adaptive radar (CoFAR) is to jointly optimize the adaptive transmit and receive functions. This type of emerging radar technology is anticipated to play a key part in the future of autonomous sensors and systems. CoFAR systems present a number of unique testing challenges relative to traditional systems. In particular the highly adaptive nature of these systems will generally require more rigorous testing to ensure good performance over a wide range of operating environments. For example, a CoFAR system will need to be presented with a wide range of operating scenarios and conditions to ensure a desired level of performance will be met during actual operations of the radar. This will typically preclude traditional approaches for testing using limited numbers of flight tests in test ranges that represent only a small number of scenarios and conditions expected to be encountered in real operations. Testing over a wider range of conditions will typically be cost prohibitive. This paper presents a new method for testing CoFAR systems in a “virtual test range” using high-fidelity simulated data. We provide a hardware in-the-loop demonstration of the approach using an actual maritime radar system.

Adolescents in a southeastern, rural school were given the Five Factor Wellness Inventory and a survey to examine the relationship between bullying and wellness. A significant correlation between an aggregate score of bullying and total wellness (r = −.43, p Language: en

INTRODUCTION The purpose of this study was to gain a better understanding of the perspectives of low-income, minority primary caregivers to inform the design of pediatric interventions to prevent mental health problems. METHOD The authors conducted a follow-up study of female primary caretakers of children ages 4-5 years old in an urban northeastern pediatric practice, including 5 mothers of children with low Child Adverse Childhood Experiences (C-ACE) scores and 13 mothers of children with high C-ACE scores. RESULTS Participation in early speech therapy, preschool programs, or mental health treatment was less likely for children with high C-ACE scores. Mothers of children with behavior problems expressed the most interest in developmental behavioral evaluations, parenting interventions, and mental health treatment. Information about nutrition and exercise options was of interest to mothers from low and high C-ACE groups. DISCUSSION Results suggest that screening for C-ACE along with developmental and behavioral screening may help pediatric health care providers to identify children who are both at greatest risk for mental health problems and in need of help in accessing services. Incorporation of nutrition and exercise components into mental health interventions may increase enrollment and retention, as may targeting mental health interventions and referrals to parents with child behavior concerns. (PsycINFO Database Record

Anxiolytic and possible side effects of clonidine 150 μg compared to midazolam 7.5 mg for premedication in surgical wisdom tooth extraction were evaluated. In a prospective, randomized, double-blind crossover trial, ten patients undergoing bilateral wisdom tooth surgery received clonidine or midazolam orally 1 h before the treatment. Patients receiving midazolam for the first surgery received clonidine at the second surgery and vice versa. The anxiolytic efficacy was evaluated with a visual analogue scale (VAS) upon admission and 30, 50 and 60 min after administration of the medication. Patient satisfaction was recorded on a VAS after surgery and 7 days postoperatively. As soon as 30 min after administration of midazolam (p

School counselors at all grade levels are faced with student suicidal ideation on a regular basis. As the primary mental health providers at their sites, school counselors are the ideal professiona...

Matuliene G, Studer R, Lang NP, Schmidlin K, Pjetursson BE, Salvi GE, Bragger U, Zwahlen M. Significance of Periodontal Risk Assessment on the recurrence of periodontitis and tooth loss. J Clin Periodontol 2010; 37: 191–199. doi: 10.1111/j.1600-051X.2009.01508.x. Abstract Aim: To investigate the association of the Periodontal Risk Assessment (PRA) model categories with periodontitis recurrence and tooth loss during supportive periodontal therapy (SPT) and to explore the role of patient compliance. Material and Methods: In a retrospective cohort, PRA was performed for 160 patients after active periodontal therapy (APT) and after 9.5 ± 4.5 years of SPT. The recurrence of periodontitis and tooth loss were analysed according to the patient's risk profile (low, moderate or high) after APT and compliance with SPT. The association of risk factors with tooth loss and recurrence of periodontitis was investigated using logistic regression analysis. Results: In 18.2% of patients with a low-risk profile, in 42.2% of patients with a moderate-risk profile and in 49.2% of patients with a high-risk profile after APT, periodontitis recurred. During SPT, 1.61 ± 2.8 teeth/patient were lost. High-risk profile patients lost significantly more teeth (2.59 ± 3.9) than patients with moderate- (1.02 ± 1.8) or low-risk profiles (1.18 ± 1.9) (Kruskal–Wallis test, p=0.0229). Patients with erratic compliance lost significantly (Kruskal–Wallis test, p=0.0067) more teeth (3.11 ± 4.5) than patients compliant with SPT (1.07 ± 1.6). Conclusions: In multivariate logistic regression analysis, a high-risk patient profile according to the PRA model at the end of APT was associated with recurrence of periodontitis. Another significant factor for recurrence of periodontitis was an SPT duration of more than 10 years.

