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Articles 2791 - 2820 of 3508
Full-Text Articles in Medical Specialties
The Effect Of Active Video Games On The Heart Rate Of Older Adults, Yeon Bai, Shahla M. Wunderlich, Diane M. Hanel
The Effect Of Active Video Games On The Heart Rate Of Older Adults, Yeon Bai, Shahla M. Wunderlich, Diane M. Hanel
Department of Nutrition and Food Studies Scholarship and Creative Works
Background: Heart rate is used as a health biomarker. This aim of this study was to investigate the effects of playing active video games on the heart rate of older adults, in comparison to the heart rate after common table recreational activity.
Methods: An experimental study with 40 participants was conducted: a control group (n=20) participated in common Pokeno® card games; an experimental group (n=20) played WiiTM bowling. The participants’ pre- and post-activity heart rates were measured and compared between and within groups using t-tests.
Results: The findings signified an 11.9% increase (p
Conclusions: The inclusion of active video games …
Caregiver Perceptions Of Their Influence On Cancer Treatment Decision Making: Intersections Of Language, Identity, And Illness, Janice L. Krieger, Angela L. Palmer-Wackerly, Jessica L. Krok-Schoen, Phokeng M. Dailey, Julianne C. Wojno, Nancy Schoenberg, Electra D. Paskett, Mark Dignan
Caregiver Perceptions Of Their Influence On Cancer Treatment Decision Making: Intersections Of Language, Identity, And Illness, Janice L. Krieger, Angela L. Palmer-Wackerly, Jessica L. Krok-Schoen, Phokeng M. Dailey, Julianne C. Wojno, Nancy Schoenberg, Electra D. Paskett, Mark Dignan
Department of Communication Studies: Faculty Publications
Serious illness of a loved one can disrupt a caregiver’s sense of self and relationships. We examined the language caregivers use to describe the cancer treatment decision making of a loved one to understand how caregivers frame their own identity relative to a patient’s illness. We analyzed transcripts from in-depth interviews conducted with caregivers (N = 58) of cancer patients to examine the intersection among language, identity, and illness. Caregivers with a patient-level personal identity frame used phrases such as their body, their decision. Caregivers with a relational identity frame used plural pronouns such as we or our when describing …
Uncovering Meanings Of Death, Trauma, And Loss As Experienced By Hospice Bereavement Coordinators: A Phenomenological Study, Rochelle S. Clarke
Uncovering Meanings Of Death, Trauma, And Loss As Experienced By Hospice Bereavement Coordinators: A Phenomenological Study, Rochelle S. Clarke
Department of Family Therapy Dissertations and Applied Clinical Projects
This study examined the experiences of Hospice Bereavement Coordinators (HBCs) and Hospice Chaplains working with grief narratives from patient-family units exhibiting signs of anticipatory or complicated grief. While a significant amount of research has been conducted on Hospice employees, no qualitative studies have examined the interpretation of meaning from employees whose primary role focused on the psychosocial-spiritual aspects of clients exhibiting anticipatory or complicated grief. The researcher identified shared meaning of death, trauma, and loss from six participants in the context of a high stress and high loss environment. This study‘s findings revealed ten central themes: Death is an earthly …
Programmed Physical Exertion In Recovery From Sports-Related Concussion: A Randomized Pilot Study, Arthur C. Maerlender, Wanda Rieman, Jonathan Lichtenstein, C. Condiracci
Programmed Physical Exertion In Recovery From Sports-Related Concussion: A Randomized Pilot Study, Arthur C. Maerlender, Wanda Rieman, Jonathan Lichtenstein, C. Condiracci
Department of Psychology: Faculty Publications
Although no data exist, general practice recommends only rest following concussion. This randomized clinical trial found that programmed physical exertion during recovery produced no significant differences in recovery time between groups of participants. However, high levels of exertion were deleterious. This study provides initial evidence that moderate physical activity is a safe replacement behavior during recovery.
Ua68/10/1 Potter College Of Arts & Letters Sociology Publications, Wku Archives
Ua68/10/1 Potter College Of Arts & Letters Sociology Publications, Wku Archives
WKU Archives Collection Inventories
Publications created by and about Sociology. Including Sociology, Anthropology & Social Work while a part of Potter College.
