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The main objective of this study was to investigate the effect of principal's leadership style on school outcome. This study focused on the indirect relationship between the leadership style and the school environment. An additional objective was to investigate the impact of culture on leadership style as related to school environment and outcome. Data from the TIMSS 1995 on Kuwait and the USA were used in this empirical investigation. Descriptive statistics and an ANOVA were used in the statistical analysis. Several conclusions were found in this study. The data analysis supported the hypothesis that the principal's leadership style was related to school outcomes. This relationship is found to be direct and indirect through the school environment. In the USA schools, the integrative principal leadership style is found to encourage and create a cooperative school environment for better school outcome than schools with authoritative principals. The principal's leadership style was found to be very different between Kuwait and USA school. Kuwait schools' principals are authoritative in their leadership style, while their USA counterparts tend to be integrative. Interestingly, although Kuwait school principals are authoritative in nature, data indicated that a cooperative school environment showed higher school outcomes. This suggests that the USA model is inapplicable in a culture similar to Kuwait. This study also concludes that there are no universal or appropriate leadership styles for all cultures.

The Physical Activity Guidelines for Americans, second edition recommends that older adults do multicomponent physical activity, which includes balance training in addition to aerobic and muscle-strengthening activities. The authors estimated the prevalence of U.S. older adults (age ≥65 years) who do balance activities and meet the aerobic and muscle-strengthening physical activity guidelines. The authors analyzed data on 1,012 respondents to the 2019 FallStyles survey, a nationwide web-based panel survey. Approximately four in 10 respondents (40.7%) reported doing balance activities on ≥1 day/week, 34.0% on ≥2 days/week, and 25.3% on ≥3 days/week. Prevalence differed by sex, education level, income level, census region, body mass index category, and meeting the aerobic and/or muscle-strengthening guidelines. The combined prevalence of participation in balance activities and meeting aerobic and muscle-strengthening guidelines ranged from 12.0% for ≥3 days/week to 15.8% for ≥1 day/week. Opportunities exist to introduce and increase participation in balance and multicomponent activities by older adults. [ABSTRACT FROM AUTHOR]

Background Extended spectrum beta-lactamase producing Enterobacterales (ESBL-PE) present a risk to public health by limiting the efficacy of multiple classes of beta-lactam antibiotics against infection. International travellers may acquire these organisms and identifying individuals at high risk of acquisition could help inform clinical treatment or prevention strategies. Methods We used data collected from a cohort of 528 international travellers enrolled in a multicentre US-based study to derive a clinical prediction rule (CPR) to identify travellers who developed ESBL-PE colonization, defined as those with new ESBL positivity in stool upon return to the United States. To select candidate features, we used data collected from pre-travel and post-travel questionnaires, alongside destination-specific data from external sources. We utilized LASSO regression for feature selection, followed by random forest or logistic regression modelling, to derive a CPR for ESBL acquisition. Results A CPR using machine learning and logistic regression on 10 features has an internally cross-validated area under the receiver operating characteristic curve (cvAUC) of 0.70 (95% confidence interval 0.69–0.71). We also demonstrate that a four-feature model performs similarly to the 10-feature model, with a cvAUC of 0.68 (95% confidence interval 0.67–0.69). This model uses traveller's diarrhoea, and antibiotics as treatment, destination country waste management rankings and destination regional probabilities as predictors. Conclusions We demonstrate that by integrating traveller characteristics with destination-specific data, we could derive a CPR to identify those at highest risk of acquiring ESBL-PE during international travel. [ABSTRACT FROM AUTHOR]

This article seeks to identify factors associated with the formation and development of nonmetropolitan destinations for older in-migration, thereby explaining why some U.S. counties are more likely than others to be nonmetro retirement destinations. We contend that most nonmetro retirement destinations are established and developed over time through a path-dependent process. When amenities are commodified as recreation and tourism, migration streams tend to be established that ultimately produce sustained in-migration of older persons to selected destination communities. We use data from a variety of official sources and a spatial statistics methodology to examine intercounty variability in net migration rates at ages 60-74. Our findings are consistent with the aforementioned path-dependent development framework. Counties with a long history of population growth, previous experience attracting older in-migrants, attractive natural amenities, and a developed recreation and tourism industry are those most likely to be retirement-age migration destinations. In contrast, agricultural heartland and relatively large population size are associated with lower rates of older in-migration. Older in-migration should be seen as neither a panacea for strapped rural communities nor a "pensions and care issue." Older migrants can be "gray gold," but they can also pose challenges, such as possibly increased demand for public services as they age in place. (Contains 3 figures, 2 tables and 25 footnotes.)

