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Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.

BackgroundAcross the United States, substance use disorder (SUD) treatment programs vary in terms of tobacco-related policies and cessation services offered. Implementation of tobacco-related policies within this setting can face several barriers. Little is known about how program leadership anticipate such barriers at the pre-implementation phase. This study used the Consolidated Framework for Implementation Research (CFIR) during the pre-implementation stage to identify factors that may influence the implementation stage of tobacco-related cessation policies and services in residential SUD programs.MethodsWe conducted semi-structured qualitative interviews with sixteen residential treatment program directors in California. The analysis was guided by a deductive approach using CFIR domains and constructs to develop codes and identify themes. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts.FindingsThemes that arose as anticipated facilitators for implementation included the relative advantage of the intervention vs. current practice, external policies/incentives to support tobacco-related policy, program directors' strong commitment and high self-efficacy to incorporate cessation into SUD treatment, and recognizing the importance of planning and engaging opinion leaders. Potential barriers included the SUD recovery culture, low stakeholder engagement, organizational culture, lack of workforce expertise, and lack of reimbursement for smoking cessation services.ConclusionTo support successful implementation of tobacco-related organizational change interventions, staff and clients of residential SUD programs require extensive education about the effectiveness of evidence-based medications and behavioral therapies for treating tobacco dependence. Publicly funded SUD treatment programs should receive support to address tobacco dependence among their clients through expanded reimbursement for tobacco cessation services.

International kindergartens, which offer an immersive dual-language (English and Chinese) environment, are popular among middle-class families in Hong Kong. The international learning and teaching environment is cultivated primarily by developing a diverse workforce, in which Chinese-speaking (Putonghua and/or Cantonese) teachers with local training or from mainland China generally work with their English-speaking counterparts from overseas in the same classroom. Such heterogeneity has complicated the already challenging concept of collaborative teaching. This article presents a case study of the collaborative teaching practice in a trilingual international kindergarten which had been established for over 50 years. Through in-depth interviews, questionnaires, text messaging, document analysis, site visits, and observations, the study examined the collaborative teaching practices among international colleagues in the kindergarten. The findings revealed that collaboration among international colleagues was made successful by: (1) senior management and teachers sharing a common goal; (2) a dynamic whole-school supportive structure that embraced heterogeneity; and (3) the development of a shared culture of professional learning. The implications of these findings for management, practice, and research are discussed, including the need to foster a culture of collaboration, the importance of professional development, and the need for further research on collaborative teaching practices in diverse educational settings.

State and local health departments established the California Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Respiratory Virus Sentinel Surveillance System to conduct enhanced surveillance for SARS-CoV-2 and other respiratory pathogens at sentinel outpatient testing sites in 10 counties throughout California, USA. We describe results obtained during May 10, 2020‒June 12, 2021, and compare persons with positive and negative SARS-CoV-2 PCR results by using Poisson regression. We detected SARS-CoV-2 in 1,696 (19.6%) of 8,662 specimens. Among 7,851 specimens tested by respiratory panel, rhinovirus/enterovirus was detected in 906 (11.5%) specimens and other respiratory pathogens in 136 (1.7%) specimens. We also detected 23 co-infections with SARS-CoV-2 and another pathogen. SARS-CoV-2 positivity was associated with male participants, an age of 35-49 years, Latino race/ethnicity, obesity, and work in transportation occupations. Sentinel surveillance can provide useful virologic and epidemiologic data to supplement other disease monitoring activities and might become increasingly useful as routine testing decreases.

BackgroundDespite disproportionately high rates of smoking among people in residential substance use disorder (SUD) treatment, few receive tobacco cessation services. Little is known about how smoking among treatment staff may impact this disparity. We explored the relationship between staff tobacco use and client tobacco use. Additionally, we examined the relationship between staff tobacco use and tobacco-related services reported by staff and clients.MethodsStaff (n = 363) and clients (n = 639) in 24 California publicly-funded residential SUD treatment programs were surveyed in 2019-20. Staff self-reported current tobacco use, as well as their beliefs, self-efficacy, and practices regarding smoking cessation. Clients reported their tobacco use and they services received while in treatment. Regression analyses examined the adjusted and unadjusted associations between staff and client tobacco use and other outcomes.ResultsUse of any tobacco product by staff ranged from 0% to 100% by program, with an average of 32% across programs. Adjusted analyses found that higher rates of staff tobacco use were associated with higher rates of client tobacco use, and with fewer clients receiving tobacco-related counseling. In programs that had higher rates of staff tobacco use, staff were less likely to believe that clients should quit smoking in treatment and had lower self-efficacy to address smoking.ConclusionHigher rates of tobacco use among staff are associated with higher rates of client tobacco use and fewer clients receiving cessation counseling. Efforts to reduce tobacco use among SUD clients should be supported by efforts to reduce tobacco use among staff. SUD treatment programs, and agencies that fund and regulate those programs, should aim to reduce the use of tobacco products among staff.

