Search

Writing about writing (WAW) pedagogy is becoming a dominant approach to teaching writing, yet lacks descriptive empirical studies. In response to this deficit, we surveyed postsecondary instructors using WAW in the US and Canada to discover how they define WAW conceptually (what they think) and operationally (what they do). We used grounded theory to code data and inform our analysis of surveys, interviews, and course materials, including reading and writing assignments. Participants defined WAW as a movement, a pedagogical approach, and a subject matter whereby students read disciplinary literature in writing studies, use writing to investigate and understand writing and writing processes (especially their own), and develop metacognition about writing (including for transfer). The course subject or focus was writing itself, disciplinary content of writing studies (including research), and students' own reflective awareness. Instructors used a range of readings to teach disciplinary content and research methods in writing studies. Classroom activities included practicing and reflecting on writing and researching writing. Assignments focused on the topic of writing including rhetorical analysis and real-world writing tasks, often emphasizing reflection and metacognition.

Most current autism research focuses on Western countries, where service availability and cultural experiences differ from those of individuals living in Asian countries, where collectivistic cultural values prevail and understanding of autism is emerging. By gathering data from Vietnamese parents of autistic children (N = 339), the current measurement study examined measure variance and invariance between the English version of the "Illness Perception Questionnaire--Revised for Autism Spectrum Disorder" (IPQ-R-ASD) and a Vietnamese translation of it, at the item, scalar, and factor levels. Results indicated measurement variance for only three of 37 items and highlighted different perceptions of autism between Vietnamese and North American parents, based on responses to the IPQ-R-ASD. Responses indicated that Vietnamese parents may have a different interpretation of the questions. Seven factors emerged on both the Vietnamese and English instruments, but items loaded differently, and a distinct factor emerged on the Vietnamese version. In sum, the current findings suggest that the IPQ-R-ASD can be useful for better understanding Vietnamese parents' perceptions of their children's autism, but the interpretation is somewhat different than on the English version, highlighting the importance of cross-cultural considerations in the study of autism in Western versus Eastern cultures.

American healthcare is known for insufficient competition, high prices, and porous quality. This landscape seems to have not only degraded consumer welfare in general terms but also harmed marginalized communities. As examples, high prices levy greater costs on uninsured people who are more likely to forego treatment while medical bills constitute a primary reason why Americans declare bankruptcy. Helping to explain this state of affairs, hospitals, providers, and doctors adhere to a curious type of practice about prices: there are no prices. By preventing comparison shopping, opacity seems to restrict competition, erect barriers to entry, and enable firms to charge supracompetitive prices. So why hasn't antitrust law scrutinized one of the most anomalous, unique, and perhaps anticompetitive practices in healthcare?. One theory has surfaced that opaque pricing is procompetitive. The assertion is that providers and hospitals would collude (even more) if prices were known; absent knowledge of each other's rates, hospitals cannot supposedly fix them. Put differently, opacity appears to satisfy antitrust law because it is ostensibly the presence of visible prices that enables collusion. Helping to explain this argument's success, some authorities have treated healthcare with an antithetical approach to antitrust's conventional principles in that competition is said to harm patients and consumers. Antitrust courts have even called hospitals "good citizens" who wouldn't abuse their monopoly power. As a result, pricing opacity has largely evaded antitrust scrutiny even though U.S. healthcare bears the traits of an uncompetitive market. This Article argues that opaque pricing must, in many instances, incur antitrust review. It shows that healthcare markets can seldom support more than a few firms, making collusion more sustainable and achievable. Further, people can rarely avoid buying critical care, which prevents markets from self-correcting and enables providers to charge supracompetitive premiums. And since most patients make decisions based upon their doctor's guidance, opacity creates informational asymmetries whereby providers can dictate prices and prescribe unnecessary treatments. In essence, this Article sheds light on how pricing opacity impedes competition, helping to explain the high prices, waste, and inequities plaguing U.S. healthcare. [ABSTRACT FROM AUTHOR]

A unique challenge for organizations is in leading diverse, dispersed teams whose members are motivated to work independently, but are willing to collaborate. The purpose of this study was to gain an understanding of how nuanced variations in motivational patterns influences the relationship between work satisfaction and virtual team effectiveness. A sequential, mixed methods design was used to analyze and explain the moderating effects of motivational orientation on this relationship. In the first, quantitative phase, participating virtual team members completed an online survey with items comprising the five motivation source scales from the Motivation Sources Inventory, work satisfaction, and eleven variables measuring utilization of virtual team effectiveness attributes from the Virtual Teams Survey. Seven hypotheses were tested, with support found for three of the hypotheses. Work satisfaction and utilization of the virtual team effectiveness attributes were found to be positively correlated. Support was also found for hypotheses that the relationship between work satisfaction and utilization of the virtual team effectiveness attributes will be stronger for virtual team members (VTMs) with low self-concept external and / or moderate or high goal internalization patterns. In the second, qualitative phase, follow-up interviews were conducted to support and provide rationale for the quantitative results. Qualitative analysis of interviews revealed three major themes focused on concerns regarding team leadership, organizational support, and technology. Viewed in context with the quantitative results, the themes suggest that work satisfaction may be improved for most VTMs, regardless of motivation pattern, by strengthening leadership, aligning rewards with goals, and enhancing the technology used for team communication.

