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Purpose: To examine the concept of self-esteem among African American and Latinx adolescents with overweight and/or obesity and depressive symptoms in the United States. Method: Using key terms in CINAHL, PubMed, and PsycINFO databases, an initial search yielded 371 articles; after examining title, abstract, and full text, 33 articles remained. The concept of adolescent self-esteem was analyzed using Rodger's evolutionary method. Results: Several antecedents of self-esteem in this context were identified, including bullying, negative portrayal in the media, stressors and hassles, low socioeconomic status, dieting, and family dietary influences. Attributes identified were body image and misperception, body image dissatisfaction, diminished social status, and isolation. Consequences included stigma, somatic complaints, decreased earnings over a lifetime, decreased quality of life, lower educational attainment over a lifetime, and increased substance use. Increased self-esteem, increased number of friends, and in-depth friendships were associated with a lower risk of being overweight or obese. Conclusion: Adolescent self-esteem varied based on gender, racial and ethnic group, and changed over time in the African American population but remained static in the Latinx population. [Journal of Psychosocial Nursing and Mental Health Services, 62(12), 17–25.] [ABSTRACT FROM AUTHOR]

Simple Summary: Hepatocellular carcinoma is the most common type of liver cancer and is often seen in people with chronic liver diseases. For patients with hepatocellular carcinoma who cannot receive surgery, other treatments include atezolizumab plus bevacizumab, sorafenib, or lenvatinib. We compared the length of life among 1874 United States veterans who received these therapies, both in the overall population of patients and in groups by race/ethnicity. The results showed that the risk of death was 30% lower with atezolizumab plus bevacizumab compared with sorafenib, and 26% lower compared with lenvatinib. These trends were consistent across White, Black, and Hispanic patients. Thus, patients who received atezolizumab plus bevacizumab had improved survival outcomes compared with those treated with sorafenib or lenvatinib, regardless of race or ethnicity. Background/Objectives: This study evaluated comparative overall survival (OS) of United States veterans with unresectable hepatocellular carcinoma (uHCC) receiving first-line (1L) atezolizumab plus bevacizumab vs. sorafenib or lenvatinib, overall and across racial and ethnic groups. Methods: In this retrospective study, patients with uHCC who initiated atezolizumab plus bevacizumab (post-2020) or sorafenib or lenvatinib (post-2018) were identified from the Veterans Health Administration National Corporate Data Warehouse (1 January 2017–31 December 2022). Patient characteristics were evaluated in the year prior to 1L treatment initiation. Kaplan–Meier and multivariable Cox regression methods were used to compare OS starting from treatment between cohorts, both overall and by race and ethnicity. Results: Among the 1874 patients included, 405 (21.6%) received 1L atezolizumab plus bevacizumab, 1016 (54.2%) received sorafenib, and 453 (24.2%) received lenvatinib, with a median follow-up time of 8.5, 7.6, and 8.2 months, respectively. Overall, patients receiving atezolizumab plus bevacizumab had longer unadjusted median OS (12.8 [95% CI: 10.6, 17.1] months) than patients receiving sorafenib (8.0 [7.1, 8.6] months) or lenvatinib (9.5 [7.8, 11.4] months; both log-rank p < 0.001). After adjustment, atezolizumab plus bevacizumab was associated with a reduced risk of death by 30% vs. sorafenib (adjusted HR: 0.70 [95% CI: 0.60, 0.82]) and by 26% vs. lenvatinib (0.74 [0.62, 0.88]; both p < 0.001). OS trends in the White, Black, and Hispanic patient cohorts were consistent with that of the overall population. Conclusions: Atezolizumab plus bevacizumab was associated with improved survival outcomes compared with sorafenib and lenvatinib in patients with uHCC, both overall and across racial and ethnic subgroups. [ABSTRACT FROM AUTHOR]

Objective: Physical activity is important for health, yet most young adults are insufficiently active. Physical activity is regulated in part, by habit, typically operationalised as automaticity. Little is known about the characteristics of automaticity, or whether broad bandwidth unidimensional measures of automaticity for physical activity are superior to narrower bandwidth multi- dimensional measures. Design: This secondary analysis (N = 238) investigated the nature of automaticity, and relations between the dimensions of automaticity, global automaticity, and physical activity.Main Outcome Measures: The structure of the Generic Multifaceted Automaticity Scale (GMAS) was examined by confirmatory factor analyses. Structural equation models were estimated to evaluate relations between automaticity (measured on the GMAS and the Self- Report Behavioral Automaticity Index, SRBAI) and device- measured activity.Results: The hypothesised 3- factor structure of the GMAS was rejected, in favour of a 2- factor solution. Lack of intention/control and efficiency were associated with global automaticity, but not physical activity. Global automaticity was associated with moderate to vigorous physical activity and daily steps, but not light physical activity.Conclusion: Multi- dimensional measures of automaticity may not provide a more nuanced understanding of automaticity when predicting overall physical activity. [ABSTRACT FROM AUTHOR]

Purpose: Financial hardship as a result of cancer treatment can have a significant and lasting negative impact on adolescents and young adults (AYAs) and their families. To address a lack of developmentally informed and psychometrically sound measures of financial hardship for AYAs and their caregivers, we used rigorous measurement development methods recommended by the National Institutes of Health's Patient-Reported Outcomes Measurement Information System® (PROMIS®) to determine comprehensibility and relevance of measure content. Methods: Our multi-step approach involved item identification, refinement, and generation; translatability and reading level review; and cognitive interviews. A purposive sample of 25 AYAs and 10 caregivers participated, ensuring representation across age, education, gender, race/ethnicity, and cancer type. Results: Fifty patient-reported and caregiver-reported items were developed across material, psychosocial, and behavioral subdomains of financial hardship. Translatability and reading level reviews resulted in 22 patient-reported and 25 caregiver-reported items being rewritten. Eighty-eight percent of patients and all caregivers described the items as easy to answer. Younger AYAs (15 to 25 years of age) were more likely to say the items were less relevant for them. Forty-six patient-reported and 48 caregiver-reported items were recommended for further testing. Conclusion: This study is the first to use in-depth qualitative methods to center AYA patient and caregiver experiences in the creation of new measures of financial hardship. Data support the comprehensibility and content validity of these preliminary item banks. Future large-scale, quantitative testing will lead to additional refinements and support the use of short forms and computer-adaptive testing for a diverse sample of AYAs and their caregivers. [ABSTRACT FROM AUTHOR]

