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Importance: Pediatric patients with complex medical problems benefit from pediatric sub-specialty care; however, a significant proportion of children live greater than 80 mi. away from pediatric sub-specialty care. Objective: To identify current knowledge gaps and outline concrete next steps to make progress on issues that have persistently challenged the pediatric nephrology workforce. Evidence review: Workforce Summit 2.0 employed the round table format and methodology for consensus building using adapted Delphi principles. Content domains were identified via input from the ASPN Workforce Committee, the ASPN's 2023 Strategic Plan survey, the ASPN's Pediatric Nephrology Division Directors survey, and ongoing feedback from ASPN members. Working groups met prior to the Summit to conduct an organized literature review and establish key questions to be addressed. The Summit was held in-person in November 2023. During the Summit, work groups presented their preliminary findings, and the at-large group developed the key action statements and future directions. Findings: A holistic appraisal of the effort required to cover inpatient and outpatient sub-specialty care will help define faculty effort and time distribution. Most pediatric nephrologists practice in academic settings, so work beyond clinical care including education, research, advocacy, and administrative/service tasks may form a substantial amount of a faculty member's time and effort. An academic relative value unit (RVU) may assist in creating a more inclusive assessment of their contributions to their academic practice. Pediatric sub-specialties, such as nephrology, contribute to the clinical mission and care of their institutions beyond their direct billable RVUs. Advocacy throughout the field of pediatrics is necessary in order for reimbursement of pediatric sub-specialist care to accurately reflect the time and effort required to address complex care needs. Flexible, individualized training pathways may improve recruitment into sub-specialty fields such as nephrology. Conclusions and relevance: The workforce crisis facing the pediatric nephrology field is echoed throughout many pediatric sub-specialties. Efforts to improve recruitment, retention, and reimbursement are necessary to improve the care delivered to pediatric patients. [ABSTRACT FROM AUTHOR]

Acceptance and Commitment Therapy (ACT) is a counseling modality that features values clarification interventions. However, a well-established ACT-consistent measure of values for practitioners and researchers is lacking. The present study, therefore, examined an exploratory measure called the Valued Time and Difficulty Questionnaire (VTDQ; Wilson et al. 2010) and investigated the possible explanatory role of multiple ACT constructs on psychological distress. Obtained cross-national differences with a sample of 188 U.S. and 223 Japanese students were consistent with previous research. Moreover, a multiple mediator model revealed significant indirect effects of VTDQ subscale scores for time and difficulty on the association between culture and symptoms.

As prior secondary teachers, the authors had served as cooperating teachers for student teachers and had worked with university supervisors from local colleges and universities, and during their graduate work at different universities, they had supervised the student teachers themselves. Consequently, the authors, as well as most participants in teacher education, were quite familiar with the use of the term "university supervisor" to describe the individual who oversees student teachers' work and represents the university during teacher candidates' internship in the K-12 schools. As they discussed their prior work with student teachers, however, they discovered that, although they had had similar experiences, their practices were certainly not identical. This finding prompted them to question the notion of universality in the practices of university supervisors. They wanted to determine whether there was clear understanding, not only across the nation but even within one department, of what a university supervisor actually does. This study explores how individual university supervisors, operating within a teacher education department of a college of education at a large public U.S. institution, valued, defined, and enacted their supervision of student teachers. (Contains 4 tables and 1 note.)

In a recent issue of Child Maltreatment (2023 vol. 28 (4)), an editorial by Palusci et al. and a commentary by Briggs et al. were published. These two publications express the American Professional Society on the Abuse of Children (APSAC) Board's and the Child Maltreatment editorial team's stance relative to Diversity, Equity, Inclusion and Justice (DEIJ). The current commentary expresses a range of concerns regarding how APSAC and Child Maltreatment plan to advance DEIJ through their editorial policies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to study the viability of implementing a protocol-guided model designed to provide structure and focus for teacher collaboration from Shanghai in today's US public schools. The authors examine whether the new model, Teacher Peer Excellence Group (TPEG), fosters the desired key features of productive communities of practice where teachers can jointly construct, transform, preserve, and continuously deepen the meaning of effective teaching. The authors also explore the extent to which existing school conditions--principal instructional leadership, trust, teacher efficacy, and teachers' sense of school-wide professional community--enable or moderate the desired outcomes. Design/methodology/approach: Data for this paper are drawn from a series of surveys administered to teachers from 24 pilot schools in six school districts over two school years. Descriptive and multilevel modeling analyses are conducted. Findings: The findings provide encouraging evidence that, given sufficient support and guidance, teachers report higher levels of engagement in deprivatized practice and instructional collaboration. These findings also hold after controlling for key enabling conditions and school characteristics. Social implications: The TPEG approach challenges school leaders to take on the responsibilities of helping teachers make their practice public, sharable, and better--three critical objectives in the shift to develop the profession of teaching. Originality/value: The indication of TPEG model's positive impact on strengthening the features of communities of practice in selected public schools provides the impetus for further efforts in understanding the transformational changes needed and challenges ahead at the classroom, school, and district levels.

Purpose: Individuals with psychiatric disorders are at increased risk for treatment non-adherence and related complications, especially during transitions of care. Medication reconciliation is now a standard process during hospital admissions that is uniformly recommended by international organizations to aid in safe and effective care transitions. Pharmacy-led medication reconciliation (PMR) practices are poised to represent a standardized method of reconciliation attempt within this underserved population with complex medication histories. Methods: A retrospective cross-sectional study using medical chart review was conducted for all adults admitted to the inpatient psychiatric service at a community hospital in Buffalo, NY, during 2 months in 2018. Outcomes were 30- and 180-day psychiatric readmission rates, 30- and 180-day visit rates to the outpatient comprehensive psychiatric emergency program (CPEP), and composite 30- and 180-day relapse. Receipt of pharmacy-led medication reconciliation was identified from pharmacy documentation in the electronic medical record. Results: 78% of patient's medication lists on admission were reconciled, with 49% of reconciliations made by the inpatient pharmacy. Presence of a PMR did not alter the odds of inpatient readmission alone, however patients without a PMR were found to have 2.13 times higher odds of visiting the hospital's outpatient CPEP within 30-days (P =.012) and 1.9 times higher odds of any composite psychiatric relapse within 30-days (P =.024). Conclusions: Implementation of hospital-wide pharmacy-led medication reconciliation on admission may help reduce psychiatric relapse across multiple care settings. [ABSTRACT FROM AUTHOR]