Increasing impacts from wildfires are reshaping fire policies worldwide, with expanded investments in a wide range of fuel reduction strategies. In many fire prone regions, especially in the Mediterranean basin, fuel management programs have relied on fuel break networks for decades to facilitate fire suppression and reduce area burned and damage. By contrast, on the fire prone federal forests in the western United States, fuel management is guided primarily by landscape restoration goals, including improving fire resiliency such that wildfires can be managed for ecological benefit, and suppression is used more as a tool to shape burn patterns and less to extinguish fires. New policies in both fire systems are now calling for hybrid approaches that rely on both types of investments and efficient allocation of alternative spatial treatment patterns: linear networks versus patches across the landscape. However, studies that combine these strategies and examine alternative co-prioritization outcomes and potential synergies are largely non-existent. Here, we analyzed scenarios for implementing both types of treatments in concert while varying the prioritization metrics for one type or the other on a western United States national forest. We measured the response related to both treatment strategies including fire intersection rate, improvement in forest resiliency, and net revenue. We found that projects with benefits to both strategies can be identified and mapped independently of the implementation scenario and restoration objective. However, scenarios prioritized for fuel breaks preceding restoration resulted in the identification of more projects that met the criteria for providing dual benefits. The study is a rare example of optimizing hybrid fuel treatment projects that serve both restoration and fire protection goals with different spatial treatment designs. [ABSTRACT FROM AUTHOR]

Little is known about the barriers and facilitators to organizational maintenance of faith-based health promotion programs. This study used qualitative data (collected from 2016–2019) from pastors (n = 81) and program coordinators (n = 103) to identify barriers and facilitators to 24-month maintenance of a faith-based physical activity (PA) and healthy eating (HE) intervention in South Carolina. Barriers differed for PA versus HE: resistance to change impeded HE while church characteristics tended to impede PA. Similar themes emerged for PA and HE facilitators: healthy opportunities, church communication, and consistency. Future research should build upon this study to tailor faith-based health promotion programs for long-term sustainability. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Social difficulties and mental health are primary behavioral health concerns in autistic young adults, perhaps especially during key life transitions such as entering college. This study evaluated how dissatisfaction with social connectedness may predict and/or maintain depression and anxiety symptoms in neurodiverse, first-semester, undergraduate students (N = 263; n = 105 with diagnosed or suspected autism). Participation included a baseline survey battery, a brief survey completed twice per week across 12 weeks, and an endpoint survey battery. Social dissatisfaction at baseline was prospectively associated with biweekly ratings of depression symptoms, when controlling for baseline depressive symptoms. Social dissatisfaction was synchronously related to elevated sadness, anhedonia, and anxiety throughout the semester. These relationships were generally consistent across levels of baseline social motivation; however, there was one significant moderation effect—the negative relationship between baseline social satisfaction and anxiety was strongest for more socially motivated participants. More autistic traits were related to lower social satisfaction at baseline and greater mood concerns across timepoints. In contrast, greater autistic traits at baseline were related to greater satisfaction with social connectedness throughout the semester. Results support ongoing efforts to address mental health in autistic college students by highlighting the importance of social satisfaction. How satisfied people feel with their social connections and support is related to mental health outcomes for many different types of people. People may feel less socially connected at some times in their life—like when they start college. Feeling disconnected from others could lead to depression or anxiety. The transition to college may be especially difficult for autistic students as they are more likely to have difficulties adjusting socially. In our study, we asked 263 college students to answer questions about their emotions and social satisfaction twice per week during their first semester of college. We found that students who reported being less satisfied with their social connectedness (either at the beginning or throughout the semester) tended to express more symptoms of depression and anxiety. This relationship between social satisfaction and anxiety was even stronger for people who had a strong desire for social interaction (i.e. were more socially motivated). Students with more autistic traits tended to report more mood concerns, and they also reported being less satisfied with friendships at the beginning of the semester. This information may help to support ongoing efforts to better address mental health in autistic college students by encouraging efforts to improve social satisfaction. [ABSTRACT FROM AUTHOR]

Context Previous studies have demonstrated associations of endogenous thyroid hormones with diabetes; less is known about stages of diabetes development at which they are operative, mechanisms of associations, and the role of the hypothalamic-pituitary-thyroid axis. Objective This study examined associations of thyroid hormones with incident prediabetes and diabetes and with changes in glycemic traits in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the largest cohort of Hispanic/Latino adults with diverse backgrounds in the United States. Methods The study includes 592 postmenopausal euthyroid women and 868 euthyroid men aged 45 to 74 years without diabetes at baseline participating in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Baseline hormones included thyrotropin (TSH), free thyroxine (FT4), total triiodothyronine (T3), and indices calculated from thyroid hormones evaluating pituitary sensitivity to thyroid hormone. Transitions to diabetes and prediabetes, and changes in glycemic traits determined at the 6-year follow-up visit, were examined using multivariable Poisson and linear regressions. Results Among women, T3 (incident rate ratio [IRR] = 1.65; 95% CI, 1.22-2.24; P =.001) and TSH (IRR = 2.09; 95% CI, 1.01-4.33; P =.047) were positively, while FT4 (IRR = 0.59; 95% CI, 0.39-0.88; P =.011) was inversely, associated with transition from prediabetes to diabetes. Among men, the T3/FT4 ratio was positively associated with transition from normoglycemia to prediabetes but not from prediabetes to diabetes. Indices measuring sensitivity of the pituitary to thyroid hormone suggested increased sensitivity in men who transitioned from prediabetes to diabetes. Conclusion Positive associations in women of T3 and TSH and inverse associations of FT4, as well as inverse associations of thyroid indices in men with transition from prediabetes to diabetes, but not from normoglycemia to diabetes, suggest decreased pituitary sensitivity to thyroid hormones in women and increased sensitivity in men later in the development of diabetes. [ABSTRACT FROM AUTHOR]

