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This quantitative study focuses on substance use professionals and students who are seeking employment in substance use treatment or support services. Abstinence-based treatment has been and continues to be the primary method of treatment preferred in the United States. Since 1980, harm reduction increased in application in the profession but remains a less popular method of treatment. This study examines substance use professionals and students (N = 141) interested in employment in substance use treatment or support attitudes in harm reduction and whether their beliefs toward these treatment approaches were associated with their personal characteristics. Goddard's Harm Reduction Acceptability Scale and a demographic survey form were utilized to measure the variables. One-way analysis of variance showed that current and aspiring substance use professionals have favorable attitudes toward harm reduction. The purpose of this study was to examine the attitudes in substance use treatment approaches by substance use professionals. Results revealed that the professionals have slightly more favorable attitudes toward the harm reduction treatment approach. [ABSTRACT FROM AUTHOR]

On June 24, 2022, the US Supreme Court decided in Dobbs vs. Jackson Women's Health Organization (597 U.S. (2022)) to overturn the constitutional right to abortion, a seismic shift in abortion policy that makes the states key battlegrounds in fights over abortion and broader reproductive rights. This article focuses on the role of state supreme courts in setting state abortion policies. Using an original data set of state court decisions surrounding abortion from the past 20 years, the authors investigate how two overarching factors affect state supreme court decision-making on abortion. First, they track how states' political environments affect the decisions courts make about access to abortion. Second, the authors consider the scope of the abortion policy considered by the courts. The authors find that the partisan makeup of state legislatures does not influence the direction of state supreme courts' rulings on abortion issues, but it does affect the scope of abortion regulation being considered by the courts. Additionally, they find that elected judges tend to be more responsive to constituent preferences when ruling on abortion policies. Overall, these findings illustrate the multifaceted dynamics involved in state supreme courts' rulings on abortion. [ABSTRACT FROM AUTHOR]

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Although there are many alternative schools that strive for the successful education of their students, negative images of alternative schools persist. While some alternative schools are viewed as "idealistic havens", many are viewed as "dumping grounds" or "juvenile detention centers". Employing narrative inquiry, this article interrogates how a student, Kevin Gonzales, experiences his alternative education and raises questions about the role of alternative schools. Kevin Gonzales's story is presented in a literary form of biographical journal to provide a "metaphoric loft" that helps us imagine other students like Kevin. This, in turn, provokes us to examine our current educational practice and (re)imagines ways in which alternative education can provide the best possible educational experiences for disenfranchised students who are increasingly underserved by the public education system. (Contains 4 notes and 2 figures.)

Using a unique setting of exogenous variations in non‐compete agreement (NCA) enforceability in the United States, we investigate whether companies strategically engage in corporate social responsibility (CSR) practices to retain employees. Using a difference‐in‐differences design, we find that an increase in the enforceability of NCAs deteriorates CSR performance. Cross‐sectional tests indicate that peer pressure affects CSR performance interactively with enforceability of NCAs. These findings demonstrate the unintended consequences of regulation and are consistent with the notion that firms strategically engage in CSR practices to retain employees, thereby reducing knowledge spillover associated with employee mobility. [ABSTRACT FROM AUTHOR]

The recent financial crisis has stimulated a renewed interest in understanding the determinants of stock price crash risk (i.e., left tail risk). Recent research shows that opaque financial reports enable managers to hide and accumulate bad news for extended periods. When the accumulated bad news reaches a certain tipping point, it will be suddenly released to the market at once, resulting in an abrupt decline in stock price (i.e., a crash). This study extends this line of research by examining the impact of financial reporting opacity on perceived or expected crash risk. Prominent economists, such as Olivier Blanchard, argue that removing the perception of tail risks (in addition to realized tail risks) is crucial in restoring investor confidence and stabilizing the stock market. Using the steepness of option implied volatility skew as a proxy for perceived crash risk, we find that accrual management, the presence of financial statement restatements, and auditor-attested internal control weakness are all positively and significantly associated with the level of perceived crash risk. Our results suggest that improving financial reporting transparency is an important mechanism for firms and policymakers to reduce the perception of tail risks and stabilize the stock market. [ABSTRACT FROM AUTHOR]

BACKGROUND: Individuals with hearing loss experience unique barriers to employment frequently documented in the areas of communication and education. The purpose of this article is to contribute to extend this inquiry to the uniqueness of workplace discrimination involving persons with hearing loss. OBJECTIVE: This study investigated differences in allegations of workplace discrimination filed by persons with hearing loss ("Hearing") compared to those filed by persons with other physical or neurological disabilities (General Disability, or "GENDIS") before and after the enactment of the 2008 Americans with Disabilities Act Amendments Act (2008 Amendments). METHODS: Using secondary data collected from the Equal Employment Opportunity Commission (EEOC) Integrated Mission System, we employ simple measures of proportion and odds ratios to describe differences between allegations derived from GENDIS and Hearing loss populations. These are population statistics, and not samples, of all allegations of discrimination reported to the EEOC through 2016. The comparisons involve Characteristics of the Charging Parties, Issues or discriminatory behaviors alleged, and closure statuses or Merit Rate of the EEOC's investigations – both before and after the 2008 Amendments. RESULTS: Following the 2008 Amendments, Charging Parties changed dramatically on age and gender status. Reasonable Accommodation, Hiring, Harassment, and employment Terms and Conditions showed unique features between groups and/or time periods. The "veracity" (confirmed truthfulness or merit) of the EEOC allegation (or Merit) rate also changed following the Amendments: higher for GENDIS; lower for Hearing. CONCLUSIONS: Possible rationale for these findings are offered, and new research questions are raised. Finally, implications for the cross-disability movement are presented. [ABSTRACT FROM AUTHOR]