IntroductionThe COVID-19 pandemic may present special challenges for residential substance use disorder (SUD) treatment facilities, which may lack infrastructure and support to implement infection control protocols while maintaining on-site treatment services. However, little is known about how residential SUD treatment programs are impacted by the COVID-19 pandemic.MethodsThe research team conducted semi-structured interviews with 17 directors of 20 residential SUD treatment programs across California during the state's shelter-in-place order. The researchers then analyzed qualitative interview data thematically and coded them using ATLAS.ti software.FindingsThematic analyses identified six major themes: program-level impacts, staff impacts, client impacts, use of telehealth, program needs, and positive effects. "Program-level impacts" were decreased revenue from diminished client censuses and insufficient resources to implement infection control measures. "Staff impacts" included layoffs, furloughs, and increased physical and emotional fatigue. "Client impacts" were delayed treatment initiation; receipt of fewer services while in treatment; lower retention; and economic and psychosocial barriers to community re-entry. "Use of telehealth" included technical and interpersonal challenges associated with telehealth visits. "Program needs" were personal protective equipment (PPE), stimulus funding, hazard pay, and consistent public health guidance. "Positive effects" of the pandemic response included increased attention to hygiene and health, telehealth expansion, operational improvements, and official recognition of SUD treatment as an essential health care service.ConclusionStudy findings highlight COVID-related threats to the survival of residential SUD treatment programs; retention of the SUD treatment workforce; and clients' SUD treatment outcomes. These findings also identify opportunities to improve SUD service delivery and suggest avenues of support for residential SUD treatment facilities during and after the COVID-19 pandemic.

This paper critically examines parents' and service providers' reception of the Pre-primary Education Voucher Scheme (PEVS), which was designed to enhance the quality of early childhood education in Hong Kong. The PEVS was a universal voucher policy that was designed to harness market forces and increase direct governmental control of quality in a private education market wherein pre-academic training and competition are emphasized. This paper presents the results of a survey of 413 parents and 215 service providers. Findings indicated that despite the government's efforts in promoting quality as 'child-centeredness' and the efforts of preschools in meeting the quality standards, parents remained relatively neutral about the policy's influence on preschool quality. However, all parents appreciated the financial benefits they accrued from the PEVS, and more socially-advantaged families allocated the additional disposable income on extra educational activities and programs for their children. Findings suggest the implementation of the PEVS in a fully private market might unexpectedly exacerbate inequity in educational opportunities. The enrolment size of the preschool was also found to be a determinant of respondents' views of the PEVS. We argue the government's idea of 'joyful learning' may be even harder to achieve with the current means of service governance.

A long-neglected sector in education, early childhood education (ECE) in Hong Kong has generated much attention in recent years following the government's heavy promotion as laying the foundation for lifelong learning and all-round development. Enhancing 'teacher professionalism' by raising qualifications and remuneration is seen as a vehicle to achieve quality ECE. While the once lowly perceived occupation is now 'in fashion' among college applicants, little is known about how prospective teachers view ECE teachers' professionalism in Hong Kong. This study explored the views of 175 Hong Kong pre-service ECE teachers from 7 teacher education institutions using self-administered, open-ended survey questionnaires. The results showed that the pre-service ECE teachers generally described Hong Kong ECE teachers positively and viewed them as professionals. However, they also revealed a sharp dissonance between the participants' own perception and society's perception of the professionalism of ECE teachers due to the different emphases they used to define professionalism when shifting their perspectives. The results reflect a generally pessimistic view of the pre-service teachers on teaching in ECE as a career. Implications and suggestions for government policies, ECE teacher training, and research are discussed.

