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Curriculum planning for the development of graphicacy capability has not been systematically included in general education to coincide with the graphicacy needs of human society. In higher education, graphicacy curricula have been developed to meet the needs of certain disciplines, for example medical and teacher training and engineering, among others. A framework for graphicacy curricula, anticipating the graphicacy needs in higher education, has yet to be strategically planned for general education. This is partly a result of lack of research effort in this area, but also a result of lack of systematic curriculum planning in general. This paper discusses these issues in the context of graphicacy curricula for engineering. The paper presents three broad individual case studies spanning Europe and the USA, brought together by the common denominator, graphicacy. The case studies are based on: an analysis of graphicacy within general education curricula, an analysis of graphicacy for engineering education in Europe and an analysis of graphicacy for engineering education in the USA. These three papers were originally presented in a plenary session at the American Society for Engineering Education, Engineering Design Graphics Division at the University of Limerick in November 2012. The case studies demonstrate the potential for strategic curriculum planning in regard to the development of graphicacy in general education and an overview of a methodology to achieve that. It also offers further evidence towards the importance of the systematic classification of graphics capabilities in Engineering and how the lack of a developed theoretical framework in this area undermines the case for the importance of graphics within engineering education.

Background: Recent observations suggest that prostate cancer is an increasing disease among older adolescents and young adults.Methods: Incidence, mortality, and survival data were obtained from the US National Cancer Institute Surveillance, Epidemiology, and End Results program and the Institute for Health Metrics and Evaluation Global Burden of Disease database.Results: Worldwide, the incidence of prostate cancer has increased in all groups between ages 15 and 40 years and increased globally at a steady rate averaging 2% per year since 1990 (P < .01). In the United States, this age group was >6 times more likely than older men to have distant disease at diagnosis. Stage for stage, their survival rate improved less than in older men. Whereas the overall 5-year relative survival rate in the United States for men diagnosed between ages 40 and 80 years was between 95% and 100%, it was 30% in those aged 15 to 24 years, 50% in those aged 20 to 29 years, and 80% in those aged 25 to 34 years.Conclusions: Prostate cancer in older adolescent and young adult men has increased in most countries. There is some evidence that this may be caused in part by underdiagnosis, prostate-specific antigen screening, and overdiagnosis. It also may be caused by trends in obesity, physical inactivity, HPV infection, substance exposure, environmental carcinogens, and/or referral patterns. How the biology of these cancers differs from that in older men and how the etiologies vary from country to country remain to be determined. [ABSTRACT FROM AUTHOR]

This paper aims to estimate lifetime costs resulting from abusive head trauma (AHT) in the USA and the break-even effectiveness for prevention. A mathematical model incorporated data from Vital Statistics, the Healthcare Cost and Utilization Project Kids' Inpatient Database, and previous studies. Unit costs were derived from published sources. From society's perspective, discounted lifetime cost of an AHT averages $5.7 million (95% CI $3.2-9.2 million) for a death. It averages $2.6 million (95% CI $1.0-2.9 million) for a surviving AHT victim including $224,500 for medical care and related direct costs (2010 USD). The estimated 4824 incident AHT cases in 2010 had an estimated lifetime cost of $13.5 billion (95% CI $5.5-16.2 billion) including $257 million for medical care, $552 million for special education, $322 million for child protective services/criminal justice, $2.0 billion for lost work, and $10.3 billion for lost quality of life. Government sources paid an estimated $1.3 billion. Out-of-pocket benefits of existing prevention programming would exceed its costs if it prevents 2% of cases. When a child survives AHT, providers and caregivers can anticipate a lifetime of potentially costly and life-threatening care needs. Better effectiveness estimates are needed for both broad prevention messaging and intensive prevention targeting high-risk caregivers. [ABSTRACT FROM AUTHOR]

