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Intergenerational volunteerism is a global phenomenon that aids multiple generations. Considering the positive evidence of volunteering among older adults and their desire for engagement with children, it is important to explore older adult volunteers' experiences in intergenerational programs with a specific focus on the cultural and social impacts of volunteering in educational settings. Using a phenomenological qualitative approach, 43 interviews with older adult volunteers (23 in South Korea (Korea) and 20 in the United States (US) in intergenerational programs were conducted. Participants were recruited from the Beautiful Story Grandma (BSG) in Korea and the Foster Grandparent Program (FGP) in the US in 2019. Three major themes emerged from the interviews revolving around the role of culture and other demographics in the experience of volunteering: (1) Benefits from volunteering with children that transcend demographic and geographic differences; (2) distinctive cultural factors lead to different experiences of volunteering in educational settings; and (3) operational and procedural differences of volunteer programs impact older adult volunteers' experiences in educational settings. This comparative research can inform the development of culturally responsive intergenerational volunteering programs for older adults and other generations in their communities.

Background: In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States. Methods: A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis. Conclusions: These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.) [ABSTRACT FROM AUTHOR]

Test weight (TW) is a unit of bulk density that is influenced by several factors, including both genetics and environment. A subset of the trials in the Uniform Soybean Tests—Southern States was used to correlate seed composition traits of oil and protein percentages, and seed weight (SW) with TW to investigate the interaction of these traits in multi‐environments for four different maturity group (MG) tests. The results indicate that environment (location and year combination) had a larger impact on TW than genetic effect in all MG tests. This difference was greater in the earlier MGs, compared to MG VI and MG VII. In all tests across four MGs, the genotype interaction with environment effect was significant, but practically was not as important as genotype or environment effects. Significant negative correlations between TW and SW (MG V, VI, and VII tests), and TW and oil (MG V and VI tests) were observed but not consistent in all environments within these tests. TW and protein correlations were inconsistent with a negative relationship in MG V but a positive relationship in MG VII. As anticipated, the inconsistencies in the relationships across MGs for TW and seed composition traits suggest that selection strategies for improving TW will differ across soybean breeding programs. In the future, a similar study using a diverse panel of cultivars that do not change from year to year may shed more light on the influence of seed composition and environmental conditions on TW. Core Ideas: Soybean test weights are heritable.Test weight and seed trait correlations differ across maturity groups.Test weight values across Uniform Soybean Test—Southern States were lower than the standard 60 lb bu‐1. [ABSTRACT FROM AUTHOR]

Simple Summary: Until recently, checkpoint inhibitors have largely been reserved for the metastatic disease space in clear cell renal cell carcinoma (ccRCC). Over the last several years, a growing body of trials have investigated the application of checkpoint inhibitor therapy in the neoadjuvant and adjuvant settings. However, these trials have yielded mixed results, due largely in part to a lack of high-fidelity biomarkers for patient selection and response prediction. Here, we present a simple workflow leveraging genomic data to characterize the immune microenvironment in ccRCC and identify a key macrophage subset that is associated with aggressive tumor biology, poor prognosis, and decreased response to immune checkpoint blockade (ICB). This work lays the foundation for future mechanistic discovery and prospective validation of integrating macrophage content into a ccRCC immune checkpoint blockade biomarker strategy. There is a need to optimize the treatment of clear cell renal cell carcinoma (ccRCC) patients at high recurrence risk after nephrectomy. We sought to elucidate the tumor immune microenvironment (TIME) of localized ccRCC and understand the prognostic and predictive characteristics of certain features. The discovery cohort was clinically localized patients in the TCGA-Kidney Renal Clear Cell Carcinoma (KIRC) project (n = 382). We identified an M0 macrophage-enriched cluster (n = 25) in the TCGA-KIRC cohort. This cluster's median progression-free survival (PFS) and overall survival (OS) were 40.4 and 45.3 months, respectively, but this was not reached in the others (p = 0.0003 and <0.0001, respectively). Gene set enrichment (GSEA) analysis revealed an enrichment of epithelial to mesenchymal transition and cell cycle progression genes within this cluster, and these patients also had a lower predicted response to immune checkpoint blockade (ICB) (4% vs. 20–34%). An M0-enriched cluster (n = 9) with shorter PFS (p = 0.0006) was also identified in the Clinical Proteomics Tumor Analysis Consortium (CPTAC) cohort (n = 94). Through this characterization of the TIME in ccRCC, a cluster of patients defined by enrichment in M0 macrophages was identified that demonstrated poor prognosis and lower predicted ICB response. Pending further validation, this signature can identify localized ccRCC patients at high risk of recurrence after nephrectomy and who may require therapeutic approaches beyond ICB monotherapy. [ABSTRACT FROM AUTHOR]