What Impacts Life Satisfaction Of Aging Adults Following Stressful Life Events?: An Examination Of The Buffering Effect Of Personal Resources, Cassandra Barragan
What Impacts Life Satisfaction Of Aging Adults Following Stressful Life Events?: An Examination Of The Buffering Effect Of Personal Resources, Cassandra Barragan
Wayne State University Dissertations
Purpose: Existing research has shown that elders experience changes in their life satisfaction following stressful life events. There is an abundance of literature supporting the predictive nature of not only stressful life events on life satisfaction, but social support, autonomy, and financial security. What the literature is lacking, is examination of the buffering effect of social support, autonomy, and financial security on the relationship between stressful life events and life satisfaction. This study hypothesizes that increases in social support, autonomy, and financial security will buffer the impact of SLEs for elders and thus, they will experience increases in their life …
Children With Sli Exhibit Delays Resolving Ambiguous Reference, Julie M. Estis, Brenda L. Beverly
Children With Sli Exhibit Delays Resolving Ambiguous Reference, Julie M. Estis, Brenda L. Beverly
University Faculty and Staff Publications
Fast mapping weaknesses in children with specific language impairment (SLI) may be explained by differences in disambiguation, mapping an unknown word to an unnamed object. The impact of language ability and linguistic stimulus on disambiguation was investigated. Sixteen children with SLI (8 preschool, 8 school-age) and sixteen typically developing age-matched children selected referents given familiar and unfamiliar object pairs in three ambiguous conditions: phonologically distinct word (PD), phonologically similar word (PS), no word (NW). Preschoolers with SLI did not disambiguate, unlike typically developing age-matched participants, who consistently selected unfamiliar objects given PD. School-age children with SLI disambiguated given PD. Delays …
The Role Of Occupational Therapy In Primary Care, Priti Patel
The Role Of Occupational Therapy In Primary Care, Priti Patel
Occupational Therapy Doctorate Capstone Projects
The Capstone Project is focused on communicating, influencing and educating other health care professionals regarding the role of occupational therapy in the future model of primary care delivery initiated by the adoption of the Affordable Care Act and the Triple Aim Initiative. Currently, primary care, the largest health care platform in United States, is not inclusive of occupational therapy services. Occupational therapists have the scope, knowledge and understanding to be part of the redesigned team model of primary care. Educating those currently working in primary care about adding occupational therapy services can have a significant impact on the profession of …
Discrimination Of Mild Cognitive Impairment And Alzheimer's Disease Using Transfer Entropy Measures Of Scalp Eeg, Joseph Mcbride, Xiaopeng Zhao, Nancy Munro, Gregory Jicha, Charles Smith, Yang Jiang
Discrimination Of Mild Cognitive Impairment And Alzheimer's Disease Using Transfer Entropy Measures Of Scalp Eeg, Joseph Mcbride, Xiaopeng Zhao, Nancy Munro, Gregory Jicha, Charles Smith, Yang Jiang
Sanders-Brown Center on Aging Faculty Publications
Mild cognitive impairment (MCI) is a neurological condition related to early stages of dementia including Alzheimer's disease (AD). This study investigates the potential of measures of transfer entropy in scalp EEG for effectively discriminating between normal aging, MCI, and AD participants. Resting EEG records from 48 age-matched participants (mean age 75.7 years)-15 normal controls, 16 MCI, and 17 early AD-are examined. The mean temporal delays corresponding to peaks in inter-regional transfer entropy are computed and used as features to discriminate between the three groups of participants. Three-way classification schemes based on binary support vector machine models demonstrate overall discrimination accuracies …
The Retrospective Diagnosis Of Attention-Deficit/Hyperactivity Disorder In Adolescents: Family Physicians' Challenges, Adam M. Pechmann
The Retrospective Diagnosis Of Attention-Deficit/Hyperactivity Disorder In Adolescents: Family Physicians' Challenges, Adam M. Pechmann
Masters Theses
