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Introduction: Implementation science (IS) offers methods to systematically achieve the Ending the HIV Epidemic goals in the United States, as well as the global UNAIDS targets. Federal funders such as the National Institutes of Mental Health (NIMH) have invested in implementation research to achieve these goals, including supporting the AIDS Research Centres (ARCs), which focus on high‐impact science in HIV and mental health (MH). To facilitate capacity building for the HIV/MH research workforce in IS, "grey areas," or areas of IS that are confusing, particularly for new investigators, should be addressed in the context of HIV/MH research. Discussion: A group of IS experts affiliated with NIMH‐funded ARCs convened to identify common and challenging grey areas. The group generated a preliminary list of 19 grey areas in HIV/MH‐related IS. From the list, the authors developed a survey which was distributed to all ARCs to prioritize grey areas to address in this paper. ARC members across the United States (N = 60) identified priority grey areas requiring clarification. This commentary discusses topics with 40% or more endorsement. The top grey areas that ARC members identified were: (1) Differentiating implementation strategies from interventions; (2) Determining when an intervention has sufficient evidence for adaptation; (3) Integrating recipient perspectives into HIV/MH implementation research; (4) Evaluating whether an implementation strategy is evidence‐based; (5) Identifying rigorous approaches for evaluating the impact of implementation strategies in the absence of a control group or randomization; and (6) Addressing innovation in HIV/MH IS grants. The commentary addresses each grey area by drawing from the existing literature (when available), providing expert guidance on addressing each in the context of HIV/MH research, and providing domestic and global HIV and HIV/MH case examples that address these grey areas. Conclusions: HIV/MH IS is key to achieving domestic and international goals for ending HIV transmission and mitigating its impact. Guidance offered in this paper can help to overcome challenges to rigorous and high‐impact HIV/MH implementation research. [ABSTRACT FROM AUTHOR]

Many people with aphasia and people without brain injury talk to themselves in their heads, i.e., have "inner speech." Inner speech may be more preserved compared with spoken speech for some people with aphasia and may serve a variety of functions (e.g., emotion regulation), which motivates us to provide a high-fidelity characterization of it. Researchers have used multiple methods to measure this internal phenomenon in the past, which we combine here for the first time in a single study. We compare performance between individuals with and without aphasia on inner speech tasks that assess inner speech "in-the-moment" to general subjective impressions of inner speech to tease apart the relationship of aphasia severity to inner speech. Twenty people with mild-moderate aphasia and twenty neurotypical controls completed several inner speech tasks, including objective silent rhyme judgements (picture, written, and auditory), subjective reports of inner speech during naming, and subjective rating scales about inner speech experience more generally. In-the-moment inner speech during silent rhyming tasks was associated with aphasia severity only for picture and written rhyming but not auditory rhyming. In-the-moment inner speech reports during silent naming were not associated with aphasia severity, nor were the subjective ratings about general inner speech experience. Individuals with and without aphasia demonstrated a variety of subjective general inner speech experiences, demonstrating heterogeneity of this phenomenon more broadly. Methods of measuring inner speech complement each other and speak to different facets of the inner speech phenomenon, and clinicians and researchers must carefully choose the method(s) that will provide the information about inner speech that they desire. [ABSTRACT FROM AUTHOR]

Cannabis use disorder (CUD) is increasing in the United States, yet, specific neural mechanisms of CUD are not well understood. Disordered substance use is characterized by heightened drug cue incentive salience, which can be measured using the late positive potential (LPP), an event‐related potential (ERP) evoked by motivationally significant stimuli. The drug cue LPP is typically quantified by averaging the slow wave's scalp‐recorded amplitude across its entire time course, which may obscure distinct underlying factors with differential predictive validity; however, no study to date has examined this possibility. In a sample of 105 cannabis users, temporo‐spatial Principal Component Analysis was used to decompose cannabis cue modulation of the LPP into its underlying factors. Acute stress was also inducted to allow for identification of specific cannabis LPP factors sensitive to stress. Factor associations with CUD severity were also explored. Eight factors showed significantly increased amplitudes to cannabis images relative to neutral images. These factors spanned early (~372 ms), middle (~824 ms), and late (>1000 ms) windows across frontal, central, and parietal‐occipital sites. CUD phenotype individual differences were primarily associated with frontal, middle/late latency factor amplitudes. Acute stress effects were limited to one early central and one late frontal factor. Taken together, results suggest that the cannabis LPP can be decomposed into distinct, temporal‐spatial factors with differential responsivity to acute stress and CUD phenotype variability. Future individual difference studies examining drug cue modulation of the LPP should consider (1) frontalcentral poolings in addition to conventional central‐parietal sites, and (2) later LPP time windows. The current study is the first to utilize temporo‐spatial principal component analysis (PCA) to decompose the cannabis cue modulation of the late positive potential (LPP) before and after an acute laboratory stressor. Findings provide insight into potential neurophysiological markers relevant for substance use outcomes. [ABSTRACT FROM AUTHOR]

Drug overdose claimed more than 100,000 lives in the United States in 2021. Drug‐induced homicide (DIH) laws create specific criminal liability for individuals who provide drugs that cause or contribute to the death of another person. DIH prosecutions in the United States have increased substantially over the past decade despite the absence of meaningful evidence of their individual‐ or community‐level impacts. Recently, Lee et al. analyzed the impact of DIH laws on county‐level opioid overdose mortality across 92 counties in 10 states and concluded that DIH laws are associated with significant reductions in rates of opioid overdose death. In this commentary, we present evidence demonstrating that the Lee et al. study is fundamentally flawed. Specifically, the legal data used by Lee et al. to define their treatment condition (the presence or absence of a state‐level DIH law) is incorrect in almost every aspect. We also describe significant methodological weaknesses, including flawed sampling strategies that resulted in a biased sample of county overdose rates as well as flawed modeling strategies that cannot effectively evaluate the hypothesis that DIH laws negatively impact opioid overdose mortality. More research on the individual‐ and community‐level impacts of DIH laws is needed. In the meantime, we advise policymakers to strengthen state 911 Good Samaritan laws, as DIH laws appear to erode the efficacy of this proven overdose‐prevention strategy. Key points: Drug‐induced homicide laws create specific criminal liability for individuals who provide drugs that cause or contribute to the death of another person and are increasingly used in the United States despite little evidence of their impact on overdose and other harms.This paper critically evaluates a recent paper that analyzed the impact of these laws on county‐level opioid overdose mortality across 92 counties in 10 US states, concluding that these laws are associated with reduced opioid overdose deaths.We present evidence demonstrating that the previous paper is fundamentally flawed, detailing serious errors in the underlying legal research as well as significant methodological weaknesses that render the results of the paper unreliable.Reliable research on the impact of these laws is urgently needed. In the meantime, policymakers are urged to implement policies with robust evidence demonstrating their overdose‐prevention impacts: medications for opioid use disorder, naloxone access, and syringe services programs. [ABSTRACT FROM AUTHOR]

