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Status, a form of inequality based on esteem, respect, and honor, pervades social life but is poorly understood and underestimated in terms of significance. We offer a new look at status as a dynamic relationship between the shared views of others and the self that organizes behavior at the micro, meso, and macro levels of society. The status process is governed by a taken- for- granted sociocultural schema consisting of implicit norms for allocating status based on the perceived value of the individual to the group, as well as on historically changing status beliefs about what types of people are more worthy and competent than others. Status plays a role as a powerful motive for individual and group action and in the construction of durable patterns of inequality based on social differences such as race and gender. The pernicious effects of status processes can be mitigated by undermining status beliefs, stereotypes, and norms.

Background: In April 2016, the City of Chicago implemented an ordinance restricting the sale of all flavored (including menthol) tobacco products (FTPs), including electronic cigarettes, at retailers located within 500 feet of any public, private, or alternative elementary, middle ("primary"), or high ("secondary") school. We examined changes in retail availability of FTPs from before to after policy implementation among policy-affected retailers compared with retailers not subject to the policy. Method: Observational data were collected in June to September 2015 (Wave 1; pre-policy) and November to December 2016 (Wave 2; post-policy) from a panel of 194 randomly selected policy-area stores (located within 500 feet of a school), and a panel of 199 randomly selected comparison-area stores (located more than 500 feet from a school). Using generalized estimation equation regression, we assessed differences in FTP availability changes across study areas. Results: We observed a statistically significant policy effect on FTP availability (Area × Wave interaction, p<0.05); however, more than half of policy-area retailers continued to display at least one FTP after policy implementation (87.11% at Wave 1, 57.73% at Wave 2, p<0.05). Similar reductions were seen for the availability of flavored cigarillos/little cigars and menthol cigarettes, while policy effects varied across store types. Discussion: FTP availability reductions appear to be associated with policy implementation, but FTPs remained readily available at retailers subject to the policy. This study contributes to the evidence base indicating that policies with exclusions or exemptions for certain flavors, products, store types, or retailer locations have a limited effect on retail availability of FTPs.

The state takeover of schools in predominantly Black communities has not disrupted the racial subjugation of Black girls. Using proportional analyses and Detroit, Memphis, and New Orleans as research sites, we find that the takeover of school districts does not produce statistically weaker associations with the use of harsh disciplinary practices against Black girls. This finding is important in the context of education reform, as researchers begin to question the motives and outcomes of education reforms. Moreover, this study is important to literature that considers the civil rights that Black communities must forego for the promise of better schools. Finally, this finding is relevant to extant conversations in urban education, especially as those conversations consider the school-to-prison pipeline and disparate disciplinary outcomes for Black girls.

BackgroundAlthough the vaginal and urinary microbiomes have been increasingly well-characterized in health and disease, few have described the relationship between these neighboring environments. Elucidating this relationship has implications for understanding how manipulation of the vaginal microbiome may affect the urinary microbiome and treatment of common urinary conditions.ObjectiveTo describe the relationship between urinary and vaginal microbiomes using 16S rRNA gene sequencing. We hypothesized that the composition of the urinary and vaginal microbiomes would be significantly associated, with similarities in predominant taxa.Study designThis multicenter study collected vaginal swabs and catheterized urine samples from 186 women with mixed urinary incontinence enrolled in a parent study and 84 similarly aged controls. Investigators decided a priori that if vaginal and/or urinary microbiomes differed between continent and incontinent women, the groups would be analyzed separately; if similar, samples from continent and incontinent women would be pooled and analyzed together. A central laboratory sequenced variable regions 1-3 (v1-3) and characterized bacteria to the genus level. Operational taxonomic unit abundance was described for paired vaginal and urine samples. Pearson's correlation characterized the relationship between individual operational taxonomic units of paired samples. Canonical correlation analysis evaluated the association between clinical variables (including mixed urinary incontinence and control status) and vaginal and urinary operational taxonomic units, using the Canonical correlation analysis function in the Vegan package (R version 3.5). Linear discriminant analysis effect size was used to find taxa that discriminated between vaginal and urinary samples.ResultsUrinary and vaginal samples were collected from 212 women (mean age 53±11 years) and results from 197 paired samples were available for analysis. As operational taxonomic units in mixed urinary incontinence and control samples were related in canonical correlation analysis and since taxa did not discriminate between mixed urinary incontinence or controls in either vagina or urine, mixed urinary incontinence and control samples were pooled for further analysis. Canonical correlation analysis of vaginal and urinary samples indicated that that 60 of the 100 most abundant operational taxonomic units in the samples largely overlapped. Lactobacillus was the most abundant genus in both urine and vagina (contributing on average 53% to an individual's urine sample and 64% to an individual's vaginal sample) (Pearson correlation r=0.53). Although less abundant than Lactobacillus, other bacteria with high Pearson correlation coefficients also commonly found in vagina and urine included: Gardnerella (r=0.70), Prevotella (r=0.64), and Ureaplasma (r=0.50). Linear discriminant analysis effect size analysis identified Tepidimonas and Flavobacterium as bacteria that distinguished the urinary environment for both mixed urinary incontinence and controls as these bacteria were absent in the vagina (Tepidimonas effect size 2.38, P