In the United States, there exists a chronic shortage of qualified special education teachers to provide instructional services to students with disabilities. One policy solution developed to increase the number of qualified teachers is alternative routes (ARs), which are broadly defined as nontraditional and accelerated preparation paths to obtain a teaching license. In this longitudinal descriptive study, we investigate (a) the national trends of special education teacher enrollment and completion in AR programs from 2012 to 2020 and (b) the special education teacher preparation requirements in state alternative pathways that are disaggregated by their affiliation with institutions of higher education. Findings reveal that AR programs preparing special education teachers are on the rise within the United States, but they vary significantly on their preparation requirements. Implications for future research and policy recommendations needed within the recruitment and preparation of special education teachers will be discussed. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent sexual health interventions are increasingly incorporating content that is inclusive of LGBTQIA+ youth (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other marginalized sexualities and genders). Evaluations of such programs must also be inclusive to enhance the validity of evaluation results and avoid further marginalization. We present strategies for increasing LGBTQIA+-inclusivity based on our evaluation of SafeSpace, a sexual health curriculum. Methods: To design an LGBTQIA+-inclusive program evaluation, we leveraged LGBTQIA+ research staff's insights, pursued a parental consent waiver, developed an inclusive recruitment plan, and crafted demographic and sexual behavior survey measures with input from youth and equity experts. We conducted a pilot study with 42 youth ages 14-17 to assess the feasibility and efficacy of our strategies. Results: We obtained a parental consent waiver and recruited a majority LGBTQIA+ pilot study sample (62%). Using themes from cognitive interviews with youth and experts regarding inclusive framing and use of plain language, we refined demographic measures and expanded sexual behavior measures. Conclusion: Findings suggest that the strategies used to enhance LGBTQIA+-inclusivity in our evaluation of SafeSpace were effective in respectfully and more accurately capturing a fuller range of experiences and identities of LGBTQIA+ and cis-straight youth. The strategies and survey measures developed for this study can be applied to increase LGBTQIA+-inclusivity in other adolescent sexual health program evaluations. [ABSTRACT FROM AUTHOR]

Background: Most studies of the effects of prenatal alcohol exposure (PAE) on cognitive function have assumed that the dose-response curve is linear. However, data from a few animal and human studies suggest that there may be an inflection point in the dose-response curve above which PAE effects are markedly stronger and that there may be differences associated with pattern of exposure, assessed in terms of alcohol dose per drinking occasion and drinking frequency. Methods: We performed second-order confirmatory factor analysis on data obtained at school age, adolescence, and early adulthood from 2227 participants in six US longitudinal cohorts to derive a composite measure of cognitive function. Regression models were constructed to examine effects of PAE on cognitive function, adjusted for propensity scores. Analyses based on a single predictor (absolute alcohol (AA)/day) were compared with analyses based on two predictors (dose/occasion and drinking frequency), using (1) linear models and (2) nonparametric general additive models (GAM) that allow for both linear and nonlinear effects. Results: The single-predictor GAM model showed virtually no nonlinearity in the effect of AA/day on cognitive function. However, the two-predictor GAM model revealed differential effects of maternal drinking pattern. Among offspring of infrequent drinkers, PAE effects on cognitive function were markedly stronger in those whose mothers drank more than ~3 drinks/occasion, and the effect of dose/occasion was strongest among the very frequent drinkers. Frequency of drinking did not appear to alter the PAE effect on cognitive function among participants born to mothers who limited their drinking to ~1 drink/occasion or less. Conclusions: These findings suggest that linear models based on total AA/day are appropriate for assessing whether PAE affects a given cognitive outcome. However, examination of alcohol dose/occasion and drinking frequency is needed to fully characterize the impact of different levels of alcohol intake on cognitive impairment. [ABSTRACT FROM AUTHOR]

In most places in the world, teachers might be concerned that skateboarding will take students out of school rather than keep them in. Outside Afghanistan, skateboarding has long had an aura of rebellion. Rose and Strike labeled skateboarding as "dangerous" and "rebellious." Atencio, Beal, and Wilson call attention to its "non-conformity" and embrace the "risk." A T-shirt from the 1990s protested, "Skateboarding Is Not A Crime," but even "The New York Times" has called the skateboard "a talisman of youthful rebellion." These are discomfiting words to describe an activity shared by several million people in the United States, many of whom sit, perhaps disinterestedly, in middle and high school classrooms. What makes a skateboarder, really? Do skaters' teachers and peers understand? And if not, how can they begin to? This study focused on the process of socialization created by skateboarders, in addition to the actualization of skate boarders' position within the skateboarding culture and its various communities. While skateboarding serves as one of the oldest examples of skate sports still exercised today, many people's understanding of the sport (and of those who identify with it) is filled with ambiguity and misconceptions. A lesson plan is included with a hand out.

There is a critical issue of special education teacher shortages in the United States. Student populations, many of whom are multilingual and have disabilities, continue to grow while there is a decrease in the teaching workforce. One policy initiative developed to combat the teacher shortage is the Assistant to Teacher Program. The Assistant to Teacher Program is a school district policy that aims to fill high-need teacher vacancies by supporting paraprofessionals to become certified teachers in a career advancement cohort. This qualitative study examines the working experiences of multilingual paraprofessionals in special education and their perceptions of the Assistant to Teacher program within their school district. A thematic analysis reveals the bureaucratic and financial obstacles that multilingual paraprofessionals encounter in their career advancement, and their working conditions specific to special education as linguistic liaisons. Findings from the study are then linked to recommended policy actions intended to mitigate special education workforce disparities. [ABSTRACT FROM AUTHOR]

Rainfall erosivity describes the capability of rainfall to cause soil erosion from a surface during a storm. Currently, the average long-term annual and monthly rainfall erosivity for a location may be obtained from isoerodent maps using a sample of climate stations across the United States (US). However, at the state-scale these measures are sporadic, using rainfall data from an increasingly outdated period, which may not reflect possible changing rainfall erosivity. Focusing on the state of Kentucky, US, we developed rainfall erosivity grids from the state Mesonet system to determine if erosivity has changed spatially and temporally between the original erosivity datasets from the latter twentieth-century and 2011–2020. We further used the Mesonet-derived dataset to develop a GIS-based model to estimate potential soil erosion for croplands during the fallow-season when soil is most prone to erosive storms. Results indicated that monthly erosivity increased across the state between the two periods. Larger increases in erosivity during the latter part of the fallow-season resulted in higher estimated soil erosion from croplands, particularly to the west. These findings may provide guidance in identifying and targeting croplands at greatest potential risk of soil erosion during the fallow-season for additional monitoring, mitigation and management practices. [ABSTRACT FROM AUTHOR]

