Survey of genomic and physiological characteristics for survival in lymphoma: The NCI genomic data portal.

Lymphoma represents a myriad collection of neoplasms that impact lymphocytes. This cancer often involves disrupted cytokine, immune surveillance, and gene regulatory signaling, sometimes with expression of Epstein Barr Virus (EBV). We explored mutation patterns for People experiencing Lymphoma (PeL) in the National Cancer Institute (NCI) Genomic Data Commons (GDC), which contains detailed, deidentified genomic data on 86,046 people who have/had cancer with 2,730,388 distinctive mutations in 21,773 genes. The database included information on 536 (PeL), with the primary focal sample being the n = 30 who had complete mutational genomic data. We used correlations, independent samples t-tests, and linear regression to compare PeL demographics and vital status on mutation numbers, BMI, and mutation deleterious score across functional categories of 23 genes. PeL demonstrated varied patterns of mutated genes, consistent with most other cancer types. The primary PeL gene mutations clustered around five functional protein groups: transcriptional regulatory proteins, TNF/NFKB and cell signaling regulators, cytokine signaling proteins, cell cycle regulators, and immunoglobulins. Diagnosis Age, Birth Year, and BMI negatively (P < 0.05) correlated with Days to Death, and cell cycle mutations negatively correlated (P = 0.004) with survival days (R2 = 0.389). There were commonalities in some PeL for mutations across other cancer types based upon large sequence length, but also for 6 small cell lung cancer genes. Immunoglobulin mutations were prevalent but not for all cases. Research indicates a need for greater personalized genomics and multi-level systems analysis to evaluate facilitators and barriers for lymphoma survival.

The competition of ecological resonances in the quantum metabolic model of cancer: Potential energetic interventions.

Cancer (a) represents an atavistic reversion to attempted asexual reproduction; (b) metastasizes to absorber "soil" tissues based upon temporal, ontogenetic commonalities; (c) cycles/precesses with competitive immunological surveillance and self-competition within the ecological environment of the body; and (d) is potentially manageable via quantum information qubit phase transitions and universal principles of thermodynamic hysteresis and resonant driving forces . We use retro-recognition of evidence-based cancer anomalies to make these arguments, which in sum position cancer as an ecological quantum information problem. The findings reposition the quantum metabolic model of cancer and presents a research approach aimed at applied treatments: Tertiary Lymphoid Structure ecological competition with cellular transmembrane quantum energy boosting using VDAC and other voltage gated ion channels.

Allostatic Load, Mobility Disability, and Viral Effects in Cancer: A Structural Equation Model.

A growing number of cancers have been linked to specific oncogenic viruses and physiological stress. Recently, two separate studies linked mobility limitations to allostatic load and four major cancer types. The objective of this study was to determine if cancer occurrence regresses on three latent domains of Allostatic Load, Level of Physical Functioning (i.e., Mobility Disability), and Viral Exposure. We compared several structural equation models using adult participant (n = 17,969) data from three National Health and Nutrition Examination Survey (NHANES) periods. The primary two-level model with three exogenous latent factors and a single Cancer endogenous latent factor demonstrated a strong fit (GFI = 0.948, RMSEA = 0.024), and the model had a non-significant Chi-Square indicative of a strong model.What is already known on this subjectAllostatic load represents how the body responds to physiological stress and is associated with increased morbidity/mortality, including cancers.Viruses are the causative agents of 15-20% of cancers and can be stress activated.People with mobility limitations experience significantly higher allostatic loads and secondary health conditions, and one recent study indicates a heightened risk for certain cancers.What this study addsThis study is original in its testing of a conceptual model that links together cancer outcomes with latent factors/variables including disability/mobility limitations, allostatic load, and viral exposure.The study indicates that there might be important associations between allostatic load, disability burden, and viral exposure/activation on the occurrence of cancer.The research suggests the need for stress reduction, preventative health interventions, and additional supports for people with disabilities and their caregivers.

Disability and health outcomes in geospatial analyses of Southeastern U.S. county health data.

