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This study examined personality and affective variables in relation to eating disorder symptoms in anorexia nervosa (AN). Women (N=118) with DSM-IV AN completed baseline questionnaires (Beck Depression Inventory, Frost Multidimensional Perfectionism Scale) and interviews (Eating Disorder Examination, Yale-Brown-Cornell Eating Disorder Scale), followed by two weeks of ecological momentary assessment (EMA) involving multiple daily reports of affective states and eating disorder behaviors. Hierarchical regression analyses were conducted using eating disorder symptoms as dependent variables (i.e., EMA binge eating, EMA self-induced vomiting, eating disorder rituals, eating disorder preoccupations, dietary restraint). Predictor variables were maladaptive perfectionism (baseline), depressive symptoms (baseline), and affect lability (EMA). Results revealed that affect lability was independently associated with binge eating, whereas depressive symptoms were independently associated with self-induced vomiting. Depressive symptoms were independently associated with eating disorder rituals, whereas both depressive symptoms and maladaptive perfectionism were independently associated with eating disorder preoccupations. Finally, maladaptive perfectionism and affect lability were both independently associated with dietary restraint. This pattern of findings suggests the importance of affective and personality constructs in relation to eating disorder symptoms in AN and may highlight the importance of targeting these variables in the context of treatment.

Many studies illustrate variable patterns in individual species distribution shifts in response to changing temperature. However, an assemblage, a group of species that shares a common environmental niche, will likely exhibit similar responses to climate changes, and these community-level responses may have significant implications for ecosystem function. Therefore, we examine the relationship between observed shifts of species in assemblages and regional climate velocity (i.e., the rate and direction of change of temperature isotherms). The assemblages are defined in two sub-regions of the U.S. Northeast Shelf that have heterogeneous oceanography and bathymetry using four decades of bottom trawl survey data and we explore temporal changes in distribution, spatial range extent, thermal habitat area, and biomass, within assemblages. These sub-regional analyses allow the dissection of the relative roles of regional climate velocity and local physiography in shaping observed distribution shifts. We find that assemblages of species associated with shallower, warmer waters tend to shift west-southwest and to shallower waters over time, possibly towards cooler temperatures in the semi-enclosed Gulf of Maine, while species assemblages associated with relatively cooler and deeper waters shift deeper, but with little latitudinal change. Conversely, species assemblages associated with warmer and shallower water on the broad, shallow continental shelf from the Mid-Atlantic Bight to Georges Bank shift strongly northeast along latitudinal gradients with little change in depth. Shifts in depth among the southern species associated with deeper and cooler waters are more variable, although predominantly shifts are toward deeper waters. In addition, spatial expansion and contraction of species assemblages in each region corresponds to the area of suitable thermal habitat, but is inversely related to assemblage biomass. This suggests that assemblage distribution shifts in conjunction with expansion or contraction of thermal habitat acts to compress or stretch marine species assemblages, which may respectively amplify or dilute species interactions to an extent that is rarely considered. Overall, regional differences in climate change effects on the movement and extent of species assemblages hold important implications for management, mitigation, and adaptation on the U.S. Northeast Shelf.

Purpose Empathetic engagement is considered a vital component in forming respect-based relationships between patients and clinicians, leading to more optimal patient care. The purpose of this study was to explore whether there was a relationship between dental hygiene students' levels of empathy and student demographics including age, gender, year in school, and the degree type of dental hygiene program attending. Methods This was a cross-sectional observation study conducted among dental hygiene undergraduate students attending three dental hygiene programs in the Midwestern United States. Two programs offered associate degrees and one offered a baccalaureate degree. Participants completed the 20-item Jefferson Scale of Empathy © , student edition (JSE-S) along with demographic questions including age, gender, year in dental hygiene program, and degree type of dental hygiene program. Descriptive statistics and comparisons of the empathy scores were conducted using t-test and one-way analysis of variance (ANOVA). Regressions were conducted to determine whether the students' year in dental hygiene program and the type of degree program were predictors of empathy. Results Forty-one participants completed the questionnaire for a 65% response rate. The mean empathy score was 83.05 ± 10.04 among the participants. There were no statistically significant differences between levels of empathy of first- and second-year students or those attending a two-year institution versus a four-year university. Age, year in program, and type of degree were not shown to be predictors of empathy. Conclusion Results from this study did not show relationships or predictors of empathy with dental hygiene students' demographics or type of degree program. Future research should expand beyond a small homogenous convenience sample and include a longitudinal gauge to assess potential fluctuations in empathy as students progress throughout the curriculum and as practicing clinicians., (Copyright © 2024 The American Dental Hygienists’ Association.)