Background: Every year, approximately 200,000 patients will experience in-hospital cardiac arrest (IHCA) in the United States. Survival has been shown to be greatest with the prompt initiation of CPR and early interventions, leading to the development of time-based quality measures. It is uncertain how documentation practices affect reports of compliance with time-based quality measures in IHCA. Methods: A retrospective review of all cases of IHCA that occurred in the Cardiac Intensive Care Unit (CICU) at an academic quaternary hospital was conducted. For each case, a member of the code team (observer) documented performance measures as part of a prospective cardiac arrest quality improvement database. We compared those data to those abstracted in the retrospective review of "real-time" documentation in a Resuscitation Narrator module within electronic health records (EHRs) to investigate for discrepancies. Results: We identified 52 cases of IHCA, all of which were witnessed events. In total, 47 (90%) cases were reviewed by observers as receiving epinephrine within 5 min, but only 42 (81%) were documented as such in the EHR review (p = 0.04), meaning that the interrater agreement for this metric was low (Kappa = 0.27, 95% CI 0.16–0.36). Four (27%) eligible patients were reported as having defibrillation within 2 min by observers, compared to five (33%) reported by the EHR review (p = 0.90), and with substantial agreement (Kappa = 0.73, 95% CI 0.66–0.79). There was almost perfect agreement (Kappa = 0.82, 95% CI 0.76–0.88) for the initial rhythm of cardiac arrest (25% shockable rhythm by observers vs. 29% for EHR review, p = 0.31). Conclusion: There was a discrepancy between prospective observers' documentation of meeting quality standards and that of the retrospective review of "real-time" EHR documentation. A further study is required to understand the cause of discrepancy and its consequences. [ABSTRACT FROM AUTHOR]

Background There are numerous reasons for the increased use of telemedicine in orthopaedic surgery, one of which is the perception that virtual visits are more cost-effective than in-person visits. However, to our knowledge, no studies have compared the cost and time investment of virtual versus in-person visits using the time-driven activity-based costing (TDABC) method. Unlike methods that estimate cost based on charges for services rendered, TDABC provides a more precise measurement of costs, which is essential for assessing cost-effective innovations and moving to value-based healthcare. Questions/purposes (1) Are virtual visits less costly than analogous in-person visits, as measured by TDABC? (2) Does TDABC yield cost estimates that are lower or higher than the ratio of costs to charges (RCC), which is a simple, frequently used costing method? (3) Do the total time commitments of healthcare personnel, and that of the surgeon specifically, vary between the virtual and in-person settings? Methods Patients for this prospective, observational study were recruited from the practices of the highest-volume virtual-visit surgeons of three subspecialties (joints, hand, and sports) in a multihospital, tertiary-care academic institution in a metropolitan area in the Midwestern United States. Each surgeon had at least 10 years of clinical practice. Between June 2021 and September 2021, we analyzed both in-person and virtual return visits with patients who had an established relationship with the surgeon, because this represented the most frequent type of virtual visits and enabled a direct comparison between the two settings. New patients were not included in the study because of the limited availability of new-patient virtual visits; such patients often benefit from in-person physical examinations and on-site imaging. Additionally, patients seen for routine postoperative care were excluded because they were primarily seen in person by a physician assistant. Data were acquired during this period until 90 in-person and 90 virtual visits were collected according to selection criteria; no patients were lost to follow-up. Distinct process maps, which represent the steps involved in a clinic visit used to measure healthcare personnel time invested, were constructed for in-person and virtual clinic visits and used to compare total personnel and surgeon time spent. To calculate TDABC-derived costs, time allocated by personnel to complete each step was measured and used to calculate cost based on each personnel member's yearly salary. From the accounting department of our hospital, we acquired RCC cost data according to the level of service for a return visit. Results The total median cost, as measured by TDABC, was USD 127 (IQR USD 111 to 163) for an in-person visit and USD 140 (IQR USD 113 to 205) for a virtual visit (median difference USD 13; p = 0.16). RCC overestimated TDABC-calculated direct variable cost in five of six service levels (in-person levels 3, 4, and 5 and virtual levels 3 and 5) by a range of USD 25 to 88. Additionally, we found that virtual visits consumed 4 minutes less of total personnel time (in-person: 17 minutes [IQR 13.5 to 23.5 minutes], virtual: 13 minutes [IQR 11 to 19 minutes]; p < 0.001); however, this difference in personnel time did not equate to cost savings because surgeons spent 2 minutes longer on virtual visit activities than they did on in-person activities (in-person: 6 minutes [IQR 4.5 to 9.5 minutes], virtual: 8 minutes [IQR 5.5 to 13 minutes]; p = 0.003). Conclusion Orthopaedic virtual visits did not deliver cost savings compared with in-person visits because surgeons spent more time on virtual visits and participated in virtual visits at the clinical site. Additionally, as anticipated, RCC overestimated costs as calculated by TDABC. These findings suggest that cost is not a primary advantage of transitioning to virtual visits, and that factors such as patient preference and satisfaction should be considered instead. [ABSTRACT FROM AUTHOR]

Water vapor's contribution to Earth's radiative forcing is most sensitive to changes in its lower stratosphere concentration. One recognized pathway for rapid increases in stratospheric water vapor is tropopause‐overshooting convection. Since this pathway has been rarely sampled, the NASA Dynamics and Chemistry of the Summer Stratosphere (DCOTSS) field project focused on obtaining in situ observations of stratospheric air recently affected by convection over the United States. This study reports on the extreme altitudes to which convective hydration was observed. The data show that the overworld stratosphere is routinely hydrated by convection and that past documented records of stratospheric heights of convective hydration were exceeded during several DCOTSS flights. The most extreme event sampled is highlighted, for which stratospheric water vapor was increased by up to 26% at an altitude of 19.25 km, a potential temperature of 463 K, and an ozone mixing ratio >1500 ppbv. Plain Language Summary: When thunderstorms reach into the second layer of the atmosphere above Earth's surface, the stratosphere, they may impact the concentration and distribution of trace gases that are important to chemistry and climate. One gas that is routinely affected during these events is water vapor, which is typically scarce in the stratosphere. This study presents new aircraft observations of extreme heights in the stratosphere moistened by these thunderstorms. Since increases in stratospheric water vapor positively contribute to warming of Earth's climate and can activate chemistry that destroys ozone, better understanding of this phenomenon helps refine our understanding of its role in the climate system. The new aircraft observations provide clear evidence that water vapor is enhanced by thunderstorms at higher levels in the stratosphere than previously recognized. Key Points: Tropopause‐overshooting convection in the United States hydrates the stratosphere to exceptional heightsObservations of the height of stratospheric convective hydration during the Dynamics and Chemistry of the Summer Stratosphere field campaign exceed all prior global recordsThe overworld stratosphere is routinely hydrated by midlatitude overshooting convection [ABSTRACT FROM AUTHOR]