ImportanceMixed urinary incontinence, including both stress and urgency incontinence, has adverse effects on a woman's quality of life. Studies evaluating treatments to simultaneously improve both components are lacking.ObjectiveTo determine whether combining behavioral and pelvic floor muscle therapy with midurethral sling is more effective than sling alone for improving mixed urinary incontinence symptoms.Design, setting, and participantsRandomized clinical trial involving women 21 years or older with moderate or severe stress and urgency urinary incontinence symptoms for at least 3 months, and at least 1 stress and 1 urgency incontinence episode on a 3-day bladder diary. The trial was conducted across 9 sites in the United States, enrollment between October 2013 and April 2016; final follow-up October 2017.InterventionsBehavioral and pelvic floor muscle therapy (included 1 preoperative and 5 postoperative sessions through 6 months) combined with midurethral sling (n = 209) vs sling alone (n = 207).Main outcomes and measuresThe primary outcome was change between baseline and 12 months in mixed incontinence symptoms measured by the Urogenital Distress Inventory (UDI) long form; range, 0 to 300 points; minimal clinically important difference, 35 points, with higher scores indicating worse symptoms.ResultsAmong 480 women randomized (mean [SD] age, 54.0 years [10.7]), 464 were eligible and 416 (86.7%) had postbaseline outcome data and were included in primary analyses. The UDI score in the combined group significantly decreased from 178.0 points at baseline to 30.7 points at 12 months, adjusted mean change -128.1 points (95% CI, -146.5 to -109.8). The UDI score in the sling-only group significantly decreased from 176.8 to 34.5 points, adjusted mean change -114.7 points (95% CI, -133.3 to -96.2). The model-estimated between-group difference (-13.4 points; 95% CI, -25.9 to -1.0; P = .04) did not meet the minimal clinically important difference threshold. Related and unrelated serious adverse events occurred in 10.2% of the participants (8.7% combined and 11.8% sling only).Conclusions and relevanceAmong women with mixed urinary incontinence, behavioral and pelvic floor muscle therapy combined with midurethral sling surgery compared with surgery alone resulted in a small statistically significant difference in urinary incontinence symptoms at 12 months that did not meet the prespecified threshold for clinical importance.Trial registrationClinicalTrials.gov Identifier: NCT01959347.