What is the future of environmental and climate change education in the United States given the emergence of neofascist and Christian Nationalist political movements during a time of social secularization? In this essay we discuss the politically heterogenous appeal of environmental concern in America, the tenuous nature of environmental education's current Left-liberal political valence, and implications for climate change education amidst ongoing culture wars. We proceed by examining Bron Taylor's influential typology of Dark Green Religions and consider how the American political Right may emerge as having their own Dark Green Religious movement. We are concerned that the field of environmental education remains ideologically blinkered toward other normative educational projects on the political Right, a situation that leaves us unprepared for how projects such as climate change education can be appropriated for reactionary and sometimes violent ends. We argue that the field of environmental education needs to pay greater attention to the multifarious political and cultural conditions that shape its enactment and develop considerations for an anti-fascist environmental education accordingly. [ABSTRACT FROM AUTHOR]

During October 2021-June 2023, a total of 392 cases of acute hepatitis of unknown etiology in children in the United States were reported to Centers for Disease Control and Prevention as part of national surveillance. We describe demographic and clinical characteristics, including potential involvement of adenovirus in development of acute hepatitis, of 8 fatally ill children who met reporting criteria. The children had diverse courses of illness. Two children were immunocompromised when initially brought for care. Four children tested positive for adenovirus in multiple specimen types, including 2 for whom typing was completed. One adenovirus-positive child had no known underlying conditions, supporting a potential relationship between adenovirus and acute hepatitis in previously healthy children. Our findings emphasize the importance of continued investigation to determine the mechanism of liver injury and appropriate treatment. Testing for adenovirus in similar cases could elucidate the role of the virus. [ABSTRACT FROM AUTHOR]

Abstract screenings, 95 articles were reviewed in full, and 63 articles were included within this analysis. Consistent antecedents of SRB were socioeconomic status, race, gender, violence, alcohol/drug use, and mental health. Attributes included several ways of defining SRBs such as frequency of condom use and type of partners. The most consistent outcome of SRBs was contraction of STIs and subsequent health problems. Few studies examined mental health outcomes of SRBs. Future research should create a standardized tool for measuring SRBs to inform policy for providing sexual health education to TGD populations, which will ultimately decrease disparities in STIs. [ABSTRACT FROM AUTHOR]

The purpose of this article is to examine the effects and affect of schools maintaining positive and healthy relationships between principals and teachers, and to delineate those factors that facilitate and contribute to student academic success. Consequently, the purpose of the study will be threefold: 1) Examining school climate and culture phenomena germane to the development of substantive principal-teacher relationships; 2) Identifying those principal-teacher relational components that foster and affect teacher performance; and 3) Analyzing the overarching effects of the building and maintenance of substantive principal-teacher relationships on student academic achievement. Furthermore, it is the intent of the present study to hone in on these factors and report findings as one method of improving overall success for the nation's schools at large.

It is critical that teachers and administrators seek out and serve the invisible children in their classrooms and schools. When they acknowledge the condition of homeless and foster children, they can begin to address their unique learning needs and close their learning gaps. Based on definitions provided by the McKinney-Vento Act, some schools were unaware they had homeless children enrolled in their schools. They discovered that ten percent of their students would be considered homeless. This article challenges educators to be knowledgeable about homeless and foster children and their unique learning needs.

Coccidioidomycosis poses a significant cost and morbidity burden in the United States. Additionally, coccidioidomycosis requires constant decision-making related to prevention, diagnosis, and management. Delays in diagnosis lead to significant consequences, including unnecessary diagnostic workup and antibacterial therapy. Antifungal stewardship considerations regarding empiric, prophylactic, and targeted management of coccidioidomycosis are also complex. In this review, the problems facing antimicrobial stewardship programs (ASPs) in the endemic region for coccidioidomycosis, consequences due to delayed or missed diagnoses of coccidioidomycosis on antibacterial prescribing, and excess antifungal prescribing for prevention and treatment of coccidioidomycosis are elucidated. Finally, our recommendations and research priorities for ASPs in the endemic region for coccidioidomycosis are outlined. [ABSTRACT FROM AUTHOR]

Maintaining healthy behaviors is challenging. Based upon previous reports that in North Carolina (NC), USA, overweight/obese clergy lost weight during a two-year religiously tailored health intervention, we described trajectories of diet, physical activity, and sleep. We investigated whether behavior changes were associated with weight and use of health-promoting theological messages. Improvements were observed in sleep, calorie-dense food intake, and physical activity, with the latter two associated with weight loss. While theological messages were well-retained, their relationship with behaviors depended on the specific message, behavior, and timing. Findings offer insights into weight loss mechanisms, including the role of theological messages in religiously tailored health interventions. [ABSTRACT FROM AUTHOR]

Purpose: Bariatric surgery is associated with a greater venous thromboembolism (VTE) risk in the weeks following surgery, but the long-term risk of VTE is incompletely characterized. We evaluated bariatric surgery in relation to long-term VTE risk. Materials and Methods: This population-based retrospective matched cohort study within three United States–based integrated health care systems included adults with body mass index (BMI) ≥ 35 kg/m2 who underwent bariatric surgery between January 2005 and September 2015 (n = 30,171), matched to nonsurgical patients on site, age, sex, BMI, diabetes, insulin use, race/ethnicity, comorbidity score, and health care utilization (n = 218,961). Follow-up for incident VTE ended September 2015 (median 9.3, max 10.7 years). Results: Our population included 30,171 bariatric surgery patients and 218,961 controls; we identified 4068 VTE events. At 30 days post-index date, bariatric surgery was associated with a fivefold greater VTE risk (HRadj = 5.01; 95% CI = 4.14, 6.05) and a nearly fourfold greater PE risk (HRadj = 3.93; 95% CI = 2.87, 5.38) than no bariatric surgery. At 1 year post-index date, bariatric surgery was associated with a 48% lower VTE risk and a 70% lower PE risk (HRadj = 0.52; 95% CI = 0.41, 0.66 and HRadj = 0.30; 95% CI = 0.21, 0.44, respectively). At 5 years post-index date, lower VTE risks persisted, with bariatric surgery associated with a 41% lower VTE risk and a 55% lower PE risk (HRadj = 0.59; 95% CI = 0.48, 0.73 and HRadj = 0.45; 95% CI = 0.32, 0.64, respectively). Conclusion: Although in the short-term bariatric surgery is associated with a greater VTE risk, in the long-term, it is associated with a substantially lower risk. [ABSTRACT FROM AUTHOR]

