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Over recent decades, the demographic composition of children in the United States has rapidly shifted, culturally and linguistically. Concomitantly, there has been an increased need for early childhood education (ECE) teacher preparation programs to develop a culturally competent ECE workforce who are equipped to provide equitable learning experiences for culturally and linguistically diverse children and families. Given increasing attention and calls from education researchers, policymakers, and other partners to develop a culturally competent ECE workforce, the current study sought to explore program faculty's cultural competence, specifically their culturally and linguistically responsive (CLR) teaching practices, and its association with feelings of work burnout and perceived teaching efficacy – two factors likely to be influenced by such heightening demands and to impact pre-service teachers' own teaching competencies. Using structural equation modeling, the current study examined survey responses from 117 program faculty measuring their cultural competence and its association with feelings of work burnout and teaching efficacy. Analyses indicated that, overall, program faculty with higher levels of cultural competence reported minimal feelings of work burnout and higher teaching efficacy, and vice versa. Findings from the current study provide important research and practice strategies for the field of ECE teacher preparation. [ABSTRACT FROM AUTHOR]

The health burden due to mental health has historically been underestimated with focus on communicable diseases and deaths and little consideration of disability and comorbidity effects of poor mental health. Recent data show increasing trends of mental health disorders as a share of global health burdens and vulnerability of adolescents. This paper aims to explore social determinants of mental health as experienced by adolescent girls, drawing attention to gendered risks during the COVID-19 pandemic. Semi-structured interviews with twenty-two adolescent girls in urban informal settlements in Kenya and Nigeria reveal unique environmental, socio-cultural, economic and educational factors that threatened their mental wellbeing. The pandemic exacerbated these determinants. An equitable recovery will require a consideration of not only disproportional mental health outcomes, but also social determinants that contribute to these outcomes. As more than half of the urban population in sub-Saharan Africa reside in informal settlements, this study has implications for youth-focused mental health interventions in these and similar settings. [ABSTRACT FROM AUTHOR]

Migrant and Seasonal Head Start (MSHS) is a Head Start program which serves exclusively young children from the migrant farmworker community, the majority of whom are Mexican nationals and second-generation immigrants. From this early childhood context, little is known about parents' perspectives on education and the roles they take to engage in their children's education. For this inquiry, 14 in-depth interviews were conducted with migrant farmworker parents. Key findings highlight the importance of language identity and language loss in young children, cultural practices around child rearing and the roles of adults, and education for social mobility. [ABSTRACT FROM AUTHOR]

This paper describes how training school and clinical psychology graduate students in early childhood mental health consultation (ECMHC) has the potential to fill gaps in the ECMHC workforce, enhance the capacity of early care and education (ECE) providers to effectively support the mental health needs of children and families, and help ECE programs provide equitable services to children and families. We first present the need for explicit ECMHC training in school and clinical psychology doctoral programs, and how didactic coursework and practica could align with national competencies for high-quality ECMHC. We then illustrate how graduate programs might aspire to greater impact by 1) shifting to promotion and prevention, systems- and organizational-based practice orientations, and equity and cultural competence principles; and 2) leveraging ECE programming to infuse ECMHC practice. We conclude with a call to action for graduate programs to address this need for mental health professionals with specialized ECMHC competencies. [ABSTRACT FROM AUTHOR]

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In the United States, migrant and seasonal farmworkers mostly of Latino origin work seasonal jobs on large scale farms. Because many of these jobs are temporary, farmworkers often move frequently across state lines and international borders to follow the work in agriculture. Many farmworkers travel with families including young children and one challenge of this population is stable child care and access to education services for their children. Migrant and Seasonal Head Start program (MSHS), a branch of Head Start, provides seasonal childcare and early childhood education services to young children of migrant and seasonal farmworkers ages birth through 5. This case study explored how MSHS operates seasonal programs for farmworkers children and examines the ways in which educators provide consistency in care for farmworker children. Specifically, the study focused on bilingual and bicultural programing, mobility of teachers, consistency in care, and teachers' knowledge of the program and farmworker community. [ABSTRACT FROM AUTHOR]