Background: Incidence rates and trends of cancers in adolescents and young adults (AYAs) ages 15 to 39 years were reexamined a decade after the US National Cancer Institute AYA Oncology Progress Review Group was established.Methods: Data from the Surveillance, Epidemiology, and End Results program through 2011 were used to ascertain incidence trends since the year 2000 of the 40 most frequent cancers in AYAs, including tumors with nonmalignant/noninvasive behavior.Results: Seven cancers in AYAs exhibited an overall increase in incidence; in 4, the annual percent change (APC) exceeded 3 (kidney, thyroid, uterus [corpus], and prostate cancer); whereas, in 3, the APC was between 0.7 and 1.4 (acute lymphoblastic leukemia and cancers of the colorectum and testis). Eight cancers exhibited statistically significant decreases in incidence among AYAs: Kaposi sarcoma (KS), fibromatous neoplasms, melanoma, and cancers of the anorectum, bladder, uterine cervix, esophagus, and lung, each with an APC less than -1. AYAs had a higher proportion of noninvasive tumors than either older or younger patients.Conclusions: An examination of cancer incidence patterns in AYAs observed over the recent decade reveal a complex pattern. Thyroid cancer by itself accounts for most of the overall increase and is likely caused by overdiagnosis. Reductions in cervix and lung cancer, melanoma, and KS can be attributed to successful national prevention programs. A higher proportion of noninvasive tumors in AYAs than in children and older adults indicates a need to revise the current system of classifying tumors in this population. [ABSTRACT FROM AUTHOR]

Background: With prior reports indicating a lack of progress in survival improvement in older adolescents and young adults (AYAs) aged 15 to 39 years with cancer compared with both younger and older patients with cancer, the current analysis provides an update of survival trends of cancers among AYAs, children, and older adults.Methods: Data from the National Cancer Institute Surveillance, Epidemiology, and End Results database for 13 regions were used to ascertain survival trends of the 34 most frequent cancers diagnosed in AYAs compared with children and older adults.Results: As of 2002 through 2006, the 5-year relative survival rate for all invasive cancers in AYAs was 82.5% (standard error, 0.2%). In AYAs, 14 cancers demonstrated evidence of a statistically significant improvement in their 5-year relative survival since 1992. Survival improved less in AYAs than in children for acute myeloid leukemia and medulloblastoma. Fourteen cancers had survival improvements that were found to be less in AYAs compared with older adults, including hepatic carcinoma, acute myeloid leukemia, high-grade astrocytoma, acute lymphocytic leukemia, pancreatic carcinoma, low-grade astrocytoma, gastric carcinoma, renal carcinoma, cancer of the oral cavity and pharynx, Hodgkin lymphoma, ovarian cancer, fibromatous sarcoma, other soft tissue sarcoma, and thyroid carcinoma.Conclusions: Improvements in the survival of several cancer types that occur frequently in AYAs are encouraging. However, survival does not appear to be improving to the same extent in AYAs as in children or older adults for several cancers. Further investment in exploring the distinct biology of tumors in this age group, and of their hosts, must be a priority in AYA oncology. [ABSTRACT FROM AUTHOR]

Abstract. In industrialized societies, the unique pattern of crying in the first three months is "unexplained" but thought to be due to different biobehavioral factors from later crying behavior. To increase the range of the feeding and caretaking behaviors hypothesized to be relevant determinants of early crying? home observations and diary records were analyzed from samples of two subcultures of American middle-class women (La Leche League and "standard care" mothers; each n = 16) differing primarily in such practices. Both during and after the early crying stage, frequently fed infants cried or fretted less often (8.1 v 15.8 episodes per hour at 2 months of age; 10.7 v 16.6 episodes per hour at 4 months of age), and fewer of them exhibited rhythmic crying behavior (four v 11 at 2 months; eight v 13 at 4 months) during observations. However, only during the early crying period at 2 months were interval between feedings and maternal response latency shown to be independent determinants of cry/fret frequency (overall r[sup 2] = .35, P = .01), each factor accounting for approximately half of the explained individual variance. Furthermore, feeding interval was the only variable associated with rhythmic crying behavior at 2 months of age (r[sup 2] = .20; P = .01). In similar analyses at 4 months, there were no significant relationships with later crying or fretting. The results suggest that, in the presence of variation in feeding practice greater than that which is typical for our society, feeding interval may be a significant factor in early (but not later) crying behavior; furthermore, this effect is independent of and additive to the soothing effect of short response latency. Pediatrics 1988;81:529-536; cry, infant, feeding. [ABSTRACT FROM AUTHOR]

The article illustrates the fear of leprosy in the U.S. Although uncommon, leprosy is indeed seen in the United States. As of August 1990, there were 5,849 active cases of leprosy in the records of the National Hansen Disease Center in Carville, Louisiana. The vast majority of cases of leprosy in the United States occur in immigrant populations, especially Southeast Asians and Central and South Americans. As the political and economic situations in these areas continue to be unstable, there will be a steady stream of new immigrants from these endemic areas who will disperse throughout the United States.

