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Sickle cell disease (SCD) is the most common inherited blood disorder in the United States. It is a medically and socially complex, multisystem illness that affects individuals throughout the lifespan. Given improvements in care, most children with SCD survive into adulthood. However, access to adult sickle cell care is poor in many parts of the United States, resulting in increased acute care utilization, disjointed care delivery, and early mortality for patients. A dearth of nonmalignant hematology providers, the lack of a national SCD registry, and the absence of a centralized infrastructure to facilitate comparative quality assessment compounds these issues. As part of a workshop designed to train health care professionals in the skills necessary to establish clinical centers focused on the management of adults living with SCD, we defined an SCD center, elucidated required elements of a comprehensive adult SCD center, and discussed different models of care. There are also important economic impacts of these centers at an institutional and health system level. As more clinicians are trained in providing adult-focused SCD care, center designation will enhance the ability to undertake quality improvement and compare outcomes between SCD centers. Activities will include an assessment of the clinical effectiveness of expanded access to care, the implementation of SCD guidelines, and the efficacy of newly approved targeted medications. Details of this effort are provided.

Objective: We assessed sociodemographic and clinical characteristics associated with depression and anxiety in individuals with Von Willebrand disease (VWD) aged ≥12 years. Methods: The study collected data on patients' sociodemographic, joint problems and health‐related quality of life (HRQoL) using EQ‐5D‐3L, 8‐item patient health questionnaire for depression and 7‐item Generalized Anxiety Disorder Questionnaire from participants in seven geographically diverse US haemophilia treatment centres. Results: Analyses included 77 participants. The rates of depression and anxiety were 63.6% and 58.3%, respectively. Persons with low VWF displayed higher rates of depression (86.7%) or anxiety (69.2%) compared to those with VWD (58.1%, p =.04 for depression, and 55.9%, p =.38 for anxiety). Logistic regression analyses demonstrated that having joint problems (odds ratio [OR] = 6.3, confidence interval [CI] = 2.0–20.1) was the most important variable associated with depression, followed by being single, divorced, widowed, or separated in adult participants or parents of participants age < 18 years (OR = 7.0, CI = 1.7–29.0. The most important variable associated with anxiety was being single or lacking a partner (OR = 10.8, CI = 2.5–47.5), followed by age 12–17 years old (OR = 6.7, CI = 1.6–26.9), or having worse health compared to 3‐months ago (OR = 12.3, CI = 1.3‐116.2). Mean covariates adjusted EQ visual analogue scale score was significantly lower among persons with depression (68.77 ± 3.15 vs. 77.58 ± 4.24, p =.03) than those without depression. Conclusions: Our study revealed concerning levels of depression and anxiety in this VWD sample. Lack of social support was determined an important factor associated with depression and anxiety in this sample. Mental health screening is critical in VWD clinical evaluation and care. [ABSTRACT FROM AUTHOR]

Discusses the needs of lesbians and homosexuals in community colleges in terms of heterosexism. Cites specific examples of heterosexism on campus and defines homophobia, internalized homophobia, and heterosexism. Utilizes interactionist theory to identify sources of heterosexism. Discusses "coming out," and suggests solutions to heterosexism on two-year college campuses. (DMM)

Shares the success stories of the students, teacher, and director of an award-winning high school newspaper in Boston. (MG)