Simple Summary: Young adults (YAs) aged 18–39 living with advanced cancer face unique and complex challenges, but tailored behavioral interventions remain scarce. This commentary identifies unmet psychosocial needs and offers recommendations for targeted interventions to help improve overall quality of care for the often-marginalized group of YAs living with advanced cancer. The population of young adults (YAs) aged 18–39 living with advanced cancer is growing and faces a compounded set of challenges at the intersection of age and disease. Despite these substantial challenges, behavioral interventions tailored to YAs living with advanced cancer remain scarce. This commentary aims to (1) discuss the unmet psychological, social, and behavioral needs of YAs living with advanced cancer; (2) highlight the paucity of behavioral interventions tailored to this growing population; (3) offer recommendations for the development of behavioral interventions targeting the unique needs of YAs living with advanced cancer; and (4) describe potential far-reaching public health benefits of these targeted behavioral interventions. [ABSTRACT FROM AUTHOR]

Multiple factors may influence parental vaccine hesitancy towards pediatric COVID-19 vaccines and routine childhood immunizations (RCIs). Using the United States National Immunization Survey—Child COVID Module data collected from parents/guardians of children aged 5–11 years, this cross-sectional study (1) identified the trends and prevalence estimates of parental hesitancy towards pediatric COVID-19 vaccines and RCIs, (2) examined the relationship between hesitancy towards pediatric COVID-19 vaccines and RCIs, and (3) assessed trends in parental hesitancy towards RCIs by sociodemographic characteristics and behavioral and social drivers of COVID-19 vaccination. From November 2021 to July 2022, 54,329 parents or guardians were interviewed. During this 9-month period, the proportion of parents hesitant about pediatric COVID-19 vaccines increased by 15.8 percentage points (24.8% to 40.6%). Additionally, the proportion of parents who reported RCIs hesitancy increased by 4.7 percentage points from November 2021 to May 2022 but returned to baseline by July 2022. Over nine months, parents' concerns about pediatric COVID-19 infections declined; however, parents were increasingly worried about pediatric COVID-19 vaccine safety and overall importance. Furthermore, pediatric COVID-19 vaccine hesitancy was more prevalent among parents of children who were White (43.2%) versus Black (29.3%) or Hispanic (26.9%) and those residing in rural (51.3%) compared to urban (28.9%) areas. In contrast, RCIs hesitancy was higher among parents of children who were Black (32.0%) versus Hispanic (24.5%) or White (23.6%). Pediatric COVID-19 vaccine hesitancy was 2–6 times as prevalent among parents who were RCIs hesitant compared to those who were RCIs non-hesitant. This positive correlation between parental hesitancy towards pediatric COVID-19 vaccines and RCIs was observed for all demographic and psychosocial factors for unadjusted and adjusted prevalence ratios. Parent–provider interactions should increase vaccine confidence, shape social norms, and facilitate behavior change to promote pediatric vaccination rates. [ABSTRACT FROM AUTHOR]

Successful aging (SA) is an important target for HIV care. However, we have insufficient understanding of how older women living with HIV (OWLH) in the US define SA. We explored conceptions of SA by OWLH and older women at risk of HIV and examined whether SA conceptions differed by (1) HIV serostatus, and (2) participation in the Women's Interagency HIV Study (WIHS). These analyses were part of a larger mixed-methods study with a sequential design. Participants were recruited at two clinical WIHS sites. We enrolled both WIHS participants and non-WIHS clinic patients. Our sample was 84% Black and included 29 OWLH and 15 older women at risk of HIV. We conducted 21 semi-structured interviews and four focus groups. The dataset was analyzed using descriptive, comparative, and relational analysis. We found four interlinked themes: life course perspective, accepting and celebrating aging, taking care of yourself, and looking good. The life course perspective was a core theme: participants assessed their aging in comparison to their earlier life hardships. These themes were similarly present among OWLH and older women at risk of HIV, although OWLH emphasized taking care of HIV. SA conceptualizations by OWLH did not differ whether or not they participated in the WIHS. Women living with or at risk of HIV may experience severe hardships throughout their lives. Overcoming these hardships may be linked to SA. Assessing the needs and connecting women to resources and programs are critical for SA promotion. [ABSTRACT FROM AUTHOR]

Two studies (N = 676) highlight the nuanced relationship between conservatism and adherence to COVID-19 policy and recommendations intended to slow the spread of the pandemic in the United States. Study 1 provided evidence that conservative Americans who felt uncertain about themselves and the future experienced elevated levels of symbolic threat (attacks to sociopolitical identity; e.g., the pandemic threatening American democracy) and realistic threat (concrete attacks to material resources or well-being; e.g., the pandemic threatening physical health) in comparison to their more certain counterparts. In Study 2, the association between this form of uncertainty and frequency of risky social behaviors (behaviors that increase the risk of virus transmission) was partially mediated by threat perception for Americans both low and high in conservatism. We discuss findings as an integration of the motivated social cognition framework and uncertainty-identity theory. While self-uncertainty was more associated with greater overall COVID-19 threat perception for Americans high (vs. low) in conservatism, threat perception and frequency of risky social behaviors were associated with self-uncertainty in a manner that is consistent with prevailing liberal and conservative norms. [ABSTRACT FROM AUTHOR]

Introduction: For drug resistant epilepsy patients who are either not candidates for resective surgery or have already failed resective surgery, neuromodulation is a promising option. Neuromodulatory approaches include responsive neurostimulation (RNS), deep brain stimulation (DBS), and vagal nerve stimulation (VNS). Thalamocortical circuits are involved in both generalized and focal onset seizures. This paper explores the use of RNS in the centromedian nucleus of the thalamus (CMN) and in the anterior thalamic nucleus (ANT) of patients with drug resistant epilepsy. Methods: This is a retrospective multicenter study from seven different epilepsy centers in the United States. Patients that had unilateral or bilateral thalamic RNS leads implanted in the CMN or ANT for at least 6 months were included. Primary objectives were to describe the implant location and determine changes in the frequency of disabling seizures at 6 months, 1 year, 2 years, and > 2 years. Secondary objectives included documenting seizure free periods, anti-seizure medication regimen changes, stimulation side effects, and serious adverse events. In addition, the global clinical impression scale was completed. Results: Twelve patients had at least one lead placed in the CMN, and 13 had at least one lead placed in the ANT. The median baseline seizure frequency was 15 per month. Overall, the median seizure reduction was 33% at 6 months, 55% at 1 year, 65% at 2 years, and 74% at >2 years. Seizure free intervals of at least 3 months occurred in nine patients. Most patients (60%, 15/25) did not have a change in anti-seizure medications post RNS placement. Two serious adverse events were recorded, one related to RNS implantation. Lastly, overall functioning seemed to improve with 88% showing improvement on the global clinical impression scale. Discussion: Meaningful seizure reduction was observed in patients who suffer from drug resistant epilepsy with unilateral or bilateral RNS in either the ANT or CMN of the thalamus. Most patients remained on their pre-operative anti-seizure medication regimen. The device was well tolerated with few side effects. There were rare serious adverse events. Most patients showed an improvement in global clinical impression scores. [ABSTRACT FROM AUTHOR]

