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We examined Asian American college students' adherence to traditional values that are salient in Asian cultures, the students' perceptions of their mother's and father's adherence to the same values, and the discrepancies between the students and their mothers and fathers on the levels of adherence to these values. Based on the data from 301 participants who self-identified as Asian Americans, paired-samples t tests revealed that the child–parent cultural value discrepancies were present across all generational statuses of the participants with the children adhering less strongly to most of the value dimensions than their parents. The results based on correlational analyses showed that many types of value discrepancies were positively associated with the likelihood and seriousness of conflict. Several types of value discrepancies also were inversely associated with the participants' life satisfaction and self-esteem. In addition, the results from the PROCESS Macro for mediation analysis revealed significant mediation role of family conflict on the relationships between various types of value discrepancies and life satisfaction. The significant mediators were the likelihood and seriousness of family conflict and the family conflict about education and career decisions, and the value discrepancies centered on the values of conformity to norms, family recognition through achievement, and humility. Public Significance Statement: The present study revealed that high levels of child–parent value discrepancies among Asian Americans were associated with increased family conflict, which in turn was associated with child's decreased satisfaction with life and self-esteem. When counseling psychologists and other mental health professionals work with Asian American college students, it would be beneficial to explore the clients' relationships with their parents in terms of cultural value differences and how these relationships may be influencing their mental health. [ABSTRACT FROM AUTHOR]

Background An outbreak of respiratory tract infection due to Respiratory Syncytial Virus (RSV) type B in a postpartum center was reported on February 1, 2017. Investigation was conducted to identify the magnitude, possible source of infection and risk factors for this outbreak on February 2, 2017. Methods A retrospective cohort study was conducted. A case was defined as a neonate having respiratory symptoms with or without fever and stayed at the postpartum center between January 1, 2017 and February 3, 2017. Daily records of neonates were reviewed, and all parents who stayed at the postpartum center were interviewed. Virological testing of real-time polymerase chain reaction was conducted for the neonates having respiratory illness, the parents and all staff members in the facility. Results This outbreak occurred between January 17, 2017 and February 7, 2017 in a postpartum center. Thirty-five (58.3%) neonates among 59 neonates were identified as cases and 12 neonates were confirmed to be RSV-B positive. The longer length of stay in the postpartum center is the only risk factor (Relative Risk = 8.10, 95% Confidence Interval:1.84–35.62, p < 0.01) in this outbreak. Two nursing staffs and eight parents were confirmed as RSV-B positive. Conclusions Longer periods of stay in the postpartum center had an increased chance of becoming infected with RSV during this outbreak. Isolation of cases and temporary closure with environmental cleaning were recommended to the postpartum center. [ABSTRACT FROM AUTHOR]

This study examined the potential moderating influences of behavioral and values acculturation and enculturation in a sample of 113 Asian Americans. Findings from regression analyses revealed that acculturation to European American cultural values, alone and in interaction with perceived racism, was related to less psychological symptoms, whereas enculturation to Asian American values alone was associated with more psychological symptoms. Findings, which partially supported the authors' hypotheses, are discussed in light of the cultural adaptation literature. Este estudio examinó las potenciales influencias moderadoras de la aculturación y enculturación de comportamiento y valores en una muestra de 113 americanos asiáticos. Los resultados de análisis de regresión revelaron que la aculturación a los valores culturales euro‐americanos, por sí sola y en interacción con el racismo percibido, estaba relacionada con una menor incidencia de síntomas psicológicos, mientras que la enculturación a los valores asiático‐americanos por sí sola estaba relacionada con una mayor incidencia de síntomas psicológicos. Los resultados, que confirmaron parcialmente nuestras hipótesis, se discuten teniendo en cuenta la literatura sobre adaptación cultural. [ABSTRACT FROM AUTHOR]

