The findings suggest that approximately one in seven individuals diagnosed with a primary BT are at risk of suffering from PTSS as a result of their tumor experience. Notably, these results indicate that PTSS compromises neurocognitive and psychosocial functioning including overall quality of life in BT patients undergoing radiation therapy. The findings will be discussed in context of developing and implementing appropriate counseling and rehabilitation services to address the unique needs of BT survivors. Background: Oestrogen has been shown to influence cognitive functioning, and recent studies have focused on the effects of endocrine therapy on cognitive functioning in breast cancer patients. The current results, however, have been inconclusive. Objectives: To examine the effects of endocrine therapy (tamoxifen) on cognitive functioning in breast cancer patients. Methods: 20 patients receiving adjuvant chemotherapy followed by tamoxifen and 12 patients receiving chemotherapy only were assessed with neuropsychological tests before and again 4-6 weeks after completion of the chemotherapy. Results: Group differences were only found for one out of 21 neuropsychological tests. When controlling for age, patients treated with both chemotherapy and tamoxifen scored significantly lower on the letter-number sequence test (WAIS-III LN) measuring working memory (P=0.013) than patients treated with chemotherapy only. Of the 21 tests, 5 showed differences corresponding to an effect size>0.3 (Cohen's d). These 5 tests were WAIS-III LN (letter-number sequence), WAIS-III A (Arithmetic), TMA (Trail-making A), RAVL (Rey Auditory Verbal learning) and WF-N-words (Word Fluency N-words) representing the cognitive domains of working memory, processing speed and verbal fluency. Conclusion: While we cannot conclude that tamoxifen causes cognitive impairment in breast cancer patients, our results do not exclude the possibility. Our finding that 25% of the neuropsychological tests showed effect sizes greater than 0.3 are in agreement with results of previous studies. The small samples and subsequent low statistical power of existing studies suggest the need for largescale studies. If tamoxifen causes cognitive decline in breast cancer patients, this knowledge could be relevant for the patients' choice of treatment. Introduction: This study examined models of clinical survivorship care and outreach, organizational factors, and center evolution over time in the eight participating centers in the Lance Armstrong Foundation LIVESTRONG Centers of Excellence (COE) Network, to provide a set of recommendations to aid other institutions in the utilization of "best practices and processes" in the development of successful comprehensive cancer survivorship programs. Method: Guided by the Chronic Care Model this mixed methods study used both quantitative and qualitative approaches to characterize institutional barriers, models of care, community outreach and education among the COEs. The three phase approach included document review, in-depth key informant telephone interviews, quantitative surveys and site visits over a one year time period. Result: Findings identified several overarching themes, lessons, and recommendations for developing and sustaining survivorship care: one size does not fit all-each program is unique with different organizational and environmental factors that inhibit and facilitate progress ; developing survivorship models of care is an ongoing process of trial and error; leadership and institutional commitment are essential to provided needed resources and support; lack of awareness of the need for survivorship care and resistance to change are critical barriers to address in order to institute survivorship care in oncology practice; and establishing community-based centers has the potential to advance the field of survivorship beyond comprehensive cancer centers. Background: Comparatively, a higher rate of Arab Children in Israel are victims of car accidents compared to Jewish children, this may be a result of low compliance with the law regarding child restraint in cars among Arabs. One possible explanation for the low use of car restraints may be fatalistic beliefs, common in the Arab community. These beliefs suggest that health is a result of luck and beyond an individual's control. Objectives: To asses levels of fatalistic beliefs and their association with child restraint in motor vehicles among Arabs in Israel. Methods: A cross sectional observational study of child restraint in motor vehicles was conducted. Four hundred cars with 835 children under the age of 8 in them were observed while entering a parking lot. The drivers were interviewed regarding beliefs and attitudes towards child restraint and in addition their fatalistic beliefs towards road accidents and fatalistic beliefs in general. The observations were conducted within an Arab town and seven Arab villages in the northern part of Israel. Results: Of the 400 drivers, 63% were restrained while driving the car while only 32% of the children in the cars were restrained. A higher percent of the children under one year old were restrained (64%) compared to 41% of the children aged 1to 3 and 9% of children aged 3-8. Around 60% of the drivers