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In the following research review, 57 articles were analysed to get an insight into research in the field of computational thinking and programming in K-12. The results show that empirical research regarding programming and computational thinking is prevalent in the USA and Greece. The articles were published in 43 different academic journals. A fast-growing number of articles published in the research field during 2006-18 indicate growing interest. The articles were analysed and clustered into seven strands: (1) Evaluating digital resources, (2) Assessment, (3) Improving students' academic performance through programming, (4) Gender and equity, (5) Games -- as a method to learn programming, (6) Attitudes and motivations, and (7) Teachers' competencies and teaching. An extensive focus is on the evaluation of different technical solutions as well as pedagogical methods. Implications for teaching and learning programming and developing computational thinking skills are discussed.

This is the first meta-analysis to examine the outcomes of nonfamilial, intergenerational programs (IGP) on youth and older adults. Relevant studies were identified by screening the abstracts from five systematic reviews on the impact of intergenerational programs on psychosocial outcomes. After all studies were screened 23 independent studies were included in the meta-analysis. An effect size, d, was calculated for the change in youth attitudes toward older adults, as well as older adults' change in generativity, quality of life, depressive symptoms, and physical health. Results suggested that IGP have a small, but significant association with improved youth attitudes toward older adults (d = 0.42). For older adults IGP were associated with a small, significant, reduction in depressive symptoms (d = > -0.30) and increased generativity (d = 0.25), quality of life (d = 0.48) and physical health (d = 0.10). Nonsignificant heterogeneity precluded the use of moderator variables to explain variation among the studies. With a better understanding of the effectiveness of IGP, researchers can more effectively develop IGP and assess their outcomes.

Questionnaire design is routinely guided by classic experiments on question form, wording, and context conducted decades ago. This article explores whether two question order effects (one due to the norm of evenhandedness and the other due to subtraction or perceptual contrast) appear in surveys of probability samples in the United States and 11 other countries (Canada, Denmark, Germany, Iceland, Japan, the Netherlands, Norway, Portugal, Sweden, Taiwan, and the United Kingdom; N = 25,640). Advancing theory of question order effects, we propose necessary conditions for each effect to occur, and found that the effects occurred in the nations where these necessary conditions were met. Surprisingly, the abortion question order effect even appeared in some countries in which the necessary condition was not met, suggesting that the question order effect there (and perhaps elsewhere) was not due to subtraction or perceptual contrast. The question order effects were not moderated by education. The strength of the effect due to the norm of evenhandedness was correlated with various cultural characteristics of the nations. Strong support was observed for the form-resistant correlation hypothesis.

Background: Research has primarily concentrated on adults' implicit theories about high quality science education for all students. Little work has considered the students' perspective. This study investigated high school students' implicit theories about what helped them learn science. Purpose: This study addressed (1) What characterizes high school students' implicit theories of what facilitates their learning of science?; (2) With respect to students' self-classifications as African American or European American and female or male, do differences exist in the students' implicit theories? Sample, design and methods: Students in an urban high school located in south-eastern United States were surveyed in 2006 about their thoughts on what helps them learn science. To confirm or disconfirm any differences, data from two different samples were analyzed. Responses of 112 African American and 118 European American students and responses from 297 European American students comprised the data for sample one and two, respectively. Results: Seven categories emerged from the deductive and inductive analyses of data: personal responsibility, learning arrangements, interest and knowledge, communication, student mastery, environmental responsiveness, and instructional strategies. Instructional strategies captured 82% and 80% of the data from sample one and two, respectively; consequently, this category was further subjected to Mann-Whitney statistical analysis at p less than 0.05 to ascertain ethnic differences. Significant differences did not exist for ethnicity but differences between females and males in sample one and sample two emerged. Conclusions: African American and European American students' implicit theories about instructional strategies that facilitated their science learning did not significantly differ but female and male students' implicit theories about instructional strategies that helped them learn science significantly differed. Because students attend and respond to what they think and perceive to be important, addressing students' implicit theories may be one way to enhance science education reform. (Contains 5 tables.)

