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Background: The prevalence of cardiovascular events is increasing. There are many new lipids lowering therapies available in recent years. Increased evidence through literature and guidelines suggests that the use of lipid lowering therapy (LLT) benefits patients who are at risk for cardiovascular events. Objective: The objective of this study was to describe the current LLT use as well as patterns of treatment modification among adults ≥ 65 years. Methods: A retrospective analysis of administrative claims data between January 2016 and May 2018 was conducted. Patients with a LLT refill and continuous enrollment during 1-year prior and 1-year follow-up were identified. The treatment episodes captured were interruption of therapy, intensity changes, dose changes, treatment augmentation, switching, and discontinuation. An analysis of treatment patterns among patients ≥75 years was also performed. Results: The study included 14,360 patients with a LLT of which 99% of patients were on statins as monotherapy or combination. Overall non-statin therapy use either as monotherapy or combination was 2.1%. There were significant differences among new initiators and existing users of therapy. Among prevalent users 57.4% had no changes in the follow-up period, 13.6% interrupted therapy, and 6.6% discontinued. Among new users, 47.9% patients had interrupted therapy, 25% had no changes, and 21.9% discontinued therapy. Conclusion: Most patients were on monotherapy and statins with low non-statin use. The new users among them were more likely to discontinue and interrupt therapy, highlighting the limitations and issues that older patients face that need to increase adherence. [ABSTRACT FROM AUTHOR]

National- and state-level education policies are evolving to address teacher shortages that are pervasive across the United States and are particularly problematic in rural special education. In this article, we describe a policy we call "endorsement by exam" in which teachers certified in one subject area can become certified in other areas by passing a content knowledge test. Although such add-on endorsements are not uncommon in some content areas (e.g., chemistry teachers adding certification in biology), some states have extended this practice to include special education certification. The purpose of this article is to explore what state agencies have adopted endorsement by exam for special education. Despite difficulties in obtaining reliable information, we determined approximately eight states have adopted some form of this policy. We discuss results in terms of rurality and conclude by explaining our position that endorsement by exam is a potentially harmful quick fix that may in fact exacerbate teacher shortages in the long term and thus is ill advised. [ABSTRACT FROM AUTHOR]

Objective: To assess weight change and attempted weight loss during the 12-18 months before spontaneous conception in relation to the risk of pregnancy loss.Design: Prospective cohort study.Setting: United States, 2007-2011.Methods: Women (n = 629) who were attempting pregnancy reported at baseline any weight loss attempts over the past 12 months, and their minimum and maximum weights during that time. Follow up lasted one to six menstrual cycles and throughout pregnancy. Using bodyweight measured at 4 weeks' gestation, participants were categorised as having weight loss ≥5%, weight gain ≥5%, both, or neither, over the previous 12-18 months. Log-binomial models adjusted for potential confounders.Main Outcome Measures: Risk ratio (RR) and 95% confidence interval (CI) of pregnancy loss.Results: Attempted weight loss was reported by 44% of women and actual weight loss by 11%, but neither was consistently associated with pregnancy loss. The RR for recent weight gain ≥5% was 1.65 (CI 1.09, 2.49).Conclusions: Weight gain over the period spanning 12-18 months pre-conception to 4 weeks' gestation may increase the risk of pregnancy loss among fertile women with prior pregnancy losses. Attempted and actual weight loss were not associated with pregnancy loss; however, replication is needed from larger studies with data on particular weight-loss methods.Tweetable Abstract: Recent weight gain before and around the time of conception may increase the risk of pregnancy loss. [ABSTRACT FROM AUTHOR]

Background: With common over-the-counter (OTC) medication use, OTC labels as medicine information sources must be of high quality and usability. Standardized OTC labeling has been proposed in Australia using the Medicine Information Box (MIB), modeled on the US Drug Facts label. However, limited research has explored consumer opinions on existing nonstandardized Australian OTC, US Drug Facts, and proposed MIB labels. Therefore, this study aimed to explore consumer opinions on all 3 groups of OTC labels. Methods: Three focus groups (N = 21 participants) were conducted in Sydney, Australia. Participants were shown existing Australian OTC labels, US Drug Facts labels, and mock MIB formats based on the Australian Therapeutic Goods Administration proposal. Discussions were audio recorded, transcribed verbatim, and thematically analyzed. Results: Participants expressed varying opinions regarding existing nonstandardized Australian OTC labels’ content and design, from acknowledgment of positive aspects (clear headings, relevant content) to decreased perceived readability (suboptimal color use, font size) and content discrepancies. Participants identified key Drug Facts and MIB label characteristics that contributed to perceived usability and format clarity (good headings, black-and-white format). Many preferred the Drug Facts label because of its greater perceived clarity and usability. Missing content (inactive ingredients, further contact details) were identified and consequently became opportunities for MIB improvement. Conclusions: Most participants seemed to prefer the US Drug Facts label, partly because of its perceived completeness. These findings suggest further improvements for the proposed MIB as a step toward Australian OTC label standardization. [ABSTRACT FROM AUTHOR]