Gender norms, roles and relations differentially affect women, men, and non-binary individuals' vulnerability to disease. Outbreak response measures also have immediate and long-term gendered effects. However, gender-based analysis of outbreaks and responses is limited by lack of data and little integration of feminist analysis within global health scholarship. Recognising these barriers, this paper applies a gender matrix methodology, grounded in feminist political economy approaches, to evaluate the gendered effects of the COVID-19 pandemic and response in four case studies: China, Hong Kong, Canada, and the UK. Through a rapid scoping of documentation of the gendered effects of the outbreak, it applies the matrix framework to analyse findings, identifying common themes across the case studies: financial discrimination, crisis in care, and unequal risks and secondary effects. Results point to transnational structural conditions which put women on the front lines of the pandemic at work and at home while denying them health, economic and personal security – effects that are exacerbated where racism and other forms of discrimination intersect with gender inequities. Given that women and people living at the intersections of multiple inequities are made additionally vulnerable by pandemic responses, intersectional feminist responses should be prioritised at the beginning of any crises. [ABSTRACT FROM AUTHOR]

Purpose: Food insecurity, which leads to adverse health outcomes, has even more severe implications for cancer patients. Yet medically underserved cancer patients are more likely to be food insecure than the general population. Methods: This study is a cross-sectional analysis of intake data from patients who participated in the Integrated Cancer Care Access Network (ICCAN). ICCAN is a specialized program that addresses socioeconomic barriers to cancer care among underserved cancer patients in NYC. This study utilized ICCAN data from 2011 to 2017. The USDA food insecurity score, self-reported SNAP receipt, and SNAP eligibility based on household income were compared between SNAP and non-SNAP recipients. Results: 681 patients were assessed for food insecurity. Sixty-nine percent of participants lived in food insecure households. Despite SNAP assistance, most SNAP recipients (68%) were food insecure; 69% of respondents who did not receive SNAP were also food insecure. Conclusions: Underserved cancer patients who receive SNAP are still food insecure, hence at more significant risk for its associated negative outcomes. Supplemental programs for patients with chronic diseases are needed in clinics with large low income populations. SNAP benefits should account for the additional financial burden posed by treatment costs and exceptional circumstances faced by cancer patients. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate if the risk of fetal distress during term labor is related to the intrapartum maternal hemoglobin (Hb) level. Second, we investigated the relation between mode of delivery, reason for instrumental delivery and short-term neonatal outcome and maternal Hb. Third, we aimed to identify factors influencing intrapartum maternal Hb level.Methods: A retrospective cohort study was performed in a tertiary hospital in The Netherlands, including data from women who gave birth between 2009 and 2016. To determine whether the likelihood of fetal distress to occur was dependent on intrapartum Hb, multivariate regression models were run with intrapartum Hb as the main independent variable of interest. Hb was used as a continuous value. We repeated this procedure for the likelihood of instrumental vaginal delivery (IVD), cesarean section (CS), 5-min Apgar score < 7, and umbilical cord arterial pH ≤ 7.05 to occur. Also, we identified factors influencing intrapartum Hb level using linear regression analysis.Results: Data of 9144 patients were analyzed. Intrapartum Hb did not contribute to the prediction of the likelihood of fetal distress, IVD for nonprogressive labor, CS for fetal condition, 5-min Apgar score < 7, and pHa ≤ 7.05. However, there was a unique statistically significant contribution of Hb to the prediction of the likelihood of IVD for any reason and IVD for fetal distress and CS for any reason and CS for nonprogressive labor. IVD for fetal distress was related to a higher intrapartum Hb level, whereas CS for nonprogressive labor was related to a lower intrapartum Hb level. Intrapartum Hb level was influenced by maternal age, ethnicity, parity, fetal sex, and birth weight.Conclusions: The risk of fetal distress and adverse neonatal outcome is not related to intrapartum Hb levels. However, our data suggest that mode of delivery is dependent on intrapartum Hb, as shown in a large tertiary population. We recommend further investigating this relation in a large prospective study. [ABSTRACT FROM AUTHOR]

While debates continue about China's role in sub-Saharan Africa, there is growing consensus that China is a different kind of development partner. One distinct feature of Chinese partnerships is that they include support for the tobacco industry, a sector other donor states and institutions shun. Not only is tobacco a primary agricultural export in a number of Africa states, the state-owned Chinese National Tobacco Corporation is the largest tobacco company in the world. This paper analyses Chinese support for the tobacco industry in three states – Zimbabwe, Malawi and Zambia – documenting how co-operation is shaped by Chinese state capitalism and assessing the development and governance implications. Following an introduction situating the analysis within the context of China–Africa co-operation and tobacco's global value chain, Chinese engagement in each country is analysed. Findings indicate that, despite differences across case studies in terms of development outcomes, common governance implications are apparent. African elites initiated tobacco-related co-operation to meet their interests, but Chinese interests dominated implementation. Consequently, Chinese investments have maintained hierarchal governance of an exploitive and harmful industry. Analyses of Chinese African co-operation need to move beyond public–private paradigms and interrogate the nuances of Chinese state capitalism in Africa. [ABSTRACT FROM AUTHOR]