Classrooms across the United States increasingly find White teachers paired with ethnic minority students, but few of these teachers are prepared for the disparities such cultural integration presents. This is particularly true vis-a-vis science education. While classrooms have diversified, science instruction has not necessarily followed suit. Two theories, constructivism and culturally relevant pedagogy, have been identified as mechanisms to diminish the disparities in science education. Yet culturally relevant pedagogy has not had the same impact as constructivism, even though it has been posited as a crucial means to better assure ethnic minority access to education. A case study of two classroom teachers investigates whether and how constructivism can be leveraged to develop culturally relevant pedagogy in science instruction. Identifying practical possibilities for culturally relevant pedagogy in science education is important for students, teachers, and the future of the U.S. workforce because it provides a means of increasing marginalized students' access to science and technological fields. (Contains 2 tables.)

Describes use of an ICT (information and communications technology) Learning Model that integrated videoconferencing and data sharing with online Web materials to form a collaborative educational community of students and teachers from three countries (United States, United Kingdom, and Japan) that involved space science research. (LRW)

Surveys teachers in Taiwan and the United States to judge among 20 moral issues as appropriate subjects of study in grade six of primary school and in freshman year of college. Finds a great diversity of responses within each group. Identifies some differences between the respondents in the two countries. Contains 51 references. (VWC)

Background: To date, there have not been any epidemiologic studies that have evaluated the association between swimming over a lifetime and knee health.Objective: The study aimed to evaluate the relationship of a history of swimming with knee pain, radiographic knee OA (ROA), and symptomatic knee OA (SOA).Design: Cross-sectional retrospective study.Setting: Four academic centers in the United States.Participants: Respondents to the historical physical activity survey within the Osteoarthritis Initiative with knee radiographs and symptom assessments.Methods: In this retrospective study nested within the Osteoarthritis Initiative, researchers performed logistic regression with the predictor being swimming over a lifetime and over particular age ranges.Main Outcome Measurements: Person-based definitions of frequent knee pain, ROA, and SOA.Results: A total of 2637 participants were included, with a mean age of 64.3 years (SD 8.9), body mass index of 28.4 kg/m2 (SD 4.9), and 44.2% male. Over a lifetime, the adjusted prevalence measures for frequent knee pain, ROA, and SOA for any versus no history of swimming were 36.4% (33.4% - 39.5%) v. 39.9% (37.4% - 42.5%), 54.3% (51.0% - 57.6%) v. 61.1% (58.4% - 63.7%), and 21.9% (19.4% - 24.7%) v. 27.0% (24.7% - 29.4%) respectively.Conclusions: This is the first epidemiologic study to indicate that swimming is potentially beneficial toward knee health, particularly when performed earlier in life (before age 35). Future prospective studies are needed to confirm these findings and to better scrutinize the associations in older age groups. [ABSTRACT FROM AUTHOR]

Background: We investigated the incidence of ischemic heart disease (IHD) in relation to accumulated exposure to particulate matter (PM) in a cohort of aluminum workers. We adjusted for time varying confounding characteristic of the healthy worker survivor effect, using a recently introduced method for the estimation of causal target parameters.Methods: Applying longitudinal targeted minimum loss-based estimation, we estimated the difference in marginal cumulative risk of IHD in the cohort comparing counterfactual outcomes if always exposed above to always exposed below a PM2.5 exposure cut-off. Analyses were stratified by sub-cohort employed in either smelters or fabrication facilities. We selected two exposure cut-offs a priori, at the median and 10th percentile in each sub-cohort.Results: In smelters, the estimated IHD risk difference after 15 years of accumulating PM2.5 exposure during follow-up was 2.9% (0.6%, 5.1%) using the 10th percentile cut-off of 0.10 mg/m. For fabrication workers, the difference was 2.5% (0.8%, 4.1%) at the 10th percentile of 0.06 mg/m. Using the median exposure cut-off, results were similar in direction but smaller in size. We present marginal incidence curves describing the cumulative risk of IHD over the course of follow-up for each sub-cohort under each intervention regimen.Conclusions: The accumulation of exposure to PM2.5 appears to result in higher risks of IHD in both aluminum smelter and fabrication workers. This represents the first longitudinal application of targeted minimum loss-based estimation, a method for generating doubly robust semi-parametric efficient substitution estimators of causal parameters, in the fields of occupational and environmental epidemiology. [ABSTRACT FROM AUTHOR]