Objective: To determine intervention needs and to gather stakeholder input regarding healthy eating promotion for youth members served at a Boys & Girls Club in Rochester, Minnesota. Design: Mixed-methods design informed by community-based participatory research principles. Setting and Method: Young people completed a dietary habits questionnaire and height and weight measurements. Focus groups gathered stakeholder -- Boys & Girls Club members, staff, caregivers -- perspectives on opportunities to improve children's healthy eating through the club setting. Content analysis identified major themes in informants' accounts. Results: Participants identified individual and environmental barriers to healthy eating and opportunities to reduce barriers at this Boys & Girls Club site. Few children met basic nutritional guidelines related to fruit, vegetable, milk and water consumption, and limiting consumption of sugar-sweetened beverages, and nearly half were overweight/obese. Stakeholders expressed interest in healthy eating promotion and identified multiple individual-level, interpersonal and environmental opportunities to promote healthier eating through the Boys & Girls Club site. Conclusion: Findings build on a growing literature indicating afterschool programmes are uniquely positioned to address health disparities related to paediatric nutrition and obesity, and can be used to inform the design of a multi-layered intervention to address the complexities influencing dietary quality and obesity among diverse and underserved youth.

Background: Prevalence and consequences of obesity and sedentary lifestyle are well-documented public health concerns for youth in the United States of America (USA) that disproportionally affect children from low income and minority families. Objective: This mixed-method study focused on estimating levels of physical activity and sedentary behavior and prevalence of overweight and obesity among the child members served in one Boys & Girls Club in the Midwest USA. We aimed to better understand opportunities for improving children's engagement in physical activity through focus groups with members, staff, and parents/caregivers of members. Method: Social cognitive learning theory, the ecological model of health behavior, and community based participatory research principles provided the study framework. Members completed assessments of physical activity, sedentary activity, height, and weight. Focus groups with members, staff, and parents/caregivers identified barriers, facilitators, and opportunities for promoting physical activity. Results: Nearly 50% of members were overweight or obese. Most (87%) participants reported at least 60 min physical activity every day across the 3-day recall. Fewer than half (41%) reported 2 h or less of sedentary screen time every day across the 3 day recall. Focus group themes identified opportunities for addressing needs associated with health disparities in physical activity and pediatric obesity. Conclusions: Findings suggest stakeholder interest in physical activity promotion through afterschool programs. We discuss study implications regarding needs specific to individuals from diverse, low-income households that may not be adequately addressed with existing empirically-supported treatments and opportunities to address health disparities in physical activity and pediatric obesity through afterschool programs.

INTRODUCTION & HYPOTHESIS:Previous studies have suggested that women with urinary incontinence have an altered urinary microbiome. We hypothesized that the microbiome in women with mixed urinary incontinence (MUI) differed from controls and tested this hypothesis using bacterial gene sequencing techniques. METHODS:This multicenter study compared the urinary microbiome in women with MUI and similarly aged controls. Catheterized urine samples were obtained; v4-6 regions of the 16S rRNA gene were sequenced to identify bacteria. Bacterial predominance (> 50% of an individual's genera) was compared between MUI and controls. Bacterial sequences were categorized into "community types" using Dirichlet multinomial mixture (DMM) methods. Generalized linear mixed models predicted MUI/control status based on clinical characteristics and community type. Post-hoc analyses were performed in women < 51 and ≥ 51 years. Sample size estimates required 200 samples to detect a 20% difference in Lactobacillus predominance with P

Introduction and hypothesisWe describe the rationale and methods of a study designed to compare vaginal and urinary microbiomes in women with mixed urinary incontinence (MUI) and similarly aged, asymptomatic controls.MethodsThis paper delineates the methodology of a supplementary microbiome study nested in an ongoing randomized controlled trial comparing a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone for MUI. Women in the parent study had at least "moderate bother" from urgency and stress urinary incontinence symptoms (SUI) on validated questionnaire and confirmed MUI on bladder diary. Controls had no incontinence symptoms. All participants underwent vaginal and urine collection for DNA analysis and conventional urine culture. Standardized protocols were designed, and a central lab received samples for subsequent polymerase chain reaction (PCR) amplification and sequencing of the bacterial16S ribosomal RNA (rRNA) gene. The composition of bacterial communities will be determined by dual amplicon sequencing of variable regions 1-3 and 4-6 from vaginal and urine specimens to compare the microbiome of patients with controls. Sample-size estimates determined that 126 MUI and 84 control participants were sufficient to detect a 20 % difference in predominant urinary genera, with 80 % power and 0.05 significance level.ResultsSpecimen collection commenced January 2015 and finished April 2016. DNA was extracted and stored for subsequent evaluation.ConclusionsMethods papers sharing information regarding development of genitourinary microbiome studies, particularly with control populations, are few. We describe the rigorous methodology developed for a novel urogenital microbiome study in women with MUI.