Background/aims: Athletic trainers are often the point person when sports-related traumatic dental injuries (TDIs) occur. The aim of this study was to assess knowledge levels of the management of TDIs among athletic trainers in the Midwest United States, as well as evaluate variables that may influence knowledge levels., Material and Methods: A survey was sent to athletic trainers licensed in Minnesota, Nebraska, and Iowa. The survey included 28 multiple-choice and fill in the blank questions split into three sections. The three sections included background, emergency management of TDIs, and opinion questions., Results: Of the participants, 100% recalled receiving medical first aid training. However, only 71% recalled receiving formal training on emergency management of dental injuries. Although 75% were confident in managing a dental injury, over 63% of participants scored less than 70% in the knowledge score section. Majority of the participants (98.4%) reported that they believe training on the management of TDIs is important. Athletic trainers working with contact sports were more likely to have experienced managing TDIs more recently than those working in noncontact sports., Conclusions: This study shows the gaps in knowledge among athletic trainers pertaining to management of TDIs and emphasizes the importance of sports community having adequate education on emergency management of such dental injuries., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: We analyzed data from a study to evaluate the effectiveness of the Relationships Under Construction (RUC) sexual risk avoidance education program promoting positive youth development and healthy relationships., Methods: Twelve schools in the Midwestern region of the United States randomized to the intervention implemented RUC in health or science classes, while control schools collected study measures and implemented the standard curriculum., Results: Post-randomization analyses revealed significant differences in grade, race/ethnicity, and prior relationship education at baseline between intervention and control students. Subsequent analyses controlled for these differences. We distributed parental notification letters to 641 students, and no parents requested that their adolescent opt out of data collection. We obtained assent and baseline computer-assisted survey interviews or paper-and-pencil instrument forms from 100% of these students. Findings suggest that RUC significantly reduced sexual activity (odds ratio = 0.56, p = .046) at 3-month follow-up, compared to those in the control group. RUC also reduced pornography viewing and improved attitudes about delayed gratification, beliefs, decision making, and negative outcome expectations., Conclusions: Our findings suggest that RUC improves sexual attitudes, beliefs, and behaviors among this population of adolescents. Additional research is needed to assess RUC impacts among diverse populations., (© 2024, American School Health Association.)

Context: Pregnant athletes cannot receive proper care if they choose to conceal their pregnancy. Unfortunately, many factors may lead an athlete to conceal. Whereas the extant qualitative literature suggests scholarship and sponsorship are prominent factors in the decision to disclose, this research is limited to elite athletes., Objective: To quantitatively examine predictors of pregnancy disclosure beyond scholarship and sponsorship in National Collegiate Athletic Association Division III college athletes., Design: Cross-sectional study., Setting: Midwestern United States., Participants or Other Participants: Athletes on Division III women's sports teams (N = 127)., Main Outcome Measure(s): Confidence in the athletic trainer (AT), perceived training and performance changes, athletic identity, and athletic identity during pregnancy. Two separate multiple regression analyses were conducted with the 4 predictors and 2 outcomes: likelihood to disclose and time to disclosure., Results: Confidence in the AT and athletic identity during pregnancy were significant predictors in both models, whereas the variable of perceived training and performance changes was only significant in the likelihood to disclose model. Athletic identity was not a significant predictor in either model. Results suggest Division III athletes believe they would be more likely to disclose their pregnancy and may disclose sooner if they feel that their AT can properly manage their physical, emotional, and social wellness during the pregnancy. Additionally, disclosure is promoted if they believe they will still be viewed as athletes by themselves and the people around them., Conclusions: These findings emphasize the importance of the role of the AT, with implications that formal education of ATs should include the holistic support of the pregnant athlete., (© by the National Athletic Trainers’ Association, Inc.)

Background: The objective of this study is to evaluate the Respect YOU program's impact on students' eating expectancies, body image satisfaction levels, self-efficacy, and knowledge. A total of 444 (intervention cohort n = 348, control cohort n = 96) underclassmen enrolled in health or physical education courses from 7 high schools in the Midwest participated in the study., Methods: A repeated measure research design was utilized to assess students' eating expectancies, body image satisfaction levels, self-efficacy, and knowledge. More specifically, paired t-tests were conducted to compare outcome measurements to evaluate the efficacy of the intervention., Results: Among the students who received the intervention (n = 348), there was a statistically significant change in scores for eating expectancies (Z = -14.403, p < .001), body image satisfaction levels (Z = -14.114, p < .001), social media self-efficacy (Z = 14.868, p < .001), and knowledge scales (Z = -16.100, p < .001) at post-intervention and compared to the control group., Conclusions: Results indicate that the Respect YOU program was effective in improving body image scores, eating expectancies, self-esteem, and knowledge-related outcomes among students post-intervention. These results can be used to further develop educational programming to address body image concerns and disordered eating among adolescents., (© 2024, American School Health Association.)

Introduction: To examine telehealth use in chronic care management and disparity reduction among the aging population. Methods: This longitudinal cohort study compared the changes in chronic care quality measures among patients with and without telehealth visits during the COVID-19 pandemic relative to patients in the previous years and by patient sociodemographic subgroup. Participants were Medicare fee-for-service beneficiaries 65 years or older from an Accountable Care Organization in the Midwest United States. Three utilization-based measures included having 2+ A1C tests, breast cancer screening, and depression screening. Three outcome-based measures included A1C control, blood pressure control, and depression diagnosis. Results: During the study period, the pandemic cohort experienced 5-17 percentage points' decrease in utilization-based measures (e.g., 2+ A1C tests 63.9% vs. 51.1%; OR [95% confidence intervals] = 0.35 [0.34-0.36]) from baseline relative to the control cohort. The outcome-based measures also significantly decreased but at smaller magnitudes (3-5 percentage points). About 51.5% patients had at least one telehealth visit. The utilization-based measures for these patients were significantly higher than those without any telehealth visit (e.g., 2+ A1C 57.1% vs. 51.1%, p < 0.01). However, the outcome-based measures were comparable. Patients from historically underserved groups had a larger decline in health care outcomes than their counterparts. Among patient with at least one telehealth visit, these disparities were no longer significant. Discussions: Telehealth was associated with less negative impact of the pandemic and better performance in chronic care management, but more for utilization-based measures and less for outcome-based measures. Telehealth was also associated with less disparities in care outcomes.

