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This article begins with an exploration of the issues facing beginning school counselors and the educational requirements for school counselor education programs. Following this exploration, the discussion moves into a description of how service-learning can be used to foster understanding and transfer abstract professional concepts into practice. A case example of a class incorporating service-learning is presented, providing counselor educators with an in-depth understanding of the key foundational underpinnings necessary for effective service-learning projects in school counseling coursework. Potential challenges are discussed and suggestions for future research are shared.

A culturally competent survey currently does not exist to characterize the burden of Adverse Childhood Experiences (ACEs) among a HIV/AIDS population receiving care at a local Center of Excellence (COE). A qualitative study was conducted including 11 interviews involving opinions on national surveillance questions to develop a culturally competent survey. Purposive sampling, reactive probing, and analysis of transcribed interviews were completed using structured coding to determine which questions were kept, modified, or removed​ in the final survey. The final 55-question survey contained more generalized ACE questions, topics pertaining to barriers to HIV care, and a list that patients could select from to indicate what they need to improve their HIV care. The final survey provided the opportunity to characterize the burden of ACEs at a COE. Future directions involve piloting the survey as a quality improvement tool with the goal of increasing retention rates through more individualized HIV care. [ABSTRACT FROM AUTHOR]

Background: Brazil has a high burden of cervical cancer, even though it is preventable, traceable and treatable. Hence, this study evaluated levels of knowledge, attitudes and practices (KAP) related to cervical cancer screening and diagnosis and acceptance of self-screening techniques among women aged 24 and greater., Methods: A cross-sectional KAP survey was administered to n = 4206 women and spanned questions relating to cervical cancer, HPV, speculum, Pap test and colposcopy. Questionnaire was disseminated through a major hospital's social media platforms, intranet and gynecologic-oncology clinics. Logistic regressions evaluated associations between sociodemographic characteristics and knowledge, attitudes, and preventative behaviors against cervical cancer. Participants indicated willingness to try DNA-HPV self-sampling and cervix self-visualization (self-colposcopy)., Findings: Participants were mostly white individuals (70.5%) with higher education and from social classes A and B. They demonstrated superior levels of KAP than described in the literature, with over 57.8% having answered 80+% of questions correctly. KAP scores were predicted by social class, educational attainment, race, history of premalignant cervical lesions and geographic location. About 80% and 63% would be willing to try DNA-HPV self-sampling and cervix self-visualization, respectively. Interest in self-screening was associated with adequate attitude (OR = 1.85) and inadequate practice (OR = .83)., Interpretation: Adequate KAP are fundamental for the successful implementation of a self-screening program. Participants were interested in methods that provide them with greater autonomy, control and practicality. Self-screening could address barriers for under-screened women such as shame, discomfort, distance from clinics and competing commitments, enabling Brazil to reach the WHO's cervical cancer elimination goals. It could also decrease excess medical intervention in over-screened populations by promoting shared decision-making.

Objectives: The objective of this study was to identify risk factors and clinical profile of the patients presenting with ST elevation myocardial infarction (STEMI). We further evaluated the utility of the Framingham Risk Score (FRS) in the accurate identification of these patients if used before their coronary event., Methods: We evaluated the demographic, clinical, and angiographic characteristics of patients admitted with STEMI. We also calculated cardiovascular event risk using the FRS in a subset of patients without prior known coronary artery disease and diabetes mellitus., Results: A total of 44 patients, predominantly men (75%) and white (80%), with a mean age of 56 ± 10 years, were included in our analysis. Cigarette smoking was the predominant risk factor (83%) followed by hypertension (77%) and dyslipidemia (68%). The calculated FRS in a subset of patients without prior coronary artery disease or diabetes mellitus was 14.1% ± 5.8%. Based on the FRS, 8 (36%) patients had a 10-year risk >20% and 14 (63%) patients had a 10-year risk between 10% and 20%., Conclusions: In a series of consecutive patients with STEMI, we observed that high FRS was inadequate in correct identification and risk stratification of the majority of patients who had STEMI. Our study underlines the importance of being familiar with multiple risk scores and choosing the most applicable risk score based on the patient's individual characteristics. In addition, it is important to take into consideration the nontraditional risk factors or measurement of coronary artery calcium as a part of the risk assessment algorithm.