HCFC-22 (CHClF2, chlorodifluoromethane) is an ozone-depleting substance (ODS) as well as a significant greenhouse gas (GHG). HCFC-22 has been used widely as a refrigerant fluid in cooling and air-conditioning equipment since the 1960s, and it has also served as a traditional substitute for some chlorofluorocarbons (CFCs) controlled under the Montreal Protocol. A low frequency record on tropospheric HCFC-22 since the late 1970s is available from measurements of the Southern Hemisphere Cape Grim Air Archive (CGAA) and a few Northern Hemisphere air samples (mostly from Trinidad Head) using the Advanced Global Atmospheric Gases Experiment (AGAGE) instrumentation and calibrations. Since the 1990s high-frequency, high-precision, in situ HCFC-22 measurements have been collected at these AGAGE stations. Since 1992, the Global Monitoring Division of the National Oceanic and Atmospheric Administration/Earth System Research Laboratory (NOAA/ESRL) has also collected flasks on a weekly basis from remote sites across the globe and analyzed them for a suite of halocarbons including HCFC-22. Additionally, since 2006 flasks have been collected approximately daily at a number of tower sites across the US and analyzed for halo-carbons and other gases at NOAA. All results show an increase in the atmospheric mole fractions of HCFC-22, and recent data show a growth rate of approximately 4% per year, resulting in an increase in the background atmospheric mole fraction by a factor of 1.7 from 1995 to 2009. Using data on HCFC-22 consumption submitted to the United Nations Environment Programme (UNEP), as well as existing bottom-up emission estimates, we first create globally- gridded a priori HCFC-22 emissions over the 15 yr since 1995. We then use the three-dimensional chemical transport model, Model for Ozone and Related Chemical Tracers version 4 (MOZART v4), and a Bayesian inverse method to estimate global as well as regional annual emissions. Our inversion indicates that the global HCFC-22 emissions have an increasing trend between 1995 and 2009. We further find a surge in HCFC-22 emissions between 2005 and 2009 from developing countries in Asia -- the largest emitting region including China and India. Globally, substantial emissions continue despite production and consumption being phased out in developed countries currently. [ABSTRACT FROM AUTHOR]

Millions of square meters of mechanically stabilized earth (MSE) retaining walls are constructed annually in the United States. For highway applications, a roadside barrier system is placed at the edge of the wall. This barrier system generally consists of an L-shape concrete structure so that if a vehicle hits the vertical part of the L shape (barrier), the horizontal part of the L (moment slab) provides the resisting moment during the impact. This impact must be resisted by the soil, the reinforcement, and the panels in the MSE wall. This paper gives guidelines on how to design the reinforcement for pullout and yielding and the panels for flexural and shear failure. It also gives the guidelines on how to ensure the stability of the barrier. These design guidelines are developed in terms of AASHTO load and resistance factor design procedures. In a second part, a full-scale crash test on an instrumented 2.79 m high MSE wall is described and analyzed. The wall and barrier behaved very satisfactorily and represented a verification of the proposed guidelines. Pressure distributions are presented for designing the top two layers of wall reinforcement to resist barrier impact forces. A 44.5-kN static equivalent load is recommended for evaluating the stability of the barrier and moment slab system. [ABSTRACT FROM AUTHOR]

The article focuses on the critical role of women in the functioning society and their contributions as engines of sustainable development and growth in the U.S. It expounds the significance of adequate access to justice and basic human right for women to achieve their highest yield and to realize gender equity. Also elaborated is the emergence of women judges and their contribution to the creation of impartial judiciaries.

In response to a petition to list Great Basin redband trout (subspecies of rainbow trout Oncorhynchus mykiss) as threatened or endangered, the U.S. Fish and Wildlife Service conducted a status review in 1998. To support that review, we conducted a survey of the abundances of redband trout in each of six subbasins of the Great Basin that included the states of Oregon, California, and Nevada. We used a generalized random-tessellation stratified algorithm to select a target sample size of 35 sites/subbasin. Out of a target number of 210 sites, 185 were visited by three-person crews that surveyed stream habitat and estimated the abundance of fish populations in sample reaches with lengths that were nearly 20 times the respective channel widths. A minimal sampling intensity was based on previously encountered levels of between-site variance in estimates of redband trout abundance. The total population estimate of age-1 and older (age-1+) redband trout in the Great Basin was 971,313 fish, with a 95% confidence interval equaling ± 15% of the mean estimate; 95% confidence limits ranged from 15% to 31% for population estimates in individual subbasins. Age-l+ fish abundance in terms of numerical density showed no significant differences between any subbasins. However, there were significant differences in terms of biomass: Catlow Valley subbasin biomass was significantly higher than the Great Basin mean, whereas Goose Lake subbasin biomass was significantly lower than the basinwide mean. These comparisons were supported by like differences in average weight. Analysis of stream habitat characteristics and fish abundance revealed no relationships that were generally consistent throughout the Great Basin, although spatial patterns were evident within some stream systems where sampling intensity was sufficiently high. [ABSTRACT FROM AUTHOR]

Purpose - To identify factors that influence small-town consumers' satisfaction with local independent retailers and the subsequent relationships of consumer satisfaction to in shopping, community attachment, and support of local independent retailers. Design/methodology/approach - Oliver's expectancy-disconfirmation model (1980) was used as the framework to predict consumer satisfaction. Consumer mailing addresses were attained from independent retailers in three small Midwest communities in the USA wherein at least one big box retailer was located. A survey questionnaire was sent to 903 consumers of independent retailers. The return rate was 36 per cent with 328 responses. Findings - Most strategies performed by small-town independent retailers did not meet their local consumers' expectations. Specially, merchandise assortment and availability, such as offering a unique and large selection of products, showed the largest discrepancy between respondents' expectations and retailers' performance, indicating that independent retailers are not meeting their consumers' needs in these areas. Participants who were satisfied with their independent retailers, shopped locally, were strongly attached to their communities, and were willing to support their local independent retailers. Practical implications - Small-town independent retailers need to continuously examine and re-examine their business strategies to meet the changing expectations of their local consumers. Small-town consumers' expectations of local independent retailers are shifting due to varying dynamics of retail environment including the entry of big-box retailers. It is essential that independent retailers know their local customers and exploit niche strategies that big-box retailers do not provide. Originality/value - The authors adopted the concepts of satisfaction and disconfirmation from Oliver's expectancy-disconfirmation model. On the basis of Oliver's model, the authorss predicted that consumer satisfaction with local independent retailers would be affected by possible disconfirmation between consumers' expectations and independent retailers' performance. [ABSTRACT FROM AUTHOR]