This paper aims to contribute to the knowledge base about the lives of individuals who experience incarceration in the U.S. in order to advance post-release intervention services. Research has shown that among the millions of Americans who cycle through prisons and jails each year, the majority are poor, in poor health, living in contexts of chronic violence, often with mental illness, and more than half are people of color. Of particular concern for this population are high rates of trauma exposure and PTSD, though the research in this area is underdeveloped, particularly for men. Using survey data gathered during a large (n = 1,516, 90% male) multi-state randomized control trial of a reentry intervention, this study used latent class analysis (LCA) to explore types and timing of trauma exposures across the life course. LCA has been found to be an effective statistical tool in intervention research for identifying high-risk groups and for informing the tailoring of interventions. This study found three latent classes: 1) Lifetime Interpersonal Polyvictimization, 2) Lifetime Environmental Exposures, and 3) Low Exposure. About one third of the sample fell within each class. Study findings indicate that not only should trauma-informed and trauma-specific interventions be the norm in reentry services, including for men, but that these interventions should target both individual and environmental factors. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents a re-analysis of the National Child Abuse and Neglect Data System (NCANDS) data presented by Briggs et al. (2022). Methods: We review five components of that article: The aims, variables, analytic strategy, analysis, and conclusions. Results: We conclude that several of the NCANDS variables used are invalid at the national level, and that this is sufficient to call the research into question. We find concerning issues in analytic strategy and analysis as well, many stemming from a failure to account for the serious underreporting of services in NCANDS, and the wide variability in data quality and consistency across states. We also found what we consider to be issues with their statistical analysis. Discussion: The reanalysis presented in this article shows no pattern of disparate within Child Protective Services (CPS) outcomes by race and, therefore, no support for the Briggs et al. claim of pervasive anti-Black racism within the CPS system. [ABSTRACT FROM AUTHOR]

Purpose: To summarize the most noteworthy infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2021. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated articles that were deemed to have significant contributions to ID pharmacotherapy in 2021. These nominations included articles pertaining to both general ID, including coronavirus disease 2019 (COVID-19), and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. A total of 35 articles were nominated by HIDN: 30 articles pertaining to general ID pharmacotherapy and 5 articles with HIV/AIDS focus. To select the most influential articles of 2021, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 239 SIDP members who responded to the survey, there were 192 recorded votes for the top 10 general ID pharmacotherapy articles and 47 recorded votes for the top HIV/AIDS article, respectively. The top publications are summarized. Conclusion: Antimicrobial stewardship and the optimal management of infectious disease states continues to be a priority in the midst of the ongoing coronavirus disease 2019 (COVID-19) global pandemic. In light of the sheer volume of ID-related articles published in the past year, this review aims to aid clinicians in remaining up-to-date on key practice-changing ID pharmacotherapy publications from 2021. [ABSTRACT FROM AUTHOR]

In 2015, several severe cases of skin and soft tissue infection (SSTI) among US Naval Special Warfare trainees prompted the introduction of doxycycline prophylaxis during the highest-risk portion of training, Hell Week. We performed a retrospective analysis of the effect of this intervention on SSTI incidence and resulting hospital admissions during 2013-2020. In total, 3,371 trainees underwent Hell Week training during the study period; 284 SSTIs were diagnosed overall, 29 of which led to hospitalization. After doxycycline prophylaxis was introduced, admission rates for SSTI decreased from 1.37 to 0.64 admissions/100 trainees (p = 0.036). Overall SSTI rates remained stable at 7.42 to 8.86 SSTIs/100 trainees (p = 0.185). Hospitalization rates per diagnosed SSTI decreased from 18.4% to 7.2% (p = 0.009). Average length of hospitalization decreased from 9.01 days to 4.33 days (p = 0.034). Doxycycline prophylaxis was associated with decreased frequency and severity of hospitalization for SSTIs among this population. [ABSTRACT FROM AUTHOR]

In the United States, small residential care homes provide affordable community-based care for disabled older adults. Also called adult foster care homes, residential care facilities, group homes, or board and care homes, small residential care homes are typically private, small businesses operating in single-family dwellings that provide round-the-clock care in a home-like setting in residential neighborhoods. While most states license small residential care homes they also exist, legally and illegally, as unlicensed and unregulated operations. The quality of care in some unlicensed and unregulated small residential care homes can be questionable. Disabled older adults are targeted and victimized by unethical small residential care home operators for financial gain. This commentary highlights the need for whole system disruption to end victimization in unethical unlicensed and unregulated small residential care homes through case studies of the abuse and neglect of residents living in unethical unlicensed operations and recommends ambitious goals centered on reducing secondary financial gains and medically neglectful practices. These recommendations are at federal, state, and local levels, and include creating a federal definition of small residential care homes, increasing and coupling government incomes with state registration and employee misconduct registry checks, increasing oversight and assessment, improving temporary guardianship processes, providing avenues for reporting abuse, and developing older adult fatality review teams. [ABSTRACT FROM AUTHOR]

Aims: The few remaining old-growth forests in the northeastern United States are often comprised of ectomycorrhizal (EM) tree-dominated patches surrounded by arbuscular mycorrhizal (AM) tree-dominated secondary forests. We examined how (1) distance from old growth and tree neighborhood composition influenced EM colonization, fungal richness, and fungal community composition of Betula lenta L. (black birch) seedlings, a common EM tree that colonizes abandoned agricultural fields, and (2) potential effects of EM fungal genera on seedling physiological performance. Methods: We sampled soils and tree composition from the edge of an EM-dominated old-growth forest into an adjacent AM-dominated secondary forest. We used soils to grow black birch seedlings in a growth chamber bioassay. We measured seedling EM colonization and investigated effects of EM fungi and soil characteristics on seedling physiological performance. Results: We identified 20 EM fungal species and found decreases in EM colonization and fungal richness with distance from old growth, with many taxa present only near the edge. Neighborhood EM tree abundance best explained EM colonization while distance interacted with EM tree basal area to best explain EM fungal richness of seedlings. Soils from neighborhoods lacking EM trees resulted in sparse EM colonization of seedlings. We found no clear effects of EM fungal genera on seedling performance, but we detected a slight decrease in seedling photosynthetic rate with distance from old growth. Conclusions: Old-growth forests can be reservoirs of EM fungi, and EM tree patches can function as localized inoculum sources in AM-dominated secondary forests, potentially facilitating EM tree establishment. [ABSTRACT FROM AUTHOR]