Background: Endotrophin, a collagen type VI-derived peptide, mediates metabolic dysregulation, inflammation, and fibrosis in animal models, but has not been studied in human heart failure (HF). Methods: We examined the association between circulating endotrophin and outcomes in participants suffering from HF with preserved ejection fraction (HFpEF) enrolled in the TOPCAT trial (n=205). Associations were validated in a participant-level meta-analysis (n=810) that included participants with HFpEF from the PHFS study (United States; n=174), PEOPLE cohort (New Zealand; n=168), a randomized trial of vasodilator therapy (United States; n=45), a cohort from Donostia University Hospital and University of Navarra (Spain; n=171), and the TRAINING-HF trial (Spain; n=47). We also assessed associations in HF with reduced ejection fraction in PHFS (n=1,642). Results: Plasma endotrophin levels at baseline were associated with risk of future death (standardized hazard ratio [HR]=1.74; 95% confidence interval [CI]=1.36-2.24; P<0.001) and death or HF-related hospital admission (DHFA; standardized HR=2.11; 95% CI=1.67-2.67; P<0.001) in TOPCAT. Endotrophin improved reclassification and discrimination for these outcomes beyond the MAGGIC risk score and NT-proBNP (N-terminal pro b-type natriuretic peptide). Findings were confirmed in the participant-level meta-analysis. In participants with HF with reduced ejection fraction in PHFS, endotrophin levels were associated with death (standardized HR=1.82; 95% CI=1.66-2.00; P<0.001) and DHFA (standardized HR=1.40; 95% CI=1.31-1.50; P<0.001), but the strength of the latter association was substantially lower than for the MAGGIC risk score (standardized HR=1.93; 95% CI=1.76-2.12) and BNP (standardized HR=1.78; 95% CI=1.66-1.92). Conclusions: Circulating endotrophin levels are independently associated with future poor outcomes in patients with HF, particularly in HFpEF. (Funded by Bristol Myers Squibb; Instituto de Salud Carlos III [Spain] and European Regional Development Fund; European Commission CRUCIAL project; and the U.S. National Institutes of Health National Heart, Lung, and Blood Institute.) [ABSTRACT FROM AUTHOR]

The article discusses legal education innovations in relation to the case method technique which was reportedly developed by Christopher Columbus Langdell at Harvard Law School in the 19th century. Various contemporary models of professional school instruction are addressed, including methodologies employed in American schools of medicine, law, and business. Legal education reform efforts are mentioned, along with clinical legal programs and several reports on legal education methodologies.

Canine distemper is uncommon in the pet trade in the United States, in large part due to effective vaccines against Canine distemper virus (CDV). This is a report of CDV affecting 24 young dogs of multiple breeds shortly after sale by 2 pet stores in Wyoming during August–October 2010. Cases were diagnosed over 37 days. Diagnosis was established by a combination of fluorescent antibody staining, reverse transcription polymerase chain reaction, negative stain electron microscopy, and necropsy with histopathology. Viral hemagglutinin gene sequences were analyzed from 2 affected dogs and were identical (GenBank accession no. JF283477). Sequences were distinct from those in a contemporaneous unrelated case of CDV in a Wyoming dog (JF283476) that had no contact with the pet store dogs. The breeding property from which the puppies originated was quarantined by the Kansas Animal Health Department. Puppies intended for sale were tested for CDV. Canine distemper was diagnosed on site in November 2010. At that point 1,466 dogs were euthanized to eliminate dispersal of the disease through commercial channels. The investigation underscores the risks inherent in large-scale dog breeding when vaccination and biosecurity practices are suboptimal. [ABSTRACT FROM PUBLISHER]