Hand, foot, and mouth disease (HFMD) causes characteristic blisters and sores mainly in infants and children, and has been monitored in South Korea through sentinel surveillance since 2009. We described the patterns of HFMD occurrence and analyzed the effect of climatic factors on national HFMD incidence. Weekly clinically diagnosed HFMD case rates (per 1,000 outpatients) in sentinel sites and weekly climatic factors, such as average temperature, relative humidity, duration of sunshine, precipitation, and wind speed from 2010 to 2013, were used in this study. A generalized additive model with smoothing splines and climatic variables with time lags of up to 2 weeks were considered in the modeling process. To account for long-term trends and seasonality, we controlled for each year and their corresponding weeks. The autocorrelation issue was also adjusted by using autocorrelation variables. At an average temperature below 18°C, the HFMD rate increased by 10.3% for every 1°C rise in average temperature (95% confidence interval (CI): 8.4, 12.3%). We also saw a 6.6% increase in HFMD rate (95% CI: 3.6, 9.7%) with every 1% increase in relative humidity under 65%, with a 1.5% decrease in HFMD rate observed (95% CI: 0.4, 2.7%) with each 1% humidity increase above 65%. Modeling results have shown that average temperature and relative humidity are related to HFMD rate. Additional research on the environmental risk factors of HFMD transmission is required to understand the underlying mechanism between climatic factors and HFMD incidence. [ABSTRACT FROM AUTHOR]

This study examined counseling intervention designed for Asian Americans. Participants ( N = 158) rated session effectiveness after viewing a videotape of a counselor using a culturally congruent or incongruent communication style. Analyses of variance showed that the incongruent style was viewed as more satisfying and credible than the congruent style. Factor analysis showed that participants perceived 'being direct' and 'maintaining harmony' styles, and multiple regression analyses revealed that these perceptions had a positive relationship with effectiveness. [ABSTRACT FROM AUTHOR]

Students attending a Native Hawaiian–serving institution read statements from two hypothetical job candidates. The passages had equivalent meaning, but one incorporated Hawaiian leadership values (HLV) without identifying them as such. Participants judged the HLV candidate to have lower credibility, rationality, and effectiveness, and preferred the non-HLV candidate for a leadership role. Participants’ ancestry, gender, and collectivism were unrelated to candidate preference. Business majors showed the strongest preference for the non-HLV candidate. Within majors, higher grade point average predicted preference for the non-HLV candidate. The results have implications for how educators may confront implicit assumptions about leadership. [ABSTRACT FROM PUBLISHER]

This article reports the development and psychometric properties of the Interpersonal Shame Inventory (ISI), a culturally salient and clinically relevant measure of interpersonal shame for Asian Americans. Across 4 studies involving Asian American college students, the authors provided evidence for this new measure's validity and reliability. Exploratory factor analyses and confirmatory factor analyses provided support for a model with 2 correlated factors: external shame (arising from concerns about others' negative evaluations) and family shame (arising from perceptions that one has brought shame to one's family), corresponding to 2 subscales: ISI-E and ISI-F, respectively. Evidence for criterion-related, concurrent, discriminant, and incremental validity was demonstrated by testing the associations between external shame and family shame and immigration/international status, generic state shame, face concerns, thwarted belongingness, perceived burdensomeness, self-esteem, depressive symptoms, and suicide ideation. External shame and family shame also exhibited differential relations with other variables. Mediation findings were consistent with a model in which family shame mediated the effects of thwarted belongingness on suicide ideation. Further, the ISI subscales demonstrated high alpha coefficients and test-retest reliability. These findings are discussed in light of the conceptual, methodological, and clinical contributions of the ISI. [ABSTRACT FROM AUTHOR]

Asian Americans drop out of mental health treatment at a high rate. This problem could be addressed by enhancing therapists' multicultural competence and by examining clients' cultural attitudes that may affect the counseling process. In the present study, we used a video analogue design with a sample of 113 Asian American college students to examine these possibilities. The result from a t test showed that the session containing therapist multicultural competencies received higher ratings than the session without therapist multicultural competence. In addition, correlational analyses showed that participant values acculturation was positively associated with participant ratings of counseling process, while the value of emotional self-control was negatively correlated. The results of a hierarchical multiple regression analysis did not support any interaction effects among the independent variables on counseling process. All of these findings could contribute to the field of multicultural competence research and have implications for therapist practices and training. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the possible relations between perceived racism and minority status stressors as experienced by Latino/as and their mental health functioning, as operationalized in terms of somatization, anxiety, and hostility. In addition, the potentially protective moderating role of enculturation and potentially harmful moderating role of acculturation on these relationships were investigated. As hypothesized, the results indicated that perceived racism and minority status stressors were positively correlated with somatization, anxiety, and hostility. Although enculturation did moderate the relationship between perceived racism and minority status stressors and anxiety and hostility, it was in an unexpected direction. Results did not indicate that acculturation played a moderator role. [ABSTRACT FROM AUTHOR]