The perverseness of racial and ethnic inequities in the United States continues to implore the investigation of their causes. While there have been improvements in the health of the US population, these improvements have not been equally distributed. To commemorate the 100th anniversary of the American Journal of Epidemiology , in this commentary, we aim to highlight the Journal 's contributions to: 1) the definition and use of race and ethnicity in research, and 2) understanding racial and ethnic inequities, both empirically and methodologically, over the past decade. We commend the Journal for its contributions and for spearheading many of the challenges related to measuring and interpreting racial and ethnic data for the past 20 years. We identify 3 additional areas in which the Journal could make further impact to address racial and ethnic inequities: 1) devote a section in every issue of the Journal to scientific papers that make substantive epidemiologic or methodological contributions to racial and ethnic inequities in health; 2) update the Journal 's guidelines for authors to include justifying the use of race and ethnicity; and 3) diversify the field of epidemiology by bringing a new cadre of scholars from minoritized racial and ethnic groups who represent the most affected communities into the research process. [ABSTRACT FROM AUTHOR]

The "decolonizing generation" is a critical new movement that has captured the imaginations of many younger scholars. While the author would like to consider herself an older member of this generation, she questions whether this moment needs periodization. Is today's moment really so different from the past, when we saw the rise of world anthropologies, postmodernism, the crisis in representation, neo‐Marxism, and anti‐racist movements? And what is meant by "decolonizing anthropology" when experiences with colonialism and decolonization differ around the world? While acknowledging the value of reforming the discipline, the author encourages her colleagues to separate the very important critique of anthropologists' gatekeeping practices from idealized renderings of what anthropology should be. Rather than decolonization, the discipline ought to focus on establishing a continual decentering of hegemonic knowledge production. [ABSTRACT FROM AUTHOR]

Research consistently shows that solid assessment designs lead to better student learning outcomes. The development of well-designed assessments presents a challenge to preservice teachers in their attempts to master the process and to the teacher educators who instruct them. This exploratory study examined strategies for teaching assessment design utilized by 87 teacher educators in the United States. Analysis of the results showed that expository, collaborative, and hands-on approaches were used, with assessment approaches aligning to structured or unstructured approaches. Data also revealed that the participants tended to focus more on the vocabulary related to assessments rather than the strategies for design. [ABSTRACT FROM AUTHOR]

Despite notable improvements in theory and methods that center the lived experiences of Black adolescents, White supremacy endures in developmental science. In this article, we focus on one methodological manifestation of White supremacy—sampling decisions that assume Black adolescents are a homogeneous group. We examine overlooked concerns about within‐group designs with Black adolescents, such as the erasure of some African diasporic communities in the United States. We first describe the homogeneity assumption and join other scholars in advocating for within‐group designs. We next describe challenges with current approaches to within‐group designs. We then provide recommendations for antiracist research that makes informed within‐group design sampling decisions. We conclude by describing the implications of these strategies for researchers and developmental science. [ABSTRACT FROM AUTHOR]

The literature on the persistence of racial residential segregation in the United States has made significant progress by moving beyond traditional explanations—socioeconomic differences, preferences, and discrimination—to focus on the complex ways in which these factors interact with the multistage process of residential sorting. Dramatic changes in metropolitan landscapes over the past two decades, however, demand an expanded theoretical framework that can account for stability and change. In this article, we review research on contemporary urban changes that offers insights for explaining segregation's persistence amid widespread change. We identify three broad categories of mechanisms that exacerbate inequities by race and class in residential sorting processes: resource inequality, hierarchy endurance, and consolidated power. We describe developments in measuring segregation and new data and methods for studying urban change that enable researchers to consider the contemporary mechanisms, forms, and scales of segregation in the twenty-first century. [ABSTRACT FROM AUTHOR]

Objective: Recent public awareness of racial and ethnic disparities has again brought to light issues of diversity, equity, and inclusion in the eating disorders field. However, empirical information on racial and ethnic representation in eating disorders research is limited, making it difficult to understand where improvements are needed. Method: This study reviewed all studies including human participants published in the International Journal of Eating Disorders in 2000, 2010, and 2020. Differences in likelihood of reporting race and ethnicity were calculated based on study year, location, and diagnostic categories. Results: Out of 377 manuscripts, 45.2% reported information on the race and ethnicity of study participants. Studies conducted in the United States were more likely to report (128/173), and those conducted in Europe were less likely to report (5/61) on race and ethnicity than those conducted outside of those regions. Rates of reporting increased from 2000 to 2020. White participants made up approximately 70% of the samples that reported race and ethnicity data. Hispanic participants made up approximately 10% of samples reporting race and ethnicity. Participants from all other races and ethnicities made up less than 5% each. Discussion: Although rates of reporting race and ethnicity increased over time, most participants were White. Rates of reporting also differed by the geographical region, which may reflect variability in how information on race and ethnicity is collected across countries. More attention toward capturing the cultural background of research participants and more inclusivity in research are needed in the eating disorders field. [ABSTRACT FROM AUTHOR]

Social scientists have long utilized observations of human behavior in research designs. For researchers studying couples, observation of romantic partners has led to important discoveries about how such behavior is associated with physical, mental, and family health. Historically, these methods have been used in in-person laboratory paradigms that place notable limitations on reach and inclusion. This has, in turn, restricted the generalizability of such research to couples who may not attend an in-person laboratory assessment. Transferring the observational laboratory into an online format has the potential to expand the capabilities of these methods to include more diverse couples. This article presents two empirical studies that used online methods to conduct observational behavioral research with sexual and gender minority couples, populations that could be difficult to reach using traditional methods in many places. We demonstrate that we were able to reach, recruit, and enroll diverse couples that more closely resemble the population of same-sex couples in the United States than likely would have been reached in-person. Further, we show that the quality of the observational data collected via the internet allowed for over 94% of collected data to be coded, with acceptable interrater reliabilities and convergent validity. These studies provide a proof-of-concept of online observational methods, accompanied by a tutorial for using such methods. We discuss possible extensions of these online methods, their limitations, and the potential to help further the field of close relationships by reaching more diverse relationships and increasing the generalizability of our research. [ABSTRACT FROM AUTHOR]