Calvin Lunsford Beale was born in Washington, DC, on June 6, 1923, and passed away at age 85 on September 2, 2008. He was a city boy born and bred, and while he "never wanted to live in a rural area" he became one of the most astute observers of rural America in the latter half of the twentieth century. Calvin spent the majority of his professional career in the U.S. Department of Agriculture's Economic Research Service, where he was senior demographer at the time of his death. Together with his longtime friend and colleague Glenn Fuguitt, Calvin was arguably the world's most prominent and influential social scientist studying rural population dynamics. Calvin is generally acknowledged for his substantive contributions to rural population analysis, but he also made lasting contributions in the area of research design. In this article, the authors talk about Calvin Beale's legacy for rural demography. They identify three areas where Calvin Beale's name is firmly affixed to social science understandings of rural people and communities in the United States: (1) migration and population redistribution; (2) subregional variations in rural demographic processes; and (3) racial and ethnic composition of rural populations. (Contains 2 footnotes.)

Two computer viruses that have caused hundreds of millions of dollars in damage over the past four years are the Melissa and the Sasser virus. In March of 1999, the Melissa virus first appeared on the Internet and spread rapidly throughout computer systems in the United States and Europe. The virus made its way through 1.2 million computers in the United States alone. On December 9, 1999, David Smith pleaded guilty to state and federal charges associated with his creation of the Melissa virus (Vamosi, 2003). Reasons for writing the viruses; "boredom", "the challenge", and "that's what I'm good at, what I like to do. In May, 2004, the Sasser virus was released by an 18 year old in Germany (Williams, 2004). The arrest made on this "script kiddie" was the first which used Microsoft's $5,000,000 fund, even though millions has been offered for information on other viruses. Unfortunately, young virus creators are unwilling to turn one another in, claiming they write viruses because they have nothing else to do or because they just want to see what happens. The purpose of this paper is threefold. First, this paper will describe the extent of Internet/cyber use by American students. Second, this paper will present data from a resent research project showing the large amount of cyber crimes are secondary students are aware of and are participating in. Finally, this paper will present scenarios which might help the reader understand why ethical choices of today's script kiddies are not as black and white as the reader might think. (Contains 3 tables and 1 figure.)

To identify the characteristics of patients with sepsis or acute pyelonephritis (APN) combined with ureteral calculi and to analyze the risk factors in its causation. Methods: We included patients with sepsis or APN caused by ureteral calculi who received treatment in the United States from January 2003 to December 2017 using the Optum® deidentified Clinformatics® Datamart. Demographic factors and risk factors for the receipt of sepsis or APN were subsequently analyzed for statistical significance. Results: Of 467,502 urinary stone patients, age-matched multivariate analysis revealed that a history of urinary tract infection (OR 11.31, 95% CI 10.68–11.99, p < 0.0001) and female gender (OR 2.73, 95% CI 2.62–2.84, p < 0.0001) were significantly related to an increased risk of sepsis or APN. Conversely, a previous past medical history of urolithiasis (OR 0.91, 95% CI 0.87–0.95, p < 0.0001) and cancer (OR 0.91, 95% CI 0.87–0.95, p < 0.0001) were associated with a decreased risk of sepsis or APN. With regards to comorbidities, when more than one comorbidity was present, there was an additive effect with higher OR point estimates, rising to 11.31 (10.68–11.99) when three or more comorbidities present. History of urinary tract infection and female gender are risk factors for sepsis or APN in patients with ureteral calculi. Conclusions: This large national cohort reveals the characteristics of sepsis or APN combined with ureteral stone and provides an important baseline for the treatment of urolithiasis in the future. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN), which affects more than 65 million Americans, is associated with poor health-related quality of life (HRQOL). Regular physical activity (PA) has been shown to reduce blood pressure and is associated with higher levels of HRQOL. Methods: Using self-reports from 60,321 hypertensive adults age 18 y or older who participated in the 2003 Behavioral Risk Factor Surveillance Survey, we examined the independent relationship between engaging in recommended levels of moderate or vigorous PA and four measures of HRQOL developed by the Centers for Disease Control and Prevention. Results: For all age and racial/ethnic groups and both sexes, the proportion of hypertensive adults with 14 or more unhealthy days (physical or mental) in the past month was significantly lower among those who attained recommended levels of PA than among physically inactive adults. Conclusions: Participation in regular PA is one of several lifestyle strategies available to control and prevent HTN. These results suggest that PA is associated with higher levels of HRQOL among adults with HTN and highlight the importance of health programs that promote participation in regular PA. [ABSTRACT FROM AUTHOR]