The majority of prostate epithelial cell lines stably expressing wild-type (wt) or mutant (mt) androgen receptor (AR) are derived from metastatic prostate cancers. Therefore, the wt AR-expressing RC-165N/human telomerase reverse transcriptase (hTERT) cell line derived from the benign prostate tissue of an African-American patient provides a unique opportunity to assess the functional status of AR in a cellular context not studied before. Although androgen-induced expression of known androgen responsive genes such as PMEPA1, and NDRG1 was observed in RC-165N/hTERT, this cell line expresses prostate-specific antigen (PSA) at significantly lower levels. Chromatin immunoprecipitation assay revealed androgen-dependent binding of AR to androgen response elements of PSA, PMEPA1 and NDRG1 genes. Similarities, as well as differences were noted in the expression of androgen responsive genes between RC-165N/hTERT and LNCaP cells. Comprehensive evaluations of AR functions in RC-165N/hTERT cells suggest that whereas some features of known AR functions are maintained in this benign prostatic tissue-derived cell line, other AR functions are not retained. Objective evaluations of similar cell lines will lead to the understanding of AR functions in prostate growth and differentiation.Prostate Cancer and Prostatic Diseases (2007) 10, 30–38. doi:10.1038/sj.pcan.4500915; published online 31 October 2006 [ABSTRACT FROM AUTHOR]

Background: Surveys have generally found that individuals more likely to use complementary and alternative medicine are female, live in the western United States, are likely to have a health complaint, and have a higher socioeconomic status than do nonusers. What is not known is the extent to which those who use complementary and alternative medicine also engage in positive health behaviors, such as smoking cessation or increased physical activity and/or exhibit fewer health risk factors such as obesity. This has been identified as a key research question in a recent Institute of Medicine report. In the present study we sought to determine whether the use of complementary and alternative medicine is associated with health behaviors or risk factors known to impact on health status. Methods: The current study is a cross-sectional regression analysis using data from the 2002 National Health Interview Survey. Data were collected in-person from 31,044 adults throughout the 50 states and the District of Columbia. Results: After controlling for a range of other factors, we found that engaging in leisure-time physical activity, having consumed alcohol in one's life but not being a current heavy drinker, and being a former smoker are independently associated with the use of CAM. Obese individuals are slightly less likely to use CAM than individuals with a healthy body-mass index. No significant associations were observed between receipt of an influenza vaccine and CAM use. Conclusion: Those engaging in positive health behaviors and exhibiting fewer health risk factors are more likely to use CAM than those who forgo positive health behaviors or exhibit more health risk factors. The fact that users of CAM tend to pursue generally healthy lifestyles suggests that they may be open to additional recommendations toward optimizing their health. [ABSTRACT FROM AUTHOR]

Purpose—The research purpose was to identify whether changes occurred between 2000 and 2003 in the retail channel use of rural consumers for searching product information and for purchasing food and fiber products and to investigate whether differences existed between channel use groups (i.e. store only shoppers, store and catalog shoppers, and multi-channel shoppers) concerning perceived time property, satisfaction with local offerings, community attachment, shopping criteria, and financial security. Design/methodology/approach—Survey methodology was used. Questionnaires were mailed to participants living in non-metropolitan statistical areas of the USA with populations less than 12,500. In 2000, 2,198 participants returned the questionnaire. Follow-up questionnaires were mailed to the same participants during 2003 and returned by 847 participants. The analysis is based on the responses of the 847 participants. Findings—To search for information on apparel, food, or home furnishing products, internet use increased slightly as did use of the internet to purchase apparel and home furnishings. Multi-channel shoppers rated themselves as time-pressed, dissatisfied with local offerings, unattached to their community, and unconcerned with financial security while shopping. Practical implications—Rural consumers are slowly increasing their use of internet even as they report their satisfaction with shopping with local brick and mortar stores increased during the time period studied. The time is right for rural retailers to enhance both personal and professional relationships with their customers. Rural retailers can capitalize on consumer satisfaction and provide outstanding value and service to keep local customers in local markets. Originality/value—The paper provides information on new and different retailing practices that satisfy rural consumers in the USA. [ABSTRACT FROM AUTHOR]

School vouchers, particularly since the landmark U.S. Supreme Court ruling on the Cleveland program, are one of the most contentious issues in American education. Seemingly contradictory results across available studies have caused confusion among diverse audiences. The authors suggest that these divergent findings are, in part, due to three factors, unique to voucher research, associated with choice. How these factors combine for various comparison groups are examined and how the combinations likely impact estimations of voucher effect are discussed. The authors close by suggesting that the most complete understanding of the impact of vouchers on students requires the use of multiple comparison groups. [ABSTRACT FROM AUTHOR]

The article offers suggestions on how to develop writing-to-learn assignments for students in the U.S. Writing-to-learn assignments help students understand, reflect upon, and question concepts in more meaningful ways than do essay examinations, reading reports, and research papers. The examples here centers on apparel, however, they are models that can be adapted easily to other areas of family and consumer sciences (FCS), in both secondary and postsecondary programs. Furthermore, one of the best ways for students to become involved in the classroom is to write often and in as many forms as are possible.

Provides information on educational voucher program in the U.S. Definition of voucher programs; Comparison of voucher programs with other forms of school choice; Fund dissemination in voucher programs; Arguments for and against vouchers.

Perennial grass pastures provide the basis for beef production systems across the Southeast United States. One common management practice that is widely recommended among agronomists is interseeding cool-season legumes. Legumes can serve as a complementary resource for filling in production gaps, reducing supplemental feedstuffs, reducing the need for nitrogen fertilization, increasing the nutritional quality of forage available, increase biomass production, improve animal performance, and can reduce the toxic effects of endophyte-infected tall fescue through dilution. A simulated economic analysis was developed to further the economic understanding of the cost of implementation, the subsequent animal and forage performance benefits, and net returns from the inclusion of legumes over many research trials and years. Data from 15 peer-reviewed papers was used to simulate the economic benefits of implementing this production practice. Cost of production and revenue for each paper were calculated using the 10-year average from 2010 to 2019. This analysis provides users with a further understanding of the net returns, critical breakeven areas, and return on investment that is necessary in order to successfully implement the inclusion of cool-season legumes in perennial grass-based systems. [ABSTRACT FROM AUTHOR]

Examines whether preservice teachers can be trained to be clearer in their instructional presentations in the U.S. Overview of the clarity training program skills; Impact of training on improvements in teachers' clarity and ability to produce student learning; Effects of training on student satisfaction.