The Reading the Mind in the Eyes test (RMET) is a widely used measure of theory of mind (ToM). Despite its popularity, there are questions regarding the RMET's psychometric properties. In the current study, we examined the RMET in a representative U.S. sample of 1,181 adults. Key analyses included conducting an exploratory factor analysis on the full sample and examining whether there is a different factor structure in individuals with high versus low scores on the 28-item autism spectrum quotient (AQ-28). We identified overlapping, but distinct, three-factor models for the full sample and the two subgroups. In all cases, each of the three models showed inadequate model fit. We also found other limitations of the RMET, including that nearly a quarter of the RMET items did not meet the criteria for inclusion in the RMET that were established in the original validation study. Due to the RMET's weak psychometric properties and the uncertain validity of individual items, as indicated by our study and previous studies, we conclude that significant caution is warranted when using the RMET as a measure of ToM. [ABSTRACT FROM AUTHOR]

Currently, Black men in the United States are greater than 1.5 times as likely to be diagnosed with prostate cancer and more than twice as likely to succumb to the disease. While racial disparities in prostate cancer have been well documented, we must analyze these disparities in the correct context. Discussion of these disparities without correctly describing race as a social construct and acknowledging the impact of structural racism is insufficient. This article reviews the disparities seen in screening, treatment, outcomes, and clinical trial participation. We conclude by outlining future steps to help understand and study disparities, as we strive toward equitable outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Nursing facilities with nurse practitioners or physician assistants (NPs or PAs) have been reported to provide better care to residents. Assuming that freestanding nursing homes in urban areas that employ these professionals are making an investment in medical infrastructure, we test the hypotheses that facilities in states with higher Medicaid rates, and those in more competitive markets and markets with higher managed care penetration, are more likely to employ NPs or PAs. Design and Methods: The Online Survey Certification and Reporting System (OSCAR) database, Area Resource File, and information from surveys of state policies from 1993 to 2002 are used to study the employment of NPs or PAs, using a cross-sectional time-series generalized estimating equation model with surveys nested within facilities, testing several market and state-policy effects while controlling for facility and market characteristics. Results: Throughout the 1990s the proportion of nursing facilities with NPs or PAs doubled, from less than 10% to over 20%. Facilities in states in the upper quartile of Medicaid reimbursement rates were 10% more likely to employ NPs or PAs. Facilities in more competitive markets, and in markets with higher managed care penetration, were more likely to employ NPs or PAs (adjusted odds ratio = 1.27, 1.20 respectively). Implications: More generous state Medicaid nursing home reimbursement and higher competition may advance the investment in medical infrastructure, which in turn may positively affect the quality of care provided to nursing home residents.

We created a set of resources to enable research based on openly-available diffusion MRI (dMRI) data from the Healthy Brain Network (HBN) study. First, we curated the HBN dMRI data (N = 2747) into the Brain Imaging Data Structure and preprocessed it according to best-practices, including denoising and correcting for motion effects, susceptibility-related distortions, and eddy currents. Preprocessed, analysis-ready data was made openly available. Data quality plays a key role in the analysis of dMRI. To optimize QC and scale it to this large dataset, we trained a neural network through the combination of a small data subset scored by experts and a larger set scored by community scientists. The network performs QC highly concordant with that of experts on a held out set (ROC-AUC = 0.947). A further analysis of the neural network demonstrates that it relies on image features with relevance to QC. Altogether, this work both delivers resources to advance transdiagnostic research in brain connectivity and pediatric mental health, and establishes a novel paradigm for automated QC of large datasets. Measurement(s) brain white matter Technology Type(s) Diffusion Weighted Magnetic Resonance Imaging Sample Characteristic - Organism Homo sapiens Sample Characteristic - Location contiguous United States of America [ABSTRACT FROM AUTHOR]