Annually laminated sediments from the anoxic inner basin of Effingham Inlet, Pacific coast of Vancouver Island, British Columbia, Canada, yield a high-resolution 42 m paleoenvironmental record, from the present to about 14 ka [sup.14]C BP (17 ka cal BP). A new age model, based on 68 radiocarbon dates from twigs and small plant material, from the 40 m core MD02-2494 and 2 m freeze cores from the surface, is anchored by the Mazama Ash and varve counting. A Poisson-process sedimentation model is used, applying a new method to determine the Poisson k value, giving a realistic age model compatible with the multi-proxy core data. Twenty-one 'seismites', which are lithofacies in the Effingham cores that may be representative of seismically triggered mass-wasting events, are identified and dated precisely, then compared with the chronology of the deep-sea turbidite record farther south in the Cascadia Subduction Zone (CSZ), to determine if regional sediment disturbances can be identified. With 16 proposed correlations, Effingham seismite ages are 169 ± 206 years older than turbidite ages estimated largely by radiocarbon analysis of foraminifera in hemipelagic deposits. Des sediments lamines annuels provenant du bassin interieur anoxique d'Effingham Inlet, sur la cote Pacifique de l'lle de Vancouver, Colombie Britannique, Canada, ont fourni un enregistrement paleoenvironnemental a haute resolution de 42 m, depuis le present jusqu'a il y a environ 14 ka [sup.14]C avant le present (17 000 annees calendrier avant le present). Un nouveau modele d'age, base sur 68 datations radiocarbone effectuees sur des brindilles et de la matiere vegetale de petites plantes provenant de la carotte MD02-2494 (d'une longueur de 40 m) et de carottes gelees de 2 m, prelevees a la surface, est fixe par la cendre Mazama et le comptage des varves. Un modele de sedimentation a ete utilise, base sur un processus de Poisson; il applique une nouvelle methode pour determiner la valeur k de Poisson et donne ainsi un modele d'age realiste compatible avec les donnees provenant de plusieurs carottes. Vingt et une seismites, qui constituent des lithofacies dans les carottes Effingham et qui pourraient representer des evenements de mouvements de masse declenches par des seismes, sont identifiees et datees avec precision. Les seismites sont ensuite comparees a la chronologie des donnees sedimentaires enregistrees dans des turbidites en eau profonde situes plus au sud dans la zone de subduction Cascadia, afin de determiner si les perturbations aux sediments regionaux peuvent etre identifiees. Avec 16 correlations proposees, les seismites Effingham sont plus vieilles de 169 [+ or -] 206 ans que les turbidites, dont les ages ont ete en general estimes par des analyses radiocarbone des foraminiferes dans les depots hemipelagiques. [Traduit par la Redaction], Introduction Central to the interpretation of event stratigraphy is the development of an accurate age model which defines the age of sediment deposition as a function of the depths of [...]

