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This work extends previously described applications of ultrasound technology in illustrating cardiovascular phenomena to investigation of learning effectiveness. To this end, learning in ultrasound-enhanced classes was assessed by quantifying the improvement in single best answer (SBA) exams conducted before and after an ultrasound practical class. This improvement was then compared to that seen in the same SBA exams conducted in matched groups that undertook similar classes conducted without ultrasound equipment. The SBA exams were designed to include questions that directly related to the phenomena being investigated in the practical classes as well as other "filler" questions to disguise the intent of the exam and ensure that standards of physiology knowledge were similar between the two groups. Any small statistically significant gains in performance observed between the two groups were confounded by differences in baseline (pretest) performance between the groups. These results contradict our previous work, which showed that self-reported measures of learning increased after ultrasound classes. It may be optimistic to expect improvements in deep learning and test performance immediately after even the most effective educational intervention. Direct measurement of the phenomena that bring about deep, long-term learning in classes remains problematic. Notwithstanding this, there is much evidence for the value of enhancing physiology learning by providing varying contexts in the physical, semantic, and cognitive domains. Ultrasound technology is a cheap and effective means of providing such context in physiology practical classes.

The United States Pharmacopeia (USP) is an independent, nonprofit science-based organization whose mission is to improve global health through public standards and related products for medicines, food and dietary supplements. Probiotic-based dietary supplements are increasingly popular in the marketplace and USP has developed fourteen monographs specific to probiotic ingredients, including representatives from the Genera Lactobacillus, Bacillus, Streptococcus, and Bifidobacterium. These monographs include the definition of the article, tests for identification, quantification assays (enumeration in the case of probiotics), limits for contaminants, and other quality parameters when appropriate. In addition to quality, the USP also considers the safety of probiotics for monograph development. This report includes an overview of the USP admission evaluation process for probiotics as well as a tabular summary of the probiotic monographs currently available. Pharmacopeia monographs can guide manufacturers and brand owners and protect consumers through establishment of quality standards. [ABSTRACT FROM AUTHOR]

Although academic identity has received attention in the literature, there have been few attempts to understand the influence on identity from engagement with the Scholarship of Teaching and Learning (SoTL). In this paper, we (a group of eight scholars from five different countries) describe how our interactions with SoTL have impacted the shaping of our academic identities. We have struggled to define the value, purpose, outcomes, and meanings of being a disciplined SoTL scholar, sometimes in addition to and sometimes in opposition to being a disciplinary scholar. Through analysis of our own 100-word reflective narratives, we identify common conflicts and configurations around our experiences of developing a SoTL identity. We describe how navigating among conflicting identities can lead us into a troublesome but deeply reflective liminal space, prompting profound realizations and the reconstruction of academic identity. Drawing on this notion of liminality helps us to understand our journeys as moving through a necessary and important transformational landscape, and allows us to suggest ways to support those engaging with SoTL to develop an integrative SoTL identity

A critical but underattended feature of the biodiversity crisis is the contraction of geographic range experienced by most studied terrestrial vertebrates. In the United States, the primary policy tool for mitigating the biodiversity crisis is a federal law, the Endangered Species Act (ESA). For the past two decades, the federal agencies that administer the ESA have interpreted the act in a manner that precludes treating this geographic element of the crisis. Therefore, the burden of mitigating the biodiversity crisis largely falls on wildlife agencies within state government, which are obligated to operate on behalf of the interests of their constituents. We present survey research indicating that most constituents expect state agencies to prioritize species restoration over other activities, including hunting. This prioritization holds even among self-identified hunters, which is significant because state agencies often take the provisioning of hunting opportunity as their top priority. By prioritizing rewilding efforts that restore native species throughout portions of their historic range, state agencies could unify hunting and nonhunting constituents while simultaneously stemming the biodiversity crisis. [ABSTRACT FROM AUTHOR]

Entomologists have often used computational modeling to study the dynamics of insects in agricultural landscapes. Recently, important issues such as the movement of adults and immatures associated with insect resistance to GMO (genetically modified organism) crops have been addressed using computational models. We developed an individual-based model using the cellular automata approach (CA) to investigate how an intercropping system composed of maize engineered with Bacillus thuringiensis (Bt) gene, refuge areas (non-Bt maize), and grasses combined with off-season periods might influence the evolution of resistance in Spodoptera frugiperda (Lepidoptera: Noctuidae), one of the leading agricultural pests targeted by GMOs. We designed the Bt and non-Bt plants in two different arrangements: (a) a seed mixture and (b) strips rows, adding grasses in areas adjacent to the field. We added the seasonal planting dynamics (crop season and off-season), to evaluate a total of six agricultural scenarios. We followed a crop calendar from the United States to create simulations close to agricultural practice. The results showed that the frequency of the resistance allele was strongly related to the landscape arrangements and their dynamics. Since the adult insects are mobile, the seed-mixture scenario increased the frequency of the resistance the most (95.86%), followed by strips (82.10%), without grass fields. The maize harvest made it possible to reduce the frequency of resistance allele below 1%. Based on our results, we can expect that the maintenance of pasture areas, for instance next to the corn crops, will act as a reservoir of susceptible insects during off-season periods. [ABSTRACT FROM AUTHOR]

Recent research on historical thinking has instigated important disciplinary conversations and changes in pedagogical practice. They have, however, largely focused on the primary and secondary school sector, highlighting the gap in corresponding research into tertiary education. It is important to look at the experiences of history students at tertiary level, to assess the impact of perceptions and practices on graduate employment outcomes and transitions to research careers. In 2008 a national scoping study on student and staff perceptions of the nature and purposes of historical thinking was undertaken at 12 Australian universities, involving 1455 student questionnaires and 50 interviews with academics. This article examines student and staff perceptions of the social benefits of historical thinking, highlighting the great potential for transformative learning and civic contribution, and the vital role of agency in this process. (Contains 2 figures and 1 table.)