Background & Aims: Dietary supplements (DS) are popular in many countries but little data are available on their use by sub-populations such as college students. Since students share a variety of characteristics and similar lifestyles, their DS use may differ from the general population. This study assessed DS use, factors associated with DS use, and reasons for use among U.S. college students., Methods: College students (N = 1248) at 5 U.S. universities were surveyed. Survey questions included descriptive demographics, types and frequency of DS used, reasons for use and money spent on supplements. Supplements were classified using standard criteria. Logistic regression analyses examined relationships between demographic and lifestyle factors and DS use., Results: Sixty-six percent of college students surveyed used DS at least once a week, while 12% consumed 5 or more supplements a week. Forty-two percent used multivitamins/multiminerals, 18% vitamin C, 17% protein/amino acids and 13% calcium at least once a week. Factors associated with supplement use included dietary patterns, exercise, and tobacco use. Students used supplements to promote general health (73%), provide more energy (29%), increase muscle strength (20%), and enhance performance (19%)., Conclusions: College students appear more likely to use DS than the general population and many use multiple types of supplements weekly. Habits established at a young age persist throughout life. Therefore, longitudinal research should be conducted to determine whether patterns of DS use established early in adulthood are maintained throughout life. Adequate scientific justification for widespread use of DS in healthy, young populations is lacking., (Published by Elsevier Ltd.)

In the United States, nationally representative civilian studies have shown that BMI is associated with select sociodemographic characteristics. Active-duty military personnel are not included in these surveys and the persistence of these associations in military personnel is unknown. Data from the worldwide, representative 2002 and 2005 Department of Defense (DoD) Surveys of Health-Related Behaviors Among Active Duty Military Personnel were used to assess the prevalence of overweight and obesity and, the association of BMI with sociodemographic characteristics. The final response bases included 12,756 (2002) and 16,146 (2005) personnel. Results indicated that the combined prevalence of overweight and obesity in military personnel increased to an all-time high in 2005 (60.5%) with higher prevalence of obesity in 2005 compared to 2002 (12.9% vs. 8.7, respectively, P ≤ 0.01). Holding other variables constant, regression analysis indicated that women were significantly less likely than men to be overweight or obese in both survey years (P ≤ 0.0001), which is contrary to civilian data. Similar to civilian data, the prevalence of obesity was significantly associated with increased age, black or Hispanic/Latino race/ethnicity, and being married (P ≤ 0.01). US military personnel are not immune to the US obesity epidemic. Demographic characteristics associated with being overweight should be considered when developing military-sponsored weight management programs.

Bartter's and Gitelman's syndromes are characterized by hypokalemia, urinary potassium wasting, elevated plasma renin activity and aldosterone levels, normotension, and prostaglandinuria. They differ in that hypomagnesemia and hypocalciuria are universal in Gitelman's syndrome; 20% of cases of Bartter's syndrome have hypomagnesemia and hypercalciuria. We present a 44-year-old white man referred for hypokalemia. Clinical evaluation was unremarkable. He had hypokalemia (P(K), 2.8 to 3.0 mEq/L), hypochloremic metabolic alkalosis, mild azotemia (serum creatinine, 1.4 to 1.8 mg/dL; creatinine clearance, 59 mL/min), normocalcemia, marked persistent hypocalciuria (FE(Ca), 0.08% to 0.09%), and normal intact parathyroid hormone levels (51 pg/mL) and glucosuria. He had persistent hypermagnesemia (P(Mg), 2.1 to 2.8 mEq/L) with relative hypomagnesuria (FE(Mg), 3.2% to 5.2%) given the level of renal impairment and hypermagnesemia. Supine plasma renin activity and aldosterone levels were high (11 ng/mL/hr and 43 ng/dL, respectively). An excessive dietary intake of magnesium, including medications, was excluded. Studies were performed after withdrawing all medications for 8 days. A maximum water diuresis was established (an oral load of 20 mL/kg; stable Uosm, 120 mOsm/kg), and free water and solute clearances were studied at baseline and after sequential intravenous injections of 125 mg chlorothiazide and 40 mg furosemide. The patient had moderate renal impairment (technetium diethylene triamine pentacetic acid [DTPA] clearance, 35.4 mL/min/1.73 m2) and, in contradistinction to Bartter's and Gitelman's syndromes, sodium and water handling in the thick ascending limb of the loop of Henle and the distal tubule (fractional distal solute reabsorption) was normal, but there was evidence of a defect in the proximal tubule reabsorption (glucosuria, supranormal C(H2O) and high distal delivery). Hypomagnesuria and hypocalciuria appeared to be secondary to an increase in their absorption in the loop of Henle (increased excretion following furosemide). In conclusion, this combination of metabolic abnormalities has never been described. We postulate a proximal tubular defect in the absorption of NaCl leading to hypocalciuria, hypomagnesuria, and potassium wasting. Whether the tubular defect is primary or secondary to a renal parenchymal disease is, however, unclear.