A labor force of migrant farmworkers, mostly of Latino origin, largely support the agriculture industry in the US. While migrant labor is essential in the modern food system, food insecurity remains high among migrant farmworkers. Presented are the results from a survey on food insecurity, access, and farm to preschool involving 32 farmworker parents attending a national meeting as policy council representatives and affiliates for the Migrant and Seasonal Head Start program. This inquiry underscores problem of food insecurity and access in the farmworker population while suggesting parent activism, food justice, and farm to preschool could potentially address such issues. [ABSTRACT FROM AUTHOR]

Organised crime is becoming increasingly sophisticated and pervasive. Responding effectively to the dynamic and multifaceted nature of organised criminal activity is challenging. Law enforcement agencies need to find new and innovative ways to meet the demands of an ever-increasing and complex workload. Targeting resources is essential if the associated cost of organised crime is to be contained. This paper outlines a novel approach for ranking offenders specifically within the field of organised crime, in terms of investigative priority. Thirteen key people involved in the investigation of organised crime in New Zealand were brought together for a one-day workshop. Prior to attending the workshop participants were asked to rank 12 hypothetical offender profiles in terms of investigative priority. The rankings were used to stimulate discussion on the major issues relating to organised crime. As a result, six criteria were identified, and a discrete choice experiment was completed by consensus to determine the relative importance of the criteria. Community harm was considered the most important criterion (0.26), followed by corruption or infiltration (0.17), geographical influence (0.16), convertible assets (0.15), capability (0.14) and criminal influence (0.12). Fifty front-line investigators subsequently completed the experiment online, and the relative weights were found to be similar to those from the workshop. To assess the practicability of the weights, 10 known high-risk offenders were categorised and ranked using the weighted criteria from the workshop. Senior staff involved in the investigation of these offenders agreed that the resulting ranking of offenders aligned with their personal judgement. [ABSTRACT FROM AUTHOR]

Purpose: Examine the impact of traumatic brain injury (TBI) on parenting behavior over time. Method: Included 206 children (3–7 years old) with moderate to severe TBI or orthopedic injury, using a prospective longitudinal cohort study design. Assessments completed at baseline, 6-months, 12-months, 18-months, 3.5 years, and 6.8 years after injury. Dependent variables included authoritative, permissive, and authoritarian parenting. Results: Injury characteristics had limited impact on parenting behaviors over time. Levels of authoritative parenting remained stable over time; however, levels of warmth and involvement declined over time for those with TBI. Levels of permissive and authoritarian parenting declined for all participants by 3.5 years post injury. SES and stressors impacted parenting behaviors. Conclusions: While there was limited effect of TBI on parenting behavior over time, it remains unclear how individuals respond to these parenting behaviors years after injury. Clinicians should monitor family and parenting behaviors to foster an environment to promote positive recovery. [ABSTRACT FROM AUTHOR]

In the current research, we report on a peer feedback system for supporting student teamwork skill development during post-secondary education. The peer feedback system is part of a larger suite of assessments at ITPmetrics.com. This is a free assessment-based system that allows team members to provide round-robin ratings of each member's effectiveness in the team on five dimensions (communication; commitment; foundation of knowledge, skills and abilities; emphasising high standards; and focus), as well as provide anonymous written feedback to supplement the numeric scores. Team members have access to a dashboard where they can complete the assessment and store assessment reports generated from their peers' ratings. We summarise data from student learning teams suggesting that peer ratings are reliable (internally consistent, unidimensional and inter-rater correlated; n > 85,000). Recommendations for implementation are provided with respect to pre-briefing, debriefing, and assessment schedules. [ABSTRACT FROM AUTHOR]

This article contributes to discussions on the gender dimensions of disease outbreaks, and preparedness policies and responses, by providing a multi-level analysis of gender-related gaps, particularly illustrating how the failure to challenge gender assumptions and incorporate gender as a priority at the global level has national and local impacts. The implications of neglecting gender dynamics, as well as the potential of equity-based approaches to disease outbreak responses, is illustrated through a case study of the Social Enterprise Network for Development (SEND) Sierra Leone, a non-government organisation (NGO) based in Kailahun, during the Ebola outbreak. [ABSTRACT FROM AUTHOR]

