Mountain West Research Articles

Savviness of sixth graders: Student perspectives about translanguaging during science formative assessment

AbstractScience classroom assessment often requires multilingual learners to demonstrate ideas using only English‐language resources. These assessments can provide an incomplete picture of students' knowledge and limit subsequent learning opportunities. Increasingly, science teachers are incorporating translanguaging pedagogies in their instructional practices. Less is known about students' perspectives of translanguaging in science. In this manuscript, we employ equity‐as‐access and equity‐as‐transformation lenses to investigate multilingual learners' perspectives about translanguaging as a formative assessment practice. Data came from a larger participatory co‐design design study in a culturally and linguistically diverse middle school in the Mountain West. We qualitatively analyzed 8 focus group interview transcripts with 13 sixth‐grade students from across 4 formative assessment cycles. Analysis was both inductive and deductive. Findings suggest that sixth graders have savvy, nuanced views about translanguaging that bridge equity‐as‐access and equity‐as‐transformation lenses. They saw translanguaging as both supporting their English language development and as an important practice to allow them to focus bilingually on their science ideas without translating everything into English. Additionally, they highlighted tensions associated with welcoming translanguaging in schools with de facto English‐only languaging norms. This study has implications for teachers, assessment designers, and researchers. Findings signal structural/policy changes needed to authentically center translanguaging as an equity‐oriented practice across science assessment systems.

The Effect of Wildfires on Asthma and Allergies.

Climate change is a major driver of the frequency and severity of wildfires caused by extended periods of drought and hotter, drier weather superimposed on the legacy of fire suppression in the Mountain West of the United States. In recent years, increased wildfire smoke has negated the improvements in air quality made by clean energy transitions. Wildfire smoke is a complex mixture of gases and solids, a chief constituent of which is fine particulate matter (PM2.5). Exposure to PM2.5 is associated with adverse respiratory outcomes, including exacerbations of asthma and chronic obstructive pulmonary disease. In the face of increasing wildfire smoke exposures, it is critical that adaptation and mitigation strategies be put in place to minimize health effects. Individual strategies include modifying behavior and creating clean air spaces in homes to avoid wildfire smoke exposure. Community strategies include regulations promoting fire-resistant buildings and landscaping; establishing wildfire monitoring and alert systems; providing safe clean spaces where individuals can minimize wildfire smoke exposure and find evacuation routes; and creating health care response teams. Mitigation to prevent wildfires includes forest management and establishing monitoring systems and protocols to control forest fires in the wildland urban interface before they increase in size and intensity. Research into understanding the mechanism by which wildfire smoke mediates adverse health effects can inform guidelines to mitigate its health effects further.

Timing of Palliative Care Consultation and End-of-Life Care Intensity in Pediatric Patients With Advanced Heart Disease: Single-Center, Retrospective Cohort Study, 2014-2022.

Pediatric patients with advanced heart disease (AHD) often receive high intensity medical care at the end of life (EOL). In this study, we aimed to determine whether receipt and timing of pediatric palliative care (PPC) consultation was associated with EOL care intensity of pediatric patients with AHD. Retrospective cohort study. Single-center, 16-bed cardiac ICU (CICU) in a children's hospital in the Mountain West. Pediatric patients (0-21 yr) with AHD treated in the CICU and subsequently died from January 2014 to December 2022. None. We compared demographics, EOL characteristics and care, including medical interventions and mortality characteristics for patients by receipt and timing of PPC (i.e., ≥ 30 d from [early] or < 30 d of death [late]) using chi-square and Wilcoxon rank-sum tests. Of 218 patients, 78 (36%) did not receive PPC, 76 received early PPC (35%), and 64 received late PPC (29%). Compared with patients who did not receive PPC, patients receiving PPC had lower EOL care intensity (77% vs. 96%; p = 0.004) and fewer invasive interventions within 14 days of death (74% vs. 92%; p = 0.004). Receipt of PPC, vs. not, was associated with lower rate of death during cardiopulmonary resuscitation (12% vs. 32%; p = 0.004) and more use of comfort care (23% vs. 3%; p = 0.004). Among patients receiving PPC, early PPC was associated with fewer invasive interventions within 14 days of death (65% vs. 85%; p = 0.033). Care intensity was high for patients with early and late PPC. Early PPC was associated with fewer invasive interventions within 14 days of death, yet the care intensity at EOL remained high. With early PPC, families likely receive timely psychosocial and advance care planning support without significantly altering goals of care.