Purpose: The objective of this systematic review was to describe nutrition-related publications on children and adolescents diagnosed with cancer in Brazil., Methods: The methodology followed that of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medline, LILACS (the Latin American & Caribbean Health Sciences Literature), and Embase were searched in April 2019, and data extraction and rating of methodologic study quality (according to the National Institutes of Health quality score assessment) were performed independently by reviewers., Results: Twenty-seven studies met the inclusion criteria, reporting on 3,509 patients from 1994 to 2018. Most of the studies (74%) were of poor quality in methodology and reporting. Different cancer diagnoses were included in 52% of studies, whereas acute leukemia was the exclusive focus in 41%. The majority of the articles (70%) were from institutions in the Southeast Region of Brazil, mainly the state of São Paulo (74%); no publications were from the North Region of the country. Twelve studies addressed nutritional status and body composition, reporting an abundance of malnourished patients in the Brazilian population of children and adolescents with cancer. Six studies on micronutrients pointed to possible deficiencies in this population, with a yet unclear but promising role for supplementation during treatment., Conclusion: Evidence indicates that there is great interest in the impact of nutrition on childhood cancer treatment and clinical outcomes in Brazil. However, there is a need to focus on high-quality research, particularly with multicentric/national studies. This will help establish research priorities and better planned clinical interventions, adapted to each region of the country.

Adolescents and young adults (AYAs) with cancer constitute a particular group of patients with unique features, whose needs during and after treatment are poorly met. A standardized model of care for them has yet to be established, as neither the pediatric nor the adult oncology systems seamlessly fit their needs. Regardless of the setting in which they are treated, their health care providers should be aware of the impact that the disease and its treatments have on these especially vulnerable patients. Simple ways of improving the AYA experience should be considered: reducing isolation through connections with peers, adapting the staff's approach to the emotional and developmental needs of this age group, and modifying the hospital environment making it more age appropriate. Commitment of national governments is valuable; building and sharing international experience will accelerate advances in clinical care, education, and research. Further progress in the care of AYA cancer patients is still needed to improve their outcomes.

The incidence of acute myelogenous leukemia (AML) increases progressively with age. Favorable genetic mutations are most prevalent in children, and unfavorable profiles increase proportionately in adolescents and young adults (AYA) and into later adulthood. Survival rates of AYA have improved over recent decades to 50-60%, but their accrual to clinical trials remains poor. In contrast to AYA with acute lymphoblastic leukemia, the prognostic benefit for AYA with AML enrolled in pediatric compared with adult trials is minor and only seen when different protocols are used. The distinctive needs of AYA, including intensive psychological services, call for their treatment within specialized centers that offer complex supportive care., (© 2018 Wiley Periodicals, Inc.)

Objective: We estimated the disability-adjusted life-year (DALY) burden of abusive head trauma (AHT) at ages 0 to 4 years in the United States., Methods: DALYs are computed by summing years of productive life that survivors lost to disability plus life-years lost to premature death. Surveying a convenience sample of 170 caregivers and pediatricians yielded health-related disability over time according to severity of AHT (measured with the Health Utilities Index, Mark 2). Incidence estimates for 2009 came from Vital Statistics for Mortality, Healthcare Cost and Utilization Program Kids' Inpatient Database for hospitalized survivors, and published ratios of 0.894 case treated and released and 0.340 case not diagnosed/treated while in the acute phase per survivor admitted. Survival probability over time after discharge came from published sources., Results: An estimated 4824 AHT cases in 2009 included 334 fatalities within 30 days. DALYs per surviving child averaged 0.555 annually for severe AHT (95% confidence interval: 0.512-0.598) and 0.155 (95% confidence interval: 0.120-0.190) for other cases. Including life-years lost to premature mortality, estimated lifetime burden averaged 4.7 DALYs for mild AHT, 5.4 for moderate AHT, 24.1 for severe AHT, and 29.8 for deaths. On average, DALY loss per 30-day survivor included 7.6 years of lost life expectancy and 5.7 years lived with disability. Estimated burden of AHT incidents in 2009 was 69 925 DALYs or 0.017 DALYs per US live birth., Conclusions: AHT is extremely serious, often resulting in severe physical damage or death. The annual DALY burden several years after mild AHT exceeds the DALY burden of a severe burn., (Copyright © 2014 by the American Academy of Pediatrics.)