This study is an ethnographic case study that focuses on three family members from Mexican migrant farmworker households (a father, a grandmother, and mother), their discussions around the topic of educating their children, and their engagement in the seasonal early childcare programs that serve farmworker children. This study takes a sociocultural perspective to examine parental lessons in the home, views of institutionalized education, and the role of beliefs, identity, and life experience that contribute to the early years of a child's education. This study address gaps in the research related to migrant farmworker families with young children in early childhood education programs. [ABSTRACT FROM AUTHOR]

This article examines three popular renditions of female flight attendants in Canada and the United States in teen fiction, film, and advertising, with attention to representational shifts from the 1940s to the 1970s. Our analysis demonstrates that the more sexualized image of the 1960s was a significant departure from the more complicated immediate postwar presentation of the flight attendant as a resourceful and capable career girl, albeit one still constrained by dominant notions of white, middle-class femininity. Created by management decisions in the face of increased capitalist competition, in concert with the influence of popular culture and gender ideology, the sexy stewardess altered the workplace environment for female flight attendants, but the legacy of earlier popular culture may well have aided their resistance to sexualization. [ABSTRACT FROM AUTHOR]

Evening dosing of antihypertensive medications lowers nighttime blood pressure, and in one large randomized trial, it reduced the risk for cardiovascular outcomes. However, the feasibility of nighttime dosing in routine clinical practice is unknown. The purpose of this pilot study was to evaluate the effect of a brief pharmacist intervention to assign patients to take antihypertensive medications at specific times of the day. In this pilot, randomized controlled trial, 79 patients with moderate to severe chronic kidney disease (CKD) taking one or more antihypertensive medications once daily were randomized to take one once-daily antihypertensive either in the morning or in the evening. A total of 79 patients were randomized (39 to morning dosing, 40 to evening dosing). Average (SD) age was 56.5 (14) years, 68% were male, and average (SD) estimated glomerular filtration rate (eGFR) was 36.6 (8.9) mL/min/1.73m2. Adherence, defined as taking the once-daily medication at the time indicated six or seven times in the last 7 days and not taking it at any other time during the day, was 91% in the morning arm and 95% in the evening arm (p = 0.57). This pilot demonstrates the feasibility and efficacy of a pharmacist-physician collaborative to assign once-daily antihypertensive medications to either morning or evening dosing. [ABSTRACT FROM AUTHOR]

In the current research, we introduce the team CARE model for supporting team development during post-secondary education. Team CARE is part of a larger suite of assessments at itpmetrics.com. Team CARE is a free, online, survey-based assessment that allows team members to rate their team's health and functioning in four key categories (communicate, adapt, relate and educate), as well as provide written feedback about the team's functioning to add nuance and supplemental context to the numeric scores. Team members completing the assessment receive a report documenting their team's scores on the variables measured. We report on data from student learning teams suggesting that the variables in the team CARE model are reliable, and that they are correlated with team performance outcomes. Students' perceptions of the tool were also examined, and the findings suggest that team CARE is perceived to be valuable, useful and easy to use. Recommendations for practice are detailed, including sample assessment schedules for teams with differing life spans. Implications for future research and implementation are discussed. [ABSTRACT FROM AUTHOR]

Objective: A campus-wide assessment examined the physical and mental health status of a midsize midwestern public university. Participants: Two thousand and forty-nine students, faculty, and staff on a single college campus were assessed in March–April 2013. Methods: Participants completed an online survey with sections devoted to demographics, physical and mental health status, and suicide knowledge and experiences. Results: This study captured broad physical and mental health indicators. Students, faculty, and staff in certain demographic groups were more likely to report significant problems associated with mental and physical health. Specifically, women, faculty and staff of color, and nonheterosexual persons reported worse health outcomes. Across 8 mental health indicators, students reported consistently worse mental health than their faculty/staff counterparts. Conclusions: This paper presents findings from a significant campus-wide physical and mental health surveillance initiative. Results indicate the need for targeted physical and mental health support and intervention among these demographic groups. [ABSTRACT FROM AUTHOR]