Aims: Continuous glucose monitoring (CGM) systems are standard of care for youth with type 1 diabetes with the goal of spending >70% time in range (TIR; 70–180 mg/dL, 3.9–10 mmol/L). We aimed to understand paediatric CGM user experiences with TIR metrics considering recent discussion of shifting to time in tight range (TITR; >50% time between 70 and 140 mg/dL, 3.9 and 7.8 mmol/L). Methods: Semi‐structured interviews and focus groups with adolescents with type 1 diabetes and parents of youth with type 1 diabetes focused on experiences with TIR goals and reactions to TITR. Groups and interviews were audio‐recorded, transcribed and analysed using content analysis. Results: Thirty participants (N = 19 parents: age 43.6 ± 5.3 years, 79% female, 47% non‐Hispanic White, 20 ± 5 months since child's diagnosis; N = 11 adolescents: age 15.3 ± 2 years, 55% female, 55% non‐Hispanic White, 16 ± 3 months since diagnosis) attended. Participants had varying levels of understanding of TIR. Some developed personally preferred glucose ranges. Parents often aimed to surpass 70% TIR. Many described feelings of stress and disappointment when they did not meet a TIR goal. Concerns about TITR included increased stress and burden; risk of hypoglycaemia; and family conflict. Some participants said TITR would not change their daily lives; others said it would improve their diabetes management. Families requested care team support and a clear scientific rationale for TITR. Conclusions: The wealth of CGM data creates frequent opportunities for assessing diabetes management and carries implications for management burden. Input from people with type 1 diabetes and their families will be critical in considering a shift in glycaemic goals and targets. [ABSTRACT FROM AUTHOR]

This pilot study evaluated a novel psycho-educational group intervention addressing sexuality and intimacy issues among male heterosexual individuals with mental health conditions. Despite the universal need for fulfilling relationships, stigma and lack of support often distort views and promote high-risk behaviors in this population. A cognitive-behavioral framework was used in a six-session program to enhance knowledge and promote healthy sexuality among six participants recruited from an integrated vocational rehabilitation service center in Hong Kong. Quantitative pre- and post-testing alongside qualitative observations revealed that participants significantly improved their understanding of relationships, communication skills, and ability to identify safe practices. Limitations included the small, exclusively heterosexual male sample and evaluation methods. As sexuality is an important yet under-researched topic impacting this population's quality of life, these findings suggest structured group interventions may equip individuals with adaptive tools for intimacy. However, larger trials with expanded curricula are needed to validate this approach. [ABSTRACT FROM AUTHOR]

The practice of documentation has been a "hard to reach place" for many preschool teachers despite the fact that it has largely been encouraged and used as a tool in early childhood settings to assess young children's learning. Recent policy changes in Hong Kong have also called for the continuous documentation and authentic assessment of children's performance to replace traditional examinations in preschools. In this study, 62 preschools in Hong Kong were surveyed to determine the current situation of documentation as a tool for assessment of children's learning in Hong Kong preschools in the face of the new governmental requirements and interventions. The results showed that (1) preschools generally recognized the importance and necessity of using documentation to assess children's learning, (2) governmental influences were clearly demonstrated in the learning areas documented and assessed, and (3) there was a dissonance between the practice and belief of preschools, and various concerns related to the implementation were also reported. Implications for policies, professional development, and research are discussed.

Aims: Both parent and adolescent involvement in type 1 diabetes management are critical during adolescence. The current study sought to understand the factors associated with parent and adolescent satisfaction with their own and one another's involvement in diabetes management. Methods: Cross‐sectional baseline data from 157 parent‐adolescent dyads enrolled in an RCT were used. Adolescent ages ranged from 12 to 19 (Mage = 14.7, SD = 1.89) and were balanced by gender (50.3% male). Paired t‐tests examined concordance between parent and adolescent satisfaction, bivariate correlations identified correlates, and regressions examined unique associations. Results: Roughly, 43% of adolescents and 29% of parents were very satisfied with adolescent involvement in diabetes management, whereas 71% of adolescents and 26.1% of parents were very satisfied with parent involvement. Indicators of better glycaemic health (via higher percent time‐in‐range and lower HbA1c and percent time in hyperglycaemia) and psychosocial functioning (less diabetes distress and depression) were correlated with higher satisfaction. Parent satisfaction with adolescent involvement was higher among older adolescents (R = 0.198, p = 0.013). Non‐Hispanic white youth were more satisfied with their own involvement than youth of colour (t(149) = −2.783, p = 0.003). Both percent time‐in‐range and one's own diabetes distress uniquely related to parent and adolescent satisfaction with adolescent involvement. Conversely, parent satisfaction with their own involvement was only uniquely associated with parent diabetes distress. Conclusion: Both adolescent and parents' satisfaction with adolescents' involvement in self‐management are indicators of both glycaemic control and psychosocial well‐being, whereas parents' self‐evaluations are more closely tied to diabetes‐specific distress. [ABSTRACT FROM AUTHOR]