The Tintina Trench in west-central Yukon has preserved an extensive record of late Cenozoic preglacial, glacial, and interglacial deposits. These deposits comprise multiple sequences of tills, outwash, loesses, and paleosols. The sediments that were laid down directly by ice (tills) are of both local (montane) and regional (Cordilleran) provenance. The Tintina Trench area was impacted repeatedly by montane ice from the southern Ogilvie Mountains to the northwest (2500 m above sea level (asl)), and also repeatedly along its southern extent by Cordilleran ice from the Selwyn Mountains to the east (2759 m asl), the latter forming the continental divide in this region. We report here the magnetostratigraphy of three sections: Rock Creek (64°13'N, 139°07'W), West Fifteenmile River (64°29'N, 139°55'W), and East Fifteenmile River (64°23'N, 139°48'W). The majority of the units identified at these sections record late Pliocene to mid-Pleistocene glaciations, although relatively thin surficial sequences of late middle Pleistocene to late Pleistocene loesses and tills are present as well. Of the 11 units described in the Tintina Trench, seven have normal polarity, three have reversed polarity, and one has an undefined polarity. These units span about 3.0 million years. It appears that most of the polarity chrons and subchrons of the late Cenozoic are present and that the sequence of six reversals record at least 10 glaciations (three in the Brunhes Chron and seven in the Matuyama Chron), and 11 interglaciations (four in the Brunhes Chron and seven in the Matuyama Chron). The interglacials are recorded as either paleosols or unconformities between glacial or loess units having opposite polarity. While not all Matuyama Chron glacial and interglacial cycles recorded in marine isotopic records are seen on land, the terrestrial records found in the Tintina Trench have thus far proven to be the most complete in terms of the polarity record. While no absolute ages were obtained from the sediments in the trench, the extensive polarity sequence constrains the timing of glaciations to a considerably greater degree than was previously possible for this region. The magnetostratigraphy of the trench sites are compared with the glacial, glaciofluvial, and loessic deposits at the nearby Klondike River valley and Fort Selkirk sites, central Yukon, where tephras and basalts provide absolute ages, and stratigraphic units contain an extensive late Cenozoic climate proxy for northwestern North America (eastern Beringia). In this study, we present new paleomagnetic polarity data and establish a magneto-lithostratigraphy describing preglacial, glacial, and interglacial deposits in the Tintina Trench. These deposits are referred to as the West Tintina Trench Allogroup and provide a broad framework for establishing a paleoclimate record for the northern Canadian Cordillera. Le sillon de Tintina dans le centre ouest du Yukon a preserve un enregistrement complet de depots preglaciaires, glaciaires et interglaciaires datant du Cenozolque. Ces depots comprennent de multiples sequences de tills, de depots fluvio-glaciaires, de loess et de paleosols. Les sediments qui ont ete deposes directement par la glace (tills) ont une provenance locale (subalpine) et regionale (de la Cordillere). Le sillon de Tintina a subi l'impact de la glace de la Cordillere de nombreuses fois; cette glace provenait des monts Ogilvie meridionaux situees au nord-ouest (2500 m au-dessus du niveau de la mer (ASL)). Il a aussi subi l'impact repete le long de son etendue sud par de la glace de la Cordillere provenant des monts Selwyn a l'est (2759 m ASL); ces monts forment la ligne continentale de partage des eaux dans cette region. Nous rapportons ici la magneetostratigraphie de trois sections : Rock Creek (RC) (64[grados]13'N, 139[grados]07'O), West Fifteenmile River (WFR) (64[grados]29'N, 139[grados]55'O) et East Fifteenmile River (EFR) (64[grados]23'N, 139[grados]48'O). La plupart des unites identifiees a ces sections enregistrent des glaciations datant du Pliocene tardif au Pleistocene moyen, bien qu'il subsiste encore en surface des sequences relativement minces de loss et de tills datant du Pleistocene moyen tardif au Pleistocene tardif. Des 11 unitesdecrites dans le sillon de Tintina, sept ont une polarite normale, trois ont une polarite inversee et la polarite d'une unite; est indefinie. Ces unites couvrent environ 3,0 millions d'annees. Il semble que la plupart des chrons et des sous- chrons polaires du Cenozolque tardif sont presents et que la sequence de six inversions documente au moins 10 glaciations (trois dans le chron Brunhes et sept dans le chron Matuyama) et 11 interglaciations (quatre dans le chron Brunhes et sept dans le chron Matuyama). Les interglaciaires sont enregistres en tant que paleosols ou discordances entre les unites glaciaires ou de loss a polarite; opposee. Bien que les cycles glaciaires et interglaciaires du chron Matuyama enregistres dans les donnees isotopiques marines n'aient pas ete; tous vus sur le continent, les enregistrements terrestres trouves dans le sillon de Tintina se sont averesetre les plus complets en termes d'enregistrement de polarite. Bien qu'aucun age absolu n'ait ete obtenu des sediments du sillon, la sequence extensive de polarites encadre beaucoup plus le moment des glaciations qu'il n'eetait possible auparavant pour cette region. La magnetostratigraphie des sites du sillon est compareea celle des depots glaciaires, fluvio-glaciaires et loessiques des sites avoisinants de la vallee de la riviere Klondike et de Fort Selkirk, dans le centre du Yukon, oil des tephras et des basaltes fournissent des ages absolus et les unites stratigraphiques contiennent beaucoup de donneees indirectes du climat au Cenozolque tardif pour le nord-ouest de l'Ameerique du Nord (Beringie orientale). Dans cette etude, nous presentons de nouvelles donneees de polarites paleeomagneetiques et nous eetablissons une lithostratigraphie magnetique decrivant les depots glaciaires et interglaciaires dans le sillon. Ces depots sont nommees l'Allogroupe du sillon de Tintina occidental et ils fournissent un cadre geneeral pour eetablir des donneees paleoclimatiques pour le nord de la Cordillere canadienne. [Traduit par la Redaction], Introduction The terrestrial glacial record of northwestern North America is one of the most extensive of any preserved worldwide. This record was left by Cordilleran, montane, continental, and plateau glaciers. [...]