Context: There is insufficient knowledge about the chondrocyte membranome and its molecular composition. Objective: To develop a Triton X-114 based separation technique using nanoLC-MS/MS combined with shotgun proteomics to identify chondrocyte membrane proteins. Materials and methods: Articular chondrocytes from equine metacarpophalangeal joints were separated into hydrophobic and hydrophilic fractions; trypsin-digested proteins were analysed by nanoLC-MS/MS. Results: A total of 315 proteins were identified. The phase extraction method yielded a high proportion of membrane proteins (56%) including CD276, S100-A6 and three VDAC isoforms. Discussion: Defining the chondrocyte membranome is likely to reveal new biomarker targets for conventional and biological drug discovery. [ABSTRACT FROM AUTHOR]

Background:In the Venezuelan high Andes, wheat cultivation on steep slopes since colonial times has caused the degradation of extensive areas. After several decades of abandonment, natural succession has not allowed the spontaneous recovery of the original alpine vegetation. Aims:Our aim was to identify a degradation gradient, based on vegetation structure, and relate this gradient to different environmental factors (grazing intensity, physical soil degradation, distance to seed sources and loss of soil fertility) that could be preventing spontaneous succession. Methods:Vegetation structure and 22 environmental variables were sampled on 92 slopes with different degrees of degradation. Multivariate statistics were used to relate the state of the vegetation to environmental factors. Results:Six types of vegetation were identified and ranked along a degradation gradient. Several soil properties, for example C, N, clay content and cation-exchange capacity, decreased by as much as 50% along this gradient, while other variables, such as current grazing intensity were only slightly correlated to the degradation gradient. Conclusions:Vegetation and soil properties were clearly related to a strong degradation gradient, caused by former wheat cultivation and overgrazing, with symptoms of desertification. Restoration practices have to be directed towards re-establishing soil organic matter and its functional role in regulating water balance and nutrient cycling. [ABSTRACT FROM AUTHOR]

Background A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs).Objectives(a) To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideline concordant management and (b) to assess whether management varied by patient and provider factors. Research design Secondary analysis of electronic and paper medical record information of 400 AN/AIs. Measures Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors. Results A depression diagnosis was present in 141 (35%) charts and 151 (38%) had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001). In total, 258 patients (66%) received guideline concordant management, 32 (8%) had some management, and 110 (28%) received no management. Younger patient age and increased provider tenure increased odds of management. Conclusions Most AN/AIs screening positive for depression received initial guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted. [ABSTRACT FROM AUTHOR]

The article provides an analysis of the "rhetorical chorus" as a useful method for recovering women's voices in the history of rhetoric. Topics discussed include homophonic and polyphonic relationships between the lead voice of Margery Kempe, English Christian mystic, how the manuscripts allow for the entrance of multiple authors and their rhetorical agendas, and historical context of Margery Kempe and her manuscript.

This article provides a critical perspective on global health initiatives (GHIs) in response to HIV/AIDS in post-conflict African countries. Focusing on the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief and UN bodies, it argues that many global health initiatives lack consideration of the complexities of addressing HIV/AIDS in post-conflict contexts. It finds that prevention programmes fail to prioritize the population groups who are at high risk; that treatment and care interventions are shaped by an emergency aid paradigm, which does not ensure ongoing well-being for people living with HIV/AIDS; and that global health initiatives often impede the capacity of local governance and health systems. Given that global health initiatives have yet to fully engage with the challenges of implementing HIV/AIDS interventions in conflict-affected African contexts, the article concludes by proposing recommendations in this regard. [ABSTRACT FROM PUBLISHER]