Three successive administrations have supported the United States' 2015 goal to reduce food waste. Households waste more food than other supply chain segments, however, few data sources are available to track US households' progress toward this goal. We provide insights from the first four waves of a novel national survey designed to track such waste. We find a 280% year-over-year increase in self-reported waste between early 2021 and early 2022, which militates against national goal achievement. We find households wasted more food during weeks they dined out and that sample households dined out significantly more in 2022 than in 2021. [ABSTRACT FROM AUTHOR]

Students in the United States do not read well enough (Showers, Joyce, Scanlon, & Schnaubelt, 1998). While the National Assessment of Educational Progress (2003) reports an encouraging upswing in 8th-grade students' reading performance from 1992 to 2003, this fact does not stem the tide of practical concerns voiced by teachers and community members. From literacy researchers to the President of the United States, the call is out: We must help all students to read better. While this goal is laudable and necessary, the focus has been too narrowly directed at early intervention and "fixing" students before they reach Grade 3. Research overwhelmingly supports the effectiveness of early intervention initiatives (e.g., DeFord, Lyons, & Pinnell, 1991; Hiebert & Taylor, 2000), yet the omission of older students in the literacy initiatives is simply unconscionable. Too many middle level students are in dire need of assistance. This article provides support for this argument in the following sections: Assessment--Learning about the Students (Reading Achievements; and Dispositions); A Program Proposal--Real Reading Interactions (Features of the Classroom; and Understandings of the Teacher); and Moving Forward.

Service-Learning is a form of experiential learning where faculty integrate a service or community engagement component into academic coursework. Supported by a growing body of literature documenting the impact of service-learning on undergraduate students as a high-impact practice in the United States, the scholarship and practice of service-learning frequently neglects graduate students as an important and unique demographic of learners. Graduate students pursue master's degrees to achieve their career goals, but employers claim that students are graduating ill-prepared for the workforce. The disconnect between employers' perspectives and students' educational goals presented an opportunity to explore the relationship between service-learning and career preparation using Knowles' andragogy as a theoretical framework. The purpose of this interpretive phenomenological analysis study was to explore the relationship between service-learning and career preparation from the perspective of graduate students as adult learners. Findings suggest that (1) service-learning is both as a professional experience itself and is an opportunity to further prepare for their future careers and (2) service-learning is a genuine way for students to develop skills and self-efficacy important to their career trajectory. Recommendations are provided for educators who are considering integrating service-learning into their teaching to support the professional goals of graduate students. [ABSTRACT FROM AUTHOR]

Simple Summary: Ixodes scapularis, also known as the blacklegged tick or deer tick, is the vector of the bacteria that causes Lyme disease in humans, the most common vector-borne disease in the United States. Synthetic chemical pesticides are used to control ticks. Environmentally friendly, new methods are needed to manage chemical pesticide resistance. We evaluated the efficacy of the industrial mineral, Celite 610, an amorphous silica, against unfed I. scapularis nymphs. Celite is found in nature and has a mechanical, non-toxic mode of action. Dipping ticks into Celite for 1–2 s resulted in 90% mortality in as little as 69 min. Scanning electron microscopy suggested that one mode of action could be the physical obstruction of respiration. We developed another industrial mineral made from volcanic glass, ImergardTM WP, for mosquito and filth fly control. In studies here, Imergard had similar activity as Celite against the deer tick. This research, although needing further study, suggests that industrial minerals could be a new, safe ("found in toothpaste") and persistent ("it's rock") alternative to chemical pesticides to control ticks. Cases of Lyme disease in humans are on the rise in the United States and Canada. The vector of the bacteria that causes this disease is the blacklegged tick, Ixodes scapularis. Current control methods for I. scapularis mainly involve chemical acaricides. Unfortunately, ticks are developing resistance to these chemicals, and more and more, the public prefers non-toxic alternatives to chemical pesticides. We discovered that volcanic glass, ImergardTM WP, and other industrial minerals such as Celite 610 were efficacious mechanical insecticides against mosquitoes, filth flies, and agricultural pests. In this report, when 6–10- and 50–70-day old unfed I. scapularis nymphs were dipped for 1–2 s into Celite, the time to 50% mortality (LT50) was 66.8 and 81.7 min, respectively, at 30 °C and 50% relative humidity (RH). The LT50 was actually shorter at a higher 70% RH, 43.8 min. Scanning electron microscopy showed that the ticks were coated over most of their body surface, including partial to almost total coverage of the opening to their respiratory system. The other mechanical insecticide, Imergard, had similar efficacy against blacklegged unfed nymphs with an LT50 at 30 °C and 50% RH of 70.4 min. Although more research is needed, this study suggests that industrial minerals could be used as an alternative to chemical pesticides to control ticks and Lyme disease. [ABSTRACT FROM AUTHOR]

Objectives: Females with sickle cell disease now have a life expectancy that extends well into and beyond their reproductive years. Pregnancy and childbirth are accompanied by high morbidity and mortality in this population, rendering contraception a critical part of their health care.Study Design: We approached adult female patients of the Hospital of the University of Pennsylvania hematology clinic who were of reproductive age (ages 18-45) and carried a diagnosis of sickle cell disease. We evaluated contraceptive method uptake and method characteristic preferences, as well as other reproductive history, and compared contraceptive uptake rates to that from female respondent data from the National Survey of Family Growth (2017-2019).Results: Of 95 eligible patients, we completed surveys with 48 participants (response rate of 51%). Over half (n = 27, 56%) of participants were not currently using any form of contraception-double the rate of the general United States population (25%). The most common contraceptives currently used were the depot medroxyprogesterone (DMPA) injection (n = 6, 13%) and the progestin intrauterine device (IUD) (n = 6, 13%). DMPA uptake was significantly higher, and permanent contraceptive and oral contraceptive pill uptake significantly lower, among these participants with sickle cell disease compared to the general United States population. Participants' preferred contraceptive characteristics included effectiveness (n = 39, 81%), control over when to use the contraceptive (n = 39, 81%), and lack of side effects (n = 38, 79%).Conclusions: Contraceptive uptake was significantly lower and method mix different among females with sickle cell disease compared to the general United States population. Further research is needed on contraceptive safety, non-contraceptive benefits, and contraceptive decision-making for females with sickle cell disease.Implications: This study sheds light on the contraceptive choices and preferences of females with sickle cell disease, who are at disproportionate risk for pregnancy complications. In order to maximize the reproductive health of females with sickle cell disease, we must consider how their disease interacts with contraception and better understand how they approach contraceptive decision-making. [ABSTRACT FROM AUTHOR]

In the wake of COVID-19, mental health providers and treatment programs are adapting rapidly to the challenges in engaging people and delivering treatment with limited guidance. This paper will explore the challenges associated with delivering treatment within coordinated specialty care (CSC) programs for people with first episode psychosis. Suggestions for treatment will take into consideration experiences with stress, changes to the pursuit of work and school, and increased time spent with families. Drawing on the experience of several CSC programs in the United States, Israel, and China, we describe the impact and modifications to the core treatment elements in CSC including medication, family interactions, supported employment and education, individual therapy, peer support and the way they are delivered. The paper includes recommendations based on experiences from CSC programs to help staff members, participants, and family members better identify, prepare, cope and respond to the unique new challenges and suggests modifications that can be made during various stages of the coronavirus pandemic. [ABSTRACT FROM AUTHOR]