The article focuses on the basic legal aspects of healthcare contracting in the U.S., in which it cites a case of being a Deputy Commander for Administration (DCA) of a hospital. It states that the DCA, being a U.S. Army Medical Command (MEDCOM) leader, one should know that he does not have power over contractor employees. It cites the importance of acknowledging the parties in a government contract, such as the buyer and seller. It adds that MEDCOM contracts are not applicable to civilians.

Aim: Implementation research that describes how successfully resuscitation guidelines are translated into practice are lacking. We examined whether recent community-based initiatives being conducted as part of the Minnesota Heart Safe (HS) Communities program increase the delivery of CPR and use of automated external defibrillators (AED) by bystanders and first responders prior to ambulance arrival.Methods: Non-EMS witnessed out-of-hospital cardiac arrests (OHCA) with presumed cardiac etiology treated by a single ambulance service in 2013-2015 were studied. Data were obtained from the Minnesota HS program and the Cardiac Arrest Registry to Enhance Survival (CARES) Surveillance Registry. Pre-ambulance CPR and AED use within HS communities before and after completion of the program were compared.Results: As of July 2016, 17 Minnesota communities within the ambulance service area had achieved HS designation and 294 OHCAs that occurred in these communities met inclusion criteria for analysis (120 before HS designation, 174 after). CPR was initiated by bystanders or first responders prior to ambulance arrival in 83% of OHCA events that occurred before HS designation and in 95% of events that occurred after designation (OR=4.23 [1.80-9.98]). Pre-ambulance AED use increased from 63% to 77% after the community intervention (OR=1.94 [1.16-3.24]). Overall unadjusted survival to hospital discharge increased slightly after HS designation, but this difference was not statistically significant (17% vs 20%, p=0.32).Conclusion: Implementation of the Heart Safe program in communities within our ambulance service area in Minnesota has increased use of CPR and AEDs by bystanders and first responders prior to ambulance arrival. [ABSTRACT FROM AUTHOR]

Aim: This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.Methods: A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended. [ABSTRACT FROM AUTHOR]

Aim: This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.Methods: A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended. [ABSTRACT FROM AUTHOR]

The article reports on a study of the utilization of physical therapy (PT) for patients recovering from intensive care unit (ICU). It surveyed 984 physical therapists from the United States wherein each was asked about the availability of physical therapists and PT for ICU patients who need mechanical ventilation. It showed that PT is given to ICU patients during their recovery from critical illness but the frequency and the type of PT depend on the type of hospital and clinical scenario.

In 2016, the American College of Cardiology published the first expert consensus decision pathway (ECDP) on the role of non-statin therapies for low-density lipoprotein (LDL)-cholesterol lowering in the management of atherosclerotic cardiovascular disease (ASCVD) risk. Since the publication of that document, additional evidence and perspectives have emerged from randomized clinical trials and other sources, particularly considering the longer-term efficacy and safety of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors in secondary prevention of ASCVD. Most notably, the FOURIER (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk) trial and SPIRE-1 and -2 (Studies of PCSK9 Inhibition and the Reduction of Vascular Events), assessing evolocumab and bococizumab, respectively, have published final results of cardiovascular outcomes trials in patients with clinical ASCVD and in a smaller number of high-risk primary prevention patients. In addition, further evidence on the types of patients most likely to benefit from the use of ezetimibe in addition to statin therapy after acute coronary syndrome has been published. Based on results from these important analyses, the ECDP writing committee judged that it would be desirable to provide a focused update to help guide clinicians more clearly on decision making regarding the use of ezetimibe and PCSK9 inhibitors in patients with clinical ASCVD with or without comorbidities. In the following summary table, changes from the 2016 ECDP to the 2017 ECDP Focused Update are highlighted, and a brief rationale is provided. The content of the full document has been changed accordingly, with more extensive and detailed guidance regarding decision making provided both in the text and in the updated algorithms. Revised recommendations are provided for patients with clinical ASCVD with or without comorbidities on statin therapy for secondary prevention. The ECDP writing committee judged that these new data did not warrant changes to the decision pathways and algorithms regarding the use of ezetimibe or PCSK9 inhibitors in primary prevention patients with LDL-C <190 mg/dL with or without diabetes mellitus or patients without ASCVD and LDL-C ≥190 mg/dL not due to secondary causes. Based on feedback and further deliberation, the ECDP writing committee down-graded recommendations regarding bile acid sequestrant use, recommending bile acid sequestrants only as optional secondary agents for consideration in patients intolerant to ezetimibe. For clarification, the writing committee has also included new information on diagnostic categories of heterozygous and homozygous familial hypercholesterolemia, based on clinical criteria with and without genetic testing. Other changes to the original document were kept to a minimum to provide consistent guidance to clinicians, unless there was a compelling reason or new evidence, in which case justification is provided. [ABSTRACT FROM AUTHOR]

Abstract: Objective: ICU nurses are repeatedly exposed to work related stresses resulting in the development of psychological disorders including posttraumatic stress disorder and burnout syndrome. Resilience is a learnable multidimensional characteristic enabling one to thrive in the face of adversity. In a national survey, we sought to determine whether resilience was associated with healthier psychological profiles in intensive care unit nurses. Design: Surveys were mailed to 3500 randomly selected ICU nurses across the United States and included: demographic questions, the Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and the Connor–Davidson Resilience Scale. Measurements and main results: Overall, 1239 of the mailed surveys were returned for a response rate of 35%, and complete data was available on a total of 744 nurses. Twenty-two percent of the intensive care unit nurses were categorized as being highly resilient. The presence of high resilience in these nurses was significantly associated with a lower prevalence of posttraumatic stress disorder, symptoms of anxiety or depression, and burnout syndrome (<0.001 for all comparisons). In independent multivariable analyses adjusting for five potential confounding variables, the presence of resilience was independently associated with a lower prevalence of posttraumatic stress disorder (p <0.001), and a lower prevalence of burnout syndrome (p <0.001). Conclusions: The presence of psychological resilience was independently associated with a lower prevalence of posttraumatic stress disorder and burnout syndrome in intensive care unit nurses. Future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psychological profile. [Copyright &y& Elsevier]

The article discusses the changes integrated in the existing scheme of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Topics discussed include the Class of Recommendation (COR) and Level of Evidence (LOE) guidelines, and the implementation of the changes in the guidelines.