The primary purpose of the study was to identify current retrospective practices used by family physicians in the diagnosis of Attention-Deficit-Hyperactivity Disorder (ADHD) in adolescents and young adults. In other words, do physicians adhere to best practices and examine information from childhood in order to diagnose ADHD in adolescents and young adults? In addition, this study aimed to examine the information physicians request for ADHD diagnosis, types of treatments they recommend, the type of information they use to assess treatment outcomes, and professional attitudes regarding the nature of ADHD. Participants completed a questionnaire designed to answer the research questions. Participants …
Engagement In Activities And Cognitive Functioning Among Older Adults In The Health And Retirement Study, Pamela Emily May
Engagement In Activities And Cognitive Functioning Among Older Adults In The Health And Retirement Study, Pamela Emily May
Wayne State University Dissertations
The goal of this dissertation is to examine the effect of cognitive and social activities on cognitive performance and health conditions in a national sample of older adults from the Health and Retirement Study (HRS). This dissertation first aimed to identify longitudinal relations between activity frequency and cognitive functioning. Two hypotheses were tested, baseline activity frequency predicts change in cognitive functioning over time, and baseline cognitive performance predicts change in activity frequency over time. The dissertation’s second aim was to identify links between activity frequency and cognitive trajectories. The third aim was to identify longitudinal relations between activity frequency and …
The Impact Of Disability: A Comparative Approach To Medical Resource Allocation In Public Health Emergencies, Katie Hanschke, Leslie E. Wolf, Wendy F. Hensel
The Impact Of Disability: A Comparative Approach To Medical Resource Allocation In Public Health Emergencies, Katie Hanschke, Leslie E. Wolf, Wendy F. Hensel
Faculty Publications By Year
It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people.
A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when …
African American Grandparents Residing In A Nursing Facility: Perceptions Of Influence With Their Grandchildren, Family, And Community, Monica Bester
African American Grandparents Residing In A Nursing Facility: Perceptions Of Influence With Their Grandchildren, Family, And Community, Monica Bester
Wayne State University Theses
African American older adults have historically been identified as vital members of the African American family and community (Hill, 1972; Cox, 2002; Waites, 2008). Unfortunately, research has shown an increasing number of older African Americans are being admitted into nursing facilities (Paul, 2004; Feng et al., 2011). Between the years of 1998-2008, it was projected African Americans living in nursing homes increased by 10.8% (Feng et al., 2011).
This study explores the intergenerational relationships of older African American adults with their grandchildren, family, and community through the lens of Intergenerational Family Systems Theory. By viewing this qualitative study through the …
Compliance To Exercise-Oncology Guidelines In Prostate Cancer Survivors And Associations With Psychological Distress, Unmet Supportive Care Needs, And Quality Of Life, Daniel A. Galvao, Robert U. Newton, Robert A. Gardiner, Afaf Grigis, Steven J. Lepore, Anna Stiller, Cathrine Mihalopolous, Steven Occhipinti, Suzanne K. Chambers
Compliance To Exercise-Oncology Guidelines In Prostate Cancer Survivors And Associations With Psychological Distress, Unmet Supportive Care Needs, And Quality Of Life, Daniel A. Galvao, Robert U. Newton, Robert A. Gardiner, Afaf Grigis, Steven J. Lepore, Anna Stiller, Cathrine Mihalopolous, Steven Occhipinti, Suzanne K. Chambers
Research outputs 2014 to 2021
Objective The purpose of this study was to determine prevalence of Australian prostate cancer survivors meeting contemporary exercise-oncology guidelines and identify associations with distress, unmet supportive care needs, and quality of life. Methods A population-based cohort of 463 prostate cancer survivors who were on 10.8 months post-curative therapy was assessed for compliance with current exercise guidelines for cancer survivors, motivational readiness for physical activity, psychological distress, unmet supportive care needs, and quality of life. Results Only 57 men (12.3%) reported sufficient exercise levels (150 min of moderate intensity or 75 min of strenuous exercise per week and twice weekly resistance …
Psychological Wellness And Health-Related Stigma: A Pilot Study Of An Acceptance-Focused Cognitive Behavioural Intervention For People With Lung Cancer, Suzanne K. Chambers, B A. Morris, S Clutton, E Foley, L Giles, P Schofield, D O'Connell, J Dunn