The development of self is an important part of formal education, and related to the notion of self is the development of Bildung, or cultivation of the self. Bildung has been an integral part of curriculum theory in the United States. However, despite many theoretical debates on Bildung in the literature, there seems to be a lack of the pragmatic use of Bildung at the classroom level. Hence, the purpose of this article is to explore how classroom teachers or teacher educators can foster and nourish their students' Bildung at the classroom level. This study examines the Bildung processes of two doctoral students based on their autobiographical essays to show their effort of developing themselves. Foucault's notion of askēsis has been used as a theoretical framework, which is a philosophical exercise that includes three forms of reflexivity: Memory, Meditation and Method. Based on the findings, we make the following implications for curriculum studies and teacher education: 1) Bildung needs to be guided, nourished, and fostered through formal education by teachers in the classroom, which then becomes a "habitat," an environment in which both teachers and students dwell as Bildung-centered teachers and students, 2) Bildung needs to be practiced as askēsis by students and teachers as an act of care through classroom activities, 3) Bildung-centered teachers do have autonomy, agency, and independence to create such activities for their students, in which the process of Bildung can be carried out. [ABSTRACT FROM AUTHOR]

This study evaluated lead concentrations in blood and related factors among the South Korean population based on data from the Korea National Environmental Health Survey (KoNEHS) II (2012–2014) conducted by the National Institute of Environmental Research and the Ministry of Environment. Personal data were obtained from non-institutionalized civilian Korean individuals in an interview with trained community surveyors using a structured questionnaire (n = 6,455, aged 19 or older, mean age 49.7 years). The lead concentrations in whole blood were analyzed by atomic absorption spectrophotometry (AAS) with a Zeeman-effect-based background corrector. The precision and accuracy of the analytical methods were verified by internal and external quality controls (G-EQUAS, Germany). Statistical analysis was performed using weighted KoNEHS II data separated by sex, and the lead concentration was expressed as a geometric mean (GM). Multiple linear regression was performed using the SPSS 23.0 software package (SPSS Inc., Chicago, IL, USA). The total GM of lead concentrations was 19.5 µg/L. Lead concentrations increased with age and were higher in males (22.8 µg/L) than in females (16.6 µg/L). Smokers and drinkers had higher concentrations than non-smokers and non-drinkers of both sexes. People who used herbal medications had higher concentrations than those who did not among females. People of both sexes living in rural areas had higher lead concentrations than those in urban areas. Lead concentrations also varied with educational level, total family income, the type of water regularly consumed, and occupation. The average lead concentration of the general adult population in Korea has rapidly decreased over time from 45.8 µg/L (1999) to 19.45 µg/L (2012–2014); however, it remains higher than that of the United States, Germany, and Canada. The factors significantly related to lead concentration in South Korea were age, sex, smoking and alcohol drinking status, herbal medication usage by females, residential area, drinking water at home, and occupation. These factors could be used to improve occupational and environmental hygiene among the Korean population. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the impact of different types of corporate issues and employee–organization relationships (EORs) on employees' perceptions of the issues and on their communicative actions. Specifically, this study investigates how employees who have experienced an internal or an external issue within their organizations differently perceive the organizational issue and engage in positive and/or negative communicative behaviors. Design/methodology/approach: An online survey was conducted with 363 full-time employees in large-sized companies in the USA who have experienced any internal or external issues within the past six months. Findings: Employees are more cognitively aware of and feel more involved and less constrained in solving an internal company issue than an external one. Experiencing internal issues has led employees to share negative information about their organization externally. The quality of EORs pre-issue significantly increases employees' involvement and positive communication behavior and decreases constraint levels and negative communication behaviors regarding an issue. Practical implications: Corporate communication and public relations practitioners should incorporate strategic internal communication strategies to preemptively manage internal issues and to avoid them from evolving into internal crises. Originality/value: This study is among the first to distinguish internal and external issues perceived by internal stakeholders and to examine their impacts on employees' issue-specific perceptions and communicative behaviors. This study also provides significant practical guidelines for corporate communication practitioners and leaders by explicating the strategic role of issue type and employee behaviors in issue management. [ABSTRACT FROM AUTHOR]

An economic rationale for restrictions on free expression is considered. An expresser obtains positive utility from expressing something but it may have damaging effects, which can be measured by its mean squared error, on others. If social losses from expression exceed benefits significantly, restricting expression can improve social welfare. We analyse expression of distorted information and the social welfare consequences of laws that restrict speech according to three standards: whether transmitted information contains falsity, whether false statements are deliberate and whether the expresser intentionally applies a biased filter to selectively express private information. We also show that the anti-defamation law adopting the negligence rule can lead to the socially optimal level of expression by adjusting the due care standard appropriately. [ABSTRACT FROM AUTHOR]

Small mammal surveillance was conducted (2008–2010, 2012) at Camp (Cp) Humphreys, a US Army installation and new expansion site, Republic of Korea (ROK), to identify hemorrhagic fever with renal syndrome health threats to US military/civilian populations during its ongoing expansion phase. Small mammals were collected using Sherman live capture traps and transported to Korea University where they were euthanized, tissues removed, and assayed to determine hantavirus IgG antibody-positive and hantavirus-positive rates by RT-PCR. A total of 2,364 small mammals were captured over 11,300 trap nights (capture rate = 20.92%). Apodemus agrarius was the most commonly collected (76.65%), with capture rates of 9.62% and 21.70% for Cp Humphreys and the expansion site, respectively. Overall, Hantaan virus (HTNV) IgG antibody-positive (Ab+) rate for A. agrarius was 2.15% (39/1,812). A total of 5.43% (10/184) Crocidura lasiura, 0.79% (2/254) Microtus fortis and 2.44% (1/41) Micromys minutus were serologically IgG Ab+ for hantaviruses. HTNV-specific RT-PCR demonstrated that 28.2% (11/39) HTNV Ab+ A. agrarius harbored the 328-nt sequence of the GC glycoprotein-encoding M segment of HTNV. Among them, the whole genome sequences of 3 HTNV strains were obtained by conventional RT-PCR and Rapid Amplification cDNA Ends PCR. Phylogenetic analyses of the HTNV strains from Cp Humphreys and the expansion site, Pyeongtaek, show a greater diversity of rodent-borne hantaviruses compared to HTNV previously identified in Gyeonggi province of the ROK. Thus, this study provides significant insights for raising HFRS threat awareness, analysis, and risk reduction strategies in southern Gyeonggi province. [ABSTRACT FROM AUTHOR]