The impact of speed limits on labour sheds in the mountain west United States

Many state-level policies impact the location decisions of both employees and employers. As most jobs require some form of commute, one such state-level policy impacting location choices are speed limits. We consider the effect of speed limits on the size of the labour sheds in the mountain west United States. Our analysis leverages the natural experiment of changing speed limits in the 281 counties of Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming over the years 2004–2018. Utilizing the revealed commuting behaviour in the origin-destination data available through the Longitudinal Employer-Household Dynamics program we measure the geographic labour shed size as the radius of containment of commuters. Employing spatial panel methods to evaluate the significance of speed limits on the radius of containment we find evidence in favor of the hypothesis that higher speed limits correspond to larger labour sheds.

Abstract 306: Influence of healthcare access on rate of follow‐up after mechanical thrombectomy for large vessel occlusion in a unique mountain west population

Introduction Stroke remains to be a significant cause of morbidity and mortality in the US, with an estimated 800,000 strokes occurring yearly. It is well understood that thorough follow‐up care and rehabilitation has a significant impact on long‐term outcomes after experiencing a stroke, and especially after undergoing mechanical thrombectomy for a large vessel occlusion (LVO). Mountain west populations experience unique issues in terms of health care access and ability to maintain follow‐up post‐hospitalization given the large distances to stroke/rehabilitation centers/primary care physicians, financial limitations, geographic/climatological barriers. There exist several national and local stratification systems to describe healthcare access, as well as social, financial, and demographic factors at the community level, such as the Utah Healthy Places Index (HPI), Area Deprivation Index (ADI), and Health Professional Shortage Areas (HPSA). These scoring systems are can be used to guide policy and intervention at the level of local and state government, as well as directly through healthcare systems. We therefore sought to examine the influence of HPI, ADI, and HPSA on successful follow‐up after mechanical thrombectomy for LVO. Materials/Methods Patients undergoing mechanical thrombectomy for LVO at a single institution between 2016 and 2024 were retrospectively identified. Residency based on patients’ home address was identified, and non‐residents were excluded from analysis. Data collected consisted of demographics, comorbidities, clinical presentation, stroke severity, baseline modified Rankin Score (mRS), mRS on arrival, HPI percentile, ADI percentile, HPSA score, frailty score, thrombolysis score, mRS on discharge, and follow‐up duration and mRS. Of note, while a higher HPI percentile indicates better overall health, a higher ADI or HPSA score indicates lower healthcare access. Multivariable logistic regression was conducted to evaluate the odds of follow‐up relative to HPI/ADI/HPSA scores. Imputation in the form of multiple imputed chained equations was used to address any variables missing &gt;5% of datapoints. Results After exclusion of non‐resident patients, 330 patients (184 males, 146 females) were included in analysis. Fifty‐five percent of the patients were male (184) and the remaining 45% were female (146). Average age at presentation was 64 ± 16.5 years old, with a mean HPI percentile score of 48.8 ± 30.2, a mean ADI percentile score of 5.36 ± 2.90, and a median HPSA of 8.70. HPI and ADI scores were not correlated with rate of follow up, however, rate of follow‐up decreased as HPSA score increased (OR 0.24, 95% CI 0.11 ‐ 0.36, p&lt;0.001) and as frailty score increased (OR 0.97, 95% CI 0.96 ‐ 0.99, p&lt;0.001) Conclusion Although no correlation was identified between HPI/ADI and follow‐up, HPSA score did appear to significantly impact rate of follow‐up for patients undergoing mechanical thrombectomy for LVO. Increased frailty score was also associated with lower rates of follow‐up, although with a smaller effect size compared to HPSA score. Further investigation is warranted to identify the discerning factors within the HPSA score that contribute to its significant association with follow‐up in comparison to HPI/ADI scores.

Abstract 115: Influence Of Healthcare Access On Functional Outcomes After Thrombectomy In Unique Mountain West Population

Abstract 115: Influence Of Healthcare Access On Functional Outcomes After Thrombectomy In Unique Mountain West Population

Geospatial Hot Spots and Cold Spots in US Cancer Disparities and Associated Risk Factors, 2004-2008 to 2014-2018.