Everyone under the age of 20 who has grown up in North America has lived in the common market created by NAFTA--the North American Free Trade Agreement. In a zone linking the United States, Canada, and Mexico, most goods and investments flow freely across borders to users, consumers, and investors. In 1994, NAFTA created the largest relatively free trade zone in the world by phasing out tariffs and other trade restrictions on goods and investments. Today, the NAFTA area is home to approximately 450 million people, with a Gross Domestic Product (GDP) of almost $20 trillion. NAFTA countries create 23 percent of the world's total wealth. Twenty years after its enactment, how is the free trade zone working out? Did NAFTA make Canada and Mexico better off at the expense of the United States? Or did it help boost production, employment, investment, and consumption across all three countries?

This study assessed associations between school nurse workload and student health and academic outcomes. We hypothesized that lower school nurse workload would be associated with better student outcomes, with associations being greater for members of groups who experience health disparities. Our methods entailed secondary analysis of data for New York City school students in kindergarten through 12th grade during 2015–2016 (N = 1,080,923), using multilevel multivariate regression as the analytic approach. Results demonstrated lower school nurse workload was associated with better outcomes for student participation in asthma education but not chronic absenteeism, early dismissals, health office visits, immunization compliance, academic achievement, or overweight/obesity. Our findings suggest school nurses may influence proximal outcomes, such as participation in disease-related education, more easily than downstream outcomes, such as absenteeism or obesity. While contrary to our hypotheses, results align with the fact that school nurses deliver community-based, population health–focused care that is inherently complex, multilevel, and directly impacted by social determinants of health. Future research should explore school nurses' perspectives on what factors influence their workload and how they can best impact student outcomes. [ABSTRACT FROM AUTHOR]

The number of children in foster care in the United States has risen while new federal regulations in the USA require states to decrease dependence on congregate placements. As family-based settings are the preferred placement option, there is a pressing need to prioritize effective strategies to recruit and retain foster parents. The purpose of this study is to describe the demographic characteristics and life experiences of families who decided to become foster parents at various key points in time in two states: Missouri and Mississippi. A cross-sectional analysis was conducted at key milestones, which include pre-licensure training, completion of training and licensure, shortly after their initial placement, three months after initial placement, and after initial placement disruption occurred. A total of 656 prospective and current foster parents participated in the study. Survey results provide insight into the demographic characteristics of families who are attracted to fostering, those that are successful in obtaining licensure and accepted child placements, providing permanency to the children they care for, and those that decide to dissolve a foster care placement prematurely. Present in the discussion are concerns of those who have been left out of the recruitment process. Implications for policy and practice are also discussed. [ABSTRACT FROM AUTHOR]

Microstegium vimineum or stiltgrass is a novel invader widely considered one of the most significant threats to oak-hickory woodlands in the eastern United States. Due to the insubstantial weight and buoyancy of seeds, Microstegium can disperse not only via overland dispersal routes but also via sheet flow, flooding, and stream channels, creating rapid progression of existing populations and greater likelihood of introduction to new areas. Using the knowledge of Microstegium habitat from previous research and field mapping of current populations, we identified and assessed environmental variables for use in habitat suitability modeling. We found canopy openness, distance from roads, and distance from streams to be the primary drivers of Microstegium presence. We then applied a GIS-based habitat suitability analysis across seven nature reserves in Kentuckiana as a potential tool for land management. Our pilot study developed a model which can potentially guide managers of natural areas to decide where best to focus mitigation and prevention of potential Microstegium invasion and population expansion when resources are limited. [ABSTRACT FROM AUTHOR]

This study brings a fresh perspective to elite polarization by examining how policymakers and party leaders interpret and respond to it. Polarization is examined through the language and lived experience of those most familiar with it—policymakers themselves. Face-to-face interviews posed qualitative and quantitative questions to 212 legislators and 13 key informants from two states that varied in polarization. Most legislators describe polarization in negative terms. Consistent with "Community Dissonance Theory," analyses reveal differences in a legislature's institutional culture with policymakers in the more polarized state reporting more fraying of the social fabric and fracturing of decision-making processes. Specifically, legislators report more limited opportunities to build relationships with colleagues across party lines and for the minority party to make meaningful contributions. Corroborating the "Theory of Pernicious Polarization," polarization appears to function as a relationship-based process that leaders can use for instrumental political ends. Polarization depends on whether party leaders react to rifts in tribal, non-compromising ways and how the minority responds. Consistent with "Conditional Party Governance" theory, party leaders can contribute to dysfunctional polarization by encouraging homogeneity in their own party and polarity from the opposing party. Drawing on policymakers' own words, states vary in whether elite polarization is dysfunctional. [ABSTRACT FROM AUTHOR]

Recent behavior analytic studies have examined behavioral skills training to teach adults to arrange safe infant sleeping environments. These studies were conducted in an analogue environment and with all training components delivered by an expert staff trainer. The purpose of the current study was to replicate and extend this literature by substituting video‐based training for behavioral skills training. We assessed whether expectant caregivers could arrange safe infant sleeping environments following video‐based training. The results suggested that video‐based training alone resulted in positive outcomes for a portion of participants, whereas a subset of participants required feedback to reach mastery criteria. The social validity data suggest that the participants found the training procedures favorable. [ABSTRACT FROM AUTHOR]

Classmates' academic skill level (peer effects) is emerging as an important predictor of individual student achievement, particularly in the early grades. However, less is known about the influence of peer effects with regard to classmates' self-regulation skills and whether they are associated with students' academic gains. Examining this is the purpose of the current study. Using a direct measure of self-regulation, the head-toes-knees-shoulders (HTKS), which assesses students' ability to coordinate their attention, ability to inhibit and switch tasks, and working memory, the classroom mean HTKS was computed to represent peer effects. With 2 cohorts of 1st graders, the effect of peers' self-regulation on literacy outcomes was examined, controlling for individual student self-regulation. In Cohort 1, 445 participants from 46 1st grade classrooms in 10 schools were included. In Cohort 2, 633 students in 68 classrooms in 18 schools were included. Using hierarchical linear modeling, peer effects predicted children's growth in passage comprehension (Cohen's d = 0.35 for Cohort 1 and 0.31 for Cohort 2) as well as their vocabulary growth (Cohen's d = 0.24 for Cohort 1 and 0.16 for Cohort 2). These were independent effects above that of individual children's fall self-regulation and school-wide percentage of students qualifying for the U.S. free and reduced price lunch program, which were both significantly related to student literacy outcomes. (Contains 5 tables and 2 figures.)