In the United States, the wide ideological divergence in public confidence in science poses a potentially significant problem for the scientific enterprise. We examine the behavioral consequences of this ideological divide for Americans' contributions to medical research. Based on a mass survey of American adults, we find that engagement in a wide range of medical research activities is a function of a latent propensity to participate. The propensity is systematically higher among liberals than among conservatives. A substantial part of this ideological divide is due to conservative Americans' lower confidence in science. These findings raise important issues for the recruitment of subjects for medical studies and the generalizability of results from such studies. [ABSTRACT FROM AUTHOR]

Introduction: Liver disease accounts for approximately 2 million deaths per year worldwide. The majority of liver diseases are due to complications of cirrhosis, viral hepatitis, and hepatocellular carcinoma. Increased levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) may indicate liver disease. Moreover, there are additional noninvasive liver fibrosis indices that help to estimate liver damage, including AST-to-ALT ratio, AST-to-platelet ratio index (APRI), fibrosis-4 (FIB-4) score, and nonalcoholic fatty liver disease (NAFLD) fibrosis score. The aims of the present study were to (1) perform an association analysis of the patatin-like phospholipase domain containing 3 (PNPLA3) I148M (rs738409) variant with ALT, AST, and various liver fibrosis indices, and (2) determine whether there are gender-related differences in these associations. Methods: We obtained demographic, anthropometric, and metabolic phenotypes from Latino adult participants (n = 503, 64% female, 36.4 ± 0.5 years) from the Arizona Insulin Resistance (AIR) registry. SNP genotyping of I148M was performed using the TaqMan allelic discrimination assay. We used linear regression for the association analyses of the genotypes with ALT, AST, and the various liver fibrosis indices. We included genotype, age, body mass index, and alcohol status in the linear regression model. Results: The variant I148M was in Hardy-Weinberg equilibrium, with genotype distribution: non-risk CC 118, heterozygous CG 246, and risk GG 139. The G allele was significantly associated with increased ALT and AST levels (p = 7.8 × 10–7 and p = 9.7 × 10–6, respectively). Moreover, we showed that the G allele was significantly associated with higher APRI (p = 3.7 × 10–7) and FIB-4 score (p = 4.1 × 10–3). When we analyzed the data by gender, we observed similar significant trends for ALT, AST, and APRI (all, p < 0.01). In females, the G allele was significantly associated with increased FIB-4 score (p = 6.9 × 10–3), which was not observed in the males (p > 0.05). There was no association of the I148M variant with AST/ALT ratio nor NAFLD risk score, whether analyzed in all adults or by gender. Discussion/Conclusion: Our findings provide additional evidence of an association of PNPLA3 I148M with several liver disease biomarkers in male and female Latinos residing in the Southwest of the United States. [ABSTRACT FROM AUTHOR]

Many campaigns promote the preservation and consumption of leftover food items as a critical household strategy to accomplish national consumer food waste reduction goals. We fill a gap in knowledge about the consumption and creation of leftovers in the United States by analyzing data from a pilot study in which 18 subjects tracked food selection, intake, and plate waste across all eating occasions for about one week. Subjects noted which items selected for consumption were leftovers, i.e., previously prepared but uneaten items that were stored for future consumption, and which unfinished items were saved to become leftovers. We found that 12% of items selected for consumption were leftovers while 24% of selected items that were not fully consumed were kept to become a leftover. Leftovers were most frequently vegetables, cheeses, and meats, and most frequently selected on Mondays and for lunch. Regression analyses isolate significant dining patterns with respect to leftovers, including evidence that leftovers were less likely to be fully consumed than non-leftover items, and that larger meals led to more uneaten food. This suggests that strategies to reduce meal size may be most effective in reducing food waste by limiting the creation of leftovers in the first place. Strategies to make leftovers more attractive and appealing may also reduce food waste. [ABSTRACT FROM AUTHOR]

Objective: In recent years, there has been growing awareness of the need for cultural adaptation of evidence-based practices, which is essential for successful implementation in diverse cultural contexts. This study investigated the impact of a culturally adapted version of Illness Management and Recovery (IMR), an evidence-based practice developed in the United States, on Israeli Arabs with serious mental illness.Methods: Using a quasi-experimental design, we compared the outcomes of 86 people who completed the culturally adapted IMR version with outcomes from a matched control group (N=64) who received treatment as usual.Results: Mixed repeated-measures analyses of variance demonstrated significant improvements in the domains of recovery, hope, self-efficacy, and quality of life among those who completed culturally adapted IMR.Conclusions: The culturally adapted Arabic version of IMR for Israeli Arabs was found to generate significant positive improvement. The findings are discussed with emphasis on the importance of cultural adaptation. [ABSTRACT FROM AUTHOR]

Background: There are approximately 2000 lung transplants performed across the United States annually. There is limited data to identify factors predictive of long-term survival.Objective: We evaluated 10-year survivors after lung transplant to determine predictors of long-term survival.Methods: Data were collected from the United Network for Organ Sharing registry database from a single institution. Inclusion criteria were: patients who received a lung transplant between 1989 and 2005. Descriptive statistics were calculated, and survival outcomes were analyzed using the Kaplan-Meier method.Results: Three hundred sixty-one patients received a lung transplant between 1989 and 2005, and 77 patients survived at least 10 years (21%). Diagnoses at the time of transplant included: chronic obstructive pulmonary disease/emphysema 45 (58.4%), idiopathic pulmonary fibrosis 12 (15.6%), alpha 1 anti-trypsin deficiency 6 (7.8%), cystic fibrosis 4 (5.2%), primary pulmonary hypertension 2 (2.6%), and Eisenmenger's syndrome 1 (1.3%). Seventy-four recipients (96.10%) were Caucasian; 46 (59.74%) were female. Age at the time of transplant ranged from 19 to 67 years (mean 50.8; median 52). Forty-two patients (54.5%) were double lung recipients. Survival ranged from 10.0 to 21.9 years (mean 15.5y; median 15.48y). Forty-two (54.5%) subjects are currently alive; the most common causes of death included: chronic rejection (20%), and infection (17.14%).Conclusions: Ten-year survivors were significantly younger, weighed less, and had significantly shorter lengths of hospitalization after transplantation. Bilateral lung transplantation was a significant factor in prolonged survival. Survival also improved with institutional experience. [ABSTRACT FROM AUTHOR]