The past several years have seen calls from QuantCrit scholars to "disaggregate" samples into same-race groups. To date, however, there has been no attempt to empirically evaluate the benefits of disaggregation within a child welfare sample. Using a child maltreatment dataset derived from the National Child Abuse and Neglect Data System and Census data, we empirically evaluate the utility of employing sample disaggregation (in which separate records are created for White, Black and Latino populations in each county) as well as variable creation disaggregation (in which we avoid using "full county" economic measures, but instead employ "same race/ethnicity" measures). Using model fit and convergence with findings from individual-level studies as evaluation metrics, we find that both kinds of disaggregation are demonstrably beneficial. We recommend that sample and variable disaggregation be considered by any future researchers using national geographically structured child maltreatment data. [ABSTRACT FROM AUTHOR]

Black immigrants and their children represent a significant and growing share of the U.S. Black population; however, their experiences of their multifaceted identities are often collapsed into the experiences of multigenerational Black youth. The current study investigates whether generalized ethnic-racial identity measures are equivalent for Black youth with an immigrant parent and Black youth with only U.S.-born parents. Participants were 767 Black adolescents (16.6% immigrant-origin; Mage = 16.28, SD = 1.12) attending diverse high schools in two regions of the U.S. Participants completed the affirmation, exploration, and resolution subscales of the Ethnic Identity Scale-Brief (EIS-B), along with the centrality and public regard subscales of the Multidimensional Inventory of Black Identity-Teen (MIBI-T). The results indicated that, whereas the EIS-B demonstrated scalar invariance, the MIBI-T demonstrated partial scalar invariance. Accounting for measurement error, immigrant-origin youth reported lower affirmation than multigenerational U.S.-origin youth. Across groups, ethnic-racial identity exploration and resolution scores were positively associated with family ethnic socialization; ethnic-racial identity affirmation was positively associated with self-esteem; and ethnic-racial identity public regard was negatively associated with ethnic-racial discrimination, supporting convergent validity. Conversely, centrality was positively associated with discrimination among multigenerational U.S.-origin Black youth, but the relation was not significant among immigrant-origin Black youth. These results fill a methodological gap in the literature, providing researchers with empirical support for considering whether to pool immigrant-origin and multigenerational U.S.-origin Black youth in analyses regarding ethnic-racial identity. [ABSTRACT FROM AUTHOR]

In April 2011, Congress slashed funding for a majority of programs tied to education. Several programs related to professional development for teachers did not survive. While cut severely--from $119 million in Fiscal Year 2010 to $46 million (a loss of $73 million or 61% of its funding)--Teaching American History (TAH) grants lived, albeit by their fingertips, another day. Yet, given the economic challenges the United States faces and what appear to be prevailing attitudes in regard to social services and teacher development, it has become clear that history educators cannot rely on federal funding to support efforts to improve the teaching of history. Nevertheless, meaningful collaboration among K-12 teachers and academic and public historians continues to be vital. This essay describes in detail a current collaborative relationship between a history department and high school in western Michigan. Focusing specifically on four levels of interlocking benefits of collaboration--benefits for high school teachers, for teaching candidates, for high school students, and for historians--the essay documents the strengths of this collaborative effort and notes areas where purposeful concentration and improvement might benefit all parties. Significantly, the relationship examined here, between the history department at Western Michigan University (WMU) and Portage Central High School (PCHS), developed without a promise or expectation of financial incentives. It demonstrates that collaboration, while challenging, can survive in the twenty-first century without funding from a TAH grant. (Contains 20 notes.)

By examining the different methods and processes by which national data gathering agencies compile and submit their findings to the Organization for Economic Cooperation and Development (OECD), the authors (1) assess the methodological challenges of accurately reporting tertiary completion and graduation rates cross-nationally; (2) to examine the incongruence of existing internationally comparative data on tertiary completion, particularly within the OECD; and (3) to offer policy recommendations for increasing the congruence and comparability of U.S. higher education data with that of other OECD countries (and the rest of the world). (Contains 5 tables, 3 figures, and 4 footnotes.)

Research repeatedly documents that teachers are underprepared to teach mathematics effectively in diverse classrooms. A critical aspect of learning to be an effective mathematics teacher for diverse learners is developing knowledge, dispositions, and practices that support building on children's mathematical thinking, as well as their cultural, linguistic, and community-based knowledge. This article presents a conjectured learning trajectory for prospective teachers' (PSTs') development related to integrating children's "multiple mathematical knowledge bases" (i.e., the understandings and experiences that have the potential to shape and support children's mathematics learning--including children's mathematical thinking, and children's cultural, home, and community-based knowledge), in mathematics instruction. Data were collected from 200 PSTs enrolled in mathematics methods courses at six United States universities. Data sources included beginning and end-of-semester surveys, interviews, and PSTs' written work. Our conjectured learning trajectory can serve as a tool for mathematics teacher educators and researchers as they focus on PSTs' development of equitable mathematics instruction.

Background: The National Evidence-Based Practices (EBPs) Project developed and tested a model for facilitating the implementation of five psychosocial EBPs for adults with severe mental illness in the United States. Methods: The implementation model was tested in 53 sites in 8 states. In each site, one of the five EBPs was adopted for implementation and then studied for a 2-year period using a combination of qualitative and quantitative methods. Findings: At baseline, none of the sites had programs attaining high fidelity. Four factors were identified as influencing fidelity: (a) EBP-specific factors, (b) governmental factors, (c) leadership factors, and (d) fidelity review factors. Conclusion: A multipronged implementation strategy was effective in achieving high fidelity in over half of the sites seeking to implement a new EBP. (Contains 1 table and 1 figure.)