The Common Core State Standards (CCSS) are a focus of state education policy today influencing curriculum implementation and assessment in public schools. The purpose of this narrative inquiry is to understand how high school mathematics teachers experience the transition period. Based on interviews with mathematics teachers in a high school in the Midwest, we aim at bringing teachers' voices to the forefront. Through teachers' stories, we find that: a) Teachers live in the different zones of enactment; and b) Teachers' ecological view of agency should be used as a link to a transition to the CCSS for creating a genuine dialogue. This article is significant in two ways. First, it informs the administrators and policy makers of how there will be inconsistencies across states, districts, schools and classrooms in the implementation and assessment, and second, it helps to explain the need for new professional development approaches. [ABSTRACT FROM AUTHOR]

Background: Ultrasound (US) is probably the standard imaging procedure in most centers, and US-guided fine needle aspiration can be added if suspicious lymph nodes are found. However, US-guided fine needle aspiration is an invasive method to diagnose a metastasis and has showed relatively low sensitivity. In general, diffusion-weighted (DW) magnetic resonance imaging (MRI) has become an emerging technique for discriminating benign from malignant breast lesions in a short imaging acquisition time. Purpose: To evaluate the potential for using DW MRI with an apparent diffusion coefficient (ADC) value to predict axillary lymph node metastases in patients with invasive breast cancer. Material and Methods: This study enrolled 110 axillary lymph nodes from 110 consecutive women who were diagnosed with invasive breast cancer for preoperative breast MRI and US. The largest enhancing ipsilateral axillary lymph nodes were included in this study, and benign and metastatic axillary lymph nodes were compared according to the pathologic reports. The cut-off ADC value to differentiate between benign and metastatic axillary lymph nodes was evaluated with receiver-operating characteristic curve analysis. Diagnostic performance of ultrasound and DW MRI was calculated for enhancing lymph node in dynamic contrast-enhanced MRI. Results: Nodal metastases were documented in 68 (62%) axillary lymph nodes. The mean size of metastatic axillary lymph nodes was larger than that of benign axillary lymph nodes (15.5 mm vs. 10.9 mm, P < 0.001). The mean ADC value (0.69 × 10(-3 )mm(2)/s) of the metastases was significantly lower than that of the benign axillary lymph nodes (1.04 × 10(-3 )mm(2)/s) (P < 0.001). The ADC value cut-off between metastatic and benign axillary lymph nodes was 0.90 × 10(-3 )mm(2)/s. Using ADC cut-off, sensitivity, specificity, and accuracy of DW MRI were 100%, 83.3%, and 93.6%, respectively. The sensitivity, specificity, and accuracy of US showed 94.1%, 54.8%, and 79.1%, respectively. Conclusion: DW MRI of axillary lymph nodes can provide reliable information for the differentiation of benign from metastatic axillary lymph nodes in invasive breast cancer patients. [ABSTRACT FROM AUTHOR]

General labor market condition is an important contextual factor influencing employment opportunities and outcomes for people with disabilities and is particularly significant given the recent economic recession. Yet, longstanding data analytic strategies have focused only on individual predictors rather than the dynamic interaction among individual level and organizational/environmental level variables, such as considering the role of labor market conditions. This study used the Rehabilitation Services Administration Case Service Report (RSA-911) data for fiscal years 2005 and 2009 to represent two distinct time periods, one before and one during the U.S. economic recession, respectively. Hierarchical linear modeling was used to examine the relationship between state unemployment rate and its interaction with personal factors influencing the employment outcomes of people with disabilities receiving state vocational rehabilitation services. Results found negligible between-state differences, but state unemployment rates were found to moderate the relationships between some demographic variables and successful competitive employment vocational rehabilitation (VR) case closure. Specifically, the significance and magnitude of those effect sizes varied by general economic context. These findings call attention for the need to consider the role of contextual variables, such as state unemployment rates, and their impact on the predictive strength of specific demographic and disability variables on employment outcomes for people with disabilities. [ABSTRACT FROM PUBLISHER]

Background and Aim The Model for End-Stage Liver Disease ( MELD) has been widely used for predicting short-term mortality in patients with cirrhosis in the U. S. A modification of the MELD score was published in 2011. This was validated for Korean patients with cirrhosis. Methods The medical records of patients with cirrhosis who were admitted to Konkuk University Hospital from 2006 to 2010 were retrospectively reviewed. The predictive value for 3-month mortality was compared between the Refit MELD, Refit MELD- Na, MELD, MELD- Na, and Child- Pugh score. The comparison was performed by calculating the area under the receiver operating curve ( AUROC). Results A total of 882 patients were enrolled and 77 (8.7%) died within 3 months. The most common etiology was alcohol (45.4%) followed by hepatitis B (34.2%). The AUROCs of the Refit MELD, Refit MELD- Na, MELD, MELD- Na, and Child- Pugh score were 0.842, 0.817, 0.844, 0.848, and 0.831, respectively. The Refit MELD- Na showed a lower value than MELD- Na ( P = 0.0005), MELD ( P = 0.0190), and the Refit MELD ( P = 0.0174). When the patients with hepatitis B, C, and alcoholic cirrhosis were analyzed, the AUROCs were 0.960, 0.920, 0.953, 0.951, 0.896, 0.959, 0.956, 0.947, 0.956, 0.943, and 0.746, 0.707, 0.752, 0.747, 0.755. Conclusions The improvement in predictive value for 3-month mortality was not definite. The Refit MELD- Na especially showed the lowest value. This result may have been due to differences in underlying etiology of cirrhosis between Korea and the U. S. Thus, a larger prospective study is warranted. [ABSTRACT FROM AUTHOR]