This article describes the development of the Latino/a Values Scale (35 items, 14 reverseworded). Evidence of reliability and validity are presented on the basis of three studies. An examination of the factor structure of the items suggests the presence of the following dimensions: cultural pride, simpatía, familismo, and espiritismo. [ABSTRACT FROM AUTHOR]

Based on data from 61 Asian American clients at a university counseling center, the study found that client-perceived match on client-counselor belief about problem etiology was related to counselor credibility, empathy, and cross-cultural competence; the client-counselor working alliance; session depth; and the likelihood of the client recommending the counselor to another client. An interaction effect showed that both strong match on belief about problem etiology and high client expectation for counseling success were associated with strong client-counselor working alliance. [ABSTRACT FROM AUTHOR]

The authors review the empirical literature on counselors' values, describe values salient to the 4 largest ethnic minority groups in the United States, Identify similarities and differences between counselors' values and those of the minority groups, and discuss implications for counseling ethnically different clients. Understanding counselors" values can lead to an examination of how these values may affect the counseling process, particularly when clients are from ethnic minority groups that may espouse differing cultural values. [ABSTRACT FROM AUTHOR]

The present study examined the relationships between adherence to Asian and European cultural values and communication styles among 210 Asian American and 136 European American college students. A principal components analysis revealed that, for both Asian Americans and European Americans, the contentious, dramatic, precise, and open styles loaded onto the first component suggesting low context communication, and interpersonal sensitivity and inferring meaning styles loaded onto the second component suggesting high context communication. Higher adherence to emotional self-control and lower adherence to European American values explained Asian Americans' higher use of the indirect communication, while higher emotional self-control explained why Asian Americans use a less open communication style than their European American counterparts. When differences between sex and race were controlled, adherence to humility was inversely related to contentious and dramatic communication styles but directly related to inferring meaning style, adherence to European American values was positively associated with precise communication and inferring meaning styles, and collectivism was positively related to interpersonal sensitivity style. [ABSTRACT FROM AUTHOR]

The authors examined the extent to which Asian American adolescents who were living in Hawaii adhered to Asian and European American cultural values in relation to mental health variables including collective self-esteem (membership, private, public, importance to identity), cognitive flexibility, general self-efficacy, and attitudes toward seeking professional psychological help. Results and implications for counselors are discussed. [ABSTRACT FROM AUTHOR]

Possible relations among enculturation and acculturation to cultural values and attitudes toward seeking professional psychological help were examined among 146 Asian American college students. In addition, possible relations between various dimensions of Asian values and attitudes toward seeking professional psychological help were examined. As hypothesized, the results indicated a significant inverse relation between enculturation to Asian values and professional help-seeking attitudes, above and beyond that of the association with having previous counseling experience. Although bivariate correlational results suggested possible inverse relations between the Asian values dimensions of collectivism, emotional self-control, and humility and professional help-seeking attitudes, these associations were not confirmed with a hierarchical multiple regression model. Contrary to expectation, a significant relation was not observed between values acculturation and professional help-seeking attitudes. Also, the interaction between enculturation and acculturation to cultural values was not significantly predictive of professional help-seeking attitudes. [ABSTRACT FROM AUTHOR]

The authors discuss the use of storybooks to promote multicultural sensitivity among elementary school children. The increasing diversity in the United States dictates that children are sensitive to cultural differences of individuals from varied backgrounds. Because they are in a formative stage of life, children are an ideal population with which to begin teaching about diversity. [ABSTRACT FROM AUTHOR]

This study is an attempt to extend previous research regarding specific variables related to successful rehabilitation outcomes and to address the relationship among cultural competency, attitudes towards people with disabilities and quality employment outcome measures. Significant relationships were found among counselor education level, counselors' self-reported cultural competency and several employment outcome variables. Plausible explanations are offered and future research directions are suggested. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine Asian American college students' behavioral acculturation to U.S. cultural norms and behavioral enculturation to Asian cultural norms and their relationships to ratings on measures of cognitive flexibility, general self-efficacy, collective self-esteem, acculturative stress, and attitudes toward seeking professional psychological help. As hypothesized, the results indicated that both acculturation and enculturation were positively related to the membership dimension of collective self-esteem. Although not hypothesized, the results indicated that acculturation was positively related to cognitive flexibility, general self-efficacy, and the public dimension of collective self-esteem. In addition, enculturation was positively related to the private dimension and the importance of identity dimension of collective self-esteem. [ABSTRACT FROM AUTHOR]