Managing water (e.g., catchments) to increase the abundance and distribution of game is popular in arid regions, especially throughout the southwest United States, where biologists often manage water year-round for desert bighorn sheep (Ovis canadensis nelsoni). Bighorn may visit water when predators (e.g., mountain lions [Puma concolor], coyotes [Canis latrans]) do not, suggesting that differences in species ecology or their surface water requirements influence visit timing. Alternatively, visits by desert bighorn sheep and predators may align. The former outcome identifies opportunities to improve water management by providing water when desert bighorn sheep visit most, which hypothetically may reduce predator presence, range expansion and predation, thereby supporting objectives to increase sheep abundances. Since advancing water management hinges on understanding the patterns of species visits, we identified when these three species and mule deer (Odocoileus hemionus) visited managed waters in three North American deserts (Chihuahuan, Sonoran, Mojave). We unraveled the ecological basis describing why visits occurred by associating species visits with four weather variables using multi-site, multi-species models within a Bayesian hierarchical framework (3.4 million images; 105 locations; 7/2009-12/2016). Desert bighorn sheep concentrated visits to water within 4–5 contiguous months. Mountain lions visited water essentially year-round within all deserts. Higher maximum temperature influenced visits to water, especially for desert bighorn sheep. Less long-term precipitation (prior 6-week total) raised visits for all species, and influenced mountain lion visits 3–20 times more than mule deer and 3–37 times more than sheep visits. Visits to water by prey were inconsistent predictors of visits to water by mountain lions. Our results suggest improvements to water management by aligning water provision with the patterns and ecological explanations of desert bighorn sheep visits. We exemplify a scientific approach to water management for enhancing stewardship of desert mammals, be it the southwest United States or arid regions elsewhere. [ABSTRACT FROM AUTHOR]

This paper examines the effects of population growth and decline on county-level income inequality in the rural United States from 1980 to 2016. Findings from previous research have shown that population growth is positively associated with income inequality. However, these studies are largely motivated by theories of urbanization and growth in metropolitan areas and do not explicitly test for differences between the impacts of population growth and decline. Examining the effects of both forms of population change on income inequality is particularly important in rural areas of the United States, the majority of which are experiencing population decline. We analyze county-level data (N = 11,320 county-decades) from the U.S. Decennial Census and American Community Survey, applying fixed effects regression models to estimate the respective effects of population growth and decline on income inequality within rural counties. We find that both forms of population change have significant effects on income inequality relative to stable growth. Population decline is associated with increases in income inequality, while population growth is marginally associated with decreases in inequality. These relationships are consistent across a variety of model specifications, including models that account for counties' employment, sociodemographic, and ethno-racial composition. We also find that the relationship between income inequality and population change varies by counties' geographic region, baseline level of inequality, and baseline population size, suggesting that the links between population change and income inequality are not uniform across rural America. [ABSTRACT FROM AUTHOR]

Synthesizes research on the implications of demographic changes in rural areas. Explores the effects of population size, age composition, and household size and composition on public policy and public services in rural areas. (SK)

Background: Since overweight (25 ≤ BMI < 30) and obesity (BMI ≥ 30 Kg/m²) are associated with poor health-related quality of life (HRQOL) and regular physical activity is associated with higher levels of HRQOL, the authors examined the relationship between physical activity and HRQOL among overweight and obese adults (age ≥ 18 years) residing in the United States. Methods: Using the 2005 BRFSS survey, they examined the independent relationship between recommended physical activity and measures of HRQOL developed by the Centers for Disease Control and Prevention among 283,562 adults age 18 years or older with overweight or obesity. Measures of physical activity, height, weight, and HRQOL were self-reported. Multivariable logistic regression was used to obtain odds ratios and 95% confidence intervals adjusted for age, race/ethnicity, sex, education, smoking status, chronic disease, and body-mass index. Results: The proportion of adults with overweight and obesity who attained recommended levels of physical activity had higher levels of HRQOL than physically inactive adults for all age, racial/ethnic, and sex groups. After multivariable adjustment, overweight and obese adults who met the recommended level of physical activity had higher levels of HRQOL than physically inactive adults across all age strata. Conclusions: These results highlight the HRQOL role that physical activity can have among overweight and obese persons despite their excess body weight. [ABSTRACT FROM AUTHOR]