We examined differences in the receipt and delivery of extended school year (ESY) services in the United States by locale as being rural, urban, or suburban. We found that there were significant differences in the percentage of students receiving ESY services according to locale, with rural local education agencies (LEAs) having a significantly lower percentage of students receiving ESY services. Additionally, we found that special education directors perceived the number of students receiving ESY services as generally being "about right" for their LEA. We also found that urban special education directors were significantly more likely to report that there should be less students receiving ESY services while rural special education directors were less likely to report this. We then found that rural LEAs generally reported providing significantly fewer types of ESY services offered than urban or suburban LEAs. Finally, we found that urban LEAs reported significantly higher attendance rates of students who attended ESY services as compared with rural LEAs. [ABSTRACT FROM AUTHOR]

Poor oral hygiene and excessive consumption of soda are among the main drivers of systemic health issues in adolescents in the United States. This non-randomized pilot clinical trial focused on the effects of a health text message system and smartphone-based intervention on adolescent tooth-brushing behavior and dietary choices, with a convenience sample of 94 participants aged 12 to 14 years old. A group of 75 participants agreed to use a tooth-brushing app and received a health text message; the other group of 15 agreed to use the tooth-brushing app, but did not receive a health text message. Saliva specimens were collected directly before and at the end of each experiment; changes in the salivary presence of cariogenic bacteria over the duration of the study were evaluated and compared with the demographics and behavioral variables. Within the text message group, 5% of participants increased the frequency of daily tooth brushing. Within the non-intervention group, 29% of participants increased the frequency of their daily tooth brushing. There were reductions in the total salivary bacteria and total streptococci in both groups (p < 0.001), but no change in the presence of cariogenic Mutans streptococci. Raising adolescents' consciousness of oral health behavior resulted in marginal to moderate improvements to oral hygiene and dietary choices, as well as reductions in total salivary bacteria. [ABSTRACT FROM AUTHOR]

Creeping bentgrass (Agrostis stolonifera L.) is a turfgrass species that is widely used on golf courses throughout the United States. In field settings, plants are often subjected to more than one stress at a time, and studying stresses independently is likely insufficient. Stresses, such as heat stress and salt stress, can affect plant hormone levels and, in turn, plant hormone levels can affect how well the plant tolerates stress. The objectives of the experiments were to determine if the levels of heat stress and salt stress used would be detrimental to creeping bentgrass health, and if applying plant growth regulators could improve plant health during stress. During the first experiment, creeping bentgrass was transplanted to hydroponics systems in two different growth chambers. One chamber was set to have day and night temperatures of 35 °C and 30°C (heat stress), respectively, and the other had day and night temperatures of 25 °C and 20°C, respectively. Within each chamber, one block received a 50 mM NaCl treatment (salt stress) and the other did not (control). The stress treatments were applied for 14 days. Results of the first experiment indicated that the treatments were sufficient to negatively affect creeping bentgrass growth and health as indicated by fresh shoot and root weights, tillering, electrolyte leakage, and total chlorophyll content (TCC). There were significant interactions of temperature x salt level detected for shoot and root weights and electrolyte leakage. Plants that were exposed to both heat stress and salt stress were more negatively affected than plants exposed to either heat stress or salt stress alone for all metrics except for tillering. The presence of salt reduced tillering regardless of the temperature regimen. During the second experiment, plants were treated the same, but the plant growth regulator (PGR) treatments were also applied. The PGR treatments consisted of two different gibberellic acid (GA) synthesis inhibitor products, 2,4-dichlorophenoxyacetic acid, two different rates of aminoethoxyvinylglycine (AVG), an ethylene synthesis suppressor, and plants that were not treated with the PGR. In addition to the measurements of plant health and growth, dry shoot and root weights were measured. For the TCC, there was a two-way interaction between temperature x PGR treatment. For electrolyte leakage, there was a three-way interaction between temperature x salt level x PGR treatment. Combined heat stress and salt stress negatively affected all plants regardless of PGR treatment, but there were differences between PGR treatments. Plants treated with AVG exhibited improved health and growth compared with the other PGR treatments. These plants had the highest shoot and root masses. Plants treated with GA synthesis inhibitors had the lowest shoot and root masses as well as the lowest TCC when subjected to stress. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increased federal attention to advancing racial equity and support for underserved communities suggests the need for data on racial and ethnic differences in evidence-based employment services for people with serious mental illness. Individual Placement and Support (IPS) is an evidence-based model of supported employment for this population. OBJECTIVE: The objective was to identify differences based on race and ethnicity in IPS services. METHODS: This narrative review examined the empirical literature on IPS services in the U.S., assessing evidence of differences in access, retention, and effectiveness for Black and Hispanic IPS clients, relative to non-Hispanic Whites. RESULTS: We identified 12 studies examining racial and ethnic differences in access (4 studies), retention (3 studies), and effectiveness (6 studies). The findings for access to IPS were mixed, with two studies showing no differences, one finding less access for Blacks, and another finding greater access for Blacks but less access for Hispanics. Three studies found better retention rates for clients enrolled in IPS regardless of race or ethnicity. Compared to clients receiving usual vocational services, all studies found better employment outcomes for IPS clients regardless of race or ethnicity. CONCLUSION: Unlike for most of health care, few racial and ethnic differences have been found for IPS employment services in the U.S. Access to IPS is inadequate for all groups, with conflicting evidence whether Blacks and Hispanics have even less access. Based on the available evidence, Black and Hispanic clients have comparable retention and employment outcomes in IPS as non-Hispanic White clients. State and local mental health leaders responsible for monitoring IPS outcomes should routinely report statistics on race and ethnicity. They should also give active attention to client needs and equity. Research designs should answer multifaceted questions regarding disparities for historically underserved populations. [ABSTRACT FROM AUTHOR]

Surprise medical bills received after care delivery in both emergency and non-emergency situations for out-of-network (OON) or other contractual health plan regulations adds additional stress upon the care guarantor, most often the patient. The passing and continued implementation of the federal No Surprises Act (NSA) and related state-level legislation continues to influence the processes of care delivery in the United States. This rapid review evaluated the literature specific to surprise medical billing in the United States since the passing of the No Surprise Act, guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. A total of 33 articles were reviewed by the research team and the results demonstrate industry stakeholder perceptions related to two primary industry themes (constructs) surrounding surprise billing: healthcare stakeholder perspectives and medical claim dispute (arbitration) processes. Further investigation identified sub-constructs for each: the practice of balance-billing patients for OON care and healthcare provider, and facility equitable reimbursement challenges (primary theme 1), and arbitration observations and challenges surrounding (a) the NSA medical dispute process, (b) state-level arbitration processes and perceptions, and (c) use of the Medicare fee schedule as a benchmark for arbitration decisions (primary theme 2). The results indicate the need for formative policy improvement initiatives to address the generation of surprise billing. [ABSTRACT FROM AUTHOR]