reported high fatalistic beliefs. High fatalist beliefs were associated with lower education and were more frequent among women. After adjustment for gender, age of driver, education, number of children and driver's restraint, fatalism was associated with child restraint. Those with high fatalistic beliefs restrained their children more often. Conclusion: High levels of fatalism may inhibit people from use of child restraint in motor vehicle among Arabs in Israel. Targeting these beliefs may increase levels of compliance with the law. Purpose: The lack of physical activity (PA) is associated with obesity among school-aged children. Although parental support has been found to increase children's PA, few studies tested predictors and effects of parental support for PA among young Hispanic children. The main purpose of this study is to examine the effect of a multi-component intervention program on parental support for PA among predominantly Hispanic children from K to 2nd grade, accounting for parents' characteristics such as acculturation, education, and age. Design and setting: Quasi-experimental research design was used to evaluate a multi-component intervention program, in which five waves of data were collected from two sites in West Texas. Subjects. Data are collected from predominantly Hispanic and low-income parents/guardians (N=442) and their children of 5 to 9 years (N=848). Measures: Children's anthropometric measures were obtained, and their overweight status was determined based on their age-andgender adjusted BMI. A demographic questionnaire, an acculturation scale (Brief ARSMA II), and a parent survey were used among parents who reported on home environmental factors (e.g., whether there is a TV in the study child's bedroom) and children's behaviors (e.g., physical activity, TV viewing, sweetened beverage intake, family meals). Analysis: Descriptive statistics were obtained, and random coefficient regression was used to test the hypotheses. Results: Intervention increases parental support for PA (intercept). Time alone does not influence parental support (slope). The more acculturated parents provide more parental support (intercept, main effect). More acculturated parents are less influenced by the intervention (negative interaction between intervention and acculturation level), but not enough to counterbalance the effect of the intervention. Also, parents who have higher level of education are more supportive of PA, and older parents give less support for PA. Children's age and gender are not significant covariates, and neither is the site where the intervention is delivered. Conclusion…. More acculturated parents are more likely to provide support for PA. Intervention is important in raising parents' awareness of problems of children's obesity and mobilizing parents to provide more support for PA. Issues: Like many developing countries, Nepal has facing difficult problem to youth knowledge, awareness, behavior and attitude on their reproductive health and sexuality.. But, on the other hand, today's nepalese young girls and boys are more tolerant toward premarital sexual relations. The youth reproductive health services is then directed to assist youth to possess knowledge, awareness, behavior and attitude of responsible reproductive health through promotion by information, education, and communication, counseling, services for youths particularly those with particular problems, and supporting positive activities for youths. Methods: This paper aims to examine the result of the youth reproductive health services in nepal through explore the realty of their knowledge, awareness, behavior, and attitude of sexual and reproductive health from 2007 to mid 2009. To examine this reality this paper using the data from the Survey of High Risk Behavior of Adolescent Including Sexuality and HIV/AIDS Prevention with Implication on Reproductive Health which interviewed 1956 youths in 5 districts; 310 school and colleges. The data were edited and anaysed by EPI info software program. Results: The summary of the result found that the reality of the knowledge, awareness, behavior, and attitude of sexual and reproductive health is still low. For the knowledge of reproductive health: most (53,6 percent) do not know basic meaning of reproduction, 78 percent of female in rural do not know the cycle of menstruation period, 64.8 percent never discussed reproductive health and even, 51 percent never discussed it with family, and 64.6 percent didn't getting family planning lesson. But, on the other hand, there are 49.1 percent kissing, 45.8 percent embracing/ hugging, and 2.6 percent having sexual intercourse during dating. This realty implicated on enhancing effort to create and promote more attractive program in informing reproductive health information and launching friendly service concern to the young girls and boys. Context and objectives: With over 80% of those currently living with AIDS aged between 15 and 24 and 75% of these youth living in sub-Saharan Africa, young people in sub-Saharan Africa have been worst affected by the AIDS pandemic. Since HIV in Togothe most common cause of death, representing 17% of all deathsis spread primarily through unprotected sex, safe sex practices such as condom