Objective: To examine the association of universal question-based screening for prenatal substance use on racial inequities in prenatal and newborn drug testing., Methods: We conducted a retrospective cohort study of 32,802 live births of patients receiving prenatal care at an academic medical center in the midwestern United States from 2014 to 2022, before and after implementation of question-based screening in 2018. Primary outcomes included prenatal and newborn drug test orders. Logistic regression models using a generalized estimating equation framework assessed associations with question-based screening and results, birthing parent age, race, ethnicity, marital status, and insurance type. Charts of patients who indicated difficulties stopping substance use were audited for guideline-directed care., Results: A total of 12,725 of 14,992 pregnant people (85.3%) received question-based screening. Implementation of question-based screening was associated with a decrease in prenatal urine test orders (5.0% [95% CI, 4.6-5.3%] before implementation, 3.1% [95% CI, 2.8-3.4%] after implementation; P <.001), with Black birthing parents having the largest reduction in prenatal urine drug testing (10.3% [95% CI, 9.0-11.7%] before implementation, 4.9% [95% CI, 3.9-5.9%] after implementation). However, rates of newborn drug testing did not change (4.7% [95% CI, 4.4-5.0%] before implementation, 4.5% [95% CI, 4.2-4.8%] after implementation; P =.46), and clinicians continued to order significantly more newborn drug tests for newborns of Black birthing parents compared with other race and ethnicity groups., Conclusion: Implementation of question-based screening for substance use in pregnancy was associated with decreased prenatal urine drug testing but no change in overall newborn drug testing or racial inequities in newborn drug testing for Black birthing people. Further policy efforts are warranted to improve substance use treatment and to eliminate racial inequities in punitive policies such as newborn drug testing and subsequent child protective services reporting., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Violent behaviour perpetrated against women has long-lasting negative physical and mental health consequences for women, their children, their families, and their communities. Intimate partner violence (IPV) is associated with many adverse physical, psychological, and emotional consequences. Structural racism and historical trauma affect women's trust and further hinder the ability of Indigenous and Black women to seek help after experiencing IPV. The availability of IPV support services, which can include shelter, food, group therapy, legal assistance, and advocacy, can be inaccessible to women due to the inability to access often limited resources in urban environments and reasons compounded by potential geographic distance if living in rural areas or living in community. Understanding the unique reasons why Indigenous and Black women do not seek help, and the barriers they experience when seeking help after IPV, is critical. Pandemics have the potential to create further complexities on how IPV is experienced. Black and Indigenous women experiencing IPV were therefore at even greater risk for IPV-related harm because of state and local "stay at home" measures put in place to minimise the spread COVID-19. The purpose of this manuscript is to explicate the methods for a large R01 study in the Upper Midwest., (© 2024 John Wiley & Sons Australia, Ltd.)

Species are often expected to shift their distributions either poleward or upslope to evade warming climates and colonise new suitable climatic niches. However, from 18-years of fixed transect monitoring data on 88 species of butterfly in the midwestern United States, we show that butterflies are shifting their centroids in all directions, except towards regions that are warming the fastest (southeast). Butterflies shifted their centroids at a mean rate of 4.87 km year -1 . The rate of centroid shift was significantly associated with local climate change velocity (temperature by precipitation interaction), but not with mean climate change velocity throughout the species' ranges. Species tended to shift their centroids at a faster rate towards regions that are warming at slower velocities but increasing in precipitation velocity. Surprisingly, species' thermal niche breadth (range of climates butterflies experience throughout their distribution) and wingspan (often used as metric for dispersal capability) were not correlated with the rate at which species shifted their ranges. We observed high phylogenetic signal in the direction species shifted their centroids. However, we found no phylogenetic signal in the rate species shifted their centroids, suggesting less conserved processes determine the rate of range shift than the direction species shift their ranges. This research shows important signatures of multidirectional range shifts (latitudinal and longitudinal) and uniquely shows that local climate change velocities are more important in driving range shifts than the mean climate change velocity throughout a species' entire range., (© 2024 The Author(s). Journal of Animal Ecology published by John Wiley & Sons Ltd on behalf of British Ecological Society.)

Often the barriers that arise in healthcare are due to healthcare professionals lack of education, exposure, and transphobia. Another potential barrier is due to geographical location of living in a rural area where there is a lack of healthcare services. This phenomenological study investigated barriers faced by transgender individuals who were transitioning in a rural area, focusing particularly on institutional barriers present in the healthcare system. Transgender individuals were recruited using convenience and snowball sampling. Data were collected via in-depth, face-to-face interviews in a rural area of the Midwest in the United States ( n  = 8). Transgender participants discussed themes of discrimination among healthcare providers based on gender. Participants reported gender markers as a barrier for healthcare services, such as inappropriate or incomplete response options on billing and medical forms. Participants perceived discrimination among gynecology, psychiatry, and medical emergency staff, and pharmacists. Overall, transgender individuals experienced mistreatment while transitioning in a rural area which created issues with participants' progress in transitioning. This study shows that education for all types of healthcare providers is needed regarding transgender health. Particularly in rural areas-many of which continue to lack essential healthcare services for the general population-the transgender population might not receive the culturally sensitive and appropriate attention they require.