Animal movements and use of space are in part determined by interactions between individual attributes such as sex and body size and extrinsic environmental factors such as the seasonal availability, quality and spatial configuration of resource patches in the landscape. Fire is a common and widespread disturbance process that has the potential to affect animal movements through modifications to the environment. Using radiotelemetry, we examined the contribution of these factors to variation in movements and home range over a 5‐year period in a forest‐dwelling terrestrial turtle, Terrapene carolina, at fire‐maintained and unburned habitats in the southeastern United States. Female turtles had annual home‐range sizes twice as large as males and moved longer distances per day during the nesting season (June and July), but males exhibited greater spatial fidelity from year to year. Turtles at the unburned site had home‐range sizes twice as large as those at the fire‐maintained site, and home‐range size also decreased with increasing frequency and extent of fire, but this latter effect was strongest in females. Home‐range behavior was highly repeatable within individuals of both sexes over time. This is the first evidence that fire influences the spatial ecology and movements of turtles, most likely through fire's impact on the spatial configuration, availability and quality of critical resources. That individuals behaved consistently through time, but differently from one another according to both intrinsic individual attributes and extrinsic environmental factors provides strong evidence of consistent inter‐ and intra‐population variation in space use and movement behaviors in T. carolina. Such intra‐specific behavioral variation suggests applying caution when extrapolating results to other sites across the geographic range of a species for use in conservation and management. [ABSTRACT FROM AUTHOR]

Few studies have explored the characteristics and arrest patterns of sex traffickers, particularly sex traffickers of persons under the age of 18 (minors) in the U.S. The purpose of this study is to understand the behavior and characteristics of a national cross sectional sample of sex traffickers of minors during a six-year period. This study explored cases involving the arrest of sex traffickers of minors or persons under the age of 18 in the United States from 2010 to 2015. Sex traffickers of minors was defined as a person who facilitates and/or benefits by receiving something of value for the commercial sexual exploitation of a minor (person under the age of 18) or attempts to do so. During a systematic online search, 1,416 sex traffickers of minors were identified. The arrests were found in 46 states in the United States, two U.S. territories, and Washington D.C. The sex traffickers of minors were mostly males (n = 1067, 75.4%), and of those with race identified (only 51.6%), 71.7% were African American. Their ages ranged from 15 to 70 years old (M = 28.5, SD = 8.54). Characteristics of the sex trafficker and the sex trafficking situation are analyzed and implications discussed. [ABSTRACT FROM AUTHOR]

The Chief Justice of the Delaware Supreme Court begins by invoking the New Deal, and expressing admiration for the way its goals and some of its social programs have been put into practice by Northern European social democracies. Most important are their protections for workers and the unemployed—protections the Judge finds deplorably absent in U.S. law and corporate labor practices. Nevertheless, when contemplating how corporate boards in the U.S. might respond to the growing demand for U.S. public companies to address social problems like the environment and economic inequality, the Delaware judge falls back on the prescription of Adolph Berle, who, though one of the framers of the New Deal, insisted that companies "stick to their knitting" by putting shareholders first as the only way of ensuring the accountability of corporate managements and boards. Harvard Law's Mark Roe responds with a defense of corporate America against the charge of corporate short‐termism by noting that, although U.S. capital expenditures have declined in the past 15–20 years, corporate investment in R&D and other intangible assets have both grown sharply. Corporate distributions in the form of dividends and stock buybacks are rising, but so have the net borrowings of the companies making the distributions, leaving the cash balances of U.S. companies also near record levels. And the remarkably high valuations of successful high tech companies are themselves forceful rebuttals of the idea that pressure from the stock market for current earnings is a serious deterrent to investment and innovation. The University of Pennsylvania's Jill Fisch follows Roe's dismissal of the short‐termism argument with even more forceful questioning of whether corporate America in fact has a major governance problem. U.S. companies have been taking voluntary measures to address environmental problems—in some cases even in the face of federal deregulatory initiatives—and many have raised their workers' wages, without any challenges (and often with encouragement) from their shareholders. And echoing Justice Strine's concerns, Fisch also ends up questioning the premise that companies can be asked to define a single social purpose (other than maximizing shareholder value) that would be appropriate for, and end up satisfying, all their different stakeholders. Columbia Business School's Bruce Kogut closes with the suggestion that our greatest problems today may be coming not from the shortsightedness and other failings of corporations and corporate law, but from "deep distrust of the competence of the state." Kogut's main prescription is that to take advantage of the enormous potential gains from effective arm's‐length collaboration between business and the public sector, governments at all levels should find ways to strike "Coasian bargains" with the private sector that makes the best possible uses of the core competencies and resources of each. [ABSTRACT FROM AUTHOR]

Student evaluations of teaching are widely believed to contain gender bias. In this study, we conduct a randomized experiment with the student evaluations of teaching in four classes with large enrollments, two taught by male instructors and two taught by female instructors. In each of the courses, students were randomly assigned to either receive the standard evaluation instrument or the same instrument with language intended to reduce gender bias. Students in the anti-bias language condition had significantly higher rankings of female instructors than students in the standard treatment. There were no differences between treatment groups for male instructors. These results indicate that a relatively simple intervention in language can potentially mitigate gender bias in student evaluation of teaching. [ABSTRACT FROM AUTHOR]

The article highlights the government's unfortunate tendency to contract with companies found to have violated the U.S.'s labor and employment laws repeatedly. Topics discussed include policy and procedure for responsibility determinations during contract formation; and laws preventing award of contracts to contractors possessing a history of labor and employment law violations.

Coccidioidomycosis is an emerging fungal infection in Washington, USA, and the epidemiology of the disease in this state is poorly understood. We used whole-genome sequencing to differentiate locally acquired cases in Washington on the basis of the previously identified phylogeographic population structure of Coccidioides spp. Clinical isolates from coccidioidomycosis cases involving possible Washington soil exposure were included. Of 17 human infections with epidemiologic evidence of possible local acquisition, 4 were likely locally acquired infections and 13 were likely acquired outside Washington. Isolates from locally acquired cases clustered within the previously established Washington clade of C. immitis. Genetic differences among these strains suggest multiple environmental reservoirs of C. immitis in the state. [ABSTRACT FROM AUTHOR]

The children's television advertising environment generally is studied from the 1970s onward. Indeed, so little academic research was reported in the 1950s that the decade has been referred to as the prehistory of research on children's television advertising. The authors rectify that oversight by examining commercials of the 1950s in programs aimed at the child market. Content analysis shows marked distinctions from commercials of subsequent decades in total commercial time, product type, promotional appeals, age and gender of participants, production variables, and controversial techniques. Some of the differences are due to the television technology and technical standards of the 1950s, but others illustrate growth in advertisers' and television executives' understanding of the medium as a way to reach specialized child audiences. [ABSTRACT FROM AUTHOR]