Abstract: Declines in heart disease and stroke mortality rates are conventionally attributed to reductions in cigarette smoking, recognition and treatment of hypertension and diabetes, effective medications to improve serum lipid levels and to reduce clot formation, and general lifestyle improvements. Recent evidence implicates these and other cerebrovascular factors in the development of a substantial proportion of dementia cases. Analyses were undertaken to determine whether corresponding declines in age-specific prevalence and incidence rates for dementia and cognitive impairment have occurred in recent years. Data spanning 1 or 2 decades were examined from community-based epidemiological studies in Minnesota, Illinois, and Indiana, and from the Health and Retirement Study, which is a national survey. Although some decline was observed in the Minnesota cohort, no statistically significant trends were apparent in the community studies. A significant reduction in cognitive impairment measured by neuropsychological testing was identified in the national survey. Cautious optimism appears justified. [ABSTRACT FROM AUTHOR]

Abstract: Passive surveillance for disease is a public health approach that relies on documentation available within existing health records for the region or community being studied. Its two primary advantages over active case-finding are the lower cost of research and the lower burden on the population under study. The effectiveness of passive case-finding depends on the comprehensiveness of the healthcare coverage in a given community and the adequacy of the available medical records. The Rochester Epidemiology Project has permitted dementia case detection for Olmsted County, Minnesota, using a medical records-linkage system. These data were compared with case ascertainment using direct assessment of individuals in an epidemiological study of the same community. At the Group Health Research Institute, investigators compared dementia and Alzheimer’s disease cases detected using an electronic medical record database search with those identified by a parallel active case-finding study. In this article, the advantages and disadvantages of passive case-finding were discussed, and the following conclusion was drawn: the purpose of the study being conducted should determine the case-finding approach that is to be used. [ABSTRACT FROM AUTHOR]

Abstract: In principle, we want regulatory programs to be based on current realities, as reflected for example in the best knowledge of relevant experts. That would imply that old rules now on the books should be consistent with today''s knowledge base, not just what was known when a rule or standard was originally set. This paper reports on a survey of US programs, examining how often existing rules are actually updated in light of better knowledge, and identifies five programs that attempt to make policy routinely adaptive. These programs exhibit what we term Planned Adaptation: they both revise rules when relevant new knowledge appears, and take steps to produce such improved knowledge. While Planned Adaptation is rare, it is used in several nationally prominent programs, including air pollution, airplane safety, and drug safety. Planned Adaptation is a policy tool that deserves more attention. [Copyright &y& Elsevier]

This review discusses leishmaniasis in cats and dogs in the United States. Leishmaniasis is endemic in Foxhound populations in the United States and is still being characterized in this group. Pathophysiology, clinical signs, transmission, immunology, and treatment are examined in this review. Leishmaniasis is an emergent zoonosis of great public health significance. [Copyright &y& Elsevier]

Climate change raises many questions with strong moral and ethical dimensions that are important to address in climate-policy formation and international negotiations. Particularly in the United States, the public discussion of these dimensions is strongly influenced by religious groups and leaders. Over the past few years, many religious groups have taken positions on climate change, highlighting its ethical dimensions. This paper aims to explore these ethical dimensions in the US public debate in relation to public support for climate policies. It analyzes in particular the Christian voices in the US public debate on climate change by typifying the various discourses. Three narratives emerge from this analysis: ‘conservational stewardship’ (conserving the ‘garden of God’ as it was created), ‘developmental stewardship’ (turning the wilderness into a garden as it should become) and ‘developmental preservation’ (God's creation is good and changing; progress and preservation should be combined). The different narratives address fundamental ethical questions, dealing with stewardship and social justice, and they provide proxies for public perception of climate change in the US. Policy strategies that pay careful attention to the effects of climate change and climate policy on the poor – in developing nations and the US itself – may find support among the US population. Religious framings of climate change resonate with the electorates of both progressive and conservative politicians and could serve as bridging devices for bipartisan climate-policy initiatives. [Copyright &y& Elsevier]