Psychological Wellness And Health-Related Stigma: A Pilot Study Of An Acceptance-Focused Cognitive Behavioural Intervention For People With Lung Cancer, Suzanne K. Chambers, B A. Morris, S Clutton, E Foley, L Giles, P Schofield, D O'Connell, J Dunn
Research outputs 2014 to 2021
People with lung cancer experience health-related stigma that is related to poorer psychosocial and quality of life outcomes. The present Phase 1 study applied mixed methods to test the acceptability of an acceptance-focused cognitive behavioural intervention targeting stigma for this patient group. Fourteen lung cancer patients completed a 6-week Psychological Wellness intervention with pre- and post-test outcome measures of psychological and cancer-specific distress, depression, health-related stigma and quality of life. In-depth interviews applying interpretative phenomenological analysis assessed participants' experiences of the intervention. Moderate to large improvements were observed in psychological (ηp 2=0.182) and cancer-specific distress (ηp 2=0.056); depression (ηp 2=0.621); …
Psychological Distress And Quality Of Life In Lung Cancer: The Role Of Health-Related Stigma, Illness Appraisals And Social Constraints, Suzanne Chambers, P. Baade, P. Youl, J. Aitken, S. Occhipinti, S. Vinod, P.C. Valery, G. Garvey, K.M. Fong, D. Ball, H. Zorbas, J. Dunn, D.L. O'Connell
Psychological Distress And Quality Of Life In Lung Cancer: The Role Of Health-Related Stigma, Illness Appraisals And Social Constraints, Suzanne Chambers, P. Baade, P. Youl, J. Aitken, S. Occhipinti, S. Vinod, P.C. Valery, G. Garvey, K.M. Fong, D. Ball, H. Zorbas, J. Dunn, D.L. O'Connell
Research outputs 2014 to 2021
Objective: Health-related stigma is associated with negative psychological and quality of life outcomes in lung cancer patients. This study describes the impact of stigma on lung cancer patients' psychological distress and quality of life and explores the role of social constraints and illness appraisal as mediators of effect. Methods: A self-administered cross-sectional survey examined psychological distress and quality of life in 151 people (59% response rate) diagnosed with lung cancer from Queensland and New South Wales. Health-related stigma, social constraints and illness appraisals were assessed as predictors of adjustment outcomes. Results: Forty-nine percent of patients reported elevated anxiety; 41% were …
Comprendre Les Grossesses Non Désirées Au Sénégal : Rapport Du Profil Pays [Compte Rendu De L’Atelier De Dissémination Des Résultats Auprès Des Parlementaires], Babacar Mane, Bocar Mamadou Daff, Marie-Jesus Buabey, Abdelylah Lakssir
Comprendre Les Grossesses Non Désirées Au Sénégal : Rapport Du Profil Pays [Compte Rendu De L’Atelier De Dissémination Des Résultats Auprès Des Parlementaires], Babacar Mane, Bocar Mamadou Daff, Marie-Jesus Buabey, Abdelylah Lakssir
Reproductive Health
En partenariat avec le Ministère de la Santé et de l'Action Sociale et l’initiative Partners in Population and Development, le bureau du Population Council—Sénégal a organisé une rencontre avec des membres de l’Assemblée Nationale et d’autres acteurs locaux clés pour diffuser les résultats du rapport de l’étude sur le profil pays menée dans le cadre du projet de recherche "Strengthening Evidence for Programming on Unintended Pregnancy” plus connu sous l’acronyme “STEP UP.” A l’issue de la réunion, les recommandations ont été formulées concernant la législation, le renforcement des capacités et la prise en charge des problèmes de santé de la …
Availability, Use And Quality Of Care For Medical Abortion Services In Private Facilities In Kenya, Wilson Liambila, Francis Obare, Edward Ikiugu, Vitalis Akora, Jesse Njunguru, Michael Njuma, Kate Reiss, Harriet Birungi
Availability, Use And Quality Of Care For Medical Abortion Services In Private Facilities In Kenya, Wilson Liambila, Francis Obare, Edward Ikiugu, Vitalis Akora, Jesse Njunguru, Michael Njuma, Kate Reiss, Harriet Birungi
Reproductive Health
The overall goal of this study was to generate evidence on the availability, use, and quality of care for medical abortion services in private facilities (pharmacies and clinics) in Kenya. With the passing of a new constitution in 2010, there was renewed interest in the right to health and the need to reduce the high levels of maternal morbidity and mortality arising from unsafe abortion in the country. In spite of recent developments, there is limited understanding of the extent to which the changes have influenced the provision of medical abortion information and services in the country, the acceptability of …
Conceptualizing And Measuring Unintended Pregnancy And Birth: Moving The Field Forward, Population Council
Conceptualizing And Measuring Unintended Pregnancy And Birth: Moving The Field Forward, Population Council