Background Diagnostic errors cause substantial preventable harms worldwide, but rigorous estimates for total burden are lacking. We previously estimated diagnostic error and serious harm rates for key dangerous diseases in major disease categories and validated plausible ranges using clinical experts. Objective We sought to estimate the annual US burden of serious misdiagnosis-related harms (permanent morbidity, mortality) by combining prior results with rigorous estimates of disease incidence. Methods Cross-sectional analysis of US-based nationally representative observational data. We estimated annual incident vascular events and infections from 21.5 million (M) sampled US hospital discharges (2012-2014). Annual new cancers were taken from US-based registries (2014). Years were selected for coding consistency with prior literature. Disease-specific incidences for 15 major vascular events, infections and cancers ('Big Three' categories) were multiplied by literature-based rates to derive diagnostic errors and serious harms. We calculated uncertainty estimates using Monte Carlo simulations. Validity checks included sensitivity analyses and comparison with prior published estimates. Results Annual US incidence was 6.0 M vascular events, 6.2 M infections and 1.5 M cancers. Per 'Big Three' dangerous disease case, weighted mean error and serious harm rates were 11.1% and 4.4%, respectively. Extrapolating to all diseases (including non-'Big Three' dangerous disease categories), we estimated total serious harms annually in the USA to be 795 000 (plausible range 598 000-1 023 000). Sensitivity analyses using more conservative assumptions estimated 549 000 serious harms. Results were compatible with setting-specific serious harm estimates from inpatient, emergency department and ambulatory care. The 15 dangerous diseases accounted for 50.7% of total serious harms and the top 5 (stroke, sepsis, pneumonia, venous thromboembolism and lung cancer) accounted for 38.7%. Conclusion An estimated 795 000 Americans become permanently disabled or die annually across care settings because dangerous diseases are misdiagnosed. Just 15 diseases account for about half of all serious harms, so the problem may be more tractable than previously imagined. [ABSTRACT FROM AUTHOR]

This paper presents a unique 15-year dataset of Incident Management Situation Reports (IMSR), which document daily wildland fire situations across ten geographical regions in the United States. The IMSR dataset includes summaries for each reported day on national and regional wildfire activities, wildfire-specific activities, and committed fire suppression resources (i.e., personnel and equipment). This dataset is distinct from other wildfire data sources as it provides daily information on national fire suppression resource utilization, national and regional preparedness levels, and management priority for each region and fire. We developed an open-source Java program, IMSR-Tool, to process 3,124 IMSR reports available from 2007 to 2021 to generate this structured IMSR dataset, which can be updated when future reports become available. The dataset presented here and its future extension enable researchers and practitioners to study historical wildfire activity and resource use across regions and time, examine fire management perceptions, evaluate strategies for fire prioritization and fire resource allocation, and exploit other broader usage to improve wildfire management and response in the United States. [ABSTRACT FROM AUTHOR]

This paper examines how indigenous people's sovereignty and legal system, may not mesh adequately with the United States legal system. The issues and injustices indigenous peoples feel are not unique to the United States. Canada has experienced similar cultural and legal issues and has come up with a unique solution to the problems created. I intend to examine the problems from both a historical and legal societal perspective. And then suggest some potential solutions. The value of this paper is that it helps us to recognize the valuable resources we have in our diverse population and how to effectively utilize and, most importantly recognize their unique and varying skill sets. By including these peoples into our collective fabric, we will yield a better society. The fabric of our society can seem much like conventional clothing fabric, which is strengthened by the introduction of another element into the mix. [ABSTRACT FROM AUTHOR]

The systemic inflammatory response syndrome (SIRS) is a clinical reaction that can occur due to a variety of stimuli. Reamed intramedullary femoral nailing is a common orthopedic surgery that has been shown to induce SIRS. To date, no nationwide analyses have been performed to evaluate the incidence, risk factors, and economic burdens of SIRS following intramedullary femoral nailing for femoral shaft fractures. The objective of this study is to investigate the independent predictors, incidence, post-operative, and economic burden of SIRS among patients treated with intramedullary nailing for femoral shaft fractures. We utilized the 2016–2019 National Inpatient Sample (NIS) to identify patients who underwent intramedullary femoral nailing and were diagnosed with non-infectious SIRS (NI-SIRS) based on ICD-10-CM coding. Identified patients who underwent intramedullary femoral nailing were dichotomized into SIRS and Non-SIRS groups to assess independent predictors of SIRS development, and to compare post-operative complications and costs. A total of 65,240 patients with femur shaft fractures underwent IMFN, of which 665 (1.0 %) developed NI-SIRS. Patients with NI-SIRS had a higher incidence of laparotomy (OR = 13.97, p < 0.001), initial treatment with external fixation (OR = 1.845, p < 0.001), and late application of external fixation (OR = 4.884, p = 0.005). Routine discharge (OR = 0.491, p < 0.001) was less likely in patients with NI-SIRS. Length of stay (12.38 days vs 7.16 days, p < 0.001) and total charges ($278, 590 vs $145,118, p < 0.001) were both increased in patients with NI-SIRS. NI-SIRS is associated with increasing injury severity and post-operative complications. Those that developed NI-SIRS experienced higher healthcare resource utilization. Risk factors associated with development of NI-SIRS warrant further investigation. [ABSTRACT FROM AUTHOR]