Sickle cell disease (SCD) affects over 30,000 students in the United States. Central nervous system complications are widespread among students with SCD and include stroke, silent cerebral infarction, and cognitive impairment. The effects of these complications may lead to academic failure, limited career options, and for some, total disability. Despite studies describing the significant academic and cognitive impact of sickle cell disease, reports describing interventions are limited. There is a lack of awareness among educators of the academic risks associated with sickle cell disease and a lack of appropriate resource allocation. The school nurse, as community health advocate, will be called upon to bridge the gap among healthcare providers, parents, students, and educators. This article provides a review of both recent and landmark studies describing the cognitive and academic impact of sickle cell disease and discusses the role of the school nurse as an advocate, liaison, and educator.

Objectives: The purpose of this study was to explore adherence to the American Cancer Society (ACS) Head and Neck Cancer (HNC) Survivorship Care Guideline and their outlined 33 recommendations among posttreatment HNC survivors. Methods: A bi-institutional, retrospective, nested cohort study of mucosal or salivary gland HNC survivors diagnosed in 2018 was designed. Guideline adherence was assessed via retrospective chart review between 0 and 13 months after completion of oncologic treatment according to 4 categories: (1) problem assessed, (2) problem diagnosed, (3) management offered; (4) problem treated. Adherence was defined as meeting a recommendation subcategory at least once over the 13-month period. Results: Among 60 randomly selected HNC survivors, a total of 38 were included in the final cohort after exclusion of individuals with ineligible cancers and those who died or were lost to follow-up over the study period. Approximately 95% of HNC survivors were assessed for HNC recurrence and screened for lung cancer. Certain common problems such as xerostomia, dysphagia, and hypothyroidism were screened for and managed in ≥70% of eligible survivors. Conversely, screening for other second primary cancers and assessment of a majority of other physical and psychosocial harms occurred in <70% of survivors, and in many cases none to a slim minority of survivors (eg, sleep apnea and sleep disturbance, body and self-image concerns). Only 5% of survivors received a survivorship care plan. Conclusion: Overall adherence to the ACS HNC Survivorship Care Guideline in early posttreatment survivors was suboptimal. Interventions are needed to better implement and operationalize these guideline recommendations. [ABSTRACT FROM AUTHOR]

Objective: Although essential workers of color in the United States have been notably at risk during the COVID-19 pandemic, less is known about the impacts of associated life stressors within this population. Thus, the purpose of this study is to understand (a) the impact of life stressors among a sample of essential workers of color during the COVID-19 pandemic and (b) associations between life stressors and sociodemographic characteristics, work, mental health, substance use, and eating behaviors. Method: Essential workers of color (N = 319) completed the Holms-Rahe Life Stress Inventory to examine whether any set of 43 life stress experiences occurred because of COVID-19. We used latent class analysis to examine patterns of clustering. Results: We identified three latent classes: (a) minimally impacted, (b) moderately impacted, and (c) widely impacted. Most of our sample reported being minimally impacted (53%) or moderately impacted (35%) by life events during the pandemic. However, participants clustered within the widely impacted pattern (11%) reported significantly more concerns with substance use, binge eating, and perceived stress. Conclusions: Findings highlight distinct patterns of life-stress impacts caused by COVID-19 among essential workers of color. Social workers must consider how to implement policies to reduce the systematic challenges faced by those who are most marginalized. [ABSTRACT FROM AUTHOR]

Perceived discrimination is a significant risk factor for worse ageing health outcomes. Yet, the specific individual and relational stress pathways linking discrimination to disease are less understood, especially in the context of cardiometabolic health. We tested family stress and psychophysiological distress (negative affect and high‐risk lipid/fat metabolism) as mediators linking perceived discrimination to cardiometabolic morbidity and health appraisal over 20 years for midlife adults. Using data from participants who completed the Biomarker Project (2004–2009) of the Midlife in the U.S. project, and examining data over the study's three waves (1995–1996, 2004–2006, and 2013–2014), we used structural equation modelling to test pathways for participants who reported zero cardiometabolic conditions at baseline (n = 799). Greater Time 1 discrimination was associated with greater Time 2 family strain, which was in turn associated with worse negative affect; worse Time 2 negative affect was associated with worse Time 3 health appraisal; metabolic lipids risk did not serve as an indirect pathway to Time 3 cardiometabolic morbidity (χ2 = 147.74, p < 0.001; RMSEA = 0.056; CFI = 0.902; SRMR = 0.047). The inclusion of family in interventions to mitigate the impact of discrimination may be indicated for promoting cardiometabolic wellness. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and the mandated cessation of surgical procedures for a substantial portion of the 2020 year placed tremendous strain, both clinically and financially, on the health-care system in the United States. As a surgical specialty that accounts for nearly a quarter of all hospital net income, the revenue recovery of orthopaedic service lines (OSLs) is of particular importance to the financial recovery of their broader health-care institutions. In this American Orthopaedic Association (AOA) symposium report, the OSL leaders from 4 major academic medical institutions explain and reflect on their approaches to address their revenue deficits. Cost-reduction strategies, such as tightening budgets, adopting remote-work models, and limiting costs of human capital, were vital to stabilizing departmental finances at the onset of the pandemic, while strategies that focused on expanding surgical volume, such as those that improve efficiency in clinical and surgical settings, were important in growing revenue once elective procedures resumed. Institutional policy, payer administrative procedures, and the overall context of an ongoing public health crisis all placed limitations on recovery efforts, but engaging relevant stakeholders and working with available resources helped OSLs overcome these limitations. Due to clear strategic actions that were taken to address their deficits, each OSL represented in this AOA symposium saw substantial improvement in its year-end financial performance compared with its financial status at the end of the period of mandatory cessation of elective surgical cases. [ABSTRACT FROM AUTHOR]