The Low-Energy Undulator Test Line (LEUTL) at the Advanced Photon Source, Argonne National Laboratory, is intended to demonstrate the basic operation of a SASE-based free-electron laser. Goals include comparison of experimental results with theoretical predictions and scaling laws, identification of problems relevant to fourth-generation light source construction and operation and the means of addressing them, the development of operational and diagnostic techniques to optimize SASE FEL performance and increase repeatability from run to run, and performance of initial pioneering experiments capable of exploiting the unique properties of the laser.The basic layout and operational philosophy of the LEUTL experiment is presented. A summary of past results, including saturation, is reviewed, and a description of recent results is presented. We conclude with future plans, which include pressing to shorter wavelengths and incorporating user experiments into the LEUTL experimental program. [Copyright &y& Elsevier]

Background: The American Association of Colleges of Nursing (AACN, 2021) introduced "The Essentials: Core Competencies for Professional Nursing Education" (Essentials) in 2021. The AACN document necessitated a change in nursing curriculums, both undergraduate and graduate. To meet the revised standards, one college of nursing within a hierarchical organization used a Three-Step Model of Planned Change to guide curricular revisions. This article presents the lessons learned from using the Three-Step Model of Planned Change, which includes barriers, strategies, and a toolkit for implementing planned change., Step One-Desire a Change: Lessons learned include embracing the unifying values of the guiding coalition to understand the motivation(s) and urgency for change. Suggested strategies include creating a cross-sectional organizational team, utilizing collaborative approaches that value members' time, and various communication methods., Step Two-Make the Change: Lessons learned include understanding the larger hierarchical structure's process requirements and time allotment for approval. Suggested strategies include establishing a repository hub for templates and shared documents, implementing various communication channels, and repurposing standing meeting times., Step Three-Live the Change: As this process is just beginning, anticipated lessons include an understanding of changes occurring circuitously within and between steps. Considerations include significant and purposeful actions to deliver the new curriculum., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Subjective well-being influences mental and physical health. Fortunately, interventions exist to improve people's subjective well-being. Emotion regulation and self-compassion are two transdiagnostic factors that impact mental health and have been separately shown to be associated with subjective well-being. However, their combined relationship with subjective well-being has not yet been examined. To address this gap, the current novel study aimed to determine if there is a combined relationship between self-compassion, emotion regulation, and dimensions of subjective well-being cross-sectionally in adults living in the United States. Participants ( n  = 559; 50% female; M age  = 57.70 years) completed an online survey via Prime Panels from CloudResearch, capturing their responses on the interested constructs. Analyses showed that emotion regulation significantly mediated the relationships between self-compassion and various subjective well-being dimensions, specifically, positive affect ( d  = 0.32), negative affect ( d  = 1.17), and eudemonic well-being ( d  = 0.79). Our findings have both clinical and research implications., Competing Interests: Declaration of conflicting interestsParticipants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Older adults prefer ageing in place (AIP) rather than institutionalized facilities. Although its advantages, AIP can be challenging when communities are unable to meet residents' needs. This study aims to identify the relationship between the level of age-friendliness of community and AIP. We used AARP Age-friendly Community Survey data with 6670 older adults in the USA. We used responses from 63 items assessing various aspects of a community's age-friendliness to identify different types of age-friendly communities (AFCs) through latent profile analysis (LPA). We then ran multinomial logistic regression to examine whether the types of AFC were associated with AIP. LPA revealed three types of AFC: Underdeveloped, developing, and developed. Regression results showed older adults living in underdeveloped and developing communities are less likely to AIP compared to those in the developed community. These results show a positive impact of AFC on intention to AIP. Policymakers should consider expanding AFC initiatives for the growing number of older adults., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has long recognized and championed increasing diversity within the surgical workplace. SAGES initiated the Fundamentals of Leadership Development (FLD) Curriculum to address these needs and to provide surgeon leaders with the necessary tools and skills to promote diversity, equity, and inclusion (DEI) in surgical practice. In 2019, the American College of Surgeons issued a request for anti-racism initiatives which lead to the partnering of the two societies. The primary goal of FLD was to create the first surgeon-focused leadership curriculum dedicated to DEI. The rationale/development of this curriculum and its evaluation/feedback methods are detailed in this White Paper., Methods: The FLD curriculum was developed by a multidisciplinary task force that included surgeons, education experts, and diversity consultants. The curriculum development followed the Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional design model and utilized a problem-based learning approach. Competencies were identified, and specific learning objectives and assessments were developed. The implementation of the curriculum was designed to be completed in short intervals (virtual and in-person). Post-course surveys used the Kirkpatrick's model to evaluate the curriculum and provide valuable feedback., Results: The curriculum consisted of interactive online modules, an online discussion forum, and small group interactive sessions focused in three key areas: (1) increasing pipeline of underrepresented individuals in surgical leadership, (2) healthcare equity, and (3) conflict negotiation. By focusing on positive action items and utilizing a problem-solving approach, the curriculum aimed to provide a framework for surgical leaders to make meaningful changes in their institutions and organizations., Conclusion: The FLD curriculum is a novel leadership curriculum that provided surgeon leaders with the knowledge and tools to improve diversity in three areas: pipeline improvement, healthcare equity, and conflict negotiation. Future directions include using pilot course feedback to enhance curricular effectiveness and delivery., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: The War in Afghanistan ended in August 2021. Evacuation from the country was a large effort during the last days of the conflict. During evacuation efforts at Kabul Hamid Karzai International Airport, a suicide bombing occurred necessitating emergent medical care for many injured troops and civilians. The U.S. Air Force Critical Care Air Transport Teams (CCATTs) played a role in the medical care provided during the operations in Afghanistan. We report on in-flight events and interventions that took place during the final days of the Afghanistan withdrawal., Materials and Methods: We performed a retrospective chart review of patients requiring aeromedical evacuation from the Afghanistan theater of operations by CCATT from July 1 to August 30, 2021. From the CCATT patient care record, data abstractors collected patient characteristics, flight information, vital signs, laboratory values, in-flight interventions, and in-flight events in a study-specific electronic database. We performed descriptive analyses of patient characteristics and in-flight interventions. This study was approved by the San Antonio Institutional Review Board., Results: Nine patients were included in this analysis. Seven out of nine patients were foreign nationals; the remaining two were U.S. Marines. Five patients suffered penetrating injuries from gunshot wounds and four suffered blast injuries. Six received intravenous narcotic analgesia. Four received intravenous sedatives, and four received antibiotics in flight. Two patients required chest tube management. One patient received blood. Three patients were in acute respiratory distress., Conclusions: Severe injuries were sustained during the withdrawal efforts at the end of the War in Afghanistan. Critical Care Air Transport Teams played a role in the care and evacuation of patients out of theater during this unique and unprecedented time. Even given the limitations associated with retrospective studies and a small sample size, information reported in this study can help inform future decisions, and aid in preparatory efforts for future operations, that may require medical care by CCATT., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: The NIH All of Us Research Program has enrolled over 544,000 participants across the US with unprecedented racial/ethnic diversity, offering opportunities to investigate myriad exposures and diseases. This paper aims to investigate the association between PM 2.5 exposure and cancer risks., Materials and Methods: This work was performed on data from 409,876 All of Us Research Program participants using the All of Us Researcher Workbench. Cancer case ascertainment was performed using data from electronic health records and the self-reported Personal Medical History questionnaire. PM 2.5 exposure was retrieved from NASA's Earth Observing System Data and Information Center and assigned using participants' 3-digit zip code prefixes. Multivariate logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Generalized additive models (GAMs) were used to investigate non-linear relationships., Results: A total of 33,387 participants and 46,176 prevalent cancer cases were ascertained from participant EHR data, while 20,297 cases were ascertained from self-reported survey data from 18,133 participants; 9,502 cancer cases were captured in both the EHR and survey data. Average PM 2.5 level from 2007 to 2016 was 8.90 μg/m 3 (min 2.56, max 15.05). In analysis of cancer cases from EHR, an increased odds for breast cancer (OR 1.17, 95% CI 1.09-1.25), endometrial cancer (OR 1.33, 95% CI 1.09-1.62) and ovarian cancer (OR 1.20, 95% CI 1.01-1.42) in the 4th quartile of exposure compared to the 1st. In GAM, higher PM 2.5 concentration was associated with increased odds for blood cancer, bone cancer, brain cancer, breast cancer, colon and rectum cancer, endocrine system cancer, lung cancer, pancreatic cancer, prostate cancer, and thyroid cancer., Conclusions: We found evidence of an association of PM 2.5 with breast, ovarian, and endometrial cancers. There is little to no prior evidence in the literature on the impact of PM 2.5 on risk of these cancers, warranting further investigation., (© 2023. The Author(s).)