Study Objectives Fear of sleep contributes to insomnia in some individuals with posttraumatic stress disorder (PTSD) but remains uncharacterized in first responders, a population with high rates of insomnia and PTSD. We evaluated the clinical relevance of fear of sleep in first responders by (1) examining its relationship with trauma types and clinical symptoms and (2) assessing differences in fear of sleep severity between those reporting provisional PTSD, insomnia, or both. Methods A cross-sectional study of 242 first responders across the United States (59.2% male, 86.4% white, 56.2% law enforcement officers, 98.7% active duty, and M years of service = 17). Participants completed the Fear of Sleep Inventory-Short Form and measures of trauma history, psychopathology (e.g. PTSD), and sleep disturbances (insomnia and trauma-related nightmares). Results Fear of sleep was associated with trauma types characterized by interpersonal violence and victimization, as well as symptoms of PTSD, depression, anxiety, stress, alcohol use problems, insomnia, and trauma-related nightmares. Fear of sleep was most pronounced among first responders reporting provisional PTSD comorbid with insomnia compared to those with PTSD or insomnia only. Post hoc analyses revealed PTSD hyperarousal symptoms and trauma-related nightmares were independently associated with fear of sleep, even after adjusting for the remaining PTSD clusters, insomnia, sex, and years of service. Conclusions Fear of sleep is a clinically relevant construct in first responders that is associated with a broad range of psychopathology symptoms and is most severe among those with cooccurring PTSD and insomnia. Fear of sleep may merit targeted treatment in first responders. This paper is part of the Sleep and Circadian Health in the Justice System Collection. [ABSTRACT FROM AUTHOR]

The article discusses a study which evaluated the feasibility and acceptability of the personalized medical group visit (PMGV) model to engage and motivate prediabetic individuals to achieve meaningful health and therapeutic goals. Topics covered include the study design and methods, the efficacy of the model to facilitate beneficial behavior change and improved patient outcomes, and the strengths and limitations of the study.

Background: Over 15.3 million Americans relied on the individual health insurance market for health coverage in 2021. Yet, little is known about the relationships between the organizational characteristics of individual market health insurers and quality of coverage, particularly with respect to clinical outcomes.Objective: To examine variation in marketplace insurers' quality performance and investigate how performance varies by insurer organizational characteristics.Design: Retrospective cohort study.Participants: 381 insurer products, representing 184 unique insurers in 50 states in 2019 and 2020.Main Measures: Marketplace plan clinical quality measures reported in the 2019-2020 CMS Plan Quality Rating System dataset and insurer-product organizational attributes identified from several data sources, including non-profit ownership, Blue Cross Blue Shield Association membership, Medicaid focus and whether or not the insurer product is vertically integrated with a provider organization.Key Results: Among the 381 insurer products in this study, 35% are part of a provider-sponsored health plan (PSHP) and 70% of these entities received four stars or above for overall quality performance. Overall, PSHPs exhibited higher quality than non-PSHPs for both clinical quality management (0.36 increased on a 5-point scale; 95% CI = 0.11 to 0.62; P = 0.005) and enrollee experience (0.27; 95% CI = 0.03 to 0.50; P = 0.03) summary indicators. Medicaid focused insurers were associated with lower performance on enrollee experience, plan administration, and various outcomes related to clinical quality.Conclusions: Provider-sponsored health plans in the health insurance marketplaces are associated with higher-quality care, as measured by CMS clinical quality measures. [ABSTRACT FROM AUTHOR]

Background: Because the Clinical Nurse Leader (CNL) role is relatively new, little is known about the success of CNL graduates. Our aim was to describe the career path of CNL graduates and to measure satisfaction 2 to 10 years after graduation. Methods: A cross-sectional survey design was used to assess career trajectory and self-reported satisfaction with work, life, and educational preparation in a sample of 109 CNL graduates from one university. Online data collection was used, resulting in participants from across the United States. Results: Respondents were primarily Direct Entry CNL graduates. The majority (95%) were still working full- or part-time in nursing. Most (over 90%) were satisfied or extremely satisfied with their decision to become a nurse. Life satisfaction was high: the Satisfaction with Life Scale mean score was 24.9 (SD = 5.67). Conclusion: These results help describe CNL career trajectories and provide useful suggestions for education and practice. This information can help build the business case for the CNL. [ABSTRACT FROM AUTHOR]

Pulmonary complications are a leading cause of morbidity and mortality in patients with autoimmune disease. Substantial evidence suggests that biological sex (i.e., regulated by genes, hormonal profiles) and gender (i.e., a social construct based on environmental, cultural and behavioral factors and choices that affect a person's self-identity) uniquely affect fundamental molecular and cellular processes related to autoimmune lung disease pathogenesis. In addition, both sex and gender can influence disease susceptibility, clinical manifestations and response to therapy in patients with autoimmune lung disease. However, female mammals are usually excluded from basic science research, and clinical studies in this area often fail to explore the impact of sex/gender on outcomes. Recognizing the inherent value in the study of sex and gender differences in autoimmune lung diseases, the National Heart, Lung, and Blood Institute (NHLBI) partnered with the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the Office of Research on Women's Health (ORWH) to organize a two-day virtual sex- and gender-related autoimmune lung diseases (SG-RAILD) workshop in June 2021. The goals of the workshop were to discuss the influences of sex and gender on autoimmune lung diseases with a focus on novel experimental methods. Specifically, Workshop participants from diverse areas suggested innovative strategies for enhancing scientific rigor and facilitating new discovery in this area. The present Workshop report summarizes opportunities for future sex- and gender-informed preclinical and clinical research. The report also provides suggestions for training future scientists to carry this research forward. [ABSTRACT FROM AUTHOR]