Despite declining cancer death rates in the US, cancer remains the second deadliest disease and disparities persist. Although research has focused on identifying risk factors for cancer deaths and associated disparities, few studies have examined how these relationships vary over time and space. The primary objective of this study was to identify cancer mortality hot spots and cold spots - areas where cancer death rates decreased less than or more than neighboring areas over time. A secondary objective was to identify risk factors of cancer mortality hot spots and cold spots. We analyzed county-level cancer death rates from 2004 through 2008 and 2014 through 2018, exploring disparities in changes over time for socioeconomic and demographic variables. We used hot spot analysis to identify areas with larger decreases (cold spots) and smaller decreases (hot spots) in cancer death rates and random forest machine learning analysis to assess the relative importance of risk factors associated with hot spots and cold spots. We mapped spatial clustering areas. Geospatial analysis showed hot spots predominantly in the Plains states and Midwest and cold spots in the Southeast, Northeast, 2 Mountain West states (Utah and Idaho), and a portion of Texas. Factors with the strongest influence on hot spots and cold spots were unemployment, preventable hospital stays, mammography screening, and high school education. Geospatial disparities in changes in cancer death rates point out the critical role of access to care, socioeconomic position, and health behaviors in persistent cancer mortality disparities. Study results provide insights for interventions and policies that focus on addressing health care access and social determinants of health.

Understanding Community-Specific Health Behaviors to Prevent Type 2 Diabetes and Depression in Rural Adolescents: A Qualitative Study.

Type 2 diabetes (T2D) and depression co-occur, and rates are on the rise in adolescents, disproportionately affecting teenagers in rural communities and those who identify as members of historically disadvantaged racial/ethnic groups. Addressing the promotion of health behaviors is important for prevention of these comorbid health concerns; however, disparities in their prevalence highlight that a healthy lifestyle is not equally accessible for all individuals. Thus, holistic and multi-level approaches that address structural inequities, leverage cultural and family assets, and are effectively integrated into the community are critically needed. This project is an initial phase of a broader community-academic collaboration that aims to address preventable chronic diseases and mental health in adolescents living in the rural Mountain West by tailoring an evidence-based health behavior and lifestyle intervention for these communities. Interviewers conducted semi-structured interviews with N = 19 individuals (n = 11 adolescents, 11-17years, n = 8 mothers) who lived in neighboring counties in the rural Mountain Western USA and had a family history of T2D. Interview schedules were developed by an interdisciplinary team, with community input, and covered topics such as food and staying active, stress, T2D risk, and community and culture. Using thematic analysis, data were reduced through coding, categorization, and development of themes. Data revealed three major themes: "Families Face Systemic Barriers to Health," "Family Routines Support Health," and "Connection is Crucial to Holistic Health." Findings reveal opportunities for addressing health inequities and developing effective, integrated T2D and depression prevention strategies within this specific community. They also potentially contain insights that may be applicable to others interested in adapting interventions for diverse groups.

Expanded geographic distribution for two Legionella pneumophila sequence types of clinical concern.

Legionella pneumophila serogroup 1 sequence types (ST) 213 and 222, a single-locus variant of ST213, were first detected in the early 1990s in the Midwest United States (U.S.) and the late 1990s in the Northeast U.S. and Canada. Since 1992, these STs have increasingly been implicated in community-acquired sporadic and outbreak-associated Legionnaires' disease (LD) cases. We were interested in understanding the change in LD frequency due to these STs and identifying genetic features that differentiate these STs from one another. For the geographic area examined here (Mountain West to Northeast) and over the study period (1992-2020), ST213/222-associated LD cases identified by the Centers for Disease Control and Prevention increased by 0.15 cases per year, with ST213/222-associated LD cases concentrated in four states: Michigan (26%), New York (18%), Minnesota (16%), and Ohio (10%). Additionally, between 2002 and 2021, ST222 caused at least five LD outbreaks in the U.S.; no known outbreaks due to ST213 occurred in the U.S. during this time. We compared the genomes of 230 ST213/222 isolates and found that the mean of the average nucleotide identity (ANI) within each ST was high (99.92% for ST222 and 99.92% for ST213), with a minimum between ST ANI of 99.50% and a maximum of 99.87%, indicating low genetic diversity within and between these STs. While genomic features were identified (e.g., plasmids and CRISPR-Cas systems), no association explained the increasing geographic distribution and prevalence of ST213 and ST222. Yet, we provide evidence of the expanded geographical distribution of ST213 and ST222 in the U.S.IMPORTANCESince the 1990s, cases of Legionnaires' disease (LD) attributed to a pair of closely related Legionella pneumophila variants, ST213 and ST222, have increased in the U.S. Furthermore, between 2002 and 2021, ST222 caused at least five outbreaks of LD in the U.S., while ST213 has not been linked to any U.S. outbreak. We wanted to understand how the rate of LD cases attributed to these variants has changed over time and compare the genetic features of the two variants. Between 1992 and 2020, we determined an increase of 0.15 LD cases ascribed to ST213/222 per year in the geographic region studied. Our research shows that these STs are spreading within the U.S., yet most of the cases occurred in four states: Michigan, New York, Minnesota, and Ohio. Additionally, we found little genetic diversity within and between these STs nor could specific genetic features explain their geographic spread.