Despite longstanding scholarly attention to professions in the US, the relationships between lawyers and non-lawyer professionals are not well explained. Socio-legal studies and studies of professions often take for granted conflicts as the nature of inter-professional relationships. However, this understanding ignores the possibility of cooperation in which a set of professional occupations jointly attains a limited supply of necessary resources. Based on the ecological concepts of interactions and environments, the author discusses the impact of non-lawyer professions on the population of lawyers in an attempt to understand the relationships between the occupational groups. Using the panel data model to test data from 50 US states and the District of Columbia over a 10-year period, the study reveals that the legal profession is in cooperation with professionals in financial and law-affiliated areas. The analysis of ecological interactions moves beyond conflict-oriented understanding of professional occupations, and further, exhorts for the exploration of various forms of inter-professional relationships. [ABSTRACT FROM PUBLISHER]

Currently, there is a resurgence of interests in phenomenology in education. This article sheds light on the importance of hermeneutical phenomenology in teaching and learning based on the lived experience of a Sioux Indian adolescent boy, elicited from an ethnographic case study conducted at an alternative high school in the US. Employing narrative inquiry, this article seeks phenomenological ways of understanding students' lived experiences and explores the meaning of the pedagogical practice of hermeneutical phenomenology in education. I delve into how hermeneutical understanding of the phenomena of students' lived experience can catapult both students and teachers into the personal growth and development in a reciprocal way. It is my hope that such an understanding will facilitate an educational aim that focuses on the ontology of being and becoming while students' existence is brought to the center of teaching and learning. [ABSTRACT FROM AUTHOR]

Using a controversial issue that has drawn massive media coverage in South Korea, the government decision to resume imports of US beef, this study tested the applicability of the Situational Theory of Problem Solving (STOPS) to the rise of a hot-issue public. A survey of 300 respondents explored the perceptual, cognitive, and motivational antecedents of active information behaviors. Results suggest that the STOPS applies well to this unique sociopolitical situation, and that the theory works cross-culturally not only in the United States, but also in South Korea. In addition, we examined the role of cross-situational characteristics in detail, looking at whether political interest, prior experience in protest, and other sociodemographics could affect situational perceptions and cognitive frames. Theoretical and practical implications for future research and practices are discussed. [ABSTRACT FROM PUBLISHER]

Background: Clinical examination is not entirely sufficient for evaluation of the postoperative site for follow-up of patients with mastectomy. A few studies have reported that postoperative follow-up US evaluation allows early detection and proper management of local tumor recurrence. Purpose: To evaluate the diagnostic performance of the American College of Radiology (ACR) ultrasonographic (US) Breast Imaging Reporting and Data System (BI-RADS) categories 4 and 5 breast lesions at the mastectomy site. Material and Methods: Our institutional review board approved this study and waived the need for informed consent. We retrospectively reviewed the consecutive post-mastectomy US exams for palpable and non-palpable lesions in the post-mastectomy chest wall that were categorized as BI-RADS 4 (subcategorized 4a, 4b, and 4c) or 5 between January 2007 and April 2010. The positive predictive value (PPV) for final assessment was evaluated. Results: From 2681 post-mastectomy US examinations, we obtained a study population of 50 patients with 50 lesions (20 palpable, 30 non-palpable). There were nine (45%) malignancies among the palpable lesions and six (20%) malignancies among the non-palpable lesions. The palpability showed no significant correlation with malignancy in overall subcategorization (P >0.05). The PPVs of categories 4 and 5 were 14.3% for category 4a, 62.5% for category 4b, 100% for category 4c, and 100% for category 5. Conclusion: The ACR US BI-RADS categorization of 4a, 4b, 4c, and 5 for breast lesions at the mastectomy site is a feasible method for predicting local recurrence. All lesions should be managed according to US characteristics during evaluation of local recurrence at the mastectomy site, regardless of palpability. [ABSTRACT FROM AUTHOR]

This paper explores the likelihood and consequences of voluntary disclosure (proxied by management earnings forecasts) for a sample of 1005 cross-listed firms in the US from 40 countries over the period 1996-2005. Our study is grounded in a three-tiered conceptual framework that relies on insights from and implications of institutional theory, agency theory and bonding theory to explain the costs and benefits associated with voluntary disclosure. Consistent with institutional theory and agency theory, our results indicate that disclosure likelihood increases with the strength of cross-listed firms' home-country legal institutions, and is also influenced by US listing type, product market internationalization, and ownership structure. Further, our results show that voluntarily committing to US disclosure practice is associated with lower information asymmetry, which supports reputational bonding theory. Overall, our study provides a costs-and-benefits framework to understand voluntary disclosure practices in an international context. Our work also presents evidence that home-country institutions still matter when foreign firms migrate into the US financial market, which highlights the importance of country-level institution development. [ABSTRACT FROM AUTHOR]

This study investigates whether and how the quality of external auditors hired by borrowers has an impact on loan syndicate structure. Our empirical analyses, using a sample of U.S. syndicated loans from 1996 to 2009, show the following findings: First, a larger number of banks participate in syndicated loans to borrowing firms with Big 4 (or previously Big 5 or Big 6) auditors than to those with non-Big 4 auditors. Second, the percentage of a syndicated loan retained by the lead bank(s) is smaller when the borrower is a client of a Big 4 auditor than when the borrower is a client of a non-Big 4 auditor. Third, the effect of auditor quality (Big 4 versus non-Big 4) on loan ownership structure is less pronounced when lenders are able to gather more information about the borrower prior to the loan deal. Overall, our results suggest that auditor quality plays an important role in loan syndication by alleviating information asymmetries between lead banks and non-lead participant banks. [ABSTRACT FROM AUTHOR]