Early-maturing girls are at risk for internalizing and externalizing problems. Research concerning pubertal timing and mental health among Mexican Americans or the influence of parenting behaviors on these relations has been scarce. This study addressed these gaps. This was a prospective examination of 362 Mexican-origin girls and their mothers in 3 waves of data. Measures included girls self-report of pubertal development and girls and mothers report of maternal harsh parenting and daughters mental health. Using structural equation modeling, we examined whether pubertal timing in 5th grade predicted girls internalizing and externalizing outcomes in 10th grade. We also examined the mediating and moderating effects of harsh parenting on the relations between pubertal timing and internalizing and externalizing behaviors, as well as the influence of mothers and daughters nativity on these relations. Results differed depending on reporter and maternal nativity. Using daughters report, we found that Mexican American mothers harsh parenting acted as a moderator. At high levels of harsh parenting, early pubertal timing predicted higher externalizing scores, while at low levels of harsh parenting, early timing predicted lower externalizing scores. For Mexican immigrant mothers, harsh parenting mediated the effects of pubertal timing on girls internalizing and externalizing problems. There were no significant pubertal effects for mothers report. Findings suggest that maternal harsh parenting plays a key role in the relations between early pubertal timing and behavioral and emotional outcomes among Mexican-origin girls.

Despite increased governmental support and attention, improved collaboration with community-based professionals, and enhanced teacher knowledge and training in Hong Kong, studies continue to reveal the unreadiness or even resistance of kindergarten teachers to include children with special educational needs (SENs) in their classrooms. This study aimed to unveil the possible reasons behind such unreadiness and resistance among trained early childhood teachers. The research team interviewed four early childhood educators from Hong Kong with various positions, experiences, and standpoints to explore their perspectives on pre-service teacher education and practicums in preparing teachers to support children with SENs. The results indicated that, while trainee teachers had the necessary knowledge to work with children with SENs, they lacked opportunities and support to apply and connect theory to practice during their practicums. This could be due to constraints such as being assigned passive roles by mentors and trainees’ own complacency. Implications and recommendations for improving future pre-service programmes are discussed to better prepare teachers for inclusion. The analysis contributes an ecological perspective by investigating experiential learning as negotiated within dynamic sociocultural and structural forces, furthering understanding of influences shaping competence development. [ABSTRACT FROM AUTHOR]

In the face of the rising tension between Hong Kong and mainland China, Hong Kong's Chief Executive Carrie Lam blamed the city's education system for its inability to develop a sense of 'I am Chinese' national identity and vowed to step up 'national education' from preschool. This article explores how 188 young preschool teachers perceived their national identity and viewed the applicability of national education in Hong Kong preschools. Data were collected using both quantitative and qualitative measures. The findings showed that even though the participants strongly resisted their Chinese identity, they agreed that national education could be introduced in preschools if it would be rendered rational and apolitical. Nevertheless, they suspected that the administration's motive behind national education was political indoctrination. They also noted several pedagogical difficulties. Finally, the implications are discussed against the changing socio-political context, serving as lessons for local and international readers. [ABSTRACT FROM AUTHOR]

Early-maturing girls are at risk for internalizing and externalizing problems. Research concerning pubertal timing and mental health among Mexican Americans or the influence of parenting behaviors on these relations has been scarce. This study addressed these gaps. This was a prospective examination of 362 Mexican-origin girls and their mothers in 3 waves of data. Measures included girls' self-report of pubertal development and girls' and mothers' report of maternal harsh parenting and daughters' mental health. Using structural equation modeling, we examined whether pubertal timing in 5th grade predicted girls' internalizing and externalizing outcomes in 10th grade. We also examined the mediating and moderating effects of harsh parenting on the relations between pubertal timing and internalizing and externalizing behaviors, as well as the influence of mothers' and daughters' nativity on these relations. Results differed depending on reporter and maternal nativity. Using daughters' report, we found that Mexican American mothers' harsh parenting acted as a moderator. At high levels of harsh parenting, early pubertal timing predicted higher externalizing scores, while at low levels of harsh parenting, early timing predicted lower externalizing scores. For Mexican immigrant mothers, harsh parenting mediated the effects of pubertal timing on girls' internalizing and externalizing problems. There were no significant pubertal effects for mothers' report. Findings suggest that maternal harsh parenting plays a key role in the relations between early pubertal timing and behavioral and emotional outcomes among Mexican-origin girls.