Objective: Obesity and stable angina pectoris (SAP) are important public health problems in the USA. However, little is known about whether weight reduction affects the rate of SAP-related morbidities. This study was designed to test the hypothesis that bariatric surgery is associated with a lower rate of hospitalisations for SAP in obese adults.Methods: We performed a self-controlled case series study of obese adults with SAP who underwent bariatric surgery using a population-based inpatient database in three states (California, Florida and Nebraska) from 2005 to 2011. The primary outcome was hospitalisation for SAP. We used conditional logistic regression to compare the rate of the outcome event during sequential 12-month periods, using presurgery months 13-24 as a reference period.Results: Our sample consisted of 953 patients with SAP who underwent bariatric surgery. The median age was 57 years, 51% were women, and 78% were non-Hispanic white. During the reference period, 25.3% (95%CI, 22.5% to 28.1%) had a hospitalisation for SAP. The rate remained stable in the subsequent 12-month presurgery period (adjusted OR (aOR) 0.84 (95% CI, 0.69 to 1.02); p=0.07). In the first 12-month period after bariatric surgery, we observed a significantly lower rate (9.1% (95% CI, 7.3% to 11.0%); aOR 0.33 (95% CI, 0.26 to 0.43); p<0.0001). Similarly, the rate remained significantly lower in the subsequent 13-24 months after bariatric surgery (8.7% (95% CI, 6.9% to 10.5%); aOR 0.31 (95% CI, 0.24 to 0.41); p<0.0001).Conclusion: In this population-based study of obese adults with SAP, we found that the rate of hospitalisations for SAP was lower by two-thirds after bariatric surgery. [ABSTRACT FROM AUTHOR]

The rates of readmission for serious cardiovascular events among patients admitted with a diagnosis of non-specific chest pain are unknown. A national retrospective cohort study in the United States was undertaken to evaluate the rates, trends and predictors of readmission for serious cardiovascular events (acute coronary syndrome (ACS), pulmonary embolism (PE) and aortic dissection (AD)) after an inpatient episode with a primary diagnosis of non-specific chest pain. Among 1,172,430 patients with an index diagnosis of non-specific chest pain between 2010 and 2014, 2.4% were readmitted with an ACS, 0.4% with a PE and 0.06% with an AD within 6 months of discharge. Predictors of ACS readmissions were diabetes (OR 1.49 95% CI 1.17–1.32), coronary artery disease (OR 2.29 95% CI 2.15–2.44), previous percutaneous coronary intervention (OR 1.65 95% CI 1.56–1.75), previous CABG (OR 1.52 95% CI 1.43–1.61) and discharge against medical advice (OR 1.94 95% CI 1.78–2.12). Female patients (OR 0.82 95% CI 0.78–0.86) and patients in whom a coronary angiogram was undertaken (OR 0.48 95% CI 0.45–0.52) were less likely to be readmitted for ACS. For PE, predictors of readmission were pulmonary circulatory disorder (OR 2.20 95% CI 1.09–4.43), anemia (OR 1.62 95% CI 1.40–1.86) and cancer (OR 4.15 95% CI 3.43–5.02). Peripheral vascular disease (OR 8.63 95% CI 5.47–13.60), renal failure (OR 2.08 95% CI 1.34–3.24) were predictors of AD. Non-specific chest pain may not be a benign condition as readmissions for serious cardiovascular events occur in 3% of patients within 180 days. Research is needed to define measures that may mitigate readmissions among these patients. • Cardiovascular (CV) readmissions after admissions for chest pain are unknown. • 3% of patients with nonspecific chest pain have CV readmission within 6 months. • The daily readmissions for CV events appear to peak within a week of discharge. • Predictors of readmissions include diabetes and existing coronary artery disease. • The cost of these readmissions is ~$120 million dollars between 2010 and 2014. [ABSTRACT FROM AUTHOR]