This paper is written in response to Alberto J. Rodriguez and Deb Morrison's article entitled, "Expanding and Enacting Transformative Meanings of Equity, Diversity and Social Justice in Science Education." The authors provide a historical account of science education social justice research efforts within the USA and support the need to more critically incorporate social justice research agendas in science education. They summarize four main rationales used in science education research for engaging in equity, diversity and social justice: the economic, moral, demographic shift, and sociotransformative arguments. The authors remind researchers to consider systems of power and privilege when advocating for marginalized people, arguing that social justice should be embodied by the researcher and constantly be enacted within their work. The authors question why few have taken up social justice science education research. This paper expands on these authors' arguments by offering a critical race analysis of the social justice construct in science education research. I conclude with suggesting the need to deconstruct whiteness within social justice science education research agendas. [This review essay addresses issues raised in Alberto J. Rodriguez and Deb Morrison's paper entitled: "Expanding and Enacting Transformative Meanings of Equity, Diversity and Social Justice in Science Education" (EJ1218538).]

In this paper we build a conceptual framework to argue for culturally compelling instruction that leads to teaching for change. Culturally compelling instruction calls for a substantive shift in how teachers view their students, communities, and what the perspective might mean for students' future when they have access to alternative learning opportunities. The framework encourages teachers to take a stance and assume responsibility and ownership for their own decisions about the curriculum and instructional delivery. Most prominent is to acquire a depth of understanding of their students' identities and needs. To represent our vision for culturally compelling instruction we use the lead poisoned water crisis in Flint, Michigan, USA as an illustrative case. Our work provides an example of how a real-world circumstance such as Flint's may be integrated into content area subjects to frame a culturally compelling instructional practice.

Introduction and hypothesisMixed urinary incontinence (MUI) can be a challenging condition to manage. We describe the protocol design and rationale for the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) trial, designed to compare a combined conservative and surgical treatment approach versus surgery alone for improving patient-centered MUI outcomes at 12 months.MethodsESTEEM is a multisite, prospective, randomized trial of female participants with MUI randomized to a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone. We describe our methods and four challenges encountered during the design phase: defining the study population, selecting relevant patient-centered outcomes, determining sample size estimates using a patient-reported outcome measure, and designing an analysis plan that accommodates MUI failure rates. A central theme in the design was patient centeredness, which guided many key decisions. Our primary outcome is patient-reported MUI symptoms measured using the Urogenital Distress Inventory (UDI) score at 12 months. Secondary outcomes include quality of life, sexual function, cost-effectiveness, time to failure, and need for additional treatment.ResultsThe final study design was implemented in November 2013 across eight clinical sites in the Pelvic Floor Disorders Network. As of 27 February 2016, 433 total/472 targeted participants had been randomized.ConclusionsWe describe the ESTEEM protocol and our methods for reaching consensus for methodological challenges in designing a trial for MUI by maintaining the patient perspective at the core of key decisions. This trial will provide information that can directly impact patient care and clinical decision making.

In the United States, Response to Intervention (RtI) is used to promote the use of evidence-based instruction in educational institutions, with the goal of supporting general and specialized educators and enabling these professionals to work together in a comprehensive, integrated manner. In doing so, RtI provides a protocol for identifying students with specific academic deficits and who demonstrate the need for individualized forms of instruction. Specifically, professional educators utilize quantitative data accumulated from common student assessment scores, which is thought to reflect a student's response to instruction in the general classroom, in addition to his or her response to more targeted forms of intervention. This article presents a conceptual overview of RtI and discusses key dimensions most salient to its development and implementation within the United States, while carefully reviewing the research supporting the effectiveness of this multi-tiered framework. As RtI gains prominence in other countries, this article serves to educate others on what may well become a more universal response to intervention.