Search

BackgroundUnderstanding how older patients with chronic illnesses use the internet to obtain health information is relevant for the design of digital interventions aimed at improving the health and well-being of adults aged 65 years and older; this cohort represents the sickest, most expensive, and fastest-growing segment of the US population. ObjectiveThe objective of our study was to describe online health information–seeking behavior among older patients with chronic illnesses and to compare the characteristics of patients who report using the internet to obtain health information with those who do not. MethodsThe study population included 72,806 women aged 65 years and older enrolled in the Women’s Health Initiative (WHI), a national cohort study, who completed a 2014 supplemental questionnaire assessing everyday technology use and internet use for researching health conditions. Comparisons were made between participants with and without a history of chronic illness and between users and nonusers of online sources for health information. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% CIs. ResultsOf the total, 59% (42,887/72,806) of older women used the internet for health information. Compared with women who did not use the internet to obtain health information, those who used the internet were younger (median age: 76 vs 81 years), more likely to be non-Hispanic white (90% [38,481/42,887] vs 87% [26,017/29,919]), earned a higher income (over $US 50,000: 55% [23,410/42,887] vs 33% [9991/29,919]), achieved a higher educational level (more than high school: 87% [37,493/42,887] vs 75% [22,377/29,919]), and were more likely to live with a partner (52% [22,457/42,887] vs 36% [10,759/29,919]) (all P

Understanding the assembly of plant-pollinator communities has become critical to their conservation given the rise of species invasions, extirpations, and species range shifts. Over the course of assembly, colonizer establishment produces core interaction patterns, called motifs, which shape the trajectory of assembling network structure. Dynamic assembly models can advance our understanding of this process by linking the transient dynamics of colonizer establishment to long-term network development. In this study, we investigate the role of intra-guild indirect interactions and adaptive foraging in shaping the structure of assembling plant-pollinator networks by developing: 1) an assembly model that includes population dynamics and adaptive foraging, and 2) a motif analysis tracking the intra-guild indirect interactions of colonizing species throughout their establishment. We find that while colonizers leverage indirect competition for shared mutualistic resources to establish, adaptive foraging maintains the persistence of inferior competitors. This produces core motifs in which specialist and generalist species coexist on shared mutualistic resources which leads to the emergence of nested networks. Further, the persistence of specialists develops richer and less connected networks which is consistent with empirical data. Our work contributes new understanding and methods to study the effects of species intra-guild indirect interactions on community assembly.

Natural resources policies that promote sustainable management are critical for protecting diverse stakeholders against depletion. Although integrating diverse stakeholders into these policies has been theorized to improve protection, empirical evidence is lacking. Here, we evaluate 108 Sustainability Plans under Californias Sustainable Groundwater Management Act to quantify how well stakeholders are integrated into plans and protected from groundwater depletion. We find that the majority of Sustainability Plans do not integrate or protect the majority of their stakeholders. Nevertheless, our results show that when stakeholders are more integrated into a Sustainability Plan, they are more likely to be protected, particularly for those that lack formal access to decision-making processes. Our findings provide strong empirical evidence that integrating diverse stakeholders into sustainability planning is beneficial for stakeholders who are vulnerable to the impacts of natural resource depletion.

The unprecedented pace of technological advances in online interactions and digital identity have created challenges for educators and the communities they serve. Electronic portfolios (ePortfolios) have become a substantive tool that facilitates transference and access to the pertinent achievements highlighting competency, allowing administrators to weigh those strengths against the positions they are trying to fill--yet ePortfolios have limitations maximizing access to digital footprints. The purpose of the study, using mixed-methods, was to determine the views of school administrators involved in the use of ePortfolios during the hiring process of K-12 preservice teachers. Participants' survey responses were used to investigate four research questions regarding pros/cons, school administrators' needs, delivery method, and improvements of ePortfolios for increased use. One important outcome showed 59% of the participants had used ePortfolios in the past two years, and they would be more willing to use ePortfolios if there was a standard format for candidates to follow. Researchers found ePortfolios were a viable asset for the hiring officials in this study; however, new challenges are evident and must be addressed.