Sustained Improvement of Faculty Mentoring Competency with a Mentor Development Program.

The greatest challenge to forming faculty developmental networks is the limited availability of skilled mentors, emphasizing the need for mentor development programs. Limited data indicate that mentor development intervention improves mentors' self-reported mentoring competency over the short term. However, the impact on long-term mentoring competency is unknown, constituting a critical gap in the literature. The study used a randomized controlled design with multiple post-test measures to compare the effectiveness of a combined online asynchronous plus virtual synchronous mentor development program vs. an online asynchronous program alone. It tested the hypothesis that mentor development intervention results in greater and sustained improvement in self-assessed mentor competency than the control group in four Southwestern and Mountain West universities. Self-assessed mentor competency was examined using the MCA-21 Mentoring Competency Assessment scale at baseline, and 3-, 12- and 24-months. MCA-21 was rated on a seven-point Likert-type scale as 1, 'Not at all skilled' to 7, 'Extremely skilled'. The composite score was the 21-item average. Linear mixed models examined the intervention effect while accounting for repeated measures, with the main intervention effect operationalized by the intervention x period interaction. 47 intervention and 39 control faculty mentor-mentee dyads, mostly underrepresented in science, were recruited without pre-requirement for research competency. Compared to controls, MCA-21 for intervention mentors improved significantly from baseline at 3-months (Estimate (SE), 0.58 (0.19), 12 months (0.58 (0.21) and 24 months 0.74 (0.23), interaction p ≤0.005). By demonstrating sustained improvement in mentors' competency over 24 months, our findings provide the rationale for academic institutions to invest in faculty mentor development programs and will help the nation support the development of a skilled, diverse academic workforce.

Pre-licensure nursing students' experiences of psychological safety: A longitudinal qualitative study

BackgroundPrevious studies have explored the concept of psychological safety among pre-licensure nursing students; however, the literature is notably sparse on personal descriptions of pre-licensure nursing students' experiences of psychological safety in clinical settings. Individual descriptions of psychological safety will provide added insight and understanding about the elements that shape psychological safety in pre-licensure nursing students. AimThis research aimed to explore pre-licensure nursing students' experiences of psychological safety during clinical rotations and how these experiences change over time. DesignA longitudinal, qualitative, descriptive design was used for this study. SettingsParticipants were recruited from a nursing program in the Mountain West region. ParticipantsFifty-four students from three cohorts were enrolled in the study at the time of this data collection and analysis. MethodsEach participant completed a semi-structured telephone interview after finishing their first academic term involving a clinical rotation. Participants completed additional interviews after each subsequent semester. Individual waves of data were analyzed using thematic analysis, and multiple waves of data were analyzed using a simplified trajectory approach. ResultsFive themes emerged from the data: “Who I Am,” “Where I Am,” “Who I Am With,” “Responding in the Moment,” and “Anticipating the Future.” ConclusionsThe psychological safety of pre-licensure nursing students in clinical settings is fundamental to their learning and future practice within the nursing profession. The development of psychological safety is dynamic and multifaceted. It is interpersonal but also shaped by organizational factors. Any one person can make an outsized difference in a student's experience. Understanding these themes can help clinical preceptors and nursing faculty understand and better fulfill their respective roles in fostering psychological safety in clinical settings. Additional insights are expected as the longitudinal study continues.