The PTSD Checklist for DSM‐5 (PCL‐5) is a measure of posttraumatic stress disorder (PTSD) symptom severity that is widely used for clinical and research purposes. Although previous work has examined metrics of minimal important difference (MID) of the PCL‐5 in veteran samples, no work has identified PCL‐5 MID metrics among adults in primary care in the United States. In this secondary analysis, data were evaluated from primary care patients (N = 971) who screened positive for PTSD and participated in a large clinical trial in federally qualified health centers in three U.S. states. Participants primarily self‐identified as women (70.2%) and White (70.3%). We calculated test–retest reliability using clinic registry data and multiple distribution‐ and anchor‐based metrics of MID using baseline and follow‐up survey data. Test–retest reliability (Pearson's r, Spearman's ρ, intraclass correlation coefficient) ranged from adequate to excellent (.79–.94), with the shortest time lag demonstrating the highest reliability estimate. The MID for the PCL‐5 was estimated using multiple approaches. Distribution‐based approaches indicated an MID range of 8.5–12.5, and anchor‐based approaches indicated an MID range of 9.8–11.7. Taken together, the MID metrics indicate that PCL‐5 change scores of 9–12 likely reflect real change in PTSD symptoms and indicate at least an MID for patients, whereas PCL‐5 change scores of 5 or less likely are not reliable. These findings can help inform clinicians using the PCL‐5 in similar populations to track patient responses to treatment and help researchers interpret PCL‐5 score changes in clinical trials. [ABSTRACT FROM AUTHOR]

Succession in family firms is an extremely difficult and complex event in which advisors are often involved or sought. Advisors, especially business consultants, frequently play an important role in shaping and guiding such complex strategic processes. Nevertheless, it is not clear whether and to what extent the involvement of advisors, especially business consultants, in family firm succession impact the outcome of succession planning processes, such as the choice of the next chief executive officer (CEO). We explore whether family-owner socioemotional wealth, measured through their level of commitment to the firm, influences the preference for a family CEO versus a nonfamily CEO and acceptance of the advisor role in the succession planning process. We test the research questions on a sample of family firms located in the United States. [ABSTRACT FROM AUTHOR]

Highly pathogenic avian influenza viruses (HPAIVs) of subtype H5 of the Gs/GD/96 lineage remain a major threat to poultry due to endemicity in wild birds. H5N1 HPAIVs from this lineage were detected in 2021 in the United States (U.S.) and since then have infected many wild and domestic birds. We evaluated the pathobiology of an early U.S. H5N1 HPAIV (clade 2.3.4.4b, 2021) and two H5N8 HPAIVs from previous outbreaks in the U.S. (clade 2.3.4.4c, 2014) and Europe (clade 2.3.4.4b, 2016) in chickens and turkeys. Differences in clinical signs, mean death times (MDTs), and virus transmissibility were found between chickens and turkeys. The mean bird infective dose (BID50) of the 2021 H5N1 virus was approximately 2.6 log10 50% embryo infective dose (EID50) in chickens and 2.2 log10 EID50 in turkeys, and the virus transmitted to contact-exposed turkeys but not chickens. The BID50 for the 2016 H5N8 virus was also slightly different in chickens and turkeys (4.2 and 4.7 log10 EID50, respectively); however, the BID50 for the 2014 H5N8 virus was higher for chickens than turkeys (3.9 and ~0.9 log10 EID50, respectively). With all viruses, turkeys took longer to die (MDTs of 2.6–8.2 days for turkeys and 1–4 days for chickens), which increased the virus shedding period and facilitated transmission to contacts. [ABSTRACT FROM AUTHOR]

Why do political campaigns so often fail to persuade voters, and what does this say about voter decision making? Some interpret the difficulty of persuading voters as evidence that voters remain loyal to their parties even when confronted with new information. However, an informational (quasi‐Bayesian) mechanism may also contribute. We test empirical implications of these alternatives with four survey experiments (total n = 113,742) conducted during the 2020 presidential election that exposed individuals to 291 messages. Our results support the quasi‐Bayesian interpretation: We show that voters are more persuadable with information about candidates they know less about; that persuasive messages change both candidate evaluations and vote choices, and induce partisan defection; and that messages with more informational content are more persuasive. These results suggest voters' reaction to information in a manner consistent with Bayesian updating, and not only partisan loyalty, can help explain variation in and the small size of campaign effects. [ABSTRACT FROM AUTHOR]

This article explores how immigrant students in the United States utilise multimodal literacy practices to complicate dominant narratives of American national identity--narratives of facile assimilation, meritocracy and linear trajectories. Such ideologies can be explicitly evident in curricular materials or can be woven more implicitly into school literacy practices that privilege individual achievement, devalue cultural ways of knowing, and operate on a paradigm of remediation. Within this educational backdrop, we report on a practitioner research study that invited students in a summer school programme for English Language Learners to share their experiences in multiple formats and media, including comics, and to draw on their cultural and linguistic heritages as sources of knowledge. We feature comics created by two students in the programme (an 8-year-old girl of Indian heritage and a 16-year-old boy from Vietnam) to understand the potential of visual texts to articulate micronarratives of immigration. We emphasise how students blend semiotic resources in order to represent the complexity of their experiences, convey cultural hybridity and resist singular narratives. (Contains 3 figures.)

Introduction: For drug resistant epilepsy patients who are either not candidates for resective surgery or have already failed resective surgery, neuromodulation is a promising option. Neuromodulatory approaches include responsive neurostimulation (RNS), deep brain stimulation (DBS), and vagal nerve stimulation (VNS). Thalamocortical circuits are involved in both generalized and focal onset seizures. This paper explores the use of RNS in the centromedian nucleus of the thalamus (CMN) and in the anterior thalamic nucleus (ANT) of patients with drug resistant epilepsy. Methods: This is a retrospective multicenter study from seven different epilepsy centers in the United States. Patients that had unilateral or bilateral thalamic RNS leads implanted in the CMN or ANT for at least 6 months were included. Primary objectives were to describe the implant location and determine changes in the frequency of disabling seizures at 6 months, 1 year, 2 years, and > 2 years. Secondary objectives included documenting seizure free periods, anti-seizure medication regimen changes, stimulation side effects, and serious adverse events. In addition, the global clinical impression scale was completed. Results: Twelve patients had at least one lead placed in the CMN, and 13 had at least one lead placed in the ANT. The median baseline seizure frequency was 15 per month. Overall, the median seizure reduction was 33% at 6 months, 55% at 1 year, 65% at 2 years, and 74% at >2 years. Seizure free intervals of at least 3 months occurred in nine patients. Most patients (60%, 15/25) did not have a change in anti-seizure medications post RNS placement. Two serious adverse events were recorded, one related to RNS implantation. Lastly, overall functioning seemed to improve with 88% showing improvement on the global clinical impression scale. Discussion: Meaningful seizure reduction was observed in patients who suffer from drug resistant epilepsy with unilateral or bilateral RNS in either the ANT or CMN of the thalamus. Most patients remained on their pre-operative anti-seizure medication regimen. The device was well tolerated with few side effects. There were rare serious adverse events. Most patients showed an improvement in global clinical impression scores. [ABSTRACT FROM AUTHOR]