Background: As the nutritional status of people with CF (PwCF) is associated with their socioeconomic status, it is important to understand factors related to food security and food access that play a role in the nutritional outcomes of this population. We assessed the contributions of CF program-level food insecurity screening practices and area-level food access for nutritional outcomes among PwCF., Methods: We conducted a cross-sectional analysis of 2019 data from the U.S. CF Patient Registry (CFFPR), linked to survey data on CF program-level food insecurity screening and 2019 patient zip code-level food access. Pediatric and adult populations were analyzed separately. Nutritional outcomes were assessed with annualized BMI percentiles (CDC charts) for children and BMI (kg/m 2 ) for adults, with underweight status defined as BMIp <10% for children and BMI <18.5 kg/m 2 for adults, and overweight or obese status defined as BMIp >85% for children and BMI >25 kg/m 2 for adults. Analyses were adjusted for patient sociodemographic and clinical characteristics., Results: The study population included 11,971 pediatric and 14,817 adult PwCF. A total of 137 CF programs responded to the survey, representing 71% of the pediatric sample and 45% of the CFFPR adult sample. The joint models of nutritional status as a function of both program-level food insecurity screening and area-level food access produced the following findings. Among children with CF, screening at every visit vs less frequently was associated with 39% lower odds of being underweight (OR 0.61, p = 0.019), and the effect remained the same and statistically significant after adjusting for all covariates (aOR 0.61, p = 0.047). Residence in a food desert was associated both with higher odds of being underweight (OR 1.66, p = 0.036; aOR 1.58, p = 0.008) and with lower BMIp (-4.81%, p = 0.004; adjusted -3.73%, p = 0.014). Among adults with CF, screening in writing vs verbally was associated with higher odds of being overweight (OR 1.22, p = 0.028; aOR 1.36, p = 0.002) and higher BMI (adjusted 0.43 kg/m 2 , p = 0.032). Residence in a food desert was associated with higher odds of being underweight (OR 1.48, p = 0.025)., Conclusions: Food insecurity screening and local food access are independent predictors of nutritional status among PwCF. More frequent screening is associated with less underweight among children with CF, whereas screening in writing (vs verbally) is associated with higher BMI among adults. Limited food access is associated with higher odds of being underweight in both children and adults with CF, and additionally with lower BMI among children with CF. Study results highlight the need for standardized, evidence-based food insecurity screening across CF care programs and for equitable food access to optimize the nutritional outcomes of PwCF., Competing Interests: Declaration of Competing Interest Kim Reno and Cristen Clemm are employees of the Cystic Fibrosis Foundation. Georgia Brown is a person living with cystic fibrosis. All other co-authors served on the Cystic Fibrosis Foundation Food Security Committee and received a honorarium for their service., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To describe patient differences by prenatal care (PNC) model and identify factors that interact with race to predict more attended prenatal appointments, a key component of PNC adherence., Methods: This retrospective cohort study used administrative data targeting prenatal patient utilization from two OB clinics with different care models (resident vs. attending OB) from within one large midwestern healthcare system. All appointment data among patients receiving prenatal care at either clinic between September 2, 2020, and December 31, 2021, were extracted. Multivariable linear regression was performed to identify predictors of attended appointments within the resident clinic, as moderated by race (Black vs. White)., Results: A total of 1034 prenatal patients were included: 653 (63%) served by the resident clinic (appointments = 7822) and 381 (38%) by the attending clinic (appointments = 4627). Patients were significantly different across insurance, race/ethnicity, partner status, and age between clinics (p < 0.0001). Despite prenatal patients at both clinics being scheduled for approximately the same number of appointments, resident clinic patients attended 1.13 (0.51, 1.74) fewer appointments (p = 0.0004). The number of attended appointments was predicted by insurance in crude analysis (β = 2.14, p < 0.0001), with effect modification by race (Black vs. White) in final fitted analysis. Black patients with public insurance attended 2.04 fewer appointments than White patients with public insurance (7.60 vs. 9.64) and Black non-Hispanic patients with private insurance attended 1.65 more appointments than White non-Hispanic or Latino patients with private insurance (7.21 vs. 5.56)., Conclusion: Our study highlights the potential reality that the resident care model, with more care delivery challenges, may be underserving patients who are inherently more vulnerable to PNC non-adherence at care onset. Our findings show that patients attend more appointments at the resident clinic if publicly insured, but less so if they are Black than White., (© 2023. The Author(s).)