Background: Although many studies show an inverse association between operator procedural volume and short-term adverse outcomes after percutaneous coronary intervention (PCI), the association between procedural volume and longer-term outcomes is unknown.Methods: Using the National Cardiovascular Data Registry CathPCI registry data linked with Medicare claims data, we examined the association between operator PCI volume and long-term outcomes among patients ≥65 years of age. Operators were stratified by average annual PCI volume (counting PCIs performed in patients of all ages): low- (<50 PCIs), intermediate- (50-100), and high- (>100) volume operators. One-year unadjusted rates of death and major adverse coronary events (MACEs; defined as death, readmission for myocardial infarction, or unplanned coronary revascularization) were calculated with Kaplan-Meier methods. The proportional hazards assumption was not met, and risk-adjusted associations between operator volume and outcomes were calculated separately from the time of PCI to hospital discharge and from hospital discharge to 1-year follow-up.Results: Between July 1, 2009, and December 31, 2014, 723 644 PCI procedures were performed by 8936 operators: 2553 high-, 2878 intermediate-, and 3505 low-volume operators. Compared with high- and intermediate-volume operators, low-volume operators more often performed emergency PCI, and their patients had fewer cardiovascular comorbidities. Over 1-year follow-up, 15.9% of patients treated by low-volume operators had a MACE compared with 16.9% of patients treated by high-volume operators ( P=0.004). After multivariable adjustment, intermediate- and high-volume operators had a significantly lower rate of in-hospital death than low-volume operators (odds ratio, 0.91; 95% CI, 0.86-0.96 for intermediate versus low; odds ratio, 0.79; 95% CI, 0.75-0.83 for high versus low). There were no significant differences in rates of MACEs, death, myocardial infarction, or unplanned revascularization between operator cohorts from hospital discharge to 1-year follow-up (adjusted hazard ratio for MACEs, 0.99; 95% CI, 0.96-1.01 for intermediate versus low; hazard ratio, 1.01; 95% CI, 0.99-1.04 for high versus low).Conclusions: Unadjusted 1-year outcomes after PCI were worse for older adults treated by operators with higher annual volume; however, patients treated by these operators had more cardiovascular comorbidities. After risk adjustment, higher operator volume was associated with lower in-hospital mortality and no difference in postdischarge MACEs. [ABSTRACT FROM AUTHOR]

Stock-market--driven short-termism is crippling the American economy, according to legal, judicial, and media analyses. Firms forgo the R&D they need, cut capital spending, and buy back their own stock so feverishly that they starve themselves of cash. The stock market is the primary cause: directors and executives cannot manage for the long term when their shareholders furiously trade their company's stock, they cannot make long-term investments when stockholders demand to see profits on this quarter's financial statements, they cannot even strategize about the long term when shareholder activists demand immediate results, and they cannot keep the cash to invest in their future when stock market pressure drains away that cash in stock buybacks. This doomsday version of the stock-market--driven short-termism argument entails economy-wide predictions that have not been well-examined for their severity and accuracy. If the scenario is correct and strong, we should first see sharp increases in stock trading in recent decades and more frequent activist interventions, and these increases should be accompanied by (1) sharply declining investment spending in the United States, where large firms depend on stock markets and where activists are important, as compared to advanced economies that do not depend as much on stock markets, (2) buybacks bleeding cash out from the corporate sector, (3) economy-wide R&D spending declining from what it should be, and (4) a stock market unwilling to support innovative, long-term, technological firms. These are the central channels from stock-market--driven short-termism to overall economic degradation. They justify corporate law policies that seek to prevent these outcomes. But these predicted economy-wide outcomes are either undemonstrated, implausible, or untrue. Corporate R&D is not declining, corporate cash is not bleeding out, and the world's developed nations with neither American-style quarterly oriented stock markets nor aggressive activist investors are investing no more intensely in capital equipment than the United States. The five largest American firms by stock market capitalization are tech-oriented, R&D intensive, longer-term operations. The economy-wide picture is more one of capital markets moving capital from larger, older firms to younger ones; of a postindustrial economy doing more R&D than ever; and of an economy whose investment intensity depends on overall economic activity, not stock market trading nor hedge fund activism. True, the economy-wide data could hide stock market hits that hold back R&D from increasing more and that weaken American capital spending more than is fitting for a post-industrial economy. But if so, these effects have not been shown and several seem implausible. Hence, the calamitous form of the stock-market--driven short-termist argument needs to be reconsidered, recalibrated, and, quite plausibly, rejected. Then, last, comes the broadest question: why has a view that lacks strong economy-wide evidentiary support become the rare corporate governance issue that attracts attention from the media, political players, policymakers, and the public-- and that is widely accepted as true? I suggest why in this paper's final part. [ABSTRACT FROM AUTHOR]

Abstract While the body of research on effective interventions for children and young people who experience commercial sexual exploitation is growing, much remains unknown regarding intervention needs, particularly in relation to the role of residential care in meeting those needs. In an effort to fill the gap in this research, this paper will report on a study comparing case files for girls victimized (n = 73) and not victimized (n = 62) by commercial sexual exploitation who were living in a residential care setting in a large southwestern city in the United States. Findings indicate that sexually exploited girls were more likely to report experiences of child sexual abuse, substance misuse/addiction, dating violence, and gang affiliation; they were also significantly more likely to run away from the group home facility and be identified as having an ‘unsuccessful discharge’. In the second part of the article we will consider the results of this study in the context of a wider discourse on how best to intervene in the lives of CSEC survivors in the United States and throughout the world. Highlights • Comparing girls with CSEC experiences to those without helps understand their needs. • CSEC experiences are associated with gang involvement, drug use, and dating violence. • Girls who experienced CSEC are more likely to run away from a group home setting. • Traditional interventions may not be best suited to help and protect CSEC victims. [ABSTRACT FROM AUTHOR]