We develop a model in which the mode of acquisition conveys information concerning the value of the bidder. The model incorporates the possibility that offers containing both cash and stock can be made in a setting consistent with the U.S. tax code. We demonstrate that bidders with unfavorable private information about their equity value choose offers containing some stock to avoid the capital gains tax consequences of cash offers. The model yields a number of unique predictions about the construction of acquisition offers. We present evidence consistent with the model. [ABSTRACT FROM AUTHOR]

Richard Hofstadter’s provocative interpretation of what he called The American Political Tradition has long interested students and scholars. Often read as a response to the crisis times of the depression 1930s and interventionist 1940s, the book’s origins are actually rooted in deeper cultural changes in the United States. This paper argues that George Santayana’s earlier essay, “The Genteel Tradition in American Philosophy” (1911), anticipated several key aspects of Hofstadter’s argument and proved to more accurately foresee the ideological course of twentieth century American politics. [ABSTRACT FROM AUTHOR]

Projections of greater interannual and intrannual climate variability, including increasing temperatures, longer and more intense drought periods, and more extreme precipitation events, present growing challenges for agricultural production in the Southern Plains of the USA. We assess agricultural vulnerabilities within this region to support identification and development of adaptation strategies at regional to local scales, where many management decisions are made. Exposure to the synergistic effects of warming, such as fewer and more intense precipitation events and greater overall weather variability, will uniquely affect rain-fed and irrigated cropping, high-value specialty crops, extensive and intensive livestock production, and forestry. Although the sensitivities of various agricultural sectors to climatic stressors can be difficult to identify at regional scales, we summarize that crops irrigated from the Ogallala aquifer possess a high sensitivity; rangeland beef cattle production a low sensitivity; and rain-fed crops, forestry, and specialty crops intermediate sensitivities. Numerous adaptation strategies have been identified, including drought contingency planning, increased soil health, improved forecasts and associated decision support tools, and implementation of policies and financial instruments for risk management. However, the extent to which these strategies are adopted is variable and influenced by both biophysical and socioeconomic considerations. Inadequate local- and regional-scale climate risk and resilience information suggests that climate vulnerability research and climate adaptation approaches need to include bottom-up approaches such as learning networks and peer-to-peer communication. [ABSTRACT FROM AUTHOR]

The economic and ecological importance of wetlands is well documented, but there are few studies that have assessed wetland condition and extent for the United States. Many states, including Kentucky, have had no statewide field evaluation of wetlands of any kind. The National Wetland Inventory (NWI) is the largest database for mapped wetlands in the United States and the most comprehensive source of wetland information for Kentucky, but its value for determining wetland condition is limited. Therefore, our objectives were to document wetland extent and condition and assess the agreement between the NWI and field-based wetland characteristics in Kentucky. We conducted field and remote-sensing based assessments of 352 wetlands across the state. NWI-mapped and field-assessed wetlands had similar large-scale patterns; however, for individual wetlands, classification often disagreed. Based on our wetland assessment method, wetlands appear to be of moderate condition, although we found differences among basins, dominant vegetation types, and landscape positions and much variation as many sites scored very low and high. Our findings support previous work showing that rapid assessments are valuable for determining wetland condition for ambient monitoring and other applications. Also, our results provide the foundation for future status and trends studies and suggest an urgent need to update the NWI in Kentucky and elsewhere. We suggest that the NWI could be improved by using newer technology that increases wetland mapping accuracy and including predictions of wetland condition using the enhanced NWI approach. [ABSTRACT FROM AUTHOR]

There is clear and consistent evidence that regular physical activity is an important component ofhealthy lifestyles and fundamental to promoting health and preventing disease. Despite the known benefits of physical activity participation, many people in the United States remain inactive. More specifically, physical activity behavior is socially patterned with lower participation rates among women; racial/ethnic minorities; sexual minority youth; individuals with less education; persons with physical, mental, and cognitive disabilities; individuals >65 yr of age; and those living in the southeast region of the United States. Many health-related outcomes follow a pattern that is similar to physical activity participation. In response to the problem of inequities in physical activity and overall health in the United States, the American College of Sports Medicine (ACSM) has developed a national roadmap that supports achieving health equity through a physically active lifestyle. The actionable, integrated pathways that provide the foundation of ACSM's roadmap include the following: 1) communication--raising awareness of the issue and magnitude of health inequities and conveying the power of physical activity in promoting health equity; 2) education---developing educational resources to improve cultural competency for health care providers and fitness professionals as well as developing new community-based programs for lay health workers; 3) collaboration--building partnerships and programs that integrate existing infrastructures and leverage institutional knowledge, reach, and voices of public, private, and community organizations; and 4) evaluation--ensuring that ACSM attains measurable progress in reducing physical activity disparities to promote health equity. This article provides a conceptual overview of these four pathways of ACSM's roadmap, an understanding of the challenges and advantages of implementing these components, and the organizational and economic benefits of achieving health equity. [ABSTRACT FROM AUTHOR]