Background Influenza outbreaks in nursing homes pose a threat to frail residents and occur even in vaccinated populations. We conducted a pragmatic cluster-randomized trial comparing adjuvanted trivalent influenza vaccine (aTIV) versus trivalent influenza vaccine (TIV). We report an exploratory analysis to compare the effect of aTIV versus TIV on facility-reported influenza outbreaks. Methods We evaluated the impact of the intent-to-treat vaccine assignment on outbreaks reported from November 2016 to March 2017. We collected data according to standard CDC definitions for both suspected outbreaks and those with a laboratory-confirmed case and adjusted for facility-level vaccination rates and resident characteristics in nursing homes. Results Of 823 randomized nursing homes, 777 (aTIV, n = 387; TIV, n = 390) reported information on influenza outbreaks. Treatment groups had similar characteristics at baseline except for race/ethnicity: homes assigned to TIV had a higher percentage of African-American residents (18.0% vs 13.7%). There were 133 versus 162 facility-reported suspected influenza outbreaks in aTIV versus TIV facilities, respectively; of these, 115 versus 140 were laboratory confirmed. The aTIV group experienced a 17% reduction in suspected (rate ratio,.83; 95% confidence interval,.65–1.05) and laboratory-confirmed (.83;.63–1.06) influenza outbreaks. Covariate adjustment increased the estimated reduction for suspected outbreaks to 21% (.79;.61–.99) and 22% for laboratory-confirmed outbreaks (.78;.60–1.02). Conclusions In an exploratory analysis of a cluster-randomized trial we observed 17–21% fewer outbreaks with aTIV than TIV. Clinical Trials Registration. (NCT02882100). [ABSTRACT FROM AUTHOR]

Background Influenza leads in preventable infection-related hospitalization in nursing home (NH) residents. The adjuvanted trivalent influenza vaccine (aTIV) is more immunogenic than similarly dosed nonadjuvanted trivalent influenza vaccine (TIV), and observational studies suggest aTIV better prevents hospitalizations in older adults. We prospectively tested this in an NH setting. Methods NHs with ≥50 long-stay residents aged ≥65 years were randomized to offer aTIV or TIV for residents for the 2016–2017 influenza season. Using intent-to-treat resident-level analysis with Cox proportional hazards regression models adjusted for clustering by facility and a priori baseline covariates (eg, age, heart failure, and facility-level characteristics), we assessed relative aTIV:TIV effectiveness for hospitalization (ie, all-cause, respiratory, and pneumonia and influenza [P&I]). Results We randomized 823 NHs, housing 50 012 eligible residents, to aTIV or TIV. Residents were similar between groups by age (mean, ~79 years), heart failure, lung disease, and influenza and pneumococcal vaccine uptake, except aTIV homes housed fewer Black residents (14.5 vs 18.9%). Staff vaccine uptake was similar (~55%). P&I and all-cause resident hospitalization rates were lower (adjusted HR [aHR],.80 [95% CI,.66–.98; P =.03] and.94 [.89–.99; P =.02], respectively) for aTIV versus TIV, while the respiratory hospitalization rate was similar, in a season where vaccine effectiveness was considered poor. Conclusions aTIV was more effective than TIV in preventing all-cause and P&I hospitalization from NHs during an A/H3N2-predominant season when TIV was relatively ineffective. Clinical Trials Registration NCT02882100. [ABSTRACT FROM AUTHOR]

Intergenerational volunteerism is a global phenomenon that aids multiple generations. Considering the positive evidence of volunteering among older adults and their desire for engagement with children, it is important to explore older adult volunteers' experiences in intergenerational programs with a specific focus on the cultural and social impacts of volunteering in educational settings. Using a phenomenological qualitative approach, 43 interviews with older adult volunteers (23 in South Korea (Korea) and 20 in the United States (US) in intergenerational programs were conducted. Participants were recruited from the Beautiful Story Grandma (BSG) in Korea and the Foster Grandparent Program (FGP) in the US in 2019. Three major themes emerged from the interviews revolving around the role of culture and other demographics in the experience of volunteering: (1) Benefits from volunteering with children that transcend demographic and geographic differences; (2) distinctive cultural factors lead to different experiences of volunteering in educational settings; and (3) operational and procedural differences of volunteer programs impact older adult volunteers' experiences in educational settings. This comparative research can inform the development of culturally responsive intergenerational volunteering programs for older adults and other generations in their communities. [ABSTRACT FROM AUTHOR]