People with schizophrenia often experience impaired social functioning and low satisfaction with relationships. Existing measures of social impairment in schizophrenia primarily assess pleasure derived from social interactions, rather than examining impairments in social motivation, including effortful behavior. We conducted a validation study of a recently developed self-report measure of social effort in 31 participants with schizophrenia spectrum disorders, including tests of association with standard assessments of social functioning and behavior in daily life using ecological momentary assessment (EMA). We also assessed predictive validity of the scale, measuring the extent to which social effort at baseline predicted changes in social functioning over a 60-day smartphone-based social intervention. Higher social effort was associated with greater social functioning and lower negative symptom severity at baseline. Baseline social effort did not predict changes in social functioning over the intervention period, nor was it related to EMA-reported social experiences. Thus, tendencies toward social effort exertion may capture meaningful variance in gold-standard assessments of social functioning and negative symptoms, but may not track with social experiences in daily life. Further research should examine whether social effort is sensitive to change, and evaluate the utility of targeting social effort in evidence-based interventions for improving the social functioning in schizophrenia. [ABSTRACT FROM AUTHOR]

Prehospital transfusion capabilities vary widely in the United States. Here we describe a case of prehospital resuscitation using warmed, whole blood in a patient with penetrating torso trauma and associated hemorrhagic shock. A 68-year-old man sustained a single gunshot wound to the left chest and was found to have a shock index of 1.5 at the time of emergency medical services (EMS) arrival. Rapid peripheral intravenous and central venous access enabled the infusion of warmed low-titer O-positive whole blood. The EMS crew intentionally resuscitated the patient before managing the airway by means of rapid sequence intubation. An air medical services helicopter crew assumed patient care from the ground EMS crew and continued the warmed, whole blood transfusion during the flight to a regional Level I trauma center. The patient went directly to the operating room from the helipad, underwent definitive operative management, and was ultimately discharged home on hospital day nine. Early recognition of hemorrhagic shock, implementation of prehospital transfusion protocols that emphasize transfusion of warmed blood without interruption, and an organized, regional approach to trauma care are critical for improving patient survival. [ABSTRACT FROM AUTHOR]

Gray wolf (Canis lupus) recovery and conservation has been a remarkable success over the last 30 years in the United States. Remarkable success yields remarkable challenges, however. As populations expand, wolves will colonize more human-dominated landscapes and face numerous challenges, such as fragmented habitats, barriers to dispersal, and increased encounters with humans, pets, and livestock. In such areas, conflicts between humans and wolves will increase. We summarize several major scientific and social challenges that wolf conservation, recovery, and management will face in the coming years. In addition, we suggest actions to help address each challenge. Future wolf conservation in the United States will be affected by the ability of managers to predict colonization and dispersal dynamics, to reduce hybridization and disease transmission, to mitigate and deter wolf–livestock conflicts, to harvest wolves sustainably while satisfying diverse stakeholders, to avert a reduction in tolerance for wolves due to a disinterest in nature, and to engage diverse stakeholders in wolf conservation to avoid management by ballot initiative or legislative and judicial decrees. [ABSTRACT FROM AUTHOR]

Background: It is critical to understand the wide-ranging clinical and non-clinical effects of genome sequencing (GS) for parents in the NICU context. We assessed parents' experiences with GS as a first-line diagnostic tool for infants with suspected genetic conditions in the NICU. Methods: Parents of newborns (N = 62) suspected of having a genetic condition were recruited across five hospitals in the southeast United States as part of the SouthSeq study. Semi-structured interviews (N = 78) were conducted after parents received their child's sequencing result (positive, negative, or variants of unknown significance). Thematic analysis was performed on all interviews. Results: Key themes included that (1) GS in infancy is important for reproductive decision making, preparing for the child's future care, ending the diagnostic odyssey, and sharing results with care providers; (2) the timing of disclosure was acceptable for most parents, although many reported the NICU environment was overwhelming; and (3) parents deny that receiving GS results during infancy exacerbated parent–infant bonding, and reported variable impact on their feelings of guilt. Conclusion: Parents reported that GS during the neonatal period was useful because it provided a "backbone" for their child's care. Parents did not consistently endorse negative impacts like interference with parent–infant bonding. [ABSTRACT FROM AUTHOR]

By influencing soil organic carbon (SOC), cover crops play a key role in shaping soil health and hence the system's long‐term sustainability. However, the magnitude by which cover crops impacts SOC depends on multiple factors, including soil type, climate, crop rotation, tillage type, cover crop growth, and years under management. To elucidate how these multiple factors influence the relative impact of cover crops on SOC, we conducted a meta‐analysis on the impacts of cover crops within rotations that included corn (Zea mays L.) on SOC accumulation. Information on climatic conditions, soil characteristics, management, and cover crop performance was extracted, resulting in 198 paired comparisons from 61 peer‐reviewed studies. Over the course of each study, cover crops on average increased SOC by 7.3% (95% CI, 4.9%–9.6%). Furthermore, the impact of cover crop–induced increases in percent change SOC was evaluated across soil textures, cover crop types, crop rotations, biomass amounts, cover crop durations, tillage practices, and climatic zones. Our results suggest that current cover crop–based corn production systems are sequestering 5.5 million Mg of SOC per year in the United States and have the potential to sequester 175 million Mg SOC per year globally. These findings can be used to improve carbon footprint calculations and develop science‐based policy recommendations. Taken altogether, cover cropping is a promising strategy to sequester atmospheric C and hence make corn production systems more resilient to changing climates. Core Ideas: In the 61 studies that contained cover crops, the average SOC increase over each project was 7.3%.The amount of SOC stored was influenced by crop rotation, cover crop type and biomass, soil texture, and climate.Average cover crops increased SOC storage in the surface 30 cm was 0.88 Mg SOC (ha × per year).Globally, cover crop–based corn production systems have the potential to sequester 175 million Mg SOC per year. [ABSTRACT FROM AUTHOR]

