Suburban Settings Research Articles

Urban and sub-urban disparities in health outcomes among patients with COVID-19; a cross-sectional study of 234 418 patients in Iran

BackgroundIt remains crucial to understand socio-demographic determinants of COVID-19 infection to improve access to care and recovery rates from the disease. This study aimed to investigate the urban and sub-urban disparities associated with COVID-19 in patients visiting healthcare facilities in the province of Tehran, Iran.MethodsData from 234 418 patients who were diagnosed with COVID-19 infection from March 2020 to March 2021 in the province of Tehran were used in this analysis. Descriptive statistics were used to describe the characteristics of the study population. Chi-Squared test was applied to examine the association of study variables with residing area. Independent samples t-test was performed to compare mean age of patients in urban and sub-urban areas. Multiple Logistic Regression model was applied to examine the association of study variables with disease outcome.ResultsOverall, most patients resided in the urban settings (73%). Mean age of patients was significantly lower in sub-urban areas compared to their counterparts in urban settings (49 ± 23.1 years versus 53 ± 21.1 years, P < 0.001). Positive PCR test results were more common in urban areas (48.5% versus 41.3%, P < 0.001). Yet, sub-urban settings had higher rates of positive chest CT scan reports (62.8% versus 53.4%, P < 0.001). After accounting for age and sex covariates, residing in urban areas was associated with higher likelihood of being admitted to an ICU (OR = 1.27, CI: 1.240-1.305). Yet, a greater vulnerability to fatal outcome of COVID-19 infection was shown in patients living in sub-urban areas (OR = 1.13, CI: 1.105-1.175).ConclusionsThis study revealed a clear disparity in the health outcome of patients infected with COVID-19 between urban and sub-urban areas.

A Review on Hydroponics and the Technologies Associated for Medium- and Small-Scale Operations

According to the Food and Agriculture Organization of the United Nations, the world population will reach nine billion people in 2050, of which 75% will live in urban settlements. One of the biggest challenges will be meeting the demand for food, as farmland is being lost to climate change, water scarcity, soil pollution, among other factors. In this context, hydroponics, an agricultural method that dispenses with soil, provides a viable alternative to address this problem. Although hydroponics has proven its effectiveness on a large scale, there are still challenges in implementing this technique on a small scale, specifically in urban and suburban settings. Also, in rural communities, where the availability of suitable technologies is scarce. Paradigms such as the Internet of Things and Industry 4.0, promote Precision Agriculture on a small scale, allowing the control of variables such as pH, electrical conductivity, temperature, among others, resulting in higher production and resource savings.

Bionomic aspects of dengue vectors Aedes aegypti and Aedes albopictus at domestic settings in urban, suburban and rural areas in Gampaha District, Western Province of Sri Lanka

BackgroundThe lack of information on behavioural patterns of Aedes aegypti and Aedes albopictus has become a significant limitation in vector control and disease management programmes. Therefore, the current study was focused on determining some bionomics aspects: breeding, resting, host-seeking and feeding preferences of Ae. aegypti and Ae. albopictus in Sri Lanka.MethodsLarval and adult surveys were conducted from April 2017 to April 2019 monthly in six selected Medical Officer of Health (MOH) areas in Gampaha Distinct, Western province, Sri Lanka, representing urban, suburban and rural settings. Resting preferences of adult mosquitoes were observed from indoor and outdoor places using a Prockopack aspirator. The information on resting height, surface, material and locality was recorded. Human-baited double-net traps were used to determine the host-seeking time of Aedes mosquitoes. Statistical differences in the spatial distribution of mosquitoes in selected MOH areas and prevalence of vectors were analysed using general linear model (GLM). A chi-square test was used to analyse the resting behaviour.ResultsTotal of 19,835 potential breeding sites were examined at 13,563 premises, and 18.5% (n = 1856) were positive for Aedes larvae. Distribution of Ae. aegypti and Ae. albopictus was statistically significant at species level (df = 1; F = 137.134; P < 0.05 GLM) and study setting (df = 2; F = 8.125; P < 0.05). Aedes aegypti breeding was found mainly in temporary removals (18.8%; n = 34), discarded non-degradables (12.15%; n = 22) and tyres (9.95%; n = 18). Natural (14.7%; n = 246) and temporary removals (13.6%; n = 227) and discarded non-reusable items were the key ovipositing sites for Ae. albopictus. In the adult mosquito survey, the majority was comprised of Ae. albopictus (54.5%; n = 999), which denoted exophilic nature (90.8%; n = 758), and 45.5% (n = 835) represented by Ae. aegypti mosquitoes who were mainly endophilic (84.3%; n = 842). Aedes aegypti rested on cloth hangings and curtains, followed by the furniture, while Aedes albopictus was predominant in outdoor vegetation. In both vectors, biting patterns denoted a typical diurnal pattern with two peaks of host-seeking and biting activity in the morning and afternoon.ConclusionsThe majority (80%) of the larval habitats were artificial containers. The use of larvicides for vector control as the prominent measure is questionable since applying these chemicals may target only 20% of the total breeding grounds, which are permanent. The resting places of adult mosquitoes are mainly indoors. Therefore, using thermal space spraying of insecticide may not be appropriate, and indoor residual spraying is recommended as a suitable intervention to target adult mosquitoes. This study warrants a holistic vector control approach for all medically important mosquitoes and insects, ensuring the rational use of finance and resources.Graphical