This paper draws on the experiences of two graduate level curriculum theory classes taught at different teacher education institutions in the US. Teacher educators and curriculum theorists invest in creating reflexive spaces for teachers to explore the complex terrain of lived curriculum. Narrative inquiry is chronicled as acting as an important pedagogical medium toward this aim. The purpose of the paper is to explore what practicing teachers’ narratives reveal about their curricular roles in relation to theory and practice. As participating educators consider their associated teaching identities, phenomenological notions of place are found to be fitting as they navigate understandings of lived curriculum as situated, thoughtful, and intentional. Insights generated through reflexive analysis manifest three thematic intersections: (1) Teachers confronting dissonance between theory and practice as teaching identity displacement; (2) Teachers negotiating greater implacement; and (3) Teachers moving toward embodying the creative space for teaching and learning. Renewed roles surface for teacher educators and curriculum theorists, challenging all involved to purposefully foster contexts for professional learning rather than subservience, and claim the responsibilities to provide the intellectual, emotional, and pragmatic spaces where teachers’ lived curriculum efforts can be developed and nurtured. [ABSTRACT FROM AUTHOR]

In the current era of 'zero tolerance', disciplinary practices including punishment, expulsion, physical and psychological surveillance, and confinement are a major part of resistant students' lived experiences. This article is an ethnographic study of student resistance that is observed in an alternative high school in the USA, which serves students expelled from regular schools for their acts of resistance. The purpose of this study is to explore how understanding of the meaning of student resistance can be used as a theoretical and pedagogical medium with which teachers can create an equitable educational milieu that upholds views and experiences of the marginalised students. The study also offers a new insight into resistance theory drawing upon Dewey's transactional theory of resistance as a communicative act to further suggest what might be possible for the teachers and students to transcend conflicts in order to establish a more meaningful teacher-student relationship moving beyond zero-tolerance policies. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores the influence of ethnic relations in sociological globalism on the formulation process of a country’s soft power (i.e., national attraction). People migrate into a country, become an ethnic group, and experience sociological contact/interaction with other ethnic groups, through which they form more concrete and experiential attitudes toward each other. In turn, these attitudes affect their perceptions of other ethnic groups’ homeland countries. With soft power being defined as favorability toward a foreign country, this paper investigates the influence of ethnic relations in a three-predictor regression model of soft power—ethnic relations, between country relationship quality, and normative performance (i.e., reputation) of a country. In testing the model, this study uses secondary data consisting of U.S. national surveys including polls of the Chicago Council on Foreign Relations on perceptions of foreign countries and aggregate nation-level data. The findings show that ethnic relations has a sizable, significant influence on favorability, second to relationship quality, with normative performance having a weak, insignificant influence. This paper further discusses the findings’ implications for contemporary public diplomacy practice and theory and outlines directions for future study of ethnic relation’s influence on soft power in sociological globalism. [Copyright &y& Elsevier]

Missions conducted by the U.S. Military during combat involve a multitude of operational stressors that can cause deterioration in physical and military performance of soldiers. Physiological consequences of sustained operational stress include decrements in anabolic hormones, skeletal muscle mass, and loss of bone mineral density. The objective of this review is to examine the current literature and provide commanders with information on the physical and physiological decrements in soldiers conducting sustained operations. The intent is that this will provide commanders with insight on how to plan for missions to incorporate possible countermeasures to enhance or sustain wartighter performance. [ABSTRACT FROM AUTHOR]

Serial assessments of left ventricular ejection fraction (LVEF) are customary in patients with breast cancer receiving trastuzumab. Radionuclide angiography (RNA) is often used; however, a typical monitoring schedule could include 5 scans in a year. We evaluated the proportion of imaging-related ionizing radiation attributable to RNA in 115 patients with breast cancer, from 3 medical centers in the United States, Ireland, and Japan, who completed 12 months of trastuzumab treatment. Estimated radiation dose (ERD) was used to calculate exposure associated with imaging procedures spanning the 18 months before and after trastuzumab therapy. In addition, 20 cardiologists and oncologists from participating centers were surveyed for their opinions regarding the contribution of RNA to overall radiation exposure during trastuzumab treatment. When RNA was used to monitor LVEF, the mean ERD from imaging was substantial (34 ± 24.3 mSv), with the majority attributable solely to RNA (24.7 ± 14.8 mSv, 72.6%). Actual ERD associated with RNA in this population differed significantly from the perception in surveyed cardiologists and oncologists; 70% of respondents believed that RNA typically accounted for 0% to 20% of overall radiation exposure from imaging; RNA actually accounted for more than 70% of ERD. In conclusion, RNA was used to monitor LVEF in most patients in this cohort during and after trastuzumab therapy. This significantly increased ERD and accounted for a greater proportion of radiation than that perceived by surveyed physicians. ERD should be taken into account when choosing a method of LVEF surveillance. Alternative techniques that do not use radiation should be strongly considered. [ABSTRACT FROM AUTHOR]

During the coronavirus disease 2019 (COVID-19) pandemic, conclusively evaluating possible associations between COVID-19 vaccines and potential adverse events was of critical importance. The National Academy of Medicine of Korea established the COVID-19 Vaccine Safety Research Center (CoVaSC) with support from the Korea Disease Control and Prevention Agency to investigate the scientific relationship between COVID-19 vaccines and suspected adverse events. Although determining whether the COVID-19 vaccine was responsible for any suspected adverse event necessitated a systematic approach, traditional causal inference theories, such as Hill's criteria, encountered certain limitations and criticisms. To facilitate a systematic and evidence-based evaluation, the United States Institute of Medicine, at the request of the Centers for Disease Control and Prevention, offered a detailed causality assessment framework in 2012, which was updated in the recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM) in 2024. This framework, based on a weight-of-evidence approach, allows the independent evaluation of both epidemiological and mechanistic evidence, culminating in a comprehensive conclusion about causality. Epidemiological evidence derived from population studies is categorized into four levels-high, moderate, limited, or insufficient-while mechanistic evidence, primarily from biological and clinical studies in animals and individuals, is classified as strong, intermediate, weak, or lacking. The committee then synthesizes these two types of evidence to draw a conclusion about the causal relationship, which can be described as "convincingly supports" ("evidence established" in the 2024 NASEM report), "favors acceptance," "favors rejection," or "inadequate to accept or reject." The CoVaSC has established an independent committee to conduct causality assessments using the weight-of-evidence framework, specifically for evaluating the causality of adverse events associated with COVID-19 vaccines. The aim of this study is to provide an overview of the weight-of-evidence framework and to detail the considerations involved in its practical application in the CoVaSC., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