use can reduce HIV spread significantly. We examined the efficacy of a behavioral intervention to promote condom use among Togolese young people at high risk for HIV infection. Methods: We randomized -without known HIV infection -446 Togolese people aged 16 to 24 years consulting 3 sexually transmitted disease clinics in Lomé, who had recently had unprotected sex, to a 1-hour behavioral intervention or a didactic control condition. At baseline and 6 months, participants underwent interviews about their sexual behaviors and consistent condom use and testing for HIV. Results: We observed a 51% decline in HIV infection incidence (P=.03) in the intervention group. Incidence density for the intervention versus control groups was 1.6 versus 3.27 per 100 person-years (P<.001). Participants in the intervention group reported using condoms more consistently in the 30 days preceding the 6-month assessment (unadjusted analysis, intervention, 74.2% vs control, 48.7%). Participants in the intervention group reported using condoms more consistently over the entire 6-month period (adjusted odds ratio, 2.30; 95% CI, 1.51-3.50; P=.001). Conclusions: This brief behavioral intervention shows promise in reducing HIV risk behaviors among Togolese young people and may be transferable to other sub-Saharan African countries. Multinomial logistic regression was used to evaluate relationships among dependent variables and independent variables. We found no significant effect of having received in-school HIV/AIDS education on all outcome measures. Compared with females, males were more likely to initiate sex at a relatively younger age, report unprotected sex with multiple partners, and to drink alcohol before sexual intercourse. Efforts to control the HIV/AIDS epidemic among adolescents may need to focus on targeted interventions aimed at addressing gender-and racial/ethnic-specific risk exposures among this population group, including risk behaviors linked with lifetime sexual abuse. The need to re-examine the role of inschool HIV prevention programs to build adequate competencies among students, parents and community leaders is recommended. STUDY DESIGN AND DATA SOURCE: We used cross-sectional data from the 2005 Colorado Youth Behavioral Risk survey (YRBS). Details of the survey design and psychometric validity of questionnaire items are found in other publications. Briefly, the YRBS is a self-reported paper-based survey of high school students conducted every two years by the Centers for Disease Control and Prevention (CDC) in collaboration with Colorado local implementing partners. The survey monitors risk behaviors and other characteristics associated with mortality and morbidity among students in grades 9 through 12. In 2005, the survey was administered to a representative sample of 1,498 students from 29 public high schools throughout the state, and the overall response rate was 60%. Surveyed schools and classes were selected systematically with probability proportional to enrollment based on grade levels. OUTCOME VARIABLES: Sexual Risk Behavior was a threelevel variable created from items suggested in previous studies, and categorized as: no risk (never had sexual intercourse or engaged in any sexual risk behavior at the time of survey), low risk (had sex with one partner, used condom and did not drink alcohol in the last sexual intercourse, and used a method of contraception) and high risk (had sex with multiple partners, did not use condoms and/or drank alcohol before the last sexual intercourse, and used no method of contraception). Age at first sexual intercourse was categorized based on respondents' age at their first sexual intercourse as: no sexual intercourse (participants reported as not having ever had sexual intercourse at the time of survey irrespective of age), young adolescents (11-14 years), and older adolescents (≥15 years). Number of current sexual partners was assessed based on the reported number of sexual partners in the 3 months preceding the survey and categorized as following: never had sexual intercourse, had 1 partner, and had ≥2 sexual partners. These variables were selected because of their known association with transmission of HIV infections (Mullings, Marquart & Brewer, 2000) . COVARIATES: HIV/AIDS education, substance use score, physically forced sex, alcohol use. Potential confounding variables selected include age, gender, number of hours watching TV, feeling sadness or hopelessness, and cigarette smoking because of their documented relationships with sexual risk behavior. STATISTICAL ANALYSIS: Characteristics of respondents participating in the survey were compared according to race and gender using Rao-Scott χ2 tests for categorical variables. To further assess the relationship between independent and outcome variables, all independent variables that attained a statistical significance of P≤.25 in bivariate analyses were entered into multinomial logistic regression models in a manual stepwise fashion, starting with those with the lowest P-value. This method allows dependent variable to have more than two categories, thereby providing a single estimate of odds ratio (OR) for the association between the independent variables and each combination of the dependent variables, while