The article discusses the factors that shape the future of applied sociology in higher education in the U.S. It presents an overview of the history and institutional background of the discipline of sociology. It explores five alternative scenarios that are believed to be plausible for the future of applied sociology including Increasing Focus, Down and Out, and Leaving Home. It stresses that the said factors may have conflicting outcomes to applied sociology's future.

Abstract: The influence of forest fragmentation on population and community dynamics of woody plants has been well established worldwide, but rarely at the level of an individual plant. We evaluated the influence of fragmentation on juvenile stem morphology of Acer saccharum Marsh. (sugar maple), while also examining light levels and considering possible confounding effects attributed to elevation gradients in temperate forests of northeastern Ohio, USA. At two sites, plant stem dimensions, canopy openness, and relative ground level elevation were measured using randomly positioned plots in forest edge and interior habitats that were within 25 and 60–100m from a forest edge, respectively. Ratios of stem length to stem basal diameter were greater in forest interiors than near forest edges. These differences in stem morphology between habitats were likely a result of stem elongation in relation to a shade avoidance response in forest interiors that were consistently darker than forest edge areas across study sites. By contrast, such morphological differences were likely not related to variation in relative ground level elevation since a subtle elevation gradient was detected at only one site. We encourage experimentation to identify mechanisms that affect plant stem morphology of young individuals and its influence, in turn, on plant population dynamics in fragmented forests. [Copyright &y& Elsevier]

This paper addresses whether there are productivity differences between men and women among blue-collar workers. We compare the wages under piece- and time-rate contracts of men and women working in the same occupation in the same establishment in three countries: the U.S., Norway, and Sweden. The findings are summarized in four points. First, the gender wage gap is smaller under piece- than under time-rate work. According to the interpretation put forth here, two-thirds of the gap at the occupation-establishment level is due to productivity differences, while one-third is not "accounted for," but could be due to discrimination or experience or other factors. Productivity differences between sexes in typically male-dominated blue-collar industries are however very small, of 1-3%: Sweden 1%, U.S. 2%, and Norway 3%. Second, in age groups where women on average have extensive family obligations, the wage gap is larger than in other age groups. Third, under time-rate work, the wage gap is more or less independent of supposed occupation-based productivity differences between men and women, while under piece-rate work, the wage gap mirrors quite closely assumed productivity differences, with women receiving a wage premium in female-advantageous settings and a penalty in male-advantageous settings. Fourth, in contrast to Sweden, in Norway and the U.S. women sort more often into piece-rate work than men. [ABSTRACT FROM AUTHOR]

We compare the historical record of earthquake hazard experienced at 78 towns and cities (sites) distributed across New Zealand and the continental United States with the hazard estimated from the national probabilistic seismic-hazard (PSH) models for the two countries. The two PSH models are constructed with similar methodologies and data. Our comparisons show a tendency for the PSH models to slightly exceed the historical hazard in New Zealand and westernmost continental United States interplate regions, but show lower hazard than that of the historical record in the continental United States intraplate region. Factors such as non-Poissonian behavior, parameterization of active fault data in the PSH calculations, and uncertainties in estimation of ground-motion levels from historical felt intensity data for the interplate regions may have led to the higher-than-historical levels of hazard at the interplate sites. In contrast, the less-than-historical hazard for the remaining continental United States (intraplate) sites may be largely due to site conditions not having been considered at the intraplate sites, and uncertainties in correlating ground-motion levels to historical felt intensities. The study also highlights the importance of evaluating PSH models at more than one region, because the conclusions reached on the basis of a solely interplate or intraplate study would be very different. [ABSTRACT FROM AUTHOR]