This study investigated how the online health information behaviors of U.S. adults with illnesses unrelated to COVID-19 virus infection affected their coping with health problems and concerns during the COVID-19 pandemic. Guided by the cybercoping model (Kim & Lee, 2014), the study examined associations between these patients' online information behaviors (information seeking and information forwarding) and coping outcomes (health problems and affective states). The study further explored the mediating roles of health coping processes (problem-and emotion-focused) in the associations between these information behaviors and coping outcomes. Survey data from 687 participants were analyzed using structural equation modeling. The results highlighted the significance of information forwarding in enhancing both coping processes and outcomes, while information seeking enhanced problem-focused coping and health-problem coping outcomes alone. These associations were more pronounced among U.S. adults without chronic conditions than among those with chronic illnesses. These findings' implications, the study's limitations, and suggestions for future research were also addressed.

Importance: By law, patients have immediate access to discharge notes in their medical records. Technical language and abbreviations make notes difficult to read and understand for a typical patient. Large language models (LLMs [eg, GPT-4]) have the potential to transform these notes into patient-friendly language and format., Objective: To determine whether an LLM can transform discharge summaries into a format that is more readable and understandable., Design, Setting, and Participants: This cross-sectional study evaluated a sample of the discharge summaries of adult patients discharged from the General Internal Medicine service at NYU (New York University) Langone Health from June 1 to 30, 2023. Patients discharged as deceased were excluded. All discharge summaries were processed by the LLM between July 26 and August 5, 2023., Interventions: A secure Health Insurance Portability and Accountability Act-compliant platform, Microsoft Azure OpenAI, was used to transform these discharge summaries into a patient-friendly format between July 26 and August 5, 2023., Main Outcomes and Measures: Outcomes included readability as measured by Flesch-Kincaid Grade Level and understandability using Patient Education Materials Assessment Tool (PEMAT) scores. Readability and understandability of the original discharge summaries were compared with the transformed, patient-friendly discharge summaries created through the LLM. As balancing metrics, accuracy and completeness of the patient-friendly version were measured., Results: Discharge summaries of 50 patients (31 female [62.0%] and 19 male [38.0%]) were included. The median patient age was 65.5 (IQR, 59.0-77.5) years. Mean (SD) Flesch-Kincaid Grade Level was significantly lower in the patient-friendly discharge summaries (6.2 [0.5] vs 11.0 [1.5]; P < .001). PEMAT understandability scores were significantly higher for patient-friendly discharge summaries (81% vs 13%; P < .001). Two physicians reviewed each patient-friendly discharge summary for accuracy on a 6-point scale, with 54 of 100 reviews (54.0%) giving the best possible rating of 6. Summaries were rated entirely complete in 56 reviews (56.0%). Eighteen reviews noted safety concerns, mostly involving omissions, but also several inaccurate statements (termed hallucinations)., Conclusions and Relevance: The findings of this cross-sectional study of 50 discharge summaries suggest that LLMs can be used to translate discharge summaries into patient-friendly language and formats that are significantly more readable and understandable than discharge summaries as they appear in electronic health records. However, implementation will require improvements in accuracy, completeness, and safety. Given the safety concerns, initial implementation will require physician review.

Plasma metabolomics profiling is an emerging methodology to identify metabolic pathways underlying cardiovascular health (CVH). The objective of this study was to define metabolomic profiles underlying CVH in a cohort of Black adults, a population that is understudied but suffers from disparate levels of CVD risk factors. The Morehouse-Emory Cardiovascular (MECA) Center for Health Equity study cohort consisted of 375 Black adults (age 53 ± 10, 39% male) without known CVD. CVH was determined by the AHA Life's Simple 7 (LS7) score, calculated from measured blood pressure, body mass index (BMI), fasting blood glucose and total cholesterol, and self-reported physical activity, diet, and smoking. Plasma metabolites were assessed using untargeted high-resolution metabolomics profiling. A metabolome wide association study (MWAS) identified metabolites associated with LS7 score after adjusting for age and sex. Using Mummichog software, metabolic pathways that were significantly enriched in metabolites associated with LS7 score were identified. Metabolites representative of these pathways were compared across clinical domains of LS7 score and then developed into a metabolomics risk score for prediction of CVH. We identified novel metabolomic signatures and pathways associated with CVH in a cohort of Black adults without known CVD. Representative and highly prevalent metabolites from these pathways included glutamine, glutamate, urate, tyrosine and alanine, the concentrations of which varied with BMI, fasting glucose, and blood pressure levels. When assessed in conjunction, these metabolites were independent predictors of CVH. One SD increase in the novel metabolomics risk score was associated with a 0.88 higher LS7 score, which translates to a 10.4% lower incident CVD risk. We identified novel metabolomic signatures of ideal CVH in a cohort of Black Americans, showing that a core group of metabolites central to nitrogen balance, bioenergetics, gluconeogenesis, and nucleotide synthesis were associated with CVH in this population., (© 2024. The Author(s).)