The leaders of the American School Counselor Association (ASCA), the professional organization that creates policy and advocates for school counselors, state: "[professional school counselors design and deliver comprehensive school counseling programs that promote student achievement. These programs are comprehensive in scope, preventative in design and developmental in nature (. ..). The ASCA National Model[R] brings professional school counselors together with one vision and one voice, which creates unity and focus toward improving student achievement" (ASCA, 2005 [paragraph] 1). The advantages of developmental, comprehensive school counseling programs (CDSC) have been espoused for decades (Gysbers, 2004), yet these programs were slow to emerge. In 1997, the ASCA Standards were developed to identify and monitor student competencies with a focus on student growth in the academic, career, and personal/social domains (ASCA, 2003). In 2001, the governing council of the American School Counseling Association took these Standards to the next level through the development of a template for professional school counselors to use in designing their own CDSC program. The result is the ASCA National Model[R] (ASCA). Despite the ASCA's active campaign to promote awareness of the benefits of a CDSC program, many professional school counselors have not yet instituted a comprehensive, developmental school counseling program in their schools. In one study (Oberman & Studer, 2008), 51% of the surveyed school counselors reported that they had not instituted a CDSC program in their schools, 26% of the participants reported having a comprehensive, developmental counseling program in place, and 23% reported that they were in the process of implementing this type of program. School counselor training is disjointed when trainees are supervised by professional school counselors who work in a program that reflects a traditional, reactive school counseling program, but receive training in a CDSC perspective from their school counselor education program. As one high school counselor stated to a class of school counseling students who were learning about the benefits of a CDSC program, "you can forget everything you are learning in your classes since you will never use any of it when you enter the schools." It was clear from this statement that there was a disconnect between the philosophy of this practicing school counselor and those of the training program goals. School Counselor Performance Standards and CDSC Programs When the ASCA National Standards were first developed, there was some uncertainty as to whether the Standards were written for school counselor practitioners or for K-12 students. This confusion was clarified in the ASCA National Model: A Framework for School Counseling Programs in which it was stated that these competencies were designed "for students, not programs" (ASCA, 2003, p. 10). However, because school counselors serve as leaders of their program and are responsible for monitoring and assessing the effectiveness of their services, school counselor performance standards are also addressed in this document. Consequently, these standards were formatted into an evaluation document entitled School Counseling Standards: School Counselor Competencies that "... is organized and consistent with the ASCA National Model[R].... [and] will equip the school counselor with the skills to establish, maintain and enhance the developmental school counseling program in all three domains (academic, personal/social, and career" (ASCA, n.d. [paragraph] 6). Although graduates from school counseling programs are expected to fulfill the same roles and effectively perform the same competencies as their more experienced colleagues, the reality is that many competencies are not mastered until years of experience are attained. The Trainee in a CDSC Program Several researchers investigated school counseling programs that relate to the ASCA National Model[R]. …

Die Speicheldrüsen können mittels Sonographie – eine rasch verfügbare und kostengünstige Untersuchung – bestens abgeklärt werden. Nur in seltenen Fällen braucht es ein anderes bildgebendes Verfahren. Anamnese und Befunde deuten auf bestimmte Krankheiten hin, die Sonographie grenzt die Differentialdiagnose weiter ein oder bestätigt eine Diagnose. Raumforderungen müssen mittels Feinnadelpunktion weiter abgeklärt werden. Diese ersetzt jedoch nicht die histologische Klärung.

In Deep Water development wells, the challenge of successfully positioning the drain through the pay zone is key to meet the economics of a project. The industry today provides a wide range of advanced geosteering solutions that are essential to face such challenges. It is indeed possible to drill tortuous 3D horizontal drains to enhance well placement through the sweetest parts of a reservoir sequences along several thousand meters, the directional bottom hole assembly (BHA) being able to trip in and out of hole without too much issues. The question remains whether the Sand Control (SC) completion string will make it to target depth (TD) at all times? This paper shows that the success of running completion to the intended depth depends critically on the well trajectory surveys spacing (standard versus continuous) taken into account in the torque and drag analysis. This paper illustrates a recent case of failing to reach TD while running in hole (RIH) a SC completion string in a complex 3D well drilled as part of a major deep water development project in West Africa. The reservoir drain was lost with the completion string stuck 170m above TD and a costly sidetrack had to be drilled to recover the well. A thorough post-mortem analysis of the case was performed, deploying a unique 3rd party approach based on an advanced drilling engineering methodology, to determine the root causes of the incident: First, the surveyed well trajectory was reconstructed to precisely define the borehole oscillation along the 12 ¼ in. and 8 ½ in. drilled sections, using an advanced rock and bit-BHA coupling model, Second, simultaneous torque, drag and buckling analysis using stiff-string model were conducted in the reconstructed tortuous well trajectory and compared with standard surveys. This innovative methodology allowed a precise reproduction of lock-up during the incident while using standard friction factors values (0.22 cased hole & 0.35 open hole) with the stiff-string model, instead of unrealistic 0.6 friction factors using the conventional soft-string solution. The analysis showed the mechanical lock-up of the screens through the tortuous open hole as well as lock-up of drill pipe just above the top of the 9 5/8 in. liner. Combining both advanced solutions processes is proving very robust in preventing reoccurrence of such an incident. The method can be deployed while drilling, and permits the design of “ad hoc” SC completion strings and centralization to overcome the mechanical hole conditions and ultimately managing successful deployment at an intended depth.