The development of the 42-item Asian American Values Scale-Multidimensional (AA VS-M) is presented. In Study 1, data from 163 Asian American respondents were subjected to a principal components analysis, which reduced the initial set of 180 items to 42 items divided into 5 components: collectivism, conformity to norms, emotional selfcontrol, family recognition through achievement, and humility. The data also revealed initial evidence of the AA VS-M total and subscale scores' reliability and validity, in Study 2, data from 189 Asian American respondents were subjected to a confirmatory factor analysis, which supported a hierarchical factor structure underlying the AA VS-M. Additional reliability and validity evidence of AA VS-M total and subscale scores were found. In Study 3, data from 38 Asian American respondents yielded evidence of AA VS-M total and subscale scores' test-retest reliability. [ABSTRACT FROM AUTHOR]

Asian American college students' adherence to Asian and European American cultural values and their relations to collective self-esteem, acculturative stress, cognitive flexibility, and general self-efficacy were examined. On the basis of data from 156 respondents, the results supported the hypothesis that adherence to Asian and European American values are positive predictors of membership and private dimensions of collective self-esteem. However, contrary to the authors' hypotheses, no relations were observed between adherence to Asian and European American values and other criterion variables. It is interesting that post hoc examination of the results indicated that adherence to Asian values was a positive predictor of the importance to identity dimension of collective self-esteem. Also, adherence to European American values was a positive predictor of cognitive flexibility and general self-efficacy. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical findings, histopathologic changes, and risk factors for pyogenic granuloma formation complicating silicone punctal plug therapy. Design: Retrospective observational case series. Methods: Between November 2000 and April 2004, 903 silicone punctal plugs of the same brand were inserted in 404 subjects. Cases associated with pyogenic granuloma formation were identified and reviewed. Granulation tissue was obtained from 10 patients for histopathologic examination. Multiple risk regression analyses identified factors related to pyogenic granuloma development and factors associated with histologic patterns. Results: Pyogenic granuloma development led to the extrusion of 4.2% of all plugs placed in a median time period of 141 days. All patients presented with varying degrees of plug extrusion. Similar distributions of partial and complete plug extrusions, as well as bilateral and unilateral plug extrusions, were seen. Findings at presentation ranged from a subclinical pyogenic granuloma causing partial plug extrusion to a pyogenic granuloma in the punctum with a ring of fibrovascular tissue retaining a completely extruded plug. Histopathologic examination revealed two patterns, representing either acute pyogenic granuloma or involuting pyogenic granuloma. Pyogenic granulomas resolved after 3.1 ± 1.3 weeks in all patients after plug removal. Multiple regression analysis revealed that large plug size was associated with increased pyogenic granuloma formation (P < .0001). Partial or complete plug extrusion was associated with active or involuting pyogenic granuloma, respectively (P = .023). Conclusion: Pyogenic granuloma-related spontaneous plug extrusions may be more common than previously thought and can present with a range of clinical findings. The degree of plug extrusion correlates with the histopathologic pattern. Larger plug size and sharp edges in plug geometry may be responsible for pyogenic granuloma formation. [Copyright &y& Elsevier]

The 18-item European American Values Scale for Asian Americans (M. M. Wolfe, P. H. Yang, E. C. Wong, & D. R. Atkinson, 2001) was revised on the basis of results from a psychometric analysis using the Rasch Model (G. Rasch, 1960). The results led to the establishment of the 25-item European American Values Scale for Asian Americans—Revised. [ABSTRACT FROM AUTHOR]

After assessing their expectation for counseling success, adherence to Asian cultural values, and adherence to European American cultural values, 88 Asian American volunteer clients with personal concerns engaged in single-session counseling with 1 of 11 female counselors who either matched or mismatched the client's worldview. Clients in the worldview match condition perceived stronger client- counselor working alliance and counselor empathy than those in the mismatch condition. Client adherence to Asian cultural values was positively related to client-counselor working alliance. Client adherence to European American values was positively associated with client-counselor working alliance and session depth. In addition, an interaction effect was observed such that high expectation for counseling success and strong adherence to European American cultural values were associated with increased perception of counselor empathy. [ABSTRACT FROM AUTHOR]

Evaluates the revision of the Asian Values Scale (AVS) on the basis of G. Rasch model in the U.S. Use of the Rasch model to estimate an individuals trait; Difficulty level of AVS; Process in establishing the revised AVS.