BACKGROUND: The association of pelvic radiation with pelvic fracture risk has not been examined in prospective cohort settings with comprehensive fracture risk assessment, cancer-free comparison populations, and long-term follow-up. Our objective is to better characterize pelvic fracture and overall mortality risks in postmenopausal women participating in the Womens Health Initiative. METHODS: A total of 135 743 Womens Health Initiative participants aged 50 to 79 years enrolled from 40 US clinical centers from 1993 to 1998 who had entry Fracture Risk Assessment Tool scores were eligible. Outcomes included pelvic cancer diagnosis, pelvic fracture occurrence, and mortality. Cox proportional hazards regression models were used to examine associations of pelvic cancer and pelvic radiation with pelvic fracture and mortality risk. RESULTS: After 17.7 years (median) follow-up, 4451 pelvic cancers, 10 139 pelvic fractures, and 33 040 deaths occurred. In multivariable analyses, women with incident pelvic cancer, compared with women who remained pelvic cancer free, had higher pelvic fracture risk (hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43) and higher overall mortality risk (HR = 2.91, 95% CI = 2.77 to 3.05). Women with pelvic cancer treated with pelvic radiation, compared with women with pelvic cancer not treated with pelvic radiation, had higher pelvic fracture risk (HR = 1.98, 95% CI = 1.41 to 2.78) and higher overall mortality after pelvic cancer (HR = 1.32, 95% CI = 1.15 to 1.52). CONCLUSIONS: Postmenopausal women with pelvic cancer, especially those receiving pelvic radiation, are at higher pelvic fracture risk and higher overall mortality risk. As therapeutic advances have reduced cancer mortality, attention to and interventions for pelvic fracture prevention may be important in pelvic cancer survivors.

BackgroundHigher physical activity levels are associated with lower breast cancer-specific mortality. In addition, the metabolic syndrome is associated with higher breast cancer-specific mortality. Whether the physical activity association with breast cancer mortality is modified by number of metabolic syndrome components (cardiometabolic risk factors) in postmenopausal women with early-stage breast cancer remains unknown.MethodsCardiovascular risk factors included high waist circumference, hypertension, high cholesterol, and diabetes. Breast cancers were verified by medical record review. Mortality finding were enhanced by serial National Death Index queries. Cox proportional hazards regression models were used to estimate associations between baseline physical activity and subsequent breast cancer-specific and overall mortality following breast cancer diagnosis in Women's Health Initiative participants. These associations were examined after stratifying by cardiometabolic risk factor group.ResultsAmong 161,308 Women's Health Initiative (WHI) participants, 8543 breast cancers occurred after 9.5 years (median) follow-up in women, additionally with information on cardiometabolic risk factors and physical activity at entry. In multi-variable analyses, as measured from cancer diagnosis, higher physical activity levels were associated with lower all-cause mortality risk (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.78-0.95, trend P

The practice of completing a student evaluation of a professor's teaching effectiveness is a common experience among college students. Research of this practice can be found as early as the beginning part of last century. In recent years, a variety of web-based non-university approved tools are being utilized by students to communicate with their peers. The current study sought the correlation between three perceived factors: professors' ratings from a widely used external evaluation service, effects of the size of the institution within the same public university system, and the levels of difficulty of course content. The results indicated that students scored professors higher when they perceived the material to be accessible, with some academic challenge, and at a medium sized university. Limitations are noted and suggestions for further research are included.

BackgroundTriple-negative breast cancer (TNBC) has a high recurrence risk and poor clinical outcomes. Associations between metabolic syndrome (MetS) risk components and mortality in postmenopausal women with TNBC were examined in the Women's Health Initiative.MethodsFive hundred forty-four postmenopausal women were diagnosed with nonmetastatic TNBC. Baseline risk components included a high waist circumference (≥88 cm), high blood pressure, hypercholesterolemia, and diabetes. Groups were categorized by the number of MetS risk components: none, 1 or 2, or 3 or 4. Hazard ratios (HRs) and 95% confidence intervals (CIs) across groups were computed with multivariable adjusted Cox models. Outcomes included breast cancer-specific mortality and breast cancer overall mortality (breast cancer followed by death from any cause). Variables in the multivariable model included age at TNBC diagnosis; race/ethnicity; income; education; clinical/observational trial status; history of oral contraceptive, hormone, and/or statin use; cancer stage; and chemotherapy and/or radiation treatment status.ResultsOf the 544 participants with TNBC, 33% had no MetS risk components (n = 178), 59% had 1 or 2 risk components (n = 323), and 8% had 3 or 4 risk components (n = 43). After a median follow-up from diagnosis of 8.3 years, multivariable results showed that women with 3 or 4 risk components had a nonsignificantly higher risk of breast cancer mortality (HR, 2.05; 95% CI, 0.94-4.47 trend P = .114) and a significantly higher risk of overall mortality (HR, 2.13; 95% CI, 1.22-3.71; trend P = .006) versus women with 0 risk components.ConclusionsPostmenopausal women with TNBC and 3 or 4 MetS risk components have a nonsignificantly higher breast cancer mortality risk and a significantly higher overall mortality risk, likely because of negative influences of metabolic risk factors on several causes of death.