Categorizing places based on their network connections to other places in the region reveals not only population concentration but also economic dynamics that are missed in other typologies. The US Office of Management and Budget categorization of counties into metropolitan/micropolitan and central/outlying is widely seen as insufficient for many analytic purposes. In this article, we use a coreness index from network analysis to identify labor market centrality of a county. We use county-to-county commute flows, including internal commuting, to identify regional hierarchies. Indicators broken down by this typology reveal counterintuitive results in many cases. Not all strong core counties have large populations or high levels of urbanization. Employment in these strong core counties grew faster in the postrecession (2008–2015) than in other types of counties. This economic dimension is missed by other typologies, suggesting that our categorization may be useful for regional analysis and policy. [ABSTRACT FROM AUTHOR]

Since 1982, the National Collegiate Athletic Association (NCAA) has collaborated with athletic trainers (ATs) to create the largest ongoing collegiate sports injury database in the world. This report provides an operational update of the NCAA Injury Surveillance Program (NCAA ISP) during the academic years 2014–2015 through 2018–2019. The NCAA ISP used a convenience sampling technique via a rolling recruitment model. The ATs at contributing institutions voluntarily submitted data into their respective electronic medical record systems; common data elements were pushed to and maintained by the Datalys Center. The ATs provided information about all team-related activities, even if no injury occurred during that activity, as well as detailed reports on each injury, including condition and circumstances. The NCAA ISP has a long-standing role in supplying NCAA stakeholders with crucial injury surveillance data, playing a critical part in safeguarding student-athletes participating in collegiate sports. [ABSTRACT FROM AUTHOR]

Background: Valid and reliable quality measures can help catalyze improvements in health care. The care of transgender patients is ripe for quality measurement, as there is increasing awareness of the increasing prevalence of this population and the urgency of improving the health care they receive. While best practices may not exist for some aspects of transgender health care, other aspects are characterized by well-developed and highly evidence-based recommendations. Our objective was to create a list of potential quality measures for transgender care.Methods and Results: In consultation with our advisory panel, which consisted of clinical and academic experts in transgender medicine, we selected eight prominent clinical practice guidelines of transgender health care for review. Our four team investigators carefully reviewed all eight clinical practice guidelines. Through the course of multiple consensus-building meetings, we iteratively refined items until we had agreed upon a list of forty potential quality measures, all of which met the criteria for quality measures set forth in the Center for Medicare and Medicaid Services Blueprint for developing quality measures.Conclusions: This manuscript explains the origin of the quality measures we developed, and also provides a useful roadmap to any group hoping to develop quality measures for a field that has not previously had any. [ABSTRACT FROM AUTHOR]

Background: Harmevents such as pneumothoraces and pneumonia continue to be associated with feeding tube insertion. Most bedside verification methods are not accurate to discriminate pulmonary from gastrointestinal system. Evidence-based clinical practice guidelines do not support auscultation of feeding tubes in adults, yet auscultation is the most common method used. Objectives: Our survey assessed national feeding tube verification practices used by critical care nurses, including progress in auscultation method deimplementation, and stylet reinsertion and cleansing practices. Methods: A national survey of 408 critical care nurses was performed. Results: The majority performed auscultation (311 of 408 [76%]) to verify feeding tube placement. In the final multivariable model, nursing education, facility type, observation of colleagues performing auscultation, and awareness of an institutional policy were associated with auscultation of feeding tubes. Thirty-five percent used enteral access devices to verify initial feeding tube placement. Stylet cleansing methods were variable; 38% of reinserted stylets were not cleansed. Discussion: Minimal progress has been made in deimplementation of auscultation in the past 7 years despite passive knowledge dissemination in research articles, clinical practice guidelines, and procedure manuals. Although pH measure is used as a first-line feeding tube verification method in the United Kingdom, it is rarely used in the United States. Clinical practice guidelines should be updated to incorporate new research on enteral access systems. Conclusions: Tradition-based practices such as auscultation and certain stylet cleansing methods should be deimplemented. A focused interdisciplinary, multifaceted program is needed to deimplement auscultation practice for adult feeding tubes. [ABSTRACT FROM AUTHOR]

Background and Aims: A substantial share of fatal drug overdoses is missing information on specific drug involvement, leading to under‐reporting of opioid‐related death rates and a misrepresentation of the extent of the opioid epidemic. We aimed to compare methodological approaches to predicting opioid involvement in unclassified drug overdoses in US death records and to estimate the number of fatal opioid overdoses from 1999 to 2016 using the best‐performing method. Design This was a secondary data analysis of the universe of drug overdoses in 1999–2016 obtained from the National Center for Health Statistics Detailed Multiple Cause of Death records. Setting: United States. Cases A total of 632 331 drug overdose decedents. Drug overdoses with known drug classification comprised 78.2% of the cases (n = 494 316) and unclassified drug overdoses (ICD‐10 T50.9) comprised 21.8% (n = 138 015). Measurements Known opioid involvement was defined using ICD‐10 codes T40.0–40.4 and T40.6, recorded in the set of contributing causes. Opioid involvement in unclassified drug overdoses was predicted using multiple methodological approaches: logistic regression and machine learning techniques, inclusion/exclusion of contributing causes of death and inclusion/exclusion of county‐level characteristics. Having selected the model with the highest predictive ability, we calculated corrected estimates of opioid‐related mortality. Findings Logistic regression and random forest models performed similarly. Including contributing causes substantially improved predictive accuracy, while including county characteristics did not. Using a superior prediction model, we found that 71.8% of unclassified drug overdoses in 1999–2016 involved opioids, translating into 99 160 additional opioid‐related deaths, or approximately 28% more than reported. Importantly, there was a striking geographic variation in undercounting of opioid overdoses. Conclusions: In modeling opioid involvement in unclassified drug overdoses, highest predictive accuracy is achieved using a statistical model—either logistic regression or a random forest ensemble—with decedent characteristics and contributing causes of death as predictors. [ABSTRACT FROM AUTHOR]