Reproductive Health
Given the complexity of conceptualizing and measuring unintended pregnancy, STEP UP convened an expert group meeting in Accra, Ghana with the objectives of contributing to a clearer understanding and agreed-upon definition of unintended pregnancy; reviewing existing approaches to the conceptualization and measurement of unintended pregnancy; drawing from existing approaches to propose and draft indicators, metrics, data collection instruments, and analysis strategies for measuring and tracking unintended pregnancy through multiple data collection procedures; and identifying challenges and opportunities for communicating evidence on unintended pregnancy and informing policy, planning, and investment decisions. Following presentations and discussions on these issues, participants reviewed the …
Fertility Transitions In Kenya And Ghana: Trends, Determinants And Implications For Policy And Programs, Ian Askew, Baker Ndugga Maggwa, Francis Onyango
Fertility Transitions In Kenya And Ghana: Trends, Determinants And Implications For Policy And Programs, Ian Askew, Baker Ndugga Maggwa, Francis Onyango
Reproductive Health
No abstract provided.
The Feasibility Of Implementing A Novel Electrical Stimulation Device In The Self-Management Of Hand Burn Pain, Katrina Liddiard
The Feasibility Of Implementing A Novel Electrical Stimulation Device In The Self-Management Of Hand Burn Pain, Katrina Liddiard
Theses : Honours
Burns are widely acknowledged as one of the most painful injuries experienced, and poorly controlled pain following burn injury has been linked to reduced psychological adjustment, lower quality of life, and increased risk of developing a chronic pain state. Transcutaneous electrical nerve stimulation has been used for pain relief in a range of medical conditions, and may have the potential to reduce pain and analgesic consumption for burns patients. The burn care environment presents unique challenges to the introduction of new interventions, and the feasibility of introducing a novel form of electrical stimulation into this environment has not been tested. …
A Qualitative Study Of How Children Experience And Live With Long Qt Syndrome, Patrick Mcelwaine
A Qualitative Study Of How Children Experience And Live With Long Qt Syndrome, Patrick Mcelwaine
PCOM Psychology Dissertations
Long QT syndrome (LQTS) is an inherited and potentially fatal disorder affecting approximately 1 in 2,000 people. Children often experience anxiety and a sense of loss of control as they try to manage the medical, social, and psychological stress that accompanies being diagnosed with LQTS. The present study utilized a qualitative research design to examine how children experience and live with long QT syndrome. Semistructured interviews were conducted with eight children between the ages of 7 to 12 who were diagnosed with LQTS. This period in a child’s life is very important for developing social skills and self-esteem as peers …
The Influence Of Positive And Negative Death Attitudes On Medical Students' Empathy And Attitudes Toward End-Of-Life Care, Elizabeth Palumbo
The Influence Of Positive And Negative Death Attitudes On Medical Students' Empathy And Attitudes Toward End-Of-Life Care, Elizabeth Palumbo
PCOM Psychology Dissertations
This quantitative study employed a cross-sectional survey research design in order to examine the relationships between medical students’ death attitudes, empathy, and attitudes toward end-of-life care. The participants were 206 medical students currently enrolled in the Doctor of Osteopathic Medicine program at the Philadelphia College of Osteopathic Medicine, Philadelphia campus. Results indicated that there were no significant differences in the level of empathy between medical students who held strong positive death attitudes and medical students with strong negative death attitudes. However, results indicated that significant differences existed in attitudes toward end-of-life care between medical students who held strong positive death …
The Psychometric Properties Of The Professionalism Assessment Rating Scale, Jennifer K. Olivetti
The Psychometric Properties Of The Professionalism Assessment Rating Scale, Jennifer K. Olivetti
PCOM Psychology Dissertations
The issue of professionalism in the training of medical students has become a major focus within the field of medical education. For years, the Philadelphia College of Osteopathic Medicine (PCOM) has measured the quality of osteopathic medical students (DO students) interpersonal and communication skills through SP (SP) encounters in which SPs rate the DO students relative to eight criteria (items) which, in aggregate, are known as the Professionalism Assessment Rating Scale (PARS). These criteria are linked in the literature to patient outcomes, patient adherence, patient satisfaction, and malpractice. This study investigated the psychometric properties of the PARS, based on data …