In the United States, sex trafficking victims have been identified at ages across the lifespan but young persons (under age 25) have been found to have unique vulnerabilities. At-risk youth, such as those who run away from home or those experiencing homelessness, are also at an increased risk of sexual exploitation. To better understand the scope and complexity of sex trafficking among these at-risk youth, a convenience sample of 131 homeless youth aged 12 to 25 years old experiencing homelessness recruited from Kentuckiana youth service providers completed an enhanced version of the Youth Experiences Survey (YES). Univariate and bivariate analyses were conducted. Results indicated that 41.2% of the homeless youth were victims of sex trafficking. The sex trafficked youth were more likely to report previous self-harm behaviors, suicide attempts, and substance use. This study not only provides support for improved service delivery, but also provides essential statistics that should inform internal policy and procedures for youth serving agencies in Kentucky and Indiana. Findings highlight a need for trauma-informed interventions designed to treat not only females but also males and LGBTQ youth. Additionally, service providers should consider partnering with victim providers and clinicians to offer therapeutic groups, individual therapy, and supportive services that increase prevention, education, and wraparound care for clients. In regards to future research, findings point towards a need to better understand the role that trauma and adverse childhood experiences may play in making young people vulnerable to sex trafficking, and encourage the need for testing prevention and early intervention practices among vulnerable youth. [ABSTRACT FROM AUTHOR]

Despite their status as the largest and most systematic of government programs to promote local foods in the US, few studies identify the factors that are associated with the school district decision to participate in farm to school (FTS) programs. We are the first to leverage the USDA’s Farm to School Census to analyze factors associated with FTS participation, the types of FTS activities implemented, and the challenges faced by participating school districts. Because a school’s participation is circumscribed by access to local foods, we control for the supply of local foods. We use spatially articulate data to estimate the spatial spillover effects of FTS participation. The results demonstrate that both school characteristics and local farm production factors are associated with FTS participation. The estimated spatial spillover effect is positive suggesting that areas with a high penetration of FTS activities have lower barriers associated with implementing FTS programs. [ABSTRACT FROM AUTHOR]

Background: In health care, burnout has been defined as a psychological process whereby human service professionals attempting to positively impact the lives of others become overwhelmed and frustrated by unforeseen job stressors. Burnout among various physician groups who primarily practice in the hospital setting has been extensively studied; however, no evidence exists regarding burnout among hospital clinical pharmacists. Objective: The aim of this study was to characterize the level of and identify factors independently associated with burnout among clinical pharmacists practicing in an inpatient hospital setting within the United States. Methods: We conducted a prospective, cross-sectional pilot study utilizing an online, Qualtrics survey. Univariate analysis related to burnout was conducted, with multivariable logistic regression analysis used to identify factors independently associated with the burnout. Results: A total of 974 responses were analyzed (11.4% response rate). The majority were females who had practiced pharmacy for a median of 8 years. The burnout rate was high (61.2%) and largely driven by high emotional exhaustion. On multivariable analysis, we identified several subjective factors as being predictors of burnout, including inadequate administrative and teaching time, uncertainty of health care reform, too many nonclinical duties, difficult pharmacist colleagues, and feeling that contributions are underappreciated. Conclusions: The burnout rate of hospital clinical pharmacy providers was very high in this pilot survey. However, the overall response rate was low at 11.4%. The negative effects of burnout require further study and intervention to determine the influence of burnout on the lives of clinical pharmacists and on other health care-related outcomes. [ABSTRACT FROM AUTHOR]

Background: Sex differences in early mortality after myocardial infarction (MI) vary by age. MI with nonobstructive coronary arteries (MINOCA [<50% stenosis]) is more common among younger patients and women, and MINOCA has a better prognosis than MI with obstructive coronary artery disease (MI-CAD). The relationship between age, sex, and obstructive CAD status and outcomes post-MI has not been established.Methods and Results: Adults who underwent coronary angiography for acute ST-segment-elevation and non-ST-segment-elevation MI in the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines) from 2007 to 2014 were identified. Patients with cardiac arrest, thrombolytic therapy, prior revascularization, or missing demographic or angiographic data were excluded. The primary outcome was all-cause, in-hospital mortality. Secondary outcomes included major adverse cardiovascular events. Demographics, clinical history, presentation, and in-hospital treatments were compared by sex and CAD status (MI-CAD or MINOCA). Mortality and major adverse cardiovascular outcomes were analyzed by age, sex, and CAD status. Among 322 523 patients with MI, MINOCA occurred in 18 918 (5.9%). MINOCA was more common in women than men (10.5% versus 3.4%; P<0.0001), and women had higher mortality than men overall (3.6% versus 2.4%; P<0.0001). In-hospital mortality was lower after MINOCA than MI-CAD (1.1% versus 2.9%; P<0.0001). Among patients with MI-CAD, women had higher mortality than men (3.9% versus 2.4%; P<0.0001) while no sex difference in mortality was observed with MINOCA (1.1% versus 1.0%; P=0.84). The higher risk of post-MI death among women with MI-CAD was most pronounced at younger ages.Conclusions: MINOCA was associated with lower mortality than MI-CAD. Higher risk of post-MI death among women in comparison to men was restricted to patients with MI-CAD. [ABSTRACT FROM AUTHOR]

Background: Practice patterns in anticoagulant strategies used during percutaneous coronary intervention (PCI) in the United States for patients with non-ST-segment-elevation myocardial infarction and the comparative outcomes between bivalirudin and unfractionated heparin (UFH) have not been well described.Methods and Results: Trends in anticoagulant use were examined among 553 562 PCIs performed by 9254 operators at 1538 hospitals for non-ST-segment-elevation myocardial infarction from 2009 to 2014 within the CathPCI Registry. To compare bivalirudin with UFH, propensity score matching and instrumental variable (IV) methods with operator preference for bivalirudin as the instrument were used. To determine whether differences in outcomes were because of differences in glycoprotein IIb/IIIa inhibitor (GPI) use, a test of mediation was performed using the IV. Outcomes were in-hospital bleeding and mortality. Bivalirudin use increased from 2009 to 2013 but declined during 2014. GPI use was 50.5% during UFH PCIs and 12.0% during bivalirudin PCIs. Before GPI adjustment, bleeding reductions with bivalirudin ranged from 2.04% (IV: 95% confidence interval [CI]: 1.81%, 2.27%) to 2.29% (propensity score: 95% CI: 2.14%, 2.44%) and mortality reductions ranged from 0.16% (IV: 95% CI: 0.03%, 0.28%) to 0.25% (propensity score: 95% CI: 0.17%, 0.33%). After GPI adjustment in the IV, more than half the bleeding reduction with bivalirudin was because of the lower use of GPIs (risk difference, -0.84%; 95% CI: -1.11%, -0.57%), and no survival benefit was apparent (risk difference, -0.10%; 95% CI: -0.24%, 0.05%). Bleeding reductions with bivalirudin were largest for transfemoral PCI (GPI-adjusted risk difference, -1.11%; 95% CI: -1.43%, -0.80%) and negligible for transradial PCI (GPI-adjusted risk difference, 0.09%; 95% CI: -0.32%, 0.50%).Conclusions: In the largest comparative analysis of bivalirudin versus UFH for non-ST-segment-elevation myocardial infarction to date, bivalirudin was associated with lower in-hospital bleeding and mortality given current practices with respect to GPI use and access site. Bleeding differences were, in part, explained by the greater use of GPIs with UFH. Reductions in bleeding were largest among those undergoing transfemoral PCI, whereas no bleeding benefit was observed for those treated with transradial PCI. [ABSTRACT FROM AUTHOR]