Purpose: The System for Observing Play and Recreation in Communities (SOPARC) is a valid, reliable method for understanding how people engage in physical activity (PA) in various permanent settings (e.g., parks) and contexts. However, its utility, reliability, and validity in temporary spaces has not been examined. Temporary spaces can provide PA opportunities often absent in low-income communities due to inadequate safe permanent PA spaces. Play Streets involve temporary closure of streets or other publicly accessibly spaces (e.g., parking lots, open-fields) to create safe play spaces for a specified time-period. We describe the utility, reliability, and validity of using SOPARC to assess PA in temporary spaces like Play Streets. Method: Trained SOPARC/iSOPARC (iPad App) research staff completed systematic observations during Play Streets occurring in four diverse low-income rural U.S. communities during summer 2017. Results: We successfully used iSOPARC to document PA and how spaces were used at Play Streets (n = 16), confirming its utility, reliability, and validity. Unlike observations of permanent spaces, target areas could not be pre-established since play spaces often changed during set-up, requiring time onsite to identify target areas and boundaries. Play areas frequently appeared and/or disappeared during Play Streets, and this was systematically addressed by using physical target area boundaries instead of activities. Conclusions: Understanding how temporary spaces are used for PA is critical for promoting their use. SOPARC/iSOPARC methods are useful in a Play Streets' context; however, systematic methods and training are needed to address inherent unpredictable and dynamic changes within and across target areas. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of sepsis, age, and comorbidities on death following an acute inpatient admission and to model and forecast inpatient and skilled nursing facility costs for Medicare beneficiaries during and subsequent to an acute inpatient sepsis admission.Design: Analysis of paid Medicare claims via the Centers for Medicare & Medicaid Services DataLink Project (CMS) and leveraging the CMS-Hierarchical Condition Category risk adjustment model.Setting: All U.S. acute care hospitals, excepting federal hospitals (Veterans Administration and Defense Health Agency).Patients: All Part A/B (fee-for-service) Medicare beneficiaries with an acute inpatient admission in 2017 and who had no inpatient sepsis admission in the prior year.Interventions: None.Measurements and Main Results: Logistic regression models to determine covariate risk contribution to death following an acute inpatient admission; conventional regression to predict Medicare beneficiary sepsis costs. Using the Hierarchical Condition Category risk adjustment model to illuminate influence of illness on outcome of inpatient admissions, representative odds ratios (with 95% CIs) for death within 6 months of an admission (referenced to beneficiaries admitted but without the characteristic) are as follows: septic shock, 7.27 (7.19-7.35); metastatic cancer and acute leukemia (Hierarchical Condition Category 8), 6.76 (6.71-6.82); all sepsis, 2.63 (2.62-2.65); respiratory arrest (Hierarchical Condition Category 83), 2.55 (2.35-2.77); end-stage liver disease (Hierarchical Condition Category 27), 2.53 (2.49-2.56); and severe sepsis without shock, 2.48 (2.45-2.51). Models of the cost of sepsis care for Medicare beneficiaries forecast arise approximately 13% over 2 years owing the rising enrollments in Medicare offset by the cost of care per admission.Conclusions: A sepsis inpatient admission is associated with marked increase in risk of death that is comparable to the risks associated with inpatient admissions for other common and serious chronic illnesses. The aggregate costs of sepsis care for Medicare beneficiaries will continue to increase. [ABSTRACT FROM AUTHOR]

Waterpipe tobacco smoking has grown in popularity among US college students and is associated with serious health risks. Much of the waterpipe tobacco smoking takes place in establishments such as "hookah bars" or in lounge settings. Web-based data platforms such as Yelp have demonstrated utility in locating these establishments but are prone to over- and underestimation. The purpose of this study was to optimize strategies for algorithmically estimating the prevalence of waterpipe tobacco smoking establishments. We conducted searches for potential waterpipe tobacco smoking establishments near highly residential US universities (N = 41). Of 521 potential establishments, independent coders confirmed 257 as permitting waterpipe tobacco smoking. We compared four strategies for using Yelp metadata to estimate the number of confirmed waterpipe tobacco smoking establishments by location. An accuracy-weighted approach generated estimates that closely matched confirmed data without significant over- or underestimation. The use of algorithms such as these may dramatically improve the feasibility and efficacy of future research linking environmental data and health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate rolling entry matching (REM), a new statistical method, for comparison group selection in the context of staggered nonuniform participant entry in nonrandomized interventions.Study Setting: Four Health Care Innovation Award (HCIA) interventions between 2012 and 2016.Study Design: Center for Medicare and Medicaid Innovation HCIA participants entering these interventions over time were matched with nonparticipants who exhibited a similar pattern of health care use and expenditures during each participant's baseline period.Data Extraction Methods: Medicare fee-for-service claims data were used to identify nonparticipating, fee-for-service beneficiaries as a potential comparison group and conduct REM.Principal Findings: Rolling entry matching achieved conventionally-accepted levels of balance on observed characteristics between participants and nonparticipants. The method overcame difficulties associated with a small number of intervention entrants.Conclusions: In nonrandomized interventions, valid inference regarding intervention effects relies on the suitability of the comparison group to act as the counterfactual case for the intervention group. When participants enter over time, comparison group selection is complicated. Rolling entry matching is a possible solution for comparison group selection in rolling entry interventions that is particularly useful with small sample sizes and merits further investigation in a variety of contexts. [ABSTRACT FROM AUTHOR]

Objective: To develop an empiric approach for evaluating the performance of physician peer groups based on patient-sharing in administrative claims data.Data Sources: Surveillance, Epidemiology and End Results-Medicare linked dataset.Study Design: Applying social network theory, we constructed physician peer groups for patients with breast cancer. Under different assumptions of key parameter values-minimum patient volume for physician inclusion and minimum number of patients shared between physicians for a connection-we compared agreement in group membership between split samples during 2004-2006 (T1) (reliability) and agreement in group membership between T1 and 2007-2009 (T2) (stability). We also compared the results with those derived from randomly generated groups and to hospital affiliation-based groups.Principal Findings: The sample included 142 098 patients treated by 43 174 physicians in T1 and 136 680 patients treated by 51 515 physicians in T2. We identified parameter values that resulted in a median peer group reliability of 85.2 percent (Interquartile range (IQR) [0 percent, 96.2 percent]) and median stability of 73.7 percent (IQR [0 percent, 91.0 percent]). In contrast, stability of randomly assigned peer groups was 6.2 percent (IQR [0 percent, 21.0 percent]). Median overlap of empirical groups with hospital groups was 32.2 percent (IQR [12.1 percent, 59.2 percent]).Conclusions: It is feasible to construct physician peer groups that are reliable, stable, and distinct from both randomly generated and hospital-based groups. [ABSTRACT FROM AUTHOR]

Many people poised to move through housing choice voucher programs cite violence as a primary factor in their decision-making. This study synthesizes a body of qualitative data to explore how participants recount their experiences with neighborhood violence and analyzes its relationship to residential decision-making. We find that while participants expressed a desire to move to improve their circumstances, they also recounted how neighborhood violence constrained choice by influencing a multitude of factors in the decision-making process. This shows the stress neighborhood violence places on households and how neighborhood factors constrain housing choice. [ABSTRACT FROM AUTHOR]