Expert insights on managing harmful algal blooms

Freshwater harmful algal blooms (HABs) are a global environmental, economic, social, and public health hazard. While there is an increasing understanding of the ecological considerations of HABs, there is limited understanding of human dimensions and management needs. We conducted semi-structured key informant interviews with 28 water managers and researchers to better understand how they perceive current management and to identify future management priorities in regard to HABs. For this study, we interviewed 31 key informants from three regions of the United States (New England, Ohio, and the Mountain West). We solicited insights across aspects of HABs management, including prevention, forecasting, monitoring, response, and communication. Nutrient management was the main consideration for the prevention of HAB events. Key informants noted that forecasting has the potential to be a valuable tool in the future but is not yet accurate enough at a local scale for widespread use. Monitoring was found to be implemented in varying ways across and even within the states and regions, with a need for more funding and standardization. HAB event responses vary greatly from chemical and physical treatments that suppress toxins to no-swim advisories, all with a mix of strengths and weaknesses. Finally, an increase in and improvement of communication efforts was identified as critical for reducing public health risks. These findings provide perceptions of current management practices and future plans while including opportunities to improve current freshwater HAB management efforts.

Trends in pre-biopsy MRI usage for prostate cancer detection, 2007-2022.

Clinical guidelines favor MRI before prostate biopsy due to proven benefits. However, adoption patterns across the US are unclear. This study used the Merative™ Marketscan® Commercial & Medicare Databases to analyze 872,829 prostate biopsies in 726,663 men from 2007-2022. Pre-biopsy pelvic MRI within 90 days was the primary outcome. Descriptive statistics and generalized estimating equations assessed changes over time, urban-rural differences, and state-level variation. Pre-biopsy MRI utilization increased significantly from 0.5% in 2007 to 35.5% in 2022, with faster adoption in urban areas (36.1% in 2022) versus rural areas (28.3% in 2022). Geographic disparities were notable, with higher utilization in California, New York, and Minnesota, and lower rates in the Southeast and Mountain West. The study reveals a paradigm shift in prostate cancer diagnostics towards MRI-guided approaches, influenced by evolving guidelines and clinical evidence. Disparities in access, particularly in rural areas and specific regions, highlight the need for targeted interventions to ensure equitable access to advanced diagnostic techniques.

Implementation of a rural emergency department-initiated buprenorphine program in the mountain west: a study protocol

BackgroundOpioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days. However, few studies assess rural ED-initiated buprenorphine implementation, which has unique implementation barriers. This protocol outlines the rationale and methods of a rural ED-initiated buprenorphine program implementation study.MethodsThis is a two-year longitudinal implementation design with repeated qualitative and quantitative measures of an ED-initiated buprenorphine program in the rural Mountain West. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outlines intervention assessments. The primary outcome is implementation measured by ED-initiated buprenorphine protocol core components. Reach, adoption, and maintenance are secondary outcomes. External facilitators from an academic institution with addiction medicine and prior program implementation expertise partnered with community hospital internal facilitators to form an implementation team. External facilitators provide ongoing support, recommendations, education, and academic detailing. The implementation team designed and implemented the rural ED-initiated buprenorphine program. The program includes OUD screening, low-threshold buprenorphine initiation, naloxone distribution and administration training, and patient navigator incorporation to provide warm hand off referrals for outpatient OUD management. To address rural based implementation barriers, we organized implementation strategies based on Expert Recommendations for Implementing Change (ERIC). Implementation strategies include ED workflow redesign, local needs assessments, ED staff education, hospital leadership and clinical champion involvement, as well as patient and community resources engagement.DiscussionMost ED-initiated buprenorphine implementation studies have been conducted in urban settings, with few involving rural areas and none have been done in the rural Mountain West. Rural EDs face unique barriers, but tailored implementation strategies with external facilitation support may help address these. This protocol could help identify effective rural ED-initiated buprenorphine implementation strategies to integrate more accessible OUD treatment within rural communities to prevent further morbidity and mortality.Trial RegistrationClinicalTrials.gov National Clinical Trials, NCT06087991. Registered 11 October 2023 – Retrospectively registered, https://clinicaltrials.gov/study/NCT06087991.