Background: Early trauma (general, emotional, physical, and sexual abuse before age 18 years) has been associated with both cardiovascular disease risk and lifestyle-related risk factors for cardiovascular disease, including smoking, obesity, and physical inactivity. Despite higher prevalence, the association between early trauma and cardiovascular health (CVH) has been understudied in Black Americans, especially those from low-income backgrounds, who may be doubly vulnerable. Therefore, we investigated the association between early trauma and CVH, particularly among low-income Black Americans., Methods: We recruited 457 Black adults (age 53±10, 38% male) without known cardiovascular disease from the Atlanta, GA, metropolitan area using personalized, community-based recruitment methods. The Early Trauma Inventory was administered to assess overall early traumatic life experiences which include physical, sexual, emotional abuse, and general trauma. Our primary outcome was the American Heart Association Life's Simple 7, which is a set of 7 CVH metrics, including 4 lifestyle-related factors (smoking, body mass index, physical activity, and diet) and three physiologically measured health factors (blood pressure, total blood cholesterol, and blood glucose). We used linear regression models adjusting for age, sex, socioeconomic status, and depression to test the association between early trauma and CVH and tested the early trauma by household income (<$50 000) interaction., Results: Higher levels of early trauma were associated with lower Life's Simple 7 scores (β, -0.05 [95% CI, -0.09 to -0.01], P =0.02, per 1 unit increase in the Early Trauma Inventory score) among lower, but not higher, income Black participants ( P value for interaction=0.04). Subtypes of early trauma linked to Life's Simple 7 were general trauma, emotional abuse, and sexual abuse. Exploratory analyses demonstrated that early trauma was only associated with the body mass index and smoking components of Life's Simple 7., Conclusions: Early trauma, including general trauma, emotional abuse, and sexual abuse, may be associated with worse CVH among low-, but not higher-income Black adults.

Objectives: To explore the pathway associated with dental service use among Hispanic and non-Hispanic Black children, applying Andersen's model of health care service utilization., Methods: Samples of Hispanic (n = 5,055) and non-Hispanic (NH) Black (n = 2,695) children aged 2-17 years from the 2016 National Survey of Children's Health (NSCH) were included in this study. We used structural equation modeling (SEM) to examine the path of the relationship between dental care visits and the three groups of characteristics in Andersen's behavioral model., Results: In the models for Hispanic and non-Hispanic Black children, parents' educational attainment directly and positively affected income and having insurance. Also, insurance (Hispanic children: β = 0.17, P ≤ 0.01; NH Black children: β = 0.25, P ≤ 0.01) and age of the child (Hispanic children: β = 0.14, P ≤ 0.01; NH Black: β = 0.21, P ≤ 0.01) directly and positively affected dental care use. However, there was no direct effect of the need factor on dental care use in either model., Conclusions: Children may receive dental services that eliminate acute dental problems, probably as a result of the ACA and CHIP coverage. The patterns of findings suggest the need for policy changes to improve pediatric dental coverage and promote professional recommendations for effective dental hygiene., (© 2020 American Association of Public Health Dentistry.)

Objective: To simultaneously examine multiple individual-level neighbourhood perceptions and psychosocial characteristics and their relationships with cardiovascular health (CVH) among blacks., Design: Cross-sectional study., Setting: Subjects were recruited between 2016 and 2018 via convenience sampling., Participants: 385 Black men and women, age 30-70 living in the Atlanta metropolitan area (Georgia, USA)., Primary Outcome Measure: Individual's CVH was summarised as a composite score using American Heart Association's Life's Simple 7 (LS7) metrics., Methods: We implemented unsupervised learning (k-means) and supervised learning (Bayesian Dirichlet process clustering) to identify clusters based on 11 self-reported neighbourhood perception and psychosocial characteristics. We also performed principal component analysis to summarise neighbourhood perceptions and psychosocial variables and assess their associations with LS7 scores., Results: K-means and Bayesian clustering resulted in 4 and 5 clusters, respectively. Based on the posterior distributions, higher LS7 scores were associated with better neighbourhood perceptions and psychosocial characteristics, including neighbourhood safety, social cohesion, activities with neighbours, environmental mastery, purpose in life, resilient coping and no depression. Taken together, the first principal components of neighbourhood perceptions and psychosocial characteristics were associated with an increase of 0.07 (95% CI -0.17 to 0.31) and 0.31 (95% CI 0.06 to 0.55) in LS7 score, respectively, after accounting for age, sex, household income and education level., Conclusion: Both neighbourhood perception and psychosocial domains were related to CVH, but individual psychosocial characteristics appeared to contribute to CVH most. Approaches that acknowledge the importance of factors in both domains may prove most beneficial for enhancing resilience and promoting CVH among black communities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The goal of the Patient Protection and Affordable Care Act (ACA) is to increase access to health insurance and decrease health care cost while improving health care quality. With more articles examining the relationship between one of the ACA provisions and dental health outcomes, we systematically reviewed the effect of the ACA on dental care coverage and access to dental services. We searched literature using the National Library of Medicine's Medline (PubMed) and Thomson Reuters' Web of Science between January 2010 and November 2020. We identified 33 articles related to dental coverage, and access/utilization of dental care services. This systematic review of studies showed that the ACA resulted in gains in dental coverage for adults and children, whereas results were mixed with dental care access. Overall, we found that the policy led to a decrease in cost barriers, an increase in private dental coverage for young adults, and increased dental care use among low-income childless adults. The implementation of the ACA was not directly associated with dental insurance coverage among people in the U.S. However, results suggest positive spillover effects of the ACA on dental care coverage and utilization by people in the national level dataset.