BACKGROUND: People with disabilities tend to be at risk for secondary conditions. There is a need for comprehensive disability and health databases, including geographic information systems to evaluate trends in health, functioning, and employment. OBJECTIVE: We evaluated county levels in morbidity and mortality across the Southeastern United States using spatial regression, examining 2015 trends in accordance with Healthy People 2020 objectives. METHODS: We merged 2015 National County Health Rankings and the 2015 Social Security Administration's Report on SSDI Beneficiaries, all for n = 1387 Southeastern U.S. county units. We used GeoDa to regress health and disability multivariable models for the dependent variable, age-adjusted Years of Potential Life Lost (YPLL) per 100,000 population. RESULTS: The principal Health/Demographic multivariable model of factors impacting YPLL yielded an adjusted R2 = 0.743 (F = 188.3, p < 0.001) with percentage physically inactive, preventable hospital stays, percentage diabetics, and low college attendance figuring prominently. A Socioeconomic/Demographic multivariable model impacting YPLL yielded R2 = 0.631 (F = 156.0, p < 0.001), with disability and percentage unemployment being major associated variables. CONCLUSIONS: For the Southeastern U.S., counties with higher prevalence of SSDI disability workers correlated with significantly higher YPLL and poorer health outcomes. The research augments CDC Disability and Health GIS systems to measure Healthy People 2020 outcomes for persons with disabilities nationwide. Spatial regression represents a robust approach for improved analysis of geographic data for population health measures.

Biomarkers of chondriome topology and function: implications for the extension of healthy aging.

Multiple theories of aging (e.g., free radical, error catastrophe, mitochondrial) are complementary but fail to provide adequate models that comprehensively predict lifelong aging processes and that are valid across species. Hayflick (PLoS Genet 3(12):2351-2354, 2007) described six universal characteristics of aging that focus upon post-reproductive molecular entropy. Here we present a thermodynamic potential model of aging in which the energetic and topological properties of the mitochondrion drive functional and structural stabilities within living systems. Using multivariate regressions of physiological assessments from the National Health and Nutrition Examination Survey, VO2 max consistently declined with age regardless of gender or race, although it had a significantly greater decline for African American females. Percent fat (negative), hematocrit (negative), and urine creatinine (negative) were strongly and significantly associated with VO2 max and male aging, although cholesterol (positive) was an additional factor for African American males. Bioenergetic measures such as VO2 max can be useful for physical assessments to promote healthy aging.

Heart age differentials and general cardiovascular risk profiles for persons with varying disabilities: NHANES 2001-2010.

BACKGROUND: Persons with disabilities are at risk for secondary conditions, including allostatic load contributing to cardiovascular disease. The General Cardiovascular Risk Profile (GCRP) estimates cardiovascular disease risk for individuals. The GCRP variables are present in the National Health and Nutrition Examination Survey (NHANES) for the Healthy People 2010 decade. OBJECTIVE/HYPOTHESIS: The objective of this study was to compare persons with varying disabilities versus persons without disabilities on GCRP cardiovascular disease risk estimates across the Healthy People 2010 decade. METHODS: Weighted cross-sectional one-way Analyses of Variance (ANOVA) and non-parametric Kruskal-Wallis analyses compared persons with each of eight disability types versus persons without disabilities for point estimate GCRP heart vascular age differential and Cox regression model ten-year risk estimate in each NHANES survey year for 2001-2010. RESULTS: Persons with mobility or vision disabilities had significantly (p < .025) greater ten-year percent risks for cardiovascular disease and negative heart vascular age differentials (with respect to actual age, therefore "older" hearts) than persons without disabilities. The GCRP dual models conflict for certain disabilities (e.g., hearing, physical/mental/emotional) but are consistently reliable measures of GCRP for persons with mobility limitations and vision disabilities. CONCLUSIONS: With higher CVD risk among persons with disabilities, there is a clear need for increased interventions to benefit the health of persons with disabilities. The GCRP represents a valuable, simple measurement that uses routinely collected examination data. Physicians and nurses can use the GCRP to make immediate CVD assessments and to provide point-of-contact counseling to patients with and without disabilities.

Attitudes & effectiveness of professional programs for primary prevention of violence: exploratory validation of the PREVENT primary prevention of violence self-assessment.