Aim: Describe nurses' perceptions of the barriers and facilitators that influence acceptance and use of remote visual monitoring technology. Background: Research has shown remote visual monitoring to be a useful patient safety intervention, yet nurses underutilize the technology. Methods: Using a qualitative descriptive study design, we completed a conventional content analysis of focus group feedback from two nurse leader groups and two direct care nurse groups (n = 13 participants) to explore factors influencing nurses' perceptions and utilization of remote visual monitoring. Results: Five main themes were identified: (1) Contextual human factors that impact nurse acceptance; (2) facilitators and barriers related to remote visual monitoring's functionality; (3) nurse leaders' role in maintaining device availability and efficient use; (4) nurse leaders' role in promoting adoption of the technology; and (5) nurse leaders' role in valuing nursing professional judgement. Conclusion: Findings indicate that nurse leaders can play a crucial role in direct care nurses' acceptance and use of remote visual monitoring technology. Implications for Nursing Management: In an era of limited staffing resources, remote visual monitoring has the potential to increase patient safety and decrease workload demands. Nurse leaders should identify barriers and facilitators to their nursing team's use of remote visual monitoring to promote the acceptance and use of technology that increases patient safety and cost‐effectiveness of care. [ABSTRACT FROM AUTHOR]

Historical and contemporary political events underscore that Latinx people do not necessarily view race and racism in the United States through a shared lens with other Latinx people and other communities of color. Thus, it is critical to understand how Latinx youth develop attitudes, beliefs, and behaviors that challenge white supremacy—or anti‐racist identities and behaviors—that actively disrupt racial oppression communities of color face as well as their own communities. In this paper, we review theoretical mechanisms by which Latinx youth may develop anti‐racist identities and actions on behalf of their own ethnic/racial communities and other communities oppressed by white supremacy. We conclude by offering suggestions for how institutions may support Latinx youth's anti‐racist identities and actions. [ABSTRACT FROM AUTHOR]

Medicaid managed care insurers play a crucial role in facilitating access to buprenorphine to treat opioid use disorder. Using a novel set of provider directory and prescription claims data, we examined variation in access to in-network buprenorphine-prescribing primary care providers among Medicaid managed care enrollees. Approximately 32.2 percent of enrollees had fewer than one in-network buprenorphine prescriber per 100,000 county residents. On average, there were a greater number of in-network buprenorphine-prescribing primary care providers in states with higher compared with lower overdose death rates. However, most enrollees lived in areas with a shortage of these providers. We found that a 25 percent higher network participation rate by prescribers compared with nonprescribers could improve the probability that enrollees see a prescriber by approximately 25 percent. Policies to improve access within Medicaid managed care include using primary care provider assignment algorithms to match patients with buprenorphine prescribers and requiring that networks include a minimum number of buprenorphine prescribers. [ABSTRACT FROM AUTHOR]

Introduction: 'Fit' refers to an applicants' perceived compatibility to a residency programme. A variety of structural, identity‐related and relational factors contribute to self‐assessments of fit. The 2021 residency recruitment cycle in the USA was performed virtually due to the COVID‐19 pandemic. Little is known about how video‐interviewing may affect residency applicants' ability to gauge fit. Methods: A multidisciplinary, anonymous survey was distributed to applicants at a large academic institution between rank order list (ROL) certification deadline and Match Day 2021. Using Likert‐type scales, applicants rated factors for importance to 'fit' and their ease of assessment through video‐interviewing. Applicants also self‐assigned fit scores to the top‐ranked programme in their ROL using Likert‐type scales with pairs of anchoring statements. Results: Four hundred seventy‐three applicants responded to the survey (25.7% response rate). The three most important factors to applicants for assessment of fit (how much the programme seemed to care, how satisfied residents seem with their programme and how well the residents get along) were also the factors with the greatest discrepancy between importance and ease of assessment through video‐interviewing. Diversity‐related factors were more important to female applicants compared with males and to non‐White applicants compared with White applicants. Furthermore, White male applicants self‐assigned higher fit scores compared with other demographic groups. Conclusion: There is a marked discrepancy between the most important factors to applicants for fit and their ability to assess those factors virtually. Minoritised trainees self‐assigned lower fit scores to their top‐ranked programme, which should raise concern amongst medical educators and highlights the importance of expanding current diversity, equity and inclusion efforts in academic medicine. This paper offers examination of how residency applicants assess fit to the programs at which they interview during the virtual recruitment era, showing that female and minority applicants perceive poorer fit. [ABSTRACT FROM AUTHOR]

Objective: Individual placement and support (IPS), an evidence-based supported employment practice, is a core service in community mental health in the United States. Several factors promote the growth of IPS, including a network of 24 states participating in a learning community devoted to expanding IPS services. This study examined growth of IPS in the United States from 2016 to 2019, comparing growth rates for states within and outside the learning community.Methods: This national survey included telephone interviews with 70 representatives from state mental health and vocational rehabilitation agencies in 50 states and the District of Columbia, replicating methods of a 2016 survey. The primary outcomes were the number of IPS programs and clients served. The survey inquired about four indicators of state-level support for IPS implementation and sustainment: collaboration between state agencies, independent fidelity reviews, technical assistance and training, and funding.Results: In 2019, 41 (80%) of 50 states and the District of Columbia had IPS services, with 857 IPS programs serving an estimated 43,209 clients. Between 2016 and 2019, the number of programs increased from 272 to 486 in 22 learning-community states and two learning-community counties, and from 251 to 371 in 18 states outside the learning community. State-level support for IPS was significantly greater in learning-community states, compared with non-learning-community states.Conclusions: IPS services expanded substantially in the United States between 2016 and 2019. Learning-community states had more rapid growth and provided greater implementation support, facilitating implementation, expansion, and sustainment of high-fidelity IPS. Nevertheless, access to IPS remains limited. [ABSTRACT FROM AUTHOR]