Background. Recent reports indicate a decline in rates of Fetal Alcohol Syndrome (FAS) among Alaska Native and American Indian (AN/AI) infants. Nevertheless, AN/AI infants remain disproportionately impacted by the effects of prenatal alcohol exposure. Methods. AN/AI pregnant women in their 3rd trimester completed a questionnaire on demographic data and the amount and frequency of their alcohol consumption in the month prior to conception and during pregnancy. Differences across demographics and trimesters were tested with the Chi-square, Fisher's exact or McNemar's test as appropriate. Results. Of the 125 participants, 56% (n-71) reported no alcohol consumption in the 1st through 3rd trimesters of pregnancy; 30% (n-38) of the 125 participants also reported no alcohol consumption in the month before pregnancy. Of the 43% (n-54) who reported consuming alcohol during pregnancy (1st, 2nd and/or 3rd trimester), most (35%) reported alcohol use only in the 1st trimester. Binge drinking in the 1st or 2nd trimester was reported amongst 20% (n-25) of participants with an additional 18% (n-29) reporting binge drinking in the month prior to pregnancy. Women who reported pre-conception binge drinking were significantly more likely to report binge drinking during their 1st trimester (p<0.0001) and 2nd trimester (p<0.0001). A history of tobacco use (p-0.0403) and cigarette smoking during pregnancy (p<0.0001) were also associated with binge drinking during pregnancy. Conclusion. Among study participants, reported use of alcohol was primarily limited to pre-conception and the 1st trimester, with a dramatic decrease in the 2nd and 3rd trimesters. Prevention programmes, such as the Alaska FAS Prevention Project, may have contributed to observed decreases in the 2nd and 3rd trimesters. Additional study and focus on pre-conception, the 1st trimester and binge drinking, as well as tobacco use might augment Fetal Alcohol Spectrum Disorder prevention efforts. [ABSTRACT FROM AUTHOR]

Background. Between 1995 and 1998, tribally owned Southcentral Foundation (SCF) incrementally assumed responsibility from the Indian Health Service (IHS) for primary care services on the Alaska Native Medical Center (ANMC) campus in Anchorage, Alaska. In 1999, SCF began implementing components of a Patient- Centered Medical Home (PCMH) model to improve access and continuity of care. Objective. To evaluate hospitalisation trends before, during and after PCMH implementation. Design. Time series analysis of aggregated medical record data. Methods. Regression analysis with correlated errors was used to estimate trends over time for the percent of customer-owners hospitalised overall and for specific conditions during 4 time periods (March 1996-July 1999: SCF assumes responsibility for primary care; August 1999-July 2000: PCMH implementation starts; August 2000-April 2005: early post-PCMH implementation; May 2005-December 2009: later post-PCMH implementation). Analysis was restricted to individuals residing in Southcentral Alaska and receiving health care at ANMC. Results. The percent of SCF customer-owners hospitalised per month for any reason was steady before and during PCMH implementation, declined steadily immediately following implementation and subsequently stabilised. The percent hospitalised per month for unintentional injury or poisoning also declined during and after the PCMH implementation. Among adult asthma patients, the percent hospitalised annually for asthma declined prior to and during implementation and remained lower thereafter. The percent of heart failure patients hospitalised annually for heart failure remained relatively constant throughout the study period while the percent of hypertension patients hospitalised for hypertension shifted higher between 1999 and 2002 compared to earlier and later years. Conclusion. Implementation of PCMH at SCF was accompanied by decreases in the percent of customerowners hospitalised monthly for any reason and for unintentional injury and in the percent of asthma patients hospitalised annually for asthma. Increased accessibility to empanelled care teams may have contributed to decreased need for hospitalisation. [ABSTRACT FROM AUTHOR]

Background. On July 12, 2010, Boston Medical Center (BMC), the busiest emergency department (ED) in Massachusetts, with more than 100,000 adult patient visits per year, consolidated its two fully functional EDs into one. In preparation for this consolidation, BMC implemented systems changes to mitigate potential negative effects on both BMC and emergency medical services (EMS) providers, including Boston Emergency Medical Services (Boston EMS), the provider of 9-1-1 EMS to the City of Boston. Objective. To examine the impact of the closure of an ED on an urban EMS system in a setting where ambulance diversion is not allowed. Methods. We performed a before-and-after study that examined the effects of an ED closure on BMC and Boston EMS. We examined ED and Boston EMS volumes and ambulance turnaround intervals from June 1, 2010, to July 11, 2010 (preclosure) as compared with July 12, 2010, to August 26, 2010 (postclosure). Mean ED and Boston EMS volumes and Boston EMS turnaround intervals were calculated in four-hour shifts. We used multivariate analysis to analyze electronic medical systems data from BMC and Boston EMS and linear regression. We used autoregressive integrated moving average (ARIMA) models to determine the effect of the ED closure on turnaround intervals, ED volumes, and transport volumes. All analyses were adjusted for shift, ED volume, day of the week, and citywide EMS transport volumes. Results. After ED closure, there was a statistically significant increase of 0.89 minutes (p == 0.02) in the mean EMS turnaround intervals. Additionally, the total ED volume decreased by 3.67 visits per shift (p < 0.001). The ratio of patients transported by Boston EMS to BMC remained unchanged (p == 0.11) for two weeks before and two weeks after the closure. Conclusions. The closure of one ED resulted in a statistically significant increase in turnaround intervals and a significant decrease in ED volume independent of EMS volumes. In the absence of ambulance diversion, ratios of EMS turnaround intervals and EMS volumes according to hospital destination can be used as alternatives to ambulance diversion times to examine the effects of system-level changes such as closure of an ED on an urban EMS system. Key words: emergency department; EMS system; closure; impact; consolidation [ABSTRACT FROM AUTHOR]