The PREVENT (Preventing Violence through Education, Networking, and Technical Assistance) project trained violence practitioners across the USA in Primary Prevention of Violence techniques (PPV). The purpose of this study is to describe the development and psychometric properties of the subscales of the PREVENT PPV Self Assessment. Of 800 participants, 585 responded (73.1%). We analyzed the data using factor analyses, reliabilities and LISREL structural equation measurement models. The Perceived PPV Project Success subscale exhibited a one-factor structure (R2 = .534, X2/df = 1.28, p = .277, GFI = .99, NNFI = .99); PPV Self-Efficacy and Support showed a four-factor structure (R2 = .583, X2/df = 3.7, p = .00, GFI = .94, NNFI = .93); Perceived PPV Collaboration showed a three factor structure (R2 = .544, X2/df = 4.20, p = .00, GFI = .92, NNFI = .93); Anticipated Future PPV Work yielded a three-factor structure (R(2) = .656, X(2)/df = 4.76, p = .00, GFI = .94, NNFI = .91); and PPV Confidence a marginally acceptable two-factor structure (R2 = .759, X2/df = 11.1, p = .00, GFI = .95, NNFI = .99). Perceived PPV Project Success demonstrated very strong predictive validity (χ2/df = 2.33, p = .0167, GFI = .984, RMSEA = .0585) of increased time devoted to PPV. These construct validated subscales represent a rich source of material for assessing professionals' attitudes and perseverance towards personal implementation of PPV. From these results, we recommend specific items from each subscale for further use by PPV trainers.

Cross-sectional changes in patterns of allostatic load among persons with varying disabilities, NHANES: 2001-2010.

BACKGROUND: Allostatic Load (AL) is a measure of physiological stress that correlates with morbidity and mortality. OBJECTIVE: The purpose of this study was to evaluate patterns of AL among persons with each of eight categories of disability versus persons with no disabilities over the 10-year Healthy People 2010 examination period. METHODS: The study examined measures of AL from the 2001-2010 National Health and Nutrition Examination Survey (NHANES). The independent variable was Disability Status (hearing, vision, memory, physical-mental-emotional, walking up 10 steps, bending or kneeling, lifting or carrying, assistive devices, no disability). Eight laboratory and one social AL dependent variables included blood pressure, body mass index (BMI), HDL cholesterol, number of friends, and neutrophil percentages. Weighted statistical analyses included one-way ANCOVA with age as the covariate and chi-square tests. RESULTS: Among respondents, 2.3% had hearing disabilities; 14.0% vision disabilities, 4.6% memory disabilities; 1.5% physical, mental, emotional disabilities; 1.3%, 5.9%, and 3.5% various mobility disabilities; and 5.3% used assistive devices. Persons with disabilities had significantly higher BMI, lower HDL cholesterol, higher C-reactive protein, and higher neutrophil levels than persons without disabilities. Systolic and diastolic blood pressures decreased during the decade, but BMI increased. A range of 36.2-61.0% of persons with non-hearing disabilities exceeded BMI obesity thresholds during 2009, and 13.8-29.9% had fewer than three friends during 2009. CONCLUSIONS: These findings support previous research linking risks for secondary conditions/morbidity and allostatic load while demonstrating associations between disabilities and AL, especially for persons with mobility disabilities.

Exploratory validation of the Fruit and Vegetable Neophobia Instrument among third- to fifth-grade students.

Children's unwillingness to try new foods, or food neophobia, may impact dietary behaviors. As part of an effort to evaluate Farm to School programs, the Fruit and Vegetable Neophobia Instrument (FVNI) was developed to measure student attitudes toward new fruits and vegetables. A self-administered, paper/pencil, 18-item questionnaire, the FVNI was adapted from the Food Neophobia Scale. The FVNI has two subscales: a fruit subscale that asks about a child's willingness to try new fruits in different circumstances and an analogous vegetable subscale. The FVNI was administered to 1485 third-through fifth-grade students (ages 8-10 years) from nine schools in two states at the start of the 2009-2010 school year. Data analysis used factor analyses, reliabilities, and LISREL structural equation models. The FVNI exhibited a two-factor structure and strong measures of model fit (χ(2)/df=5.36; Goodness of Fit=0.92; Adjusted Goodness of Fit=0.89; Non-Normed Fit Index=0.97; RMSEA=0.07; and RMSR=0.052). In this exploratory analysis, the FVNI proved to be internally consistent in assessing third-through fifth-grade students' fruit and vegetable neophobia.

Concurrent validation of CHIRP, a new instrument for measuring healthcare student attitudes towards interdisciplinary teamwork.

Positive attitudes towards teamwork among health care professionals are critical to patient safety. The purpose of this study is to describe the development and concurrent validation of a new instrument to measure attitudes towards healthcare teamwork that is generalizable across various populations of healthcare students. The Collaborative Healthcare Interdisciplinary Planning (CHIRP) scale was validated against the Readiness for Inter-Professional Learning Scale (RIPLS). Analyses included student (n = 266) demographics, ANOVA, internal consistency, factor analysis, and Rasch analysis. The two instruments correlated at r = .582. The CHIRP showed a multifactorial structure having excellent internal consistency (alpha = .850), with 25 of the 36 scale items loading onto a single Teamwork Attitudes factor. The RIPLS likewise had strong internal consistency (alpha = .796) and a three-factor structure, supporting previous studies of the instrument. However, Rasch analyses showed 14 (38.9%) of the 36 CHIRP items, but only four (21.1%) of the 19 RIPLS items remaining within the satisfactory standardized OUTFIT zone of 2.0 standard deviation units. We propose the 14 fitting items as a new, validated teamwork attitudes scale.