Population aging is being experienced by many rural communities in the United States, as evidenced by increases in the median age and the high incidence of natural population decrease. The implications of these changes in population structure for the daily lives of the residents in such communities have received little attention. We address this issue in this study by examining the relationship between population aging and the availability of service-providing establishments in the rural United States between 1990 and 2010. Using data mainly from the U.S. Census Bureau and the Bureau of Labor Statistics, we estimate a series of fixed-effects regression models to identify the relationship between median age and establishment counts net of changes in overall population and other factors. We find a significant but nonlinear relationship between county median age and the total number of service-providing establishments, and counts of most specific types of services. We find a positive effect of total population size across all of our models. This total population effect is consistent with that found in other research, but the independent effect of age structure that we observe represents a novel finding and suggests that age structure is a salient factor in local rural development and community well-being. [ABSTRACT FROM AUTHOR]

Objective: Prescription opioid misuse and abuse is a serious public health concern that can lead to overdose, addiction, and death. The development of opioid formulations designed to deter misuse and abuse is considered an important step towards addressing the problem, but the extent to which abuse-deterrent opioids (ADOs) actually deter abuse in the community requires confirmation through epidemiologic studies. Epidemiologic evaluations of misuse and abuse present several unique challenges related to study design, sources of data, and methodology, particularly for new entrant ADOs with low population exposure. The purpose of this article is to review the critical methodologic issues that must be considered when designing an epidemiologic evaluation of prescription opioid misuse and abuse, and deterrence for new entrant ADOs.Methods: A systematic feasibility assessment was conducted by critically evaluating and applying epidemiologic principles to combinations of epidemiology study design, study directionality, population, data source, clinical and patient-reported endpoints, type of comparator, effect size, and the ability to control for confounding variables.Results: Ten epidemiologic factors were identified that are considered key to an epidemiologic evaluation, and the issues associated with each are summarized.Conclusion: Given the low population exposure of new entrant ADOs, there is limited feasibility in conducting the epidemiologic studies necessary to evaluate the effectiveness of these products in deterring abuse. Clear regulatory guidance is needed. [ABSTRACT FROM AUTHOR]

Recently, there has been increased attention to including cultural diversity in the education of health professionals, including concern for lesbian, gay, bisexual, and transgender (LGBT) inclusion and visibility. Studies regarding cultural exposure and acceptance of LGBT populations have been concentrated in medicine, with findings showing that medical providers often graduate having missed the preparation required to care for LGBT persons. A visible, comprehensive, culturally competent environment in dental schools would help ensure that all oral health professionals and students are aware of services available to address the particular needs of LGBT students. The aims of this survey-based study conducted in 2015-16 were to determine dental students' perceptions regarding LGBT students' needs and to assess dental students' knowledge of resources for LGBT persons at three U.S. dental schools, one each in the Midwest, West, and South. Of the 849 students invited to participate, 364 completed the survey (338 dental, 26 dental hygiene), for an overall response rate of 43%. The response rate at individual schools ranged from 30% to 55%. The results showed perceptions of insufficient LGBT information, resources, and support at these institutions, especially at the Western school. There were significant differences among the three schools, with students at the Western school more than the other two schools perceiving that their institution was less aware of whether it met the academic, social support, and spiritual needs of LGBT students. There were no significant differences between LGBT and non-LGBT students' perceptions. The authors urge dental school administrators to explore the degree to which their programs teach respectful and caring behavior towards LGBT students and, by extension, LGBT patient populations. [ABSTRACT FROM AUTHOR]