With aquifers around the world stressed by over-extraction, water managers are increasingly turning to managed aquifer recharge (MAR), directly replenishing groundwater resources through injection wells, recharge basins, or other approaches. While there has been progress in understanding the geological and infrastructure-related considerations to make MAR more effective, critical evaluations of its institutional design and implementation are limited. This study assesses MAR projects, using a case study of projects proposed by groundwater sustainability agencies (GSAs) in California to comply with the state's Sustainable Groundwater Management Act of 2014; these projects will almost double the number of MAR projects in the United States. We draw on content analysis of groundwater sustainability plans that propose these projects. We first assess the types of recharge projects proposed and the stated aims of the projects, to assess when and why agencies are turning to MAR as a solution. We find that recharge basins are by far the most common approach, and that GSAs hope these basins will improve water table levels, reduce subsidence, and improve water quality. We then analyze potential barriers to project implementation and assess the projects' ability to achieve the stated goals. Primary concerns identified include a potential lack of available water, a potentially challenging legal framework, and minimal consideration of funding and cumulative land needs. To conclude, we discuss broader considerations for ensuring that MAR is an effective water management tool.

This study examined life satisfaction of former gifted students who graduated from a gifted program in Vietnam 10 years ago. The authors surveyed adults in their mid- to late-20s to discover whether being identified as gifted during their high school years impacted their quality of life as adults. The research instrument that was used for this study was Flanagan's Quality of Life Scale (QoLS) translated into Vietnamese. The findings indicated that former gifted students achieved a high satisfaction of their life, and consistently across five domains: Physical and Material Well-being, Relations with other People, Social, Community, and Civic Activities, Personal Development and Fulfillment, and Recreation. There were no significant differences in terms of STEM and non-STEM professionals as well as gender. Implications of the cross-cultural validity of the QoLS and other QoL instruments used in a Vietnamese-speaking population are also discussed.

BackgroundInsulin resistance has been proposed as a mediator of the increased cancer incidence and mortality associated with obesity. However, prior studies included limited cancer deaths and had inconsistent findings. Therefore, we evaluated insulin resistance and cancer-specific and all-cause mortality in postmenopausal women participating in the Women's Health Initiative (WHI).MethodsEligible were a subsample of 22 837 WHI participants aged 50-79 years enrolled at 40 US clinical centers from 1993 to 1998 who had baseline fasting glucose and insulin levels. Baseline insulin resistance was measured by the homeostasis model assessment of insulin resistance (HOMA-IR). Cancers were verified by central medical record review and deaths verified by medical record and death certificate review enhanced by National Death Index queries. Cox proportional hazards regression models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific and all-cause mortality. All statistical tests were two-sided.ResultsDuring a median of 18.9 years of follow-up, 1820 cancer deaths and 7415 total deaths occurred. Higher HOMA-IR quartile was associated with higher cancer-specific mortality (Q4 vs Q1, HR = 1.26, 95% CI = 1.09 to 1.47; Ptrend = .003) and all-cause mortality (Q4 vs Q1, HR = 1.63, 95% CI = 1.51 to 1.76; Ptrend < .001). A sensitivity analysis for diabetes status did not change findings. Among women with body mass index less than 25 kg/m2, higher HOMA-IR quartile was associated with higher cancer mortality (Fine and Gray, P = .004).ConclusionsHigh insulin resistance, as measured by HOMA-IR, identifies postmenopausal women at higher risk for cancer-specific and all-cause mortality who could potentially benefit from early intervention.