Background & Aims: Although diabetes occurs frequently in pancreatic cancer, the value of new-onset diabetes as a marker of underlying pancreatic cancer is unknown. Methods: We assembled a population-based cohort of 2122 Rochester, Minnesota, residents age ≥50 years who first met standardized criteria for diabetes between January 1, 1950, and December 31, 1994, and identified those who developed pancreatic cancer within 3 years of meeting criteria for diabetes. We compared observed rates of pancreatic cancer with expected rates based on the Iowa Surveillance Epidemiology and End Results registry. In a nested case control study, we compared body mass index (BMI) and smoking status in diabetes subjects with and without pancreatic cancer. Results: Of 2122 diabetic subjects, 18 (0.85%) were diagnosed with pancreatic cancer within 3 years of meeting criteria for diabetes; 10 of 18 (56%) were diagnosed <6 months after first meeting criteria for diabetes, and 3 were resected. The observed-to-expected ratio of pancreatic cancer in the cohort was 7.94 (95% CI, 4.70–12.55). Compared with subjects without pancreatic cancer, diabetic subjects with pancreatic cancer were more likely to have met diabetes criteria after age 69 (OR = 4.52, 95% CI, 1.61–12.74) years but did not differ significantly with respect to BMI values (29.2 ± 6.8 vs 26.5 ± 5.0, respectively). A larger proportion of those who developed pancreatic cancer were ever smokers (92% vs 69%, respectively), but this did not reach statistical significance. Conclusions: Approximately 1% of diabetes subjects aged ≥50 years will be diagnosed with pancreatic cancer within 3 years of first meeting criteria for diabetes. The usefulness of new-onset diabetes as marker of early pancreatic cancer needs further evaluation. [Copyright &y& Elsevier]

The article discusses an assessment in writing achievement and how to enhance it in urban areas in the U.S. Among young adolescents, writing achievements has been an important concern. An interview of 25 teachers done in an attempt to explain the differences in writing achievement of students between 2001 and 2003 showed that the processes that have enhanced writing achievement include school-wide focus on writing, writing instruction professional development, specific writing curriculum in English writing, consensus scoring, and administrative accountability for writing instruction. The interview did not only include English classes but also social studies, science, mathematics, core elective classes.

Discusses the protection of computer network security in colleges and universities in the U.S. Percentage of higher education institutions that have a chief information technology security officer; Comparison between information security and computer security; Distinction between database security and communication security.

The No Child Left Behind Act (NCLB) has generated a significant amount of debate regarding its impact on education in the United States. At the heart of the issue we find the problematic relationship between external and internal control and the implication for organizational change and improvement. NCLB's reliance on data from annual student achievement scores to determine the future of schools, students and school personnel brings about a complicated and ominous challenge to the daily professional life of school superintendents. The demand for proven results, extensive evaluations, and data-driven decision-making has moved the role of the superintendent from the sideline to the frontline of supporting student achievement. As a result, superintendent preparation programs must also change. The requirements of NCLB push programs to develop candidates with the necessary knowledge, experiences and expertise to substantively address the new reform agenda. In this manuscript we discuss the influences of NCLB on four critical areas on the job of the superintendent; (1) assessment and accountability, (2) parental choice, (3) resource flexibility, and (4) quality teachers. We also consider how these new responsibilities should be reflected in programs that prepare school and school system leaders. [ABSTRACT FROM AUTHOR]