Recently, there has been increased attention to including cultural diversity in the education of health professionals, including concern for lesbian, gay, bisexual, and transgender (LGBT) inclusion and visibility. Studies regarding cultural exposure and acceptance of LGBT populations have been concentrated in medicine, with findings showing that medical providers often graduate having missed the preparation required to care for LGBT persons. A visible, comprehensive, culturally competent environment in dental schools would help ensure that all oral health professionals and students are aware of services available to address the particular needs of LGBT students. The aims of this survey-based study conducted in 2015-16 were to determine dental students' perceptions regarding LGBT students' needs and to assess dental students' knowledge of resources for LGBT persons at three U.S. dental schools, one each in the Midwest, West, and South. Of the 849 students invited to participate, 364 completed the survey (338 dental, 26 dental hygiene), for an overall response rate of 43%. The response rate at individual schools ranged from 30% to 55%. The results showed perceptions of insufficient LGBT information, resources, and support at these institutions, especially at the Western school. There were significant differences among the three schools, with students at the Western school more than the other two schools perceiving that their institution was less aware of whether it met the academic, social support, and spiritual needs of LGBT students. There were no significant differences between LGBT and non-LGBT students' perceptions. The authors urge dental school administrators to explore the degree to which their programs teach respectful and caring behavior towards LGBT students and, by extension, LGBT patient populations. [ABSTRACT FROM AUTHOR]

The article focuses on the trends in cardiovascular system education and training in the U.S. Topics discussed include the future of pediatric cardiology training, the measurement of training outcomes, the environment of the training, the cardiovascular training, and the predicted adult cardiovascular medicine training.

Objective: To analyze health care disparities in pediatric quality of care measures and determine the impact of data imputation.Data Sources: Five HEDIS measures are calculated based on 2012 administrative data for 145,652 children in two public insurance programs in Florida.Methods: The Bayesian Improved Surname and Geocoding (BISG) imputation method is used to impute missing race and ethnicity data for 42 percent of the sample (61,954 children). Models are estimated with and without the imputed race and ethnicity data.Principal Findings: Dropping individuals with missing race and ethnicity data biases quality of care measures for minorities downward relative to nonminority children for several measures.Conclusions: These results provide further support for the importance of appropriately accounting for missing race and ethnicity data through imputation methods. [ABSTRACT FROM AUTHOR]

Purpose: From 1996 to 2013, a 6-day Physical Activity and Public Health Course for Practitioners has been offered yearly in the United States. An evaluation was conducted to assess the impact of the course on building public health capacity for physical activity and on shaping the physical activity and public health careers of fellows since taking the courses.Method: An evaluation quantified time that fellows spent in different course offerings and surveyed fellows.Results: From 1996 to 2012, 410 fellows attended the course, and in 2013, 186 participated in the Web-based survey (56% response rate). The number of fellows attending the course ranged from 15 to 33 yearly. From 1996 to 2012, the course averaged 38 hr of instructional time that included topics on interventions and environment/policy work to increase physical activity, program evaluation, public health research, and health disparities. The course included consultations, collaborative work, and field-based experiences. Fellows who participated in the survey agreed that the course had a positive impact on the physical activity research or practice work they did (98%), met their expectations (96%), helped them with research/practice collaborations with other physical activity professionals (96%), assisted them in conducting higher-quality interventions/programs (95%), helped increase their professional networking in the field (93%), and had a positive impact on other work they did (91%). Following the course, 66% and 56% had further contact with faculty and other fellows, respectively.Conclusion: The Physical Activity and Public Health Course for Practitioners made important contributions toward building the capacity of physical activity and public health practitioners. [ABSTRACT FROM AUTHOR]

Soluble stem carbohydrates are a component of drought response in wheat (Triticum aestivum L.) and other grasses. Near-infrared spectroscopy (NIR) can rapidly assay for soluble carbohydrates indirectly, but this requires a statistical model for calibration. The objectives of this study were: (i) to build a robust calibration between the NIR spectra and soluble carbohydrate concentration of ground wheat stems; and (ii) to determine whether soluble stem carbohydrates are correlated with yield rankings of drought-stricken wheat grown in the northwestern United States. Five spring wheat cultivars were grown in field trials conducted at six environments in the state of Washington varying in annual precipitation from 212 to 474 mm. Wheat stems were harvested from all plots at the onset of grain fill and assayed for NIR reflectance. Soluble stem carbohydrates were determined on a subset of the samples. The NIR data were calibrated to soluble stem carbohydrates using multiple linear regression, partial least squares regression, ridge regression with best linear unbiased prediction, random forest, least absolute shrinkage and selection operator (lasso), elastic net, and Bayesian lasso regression. Partial least squares regression provided the most accurate and reliable predictions for soluble carbohydrates. Correlations between soluble stem carbohydrates and grain yield were consistent across environments (r = 0.904 and r = 0.80). The effect of environment on the variation in response variables was lower for soluble carbohydrates than yield (5.93 and 71.7%, respectively) across environments. These data provide evidence that stem carbohydrates can aid in selecting cultivars with enhanced drought resilience. [ABSTRACT FROM AUTHOR]