Abstract Researchers seeking to identify public policies to reduce automobile use have frequently compared characteristics such as population density and freeway provision across metropolitan regions to identify differences, their causes, and their implications for automobile reliance. One frequent comparison has been between metropolitan regions in Canada and the United States given their similar contexts but differing modal shares. However, past studies have produced inconsistent findings with respect to how Canadian and American metropolitan regions can be distinguished with respect to population densities and freeways. In response to methodological concerns with past research, this paper measures population densities and freeways in the 57 North American metropolitan regions with at least one million residents. Two spatial scales (metropolitan region and central core) are used to measure overall density, population-weighted average census tract density, and density of the top 5% of the population. These same spatial scales are also used to measure the absolute and per capita quantities of freeway lanes. The paper provides methodological explanations using Los Angeles and Vancouver as examples. While Canada's metropolitan regions are commonly portrayed as denser and less auto-oriented than their US counterparts, the six largest of Canada's metropolitan regions do not have population higher densities and fewer freeways than all of the 51 largest US metropolitan regions. Indeed, this generalization holds only when individual results are combined to produce national averages, as there are numerous US metropolitan regions that have density and freeways in the same range as Canada's metropolitan regions. The paper discusses some of the differences and recommends approaches for future comparative research into the causes of variation in transport and land use. [ABSTRACT FROM AUTHOR]

As awareness of the potential threats posed by climate change increases, researchers and agricultural advisors are being called upon to determine the risks that different stakeholder groups will likely confront and to develop adaptive strategies. Yet, engaging with stakeholders takes time. It also requires a clear and detailed plan to ensure that research and outreach activities yield useful outputs. In this article, we focus on the role of anthropologists as researchers and conveners in stakeholder engagement and provide a generalised overview of a long-term engagement process proceeding in three stages: (1) fact-fi nding and relationship-building; (2) incubation and collaborative learning; and (3) informed engagement and broad dissemination. We conclude with a discussion of perspectives and challenges that were encountered during two engagement experiences in the south-eastern United States. [ABSTRACT FROM AUTHOR]

The authors convey their thoughts about the evidence made in the core components of evidence-based public health as making decisions on the basis of the best available scientific evidence. They say that the gap between scientific evidence and public health practice is still large. Challenges posed by randomized controlled trials for directly informing public health practice are mentioned. The authors also discuss the popularity of pre-post study design.

Introduction : Every year, 4500 children die in motor-vehicle crashes in the United States, with estimated costs of more than $40,000 and $240 billion in productivity losses. The majority of deaths and injuries are associated with improper use of restraint devices, alcohol, high speeds, and built environments. Methodology : This is a retrospective study using U.S. panel data from 1997 through 2005. Data sources included the Fatality Analysis Reporting System, the Insurance Institute for Highway Safety, the U.S. Census Bureau, the Atlas of Presidential Elections, and the U.S. Bureau of Labor Statistics. This study used conditional fixed effects negative binomial regression to analyze the effect of the covariates on mortality by state and year. Results : A total of 32,893 children died in motor-vehicle crashes (MVCs). States that allowed fines greater than $50 for lack of restraint use experienced significant reductions in mortality as well as states with laws allowing the use of red light cameras. Graduate licensing programs requiring a minimum age of 16 for the intermediate-level experienced mortality reductions as much as 90% compared with a minimum age of 14. Higher posted speeds were associated with higher mortality rates, particularly on local roads. Conclusion : This research focuses on the effects injury prevention laws have on mortality, but not on how effectively these laws are implemented and/or enforced. Results may be useful to policy-makers and public health practitioners involved in injury prevention and public health. Practical applications : Design appropriate education and training programs in road safety, implement effective road safety interventions and improve traffic safety legislation. [ABSTRACT FROM AUTHOR]

We argue that one important role of the contemporary president is to be a conductor of public feelings. To demonstrate, we analyze U.S. President Barack Obama’s national eulogy speech delivered on January 12, 2011 in Tucson, Arizona. We show how Obama acts as a musical or energy conductor, redirecting a soundscape of boisterous enthusiasm to be in concert with discordant feelings of national pain and anger and moving them toward social love that is non-partisan and at times civic-centered. This essay has implications for public policy, racial registers of feeling, and writing the bodies of rhetorical scholars into criticism. [ABSTRACT FROM AUTHOR]

Introduction: Human immunodeficiency virus (HIV) case surveillance and other health care databases are increasingly being used for public health action, which has the potential to optimize the health outcomes of people living with HIV (PLWH). However, often PLWH cannot be located based on the contact information available in these data sources. We assessed the accuracy of contact information for PLWH in HIV case surveillance and additional data sources and whether time since diagnosis was associated with accurate contact information in HIV case surveillance and successful contact. Materials and Methods: The Case Surveillance-Based Sampling (CSBS) project was a pilot HIV surveillance system that selected a random population-based sample of people diagnosed with HIV from HIV case surveillance registries in 5 state and metropolitan areas. From November 2012 through June 2014, CSBS staff members attempted to locate and interview 1800 sampled people and used 22 data sources to search for contact information. Results: Among 1063 contacted PLWH, HIV case surveillance data provided accurate telephone number, address, or HIV care facility information for 239 (22%), 412 (39%), and 827 (78%) sampled people, respectively. CSBS staff members used additional data sources, such as support services and commercial people-search databases, to locate and contact PLWH with insufficient contact information in HIV case surveillance. PLWH diagnosed <1 year ago were more likely to have accurate contact information in HIV case surveillance than were PLWH diagnosed ≥1 year ago (P = .002), and the benefit from using additional data sources was greater for PLWH with more longstanding HIV infection (P < .001). Practice Implications: When HIV case surveillance cannot provide accurate contact information, health departments can prioritize searching additional data sources, especially for people with more longstanding HIV infection. [ABSTRACT FROM AUTHOR]

Social and interregional inequality patterns across US states from 1929–2012 are analyzed using exploratory space–time methods. The results suggest complex spatial dynamics for both inequality series that were not captured by the stylized model of Alonso. Interpersonal income inequalities of states displayed a U-shaped pattern ending the period at levels that exceeded the alarmingly high patterns that existed in the 1920s. Social inequality is characterized by greater mobility than that found for state per capita incomes. Spatial dependence is also distinct between the two series, with per capita incomes exhibiting strong global spatial autocorrelation, while state interpersonal income inequality does not. Local hot and cold spots are found for the per capita income series, while local spatial outliers are found for state interpersonal inequality. Mobility in both inequality series is found to be influenced by the local spatial context of a state. [ABSTRACT FROM AUTHOR]

Considering gratitude as a virtue, rather than a positive emotion, requires measures different from those more commonly used and which conflate gratitude with appreciation. We here describe those measures, explaining why they are appropriate to the study of gratitude as a virtue. We then discuss how each measure was coded for this special issue, the manner of recruitment of our participants across the seven research sites (Brazil, Guatemala, the United States, Russia, Turkey, China, and South Korea), the overall hypotheses, and the analytic strategies used. [ABSTRACT FROM AUTHOR]