The elm zigzag sawfly (EZS), Aproceros leucopoda Takeuchi, was detected in the United States for the first time in Virginia in 2021. In 2022, it was confirmed in 4 additional states: Pennsylvania, North Carolina, Maryland, and New York. These are the first records of this species in the United States and demonstrate a rapid range expansion of an invasive defoliating pest. Native to Asia, EZS feeds exclusively on Ulmus spp. (elms; Ulmaceae). In the United States, feeding damage ranges in severity from minor to severe. Young instars create a zigzag-shaped pattern in leaves as they feed, while older larvae feed more completely on foliage, leaving only the midvein and sometimes thick lateral veins. This more complete feeding often obscures the signature zigzag defoliation of younger instars. Long-term health impacts to host trees are unknown, though aesthetic damage, growth loss, and branch dieback occur in Europe where it is also invasive. Little is known about management options for this pest, and continued expansion of this species' range in the United States is expected. [ABSTRACT FROM AUTHOR]

This paper examines the link between political support for basic income funded by linear income taxation and income inequality by household and gender. We develop a model with an increasingly right-skewed distribution of skill across households and a gender wage gap within households. Household preference for basic income decreases as skill level increases and female labour supply decreases with time spent rearing children. Majority voting supports the basic income scheme as mean relative to median household skill increases. Household fertility and skill level are inversely related under the scheme. An increase in the marginal tax rate to fund required government revenue could exacerbate gender inequality by reducing female labour supply. Quantitative illustrations suggest that the recent peak in the mean to median wage gap would provide voting support for basic income from the majority of households in the United States. Basic income of $12,000 conditional on below-median wages would increase government spending by 10.8% which, if funded by progressive income taxation, could reduce the adverse effects on gender inequality. [ABSTRACT FROM AUTHOR]

The Colorado River is a critical water resource in the southwestern United States, supplying drinking water for 40 million people in the region and water for irrigation of 2.2 million hectares of land. Extended drought in the Upper Colorado River Basin (UCOL) and the prospect of a warmer climate in the future pose water availability challenges for those charged with managing the river. Limited water availability in the future also may negatively affect aquatic ecosystems and wildlife that depend upon them. Water availability components of special importance in the UCOL include streamflow, salinity in groundwater and surface water, groundwater levels and storage, and the role of snow in the UCOL water cycle. This manuscript provides a review of current "state of the science" for these UCOL water availability components with a focus on identifying gaps in data, modeling, and trends in the basin. Trends provide context for evaluations of current conditions and motivation for further investigation and modeling, models allow for investigation of processes and projections of future water availability, and data support both efforts. Information summarized in this manuscript will be valuable in planning integrated assessments of water availability in the UCOL. [ABSTRACT FROM AUTHOR]

Runoff from the Upper Colorado River Basin (UCRB) is an important water resource in the western United States. The majority of annual runoff is derived from spring snowmelt, and therefore April–July water supply volume (WSV) forecasts produced by the Colorado Basin River Forecast Center are critical to basin water management. The primary objective of this study was to evaluate the impact of snow data assimilation (DA) in a distributed hydrologic model on WSV forecasting error and skill in headwater catchments of the UCRB. To do this, a framework was built to use the Localized Ensemble transform Kalman filter to update modeled snow water equivalent (SWE) states in the Hydrology Laboratory‐Research Distributed Hydrologic Model with SNOTEL SWE observations and spatially and temporally complete MODIS Snow Covered‐Area and Grain size data. The DA approach was assessed by evaluating ensemble streamflow prediction forecasts over a 20‐year period for 23 catchments in the UCRB. Overall, the DA approach improved water supply forecast skill in 80% of pilot basins with an average improvement in the median continuous rank probability skill score of 4%. A research‐to‐operations transition was facilitated by automating the implementation of the DA approach. This work demonstrates the capacity for gridded and point snow products to be used to objectively update model states in an operational forecasting setting. [ABSTRACT FROM AUTHOR]

Influenza vaccination rates are decreasing in the United States. Disinformation surrounding COVID-related public health protections and SARS-CoV-2 vaccine roll-out may have unintended consequences impacting pediatric influenza vaccination. We assessed influenza vaccination rates before and during the COVID-19 pandemic in one pediatric primary care center, serving a minoritized population. A cross-sectional study assessed influenza vaccination rates for children aged 6 months to 12 years over the following influenza seasons (September-May): 1) 2018–19 and 2019–20 (pre-pandemic), and 2) 2020–21 and 2021–22 (intra-pandemic). Demographics and responses to social risk questionnaires were extracted from electronic health records. Total tetanus vaccinations across influenza seasons served as approximations of general vaccination rates. Generalized linear regression models with robust standard errors evaluated differences in demographics, social risks, and influenza vaccination rates by season. Multivariable logistic regression with robust standard errors evaluated associations between influenza season, demographics, social risks, and influenza vaccination. Most patients were young (mean age ∼ 6 years), non-Hispanic Black (∼80%), and publicly insured (∼90%). Forty-two percent of patients eligible to receive the influenza vaccine who were seen in 2019–20 influenza season received the influenza vaccine, compared to 30% in 2021–22. Influenza and tetanus vaccination rates decreased during the COVID-19 pandemic (p < 0.01). The 2020–21 and 2021–22 influenza seasons, older age, Black race, and self-pay were associated with decreased influenza vaccine administration (p < 0.05). Influenza vaccination rates within one pediatric primary care center decreased during the COVID-19 pandemic and have not rebounded, particularly for older children, those identifying as Black, and those without insurance. [ABSTRACT FROM AUTHOR]