Employing pre-colonial Tunisia as a site, this article investigates ways of ‘making a living’ in an age of migrations. It studies occupations linked to the sea, such as fishing or coastal trading, that integrated North Africa and the nearby islands into trans-Mediterranean and larger exchange systems. It argues that subsistence migration increased the volume of extra-legal transactions whose nodal points were the Tunis region, the Cap Bon, Bizerte, Algeria and nearby islands. Estimates of the trade's volume or value, impossible to determine given the sources, are less important than charting dense flows of labour, goods, services and capital under-girding the political economy of contraband in relationship to labour migration. That the actors involved hailed from different religions, ethnic groups and classes renders this a perfect vantage point for probing inter-communal and intra-confessional relationships as well as the declining political fortunes of the Tunisian state. [ABSTRACT FROM PUBLISHER]

This study examined how infants' age, joint attention (JA) skills, caregiver ratings of language and temperament, and caregiver JA style related to JA in a structured literacy task with an augmentative and alternative communication (AAC) system. Sixteen infants (mean == 10.6 months) without disabilities participated in two storybook reading interactions with anexperimenter in two conditions where the AAC system was either aligned or divided from the experimenter's eye gaze. Individual differences in JA skills, caregiver JA style, and temperament were associated with coordinated JA across both conditions. The findings suggest it is important to examine both extrinsic and intrinsic factors, which may not only reduce attention demands but also mediate the success of JA interactions with AAC systems. [ABSTRACT FROM AUTHOR]

The idea that HIV and AIDS gets too much attention and funding emerged in 2008 with a call to end 'AIDS exceptionalism.' This article outlines a short history of AIDS exceptionalism — the idea that HIV and AIDS require a response above and beyond 'normal' health interventions and is privileged in terms of attention and resources when compared with other diseases — and the reasons for the backlash to this idea. We argue that in some settings HIV and AIDS must be treated as exceptional. These are the hyperendemic countries of southern Africa, where HIV epidemics have shown substantial and lasting demographic and social impact, and parts of Eastern Europe where the epidemic is augmenting troubling demographic changes, such as declines in fertility rates and population growth, and impacting society in nuanced ways. Also included are resource-poor settings, mostly in Africa, where the combination of the high number of HIV infections and the cost of treatment have created issues concerning donor dependency and sustainable responses. An HIV epidemic must be seen as a long-wave event, with complex challenges to both HIV prevention and treatment responses. The article reviews the available data and literature to provide evidence for our arguments. We conclude that the perception that AIDS exceptionalism is outdated ignores the complexity of different HIV epidemics and obfuscates the challenges to effective responses. [ABSTRACT FROM PUBLISHER]

This paper draws attention to the obligation and opportunity to respond to the mental health impacts of collective sexual violence (CSV) among genocide-rape survivors in post-genocide Rwanda. Qualitative data gathered from CSV survivors who were members of Rwandan women's genocide survivor associations are presented to illustrate how they strive to overcome adversity while seeking access to quality mental health care and using informal community mental health services. The results reveal that a system of high quality, holistic health and mental health care is yet needed to meet Rwandan CSV survivors' complex and serious health and mental health needs. Given that a rural health system, modelled on community-based, comprehensive HIV/AIDS care and treatment, is currently being implemented in Rwanda, we recommend enhancements to this model that would contribute to meeting the mental health care needs of CSV survivors while benefiting the health and mental health system as a whole within Rwanda. [ABSTRACT FROM AUTHOR]

Joint attention is critical for language development in children. Children with complex communication needs have additional challenges in managing their joint attention, and there is minimal information on how to reduce these demands. Sixteen infants without disabilities and their caregivers participated in a within-subjects design with two storybook reading interactions. In reading, the researcher either held a high-tech AAC system directly in front of herself (aligned with eye-gaze) or to the side (divided from eye-gaze). The frequency and duration of coordinated and passive joint attention episodes were analyzed. The aligned condition resulted in significantly greater frequency and duration of coordinated joint attention than passive joint attention in episodes involving the AAC system. Age was significantly related to frequency and duration of joint attention only in the aligned condition. Future directions and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