This study was designed to identify risk factors associated with violence within a forensic inpatient hospital setting. The primary purpose was to develop a screening tool to aid in the rapid identification of patients requiring high versus low security ward placement. Subjects included 232 consecutive admissions during a five-month period to a 300-bed forensic division within a public-sector psychiatric hospital. Demographic, historical, and current clinical variables were collected, and dangerous behaviors were documented by nursing staff on a daily basis. The associations between dangerous outcomes and various risk factors were examined using chi-square or t tests, as appropriate. Stepwise logistic regression analysis was performed to assess the contribution of each risk factor significantly associated with violent behavior. A strong association was found between 10 risk factors and the incidence of violence in our forensic population. These factors included current clinical factors (grossly inappropriate behavior observed on the ward, an assessment of current escape risk); historical factors (psychiatric hospitalization history, criminal history variables, and a self-report of prior violence); and one demographic variable (length of stay). Of the 10 risk factors then included in the stepwise regression analysis, four contributed significantly to the final predictive model. Grossly inappropriate behavior, patient self-report of prior violence, history of psychiatric hospitalization, and a history of 10 or more prior psychiatric hospitalizations were most predictive of a violent outcome. Although situational and environmental variables also must be incorporated into final assessments and decisions, the identified significant variables can provide an additional tool in the rapid assessment of violence potential.