This article focuses on effects of counseling style and client adherence to Asian cultural values on counseling process with Asian American college students. Fifty-two clients were classified as having either high or low adherence to Asian values and assigned to a counseling session with a European American female counselor, who employed either a directive or a non-directive style. Immediately following the session, clients completed measures of counselor credibility, counselor empathic understanding, client-counselor working alliance, session depth and counselor cross-cultural counseling competence.

This article describes the development and psychometric properties of the Asian American Multidimensional Acculturation Scale (AAMAS). The results of 3 separate studies provide strong evidence of the instrument's reliability and validity. The principles for the development of the AAMAS were orthogonality of cultural dimensions, inclusion of a pan-ethnic Asian American dimension, and ease of use across ethnic groups. Exploratory and confirmatory factor analyses indicate that within each cultural dimension (AAMA S-Culture of Origin, AAMAS-Asian American, and AAMAS-European American) there are 4 reliable acculturation domains of cultural identity, language, cultural knowledge, and food consumption. These features of the AAMAS allow for a more complex assessment of acculturation level of Asian Americans and its relationship to psychological functioning. [ABSTRACT FROM AUTHOR]

On the basis of data from 2 studies with counseling graduate students, the Multicultural Awareness, Knowledge, and Skills Survey-Counselor Edition (M. D'Andrea, d. Daniels, & R. Heck, 1991) was revised. The new 33-item instrument consists of 10-item Awareness, 13-item Knowledge, and 10-item Skills subscales. Evidence of reliability and validity are described. [ABSTRACT FROM AUTHOR]

Counselor's multicultural counseling competence (attitudes/beliefs, knowledge, and skills) has been highlighted as an important ingredient in creating positive counseling outcomes when the clients are ethnic and racial minorities. The use of experiential activities in general, and games in particular, is presented as a potentially useful strategy to instill and enhance multicultural competence in counselor trainees. Illustrative games and guidelines for implementation are described. [ABSTRACT FROM AUTHOR]

After completing a measure of adherence to Asian cultural values, 62 East Asian American clients talked about personal issues in a counseling session with a European American counselor who either disclosed personal information or refrained from disclosing personal information. Disclosure condition and client adherence to Asian values did not predict session outcome. However, type and intimacy of disclosure were related to immediate process and session outcome. Disclosures of strategies were perceived by the clients to be more helpful than disclosures of approval/reassurance, facts/credentials, and feelings, with disclosures of insight perceived as intermediate in helpfulness. Disclosures of strategies occurred more frequently in highly rated sessions than in sessions rated low. Also, client-and counselor-perceived intimacy of disclosures was significantly correlated with client- and counselor-perceived helpfulness of disclosures, respectively. [ABSTRACT FROM AUTHOR]

Adaptation experiences of 1.5-generation Asian American college students (N = 10) were examined using the consensual qualitative research method. Results indicated 4 domains of adaptation experiences: preimmigration experiences, acculturation and enculturation experiences, intercultural relationships, and support systems. Participants reported that English proficiency played a significant role in their initial adjustment. Currently, most of the participants reported feeling identified with both the U.S. and Asian cultures. Some participants reported having experienced racism in the past. Many participants noted that they currently have no difficulty establishing friendships with culturally different persons. Participants reported currently feeling most close to friends of a similar background and that they usually seek support from friends, family, and religious organizations, but not from a psychologist or counselor. [ABSTRACT FROM AUTHOR]

Five Asian American and 5 European American female counselors each saw 3 Asian American volunteer clients for 1 session of career-focused individual counseling. Examination of counselor nonverbal behaviors revealed that European American counselors displayed significantly greater frequency of adaptors, postural shifts, and smiles than did Asian American counselors. The frequency of smiles was significantly positively correlated with client-rated session positivity and session arousal, and the frequency of postural shifts was significantly positively correlated with client-rated session arousal. Limitations and implications of the findings are described. [ABSTRACT FROM AUTHOR]