Traditional "Marshallian" theories predict a linear relationship between internal migration and regional wage differentials. Using panel data on gross place-to-place migration flows in the United States, we estimate a semiparametric version of the modified gravity model and find evidence of a nonlinear effect of wage differentials in line with alternative theories of interregional migration, including the "option value of waiting" theory, liquidity constraints, and wealth-conditioned immobility. Traditionally, the migration decision process is believed to be mainly composed of two criteria: "whether to move" and "where to move." However, the empirical evidence of nonlinearity found in this study supports the potential presence of another important decision criterion, "when to move" on interregional migration. [ABSTRACT FROM AUTHOR]

College campus-based surveys of sexual assault in the United States have generated one of the most high-profile and contentious figures in the history of social science: the ‘1 in 5’ statistic. Referring to the number of women who have experienced either attempted or completed sexual assault since their time in college, ‘1 in 5’ has done significant work in making the prevalence of this experience legible to the public and to policy-makers. Here I examine how sexual assault surveys have participated in structuring the ontology of date/acquaintance rape from the 1980s to today. I review the foundational work of feminist social scientists Diana Russell and Mary Koss, with particular attention to the methodological practices through which the concept of the ‘hidden’ or ‘unacknowledged’ rape victim emerged. I then examine a selection of early 21st-century sexual assault surveys and highlight the ongoing preoccupation with survey methodology in responses to their results. I argue that the survey itself has been a central actor in the ontological politics of sexual assault, and only by closely attending to its performativity can we understand the paradoxical persistence both of critical responses to the ‘1 in 5’ statistic and of its effective deployment in anti-violence policy. [ABSTRACT FROM AUTHOR]

Older Black patients are at increased risk for experiencing a hospital readmission. This disparity may be related to a variety of factors, including care received during hospitalization. The purpose of this study was to elicit the perceptions of older Black patients at high risk for readmission, and explore their nursing care needs and preferences during and following hospitalization. A qualitative descriptive design was used, including individual interviews with 19 Black members of a Program of All-Inclusive Care for the Elderly facility located in a northeastern urban setting. Four themes were captured encompassing characteristics of nursing care quality, unmet care needs, nurse–patient communication, and observations of competing nursing demands. Efforts to improve care transitions and prevent readmissions must address the needs and preferences of high-risk older Black patients while also attending to system-level inefficiencies that decrease the ability for nurses to complete all aspects of care. [ABSTRACT FROM AUTHOR]

This article presents data from a collection of yearlong case studies on resident multilingual writers' college admissions essays. The focal student in this piece revealed the challenges that such writers face in presenting themselves to college admissions officers. Exploring these cultural and linguistic conflicts, this analysis uses Goffman's performance theories, which argue that writers (re)construct identities in response to changing social cues. Literacy educators, researchers, and policymakers can use these insights to help resident multilingual writers balance the demands of academic audiences with their preferred forms of representation. [ABSTRACT FROM AUTHOR]

Objectives: Prior research emphasizes the importance of the residential neighborhood context during later life but little attention has been afforded to other areas that older adults encounter as they move beyond their residential environments for daily activities and social interactions. This study examines the predominance of the residential context within older adults' everyday lives. Method: We provided 60 older adults in four New York City neighborhoods with iPhones, which captured Global Positioning Systems (GPS) locations at 5-min intervals over 1 week (n = 55,561) and 17 ecological momentary assessments (EMAs) over 4 days (n = 757) to assess real-time activities. Results: Older adults in our sample spent nearly 40% of their time outside of their residential tracts and they visited 28 other tracts, on average. Exercising, shopping, socializing, and social activities were especially likely to take place outside of residential tracts. Differences in residential and nonresidential poverty exposure vary across gender, race/ethnicity, education, car ownership, and residential areas. Discussion: Measuring activity space, rather than relying on residential tracts, allows examination of the social environments that are relevant for older adults' everyday lives. Variation in characteristics of activity spaces may be an underexplored source of differences in health and well-being during later life. [ABSTRACT FROM AUTHOR]

Background: Overuse of antibiotics is a major public health problem, contributing to growing antibiotic resistance. Procalcitonin has been reported to be commonly elevated in bacterial, but not viral infection. Multiple European trials found procalcitonin-guided care reduced antibiotic use in lower respiratory tract infection, with no apparent harm. However, applicability to US practice is limited due to trial design features impractical in the US, between-country differences, and residual safety concerns.Methods: The Procalcitonin Antibiotic Consensus Trial (ProACT) is a multicenter randomized trial to determine the impact of a procalcitonin antibiotic prescribing guideline, implemented with basic reproducible strategies, in US patients with lower respiratory tract infection.Discussion: We describe the trial methods using the Consolidated Standards of Reporting Trials (CONSORT) framework, and the rationale for key design decisions, including choice of eligibility criteria, choice of control arm, and approach to guideline implementation.Trial Registration: ClinicalTrials.gov NCT02130986 . Registered May 1, 2014. [ABSTRACT FROM AUTHOR]

Background and aims Studies on alcohol use and related constructs rarely test for measurement invariance to assess the reliability and validity of measures of alcohol use across different subpopulations of interest or ages. This failure to consider measurement invariance may result in biased parameter estimates and inferences. This study aimed to test measurement invariance of alcohol use across gender and age using a US nationally representative sample to inform future longitudinal studies assessing alcohol use. Design The National Longitudinal Study of Adolescent to Adult Health, a school-based, nationally representative longitudinal study conducted in 1994-95, 2001-02 and 2008. Setting All regions within the United States; participants were selected via a clustered sample design from 80 high schools that represented the national population. Participants Youth and young adults aged 13-31 years who had valid data on all three alcohol items within wave: 18 923 from wave 1; 14 315 from wave 3; and 14 785 from wave 4. Measurements Alcohol use measurement models were constructed using past-year general drinking frequency, heavy episodic drinking frequency and average quantity when drinking. Configural (factor structure), metric (factor loadings) and scalar (item intercepts) measurement invariance models were tested by gender and for each year of age from 13 to 31 years. Findings All models passed the threshold for configural invariance. Comparisons between males and females demonstrated metric (and usually scalar) non-invariance for most ages beyond middle adolescence. Nearly all 1- and 2-year contrasts passed metric invariance. Scalar non-invariance was most prevalent in age comparisons between late adolescence and early adulthood, particularly for tests using 2-year age increments. Conclusions Studies that do not account for the effects of gender and age on the measurement of alcohol use may be statistically biased. [ABSTRACT FROM AUTHOR]