The purpose of this study was to assess the amount of thoracic segmental flexion associated with cervical forward bending. Twenty-four healthy men and women between the ages of 21-29, with no past or present cervical or thoracic dysfunction, participated. Spinal segmental mobility in the thoracic region was measured in the neutral sitting position and sitting with the cervical spine in the forward bent position. Mobility was measured by the Faro Metrecom Skeletal Analysis System. The Faro Metrecom is an external measuring device that records each individual spinal segment's position within the body. Descriptive statistics were used to describe the position of the thoracic segments when the cervical region was in the neutral and in the forward bent positions. Additionally, intrarater reliability, .83 and .76, and interrater, .72, were analyzed for the thoracic segments in the neutral position. The results show that with cervical flexion there was thoracic segmental flexion. Segments T1-4 demonstrated forward bending ranging from 2.88-4.42°. The greatest amount of flexion occurred at T2, 4.42 degrees, and T3, 4.19 degrees. Below T4 no pattern was noted. The results indicate that upper-thoracic segmental flexion occurs during cervical forward bending.During evaluation and treatment of patients with cervical dysfunction physical therapists routinely evaluate spinal segmental mobility. It is clear to clinicians that cervical segmental mobility is important to cervical range of motion. What it not clear is the role of thoracic segmental mobility in cervical range of motion. Physical therapists frequently evaluate and treat the thoracic region when patients have cervical dysfunction. Therefore, the purpose of this study was to assess the amount of thoracic segmental flexion associated with cervical forward bending.Since the early 1970s when the concept of joint mobilization was brought to American physical therapists, interest in spinal segmental motion has increased. Though interest in this area exists, there is a scarcity ofresearch documenting normal and abnormal spinal segmental mobility. Additionally, most of the studies on spinal segmental mobility have been conducted on cadavers or through radiographic methods.Lysell studied intersegmental movements of the cervical spine using autopsy specimens. Steel balls were placed in fixed points on each vertebrae and then a three-dimensional radiographic examination was used to measure movements of these points during cervical range of motion.1 Ball and Meijers studied cervical mobility using fresh cadaveric cervical spinal specimens. In this study steel pins were inserted into the cervical bodies and serial x-rays were taken.2 Panjabi, Dvorak, and Duranceau studied upper-cervical spine mobility using fresh cadaveric whole cervical spine specimens and steel balls. Their specimens were set into a quick-setting epoxy material to help align the centers of C2 and C7, thereby providing fixation.3 Yamamoto et al. studied three-dimensional movements of the lumbar spine and lumbosacral joint. They used fresh cadaveric whole lumbar spine specimens analyzing from L1 to the sacrum.4 Robert studied intervertebral motion of the whole spine. This was performed with cadavers as the segmental excursions were determined from a point at the inferior surface of the vertebrae to the tip of the spinous process.5Three separate noncadaveric studies were conducted by Penning,6 Felding7 and Moll and Wright.8 Penning studied normal movements of the cervical spine by superimposing two x-ray films representing the cervical spine in the end positions (i.e., flexion and extension). Fielding studied normal and abnormal motion of the cervical spine from C2 and C7 using cineroentgenography; roentgenograms were taken while the subjects were moving. Moll and Wright studied normal range of spinal mobility using live subjects with markers on the skin. When the subjects moved the separation of the skin markers was recorded.The above studies used procedures that are not convenient for use during clinical sessions. Additionally, the above studies did not evaluate thoracic mobility in relation to cervical motion.In the textbook, Common Vertebral joint Problems,9 Grieve presents a complete discussion of vertebral motion. This section is highly referenced as it pertains to segmental spinal mobility.9 White and Panjabi are the most frequently cited source on spinal segmental mobility.10,11 They reported flexion/extension degrees of motion for the thoracic segments. The ranges of the motion and the "representative angle" (most likely the mean angle) in degrees for each thoracic segment are T1-T5 2-5 (4); T6 2-7 (5); T7-T9 3-8 (6); T10 4-14 (9); and T11-T12 6-20 (12). However, they did not state how their estimated range and "representative angle" in degrees of segmental spinal mobility were measured.10,11 Valencia in the book Physical Therapy of the Cervical and Thoracic Spine states similar motion for the thoracic segments.12The upper-thoracic spine, T1-T6, has been related to the cervical region anatomically. The upper-thoracic facet joints are orientated like the cervical facet joints and have a similar pattern of movement.11,13 Additionally, the caudal attachment of many cervical muscles is in the thoracic region.13.

A double-blind, randomized study was conducted in 30 adult medical intensive care unit patients to determine if the presence of heparin in continuous-flush solutions prolongs the functional life span of radial arterial catheters compared with catheters flushed with solutions not containing heparin. Patients were consecutively entered into the study and randomly assigned to receive arterial line flush solutions containing 0.9% sodium chloride (NSS) or heparin 4 U/ml in 0.9% sodium chloride. The flow rate of each flush solution was approximately 3 ml/hr. Use of the heparin-containing flush solution resulted in a catheter survival rate of 86% at 96 hours compared with a rate of only 52% after 40 hours with NSS (p less than 0.05). In addition, the heparin-flushed catheters required significantly less manipulation to prevent catheter occlusion and arterial pressure-wave dampening (p less than 0.01). The use of NSS as a continuous flush for radial artery catheters is associated with an increased frequency of catheter occlusion and malfunctions compared with solution containing heparin, and thus is not recommended in patients with normal coagulation status and platelet count.