Effect of a geriatric curriculum on emergency medicine resident attitudes, knowledge, and decision-making.

OBJECTIVES: Despite an increasing number of elderly emergency department (ED) patients, emergency medicine (EM) residency training lacks geriatric-specific curricula. The objective was to determine if a 1-year geriatric curriculum, designed for residents, would affect residents' attitudes, knowledge, and decision-making for older patients seen in the ED. METHODS: The authors created a geriatric curriculum for EM residents composed of six lectures on the following topics: trauma, abdominal pain, transitions of care, medication management, iatrogenic injuries, and confusional states. A second component of the curriculum included seven high-fidelity simulation skills training sessions on aortic aneurysm, salicylate toxicity, drugs of abuse, infection from a posterior pressure ulcer, medication-induced elevated prothrombin time resulting in gastrointestinal bleeding, mesenteric ischemia, and myocardial infarction. Before and after completion of the curriculum, residents were assessed on attitudes toward caring for geriatric patients using a validated survey and knowledge of geriatric principals of care using a 35-question multiple choice test. To determine differences before and after the new curriculum was implemented, the paired t-test was performed on knowledge and attitude scores. ED records were also reviewed for frequency of chemical sedation and urinary catheter placement in patients aged 65 and over, both before and after the educational intervention, as a measure of appropriate decision-making. Appropriateness of urinary catheter placement was determined by two physician reviewers using criteria adapted from the Centers for Disease Control and Prevention indications for appropriate urinary catheter use. Reviewers met to adjudicate any disagreements about appropriateness. Fisher's exact test was used to examine differences in frequency of chemical sedation and urinary catheter placement. RESULTS: Twenty-nine EM residents underwent the training. There was no measured change in attitudes. Knowledge improved from the pre- to posttest with average scores of 58.5 and 68.0%, respectively (p < 0.0001), among the 25 residents who completed both tests. There was no change in the percentage of elderly patients receiving chemical sedation and urinary catheters before and after the curriculum (5.4% vs. 4.5%, p = 0.47; and 7.4% vs. 5.9%, p = 0.3, respectively). The number of inappropriate urinary catheters placed significantly decreased after the curriculum, from 8 of 49 to 1 of 47 (16.3% vs. 2.1%, p = 0.03). CONCLUSIONS: Geriatric educational curricula for EM residents may positively affect knowledge base and appropriate decision-making when working with older adults in the ED. These educational enhancements may place elderly patients at less risk of adverse outcomes.

Creating a multi-institutional family medicine clerkship examination: lessons learned.

BACKGROUND AND OBJECTIVES: Multiple choice examinations assess learners' attainment of medical knowledge. Developing multiple choice examinations that discriminate among learners is difficult and time-consuming. Many institutions avoid this effort by using the National Board of Medical Examiners (NBME) subject examinations, which can also provide comparisons to a national norm. The family medicine subject examination has been criticized, however, because the test's content does not reflect the learning expected during the clerkship. Additionally, the test results cannot guide clerkship directors sufficiently to help students study or to improve the curriculum. METHODS: Family medicine clerkships at three different institutions used a common 75-item examination based on the textbook Essentials of Family Medicine, Fifth Edition, for one academic year. Data were pooled and analyzed. The Raush Item Response Theory assessed student and item performance. RESULTS: A total of 451 students took the examination. Across the three schools: (1) item separations (Rasch) were high (8.64), indicating good spread in item difficulty, (2) person separations were lower (1.65), indicating that medical students are likely a relatively homogeneous group, (3) Rasch item reliabilities were strong (ranging from .96-.99), and (4) Rasch person reliabilities (.54-.73) were lower. True internal consistencies across items as measured by the Kuder-Richardson 20 (KR-20) reliabilities were just adequate at .71-.77. CONCLUSIONS: By pooling resources, clerkship directors can share the creation and implementation of a written examination that has acceptable reliability and greater face validity than the NBME subject examination. They also have more control over examination content and can guide students' learning and curriculum improvements more accurately.