Native WEB (Women Enjoying the Benefit) is a unique training program for nurses employed by the Indian Health Service (IHS), tribal clinics, and other clinics with large, underserved populations. It teaches nurses breast and cervix cancer screening techniques and trains them to administer and maintain high-quality screening programs that include patient outreach, education, and training. We review American Indian (AI)/Alaska Native (AN) women's need for screening services, identify some of the obstacles to screening, and present our evaluation of the Native WEB's impact on clinics, nurses, and patients. Findings show that Native WEB training is associated with increased screening activity at all three levels. Key words: cancer screening, Native American health care, nurse training, professional developments, program evaluation [ABSTRACT FROM AUTHOR]

Examines the association of pancreatic cancer with the family history of the disease in the U.S. Percentage of the cancer patients with a family history of the disease; Occurrence of cancer syndrome due to germline mutations; Risk of individual with a family history of pancreatic cancer in multiple first-degree relatives of pancreatic cancer.

Focuses on the study of trends and variations in representative U.S. newspaper coverage of the United Nations. Source of current events data about the United Nations; Benchmarks of journalistic performance; Decline in coverage of United Nations activities.

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The Texaco-Metropolitan Opera Broadcast is a landmark program in the history of American broadcasting. It is the longest-running, continuously sponsored program still on the air. The Metropolitan Opera's relationship with Texaco as sponsor of their program is unique in many regards. Texaco's commitment to the broadcasts has survived over fifty years and three changes of networks. Using Meehan's "Relational System", this paper investigates the program as the prototype of contemporary corporate advertising by investigating how the alliance between sponsor and program came to be. Ultimately, the program's loyal audience is credited with attracting the sponsor and maintaining the sponsor's allegiance. [ABSTRACT FROM AUTHOR]

Background: The US pregnancy-related mortality ratio has not improved over the past decade and includes striking disparities by race and ethnicity and by state. Understanding differences in pregnancy-related mortality across and within urban and rural areas can guide the development of interventions for preventing future pregnancy-related deaths.Objective: We sought to compare pregnancy-related mortality across and within urban and rural counties by race and ethnicity and age.Study Design: We conducted a descriptive analysis of 3747 pregnancy-related deaths during 2011-2016 (the most recent available data) with available zone improvement plan code or county data in the Pregnancy Mortality Surveillance System, among Hispanic and non-Hispanic White, Black, American Indian or Alaska Native, and Asian or Pacific Islander women aged 15 to 44 years. We aggregated data by US county and grouped counties per the National Center for Health Statistics Urban-Rural Classification Scheme for Counties. We used R statistical software, epitools, to calculate the pregnancy-related mortality ratio (number of pregnancy-related deaths per 100,000 live births) for each urban-rural grouping, obtain 95% confidence intervals, and perform exact tests of ratio comparisons using the Poisson distribution.Results: Of the total 3747 pregnancy-related deaths analyzed, 52% occurred in large metro counties, and 7% occurred in noncore (rural) counties. Large metro counties had the lowest pregnancy-related mortality ratio (14.8; 95% confidence interval, 14.2-15.5), whereas noncore counties had the highest (24.1; 95% confidence interval, 21.4-27.1), including race and ethnicity and age groups. Pregnancy-related mortality ratio age disparities increased with rurality. Women aged 25 to 34 years and 35 to 44 years living in noncore counties had pregnancy-related mortality ratios 1.5 and 3 times higher, respectively, than women of the same age groups in large metro counties. Within each urban-rural category, pregnancy-related mortality ratios were higher among non-Hispanic Black women than non-Hispanic White women. Non-Hispanic American Indian or Alaska Native pregnancy-related mortality ratios in small metro, micropolitan, and noncore counties were 2 to 3 times that of non-Hispanic White women in the same areas.Conclusion: Although more than half of pregnancy-related deaths occurred in large metro counties, the pregnancy-related mortality ratio rose with increasing rurality. Disparities existed in urban-rural categories, including by age group and race and ethnicity. Geographic location is an important context for initiatives to prevent future deaths and eliminate disparities. Further research is needed to better understand reasons for the observed urban-rural differences and to guide a multifactorial response to reduce pregnancy-related deaths. [ABSTRACT FROM AUTHOR]