This study examines the relationship between household compositional change and residential mobility of subsidized householders. Data from the U.S. Department of Housing and Urban Development Annual Longitudinal Files 2005–2018 is used to measure household compositional change and mobility for subsidized householders in the Public Housing and Housing Choice Voucher programs. Householders are 67% more likely to move when a change in household composition occurs. Members entering the household induce larger estimated mobility effects than members exiting the household. Although the odds that a householder move are associated with a household compositional change is greatest in the Housing Choice Voucher program for tenant-based vouchers, there is still a strong association with household compositional changes and mobility in Public Housing and for project-based voucher units where options for mobility are limited. The results have implications for future research on program design factors such as occupancy standards in subsidized housing in the United States. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to test a modified version of the Technology Acceptance Model, which describes users' technology adoption, to examine the relations between patient portal use and potential influencing factors in adult patients who have used patient portals. The modified model posits that patient portal use can be explained by attitude and self‐efficacy for using patient portals, perceived usefulness and ease of use, data privacy and security concerns, eHealth literacy, education level, and age. Design: A cross‐sectional anonymous online survey was conducted for adult patients who had used their patient portals in the past 12 months. Methods: Participants were recruited from 20 settings selected in a large integrated health care system. Data from 743 patients were subject to structural equation modeling for model testing. Findings: Sixty‐eight percent were White and female, with a mean age of 53.1 years (SD = 15.34). Forty‐seven percent used patient portals about monthly or more frequently. Scores for perceived usefulness and ease of use of patient portals were relatively high (as measured using the modified Perceived Health Web Site Usability Questionnaire; each item mean, 6.0–6.2; range, 1–7). The final model adequately fit the data (comparative fit index =.983, standardized root mean square residual =.064, root mean square error of approximation =.059). Patient portal self‐efficacy and data privacy and security concerns had a direct impact on patient portal use. Perceived usefulness and ease of use, eHealth literacy, education level, and age indirectly influenced patient portal use. Conclusions: This study contributes to expanding a theoretical understanding of adult patients' patient portal use in a real health care environment. Future studies need to include more diverse populations in various settings. Clinical Relevance: Knowledge gained from this study can be used by technology experts to make patient portals more user friendly and by administrators to implement patient portals more effectively. [ABSTRACT FROM AUTHOR]

Temperate deciduous forests in the United States are located in the most densely populated states across the northern and mid-Atlantic east coast. Land development and associated human activities result in small forests that are susceptible to anthropogenic influences, such as urbanization and non-native plant invasion.The overall objective of this study was to assess spatial and temporal drivers of forest vegetation structure and diversity in small forests embedded across developed landscapes. We assessed woody plant composition across spatial gradients (i.e., urbanization and non-native plant invasion) and a temporal gradient (i.e., time since canopy closure) across 38 forests along the east coast of the United States in northern Delaware and southeastern Pennsylvania.Surprisingly, we found the invasion gradient was not related to the urban gradient across our forests. Across all forests, the canopy consisted of native species (98% of all trees), whereas the forest understory was most vulnerable to non-native plant invasion (65% of all woody plant stems). Greater native species richness in forest canopies and understories with increasing urbanization supports the conclusion that urban forests maintain native species and are not inherently degraded ecosystems. Non-native plant invasion has a strong influence on understory plant communities, and the duration of intact forest canopy had a strong negative correlation with non-native plant invasion suggesting intact forests can resist invasion.Synthesis. This is the first study to compare simultaneously the importance of invasion and urbanization in determining plant community composition in forests embedded across developed landscapes, and to discover that younger forests harbor more invasive plants and urban forests maintain native plants. [ABSTRACT FROM AUTHOR]