Background and Purpose: Data monitoring committees are responsible for safeguarding the interests of study participants and assuring the integrity and credibility of clinical trials. The independence of data monitoring committees from sponsors and investigators is essential in achieving this mission. Creative approaches are needed to address ongoing and emerging challenges that potentially threaten data monitoring committees' independence and effectiveness. Methods: An expert panel of representatives from academia, industry and government sponsors, and regulatory agencies discussed these challenges and proposed best practices and operating principles for effective functioning of contemporary data monitoring committees. Results and Conclusions: Prospective data monitoring committee members need better training. Options could include didactic instruction as well as apprenticeships to provide real-world experience. Data monitoring committee members should be protected against legal liability arising from their service. While avoiding breaches in confidentiality of interim data remains a high priority, data monitoring committees should have access to unblinded efficacy and safety data throughout the trial to enable informed judgments about risks and benefits. Because overly rigid procedures can compromise their independence, data monitoring committees should have the flexibility necessary to best fulfill their responsibilities. Data monitoring committee charters should articulate principles that guide the data monitoring committee process rather than list a rigid set of requirements. Data monitoring committees should develop their recommendations by consensus rather than through voting processes. The format for the meetings of the data monitoring committee should maintain the committee's independence and clearly establish the leadership of the data monitoring committee chair. The independent statistical group at the Statistical Data Analysis Center should have sufficient depth of knowledge about the study at hand and experience with trials in general to ensure that the data monitoring committee has access to timely, reliable, and readily interpretable insights about emerging evidence in the clinical trial. Contracts engaging data monitoring committee members for industry-sponsored trials should have language customized to the unique responsibilities of data monitoring committee members rather than use language appropriate to consultants for product development. Regulatory scientists would benefit from experiencing data monitoring committee service that does not conflict with their regulatory responsibilities. [ABSTRACT FROM AUTHOR]

A recent development in psychiatric rehabilitation is the identification and standardization of evidence-based practices (EBP). In this article we report on the implementation of one of the EBPs, Illness Management and Recovery (IMR), in a group format in two settings and cultures, Israel and the United States (North Carolina) to address generic issues of implementation that arise across settings. The unique characteristics of the group format, ways in which they can be both enriching and challenging, and the importance of considering local cultural influences when using a standardized EBP are discussed. [ABSTRACT FROM AUTHOR]

Background: Patients with cardiac arrest and other life-threatening emergencies are unable to provide prospective consent for clinical trials. In the United States and other countries, regulations permit an exception from the requirement for informed consent in emergency settings. However, many potential barriers exist, as evidenced by the scarcity of US trials conducted under exception from the requirement for informed consent. One persistent challenge is the requirement that investigators consult communities prior to study approval. Methods: To improve the community consultation process for emergency studies under exception from the requirement for informed consent, we propose that prioritizing engagement of individuals who have experienced the condition under study, or are at high risk for the condition, fulfills regulatory goals and represents the interests of potential enrollees and the community without impeding research. Results: Prioritizing patients engages individuals who are more likely to understand the concerns and experiences of study subjects, to appreciate risks and benefits of the study, and to understand the impact of the disease and intervention on patients’ lives than are members of the general public. Similarly, those explicitly at high risk are more likely to identify as potential participants and may impart some level of accountability on the investigator. Finally, the most logical community of relevance is defined by a combination of condition-related experience and living in the area where a study will be conducted; geographic and condition-related communities should not be treated as distinct. In this sense, patients, their family members, and individuals at high risk within the catchment area represent the appropriate “community.” Conclusion: Exception from the requirement for informed consent regulations have advanced the goal of improving care for emergency conditions, but common interpretations of the community consultation requirement threaten research in the United States. Focusing on the goals of learning from and demonstrating respect for those most directly affected by a study through engaging people most connected to the condition of interest will make community consultation more valuable, better inform institutional review boards, and increase efficiency. [ABSTRACT FROM AUTHOR]

In 1998, 2 petitions to list the black-tailed prairie dog (Cynomys ludovicianus) as threatened under the Endangered Species Act of 1973 were submitted to the United States Fish and Wildlife Service. The 12-month finding was that the black-tailed prairie dog was warranted but precluded for listing. In order to meet or maintain minimum conservation standards set forth in the Conservation Assessment and Strategy and the Multi-State Conservation Plan, which were developed in an effort to promote conservation and avoid the listing of the black-tailed prairie dog, some states may need to conduct live relocations. By conducting relocation efforts under the guidance of recent scientific information and best management practices, wildlife and range managers will be able to maximize retention, decrease impacts to the habitat and to other species of wildlife, minimize potential negative impacts to adjacent landowners, and increase tolerance among the public and the agricultural industry. Soil, vegetation, slope, elevation, previous use of the relocation site by prairie dogs, proximity of the site to existing prairie dogs, proximity of the site to neighboring properties, and natural dispersal barriers are important factors to consider when evaluating the suitability of a relocation site. [ABSTRACT FROM AUTHOR]

Large randomized clinical trials in cardiovascular disease have proliferated over the past 3 decades, with results that have influenced every aspect of cardiology practice. Despite these advances, there remains a substantial need for more high-quality evidence to inform cardiovascular clinical practice, given the increasing prevalence of cardiovascular disease around the world. Traditional clinical trials are increasingly challenging due to rising costs, increasing complexity and length, and burdensome institutional and regulatory requirements. This review will examine the current landscape of cardiovascular clinical trials in the United States, highlight recently conducted registry-based clinical trials, and discuss the potential attributes of the recently launched pragmatic clinical trial by the Patient-Centered Outcomes Research Institute's National Patient-Centered Clinical Research Network, called the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing the Benefits and Long-term Effectiveness) trial. [ABSTRACT FROM AUTHOR]