This study uses photovoice to examine the ways in which Chicanx youths hone their critical and multimodal literacy skills in a secondary ethnic studies course. While the institutionalization of secondary ethnic studies courses swiftly expands in school districts across the United States, more research is necessary to understand the nature of these courses. This inquiry examines student photovoice compositions, participant observations, and in-depth semistructured interviews to ascertain some of the affordances of an ethnic studies course from the perspectives of participating students. The following question guides this paper: How do students articulate the importance of ethnic studies in their lives? Students' creations of photovoice compositions allowed them to communicate ideas around ethnic studies in authentic ways that valued their cultural practices and resources. Findings highlight student literacies of social action across three domains: individual, community, and structural. [ABSTRACT FROM AUTHOR]

Background: Methods for improving the utility of short dietary assessment instruments are needed.Objective: We sought to describe the development of the NHANES Dietary Screener Questionnaire (DSQ) and its scoring algorithms and performance.Methods: The 19-item DSQ assesses intakes of fruits and vegetables, whole grains, added sugars, dairy, fiber, and calcium. Two nonconsecutive 24-h dietary recalls and the DSQ were administered in NHANES 2009-2010 to respondents aged 2-69 y (n = 7588). The DSQ frequency responses, coupled with sex- and age-specific portion size information, were regressed on intake from 24-h recalls by using the National Cancer Institute usual intake method to obtain scoring algorithms to estimate mean and prevalences of reaching 2 a priori threshold levels. The resulting scoring algorithms were applied to the DSQ and compared with intakes estimated with the 24-h recall data only. The stability of the derived scoring algorithms was evaluated in repeated sampling. Finally, scoring algorithms were applied to screener data, and these estimates were compared with those from multiple 24-h recalls in 3 external studies.Results: The DSQ and its scoring algorithms produced estimates of mean intake and prevalence that agreed closely with those from multiple 24-h recalls. The scoring algorithms were stable in repeated sampling. Differences in the means were <2%; differences in prevalence were <16%. In other studies, agreement between screener and 24-h recall estimates in fruit and vegetable intake varied. For example, among men in 2 studies, estimates from the screener were significantly lower than the 24-h recall estimates (3.2 compared with 3.8 and 3.2 compared with 4.1). In the third study, agreement between the screener and 24-h recall estimates were close among both men (3.2 compared with 3.1) and women (2.6 compared with 2.5).Conclusions: This approach to developing scoring algorithms is an advance in the use of screeners. However, because these algorithms may not be generalizable to all studies, a pilot study in the proposed study population is advisable. Although more precise instruments such as 24-h dietary recalls are recommended in most research, the NHANES DSQ provides a less burdensome alternative when time and resources are constrained and interest is in a limited set of dietary factors. [ABSTRACT FROM AUTHOR]

Background: Thyroid cancer incidence is increasing in the United States (US) and many other countries. The objective of this study was to develop and evaluate algorithms using administrative medical claims data for identification of incident thyroid cancer.Methods: This effort was part of a prospective cohort study of adults initiating therapy on antidiabetic drugs and used administrative data from a large commercial health insurer in the US. Patients had at least 6 months of continuous enrollment prior to initiation during 2009-2013, with follow-up through March, 2014 or until disenrollment. Potential incident thyroid cancers were identified using International Classification of Diseases, 9th Revision (ICD-9) diagnosis code 193 (malignant neoplasm of the thyroid gland). Medical records were adjudicated by a thyroid cancer specialist. Several clinical variables (e.g., hospitalization, treatments) were considered as predictors of case status. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated to evaluate the performance of two primary algorithms.Results: Charts were requested for 170 patients, 150 (88%) were received and 141 (80%) had sufficient information to adjudicate. Of the 141 potential cases identified using ≥1 ICD-9 diagnosis code 193, 72 were confirmed as incident thyroid cancer (PPV of 51% (95% CI 43-60%)). Adding the requirement for thyroid surgery increased the PPV to 68% (95% CI 58-77%); including the presence of other therapies (chemotherapy, radio-iodine therapy) had no impact. When cases were required to have thyroid surgery during follow-up and ≥2 ICD-9 193 codes within 90 days of this surgery, the PPV was 91% (95% CI 81-96%); 62 (82%) of the true cases were identified and 63 (91%) of the non-cases were removed from consideration by the algorithm as potential cases.Conclusions: These findings suggest a significant degree of misclassification results from relying only on ICD-9 diagnosis codes to detect thyroid cancer. An administrative claims-based algorithm was developed that performed well to identify true incident thyroid cancer cases. [ABSTRACT FROM AUTHOR]

Background: Hospital readmissions are associated with higher resource utilization and worse patient outcomes. Causes of unplanned readmission to the hospital are multiple with some being better targets for intervention than others. To understand risk factors for surgical readmission and their incremental contribution to current Veterans Health Administration (VA) surgical quality assessment, the study, Improving Surgical Quality: Readmission (ISQ-R), is being conducted to develop a readmission risk prediction tool, explore predisposing and enabling factors, and identify and rank reasons for readmission in terms of salience and mutability.Methods: Harnessing the rich VA enterprise data, predictive readmission models are being developed in data from patients who underwent surgical procedures within the VA 2007-2012. Prospective assessment of psychosocial determinants of readmission including patient self-efficacy, cognitive, affective and caregiver status are being obtained from a cohort having colorectal, thoracic or vascular procedures at four VA hospitals in 2015-2017. Using these two data sources, ISQ-R will develop readmission categories and validate the readmission risk prediction model. A modified Delphi process will convene surgeons, non-surgeon clinicians and quality improvement nurses to rank proposed readmission categories vis-à-vis potential preventability.Discussion: ISQ-R will identify promising avenues for interventions to facilitate improvements in surgical quality, informing specifications for surgical workflow managers seeking to improve care and reduce cost. ISQ-R will work with Veterans Affairs Surgical Quality Improvement Program (VASQIP) to recommend potential new elements VASQIP might collect to monitor surgical complications and readmissions which might be preventable and ultimately improve surgical care. [ABSTRACT FROM AUTHOR]

The concept of fiscal sustainability has become increasingly used over the last 20 years. However, much of the literature on fiscal sustainability at the sub-national level ignores the role of intergovernmental fiscal relations. To address this gap, this paper discusses a sufficient condition for sub-national fiscal sustainability and examines the importance of intergovernmental aid in determining that sustainability. Using panel data of counties and municipalities in the US, and using unit root and cointegration analytic techniques, this paper finds different levels of fiscal sustainability between counties and municipalities. We also find that intergovernmental aid plays an important role for fiscal sustainability for both counties and municipalities. [ABSTRACT FROM AUTHOR]