controlling for potential confounders. Odds ratios (OR) were calculated and used as estimates of risk ratios. The likelihood ratio test was used to compare models to determine which variables were retained in multivariate models at a significance level α=.05. Age and grade level were not included in the same models because of potential collinearity. All analyses were performed with SAS 9.1.3 (SAS Institute, Cary, NC) and the survey weight variable was used to account for the complex sampling design of the survey to provide estimates representative of the high school student population across the state. RESULTS: Nearly 64% of respondents were non-Hispanic whites, Hispanics 24% while Blacks and other racial/ethnic groups represented 12%. These proportions mirror the approximate distribution of racial groups across the state. Both genders are equally represented in this sample with older adolescents (ages 15-18 years) being the predominant group. Nearly 85% of students reported receiving voluntary in-school HIV/AIDS education. In adjusted analyses, predictors significantly associated with high risk sexual behaviors included being male, Hispanic, and having had physically forced sex. Likewise, light and binge drinking, smoking, and illegal substance use showed significant effects on sexual risk behaviors. The highest risk for early sexual debut was observed among Blacks, and Hispanics. Similarly, there was an 8-fold increase in the odds of early sexual debut among adolescents reporting physically forced sex. A dose-response relationship was observed between illegal substance use and age of sexual debut, with the strongest effect among young adolescents. Likewise, current or past smoking was associated with increased odds of early sexual debut. Statistically significant correlates of having one or more sexual partners included being Latino and high user of illegal substances, reporting forced sex, drinking alcohol, and current smoking. Associations appeared more marked among respondents using two or more drugs and having ≥2 sexual partners.  IPS-1 Is Essential for the Control of West Nile Virus Infection and Immunity The innate immune response is essential for controlling West Nile virus (WNV) infection but how this response is propagated and regulates adaptive immunity in vivo are not defined. Herein, we show that IPS-1, the central adaptor protein to RIG-I-like receptor (RLR) signaling, is essential for triggering of innate immunity and for effective development and regulation of adaptive immunity against pathogenic WNV. IPS-1(−/−) mice exhibited increased susceptibility to WNV infection marked by enhanced viral replication and dissemination with early viral entry into the CNS. Infection of cultured bone-marrow (BM) derived dendritic cells (DCs), macrophages (Macs), and primary cortical neurons showed that the IPS-1-dependent RLR signaling was essential for triggering IFN defenses and controlling virus replication in these key target cells of infection. Intriguingly, infected IPS-1(−/−) mice displayed uncontrolled inflammation that included elevated systemic type I IFN, proinflammatory cytokine and chemokine responses, increased numbers of inflammatory DCs, enhanced humoral responses marked by complete loss of virus neutralization activity, and increased numbers of virus-specific CD8+ T cells and non-specific immune cell proliferation in the periphery and in the CNS. This uncontrolled inflammatory response was associated with a lack of regulatory T cell expansion that normally occurs during acute WNV infection. Thus, the enhanced inflammatory response in the absence of IPS-1 was coupled with a failure to protect against WNV infection. Our data define an innate/adaptive immune interface mediated through IPS-1-dependent RLR signaling that regulates the quantity, quality, and balance of the immune response to WNV infection. West Nile virus (WNV) is a neurotropic flavivirus and is an emerging public health threat. Infection with WNV now constitutes the leading cause of mosquito-borne and epidemic encephalitis in humans in the United States [1] . WNV is enveloped and contains a single strand positive sense RNA genome of approximately 11 kb in length that encodes three structural (C, prM/M, and E) and seven non-structural proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B, and NS5). It cycles enzootically between birds and Culex mosquitoes, with humans infected as dead-end hosts. WNV infection has been modeled in inbred mice wherein infection and pathogenesis recapitulate many of the features of human infection (reviewed in [2] ). Following subcutaneous inoculation, WNV replicates in dendritic cells (DCs) at the portal of entry and in the draining lymph node. A primary viremia develops and virus spreads to visceral organs including the spleen, where further amplification occurs, leading to central nervous system (CNS) dissemination and encephalitis. In humans, WNV causes an acute febrile illness that can progress to severe and sometimes lethal neuroinvasive disease, especially in the elderly and immunocompromised [3] . However, healthy young adults are also afflicted with severe neurological disease [4, 5, 6] , indicating that virulence can occur independently of immune deficiencies or aging.