This study investigated the types of supervisory activities provided to school counselor trainees. The researchers examined the responses of 73 practicing school counselors from the Southern region who were members of the American School Counselor Association. The supervisory activities provided to trainees working in a traditional school counseling program were compared with trainees performing in a developmental program as recommended in the ASCA National Model®. The researchers also examined the years of experience as a school counselor, the amount of training received in supervision, differences in supervision at various grade levels, and the principal's understanding of the school counselor's role when working in a traditional or a transformed school counseling model. Implications for school counselors are included.

This descriptive study identifies oral health practices, attitudes, knowledge, and beliefs about dental care among Fijians living in Vanua Levu. Using convenience sampling, people attending a free community dental clinic volunteered to complete a structured questionnaire. Oral health practices, knowledge, beliefs, and attitudes about dental care, identified included: more females (95%) than males (88%) practiced brushing their teeth after every meal; the majority (83%) had problems with their teeth and 56% were missing one to five teeth; and knowledge about dental health was higher in females than males. This study supports the need for ongoing education in dental care and will be used for planning future interventions in health education and prevention of caries and other preventable dental problems in this population.

Synthetic 6,7-annulated-4-substituted indole compounds, which elicit interesting antitumor effects in murine L1210 leukemia cells, were tested for their ability to inhibit human HL-60 tumor cell proliferation, disrupt mitosis and cytokinesis, and interfere with tubulin and actin polymerization in vitro.Various markers of metabolic activity, mitotic disruption and cytokinesis were used to assess the effectiveness of the drugs in the HL-60 tumor cell system. The ability of annulated indoles to alter the polymerizations of purified tubulin and actin were monitored in cell-free assays and were compared to the effects of drugs known to disrupt the dynamic structures of the mitotic spindle and cleavage furrow.With one exception, annulated indoles inhibited the metabolic activity of HL-60 tumor cells in the low-micromolar range after two and four days in culture but these anti-proliferative effects were weaker than those of jasplakinolide, a known actin binder that blocks cytokinesis. After 24-48 h, antiproliferative concentrations of annulated indoles increased the mitotic index of HL-60 cells similarly to vincristine and stimulated the formation of many bi-nucleated cells, multi-nucleated cells and micronuclei, similarly to taxol and jasplakinolide, suggesting that these antitumor compounds might increase mitotic abnormality, induce chromosomal damage or missegregation, and block cytokinesis. Since annulated indoles mimicked the effect of vincristine on tubulin polymerization, but not that of taxol, these compounds might represent a new class of microtubule de-stabilizing agents that inhibit tubulin polymerization. Moreover, annulated indoles remarkably increased the rate and level of actin polymerization similarly to jasplakinolide, suggesting that they might also stabilize the cleavage furrow to block cytokinesis.Although novel derivatives with different substitutions must be synthesized to elucidate structure-activity relationships, identify more potent antitumor compounds and investigate different molecular targets, annulated indoles appear to interact with both tubulin to reduce microtubule assembly and actin to block cytokinesis, thereby inducing bi- and multinucleation, resulting in genomic instability and apoptosis.

Too often, school counselors are evaluated through a teacher assess ment process, which has little meaning or relevance to the professional school counselor's tasks or role. The unclear definition and confusion surrounding the role may be a result of the historical changes sur rounding this position, the discrepancies in school counselor tasks among counselors themselves, and the lack of a clear definition on the role of the school counselor.

Continuous passive motion manifests therapeutic effects on inflamed articular joints by an as-yet-unknown mechanism. Here, we show that application of cyclic tensile stress (CTS) in vitro abrogates the catabolic effects of IL-1β on chondrocytes. The effects of CTS are mediated by down-regulation of IL-1β-dependent inducible NO production, and are directly attributed to the inhibition of inducible NO synthase (iNOS) mRNA expression and protein synthesis. The inhibition of iNOS induction by CTS is paralleled by abrogation of IL-1β-induced down-regulation of proteoglycan synthesis. Furthermore, CTS inhibits iNOS expression and up-regulates proteoglycan synthesis at concentrations of IL-1β frequently observed in inflamed arthritic joints, suggesting that the actions of CTS may be clinically relevant in suppressing the sustained effects of pathological levels of IL-1β in vivo. These results are the first to demonstrate that mechanisms of the intracellular actions of CTS in IL-1β-activated chondrocytes are mediated through inhibition of a key molecule in the signal transduction pathway that leads to iNOS expression.