In many teacher preparation programs at institutions of higher education in the United States, pre-service teachers receive mentoring and constructive feedback during their internship placement from an experienced supervising teacher and a university coordinator. Often the feedback loop is closed by asking interns, 'was this useful?' To better answer this question, researchers employed a phenomenological approach to collect interview and focus group data on the lived experiences, perceptions, and understandings of six pre-service special education interns during their internship experience. Emerging themes included satisfaction with level of support provided by supervisory stakeholders, a feeling of isolation from peer support, special consideration of the components within the evaluation tool, and a request to be provided with additional background information for their assigned university coordinators. These lessons were aggregated, presented, and then integrated into the experiences provided to forthcoming pre-service educators. [ABSTRACT FROM AUTHOR]

It is critically important for leadership personnel in special education to develop knowledge and skills in policy and advocacy. The Pew Charitable Trust initiated a survey to uncover resources and experiences impacting doctoral-level preparation at institutes of higher education. Results indicated that fewer than 30 percent of doctoral students were provided the opportunity for an internship experience. Thus, a large university located in the southeast United States created an internship experience reflective of current policies and trends within the field of special education. This article discusses interns' responsibilities with reference to policy and politics, opportunities for mentorship, the development of personal contacts and networking, and the impact of each experience on the intern's future role in special education teacher education and advocacy. [ABSTRACT FROM AUTHOR]

Introduction:The high prevalence of chronic illnesses is a serious public health problem in the United States, and more than 70 million older adults have at least one chronic illness. Patient portals (PPs) have an excellent potential to assist older adults in managing chronic illnesses; however, older adults' PP adoption rates have been low. Lack of support for older adults using PPs remains a critical gap in most implementation processes. The main aim of this study was to assess the impact of an older adult friendly Theory-based Patient portal e-Learning Program (T-PeP) on PP knowledge, selected health outcomes (health decision-making self-efficacy [SE] and health communication), PP SE and use, and e-health literacy in older adults. Materials and Methods:A two-arm randomized controlled trial was conducted with older adults (N = 272) who had chronic conditions. Participants were recruited online, and data were collected at baseline, 3 weeks, and 4 months. The main intervention effects were tested using linear mixed models. Results:The average age of participants was 70.0 ± 8.5 years, and 78.3% (n = 213) were white. At 3 weeks, the intervention group showed significantly greater improvement than the control group in all outcomes except PP use. At 4 months, the intervention effects decreased, but PP SE remained significant (p = 0.015), and the intervention group showed higher frequency of PP use than the control group (p = 0.029). Conclusion:The study findings showed that the T-PeP was effective in improving selected health and PP usage outcomes. Further studies are needed to test the long-term effects of T-PeP using more diverse samples. [ABSTRACT FROM AUTHOR]

There are less data available on the effect of the ACA on breast cancer care beyond the screening level. A retrospective review at participating iCaRe2/BCCR institutions was completed before and after ACA. Post‐ACA, patients were older, more urban, and more likely to be insured through Medicaid. Increased imaging use was noted post‐ACA. These patients were less likely to be diagnosed with late‐stage cancers, received fewer mastectomies, and were more likely to have radiation. [ABSTRACT FROM AUTHOR]

Background Little is known about variation in use of rehabilitation services provided in acute care hospitals for people who have had a stroke. Objective The objective was to examine patient and hospital sources of variation in acute care rehabilitation services provided for stroke. Design This was a retrospective, cohort design. Methods The sample consisted of Medicare fee-for-service beneficiaries with ischemic stroke admitted to acute care hospitals in 2010. Medicare claims data were linked to the Provider of Services file to gather information on hospital characteristics and the American Community Survey for sociodemographic data. Chi-square tests compared patient and hospital characteristics stratified by any rehabilitation use. We used multilevel, multivariable random effect models to identify patient and hospital characteristics associated with the likelihood of receiving any rehabilitation and with the amount of therapy received in minutes. Results Among 104,295 patients, 85.2% received rehabilitation (61.5% both physical therapy and occupational therapy; 22.0% physical therapy only; and 1.7% occupational therapy only). Patients received 123 therapy minutes on average (median [SD] = 90.0 [99.2] minutes) during an average length of stay of 4.8 [3.5] days. In multivariable analyses, male sex, dual enrollment in Medicare and Medicaid, prior hospitalization, ICU stay, and feeding tube were associated with lower odds of receiving any rehabilitation services. These same variables were generally associated with fewer minutes of therapy. Patients treated by tissue plasminogen activator, in limited-teaching and nonteaching hospitals, and in hospitals with inpatient rehabilitation units, were more likely to receive more therapy minutes. Limitation The findings are limited to patients with ischemic stroke. Conclusion Only 61% of patients with ischemic stroke received both physical therapy and occupational therapy services in the acute setting. We identified considerable variation in the use of rehabilitation services in the acute care setting following a stroke. [ABSTRACT FROM AUTHOR]