This study investigated question acquisition in Cantonese-speaking young children with a focus on the development of interrogative forms and functions. Data from a child Cantonese corpus (492 children aged 36, 48 and 60 months) were analysed. The main results were that: (1) all the interrogative forms and functions were produced by the three age groups and no age difference was found; (2) significant gender differences in favour of females were found; and (3) a significant form-function preference was obtained, with "wh"- and multiple questions being primarily used to seek information, and "yes/no" and rising tone/echo questions being largely used to request action.

Existing work has identified perceived discrimination as a risk factor that may contribute to the relatively poorer academic outcomes exhibited by Mexican-origin adolescents in the U.S. The current study examined the longitudinal associations among perceived discrimination and three indices of adolescent adjustment in the school setting (i.e., grade point average, teacher reports of externalizing, adolescents' deviant peer associations) among 178 Mexican-origin adolescents (53% female). Ethnic identity affirmation was examined as a protective factor expected to reduce the negative effects of discrimination on adolescents' adjustment, and gender was examined as a potential moderator of the associations of interest. Findings indicated that the deleterious effects of discrimination on adolescents' adjustment in school were particularly salient for Mexican-origin male adolescents. Importantly, ethnic identity affirmation emerged as a protective factor for Mexican-origin male adolescents by buffering the negative effects of discrimination on their externalizing behaviors in school. (Contains 3 tables and 3 figures.)

Two waves of reform have been conducted in China since the 1980s to transform its early childhood curriculum into a Western-style, progressive model. Western curricula and programs such as the Montessori method, the project approach, the Reggio Emilia method, and the high/scope method have been imported and adopted all over the country. But the top-down reforms and these "imported" ideas have been challenged by scholars and practitioners. Aiming to understand how practices in kindergartens measure up with the reform objectives, the present study investigated the teachers' beliefs and practices in five Shenzhen kindergartens' literacy instruction. Altogether, ten early childhood classrooms were observed for one school week, and the ten classroom teachers were interviewed about the observed Chinese teaching practices. The teachers and teaching assistants of the ten classes (N = 20) were also surveyed about their teaching beliefs and practices. The results indicated a remarkable belief-practice gap as well as a policy-practice gap. Most of the curriculum reform ideas were expressed by the teachers in their self-reported beliefs but had not been implemented in their teaching practice. The traditional Chinese model with the teacher directing the whole-class session was still dominating. Slight differences were also found among the ten classes, which reflect the cascading effects of curriculum reform. These findings suggest that curriculum reforms should take into consideration the culture, language, teachers, parents, resources available, and the prevailing education system. (Contains 1 figure and 2 tables.)

Hong Kong launched the "Pre-primary Education Voucher Scheme" (PEVS) in 2007 to promote the "3A's" of early childhood education (ECE): affordability, accessibility, and accountability. The PEVS has three unique features: discriminating against profit kindergartens, promoting teacher professional development, and limiting parents' choice to only non-profit schools. To understand the voucher scheme's perceived impacts, this study conducted stratified random sampling to include 10% of Hong Kong kindergartens and surveyed their parents, principals, and teachers. A total of 380 completed questionnaires were collected and analyzed, and the results indicated that (1) the majority of the respondents perceived positive impacts on the 3A's of ECE; (2) significant effects of stakeholders (parents, teachers and principals), school types (profit or non-profit), eligibility, and familiarity were found in between- and within-group comparisons; (3) the parents and especially those from non-profit/eligible kindergartens tended to perceive more positive impacts than others; and (4) the principals and teachers reported some implementation difficulties. Implications for voucher reform in others countries are discussed. (Contains 4 tables.)

Educational authorities in the Hong Kong Special Administrative Region (HKSAR) of China introduced an early childhood education voucher system in 2007 with two implicit goals: to turn profit kindergartens into non-profit ones and to curtail parental choice. This initiative has caused a great deal of controversy locally and internationally, so the development of the voucher theory and practice in the Chinese context has become an interesting case to study. To investigate public views in Hong Kong on how well this voucher scheme adapts to local needs and to the local context, we collected Internet posts and analysed all the views presented in both Chinese and English virtual communities. Content and statistical analyses were conducted on the search results, and it was found that (1) there is overwhelming support for the voucher system; and (2) there is a range of opposing or supporting opinions and rationales on the two implicit goals. Based on the results, this unique Hong Kong voucher scheme is judged to be a rationally localised development of the voucher theory. The sociocontextual factors that shape the policy-making process are discussed, and the implications of this policy beyond Hong Kong and the field of ECE are also addressed. (Contains 4 footnotes.)