Objectives: Health consequences of shaken baby syndrome, or pediatric abusive head trauma (AHT), can be severe and long-lasting. We aimed to estimate the multiyear medical cost attributable to AHT., Methods: Using Truven Health MarketScan data, 2003-2011, we identified children 0 to 4 years old with commercial or Medicaid insurance and AHT diagnoses. We used exact case-control matching based on demographic and insurance characteristics such as age and health plan type to compare medical care between patients with and without AHT diagnoses. Using regression models, we assessed service use (ie, average annual number of inpatient visits per patient) and inpatient, outpatient (including emergency department), drug, and total medical costs attributable to an AHT diagnosis during the 4-year period after AHT diagnosis., Results: We assessed 1209 patients with AHT and 5895 matched controls. Approximately 48% of patients with AHT received inpatient care within 2 days of initial diagnosis, and 25% were treated in emergency departments. AHT diagnosis was associated with significantly greater medical service use and higher inpatient, outpatient, drug, and total costs for multiple years after the diagnosis. The estimated total medical cost attributable to AHT in the 4 years after diagnosis was $47,952 (95% confidence interval [CI], $40,219-$55,685) per patient with AHT (2012 US dollars) and differed for commercially insured ($38,231 [95% CI, $29,898-$46,564]) and Medicaid ($56,691 [95% CI, $4290-$69,092]) patients., Conclusions: Children continue to have substantial excess medical costs for years after AHT. These estimates exclude related nonmedical costs such as special education and disability that also are attributable to AHT., (Copyright © 2014 by the American Academy of Pediatrics.)

Objective: To examine national, regional, and state abusive head trauma (AHT) trends using child hospital discharge data by applying a new coding algorithm developed by the Centers for Disease Control and Prevention (CDC)., Methods: Data from 4 waves of the Kids' Inpatient Database and annual discharge data from North Carolina were used to determine trends in AHT incidence among children <1 year of age between 2000 and 2009. National, regional, and state incidence rates were calculated. Poisson regression analyses were used to examine national, regional, and state AHT trends., Results: The CDC narrow and broad algorithms identified 5437 and 6317 cases, respectively, in the 4 years of KID weighted data. This yielded average annual incidences of 33.4 and 38.8 cases per 100,000 children <1 year of age. There was no statistically significant change in national rates. There were variations by region of the country, with significantly different trends in the Midwest and West. State data for North Carolina showed wide annual variation in rates, with no significant trend., Conclusions: The new coding algorithm resulted in the highest AHT rates reported to date. At the same time, we found large but statistically insignificant annual variations in AHT rates in 1 large state. This suggests that caution should be used in interpreting AHT trends and attributing changes in rates as being caused by changes in policies, programs, or the economy.

Hematopoietic stem cell transplantation is a highly expensive clinical intervention with considerable therapeutic benefit but serious adverse effects on health status in some circumstances. Consequently, it is an important target for economic evaluation in which the monetary costs and clinical consequences of optional treatment strategies are compared. The need for such formal assessment is further demanded by the expanded use of hematopoietic stem cell transplantation globally, including its utilization in developing countries. With respect to costs, those incurred by patients and families are often substantial, while those incurred by hospitals may be inadequately reimbursed. Determination of consequences should not be limited to measurements of clinical effectiveness but rather include adjustments for quality of life. Rigorous economic evaluation can provide hard evidence in deliberations of value for money, especially in the context of limited resources for health care.

The clinical care of young adults with cancer, and related research, was a novel focus of oncology a decade ago, but 10 years of data on patients' needs and outcome disparities, well-reviewed in the articles of this special issue and its predecessor (June 2009), prove the merit of this subspecialty. The field, emerging from its childhood and entering adolescence, must continue to look to the future to solidify its worth. In this concluding article we examine important themes that must receive attention for the discipline to develop and flourish. We must overcome the challenges inherent in serving a population that is difficult to define, and which crosses traditional boundaries and disciplines. The field must strengthen its research in clinical trials and comparative outcomes, and must articulate the key competencies that distinguish a practitioner of young adult oncology (both to define clinical programs and educational curricula). Key opportunities are collaborations with leaders in oncofertility, developmental psychology, and transitional care, and with patient advocates. We must garner support from federal entities, as well as philanthropic agencies and accrediting bodies. With strategic effort, the field of young adult oncology will mature and grow wise.

Among 20- to 39-year-olds, cancer causes more deaths than any other disease except depression that culminates in suicide. More females in the age group die of cancer than of the next three causes combined. Yet, substantially less attention has been given to young adults than to children and older adults, and the relative improvement in the survival rate in young adults has not kept pace with that achieved in younger or older patients. Additionally, there is evidence that a substantial proportion of the cancers in young adults have a different biology, and probably etiology/pathogenesis, than that of what appears to be the same cancer in younger or older persons. The challenges of early detection, diagnosis, treatment, and follow-up are therefore likely to be distinctly different than in persons of a different age. As an introduction to this Seminars in Oncology issue on young adults with malignant disease, this overview summarizes cancer epidemiology, risk factors, survival, racial/ethnic and gender differences, diagnostic and treatment approaches, psychosocial challenges, and current organizational research and supportive care strategies in young adults.