Background Limited data currently exist on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among fully vaccinated persons or reinfections in college-aged populations. Centers for Disease Control and Prevention (CDC) partnered with National Collegiate Athletic Association (NCAA) institutions to analyze retrospective data and present characteristics of positive coronavirus disease 2019 (COVID-19) cases among student athletes 18 years of age and older. Methods De-identified, individual-level data contributed by 21 universities on 1378 student athletes who tested positive for SARS-CoV-2 from January through November 2021 (pre-Omicron) were examined to determine percentages of infection among unvaccinated, partially vaccinated, and fully vaccinated individuals (breakthrough infections) as well as reinfections. Comparisons by demographic characteristics and regions were also made to further characterize these infections. Results Among the 1378 student athletes positive for SARS-CoV-2, 1070 (77.6%) were infected when unvaccinated and 22.4% (n = 308) were infected after full vaccination. There was a significant difference between Black (14.7%, n = 40) and White (23.9%, n = 168) student athletes who experienced a SARS-CoV-2 infection after being fully vaccinated (P  < .01). Proportions of infections among fully vaccinated individuals did not differ statistically by sex (p  = 0.06). Conclusions This article adds to the knowledge of SARS-CoV-2 infections among fully vaccinated individuals in college-aged populations. The level of infections among fully vaccinated student athletes indicates the need for maintaining precautions to prevent infection. Further study of COVID-19 vaccination, infection, and reinfection among the well-resourced and diverse population of student athletes might contribute further understanding of factors that play a role in health equity among young adults. [ABSTRACT FROM AUTHOR]

Recent world events have increased concern and preparations for possible bioterror events. Despite worldwide efforts to limit access to bio-weapons, smallpox is still considered a potential bioterror threat. Americans' understanding of smallpox could prevent panic and enhance the willingness of citizens to receive vaccinations. Objective: The authors' purpose in this study was to describe graduating college students' levels of smallpox-related knowledge. Method summary: Participants at a graduation ceremony--mostly female, with a mean age of 28.4 plus or minus 8.1 years--were handed a 35-item questionnaire that assessed smallpox knowledge and whether respondents would submit to vaccination under hypothetical circumstances. Results: The convenience sample was ignorant of numerous facts about smallpox and unaware of government efforts to prepare for an attack, answering an average of 3.8 out of 10 items correctly. Conclusion: These findings raise concern because, in a smallpox event, prompt responses to directives of public health officials will be necessary to maximize the effectiveness of response plans.

State-level child welfare policies and practices affect what can be referred, investigated, and substantiated as child maltreatment, and these institutional factors vary across states and over time. Researchers typically have not accounted for these factors in analyses, confounding institutional features with the underlying construct they seek to study. The present study addresses this limitation by demonstrating how changes in specific state child welfare policies and practices influence reported and substantiated maltreatment in the National Child Abuse and Neglect Data System (NCANDS). Using negative binomial models with state and year fixed-effects to analyze data from 2005 to 2018, we found significant influence of state policy and practice changes on state-level rates of reported and substantiated maltreatment over time. If a state implemented three of the most common policy changes—adding mandated reporters, centralized intake, and staff—its maltreatment reports were an estimated 32% higher than they would have been in the absence of these changes. By contrast, most state policy changes decreased the number of reports that were substantiated—by 24% if they implemented both differential response and higher standards of proof. Implications for future research and policy are discussed. [ABSTRACT FROM AUTHOR]

With 1.7 million children in the United States with an incarcerated parent, the need to provide evidence-based programming, which helps incarcerated mothers re-establish healthy relationships with their children, is essential. This study examines Parenting, Prison, and Pups, a jail-based parenting course for incarcerated women, integrated with the use of animal-assisted therapy (AAT). Utilizing a mixed-method quasi-experimental design, the authors examined differences between mothers who completed a parenting course with AAT, compared with those who completed the same course without AAT; statistically significant lower rates of parental stress and higher rates of self-esteem and parental knowledge among the AAT group were found. Based on qualitative data, the presence of therapy dogs appeared to encourage communication, trust, and connectedness between group members. These results indicate the importance of using innovative tools to help incarcerated women, who often have long histories of trauma and abuse, to develop healthy bonds with their children. [ABSTRACT FROM AUTHOR]

Introduction: Current in‐hospital burden and healthcare utilization patterns for persons with haemophilia (PWH) A and B, including both children (ages < 18 years) and adults (ages ≥ 18 years), in the United States (US) are lacking. Aim: To evaluate healthcare utilization, the prevalence of comorbidities, and mortality in hospitalized paediatric and adult PWH using a contemporary nationally representative cohort. Methods: Hospitalizations of PWH either as the primary reason for admission (principal diagnosis) or one of all listed diagnoses were identified using ICD‐10 codes from the 2017 Nationwide Inpatient Sample (NIS), the largest publicly available all‐payer inpatient discharge database in the US. Sampling weights were applied to generate nationally representative estimates. Results: The contemporary cohort included 10,555 hospitalizations (paediatrics, 18.3%; adults, 81.7%) among PWH as one‐of‐all listed diagnoses (n = 1465 as principal diagnosis). Median age (interquartile range) was 46 (24–66) years overall; adults, 54 (35–70) years and paediatric, 4 (1–11). The most common comorbidities in adults were hypertension (33.4%), hyperlipidaemia (23.6%), and diabetes (21.1%). In children, hemarthrosis (11.4%), contusions (9.6%), and central line infections (9.3%) were the most common. The overall mortality rate was 2.3%. Median hospital charges per haemophilia admission were $52,616 ($24,303–$135,814) compared to $26,841 ($12,969–$54,568) for all‐cause admissions in NIS. Conclusion: Bleeding and catheter‐related infections are the significant reasons for paediatric haemophilia admissions. Adult haemophilia admissions tend to be associated with age‐related comorbidities. Costs for haemophilia‐related hospitalizations are higher than the national average for all‐cause hospitalizations. [ABSTRACT FROM AUTHOR]