Background: Lack of physical activity is a concern for children across diverse backgrounds, particularly affecting those in rural areas who face distinct challenges compared to their urban counterparts. Community-derived interventions are needed that consider the unique context and additional physical activity barriers in under-resourced rural settings. Therefore, a prospective pre-post pilot/feasibility study of Hoosier Sport was conducted over 8-weeks with 6th and 7th grade children in a low-socioeconomic rural middle school setting. The primary objective of the present study was to assess trial- and intervention-related feasibility indicators; and the secondary objective was to collect preliminary assessment data for physical activity levels, fitness, psychological needs satisfaction, and knowledge of physical activity and nutrition among participating youth., Methods: This prospective 8-week pilot/feasibility study took place in the rural Midwestern United States where twenty-four middle school students participated in a mixed-methods pre-post intervention during physical education classes. The intervention included elements like sport-based youth development, individualized goal setting, physical activity monitoring, pedometer usage, and health education. Data were collected at baseline (T1) and post-intervention (T3), with intermediate measures during the intervention (T2). Qualitative data were integrated through semi-structured interviews. Analytical methods encompassed descriptive statistics, correlations, repeated measures ANOVA, and thematic analysis., Results: Key findings indicate robust feasibility, with intervention-related scores (FIM, AIM, and IAM) consistently surpassing the "good" threshold and 100% retention and recruitment success. Additionally, participants showed significant physical performance improvement, shifting from the 25th to the 50th percentile in the 6-minute walk test (p < 0.05). Autonomy and competence remained high, reflecting positive perceptions of program practicality. Nutrition knowledge, initially low, significantly improved at post-intervention (p < 0.01), highlighting the efficacy of targeted nutritional education in Hoosier Sport., Conclusions: This study pioneers a community-engaged model for physical activity intervention in under-resourced rural settings. Positive participant feedback, coupled with improvements in physical fitness and psychosocial factors, highlights the potential of the co-design approach. The findings offer valuable insights and a practical template for future community-based research, signaling the promising impact of such interventions on holistic well-being. This research lays the foundation for subsequent phases of the ORBIT model, emphasizing collaborative, community-driven approaches to address the complex issue of declining physical activity levels among adolescents., (© 2024. The Author(s).)

Background: Depression is a major source of morbidity but often goes undiagnosed. Broader screening is recommended, and pharmacists could contribute., Objectives: This study aimed to assess the feasibility of community pharmacy depression and anxiety screening and describe the medication-related problems (MRPs) identified, pharmacist interventions, and provider responses for high-risk patients., Methods: This pilot was conducted between October 2022 and January 2023 at an independently owned community pharmacy in the Midwest United States. Patients aged 18-45 years with ready prescriptions were identified through weekly reports, and tags were placed on prescription bags. A convenience sample of patients fluent in English were offered the Patient Health Questionnaire (PHQ2) and Generalized Anxiety Disorder (GAD2), with follow-up PHQ9 and GAD7 for at-risk individuals. High-risk individuals met with the pharmacist for consultation and recommendations were discussed. Descriptive statistics were calculated for participant demographics, questionnaire responses, MRPs, and provider responses. Patient profiles were examined 2 months after the workup to identify medication changes., Results: A total of 29 patients volunteered to be screened for anxiety and depression; of these, 41% scored in the high-risk category for depression or anxiety and met with the pharmacist for the consultation. The pharmacist identified multiple MRPs. The most common was the need for additional therapy and inadequate dosages. Patients were reluctant for the pharmacist to follow up with their prescriber and were unreachable for telephone follow-up. Profiles reviewed 2 months after assessment showed half of the at-risk patients had one or more mental health medication changes., Conclusion: Community pharmacists may have a role in the screening and management of patient mental health, although there were challenges with screening uptake and follow-up. The pharmacist identified multiple MRPs for this high-risk group for which greater routine monitoring and follow-up may be beneficial. More work seems needed to engage both patients and prescribers., Competing Interests: Disclosure The authors declare no relevant conflicts of interest or financial relationships., (Copyright © 2024 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Purpose: Increasing racial and ethnic diversity in U.S. nursing facilities has necessitated the provision of more culturally competent care. This study explored the cultural challenges in providing palliative care from the perspective of certified nursing assistants (CNAs) and nurses in nursing facilities., Method: A thematic analysis approach was used to examine data from semi-structured interviews with 12 CNAs and 11 nurses from six nursing facilities in a U.S. Midwestern state., Results: Four themes emerged from the data: Cultural Needs Expressed by Residents , Cultural Needs Expressed by Family Members , Accommodating Residents' Cultural Needs , and Organizational Responses to Cultural Competency Challenges ., Conclusion: Results highlighted the training variations on diversity and cultural competency issues and the varying cultural competency levels possessed by staff. To support residents' culture-related needs, staff need education and support. Organizations can provide foundational resources for this diversity of cultural expression, including providing more culturally diverse programming facilities. [ Journal of Gerontological Nursing, 50 (7), 35-41.].

Background: U.S. journalists embedded in rural and agricultural communities could adversely affect the health of residents if they avoid alerting and engaging their readers - farmers, ranchers, and community members - on environmental and health issues. We expected reporters would maintain community status quo and inaction by framing local water pollution and quality issues neutrally deemphasizing threats and solutions to maintain their own credibility as unbiased informational sources., Method: In a content analysis of local water quality newspaper articles from five farming and cattle ranching states in the west central U.S. Midwest, we employed seven variables to investigate whether journalists practiced neutral, detached forms of journalism (i.e. dissemination versus interpretative role enactment, government-frame) as well as whether they deemphasized water pollution as a concerning issue (i.e. problem, threat), water pollution solutions, and readers' efficaciousness., Results: The results showed these journalists relied heavily on government-driven narratives presenting water quality issues from an impartial, straight reporting lens in which they primarily followed the journalistic dissemination role enactment, while neglecting to provide readers with interpretative, threat, efficacy, or solution's information., Conclusions: The study seeks to help communicators understand the information diet people living in this part of the country likely receive on environmental and health risks in the context of water pollution. Communicators seeking to reach and affect audiences in this region should understand local information practices to navigate how to craft culturally specific public health messages.

