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Introduction: Advancements in therapy have led to dramatic increases in the life expectancy of patients with cystic fibrosis (CF). As survival improves, young women with CF will have expectations for their sexual and reproductive health (SRH) futures similar to their counterparts without CF. As they face unique CF-specific SRH concerns, they may rely on CF care providers for disease-specific SRH care provision. The purpose of this study was to investigate the attitudes of CF providers toward female SRH and perceived barriers in the current CF care model. Materials and Methods: U.S. CF program directors (n=16) participated in qualitative interviews investigating attitudes and barriers to female CF SRH care. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Results: Participants (nine pediatric, five adult, and two combined) all agreed CF providers have a fundamental role in CF female SRH care. Most respondents named lack of time and patient and provider discomfort as significant barriers to effective SRH communication. Other reported barriers included: lack of training in SRH, family members in the room, low priority of SRH in setting of other CF issues, and lack of adequate rapport with patients. Discussion: This is the first study to assess the attitudes and experiences of CF care providers toward SRH discussion and care among female CF patients. Despite their perceived fundamental role in CF female SRH care, CF providers face significant barriers. Investment in provider training is needed to better address the complex SRH needs of young female patients. © 2015 Wiley Periodicals, Inc. Source

Weaver M.S.,Tennessee | Reeve B.B.,University of North Carolina at Chapel Hill | Baker J.N.,Tennessee | Martens C.E.,University of North Carolina at Chapel Hill | And 6 more authors.
Cancer | Year: 2015

BACKGROUND: Symptoms arising from disease or treatment are subjective experiences. Insight into pediatric oncology treatment side effects or symptoms is ideally obtained from direct inquiry to the ill child. A concept-elicitation phase in a patient-reported outcome (PRO) instrument design provides an opportunity to elicit children's voices to shape cancer symptom selection and terminology. METHODS: Through semistructured, one-on-one, voice-recorded interviews, symptom data were collected from 96 children with cancer between the ages of 7 and 20 years who were undergoing oncologic treatment at 7 pediatric oncology sites in the United States and Canada. RESULTS: The mean number of symptoms reported per child over the prior 7 days was 1.49 (range, 0-7; median, 1; standard deviation, 1.56). The most common symptoms across all age groups were tiredness or fatigue, nausea or vomiting, aches or pains, and weakness. There was not a statistically significant correlation between self-reported wellness and the number of reported symptoms (r=-0.156, n=65, P=.215) or the number of symptoms reported by age group or diagnosis type. Forty participants reported experiencing a change in their body in the past week, with one-third of these changes unanticipated. Only through direct questions about feelings were emotional symptoms revealed because 90.6% of interviewees who discussed feelings (48 of 53) did so only in the context of direct questioning on feelings. Adolescents were more likely than younger children to discuss feelings as part of the interview. CONCLUSIONS: Concept elicitation from children and adolescents has the potential to enable researchers to develop age-appropriate, accurately representative PRO measures. © 2015 American Cancer Society. Source

Twenty species of the paradoxosomatid millipede genus Dicladosomella Jeekel, 1982 have been identified to date, including the 18 species newly described here. Dicladosomella modesta Jeekel, 2007 and Dicladosomella segmentata Jeekel, 1982 are redescribed and illustrated here so that they may be better compared with the new species: D.abstrusa sp. nov., D.anaticula sp. nov., D.apparitor sp. nov., D.arida sp. nov., D.cerberus sp. nov., D.claridgei sp. nov., D.coctilicia sp. nov., D.cygnea sp. nov., D.fagina sp. nov., D.georgii sp. nov., D.hippica sp. nov., D.imbrialis sp. nov., D.mesibovi sp. nov., D.oraria sp. nov., D.perplexa sp. nov., D.pollex sp. nov., D.vascula sp. nov. and D.vexillifera sp. nov. © 2015 Australian Entomological Society. Source

D&C | Date: 2015-06-22

Accessories for dolls; party favors in the form of small toys; airplanes toys; toy play wands; balls for games; Christmas stockings decorative articles; dolls feeding bottles; marbles for games; building blocks toys; snow globes; play balls; soap bubbles toys; playing cards; jigsaw puzzles games; kites; rocking horses; dart boards; game consoles; decorations for Christmas trees; play sets for action figures; dice; toy swords; figurines toys; rattles; baby rattles incorporating teething rings; ring games; dominos; parlor games; games; party spinning toys; mechanical motion toys; toys for pushing; crib toys; infant development toys; water-squirting toys; inflatable bath toys; multi-activity toys for babies; musical toys; sand toys; dolls beds; snow sleds for recreational use; puppets; face masks; toy masks; crib mobiles toys; soap bubble making sets; plastic character toys; piatas; water guns; skateboards; dolls; bean bag dolls; jigsaw puzzles; ninepins; scooters toys; toy play tunnels; toy vehicles; radio-controlled toy vehicles; remote-controlled toy vehicles; dolls clothes.

Kashner T.M.,Loma Linda University | Hettler D.L.,Pennsylvania State University | Zeiss R.A.,DC | Aron D.C.,Case Western Reserve University | And 11 more authors.
Health Services Research | Year: 2016

Objective: To assess how changes in curriculum, accreditation standards, and certification and licensure competencies impacted how medical students and physician residents value interprofessional team and patient-centered care. Primary Data Source: The Department of Veterans Affairs Learners' Perceptions Survey (2003-2013). The nationally administered survey asked a representative sample of 56,569 U.S. medical students and physician residents, with a comparison group of 78,038 nonphysician trainees, to rate satisfaction with 28 elements, in two overall domains, describing their clinical learning experiences at VA medical centers. Study Design: Value preferences were scored as independent adjusted associations between an element (interprofessional team, patient-centered preceptor) and the respective overall domain (clinical learning environment, faculty, and preceptors) relative to a referent element (quality of clinical care, quality of preceptor). Principal Findings: Physician trainees valued interprofessional (14 percent vs. 37 percent, p < .001) and patient-centered learning (21 percent vs. 36 percent, p < .001) less than their nonphysician counterparts. Physician preferences for interprofessional learning showed modest increases over time (2.5 percent/year, p < .001), driven mostly by internal medicine and surgery residents. Preferences did not increase with trainees' academic progress. Conclusions: Despite changes in medical education, physician trainees continue to lag behind their nonphysician counterparts in valuing experience with interprofessional team and patient-centered care. © Health Research and Educational Trust. Source

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