Background: The United States spends more than most other countries per capita on maternal and child health (MCH), and yet lags behind other countries in MCH outcomes. Local health departments (LHDs) are responsible for administering various maternal and child health programs and interventions, especially to vulnerable populations. The goal of this study was to identify local health department jurisdictions (LHDs) that had exceptional maternal and child health outcomes compared to their in-state peers - positive deviants (PDs) - in Washington, Florida and New York in order to support the identification of strategies that can improve community health outcomes.Methods: We used MCH expenditure data for all LHDs in FL (n = 67), and WA (n = 35), and most LHDs in NY (n = 48) for 2009-2010 from the Public Health Activities and Services Tracking (PHAST) database. We conducted our analysis in 2014-2015. Data were linked with variables depicting local context and LHD structure. We used a cross-sectional study design to identify communities with better than expected MCH outcomes and multiple regression analysis to control for factors outside of and within LHD control.Results: We identified 50 positive deviant LHD jurisdictions across 3 states: WA = 10 (29 %); FL = 24 (36 %); NY = 16 (33 %). Overall, internal factor variables improved model fit for identifying PD LHD jurisdictions, but individual variables were not significant.Conclusions: We empirically identified LHD jurisdictions with better MCH outcomes compared to their peers. Research is needed to assess what factors contributed to these exceptional MCH outcomes and over which LHDs have control. The positive deviance method we used to identify high performing local health jurisdictions in the area of maternal and child health outcomes can assist in better understanding what practices work to improve health outcomes. We found that funding may not be the only predictor of exceptional outcomes, but rather, there may be activities that positive deviant LHDs are conducting that lead to improved outcomes, even during difficult financial circumstances. This method can be applied to other outcomes, communities, and/or services. [ABSTRACT FROM AUTHOR]

The current work is the first known representative poll of adults ( N = 610) aimed at determining the prevalence of parental alienation. Parental alienation describes actions that a parent takes to intentionally, or unintentionally, distance a child (or children) from the other parent (Darnell, 1998). Results revealed that 13.4% of parents (or 9.03% of the entire sample) have been alienated from one or more of their children. Our findings suggest that tens of millions of adults and their children may be impacted by parental alienation, which is much higher than previous estimates. Furthermore, findings show evidence of parental alienation across all socio-economic and demographic indicators. However, when compared to Census estimates of different demographic groups in the U.S. population, targeted parents were over-represented among Blacks/African Americans and Native Americans, and those with only a high school diploma level education. The sheer magnitude of parental alienation uncovered in this study indicates the need for more attention to be paid to this important and pervasive problem. [ABSTRACT FROM AUTHOR]

African Americans suffer disproportionately from smoking-related morbidity and mortality and make more quit attempts but report less success in quitting. Smokers tend to identify more strongly with African American culture. Qualitative interviews were conducted to elicit perceptions toward smoking and intervention content. Seventy-one African American smokers recruited from community locations participated. The majority stated they would not use any cessation aids if trying to quit smoking, despite the availability of free nicotine replacement. Acculturative stress scores were significantly higher in younger participants and those with higher income. Higher African American acculturation did not predict smoking cessation intervention preference. Family and social relationships were cited as both reasons for wanting to quit and reasons for continuing to smoke. Based on these findings, interventions for urban African Americans should address household members continuing to smoke, social/family connections, stress management, and cultural identification in urban areas. [ABSTRACT FROM AUTHOR]

Background: In the study of medicine and management, there is a strong interest in cross-country comparison. Across healthcare systems in industrialised countries, New Public Management has provided a similar reform template, but new governing arrangements exhibit significant national variations. The comparative perspective also offers a leverage to overcome the resistance focus of earlier studies. Comparison raises two overall questions: in what similar and different ways are relations between medicine and management changing across industrialised countries? Why is change occurring in different ways? The questions reflect exploration and explanation as the two basic rationales for comparison.Methods: The aim was to provide a critical discussion of different approaches to comparing medicine and management across countries. The analysis was based on a narrative review of relevant studies from several bodies of literature.Results and Discussion: The majority of studies exploring medicine and management adopt macro level approaches to comparison. Studies draw on a range of notions, including area specific ideal types of professionalism, professionalism as countervailing powers and governmentality. There are much fewer studies exploring relations between medicine and management at the meso level. Analyses treat comparison as a two-dimensional exercise looking across both countries and levels. The majority of studies draws on institutional explanations. These are variations of the path dependency argument and studies include both sector specific and broader political and administrative institutions. There is an emerging body of process-based explanations which connect macro level institutions to organisations and which promote more non-linear comparisons.Conclusion: The lack of meso level comparisons drawing on process explanations is problematic. Empirically, we need to know more about how relations between medicine and management are different across countries. Theoretically, we need to better understand how we can transpose analytical insights from institutional explanations at macro level to studies that are multi-level and also include the meso level of organisations. Methodologically, we need to address the challenges arising from more non-linear approaches to comparison, especially how to organise close international research collaboration over an extended period of time. [ABSTRACT FROM AUTHOR]

This research was part of a larger mixed-methods study examining culture, distress, and help seeking. We surveyed 209 Japanese women living in the United States recruited from clinic and community-based sites, and carried out semi-structured ethnographic interviews with a highly distressed subsample of 25 Japanese. Analytic Ethnography revealed that women described themselves as a “self-in-context,” negotiating situations using protective resources or experiencing risk exposure. Women experienced quality of life (QOL) when they were successful. However, a related goal of achieving Ikigai (or purpose in life) was differentiated from QOL, and was defined as an ongoing process of searching for balance between achieving social and individual fulfillment. Our resulting hypothetical model suggested that symptom level would be related to risk and protective factors (tested for the full sample) and to specific risk and protective phenomenon (tested in the distressed subsample). The t tests in the full sample found that women who were above threshold for depressive symptoms (n = 26) had higher social stressor and lower social support means. Women who were above the threshold for physical symptoms (n = 99) had higher social stressor means. Analysis of the interviewed subsample found that low self-validation and excessive responsibilities were related to high physical symptoms. We conclude that perceived lack of balance between culturally defined, and potentially opposing, markers of success can create a stressful dilemma for first-generation immigrant Japanese women, requiring new skills to achieve balance. Perceptions of health, as well as illness, are part of complex culturally based interpretations that have implications for intervention for immigrant Japanese women living in the United States. [ABSTRACT FROM AUTHOR]

During its first century, the Johns Hopkins University Bloomberg School of Public Health has been home to several faculty members who have played leading roles in defining and expanding the field and science of epidemiology. They have done so by training leaders in the field, creating new methods and applications, and making relevant discoveries in the worlds of infectious and chronic diseases. These methodologic innovations and discoveries underlie many of today's major health policies and practices. [ABSTRACT FROM AUTHOR]