Abstract: This study looked for associations between measures of emotional intelligence in an intensive clinical experience for nursing students in their final semester of an associate degree program. Twenty nursing students from a technical college in the Midwest volunteered to complete the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) before and after an intensive clinical experience. The results were mixed with a significant decrease in several specific scores within the MSCEIT on the Time Point 2 test. Stress levels or fatigue could have impacted participants' decreased performance on the MSCEIT., Competing Interests: The author has declared no conflict of interest., (Copyright © 2023 National League for Nursing.)

Objectives: Examines whether a personality characteristic, need for approval, moderates the relationship between harassment exposure and alcohol misuse over time in a college sample, and compare the results between genders. Participants: Six waves of data (fall 2011 to fall 2015) were collected from 1,240 study participants sampled from eight colleges and universities in the Midwestern United States. Methods: Two-level mixed modeling was conducted separately for exposure to sexual and generalized harassment and modeled separately for women and men. Results: In men only, need for approval significantly moderated the relationship between generalized harassment and binge drinking over time, where a higher need for approval put male students at increased risk. Conclusions: Harassment is a risk factor contributing to high levels of drinking among college students. School counseling centers and mental health professionals should take this factor into consideration, as well as individual personality characteristics when addressing student health and wellness.

Black sexual minority men who have sex with men (MSM) in the United States are at disparate risk for contracting HIV infection, but pre-exposure prophylaxis (PrEP) use is suboptimal. Social network methods were used to recruit a community sample of racial minority MSM and transgender women (TGW) in two Midwestern US cities. 250 PrEP-eligible (HIV-negative) participants completed measures assessing current and intended PrEP use; demographic characteristics; PrEP knowledge, attitudes, norms, stigma, and self-efficacy; and structural barriers to PrEP. Multivariate analyses established predictors of current and intended PrEP use. Only 12% of participants reported currently using PrEP, which was associated with greater PrEP knowledge and not having a main partner, with trends for greater PrEP use by younger participants and those with partners living with HIV. Among participants not currently on PrEP, strength of PrEP use intentions was associated with higher PrEP knowledge, PrEP descriptive social norms, and PrEP use self-efficacy. This study is among few to directly compare Black who have adopted PrEP with those who have not. Its findings underscore the potential benefits of employing social network approaches for strengthening PrEP use peer norms, increasing PrEP knowledge and self-efficacy, and optimizing PrEP uptake among racial minority MSM and TGW.

This study examines the moderating effects of distant leader's practice of transformational leadership on the relationship between secondary traumatic stress (STS) and burnout among child welfare workers. Caseworkers and supervisors in a Midwest U.S. state (N = 210) rated their regional director's use of transformational leadership skills using a survey. Given the nature of the clustered data, multilevel modeling was employed to examine the main effects of transformational leadership on worker burnout and its cross-level interaction effect on the association between worker STS and burnout. Multilevel modeling demonstrated that worker burnout was positively associated with STS and negatively associated with organizational-level transformational leadership. The cross-level interaction between transformational leadership and STS was significant. Specifically, the positive association between workers' STS and burnout decreased as transformational leadership increased. These findings suggest that organizational approaches such as transformational leadership can influence workforce results. Further research will guide child welfare policymakers to develop more sophisticated training programs in leadership skills and strategies., (© 2024 National Association of Social Workers.)

Mounting evidence shows overall insect abundances are in decline globally. Habitat loss, climate change, and pesticides have all been implicated, but their relative effects have never been evaluated in a comprehensive large-scale study. We harmonized 17 years of land use, climate, multiple classes of pesticides, and butterfly survey data across 81 counties in five states in the US Midwest. We find community-wide declines in total butterfly abundance and species richness to be most strongly associated with insecticides in general, and for butterfly species richness the use of neonicotinoid-treated seeds in particular. This included the abundance of the migratory monarch (Danaus plexippus), whose decline is the focus of intensive debate and public concern. Insect declines cannot be understood without comprehensive data on all putative drivers, and the 2015 cessation of neonicotinoid data releases in the US will impede future research., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Van Deynze et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Conservation agriculture (CA) is a set of principles thought to be able to enhance crop productivity while minimizing impacts on the environment. The evidence base for CA can be challenging to synthesize because it encompasses many different practices and social and agroecological outcomes. To facilitate synthesis of CA evidence we have created a dataset organizing 218 response variables from five common categories of CA: cover crops, tillage management, pest management, nutrient management, and crop diversification. These data cover the Midwestern United States (U.S.) from 1980-2020. The dataset is also summarized and visualized on the AgEvidence website, which enables users to interactively explore, filter, and download data. We hope this dataset will help a wide variety of stakeholders, including researchers, policy makers, advocacy groups, and growers access the evidence needed to make informed and impactful decisions about how to produce food with less negative environmental impact., (© 2024. The Author(s).)