In the Northwest Atlantic (NWA), the Atlantic mackerel (Scomber scombrus) has a northern and a southern contingent, which spawn in Canada and the United States (U.S.), respectively. Both contingents mix mostly along the U.S. shelf during overwintering. The discrimination of individuals from each contingent in fisheries could improve the management of this depleted species in both countries. Here, we used genome-wide markers (>10 000 single nucleotide polymorphisms (SNPs)) to assess genomic differences between mackerel of both contingents, and possibly infer the proportions of each contingent in NWA management units. Small but significant genetic differentiation was observed between the northern and southern contingents (FST = 0.0010). Genetic assignments to reference samples from the two contingents were performed with predictive accuracy > 85%. Fish from both contingents were present along the U.S. shelf during late winter and early spring but also, without prior evidence of this, likely in Canadian waters from late spring to fall. Genetic assignments could be used as a stock discrimination tool so that fishery removals can be effectively determined and managed on a contingent level. [ABSTRACT FROM AUTHOR]

Evolution education in the US is conducted unevenly, or in cases is absent. Showing the strength of ethnography as a means of deeper explication in science education, this article explores the interactions of policy and practice in evolution education. Discussing vignettes from a larger ethnographic study, Creationist rationales and practices within the classroom are explored, with implications for science education policy and practice. (Contains 4 notes.)

Juvenile delinquency in the United States has been a persistent concern for decades. Consequently, because more juveniles have been referred to juvenile court and the arrest rate of preteen offenders has increased to almost three times that of older youth, the persistent and often controversial issue of the capacity of juvenile offenders to waive their rights (Miranda rights) and stand trial is particularly important. This article provides a brief overview of the psychological, legal, and educational issues relating to juveniles' understanding of their Miranda rights, with a particular focus on juveniles with disabilities. (Contains 2 tables.)

This study had two major purposes. The first purpose was to compare federal, state, and institutional direct grant aid, unmet needs, and headcount in 2000-2001 and 2005-2006. The second was to assess if any changes found related to the presence or absence of two key factors identified by experts as important to understanding the community college field: (a) type of Associate's College (rural, suburban, and urban) delineated by the Carnegie Foundation for the Advancement of Teaching's 2005 Basic Classification, and (b) significant local funding, using the Grapevine definition that defines 25 states as having local tax appropriations accounting for more than 10% of total funding and 25 states without. Analyzing data from the National Center for Educational Statistics' Integrated Postsecondary Education Data System, the study found that between 2000-2001 and 2005-2006, enrollment at Associate's Colleges grew by 30%, and while all categories of direct student aid also grew, the growth was overwhelmed by tuition increases averaging 40%. Analysis of descriptive data revealed stark differences between community colleges in states with the presence of local tax support, and those without, and by type of Associate's College (rural, suburban and urban). By 2005-2006, it was more difficult for low-income students to attend college without incurring debt. The paper concludes with discussion as to the impact on open access for students attending community colleges if these trends continue. (Contains 3 tables.)

Public policy aimed at supporting the caregiving capacity of families has risen to prominence on the public agenda in the United States. Initiatives at the state and federal levels have created some initial services. Three trends that are pushing the issue of family caregiving to the surface are discussed, including large-scale social, demographic, and economic changes. The pressures on women from increased caregiving demands are discussed, along with the taken-for-granted cultural value placed on the home as a locus of care for family members who need assistance with common daily activities. Experiments at the state level with consumer-directed care and capitated wrap-around services are described. The authors argue that support for caregiving families is likely to remain a prominent concern of the public and policy makers for the foreseeable future.

Educational researchers and practitioners have paid considerable attention to the use of multiuser virtual environments (MUVEs) in recent years in order to support learning across curricula. Among MUVEs, Second Life (SL) is one of the most popular environments, with over 18 million account-registered users as of May 2008. This paper reports a research collaboration between Georgia State University in the United States and Yantai University in China which explores various facets of EFL (English as a Foreign Language) learning within SL. The ultimate purpose of this research collaboration is to find appropriate ways to integrate SL into an EFL program in China. The paper reports the research collaboration background of the EFL Program in SL, including its implementation and evaluation, and suggestions for implementing similar programs for international collaboration. (Contains 2 tables.)

Family members provide the majority of care for individuals with disabilities in the United States. There is growing recognition that family caregiving deserves and may require societal support, and evidence-based practices have been established for reducing stress associated with caregiving. A substantial research literature on family support has developed, but researchers, advocates, and professionals have often worked in separate categorical domains such as family support for caregiving for the frail elderly, for individuals with mental illnesses, and for people with developmental disabilities. This article considers the merits of a cross-categorical analysis of family support. Examples of concepts from one domain of family support are applied to other domains to illustrate the potential benefits of a broader exchange of ideas.

This article extends the relevance of multicultural development to the Strengths-Based School Counseling (SBSC; Galassi & Akos, 2007) perspective. A relatively new construct for school counselors, the "multicultural personality" (MP), is introduced and defined. The MP is conceptualized as a cluster of narrow personality traits that can be subsumed under broader models of personality. Research has found that MP development is correlated with coping, adapting, and thriving in increasingly culturally diverse environments such as the United States. Suggestions for integrating MP development across the guiding principles of SBSC are presented.

Truancy has been identified as one of the top 10 educational problems in the United States and is considered an important predictor of later delinquent behavior. The purpose of this study was to track youth initially referred to the juvenile justice system because of truancy. Data were provided by the South Carolina Department of Juvenile Justice (SCDJJ). The sample was drawn from a cohort of 12,468 juveniles, all born in 1985. A longitudinal approach was taken to examine truancy offenders' interactions with the SCDJJ at their first and second referrals. Compared to non-truancy referrals, youth who are first referred for truancy are more likely to be European American and female and less likely to have a history of serious drug use. Furthermore, they are less likely to be referred for more serious crimes later in their youth and, if later incarcerated, experience shorter commitments. The results of the present study suggest that youth who are referred to the juvenile justice system for truancy represent a distinct group of juvenile offenders compared to youth who are referred for other offenses. Implications of these findings for policy and future research are addressed.