Despite persistent efforts to advance infant death investigation, most sudden unexpected infant deaths (SUIDs) remain unexplained. Law enforcement officials contribute to SUID investigations throughout the United States, but their impacts on these investigations have not been adequately examined. In this exploratory study, 26 law enforcement officials were interviewed about their experiences and perspectives with SUID investigations. Thematic analysis of qualitative data revealed three specific difficulties law enforcement encounter during SUID investigations: (1) inadequate preparation; (2) overwhelming emotions; and (3) a victim–suspect dilemma. Findings indicate that these barriers may inhibit consistent and reliable investigation of infant death and, therefore, may impede the cause and manner of death determinations. Participants' narratives also offered insights into potential solutions, including expanded SUID training for law enforcement and use of checklists, such as the Sudden Unexpected Infant Death Investigation Reporting Form. The impacts of overwhelming emotions confronted during SUID investigation warrant further study. The victim–suspect dilemma stems from the inability of law enforcement to conclusively eliminate the possibility of homicide. This dilemma may be resolved through a clear distinction between interactions with potential evidence and interactions with the family. Law enforcement must be trained to treat all SUID families in a compassionate and non‐accusatory manner, while investigating all SUID with careful attention to detail that is essential in any potential homicide investigation. A consistent, meticulous, and compassionate approach to SUID investigations will improve the reliability of information obtained and offer the best opportunity for providing answers to grieving parents. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the relationship between habitual sleep duration and blood pressure (BP) control in adults with hypertension. Methods: This cross-sectional study used data of 5163 adults with hypertension obtained from the 2015– 2018 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression was used to analyze the association between habitual sleep duration and BP control. Habitual sleep duration was self-reported and defined as the amount of sleep usually obtained in a night or main sleep period during weekdays or workdays. It was categorized as < 6, 6 - < 7, 7– 9, and > 9 hours. BP control was defined as average systolic BP < 130mmHg and diastolic BP < 80mmHg. Results: Results from the fully adjusted models show that among all adults with hypertension, habitual sleep duration of < 6 hours night/main sleep period was associated with reduced odds of BP control (OR = 0.53, 95% CI: 0ss.37– 0.76, P = 0.001) when compared to 7– 9 hours. In the subpopulation of adults who were on antihypertensive medication, those with a sleep duration of < 6 hours had lower odds of BP control than those with a sleep duration of 7– 9 hours (OR = 0.53, 95% CI: 0.36– 0.77, P = 0.002). No significant differences were noted in all adults with hypertension and in the subpopulation of those on antihypertensive medication in BP control between the reference sleep duration group (7– 9 hours) and the 6 - < 7 or > 9 hours groups. There were no significant differences across age groups or gender in the relationship between habitual sleep duration and BP control. Conclusion: Sleep duration of < 6 hours is associated with reduced odds of hypertension control. These significant findings indicate that interventions to support adequate habitual sleep duration may be a promising addition to the current hypertension management guidelines. [ABSTRACT FROM AUTHOR]

Parents and friends are important influences on adolescents' academic outcomes. We examine whether and how adolescents' social networks compensate for or enhance the effects of their parents' education on academic outcomes. Among a large ethnoracially diverse sample of high school students in the Southwestern (N = 2,136) and Midwestern (N = 1,055) United States, results from network autocorrelation models showed that higher levels of mother and father education were related to greater academic self‐efficacy and engagement and higher aspirations, expectations, and grade point averages at both schools. Friends' parents' education levels were positively associated with adolescents' academic aspirations, expectations, and grade point averages across all of the models; higher levels of friends' parents' education were related to greater academic self‐efficacy across all models, except for mothers in the Southwest; and friends' fathers' education levels were positively related to adolescents' academic engagement for students in the Midwestern school only. There were no significant interaction effects between parents' and friends' parents' education levels in predicting academic outcomes. Differences in the distribution of parental education across ethnic‐racial groups shaped the implications of the model for adolescents' academic adjustment. Findings highlight the impact of educational opportunity across generations in shaping academic inequities. [ABSTRACT FROM AUTHOR]

In the United States, medicolegal death investigation practices and policies pertaining to sudden unexpected deaths are mandated by state government. Practices vary across states, which contributes to inconsistency in job prerequisites and training. In preparation for a study focused on occupational safety and health of medicolegal death investigators in their on‐scene and follow‐up activities, a scoping review was conducted to document known occupational safety risks and health‐related conditions associated with death investigation. Searches used Boolean and subject heading operators both broad and narrow in scope, and search terms included scene responder, hazard, investigator, forensic pathology, injury, and safety. Twenty‐five articles met inclusion criteria, which included seventeen survey‐mixed method designs, two systematic reviews, five quasi‐experimental designs, and one case study. Twelve articles addressed mental health and eleven focused on risks associated with infectious disease. One article addressed the risk of chemical exposure from cyanide among autopsy personnel (including forensic pathologists) and nine included a wide range of employees within the setting of medical examiner or coroner offices. One article, addressing burnout, included employees in a forensic science laboratory setting as well as medicolegal death investigators and two articles included forensic pathologists and medicolegal death investigators. Only one article addressed medicolegal death investigators specifically. Articles addressing occupational and environmental hazards of medicolegal death investigators associated with musculoskeletal, respiratory, cardiovascular, radiological, nuclear, electrical, or explosive threats were not identified. There is little published about safety risks inherent in conducting death investigations. Research is needed to adequately inform health promotion and injury prevention strategies. [ABSTRACT FROM AUTHOR]

Study Objective: We investigated sleep disparities and academic achievement in college. Methods: Participants were 6,002 first-year college students attending a midsize private university in the southern United States [62.0% female, 18.8% first-generation, 37.4% Black, Indigenous, or People of Color (BIPOC) students]. During the first 3-5 weeks of college, students reported their typical weekday sleep duration, which we classified as short sleep (<7 hours), normal sleep (7-9 hours), or long sleep (>9 hours). Results: The odds for short sleep were significantly greater in BIPOC students (95% CI: 1.34-1.66) and female students (95% CI: 1.09-1.35), and the odds for long sleep were greater in BIPOC students (95% CI: 1.38-3.08) and first-generation students (95% CI: 1.04-2.53). In adjusted models, financial burden, employment, stress, STEM academic major, student athlete status, and younger age explained unique variance in sleep duration, fully mediating disparities for females and first-generation students (but only partially mediating disparities for BIPOC students). Short and long sleep predicted worse GPA across students' first year in college, even after controlling for high school academic index, demographics, and psychosocial variables. Conclusions: Higher education should address sleep health early in college to help remove barriers to success and reduce disparities. [ABSTRACT FROM AUTHOR]

Social Security Administration demonstration projects that are intended to help people receiving disability benefits have increased employment but not the number of exits from disability programs. The Supported Employment Demonstration (SED) is a randomized controlled trial (RCT) of services for individuals with mental health problems before they enter disability programs. The SED aims to provide health, employment, and other support services that help them become self-sufficient and avoid entering disability programs. The target population is people who have been denied Social Security disability benefits for a presumed psychiatric impairment. Thirty community-based programs across the United States serve as treatment sites; inclusion in the SED was based on the existence of high-fidelity employment programs that use the individual placement and support model, the ability to implement team-based care, and the willingness to participate in a three-armed RCT. In the SED trial, one-third of 2,960 participants receive services as usual, one-third receive services from a multidisciplinary team that includes integrated supported employment, and one-third receive services from a similar team that also includes a nurse care coordinator for medication management support and medical care. The goals of the study are to help people find employment, attain better health, and delay or avoid disability program entry. This article introduces the SED. [ABSTRACT FROM AUTHOR]