Lead is an established neurotoxicant, and it has known associations with adverse neurodevelopmental and reproductive outcomes. Exposure to lead at any level is unsafe, and the United States (US) has enacted various federal and state legislations to regulate lead levels in drinking water in K-12 schools and childcare facilities; however, no regulations exist for higher education settings. Upon the discovery of lead in drinking water fixtures in the University of North Carolina at Chapel Hill (UNC-CH) campus, a cross-campus water testing network and sampling plan was developed and deployed. The campaign was based on the US Environmental Protection Agency's (EPA) 3Ts (Training, Testing, and Taking Action) guidance. The seven-month campaign involved 5954 tests on 3825 drinking water fixtures across 265 buildings. A total of 502 (8.43%) tests showed lead above the limit of detection (1 part per billion, ppb), which represented 422 (11.03%) fixtures. Fewer than 1.5% of the tests were above the EPA action level for public water systems (15 ppb). In conclusion, systematic testing of all the fixtures across campus was required to identify localized contamination, and each entity in the cross-campus network undertook necessary roles to generate a successful testing campaign. UNC-CH established preventative measures to test drinking water fixtures every three years, which provide a framework for other higher education institutions in responding to lead contamination.

Background: Opioid overdose deaths in the United States remain a major public health crisis. Little is known about counties with high rates of opioid overdose mortality but low availability of opioid use disorder (OUD) treatment facilities. We sought to identify characteristics of United States (US) counties with high rates of opioid overdose mortality and low rates of opioid treatment facilities., Methods: Rates of overdose mortality from 3,130 US counties were compared with availability of opioid treatment facilities that prescribed or allowed medications for OUD (MOUD), from 2018-2019. The outcome variable, "risk-availability mismatch" county, was a binary indicator of a high rate (above national average) of opioid overdose mortality with a low (below national average) rate of opioid treatment facilities. Covariates of interest included county-level sociodemographics and rates of insurance, unemployment, educational attainment, poverty, urbanicity, opioid prescribing, depression, heart disease, Gini index, and Theil index. Multilevel logistic regression, accounting for the clustering of counties within states, was used to determine associations with being a "risk-availability mismatch" county., Results: Of 3,130 counties, 1,203 (38.4%) had high rates of opioid overdose mortality. A total of 1,098 counties (35.1%) lacked a publicly-available opioid treatment facility in 2019. In the adjusted model, counties with an additional 1% of: white residents (odds ratio, OR, 1.02; 95% CI, 1.01-1.03), unemployment (OR, 1.11; 95% CI, 1.05-1.19), and residents without insurance (OR, 1.04; 95% CI, 1.01-1.08) had increased odds of being a mismatch county. Counties that were metropolitan (versus non-metropolitan) had an increased odds of being a mismatch county (OR, 1.85; 95% CI, 1.45-2.38)., Conclusion: Assessing mismatch between treatment availability and need provides useful information to characterize counties that require greater public health investment. Interventions to reduce overdose mortality are unlikely to be effective if they do not take into account diverse upstream factors, including sociodemographics, disease burden, and geographic context of communities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Rizk et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Valsartan is commonly used for cardiac conditions. In 2018, the Food and Drug Administration recalled generic valsartan due to the detection of impurities. Our objective was to determine if heart failure patients receiving valsartan at the recall date had a greater likelihood of unfavorable outcomes than patients using comparable antihypertensives., Methods: We conducted a cohort study of Optum's de-identified Clinformatics® Datamart (July 2017-January 2019). Heart failure patients with commercial or Medicare Advantage insurance who received valsartan were compared to persons who received non-recalled angiotensin receptor blockers (ARBs) and angiotensin converting enzyme-inhibitors (ACE-Is) for 1 year prior and including the recall date. Outcomes included a composite for all-cause hospitalization, emergency department (ED), and urgent care (UC) use and a measure of cardiac events which included hospitalizations for acute myocardial infarction and hospitalizations/ED/UC visits for stroke/transient ischemic attack, heart failure or hypertension at 6-months post-recall. Cox proportional hazard models with propensity score weighting compared the risk of outcomes between groups., Results: Of the 87 130 adherent patients, 15% were valsartan users and 85% were users of non-recalled ARBs/ACE-Is. Valsartan use was not associated with an increased risk of all-cause hospitalization/ED/UC use six-months post-recall (HR 1.00; 95% CI 0.96-1.03), compared with individuals taking non-recalled ARBs/ACE-Is. Similarly, cardiac events 6-months post-recall did not differ between individuals on valsartan and non-recalled ARBs/ACE-Is (HR 1.04; 95% CI 0.97-1.12)., Conclusions: The valsartan recall did not affect short-term outcomes of heart failure patients. However, the recall potentially disrupted the medication regimens of patients, possibly straining the healthcare system., (© 2024 John Wiley & Sons Ltd.)