We examine whether abortion removes from the population those infants most at risk of homicide. As part of our identification strategy, we find that abortion reduces the number of unwanted births, estimating that 1 percent increase in the abortion ratio reduces unwanted births by approximately 0.35 percent. Using cross-sectional time-series data for U.S. states between 1970 and 1998, we find that an increase in the abortion ratio (a proxy for unwanted births) reduces the expected number of infant homicides, especially among black infants. Overall, the elasticity of infant homicides with respect to unwanted births is approximately 0.089.

This is the story of the first American mathematics journal. According to its title page, the journal was "adapted to the present state of learning in America" and "designed to inspire youth with the love of mathematical knowledge, by alluring their attentions to the solutions of pleasant and curious questions".

This study investigates the impact of the perceptions of antisocial behaviour on the use of the social media platform Twitter. We extend the Unified Theory of Acceptance and Use of Technology (UTAUT) with the Perception of Antisocial Behaviour as a risk factor, and two supporting constructs: Strategic Self-Presentation and Protective Self-Presentation. We call this extended model Technology Acceptance and Use under Risk (TAUR). We investigate two groups via an online questionnaire, contrasting Anglophone countries (the UK, USA, and Canada, 200 responses), with Saudi Arabia (540 responses). In both cases the data shows that the Perception of Antisocial Behaviour impacts Twitter use, but not directly, rather it negatively impacts the influence of other factors such as Behavioural Intention – it also shows that this affects Anglophones more than Saudis. This indicates that future work should differentiate between different cultural groups, and different solutions may be needed to assuage users' fears in different parts of the world. [ABSTRACT FROM AUTHOR]

Clergy are tasked with multiple interpersonal administrative, organizational, and religious responsibilities, such as preaching, teaching, counseling, administering sacraments, developing lay leader skills, and providing leadership and vision for the congregation and community. The high expectations and demands placed on them put them at an increased risk for mental distress such as depression and anxiety. Little is known about whether and how clergy, helpers themselves, receive care when they experience mental distress. All active United Methodist Church (UMC) clergy in North Carolina were recruited to take a survey in 2019 comprising validated depression and anxiety screeners and questions about mental health service utilization. Bivariate and Poisson regression analyses were conducted on the subset of participants with elevated depressive and anxiety symptoms to determine the extent of mental health service use during four different timeframes and the relationship between service use and sociodemographic variables. A total of 1,489 clergy participated. Of the 222 (15%) who had elevated anxiety or depressive symptoms or both, 49.1% had not ever or recently (in the past two years) seen a mental health professional. Participants were more likely to report using services currently or recently (in the past two years) if they were younger, had depression before age 21, or "very often" felt loved and cared for by their congregation. The rate of mental health service use among UMC clergy is comparable to the national average of service use by US adults with mental distress. However, it is concerning that 49% of clergy with elevated symptoms were not engaged in care. This study points to clergy subgroups to target for an increase in mental health service use. Strategies to support clergy and minimize mental health stigma are needed. [ABSTRACT FROM AUTHOR]

This third Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE‐3) from the Society for Academic Emergency Medicine is on the topic adult patients with acute dizziness and vertigo in the emergency department (ED). A multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding five questions for adult ED patients with acute dizziness of less than 2 weeks' duration. The intended population is adults presenting to the ED with acute dizziness or vertigo. The panel derived 15 evidence‐based recommendations based on the timing and triggers of the dizziness but recognizes that alternative diagnostic approaches exist, such as the STANDING protocol and nystagmus examination in combination with gait unsteadiness or the presence of vascular risk factors. As an overarching recommendation, (1) emergency clinicians should receive training in bedside physical examination techniques for patients with the acute vestibular syndrome (AVS; HINTS) and the diagnostic and therapeutic maneuvers for benign paroxysmal positional vertigo (BPPV; Dix–Hallpike test and Epley maneuver). To help distinguish central from peripheral causes in patients with the AVS, we recommend: (2) use HINTS (for clinicians trained in its use) in patients with nystagmus, (3) use finger rub to further aid in excluding stroke in patients with nystagmus, (4) use severity of gait unsteadiness in patients without nystagmus, (5) do not use brain computed tomography (CT), (6) do not use routine magnetic resonance imaging (MRI) as a first‐line test if a clinician trained in HINTS is available, and (7) use MRI as a confirmatory test in patients with central or equivocal HINTS examinations. In patients with the spontaneous episodic vestibular syndrome: (8) search for symptoms or signs of cerebral ischemia, (9) do not use CT, and (10) use CT angiography or MRI angiography if there is concern for transient ischemic attack. In patients with the triggered (positional) episodic vestibular syndrome, (11) use the Dix–Hallpike test to diagnose posterior canal BPPV (pc‐BPPV), (12) do not use CT, and (13) do not use MRI routinely, unless atypical clinical features are present. In patients diagnosed with vestibular neuritis, (14) consider short‐term steroids as a treatment option. In patients diagnosed with pc‐BPPV, (15) treat with the Epley maneuver. It is clear that as of 2023, when applied in routine practice by emergency clinicians without special training, HINTS testing is inaccurate, partly due to use in the wrong patients and partly due to issues with its interpretation. Most emergency physicians have not received training in use of HINTS. As such, it is not standard of care, either in the legal sense of that term ("what the average physician would do in similar circumstances") or in the common parlance sense ("the standard action typically used by physicians in routine practice"). [ABSTRACT FROM AUTHOR]

This article describes and evaluates a new alternative: distance-based training using live video and audio courses transmitted via the Internet. This alternative may address each of the problems described above, that is, it may provide a distant expert who selects and delivers training to paraprofessionals in a cost efficient manner. Because the course is a live broadcast, the instructor can teach in an interactive manner by presenting information, obtaining responses from paraprofessional participants at a distance, adjusting instruction if necessary, and addressing questions. The authors found no research literature on live, distance-based education involving special education paraprofessionals. Therefore, this evaluation is a basic one in which participants and advisory board members responded to topics related to technology, course content, and course delivery. The article describes an initial attempt to evaluate the alternative in regards to functionality of technology and delivery of distance-based instruction. There is no attempt to compare or contrast this alternative to other training formats.

Examined the range of mathematics learning opportunities in the U.S., drawing on data gathered for the Third International Mathematics and Science Study (TIMSS). Analyses reveal a mismatch between the course title and the textbook used for nearly 40% of eighth graders. Significant relationships found were not significant enough to account for the observed variation among schools.Individual student differences represent an inadequate explanation for the observed diversity in curricular opportunities. (SLD)