Objective: : This study aims to determine whether the age-specific incidences (1) of publicly reported cases of shaken baby syndrome (SBS) and (2) of publicly reported cases of SBS with crying as the stimulus have similar properties to the previously reported normal crying curve., Methods: : The study reports cases of SBS by age of the child at the time of the inflicted trauma from the data set of the National Center on Shaken Baby Syndrome using cases entered between January 1, 2003 and August 31, 2004., Results: : There were 591 cases of infants up to 1.5 years of age who had been reported to have been shaken or shaken and physically abused. Of these, crying was reported as the stimulus in 166 cases. In both samples, the curves of age-specific incidence started at 2-3 weeks, reached a clear peak at about 9-12 weeks of age, and declined to lower more stable levels by about 29-32 weeks of age, similar to the normal crying curve. These curves have similar onsets and shapes and a slightly later peak compared to the normal crying curve., Conclusions: : The findings provide convergent indirect evidence that crying, especially in the first 4 months of age, is an important stimulus for SBS.

Incidence: Cancer occurring between the ages of 15 and 30 years is 2.7 times more common than cancer occurring during the first 15 years of life, yet is much less common than cancer in older age groups, and accounts for just 2% of all invasive cancer. Cancer in adolescents and young adults is unique in the distribution of the types that occur. Hodgkin lymphoma, melanoma, testis cancer, female genital tract malignancies, thyroid cancer, soft-tissue sarcomas, non-Hodgkin lymphoma, leukemia, brain and spinal cord tumors, breast cancer, bone sarcomas, and nongonadal germ cell tumors account for 95% of the cancers in this age group. The frequency distribution of cancer types changes dramatically from age 15-30, such that the pattern at the youngest age does not resemble the one at the oldest. The incidence of cancer in this age group increased steadily during the past quarter century. This increase is declining and at the older end of the age range appears to be returning to the incidence of the 1970s. Males in the 15- to 29-year age group have been at higher risk of developing cancer, with the risk directly proportional to age. Non-Hispanic whites have had the highest risk of developing cancer during this phase of life, and Asians, American Indians and Native Alaskans the lowest. Males had a worse prognosis than females. African-Americans, American Indian/Alaska Natives had a worse prognosis than white non-Hispanics and Asians. MORTALITY & SURVIVAL: At the beginning of the last quarter century, the diagnosis of cancer in 15- to 29-year-olds carried a more favorable prognosis, on the average, relative to cancer at other ages. Since then, there has been a lack of progress in survival improvement among older adolescents and young adults relative to all other ages. Survival improvement trends portend a worse prognosis for young adults diagnosed with cancer today than 25 years ago. The survival deficit is increasing with longer follow-up of the survivors, and is worse in males. Among 15- to 29-year-olds, non-Hispanic whites had the best survival and African Americans/blacks had the worst survival, with a 20% difference apparent by 5 years. Asians/Pacific Islanders had the second best survival, with Hispanics and American Indians/Alaska Natives next in sequence., Risk Factors: In general, there are relatively scant data to support either an environmental causation or an inherited predisposition to cancer in this age group. The majority of cases of cancer occurring before age 30 appear to be spontaneous and unrelated to either carcinogens in the environment or family cancer syndromes. Overall, family cancer syndromes appear to account for less than 5% of the cases of cancer in the age group. Melanoma, cervical carcinoma and Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin and Burkitt lymphomas accounting for the majority of environmentally induced malignancies (ultraviolet light, human papillomavirus, human immunodeficiency virus, and Epstein-Barr virus, respectively). Ultimately, a larger proportion of cases may be attributable to specific factors or genetic predisposition, but at present, most cancer in this age group appears to be sporadic and random.

Opportunities for cancer prevention in adolescents range from limitation of sun exposure to the use of human papillomavirus vaccines. Those who develop malignant disease experience longer waiting times for diagnosis and treatment than do children, especially when referred to adult treatment centers, and they are less frequently enrolled in clinical trials. More attention to developmentally appropriate psychological support, enhancement of compliance/adherence, health promotion, and palliative care is needed. Improving cancer surveillance and control in adolescents in North America will require co-ordinated national efforts, involving pediatric and adult health care providers, institutions, and multiple levels of government.