Teamwork training with nursing and medical students: does the method matter? Results of an interinstitutional, interdisciplinary collaboration.

OBJECTIVES: The authors conducted a randomised controlled trial of four pedagogical methods commonly used to deliver teamwork training and measured the effects of each method on the acquisition of student teamwork knowledge, skills, and attitudes. METHODS: The authors recruited 203 senior nursing students and 235 fourth-year medical students (total N = 438) from two major universities for a 1-day interdisciplinary teamwork training course. All participants received a didactic lecture and then were randomly assigned to one of four educational methods didactic (control), audience response didactic, role play and human patient simulation. Student performance was assessed for teamwork attitudes, knowledge and skills using: (a) a 36-item teamwork attitudes instrument (CHIRP), (b) a 12-item teamwork knowledge test, (c) a 10-item standardised patient (SP) evaluation of student teamwork skills performance and (d) a 20-item modification of items from the Mayo High Performance Teamwork Scale (MHPTS). RESULTS: All four cohorts demonstrated an improvement in attitudes (F(1,370) = 48.7, p = 0.001) and knowledge (F(1,353) = 87.3, p = 0.001) pre- to post-test. No educational modality appeared superior for attitude (F(3,370) = 0.325, p = 0.808) or knowledge (F(3,353) = 0.382, p = 0.766) acquisition. No modality demonstrated a significant change in teamwork skills (F(3,18) = 2.12, p = 0.134). CONCLUSIONS: Each of the four modalities demonstrated significantly improved teamwork knowledge and attitudes, but no modality was demonstrated to be superior. Institutions should feel free to utilise educational modalities, which are best supported by their resources to deliver interdisciplinary teamwork training.

Utility of the AAMC's Graduation Questionnaire to study behavioral and social sciences domains in undergraduate medical education.

PURPOSE: The Institute of Medicine (IOM) report on social and behavioral sciences (SBS) indicated that 50% of morbidity and mortality in the United States is associated with SBS factors, which the report also found were inadequately taught in medical school. A multischool collaborative explored whether the Association of American Medical Colleges Graduation Questionnaire (GQ) could be used to study changes in the six SBS domains identified in the IOM report. METHOD: A content analysis conducted with the GQ identified 30 SBS variables, which were narrowed to 24 using a modified Delphi approach. Summary data were pooled from nine medical schools for 2006 and 2007, representing 1,126 students. Data were generated on students' perceptions of curricular experiences, attitudes related to SBS curricula, and confidence with relevant clinical knowledge and skills. The authors determined the sample sizes required for various effect sizes to assess the utility of the GQ. RESULTS: The 24 variables were classified into five of six IOM domains representing a total of nine analytic categories with cumulative scale means ranging from 60.8 to 93.4. Taking into account the correlations among measures over time, and assuming a two-sided test, 80% power, alpha at .05, and standard deviation of 4.1, the authors found that 34 medical schools would be required for inclusion to attain an estimated effect size of 0.50 (50%). With a sample size of nine schools, the ability to detect changes would require a very high effect size of 107%. CONCLUSIONS: Detecting SBS changes associated with curricular innovations would require a large collaborative of medical schools. Using a national measure (the GQ) to assess curricular innovations in most areas of SBS is possible if enough medical schools were involved in such an effort.

Selection, training and retention of an armed private security department.

To arm or not to arm security officers? One hospital which has opted for arming its officers is Cook Children's Healthcare System, Fort Worth, TX, an integrated pediatric healthcare facility with over 4000 employees. Because of its location in a major metropolitan area and based on several factors including demographics, exterior risk assessments and crime statistics, the hospital's Administration and its Risk Manager supported the decision to operate as an armed security force, according to the author. In this article he shares its current program and presents some thoughts and ideas that may benefit others who are considering this important step.

Risk for intentional violent death associated with HLA genotypes: a preliminary survey of deceased American organ donors.