This article describes the outcomes of children with special education labels who participated in an inclusive PreK Head Start program that utilized a literacy-based integrated curriculum model over the course of eight months. Students were measured with the LAP-3 assessment instrument at the beginning and end of the treatment period. Implications for classroom practice and policy development are discussed for PreK children with disabilities within inclusive classrooms. [ABSTRACT FROM AUTHOR]

The article presents a study on the growth of health savings accounts (HSAs) among high-income households and large employers in the U.S. Topics discussed include the increase in HSAs between 2005 and 2012, the debate regarding the initiative, and the use of the 2004-2012 population-level tax information from the U.S. Internal Revenue Service (IRS) in the study.

Purpose: The purpose of this study was to examine the dose-response relationship between physical activity (PA) and health-related quality of life (HRQOL) among adults with and without limitations. Methods: We dichotomized HRQOL as ≥14 unhealthy (physical or mental) days (past 30 days), or <14 unhealthy days. By using a moderate-intensity minute equivalent, PA categories were as follows: inactive, 10-60, 61-149, 150-300, and >300 min/week. Persons with limitations reported having problems that limited their activities or required use of special equipment. Age-adjusted prevalence estimates and logistic regression analyses were performed with 2009 Behavioral Risk Factor Surveillance System data ( n = 357,665), controlling for demographics, BMI, smoking, and heavy alcohol use. Results: For adults without limitations, the odds of ≥14 unhealthy days were lower among adults obtaining any PA (10-60 min/week, AOR = 0.79, 95 % CI 0.70, 0.88), compared with those inactive. A quadratic trend ( P < 0.001) indicated enhanced HRQOL with each PA level, but improvements were less marked between lower and upper sufficient PA categories (150-300 and >300 min/week). Because of a significant age interaction, persons with limitations were stratified by age (18-34, 35-64, and 65+ years). Findings for persons aged 35 years or older with limitations were similar to those without limitations. Lower odds of poor HRQOL for persons aged 18-34 years with limitations were associated with recommended levels of PA (150-300 min/week; AOR = 0.61, 95 % CI 0.43, 0.88 and >300 min/week; AOR = 0.58, 95 % CI 0.43, 0.80). Conclusions: PA is positively associated with HRQOL among persons with and without limitations. [ABSTRACT FROM AUTHOR]

Objective. Emergency department (ED) visits for opioid overdose provide an important marker of acute morbidity. We sought to evaluate national trends of ED visits for opioid overdose. Design, Setting, and Participants. The National Hospital Ambulatory Medical Care Survey, 1993-2010, was used to identify ED visits for opioid overdose. Outcome Measures. Outcome measures were national ED visit rates for opioid overdose per 100,000 U.S. population and per 100,000 ED visits. Results. From 1993 to 2010, there were approximately 731,000 ED visits (95% CI, 586,000-877,000 visits) for opioid overdose, representing an overall rate of 14 ED visits (95% CI, 12-17 visits) per 100,000 population and 37 ED visits (95% CI, 31-45 visits) per 100,000 ED visits. Of these, 41% (95% CI, 33-50%) were for prescription opioid overdose. Between 1993 and 2010, the national visit rate increased from 7 to 27 per 100,000 population (+307%; Ptrend = 0.03), and from 19 to 63 per 100,000 ED visits (+235%; Ptrend < 0.001). Stratified analyses of the visit rate per population showed upward, but nonsignificant, trends across multiple demographic groups and U.S. regions. In stratified analyses of the visit rate per 100,000 ED visits, the rate increased significantly in several groups: age <20 years (+1188%; Ptrend = 0.002), age 20-29 years (+155%; Ptrend = 0.04), age ⩾50 years (+231%; Ptrend = 0.04), female (+234%; Ptrend = 0.001), male (+80%; Ptrend = 0.04), whites (+187%; Ptrend < 0.001), and patients in the South (+371%; Ptrend < 0.001). Conclusion. In a nationally representative database of U.S. ED visits, we found that the ED visit rate for opioid overdose quadrupled from 1993 to 2010. Our findings suggest that previous prevention measures may not be adequate. [ABSTRACT FROM AUTHOR]