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High rates of illicit drug use have been reported among gay and bisexual young men, however limited research has examined patterns of drug use among the broader population of lesbian, pansexual, trans and gender diverse, asexual and queer (LGBTQA) young people. We examined factors associated with illicit drug use in the past 6 months and lifetime experiences of self-reported concern with drug use among LGBTQA youth in Australia.A cross-sectional survey was conducted involving 6418 LGBTQA participants aged 14-21 years, 5914 of whom provided information relating to their use of illicit drugs. Multivariable logistic regressions examined demographic factors and life experiences associated with drug use in the past 6 months and lifetime experiences of self-reported concern with drug use.Overall, 26.4% of participants aged 14-17 and 41.9% aged 18-21 reported any drug use in the past 6 months, of whom 23.5% had ever been concerned about their drug use. Cannabis use was most commonly reported (28.3%), followed by ecstasy/MDMA (7.1%), antidepressants (5.6%) and LSD (3.5%). Higher odds of drug use were reported among cisgender men and those who had experienced homelessness or sexual harassment in the past 12 months. Higher odds of self-identified concern about drug use were observed among participants reporting challenging life experiences.Rates of illicit drug use among LGBTQA young people in this study were considerably higher than those observed in general population youth studies in Australia and were further elevated among those who had experienced LGBTQA-related prejudice or harassment, or homelessness.

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This study examined patient portal utilization by analyzing the pattern of time and feature use of patients, and thus to identify functionalities of portal use and patient characteristics that may inform future strategies to enhance communication and care coordination through online portals.We conducted a retrospective study of patients at 18 family medicine clinics over a 5-year period using access log records in the electronic health record database. Dimensionality reduction analysis was applied to group portal functionalities into 4 underlying feature domains: messaging, health information management, billing/insurance, and resource/education. Negative binomial regression analysis was used to evaluate how patient and practice characteristics affected the use of each feature domain.Patients with more chronic conditions, lab tests, or prescriptions generally showed greater patient portal usage. However, patients who were male, elderly, in minority groups, or living in rural areas persistently had lower portal usage. Individuals on public insurance were also less likely than those on commercial insurance to use patient portals, although Medicare patients showed greater portal usage on health information management features, and uninsured patients had greater usage on viewing resource/education features. Having Internet access only affected the use of messaging features.Efforts to enroll patients in online portals do not guarantee patients will use the portals to manage their health. When considering the use of patient portals for improving telehealth, clinicians need to be aware of technological, socioeconomic, and cultural challenges faced by their patients.

Objective To implement a collaborative statewide antibiotic stewardship initiative in both the ambulatory and inpatient settings. Methods Five participating Delaware health systems each convened internal team(s) to translate the vision set forth by the eBrightHealth LLC Choosing Wisely Work Group into clinical action through process improvement efforts at their institutions. The teams focused on implementing antibiotic time-outs, and on improving antibiotic prescribing for upper respiratory infections in ambulatory settings. The learning network utilized an "all teach, all learn" methodology via monthly conference calls and quarterly face-to-face meetings. Results All inpatient teams implemented antibiotic time-outs for at least 1 unit. Other interventions included commitment posters; submitting antibiotic utilization data nationally; provider/patient surveys; local stewardship champions; and provider prescribing data feedback. Barriers to implementation included competing priorities, lack of reliable utilization data, and suboptimal provider engagement. Overall antibiotic utilization decreased by 9%, compared to the pre-intervention period. Conclusions This initiative has demonstrated the value of multidisciplinary teams, from varying healthcare systems, coming together to work on a single project. While each team's interventions and specific goals differed slightly, all teams implemented new initiatives to promote appropriate use of antibiotics. Policy Implications Antibiotic stewardship is a national priority. Acute care hospitals are required to have antibiotic stewardship programs; similar programs are proposed for ambulatory settings.

The problem under investigation is how to nurture the exploratory and constructive behaviors of inquiry. To this end, the research, concepts, and theories of Sugata Mitra, Jacob Getzels, and Mihaly Csikszentmihalyi hold promise for developing opportunities for these pursuits. Additionally, research about the negative effects of reward informs school librarians who practice this creativity killer.

School librarian preparation programs must prepare the twenty-first century school librarian to confront the evolving changes that are facing our profession. The need for change in our traditional roles to meet demands of our profession is evident, and we have opportunity to shape the change we seek by developing emergent school library leaders during their pre-service library education programs. In this study, the researchers surveyed a sample group of school librarians about their perceptions of leadership development within their graduate education program. The results of the study suggested that increased emphasis on leadership development in graduate school library programs will more effectively prepare school librarians for service as educational leaders, change agents in the curriculum and instructional process, and partners at both the local school and wider global communities.

In the United States of America, each year almost one -third of all public high school students drop out before graduating and receiving a diploma. School librarians can play a critical role in strengthening and improving the academic achievement of all students, but especially those who are at-risk of dropping out of school. In this article, students most at-risk of dropout are identified. A research-based framework to improve student achievement through dispositions of the school librarian, nurturing relationships and supportive environments, and effective instructional practices is identified. Practical suggestions about specific school library programs are made. The article concludes with a section on implications for practice and suggestions for further study.

The results of research conducted by Werner and Smith (1992), Rutter (1983), Garmezy (1991), and others indicate that school media specialists can play an important role in promoting resiliency and building assets in youth. By developing programs and services that build connections, encourage reading and hobbies, and teach problem-solving and social skills, media specialists aid in the development of resiliency. Understanding the theories of resiliency, assets, and developmental tasks will position school media specialists to become change agents in their communities and schools by strengthening the environment in which children and teens learn. The author discusses the models developed by Benard, Wolin and Wolin, Milstein and Henry, and the Search Institute that school media specialists can apply to their media center programs and services. Practical suggestions are provided.

The goal of educators to cultivate reflective thinkers is enhanced through the inquiry-focused school library program proposed by Kuhlthau. The authors present reflection, an essential component of inquiry, as a disposition that can be "caught, taught and acquired" through a process of modeling in a school library environment which is designed to support the development of this essential critical thinking skill. A framework for strengthening the disposition of reflection is presented, based on Dewey's and Sch̦n's work on reflection and Bransford, Brown and Cocking's work on learning. The stages of reflection and inquiry are compared to dispositions-in-action, indicating their potential for enhancing student learning and understanding. Guidelines and practical suggestions are recommended for teaching reflection in a learner-, knowledge-, and assessment-centered school library program.