Treatment rationales for 2 widely used and empirically supported interventions, cognitive therapy (CT) and time-limited dynamic psychotherapy (TLDP), were examined for their perceived credibility among 136 Asian American college students. This study conducted a comprehensive analysis of culturally based variables (often assumed to underlie ethnicity) and their related effects on credibility perceptions. Variables assessed included cultural identity, self-construals, values, and mental health beliefs. Participants were randomly assigned to read either a CT or TLDP treatment rationale for depression and then rated the credibility of the interventions. Results indicated that cultural identity and self-construals moderated credibility ratings across CT and TLDP rationales. Findings underscore the importance of moving beyond ethnic group analyses to the examination of specific culturally based variables. [ABSTRACT FROM AUTHOR]

Presents a study in which Asian American college students who were experiencing career uncertainty engaged in a vocational guidance session with a European American female counselor who focused on either immediate problem resolution or insight attainment. Counselor emphasis on client expression of cognition or emotion; Asian American client adherence to Asian cultural values; Cross-cultural competence.

Investigates the relationship among Asian American client adherence to Asian cultural values, counselor expression of cultural values, counselor ethnicity and career counseling process. Comparison of adherence evaluation result on Asian cultural values than American values; Social influences of counseling process; Emphasis of analogue validity.

Using data on 570 Chinese, Filipino, Korean, and Japanese American college students from 3 previous studies (1 published [B. S. K. Kim, D. R. Atkinson, & P. H. Yang, 1999] and 2 unpublished [B. S. K. Kim, 1999; E. C. Wong, B. S. K. Kim, N. W. S. Zane, I. J. Kim, & J. S. Huang, 1999]), the authors subjected 22 items constituting 6 value dimensions of the Asian Values Scale (AVS; B. S. K. Kim et al., 1999) to the following structural equation modeling procedures: confirmatory factor analysis, factorial invariance analysis, and structured means analysis. The results of confirmatory factor analysis provided support for a hierarchical factor model when this model was compared with 2 competing models. The results of factorial invariance analysis indicated that the meanings of the factors within the hierarchical model were conceived similarly among the 4 Asian American ethnic groups. On the basis of these results, a structured means analysis was conducted, revealing similarities and differences between the ethnic groups' adherence to 6 cultural value dimensions. Implications regarding psychological services for these Asian Americans are discussed, and suggestions for future research are offered. [ABSTRACT FROM AUTHOR]

Presents information on a study which featured a scale for measuring ethnic cultural values of Asians. Details on the development of the Asians Values Scale (AVS); Comparison of AVS scores to scores on the Individualism-Collectivism Scale; Methods.

Discusses the results of two surveys investigating support for psychologists' roles advocated by three-dimensional (3-D) model of multicultural counseling. Helpfulness ratings of Asian American university students and multicultural psychologists; Consistent preference for roles as facilitator of indigenous support systems and consultation.

Presents a study which speculated the possible relationship between university students' knowledge of and attitudes toward homosexuality in the United States. Indication that societies are accepting gay and lesbian people; Details on the methodology used to conduct the study; Discussion based on the results of the study.

Actinomyces europeaeus and Actinotignum schaalii are two facultative anaerobes that are common contaminants of human flora; namely the urinary tract, the female genital tract and the gastrointestinal tract. A. europeaeus has been linked with abscesses, decubitus ulcers and purulent urethritis, while A. schaalii has been associated with urinary tract infections, bacteremia and Fournier's gangrene. Here we present a case report of an 84-year-old female patient found to have a necrotizing soft tissue infection caused by A. europeaeus and A. schaalii. To our knowledge, this is the first case report that documents A. europeaeus as a causal agent of a necrotizing infection. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss various reports within the issue on topics including smart home automation and entertainment, the Internet of Things in the home, and consumer awareness of home automation products.

Purpose: The effective use of patient-reported outcomes (PROs) can play a critical role in improving health care delivery and patient experience with care. However, PROs are not widely collected and used in clinical practice. This study aims to understand current opportunities and challenges with the use of PROs and the potential for health information technology (IT) to advance their use.Methods: The Agency for Healthcare Research and Quality held two technical expert panel (TEP) meetings to discuss the current use of PROs, challenges, and opportunities in implementation, and how health IT can be leveraged to support effective PRO use in clinical practice. Results were synthesized to identify major themes and takeaways based on different stages of PRO data utilization.Results: Findings from the TEP meetings indicated varying degrees of PRO usage in ambulatory care settings. Practices often lack a business case to collect PROs. Primary care physicians face more challenges than specialists in selecting appropriate PRO measures due to extensive variation in their patient populations. Providers also need training to use PRO data for shared decision making and population health management. Potential research areas to address PRO implementation challenges include measures harmonization, implementation process and workflow, electronic data collection and integration, and user-friendly data displays.Conclusions: Opportunities exist during different stages of PRO implementation to advance the use of PROs in clinical practice. Health IT can be utilized to address challenges in data collection, integration, and visualization to make PRO data accessible and understandable to patients and providers. [ABSTRACT FROM AUTHOR]