Neurocognitive Patterns, Symptom Clusters, And Premorbid Factors That Predict Protracted Recovery From Concussion In Females, Sarah Pulaski
Neurocognitive Patterns, Symptom Clusters, And Premorbid Factors That Predict Protracted Recovery From Concussion In Females, Sarah Pulaski
PCOM Psychology Dissertations
Concussion is an increasingly diagnosed injury that affects individuals of all ages. Although the underlying cause is unknown, research has demonstrated that females who sustain a concussion experience longer recoveries. Existing research has documented a relationship between age, gender, post-concussive headache and mental health conditions, and recovery; however, limited research has investigated the relationship between premorbid clinical variables and recovery. Research on post-injury neurocognitive declines and recovery has also demonstrated varied findings. Moreover, dizziness has been identified as significantly predictive of prolonged recovery, but no studies have investigated the effect of premorbid headache conditions on the development of dizziness. The …
Syphilis: The Forgotten Sexually Transmitted Disease. A Brief Case Report, Amy Burnett, Hatim A. Omar
Syphilis: The Forgotten Sexually Transmitted Disease. A Brief Case Report, Amy Burnett, Hatim A. Omar
Pediatrics Faculty Publications
Syphilis has declined significantly over the last 30 years. Due to that success, many physicians no longer have the skills to recognize its symptoms. We present a case of syphilis as a demonstration of this fact.
Street Fights: Corporate Social Responsibility And A Dragway's Attempt To Reduce Illegal Street Racing, Amanda E. Greene, Andy Dotterweich, Gary Lhotsky, Jason Davis
Street Fights: Corporate Social Responsibility And A Dragway's Attempt To Reduce Illegal Street Racing, Amanda E. Greene, Andy Dotterweich, Gary Lhotsky, Jason Davis
ETSU Faculty Works
This study sought to explore a professional sport venue’s use of Corporate social responsibility (CSR) to promote positive social change, by addressing illegal street racing, through events designed for community participation. This study specifically looked at public dragracing events, titled “Street Fights,” held at a professional dragway. The purpose of this study was to 1) examine drivers’ awareness of the event’s social responsibility initiatives with Street Fight events and 2) determine if these initiatives are promoting behavioral changes in drivers. Drivers at Street Fight events were surveyed (n=77, 60% response rate) on their levels of awareness of the venue’s social …
Challenges, Changes, And Opportunities In Ngb Coach Education From 2003-2015, Anna Swisher, Andy R. Dotterweich
Challenges, Changes, And Opportunities In Ngb Coach Education From 2003-2015, Anna Swisher, Andy R. Dotterweich
ETSU Faculty Works
No abstract provided.
Hood's Theory Of Aging, Drew Michael Hood
Hood's Theory Of Aging, Drew Michael Hood
All Graduate Theses, Dissertations, and Other Capstone Projects
This thesis proposes that the theory of gerotranscendence can be improved by emphasizing life course events that influence the gerotranscendence process. Further, this paper proposes that teaching gerotranscendence to long-term care staff and residents with Hood's theory of aging and with a departmental framework will yield better results in staff following gerotranscendence best practices and thus result in increased resident development towards gerotranscendence.
Tactical Medicine: An Examination Of Medical Training In Law Enforcement, Brian J. Woods Jr.
Tactical Medicine: An Examination Of Medical Training In Law Enforcement, Brian J. Woods Jr.
Williams Honors College, Honors Research Projects
In recent years, there has been a trend towards making law enforcement officers more well-rounded first responders by increasing their required medical competencies. The required medical competencies of six law enforcement agencies of varying sizes in Northeast Ohio were examined by interviews conducted with a representative from each agency. Interview question topics included information on current training requirements and the types of medical equipment issued to officers. The study found that all six of the agencies surveyed offered medical training to officers as part of required continuing education, and all six agencies currently issued, or planned to issue in the …