"A Different Kind of Hardship": Landscapes of Japanese American Resettlement During World War II

abstract: At the beginning of World War II, the United States illegally imprisoned 120,000 Japanese Americans and placed them in concentration camps for the duration of the war. What is less known about the incarceration is that more than one-quarter of the camp population, or approximately thirty-five thousand individuals, was encouraged to leave the camps and relocate to rural communities, small towns, and cities largely in the Mountain West, Midwest, and East Coast. This article focuses on the living conditions and experiences of Japanese Americans during this wartime resettlement period as they adjusted to life outside the camps and encountered a wide range of housing types, including tent camps, rooming houses, college dormitories, hostels, and, often, crowded and substandard apartments located in urban areas. Many Japanese Americans faced numerous challenges in these new environments, notably a discriminatory real estate industry and limited job opportunities. This discussion of the physical landscapes encountered during the resettlement period helps provide a more complete and richer understanding of the imprisonment of Japanese Americans during the war.

Patterns of parent media use: The influence of parent media use profiles on parental mediation, technoference, and problematic media use

Mothers play an important role in setting the overall media culture within the home. Research suggests that children model parental behavior in many ways, including in media use habits. The current study explores profiles or patterns of maternal media use and associations between these patterns and parenting behaviors surrounding media use and parent and child problematic media use two years later. In our sample of 268 mothers of young children in a large Mountain West city, latent profile analysis was utilized, and four distinct profiles of media users were identified. Results suggest that mothers in a low media use profile set limits around their child's media use and report low levels of both technoference and parent problematic media use. Conversely, mothers in a higher social use profile exhibit high levels of parent and child problematic media use compared to other profiles. We encourage mothers to be mindful users of media, remembering that their media use behaviors can impact the overall media use climate in the home.

Mortality due to falls by county, age group, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

Fall-related mortality has increased rapidly over the past two decades in the USA, but the extent to which mortality varies across racial and ethnic populations, counties, and age groups is not well understood. The aim of this study was to estimate age-standardised mortality rates due to falls by racial and ethnic population, county, and age group over a 20-year period. Redistribution methods for insufficient cause of death codes and validated small-area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual fall-related mortality. Estimates from 2000 to 2019 were stratified by county (n=3110) and five mutually exclusive racial and ethnic populations: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Estimates were corrected for misreporting of race and ethnicity on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial and ethnic population combinations with a mean annual population of less than 1000. Age-standardised mortality is presented for all ages combined and for age groups 20-64 years (younger adults) and 65 years and older (older adults). Nationally, in 2019, the overall age-standardised fall-related mortality rate for the total population was 13·4 deaths per 100 000 population (95% uncertainty interval 13·3-13·6), an increase of 65·3% (61·9-68·8) from 8·1 deaths per 100 000 (8·0-8·3) in 2000, with the largest increases observed in older adults. Fall-related mortality at the national level was highest across all years in the AIAN population (in 2019, 15·9 deaths per 100 000 population [95% uncertainty interval 14·0-18·2]) and White population (14·8 deaths per 100 000 [14·6-15·0]), and was about half as high among the Latino (8·7 deaths per 100 000 [8·3-9·0]), Black (8·1 deaths per 100 000 [7·9-8·4]), and Asian (7·5 deaths per 100 000 [7·1-7·9]) populations. The disparities between racial and ethnic populations varied widely by age group, with mortality among younger adults highest for the AIAN population and mortality among older adults highest for the White population. The national-level patterns were observed broadly at the county level, although there was considerable spatial variation across ages and racial and ethnic populations. For younger adults, among almost all counties with unmasked estimates, there was higher mortality in the AIAN population than in all other racial and ethnic populations, while there were pockets of high mortality in the Latino population, particularly in the Mountain West region. For older adults, mortality was particularly high in the White population within clusters of counties across states including Florida, Minnesota, and Wisconsin. Age-standardised mortality due to falls increased over the study period for each racial and ethnic population and almost every county. Wide variation in mortality across geography, age, and race and ethnicity highlights areas and populations that might benefit most from efficacious fall prevention interventions as well as additional prevention research. US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).