Research with Indigenous communities has demonstrated the detrimental impacts of intergenerational trauma and disproportionate adverse childhood experiences (ACEs) on health and behavioral outcomes in adulthood. A more balanced narrative that includes positive childhood experiences is needed. The construct of benevolent childhood experiences (BCEs) facilitates assessment of positive early life experiences and their impact on well-being for Indigenous peoples. We consider associations between BCEs and well-being when taking into account ACEs and adult positive experiences. Participants are from Healing Pathways, a longitudinal, community-based panel study with Indigenous families in the Midwestern United States and Canada. Data for the current analyses are derived from 453 participants interviewed at wave 9 of the study. Participants reported high levels of positive childhood experiences in the form of BCEs, with 86.5% of the wave 9 participants reporting experiencing at least six of seven positive indicators. BCEs were positively associated with young adult well-being. This relationship persisted even when accounting for ACEs and adult positive experiences. While ACEs were negatively correlated with young adult well-being, they were not significantly associated with well-being when considering family satisfaction and receiving emotional support. Evidence of high levels of BCEs reflects realities of strong Indigenous families and an abundance of positive childhood experiences., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Although multiple specialties perform neonatal circumcision (NC), overall NC proceduralist availability is limited. The approach to training new practitioners varies. This study aims to describe NC training experiences, current practices, and make suggestions for future improvements., Methods: Perinatal physicians across 11 hospitals in a large Midwestern United States city who perform NC or who conduct newborn examinations and provide circumcision counseling were recruited for semistructured interviews about NC care. Interviews were transcribed; training-related comments underwent inductive and deductive qualitative coding. Themes related to circumcision training and recommendations for improving the experience of future circumcision learners were summarized., Results: Twenty-three physicians (10 family medicine, 8 pediatrics, and 5 obstetrics; 78% currently perform circumcision) participated. All participants conducted newborn examinations and provided circumcision counseling, but only 21/23 were trained to perform circumcision. Several themes related to training emerged: (1) personal training experience, (2) training others to perform circumcision, and (3) current training needs and barriers. Most reported learning in residency by a "see one, do one, teach one" approach with minimal formal didactic or structured training. Compared with their personal experience, participants noted a shift toward more direct supervision and preprocedure preparation for current trainees. However, most reported that circumcision learning continues to be "hands-on." Participants desired a more structured approach for future trainees., Conclusions: Perinatal physicians noted a shift in the current NC training to a more hands-on approach than they experienced personally. Development of a structured NC curriculum was recommended to improve training., (Copyright © 2024 by the American Academy of Pediatrics.)

Background: Leadership development, career advancement, and collaboration among scholars are essential to nurturing nursing research excellence and sustainability. The Midwest Nursing Research Society (MNRS) has incorporated several strategies to advance nursing science and to increase the pool of future nurse leaders. In this article, we describe the process, activities, and outcomes of the Leadership Academy (LA), an innovative initiative from MNRS developed to identify, engage, and nurture future generations of leaders., Methods: For the LA 2022 to 2023 period, the MNRS leaders selected a cohort of 5 nurse scholars and engaged them in activities to develop, enhance, and advance their leadership skills. By following the LA purposes, the cohort participated in monthly meetings with MNRS leaders, received individual mentoring sessions, assessed strengths and areas for further development, attended seminars, participated in a book club, and implemented a cohort project that focused on the promotion and support of early career scholars., Results: Outcomes showed increased knowledge about organizational governance, direction, and resource development; leadership confidence culminating with leadership positions inside and outside MNRS; career development plans; engagement with board members, and enhanced networking. Moreover, the cohort members planned and executed a well-attended conference special session that engaged a large group of scholars to discuss challenges and opportunities for career development at the MNRS Annual Conference., Conclusion: The MNRS LA is a thriving organizational initiative that promotes engagement and leadership skills development thereby increasing the pool of candidates confidently prepared to lead the nursing profession., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: This study investigated the relationships among exercise engagement, psychosocial factors, and social participation for adults aging with physical disabilities (AAwPD)., Design: A cross-sectional study within a community-based cohort study of participation among AAwPD was conducted., Setting: A comprehensive survey was administered online or via telephone., Participants: Participants were 474 individuals between the ages of 45-65, primarily living in the Midwestern United States, who reported living with a physical disability for at least 5 years., Method: Survey questions created based on prior consolidation of activity domains assessed exercise engagement. Psychosocial health and social participation were measured using the Patient Reported Outcomes Measurement Information System. Chi-square tests, t -tests, and a general linear model were used to examine differences between exercisers and non-exercisers., Results: Participants who exercised reported less pain ( P < .001), fatigue ( P < .001), and depression ( P < .001) and greater self-efficacy for management of chronic conditions ( P = .002), satisfaction with participation in social roles and activities ( P < .001), and ability to participate in social roles and activities ( P < .001) compared with non-exercising participants., Conclusions: AAwPD who exercised reported fewer secondary conditions and greater social participation. Although causal relationships cannot be drawn, and the frequency, duration, and intensity of exercise were not examined, this study lays important groundwork for future research to determine the health and participation benefits of exercise for AAwPD. Future studies should also focus on the development of exercise interventions to support successful aging with disability., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This paper is an extension of a study focused on a small, suburban school district approximately 15 miles outside of Chicago, Illinois, situated in a uniquely diverse community with a host of racial, socioeconomic, linguistic identities. Despite the fact that 95% of its 2016-2017 kindergarten class had some form of preschool experience, gaps were observed in kindergarten readiness between Black and White students, leading to achievement gaps in later years. Consequently, the district has directed its focus on enhancing the levels of equity among its students. The original mixed-methods study explored potential factors of this readiness gap, including the types of services rendered by early education providers and access to high-quality early childhood education in the community. This paper narrows its focus to the experience of Black early learners in this district, particularly as it relates to their preschool experiences and special education rates. Qualitative interviews illuminated the following themes: (1) low levels of readiness and disproportionate special education service identification of Black students; (2) minimal socioeconomic and racial diversity in the community's private preschools; (3) few opportunities for special education services or financial support at private preschools; (4) high rates of minority students attending home-based childcare instead of formal preschool; and (5) differing approaches to family engagement and curriculum between the private schools and the district center. More research and community engagement is needed to fully explore the population of Black students with special needs and those who are not receiving formal childcare prior to enrolling in school., Author(s): Avery Kenly [sup.1] , Amanda Klein [sup.2] Author Affiliations: (1) Clayton County Public Schools, , Atlanta, GA, USA (2) grid.261331.4, 0000 0001 2285 7943, Ohio State University, , Columbus, [...]