The authors examined the way that teachers perceive the academic abilities of young boys before the start of formal schooling. Using a 1998 nationally representative sample of 10,956 boys assessed at the start of kindergarten, the authors showed that teachers perceive young boys who are shorter than the perceived norm as less academically capable than are boys of average or above-average height. The findings help expand one's understanding of the way that children, and subsequently adults, use body image to view ability and performance. [ABSTRACT FROM AUTHOR]

The advantages of transformative learning approaches in graduate education parallel the tenets of mentoring and lifelong learning. Under this theoretical framework, adult student achievement in leadership programming can be assessed as a developmental and individualized process. The mixed methods study presented here illustrates that it is possible to measure knowledge construction, disposition development and performance acquisition from the classroom to leadership practice through taxonomy use. The purpose of the study is to use a standards‐based taxonomy to understand the effectiveness of an educational leadership graduate degree program of two student subgroups. Based on transformative and lifelong learning theories that emphasize understanding student learning processes, students’ holistic achievement is examined in order to identify differences in student subgroup learning outcomes. The taxonomical approach used to evaluate student achievement in this study is helpful in gaining a phenomenological perspective of learning processes when evaluating the appropriateness of program design, teaching methodology and program content. [ABSTRACT FROM AUTHOR]

This paper considers the case of the Michigan Migrant Head Start program to describe and analyze the labor market conditions and teaching staff characteristics to identify the challenges faced by Migrant Head Start grantees in attracting, hiring, retaining, and training degreed teachers. The emphasis is on describing and analyzing the child care labor market characteristics that confront Migrant Head Start grantees in upstream locations and on describing the characteristics and opinions of Migrant Head Start teachers and interpreting their significance for developing educational programs that facilitate the ability of Migrant Head Start teachers to become degreed in early childhood education. The implications of the findings for making early childhood education work for Migrant Head Start teachers are discussed from the perspective of administrators of Migrant Head Start programs and teacher preparation programs at community colleges and universities. [ABSTRACT FROM AUTHOR]

Middle school children in a northeastern city in the United States were surveyed to assess their nutrition knowledge and attitudes. Basic eating behaviors, specifically the number of meals eaten, were recorded and evaluated based on gender, nutritional knowledge, and attitudes toward nutrition. In this pilot study, children were asked about their beliefs about different foods for their nutritional value, their positive or negative attitudes about the food, their intentions of eating these foods, and what meals they ate or skipped. The results showed attitudes were significantly related with intentions, and nutritional beliefs were marginally related with attitudes, and, intentions were marginally related to meals eaten. In addition, the study revealed that girls skip breakfast significantly more often on weekdays than boys, but that the opposite occurs on the weekend when boys skip breakfast significantly more often than girls. [ABSTRACT FROM AUTHOR]

Presents a science experiment on using agarose electrophoresis techniques in identifying an unknown colored protein. Materials for the experiment; Safety precautions for students; Procedures.

The connection between high school courses and student knowledge on standardized tests has seldom been studied in social studies fields-and almost never on a nations! basis and with a wide range of statistical controls. We look at the relationship between course work in U.S. history and performance on the 1994 National Assessment of Educational Progress (utilizing the 1994 High School Transcript Study to measure course enrollments). We find that students who take more and higher-level course work, who reported greater emphasis on a broad array of historical topics, and who experienced more "active" instruction performed better on the NAEP test even after adjusting for numerous student and family characteristics. The findings provide support both for increasing the amount of history course work and for enlightened instructional practices. [ABSTRACT FROM AUTHOR]

The effectiveness of middle school transition programs on high school retention and student performance are explored in this study. From a nationally representative sample of public school students, results suggest that programs targeting a combination of students, parents, and school staff in assisting students to make this transition have a measured impact, even after accounting for student demographics, family characteristics, and student behavior. Further, there is some indication that the best results may be achieved in a combination of program commitment and other middle school characteristics focused on attaining a more personal adult commitment to student success. [ABSTRACT FROM AUTHOR]

Examines the relationship between personal and contextual characteristics and principals' administrative behaviors. Importance of the principal in providing effective leadership and supportive management in the school; Types of administrative behaviors; Leadership and management behaviors; Instructional leadership inventory (ILI) designed to use with principals and other school leaders.