Revisiting the evolution of downhill thunderstorms over Beijing: a new perspective from a radar wind profiler mesonet

Abstract. Downhill thunderstorms frequently occur in Beijing during the rainy seasons, leading to substantial precipitation. The accurate intensity prediction of these events remains a challenge, partly attributed to insufficient observational studies that unveil the thermodynamic and dynamic structures along the vertical direction. This study provides a comprehensive methodology for identifying both enhanced and dissipated downhill thunderstorms. In addition, a radar wind profiler (RWP) mesonet has been built in Beijing to characterize the pre-storm environment downstream of the thunderstorms at the foothill. This involves deriving vertical distributions of high-resolution horizontal divergence and vertical motion from the horizontal wind profiles measured by the RWP mesonet. A case study of an enhanced downhill thunderstorm on 28 September 2018 is carried out for comparison with a dissipated downhill thunderstorm on 23 June 2018, supporting the notion that a deep convergence layer detected by the RWP mesonet, combined with the enhanced southerly flow, favors the intensification of thunderstorms. Statistical analyses based on radar reflectivity from April to September 2018–2021 have shown that a total of 63 thunderstorm events tend to be enhanced when entering the plain, accounting for about 66 % of the total number of downhill thunderstorm events. A critical region for intensified thunderstorms lies on the downslope side of the mountains west to Beijing. The evolution of a downhill storm is associated with the dynamic conditions over the plain compared to its initial morphology. Strong westerly winds and divergence in the middle of troposphere exert a critical influence on the enhancement of convection, while low-level divergence may lead to dissipation. The findings underscore the significant role of an RWP mesonet in elucidating the evolution of a downhill storm.

County Characteristics and Veteran Suicide in the United States, 2011–2018

IntroductionFew studies have examined county-level hotspots of veteran suicide and associated place-based contributors, limiting development of targeted community-level prevention strategies. The objectives of this national spatial analysis of all veteran suicides were to identify areas of the United States (U.S.) with higher-than-expected veteran suicide rates and determine county-level social and economic characteristics associated with areas of higher risk. MethodsUsing Bayesian hierarchical modeling, county-level standardized mortality ratios for veteran suicide deaths were estimated for time periods 2011-2018, 2011-2014, and 2015-2018. Adjusted relative risk, accounting for community characteristics, for each county was then estimated and associations between community characteristics and veteran suicide risk were examined. Analyses were conducted in 2023-2024. ResultsRisk of veteran suicide is predominantly concentrated in the Mountain West and West. Significant predictors of risk across all time periods were per capita number of firearm retailers (2011-2018 RR=1.065 [95%CI 1.030-1.102]), the proportion of residents who moved in the past year (2011-2018 RR=1.060 [95%CI 1.039-1.081]), the proportion of residents who live alone (2011-2018 RR=1.067 [95%CI 1.046-1.089]), the proportion of residents in rental housing (2011-2018 RR=1.041 [95%CI 1.018-1.065]), and the proportion of married residents (2011-2018 RR=0.915 [95%CI 0.890-0.941]). ConclusionsThis study contributes to a comprehensive public health approach to veteran suicide prevention by identifying where resources are needed most, and which place-based intervention targets have the largest potential for impact. Findings suggest that public health efforts to address suicide among veterans should address community level firearm access and identify ways to alleviate deleterious effects of social fragmentation.

How story problems strengthen arithmetic problem-solving strategy sophistication: Evidence from a learning trajectory teaching experiment in kindergarten

BackgroundThe sophistication of young children's arithmetic problem-solving strategies can be influenced through experience and instructional intervention. One potential pathway is through encountering story problems where the location of the unknown quantity varies. AimsThe goal of the present study is to characterize how arithmetic problem-solving strategy sophistication can evolve through opportunities to solve story problems. SampleWe used microgenetic principles to guide the coding of arithmetic problem-solving behavior (8843 attempts) across three timescales (time within-session, attempt to solve, and between sessions) for nine story problem structures (N = 40, 19 girls). Data come from a teaching experiment conducted in a Mountain West US state in Spring 2018. MethodsWe employed a Bayesian hierarchical ordinal regression with a nine-level response variable. The model contained fixed effects for session, attempt, story problem structure; a smooth time within session effect; and random effects for student, instructor, and equation. ResultsOur analysis indicates which transitions from less to more sophisticated strategies are better supported by additional attempts to solve the same problem vs. additional instructional sessions. Strategy sophistication also varied by the location of the unknown quantity (result unknown, find difference, start unknown), but not operation (join, separate, part-whole). ConclusionsIf confirmed by other studies, including experiments, what teachers offer children in terms of learning opportunities (more attempts within the same problem or more problems across work sessions) should vary based on the transition they are making.