Arsenic toxicokinetics are important for disease risks in exposed populations, but genetic determinants are not fully understood. We examined urine arsenic species patterns measured by HPLC-ICPMS among 2189 Strong Heart Study participants 18 years of age and older with data on ~400 genome-wide microsatellite markers spaced ~10 cM and arsenic speciation (683 participants from Arizona, 684 from Oklahoma, and 822 from North and South Dakota). We logit-transformed % arsenic species (% inorganic arsenic, %MMA, and %DMA) and also conducted principal component analyses of the logit % arsenic species. We used inverse-normalized residuals from multivariable-adjusted polygenic heritability analysis for multipoint variance components linkage analysis. We also examined the contribution of polymorphisms in the arsenic metabolism gene AS3MT via conditional linkage analysis. We localized a quantitative trait locus (QTL) on chromosome 10 (LOD 4.12 for %MMA, 4.65 for %DMA, and 4.84 for the first principal component of logit % arsenic species). This peak was partially but not fully explained by measured AS3MT variants. We also localized a QTL for the second principal component of logit % arsenic species on chromosome 5 (LOD 4.21) that was not evident from considering % arsenic species individually. Some other loci were suggestive or significant for 1 geographical area but not overall across all areas, indicating possible locus heterogeneity. This genome-wide linkage scan suggests genetic determinants of arsenic toxicokinetics to be identified by future fine-mapping, and illustrates the utility of principal component analysis as a novel approach that considers % arsenic species jointly.

White-nose syndrome has devastated bat populations in eastern North America. In Midwestern United States, prevalence increased quickly in the first year of invasion (2012-13) but with low population declines. In the second year (2013-14), environmental contamination led to earlier infection and high population declines. Interventions must be implemented before or soon after fungal invasion to prevent population collapse.

AimsMost patients with diabetes have comorbid chronic conditions that could support (concordant) or compete with (discordant) diabetes care. We sought to determine the impact of the number of concordant and discordant chronic conditions on diabetes care quality.MethodsLogistic regression analysis of electronic health record data from 7 health systems on 24,430 patients with diabetes aged 18-75 years. Diabetes testing and control quality care goals were the outcome variables. The number of diabetes-concordant and the number of diabetes-discordant conditions were the main explanatory variables. Analysis was adjusted for health care utilization, health system and patient demographics.ResultsA higher number of concordant conditions were associated with higher odds of achieving testing and control goals for all outcomes except blood pressure control. There was no to minimal positive association between the number of discordant conditions and outcomes, except for cholesterol testing which was less likely with 4+ discordant conditions.ConclusionsHaving more concordant conditions makes diabetes care goal achievement more likely. The number of discordant conditions has a smaller, inconsistently significant impact on diabetes goal achievement. Interventions to improve diabetes care need to align with a patient's comorbidities, including the absence of comorbidities, especially concordant comorbidities.

BACKGROUND: Pain and anxiety occurring from cardiovascular disease are associated with long-term health risks. Integrative medicine (IM) therapies reduce pain and anxiety in small samples of hospitalized cardiovascular patients within randomized controlled trials; however, practice-based effectiveness research has been limited. The goal of the study is to evaluate the effectiveness of IM interventions (i.e., bodywork, mind-body and energy therapies, and traditional Chinese medicine) on pain and anxiety measures across a cardiovascular population. METHODS: Retrospective data obtained from medical records identified patients with a cardiovascular ICD-9 code admitted to a large Midwestern hospital between 7/1/2009 and 12/31/2012. Outcomes were changes in patient-reported pain and anxiety, rated before and after IM treatments based on a numeric scale (0-10). RESULTS: Of 57,295 hospital cardiovascular admissions, 6,589 (11.5%) included IM. After receiving IM therapy, patients averaged a 46.5% (p-value

On August 10,2020, an intense derecho with low predictability passed over three separate WSR88Ds and produced widespread high-wind damage from eastern Nebraska through northern Indiana. Although many structures were impacted [...]

Accelerated mass spectrometry (AMS) and carbon isotope analyses provide strong tandem methodologies used by archaeologists to evaluate and reevaluate the histories of maize use in the Midwest. In this article, we present newly obtained AMS dates and carbon isotope assays of alleged maize samples from the Icehouse Bottom (40MR23) and Edwin Harness sites (22RO33). Based on original studies, samples were thought to date to the Middle Woodland period (ca. 300 BC-AD 400). The results show that samples either were not maize or date to post-AD 900. As of this finding, there are no longer any securely dated Middle Woodland macrobotanical remains of maize from the Eastern Woodlands of North America. [ABSTRACT FROM AUTHOR]

ObjectiveThe objective of this study was to evaluate the association between measures of body composition and patterns of urine arsenic metabolites in the 1989-1991 baseline visit of the Strong Heart Study, a cardiovascular disease cohort of adults recruited from rural communities in Arizona, Oklahoma, North Dakota and South Dakota.MethodsWe evaluated 3,663 Strong Heart Study participants with urine arsenic species above the limit of detection and no missing data on body mass index, % body fat and fat free mass measured by bioelectrical impedance, waist circumference and other variables. We summarized urine arsenic species patterns as the relative contribution of inorganic (iAs), methylarsonate (MMA) and dimethylarsinate (DMA) species to their sum. We modeled the associations of % arsenic species biomarkers with body mass index, % body fat, fat free mass, and waist circumference categories in unadjusted regression models and in models including all measures of body composition. We also considered adjustment for arsenic exposure and demographics.ResultsIncreasing body mass index was associated with higher mean % DMA and lower mean % MMA before and after adjustment for sociodemographic variables, arsenic exposure, and for other measures of body composition. In unadjusted linear regression models, % DMA was 2.4 (2.1, 2.6) % higher per increase in body mass index category (< 25, ≥25 &