This study investigates the different Human Leukocyte Antigen (HLA) genotypes and their possible associations with both disease and behavior, specifically by describing significant associations between particular HLA genotypes and occurrence of intentional violent death. A de-identified dataset of n = 216,426 deceased American organ donors was analyzed for all possible genotypes by comparing the Independent Variable (Each specific HLA genotype vs. remainder of sample, non-genotype) on the Dependent Variable (Intentional Violent vs. Non-violent death). For HLA-A, 17 heterozygotes were significantly associated with increased occurrence of intentional violent death, with heightened prevalence for HLA-A2, HLA-A23, HLA-A30, HLA-A68, and HLA-A74 alleles. For HLA-B, 32 heterozygotes were significant, 25 of which (e.g., HLA-B7, HLA-B8, HLA-B35, HLA-B44, and HLA-B53) exhibited heightened prevalence of violent death. For HLA-BW, homozygotes had significantly increased odds ratios for intentional violent death. For HLA-DRB1, 19 heterozygotes were significant, with heightened prevalence only for the HLA-DRB1-4 allele. There were no racial differences in risk for the significant HLA-A and HLA-B genotypes. These exploratory, not necessarily causal, results provide the first indications of possible HLA-aggression associations in humans, supporting animal models.

Progress along developmental tracks for electronic health records implementation in the United States.

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.

Griev_Ing: death notification skills and applications for fourth-year medical students.

BACKGROUND AND PURPOSE: Our study examined whether GRIEV_ING improved death notification skills of medical students, whether pretesting with simulated survivors primed learners and improved results of the intervention, and whether feedback on the simulated encounter improved student performance. METHODS: GRIEV_ING training was given to 138 fourth-year medical students divided into three groups: exposure to simulated survivor (SS) with written feedback, exposure to SS but no feedback, and no exposure to SS before the training. Students were tested on self-confidence before and after the intervention and were rated by SSs on interpersonal communication and death notification skills. ANCOVA was performed, with gender and race covariates. RESULTS: All groups improved on death notification competence and confidence at about the same rate. Competence significantly (p =.037) improved for the feedback group. Interpersonal communication scores declined for all groups. CONCLUSIONS: GRIEV_ING provides an effective model medical educators can use to train medical students to provide competent death notifications. Senior medical students are primed to learn death notification and do not require a preexposure.

Increasing interest in child and adolescent psychiatry in the third-year clerkship: results from a post-clerkship survey.

OBJECTIVE: The authors aimed to determine whether a structured clinical experience in child and adolescent psychiatry (CAP) during the third-year psychiatry clerkship would impact interest in pursuing careers in psychiatry and CAP. METHODS: The authors constructed and administered a postrotation survey, the Child and Adolescent Psychiatry Experiences Questionnaire (CAPE-Q), to evaluate clinical experiences and career interest in psychiatry and CAP both before and after a clerkship in psychiatry. The value of specific aspects of the clerkship to students' career decisions was also assessed. The students completed the surveys at the end of their psychiatry clerkship in the 2005-2006 academic year and in their first rotation of 2006-2007. RESULTS: Of the 98 respondents, the majority reported no change in interest in general psychiatry or in CAP after the clerkship. However, exposure to inpatient CAP correlated with increased interest in the field and in its influence on pursuing a CAP career. Interest in CAP positively correlated with agreement that the CAP clinical experience influenced their career decision. The influence of the CAP clinical experience on career decision was associated with interest in both psychiatry and CAP, as well as with change in CAP interest after the clerkship. CONCLUSION: These preliminary results suggest that the CAPE-Q may be useful for assessing students' clerkship experiences and the impact of these experiences on their decision to pursue a career in child psychiatry. Here, inpatient CAP experience led to increased interest in the field. The CAPE-Q could be used to identify students for whom electives and mentoring opportunities could be arranged. It could also be used in assessment of clerkship experiences.

Risk behaviors for varying categories of disability in NELS:88.

A large body of research shows that youth with disabilities, who comprise about 13% of the country's school-aged population, report comparable to higher incidence rates of alcohol, tobacco, and other drug (ATOD) use than their peers. Furthermore, youth with disabilities who reported ATOD use or who engaged in binge drinking had significantly more negative educational outcomes and engaged in sexual activity at a younger age than nonusers. This study describes risk factors for substance use, personal characteristics, aspects of the attitudinal environment, and educational, employment, and social outcomes among youth across 6 categories of disability. Data came from the National Center for Education Statistics' National Education Longitudinal Study of 1988-2000 (NELS:88). The findings indicate that (a) youth with varying types of disabilities are relatively homogenous with respect to risk behaviors, personal characteristics, and outcomes; (b) youth with emotional, learning, or multiple disabilities may be at heightened risk for binge drinking and marijuana use; and (c) youth with emotional and multiple disabilities may be less likely to graduate from high school or its equivalent 8 years beyond the 12th grade. Based on these results and limitations of the NELS sampling strategy, appropriate interventions are discussed as well as the need for more definitive operational definitions for disabilities, specifically the biopsychosocial approach used by the International Classification of Functioning, Disability, and Health.