Psychiatric crisis care in the U.S. exemplifies the "more is less paradox" of U.S. health care. We spend more for health care than any other high-income country, yet our outcomes are typically poor compared to these other countries (OECD in OECD health statistics. Retrieved from https://www.oced.org/health/health-data.html, 2020). We do this, in part, by emphasizing medical treatments for problems that are inherently social, rather than addressing social determinants of health. Medical interventions for socio-economic problems are usually expensive and ineffective. For mental health crisis care, adding unfunded, untested, medical interventions to the current mélange of poorly funded, disorganized arrangements will not help. Instead, the U.S. should address social determinants, emphasize research-based interventions, and emphasize prevention—proven strategies that decrease costs and improve outcomes. [ABSTRACT FROM AUTHOR]

Objective. To examine the relationship between self-reported health, BMI, diet, and physical activity among students at three diverse institutions of higher learning (private university, HBCU, and community college), and investigate similarities and differences in behaviors and outcomes at these schools and how targeted interventions might support positive outcomes. Participants. Students attending one of three sites within a city in the southeastern United States (n= 1,943), aged 18-30 to focus on the emerging adulthood and health behaviors. Methods. Online survey administered in Fall 2017 included questions on health-related quality of life, BMI, chronic disease, diet and exercise, other health behaviors, and demographics. Results. Chronic conditions were consistently associated with BMI and self-reported health. Days of activity were associated with lower BMI and higher self-reported health. Drink intake, but not food intake was associated with BMI. Conclusions. Differences among student body characteristics at these institutions provide insights into tailored health promotion program needs. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) is the second most common cancer among men in the United States. While the use of prostate-specific antigen has improved the ability to screen and ultimately diagnose PCa, there still remain false positives due to noncancerous conditions in the prostate gland itself and other prognostic biomarkers for PCa are needed. Contents within extracellular vesicles (EVs) have emerged as promising biomarkers that can give valuable information about disease state, and have the additional benefit of being acquired through noninvasive liquid biopsies. Meaningful communication between cancer cells and the microenvironment are carried by EVs, which impact important cellular processes in prostate cancer such as metastasis, immune regulation, and drug resistance. [ABSTRACT FROM AUTHOR]

Objective: To examine neurodevelopment in preschool-aged children with craniofacial microsomia (CFM) relative to unaffected peers. Design: Multisite, longitudinal cohort study. Setting: Tertiary care centers in the United States. Participants: We included 92 children with CFM ("cases") through craniofacial centers and clinics. Seventy-six children without CFM (controls) were included from pediatric practices and community advertisements. This study reports on outcomes assessed when participants were an average age of 38.4 months (SD = 1.9). Main outcome measures: We assessed cognitive and motor skills using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), and language function using subtests from the Clinical Evaluation of Language Fundamentals—Preschool, second edition (CELF-P2). Results: Case–control differences were negligible for Bayley-III cognitive (effect sizes [ES] = −0.06, P =.72) and motor outcomes (ES = −0.19, P =.25). Cases scored lower than controls on most scales of the CELF-P2 (ES = −0.58 to −0.20, P =.01 to.26). Frequency counts for "developmental delay" (ie, one or more scores > 1 SD below the normative mean) were higher for cases (39%) than controls (15%); however, the adjusted odds ratio = 1.73 (P = 0.21) was not significant. Case–control differences were most evident in children with microtia or other combinations of CFM-related facial features. Conclusions: Cognitive and motor scores were similar for preschool-aged children with and without CFM. However, children with CFM scored lower than controls on language measures. We recommend early monitoring of language to identify preschoolers with CFM who could benefit from intervention. [ABSTRACT FROM AUTHOR]

Introduction: Passage of cannabis laws may impact cannabis use and the use of other substances. The suggested association is of particular concern in pregnant women where exposure to substances can cause harm to both the pregnant woman and fetus. The present study contributes to the minimal literature on factors associated with cannabis use during the preconception, prenatal, and postpartum periods including state legalization status, concurrent use of tobacco and e-cigarettes and adequacy of prenatal care. Methods: We conducted a cross-sectional analysis using combined survey data from the 2016–2018 Pregnancy Risk Assessment Monitoring System (PRAMS) collected from 36,391 women. Logistic regression was used to estimate the impact of state-legalization, adequacy of prenatal care, and other substance use on cannabis use during the preconception, prenatal, and post-partum periods. Results: In the preconception model, residence in a recreationally legal state (OR: 2.37; 95% CI, 2.04–2.75) or medically legal state (OR:3.32; 95% CI, 2.90–3.80) compared to a non-legal state was associated with higher odds of cannabis use. In the prenatal model, residence in a recreationally legal state was associated with higher odds of cannabis use (OR: 1.51; 95% CI, 1.29–1.79) whereas there was no association with residence in a medically legal state. Tobacco use including e-cigarettes and moderate prenatal alcohol use were also significantly associated with cannabis use. Conclusion: Recreational cannabis legalization is associated with the use of cannabis prior to, during, and after pregnancy. Renewed clinical and policy efforts may be warranted to update prenatal substance use prevention programs, educational campaigns, and provider education as cannabis legalization evolves. [ABSTRACT FROM AUTHOR]

Objective: The authors examined how individual placement and support (IPS), an evidence-based model of supported employment, has been successfully adapted in rural communities across the United States.Methods: Interviews with 27 key informants in 15 states with successful IPS programs in rural communities identified challenges that IPS workers faced because of rurality and the work-around methods they used to overcome these challenges. The authors conducted a thematic analysis of interviews.Results: Significant challenges to implementing IPS in rural areas included limited availability of public transportation, Internet connectivity, employment opportunities, and workforce. The work-around strategies used by IPS teams differed in relation to local circumstances and cultures, but effective services generally used natural supports for transportation, provided computer access for job applicants, developed relationships with local employers, and hired IPS workers with local knowledge.Conclusions: The adaptations made to IPS in rural areas are specific to local communities but retain core IPS principles. [ABSTRACT FROM AUTHOR]