The USA is experiencing an epidemic of drug overdoses and deaths with a 200% increase in overdose deaths involving opioids including heroin. Legislation since 2013 has created paths to reduce opioid overdose deaths and since, basic life support (BLS) and police agencies have been administering naloxone to patients with suspected opioid overdoses as part of standard treatment protocols. Charts were reviewed from 1 January 2016 to 15 April 2016 on the de-identified electronic medical records of patients in a two-county system comprising the ‘Jersey Shore’ who received naloxone to determine the number of naloxone administrations and heroin overdoses. Additionally, narratives were examined for evidence of heroin use. Of the 312 patients, 213 received a first dose of naloxone by a family member or bystander, police, or by BLS; 99 received a first dose by a paramedic (ALS). About 233 were initially unresponsive or had altered mental status that improved after naloxone administration. About210 (67.3%) charts illustrated obvious opioid use. Of the note, 282 patients arrived to an emergency department alive. About 30 patients were pronounced dead. From 1 February 2016 to 31 March 2016, the number of opioid overdoses increased and the subsequent use of naloxone has increased by 176%. [ABSTRACT FROM AUTHOR]

Fish and macro-invertebrate assemblages were examined in the vicinity of 5 wind energy areas on the northeast U.S. continental shelf by using 2 sampling gears. Collections of fish and macroinvertebrates during the spring of 2014 with a 2-m beam trawl and a standard bottom trawl were compared. Correspondence analysis of proportions of taxa in the catch at sampling stations and estimated individual weights, averaged by taxon, were used to describe the composition of assemblages, and composition of the catch was compared between collections made with the 2 different gears and among different wind energy areas. These comparisons indicated that the 2 gears collected different fish and macro-invertebrate communities. Analysis of the collections by gear type indicated that assemblages varied across several spatial scales. Canonical correspondence analysis was used to examine the relationship between assemblages, sampling programs, and environmental variables to determine which variables and Correspondence analysis dimensions were aligned with stations and were related to the assemblages. Environmental variables explained 20.5% of the variation for the beam trawl stations and assemblages and 28.8% of variation for the bottom trawl stations and assemblages. Our results indicate that assessments of wind energy areas on the northeast U.S. shelf should be conducted by using multiple gear types across multiple spatial and temporal scales. [ABSTRACT FROM AUTHOR]

Students face many different obstacles in school and arbitrary exclusion should not be one of them. Despite the Supreme Court stating that students do not shed their rights at the schoolhouse gate, they in fact do shed their rights. This Note examines how school disciplinary actions deny students meaningful due process. It discusses the foundation of modern due process, including what other rights have been incorporated into the contemporary understanding of due process as well as its historic roots. Additionally, this Note explores the case that established the procedures required of school administrators to comport with a student’s right to due process, Goss v. Lopez. Finally, this Note argues why Goss’s protections do not amount to meaningful due process and how denial of meaningful due process in school disciplinary actions can have lasting negative implications on students’ futures beyond the schoolhouse gate. [ABSTRACT FROM AUTHOR]

In this narrative medicine essay, a urology fellow offers 5 actions the medical community should take to eliminate racial injustice and health disparities in the United States. [ABSTRACT FROM AUTHOR]