Importance: Drug shortages are a chronic and worsening issue that compromises patient safety. Despite the destabilizing impact of the COVID-19 pandemic on pharmaceutical production, it remains unclear whether issues affecting the drug supply chain were more likely to result in meaningful shortages during the pandemic., Objective: To estimate the proportion of supply chain issue reports associated with drug shortages overall and with the COVID-19 pandemic., Design, Setting, and Participants: This longitudinal cross-sectional study used data from the IQVIA Multinational Integrated Data Analysis database, comprising more than 85% of drug purchases by US pharmacies from wholesalers and manufacturers, from 2017 to 2021. Data were analyzed from January to May 2023., Exposure: Presence of a supply chain issue report to the US Food and Drug Administration or the American Society of Health-Systems Pharmacists (ASHP)., Main Outcomes and Measures: The main outcome was drug shortage, defined as at least 33% decrease in units purchased within 6 months of a supply chain issue report. Random-effects logistic regression models compared the marginal odds of shortages for drugs with vs without reports. Interaction terms assessed heterogeneity prior to vs during the COVID-19 pandemic and by drug characteristics (formulation, age, essential medicine status, clinician- vs self-administered, sales volume, and number of manufacturers)., Results: A total of 571 drugs exposed to 731 supply chain issue reports were matched to 7296 comparison medications with no reports. After adjusting for drug characteristics, 13.7% (95% CI, 10.4%-17.8%) of supply chain issue reports were associated with subsequent drug shortages vs 4.1% (95% CI, 3.6%-4.8%) of comparators (marginal odds ratio [mOR], 3.7 [95% CI, 2.6-5.1]). Shortages increased among both drugs with and without reports in February to April 2020 (34.2% of drugs with supply chain issue reports and 9.5% of comparison drugs; mOR, 4.9 [95% CI, 2.1-11.6]), and then decreased after May 2020 (9.8% of drugs with reports and 3.6% of comparison drugs; mOR, 2.9 [95% CI, 1.6-5.3]). Significant associations were identified by formulation (parenteral mOR, 1.9 [95% CI, 1.1-3.2] vs oral mOR, 5.4 [95% CI, 3.3-8.8]; P for interaction = .008), WHO essential medicine status (essential mOR, 2.2 [95% CI, 1.3-5.2] vs nonessential mOR, 4.6 [95% CI, 3.2-6.7]; P = .02), and for brand-name vs generic status (brand-name mOR, 8.1 [95% CI, 4.0-16.0] vs generic mOR, 2.4 [95% CI, 1.7-3.6]; P = .002)., Conclusions and Relevance: In this national cross-sectional study, supply chain issues associated with drug shortages increased at the beginning of the COVID-19 pandemic. Ongoing policy work is needed to protect US drug supplies from future shocks and to prioritize clinically valuable drugs at greatest shortage risk.

Purpose: We investigated the proportions of patients eligible for accelerated partial breast irradiation (APBI) among those with pT1-2N0 breast cancer, based on the criteria set by the American Society for Radiation Oncology (ASTRO), the Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC-ESTRO), the American Brachytherapy Society (ABS), and the American Society of Breast Surgeons (ASBS). Additionally, we analyzed the rate of APBI utilization among eligible patients., Materials and Methods: Patients diagnosed with pT1-2N0 breast cancer in 2019 were accrued in four tertiary medical centers in Korea. All patients had undergone breast conserving surgery followed by radiotherapy, either whole breast irradiation or APBI. To determine which guideline best predicts the use of APBI in Korea, the F1 score and Matthews Correlation Coefficient (MCC) were determined for each guideline., Results: A total of 1,251 patients were analyzed, of whom 196 (15.7%) underwent APBI. The percentages of eligible patients identified by the ASTRO, GEC-ESTRO, ABS, and ASBS criteria were 13.7%, 21.0%, 50.5%, and 63.5%, respectively. APBI was used to treat 54.4%, 37.2%, 27.1%, and 23.7% of patients eligible by the ASTRO, GEC-ESTRO, ABS, and ASBS criteria, respectively. The ASTRO guideline exhibited the highest F1 score (0.76) and MCC (0.67), thus showing the best prediction of APBI utilization in Korea., Conclusion: The proportion of Korean breast cancer patients who are candidates for APBI is substantial. The actual rate of APBI utilization among eligible patients may suggest there is a room for risk-stratified optimization in offering radiation therapy.

Objective: To examine the association among barriers to dental care services, dentition groups, and self-reported oral health status for Medicare beneficiaries., Methods: We used data from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES), which included participants aged ≥65 years who were enrolled in Medicare and had completed the oral health exam. We created a dentition group variable using the detailed dental examination data to account for the presence of natural, replaced, removable, or missing teeth. Through bivariate and logistic analyses, we explored the relationship between barriers to receiving dental care services, dentition groups, and reported oral and general health statuses, along with other control variables., Results: For the total Medicare population as well as in the four subgroup analyses, we showed that those with barriers to dental care services were more likely to report fair or poor oral health status. Those who were edentulous, had complete dentures, or had less than a full mouth of teeth had greater barriers and worse oral and general health than did those with all-natural teeth. Among those who reported fair or poor general health, those with less than a full mouth of teeth showed similar levels of barriers to dental care services and worse perceived oral health than did those without any teeth., Conclusions: Helping the 65 years and older population retain their teeth in good condition will improve their overall health. Investment in oral hygiene and health for the current and future Medicare populations could improve their overall health., (© 2023 American Association of Public Health Dentistry.)