Extremes in sleep duration are associated with higher cardiovascular risk in the general population, but their impact in patients with documented coronary artery disease (CAD) remains unknown and potentially of clinical significance. We hypothesized that both short and long sleep duration are associated with higher mortality in CAD. We inquired about sleep durations in 2,846 patients enrolled in the Emory Cardiovascular Biobank (mean age 64 years, 38% female, 23% Black, and 82% with obstructive CAD, defined by positive coronary angiography), who were then followed for all-cause and cardiovascular mortality. Multivariate Cox proportional hazard models were calculated to examine the association of sleep duration and mortality. Sleep durations of <6.5 hours (short), ≥6.5 to <7.5 hours (normal), and ≥7.5 hours (long) were reported by 39%, 26% and 35% of the cohort, respectively. On follow-up (median 2.8 years), mortality rates were 15%, 11%, and 17%, respectively. After adjusting for demographics and risk factors, both short and long sleep duration were associated with higher all-cause mortality (hazard ratio 1.44, 95% confidence interval [1.10 to 1.89], and 1.41 [1.08 to 1.85], respectively). A similar pattern was demonstrated for cardiovascular mortality only for short (hazard ratio 1.48 [1.05 to 2.09]), but not long sleep duration. In conclusion, in patients with frank CAD, both short and long sleep duration were independently associated with higher all-cause mortality, and short sleep was independently associated with higher cardiovascular mortality. In conclusion, our study is the first to extend the observations of sleep duration and mortality from population-based studies to patients with documented cardiac disease., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background Food deserts ( FDs ), defined as low-income communities with limited access to healthy food, are a growing public health concern. We evaluated the impact of living in FDs on incident cardiovascular events. Methods and Results We recruited 4944 subjects (age 64±12, 64% male) undergoing cardiac catheterization into the Emory Cardiovascular Biobank. Using the US Department of Agriculture definition of FD , we determined whether their residential addresses had (1) poor access to healthy food, (2) low income, or (3) both (= FD ). Subjects were prospectively followed for a median of 3.2 years for myocardial infarction (MI) and death. Fine and Gray's subdistribution hazard models for MI and Cox proportional hazard models for death/ MI were used to examine the association between area characteristics ( FD , poor access, and low income) and the rates of adverse events after adjusting for traditional risk factors. A total of 981 (20%) lived in FDs and had a higher adjusted risk of MI (subdistribution hazard ratio, 1.44 [95% CI, 1.06-1.95]) than those living in non- FDs . In a multivariate analysis including both food access and area income, only living in a low-income area was associated with a higher adjusted risk of MI (subdistribution hazard ratio, 1.40 [1.06-1.85]) and death/ MI (hazard ratio, 1.18 [1.02-1.35]) while living in a poor-access area was not significantly associated with either (subdistribution hazard ratio, 1.05 [0.80-1.38] and hazard ratio, 0.99 [0.87-1.14], respectively). Conclusions Living in an FD is associated with a higher risk of adverse cardiovascular events in those with coronary artery disease. Specifically, low area income of FDs , not poor access to food, was significantly associated with worse outcomes.

Living in neighborhoods characterized by poverty may act as a chronic stressor that results in physiological dysregulation of the sympathetic nervous system. No previous study has assessed neighborhood poverty with hemodynamic, neuroendocrine, and immune reactivity to stress. We used data from 632 patients with coronary artery disease. Patients' residential addresses were geocoded and merged with poverty data from the 2010 American Community Survey at the census-tract level. A z-transformation was calculated to classify census tracts (neighborhoods) as either having 'high' or 'low' poverty. Systolic blood pressure, diastolic blood pressure, heart rate, rate-pressure product, epinephrine, interleukin-6, and high-sensitivity C-reactive protein were measured before and after a public speaking stress task. Multilevel models were used for repeated measures and accounting for individuals nested within census tracts. Adjusted models included demographics, lifestyle and medical risk factors, and medication use. Another set of models included propensity scores weighted by the inverse probability of neighborhood status for sex, age, race, and individual-level income. The mean age was 63 years and 173 were women. After adjusting for potential confounders, participants living in high (vs. low) poverty neighborhoods had similar hemodynamic values at rest and lower values during mental stress for systolic blood pressure (157 mmHg vs. 161 mmHg; p = 0.07), heart rate (75 beats/min vs. 78 beats/min; p = 0.02) and rate-pressure product (11839 mmHg x beat/min vs 12579 mmHg x beat/min; p = 0.01). P-values for neighborhood poverty-by-time interactions were <0.05. Results were similar in the propensity weighted models. There were no significant differences in inflammatory and epinephrine responses to mental stress based on neighborhood poverty status. A blunted hemodynamic response to mental stress was observed among participants living in high poverty neighborhoods. Future studies should explore whether neighborhood poverty and blunted hemodynamic response to stress translate into differences in long-term cardiovascular outcomes., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Attention-deficit hyperactivity disorder (ADHD) is a chronic condition and pharmacotherapy is the mainstay of treatment, with a variety of ADHD medications available to patients. However, it is unclear to what extent the long-term safety and efficacy of ADHD drugs have been evaluated prior to their market authorization. We aimed to quantify the number of participants studied and their length of exposure in ADHD drug trials prior to marketing., Methods: We identified all ADHD medications approved by the Food and Drug Administration (FDA) and extracted data on clinical trials performed by the sponsor and used by the FDA to evaluate the drug's clinical efficacy and safety. For each ADHD medication, we measured the total number of participants studied and the length of participant exposure and identified any FDA requests for post-marketing trials., Results: A total of 32 clinical trials were conducted for the approval of 20 ADHD drugs. The median number of participants studied per drug was 75 (IQR 0, 419). Eleven drugs (55%) were approved after <100 participants were studied and 14 (70%) after <300 participants. The median trial length prior to approval was 4 weeks (IQR 2, 9), with 5 (38%) drugs approved after participants were studied <4 weeks and 10 (77%) after <6 months. Six drugs were approved with requests for specific additional post-marketing trials, of which 2 were performed., Conclusions: Clinical trials conducted for the approval of many ADHD drugs have not been designed to assess rare adverse events or long-term safety and efficacy. While post-marketing studies can fill in some of the gaps, better assurance is needed that the proper trials are conducted either before or after a new medication is approved.