Objective: Suicide was the 10th leading cause of death for Americans in 2010. The suicide rate is highest among men who are aged 75 and older. The prevalence of suicidal behavior in nursing homes and long-term care (LTC) facilities was estimated to be 1%. This study describes the systemic vulnerabilities found after suicidal behavior in LTC facilities as well as steps to decrease or mitigate the risk.Method: This is a retrospective review of root-cause analysis (RCA) reports of suicide attempts and completions between 1 January 2000 and 31 December 2013 in the Veterans Health Administration LTC and nursing home care units. The RCA reports of suicide attempts and completions were coded for patient demographics, method of attempt or completion, root causes, and actions developed to address the root cause.Results: Thirty-five RCA reports were identified. The average age was 65 years, 11 had a previous suicide attempt, and the primary mental health diagnoses were depression, posttraumatic stress disorder, and schizophrenia. The primary methods of self-harm were cutting with a sharp object, overdose, and strangulation.Conclusions: It is recommended that all staff members are aware of the signs and risk factors for depression and suicide in this population and should systematically assess and treat mental disorders. In addition, LTC facilities should have a standard protocol for evaluating the environment for suicide hazards and use interdisciplinary teams to promote good communication about risk factors identified among patients. Finally, staff should go beyond staff education and policy to make clinical changes at the bedside. Published 2015. This article is a U.S. Government work and is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

Objective To compare health care utilization and payments between NCQA-recognized patient-centered medical home ( PCMH) practices and practices without such recognition. Data Sources Medicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare's Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file. Study Design This study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008-June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition. Data Collection Methods Individual Medicare fee-for-service ( FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008. Principal Findings Relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices. Conclusions This study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care. [ABSTRACT FROM AUTHOR]

This paper serves as the backdrop for this edited volume by paying attention to domestic migration flows into and out of Vermont, a state with such a small population base (barely above 625,000) that its vitality could be threatened by sustained levels of out-migration. The state's very low birth rate, a rapidly aging population, and low gains from international migration make the "growth or decline" balance from interstate migration a perennial issue of concern. The state's very recent net population outflows are modest and are typical of the Northeast. Vermont attracts an unusually vigorous stream of in-migrants, enough to give the state a relatively high proportion of residents who were born in other states, yet the stream of out-migrants has recently exceeded the stream of in-migrants. The educational levels of the transplants are well above that of most states and well above that of native born Vermonters who remain in the state. Data from five statewide surveys on quality of life in Vermont conducted by the authors provide unique insights into the perceived well-being of in-migrants and identify areas of distinctiveness compared to the native born population. Given the higher levels of education and income of the in-migrants, the authors were not surprised to find many quality of life differences between the two groups, but when controlling for demographic difference in a multivariate context, statistical differences between natives and the new migrants weakened or disappeared. Among the differences that remained, in-migrants have more confidence in the state government, are less worried about population growth in the state, are less likely to feel that they need to focus on themselves and their families, and are more likely to find life "exciting" rather than dull. New migrants also tend to be more environmentally sensitive, and with their higher incomes, are more willing to pay increased taxes to support their public priorities. [ABSTRACT FROM AUTHOR]

The article discusses the relevance of U.S. novelist Norman Mailer's work "The Executioner's Song" to U.S. identity. Topics covered include the events arising from two murders committed by Gary Gilmore, the reinstatement of the death penalty in 1976, and Mailer's approach to character as a complex and problematic trope.

Background: Dementia is a progressive terminal illness which requires decisions around aggressiveness of care. Objective: The study objective was to examine the rate of intensive care unit (ICU) utilization and its regional variation among persons with both advanced cognitive and severe functional impairment. Methods: We utilized the Minimum Data Set (MDS) to identify a cohort of decedents between 2000 and 2007 who (1) were in a nursing home (NH) 120 days prior to death and (2) had an MDS assessment indicating advanced cognitive and functional impairment as identified by cognitive performance scale (CPS) ≥5 and total dependence or extensive assistance in seven activities of daily living (ADLs). ICU utilization in the last 30 days of life was determined from Medicare claims files. A multivariate logistic regression model examined the likelihood of ICU admission in 2007 versus 2000 adjusting for sociodemographics, orders to limit life sustaining treatment, and health status. Results: Among 474,829 Medicare NH residents with advanced cognitive impairment followed during 2000-2007, we observed an increase in ICU utilization from 6.1% in 2000 to 9.5% in 2007. After adjustment for sociodemographic characteristics, orders to limit life sustaining treatment, and measures of health status, the likelihood of a resident being admitted to an ICU was higher in 2007 compared to 2000 (adjusted odds ratio [OR] 1.71, 95% CI 1.60-1.81). Additionally, substantial regional variation was noted in ICU utilization, from 0.82% in Montana to 22% in the District of Columbia. Conclusions: Even among patients with advanced cognitive and functional impairment, ICU utilization in the last 30 days increased and varied by geographic region. [ABSTRACT FROM AUTHOR]