Abstract Objectives: This study assessed undergraduates’ sleep in Hawaiʻi during the COVID-19 pandemic and whether demographic characteristics, health locus of control, substance use and campus features related to sleep outcomes. Implications are considered for programs to support students’ sleep and health during pandemic conditions. Participants: About 1,288 undergraduate students from six universities in Hawai’i. Methods: Surveys assessing sleep, emotional wellbeing, ethnicity, body mass index, locus of health control, and substance use. Results: Students’ reported increased sleep time but decreased sleep quality during the pandemic. Sleep disruption related to anxiety, depression, ethnicity, substance use, BMI, health locus of control, class rank, and whether students lived at home. All campuses were associated with disrupted sleep, regardless of size, location, religious affiliation, term structure, or method of instruction. Conclusions: In response to public health crises, such as the COVID-19 pandemic, all Hawaiʻi universities should screen students for sleep disruption, emotional adjustment, social isolation and substance misuse. Programs to promote sleep and behavioral health appear particularly warranted for graduating seniors, Pacific Islanders, students with high BMI, and students who commute to college. [ABSTRACT FROM AUTHOR]

Ozone (O3) is a flash memory controller that increases the performance of a flash storage system by executing multiple flash operations out of order. In the O3 flash controller, data dependencies are the only ordering constraints on the execution of multiple flash operations. This allows O3 to exploit the multichip parallelism inherent in flash memory much more effectively than interleaving. The O3 controller also provides a prioritized handling of flash operations, equipping flash management software, such as the FTL (flash translation layer), with control knobs for managing flash operations of different time criticalities. Running a range of workloads on an FPGA implementation showed that the O3 flash controller achieves 3 to 100 percent more throughput than interleaving, with 46 to 88 percent lower response times. [ABSTRACT FROM AUTHOR]

In April 2021, The Association for Assessment and Research in Counseling Executive Council commissioned a time-referenced task group to revise the Responsibilities of Users of Standardized Tests (RUST) Statement (3rd edition) published by the Association for Assessment in Counseling (AAC) in 2003. The task group developed a work plan to implement a recursive process for document review, gap analysis, commentary representation, bias accounting, and content revision. While some updates to the document were minor, several substantive enhancements to the structure were made including a re-defined scope, definition of terms, and identification of values that are considered integral across all of the responsibilities. In addition the task group identified and included several updates to the document that are consistent with contemporary representations of evidence for test score validity/reliability and emphases on culturally responsive test administration, variance in score representation, training and supervision, use of technology-mediated testing platforms, and differential consequences of testing. [ABSTRACT FROM AUTHOR]

Introduction: The incidence and presentation of hiatal hernias after esophagectomy (HHAE) are not well characterized, and may be changing with increased survival from esophageal cancer. The aims of this study were to define the incidence and presentation of HHAE in our population of patients undergoing transhiatal esophagectomy (THE), as it may have implications for management.Methods: A retrospective cohort study (2004-2013) was performed of esophageal cancer patients who underwent THE. To determine the presence or absence of HHAE independent of the original radiology report, a radiologist sub-specializing in body imaging independently reviewed post-operative computed tomography images. A time-to-event competing risk analysis was performed to estimate the cumulative incidence of HHAE.Results: Among 192 patients, the two-year cumulative incidence of HHAE was 14 % (95 % confidence interval 7.5-21 %). Of the 22 patients determined to have HHAE by independent expert radiologist review, only 11 (50 %) were identified by the original interpreting radiologist. Seven patients were symptomatic, and each underwent hiatal hernia repair (4 via laparotomy, 3 via laparoscopy).Conclusion: HHAE is not rare and is often unrecognized. As more patients with esophageal cancer survive, the number of patients becoming symptomatic and requiring repair may also rise. Therefore, it is important to consider this diagnosis when following patients long-term after esophagectomy. [ABSTRACT FROM AUTHOR]