The increase in agricultural production over the past 40 y has greatly altered land-use patterns, often resulting in simplified landscapes composed of large swaths of monocultures separated by small fragments of natural lands. These simplified landscapes may be more susceptible to insect pest pressure because of the loss of natural enemies and the increased size and connectivity of crop resources, and a recent analysis from a single year (2007) suggests this increased susceptibility results in increased insecticide use. I broaden the temporal analysis of this connection between landscape simplification and insecticide use by examining cross-sectional and panel data models from multiple decades (US Department of Agriculture Census of Agriculture years 2007, 2002, 1997, 1992, 1987) for seven Midwestern states composed of over 560 counties. I find that although the proportion of county in cropland--my metric for landscape simplification--was positively correlated with insecticide use in 2007, this relationship is absent or reversed in prior census years and when all years are analyzed together. This broader temporal perspective suggests that landscape simplification has inconsistent effects on insecticide use and that multiyear studies will be key to unlocking the true drivers of variation in insecticide application.

BackgroundA doctor's ability to communicate effectively is key to establishing and maintaining positive doctor-patient relationships. The Consumer Assessment of Healthcare Providers and System (CAHPS(®)) Clinician and Group Survey is the standard for collecting and reporting information about patients' experiences of care in the USA.ObjectiveTo evaluate how well CAHPS(®) Clinician and Group 2.0 core and supplemental survey items (CG-CAHPS) with a 12-month reference capture doctor-patient communication.Data sources/study settingEleven of the 40 highest-rated physicians on the CG-CAHPS survey treating patients in a Midwest commercial health plan.Study designData were obtained via semi-structured interviews. Specific behaviors, practices, and opinions about doctor communication were coded and compared to the CG-CAHPS items.Principal findingsCG-CAHPS fully captures six of the nine behaviors most commonly mentioned by high-performing physicians: employing office staff with good people skills; involving office staff in communication with patients; spending enough time with patients; listening carefully; providing clear, simple explanations; and devising an action plan with each patient. Three physician behaviors identified as key were not captured in CG-CAHPS items: use of nonverbal communication; greeting patients and introducing oneself; and tracking personal information about patients.ConclusionsCG-CAHPS survey items capture many of the most commonly mentioned doctor-patient communication behaviors and practices identified by high-performing physicians. Nonverbal communication, greeting patients, and tracking personal information about patients were identified as key aspects of doctor-patient communication, but are not captured by the current CG-CAHPS. We recommend further research to assess patients' perceptions of specific verbal and nonverbal behaviors (such as leaning forward in a chair, casually asking about other family members), followed by the development of new items (if needed) that aim to capture what these specific behaviors represent to patients (e.g., listens attentively, seems to care about me as a person, empathy). We also recommend including items about greeting and tracking personal information about patients in future CAHPS item sets addressing doctor-patient communication. Enriching the content of the CAHPS communication measure can help health-care organizations improve doctor-patient communication and interactions.

Introduction: Affecting more than 3.9 million Americans, the hepatitis C virus (HCV) attacks the liver by causing inflammation. Left untreated, HCV can lead to serious consequences. Targeting high-risk individuals in the inpatient psychiatric setting can lead to increased testing and referral., Aims: This quality improvement project determined whether an intervention-consisting of a pretest, educational session, posttest, and screening implementation-increased staff knowledge about HCV screening recommendations, identified at-risk individuals, and increased the number of patients screened and referred for treatment., Method: An online HCV educational session was provided to 30 staff at a Midwest regional psychiatric unit. An online pre/posttest was conducted to determine staff knowledge and understanding prior to and after the educational session. An HCV screening tool checklist was incorporated into the electronic health record (EHR) system. A 3-month pre/post-intervention chart review was completed to determine the number of patients identified and screened for HCV., Results: A comparison of the 30 staff members' mean pre/posttest scores were calculated using an unpaired t test, showing a prescore mean of 55.15 ± 19.09 and a postscore mean of 85.75 ± 13.44, p < .001. A chi-square analysis indicated that there was a statistically significant post-intervention increase in the percentage of high-risk patients identified (5.6%-36.4%, p < .001) and screened (5.6%-31.4%, p < .001) for HCV compared with pre-intervention., Conclusion: The study intervention increased staff knowledge of HCV guidelines and the number of at-risk patients identified and screened for the disease., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

As previous research has observed, medical students and physicians alike confront vast amounts of knowledge in their education and practice, such that no one clinician can know everything there is to know about biomedicine. Even before clerkships, medical students learn to cope with this impossibility by prioritizing certain information based on its perceived utility for exams and clinical practice. Many factors can shape this process, including teamwork, wherein individual medical students rely on one another to address gaps in knowledge at the level of the group. This paper will draw on qualitative data from two allopathic medical schools in the American Midwest to demonstrate that peer-to-peer learning, a widely utilized pedagogical modality in North American medical schools, is amongst the earliest places where future physicians learn how to rely on their peers in the profession as they make choices about what to know and what not to know about biomedicine: cultivating a culture of "intraprofessionalism" between students with different knowledges and values, as they prepare to enter the same profession. The paper will also consider how differences in the student populations at two field sites impact intraprofessional development. Drawing on scholarship of peer-based learning strategies and the sociology and anthropology of medical education, the authors argue that peer-to-peer learning is a key site in the professional socialization of medical students toward the effective management of medical knowledge., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions., Objective: This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care., Methods: Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs., Results: A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support., Conclusions: Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Society of Trauma Nurses.)