Background: Among older patients with acute myocardial infarction (MI), it remains uncertain whether there is a time-dependent difference in the risk of recurrent mortality and nonfatal cardiovascular and cerebrovascular events for those with ST-segment-elevation MI (STEMI) compared with those with non-ST-segment-elevation MI.Methods and Results: Older patients ≥65 years with acute MI and significant coronary artery disease identified with coronary angiography from the ACTION Registry-GWTG (Get With the Guidelines) were linked to Medicare claims data from 2007 to 2010. We examined the unadjusted cumulative incidence of each outcome studied from hospital discharge through 2 years with log-rank tests and then performed a piece-wise proportional hazards modeling with 2 time periods: discharge to 90 days and 90 days to 2 years. Among the 46 199 patients linked with Medicare data, 17 287 (37.4%) presented with STEMI. Through 2 years, the unadjusted cumulative incidence of all-cause mortality (16.0% versus 19.8%; P<0.001) and the composite outcome (21.9% versus 27.9%; P<0.001) was lower for STEMI patients. Within the first 90 days, unadjusted rates of mortality (5.5% versus 5.3%) and the composite outcome (7.9% versus 8.1%) were similar but diverged from 90 days to 2 years (mortality, 11.1% versus 15.4%; P<0.001; composite outcome, 15.2% versus 21.5%; P<0.001). After multivariable adjustment, the adjusted risks of mortality and the composite outcome through 90 days were higher for STEMI patients, whereas risks of mortality and the composite outcome were attenuated from 90 days through 2 years.Conclusions: Among older acute MI patients with angiographically confirmed coronary artery disease discharged alive, STEMI patients (compared with non-ST-segment-elevation MI patients) were found to have a lower frequency of unadjusted postdischarge mortality and composite cardiovascular and cerebrovascular outcomes through 2 years after hospital discharge. This analysis provides unique insight into differential short- and long-term risks of ischemic cardiovascular and cerebrovascular outcomes by MI classification among older MI patients with confirmed coronary artery disease surviving to hospital discharge. [ABSTRACT FROM AUTHOR]

Background In the US familial hypercholesterolemia (FH), patients are underidentified, despite an estimated prevalence of 1:200 to 1:500. Criteria to identify FH patients include Simon Broome, Dutch Lipid Clinic Network (DLCN), or Make Early Diagnosis to Prevent Early Deaths (MEDPED). The use of these criteria in US clinical practices remains unclear. Objective To characterize the FH diagnostic criteria applied by US lipid specialists participating in the FH Foundation's CASCADE FH (CAscade SCreening for Awareness and DEtection of Familial Hypercholesterolemia) patient registry. Methods We performed an observational, cross-sectional analysis of diagnostic criteria chosen for each adult patient, both overall and by baseline patient characteristics, at 15 clinical sites that had contributed data to the registry as of September 8, 2015. A sample of 1867 FH adults was analyzed. The median age at FH diagnosis was 50 years, and the median pretreatment low-density lipoprotein cholesterol (LDL-C) value was 238 mg/dL. The main outcome was the diagnostic criteria chosen. Diagnostic criteria were divided into five nonexclusive categories: “clinical diagnosis,” MEDPED, Simon Broome, DLCN, and other. Results Most adults enrolled in CASCADE FH (55.0%) received a “clinical diagnosis.” The most commonly used formal criteria was Simon–Broome only (21%), followed by multiple diagnostic criteria (16%), MEDPED only (7%), DLCN only (1%), and other (0.5%), P < .0001. Of the patients with only a “clinical diagnosis,” 93% would have met criteria for Simon Broome, DLCN, or MEDPED based on the data available in the registry. Conclusions Our findings demonstrate heterogeneity in the application of FH diagnostic criteria in the United States. A nationwide consensus definition may lead to better identification, earlier treatment, and ultimately CHD prevention. [ABSTRACT FROM AUTHOR]

Cryptococcus gattii is a recognized pathogenic fungus along the Pacific coast of the United States from California to Washington. Here we report that C. gattii may also be endemic to the southeastern United States and has probably been present there longer than in the Pacific Northwest. [ABSTRACT FROM AUTHOR]

A recent discourse of girlhood, that of alpha girl and empowerment, has emerged in US popular literature with claims that adolescent girls are uniquely positioned to become the new economic, cultural and social winners of the twenty-first century. Similar to Sheryl Sandberg's story in Lean In, Alpha girls embody both traditional masculine characteristics, such as competitiveness and independence, with traditional features of femininity such as collaboration, according to psychologist Dan Kindlon, author of Alpha Girls: Understanding the New American Girl and How She is Changing the World. However, little research has been conducted that explores the alpha girl discourse in the day-to-day lives of adolescent girls, deemed alpha, in US public school classrooms. Using interview and observation data, this paper examines how Kindlon's supposed alpha girls and their middle school teacher make sense of and live this notion of empowerment, and argues that their experiences both complicate and reify the alpha girl discourse. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction.Methods and Results: Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014. Factors associated with use of CABG versus PCI were identified using logistic multivariable regression analyses. A total of 29 769 patients from 539 hospitals were included in the study, of which 10 852 (36.4%) were treated with CABG, 13 760 (46.2%) were treated with PCI, and 5157 (17.3%) were treated without revascularization. The overall use of revascularization increased over the study period with an increase in the proportion undergoing PCI (45% to 48.9%; Ptrend=0.0002) and no change in the proportion undergoing CABG (36.1% to 34.7%; ptrend=0.88). There was significant variability between participating hospitals in the use of PCI and CABG (range: 22%-100%; 0%-78%, respectively; P value <0.0001 for both). Patient-level, but not hospital-level, characteristics were statistically associated with the use of PCI versus CABG, including anatomic severity of the disease, early treatment of adenosine diphosphate receptor antagonists at presentation, older age, female sex, and history of heart failure.Conclusions: Among patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST-segment-elevation myocardial infarction, only one third undergo CABG during the index admission. Furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years. [ABSTRACT FROM AUTHOR]

Purpose: To examine the extent to which rehabilitation counselor educators understand and are committed to infusing social justice in the rehabilitation counseling curricula. Method: The authors used a quantitative descriptive research design to examine the level and extent of integrating social justice into rehabilitation counseling curricular. The participants were 59 rehabilitation counselor educators recruited during the eighth Annual Rehabilitation Educators Conference hosted by the National Council on Rehabilitation Education. Results: The study found that most participants perceived it important to integrate social justice into rehabilitation counseling curricula. The level and extent of integration varied by academic rank and years of teaching. Conclusion: To ensure future rehabilitation counselors gain social justice competency, it is of great significance that rehabilitation counseling educators infuse the concepts of social justice into the curricula through knowledge and fieldwork domains. [ABSTRACT FROM AUTHOR]