Objectives To describe the extent to which hospitalized nursing home ( NH) residents with advanced dementia were admitted to a skilled nursing facility ( SNF) after a qualifying hospitalization and to identify resident and nursing home characteristics associated with a greater likelihood of SNF admissions. Design Cohort study using data from the Minimum Data Set, Medicare claims, and the On-line Survey Certification of Automated Records. Setting United States, 2000-2006. Participants Nursing home residents with advanced dementia aged 65 and older with a 3-day hospitalization (N = 4,177). Measurements The likelihood of SNF admission after hospitalization was calculated. Resident and nursing home factors associated with SNF admission were identified using hierarchical multivariable logistic regression. Results Sixty-one percent of residents with advanced dementia were admitted to a SNF after their hospitalization. Percutaneous endoscopic gastrostomy ( PEG) tube placement during hospitalization was strongly associated with SNF admission (adjusted odds ratio ( AOR) = 2.31, 95% confidence interval ( CI) = 1.85-2.88), as was better functional status ( AOR = 1.21, 95% CI = 1.05-1.38). The presence of diabetes mellitus was associated with lower likelihood of SNF admission ( AOR = 0.85, 95% CI = 0.73-0.99). Facility features significantly associated with SNF admission included more than 100 beds ( AOR = 1.25, 95% CI = 1.07-1.46), being part of a chain ( AOR = 1.31, 95% CI = 1.14-1.50), urban location ( AOR = 1.21, 95% CI = 1.03-1.41), and for-profit status ( AOR = 1.28, 95% CI = 1.09-1.51). Conclusion The majority of nursing home residents with advanced dementia are admitted to SNFs after a qualifying hospitalization. SNF admission is strongly associated with PEG tube insertion during hospitalization and with nursing home factors. Efforts to optimize appropriate use of SNF services in individuals with advanced dementia should focus on these factors. [ABSTRACT FROM AUTHOR]

The article discusses a court case entitled "Pakootas v. Teck Cominco Metals, Ltd." In this case, the Ninth Circuit Court of Appeals held that the U.S. Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) applies to British Columbia-based Teck Cominco. It states that Joseph A. Pakootas and Donald R. Michel has filed the suit seeking a declaration that Teck Cominco was in violation of an unilateral administrative order.

The article focuses on education of African Americans, slavery and how it affected the American economy. It states that the Emancipation Proclamation of 1863 freed all slaves but one of the problems with it was lack of mention of education of African Americans. It mentions that misallocation of education led to decline in human capital. It highlights that African Americans would have contributed to the economy had they got equal educational opportunities.

The article introduces the issue of the journal and discusses topics such as origin myths of the U.S., the relationship between personal and collective memory, and the construction of historical narratives.

Chlamydia trachomatis is a gram-negative bacterium that infects the columnar epithelium of the cervix, urethra, and rectum, as well as nongenital sites such as the lungs and eyes. The bacterium is the cause of the most frequently reported sexually transmitted disease in the United States, which is responsible for more than 1 million infections annually. Most persons with this infection are asymptomatic. Untreated infection can result in serious complications such as pelvic inlammatory disease, infertility, and ectopic pregnancy in women, and epididymitis and orchitis in men. Men and women can experience chlamydia-induced reactive arthritis. Treatment of uncomplicated cases should include azithromycin or doxycycline. Screening is recommended in all women younger than 25 years, in all pregnant women, and in women who are at increased risk of infection. Screening is not currently recommended in men. In neonates and infants, the bacterium can cause conjunctivitis and pneumonia. Adults may also experience conjunctivitis caused by chlamydia. Trachoma is a recurrent ocular infection caused by chlamydia and is endemic in the developing world. [ABSTRACT FROM AUTHOR]