Impact of Location on Predator Control Preference Patterns

In recent decades, interactions with carnivores have increased in suburban and urban areas. However, it is unknown how predator control preferences of urban, suburban, and rural residents compare. We sought to characterize predator control preferences regarding interactions with bobcats (Lynx rufus) and coyotes (Canis latrans), and compare these preferences among people living in urban, suburban, and rural areas. We also sought to determine the factors that predicted the likelihood of respondents changing their predator control preference. We conducted cross-sectional surveys of adult residents of the United States and the state of Ohio and embedded randomly assigned carnivore interaction scenarios in which respondents were asked to choose their preferred predator control in response to each scenario. We found that when both scenarios took place in an agricultural location, respondents became significantly more sensitive to changes in the severity (i.e., they were more likely to switch their preferred method of predator control). Subjects overwhelmingly indicated a preference for non-lethal forms of predator control. Specifically, 71.8% of respondents preferred non-lethal in response to both scenarios, 18.5% gave mixed responses (i.e., preferred lethal in response to one of the scenarios but non-lethal in response to the other scenario), and only 9.7% preferred lethal predator control in response to both scenarios. The tendency to prefer only non-lethal methods decreased along the urban-rural gradient such that 78.5% of urban respondents expressed a consistent preference for non-lethal forms of control, compared with 72.8% of suburban respondents, and 51.3% rural respondents. This suggests that most urban and suburban residents view lethal predator control methods as simply inappropriate—at least for the scenarios described. In practice, the management of human-carnivore interactions in urban and suburban areas is complicated by a variety of factors (e.g., the presence and density of humans and their pets) which reduce the flexibility of wildlife managers in these areas. Additionally, management options may be further restricted by the preferences of residents, especially given that management is likely to be more visible in these areas. Strong preferences against lethal control in urban and suburban settings may incentivize the development of novel methods for controlling human-carnivore conflicts in the future.

Screening Mammography Recovery After COVID-19 Pandemic Facility Closures: Associations of Facility Access and Racial and Ethnic Screening Disparities.

BACKGROUND. Screening mammography facilities closed during the COVID-19 pandemic in spring 2020. Recovery of screening volumes has varied across patient subgroups and facilities. OBJECTIVE. We compared screening mammography volumes and patient and facility characteristics between periods before COVID-19 and early and later postclosure recovery periods. METHODS. This retrospective study included screening mammograms performed in the same 2-month period (May 26-July 26) in 2019 (pre-COVID-19), 2020 (early recovery), and 2021 (late recovery after targeted interventions to expand access) and across multiple facility types (urban, suburban, community health center). Suburban sites had highest proportion of White patients and the greatest scheduling flexibility and expanded appointments during initial reopening. Findings were compared across years. RESULTS. For White patients, volumes decreased 36.6% from 6550 in 2019 (4384 in 2020) and then increased 61.0% to 6579 in 2021; for patients with races other than White, volumes decreased 53.9% from 1321 in 2019 (609 in 2020) and then increased 136.8% to 1442 in 2021. The percentage of mammograms in patients with races other than White was 16.8% in 2019, 12.2% in 2020, and 18.0% in 2021. The proportion performed at the urban center was 55.3% in 2019, 42.2% in 2020, and 45.9% in 2021; the proportion at suburban sites was 34.0% in 2019, 49.2% in 2020, and 43.5% in 2021. Pre-COVID-19 volumes were reached by the sixth week after reopening for suburban sites but were not reached during early recovery for the other sites. The proportion that were performed on Saturday for suburban sites was similar across periods, whereas the proportion performed on Saturday for the urban site was 7.6% in 2019, 5.3% in 2020, and 8.8% in 2021; the community health center did not offer Saturday appointments during recovery. CONCLUSION. After reopening, screening shifted from urban to suburban settings, with a disproportionate screening decrease in patients with races other than White. Initial delayed access at facilities serving underserved populations exacerbated disparities. Interventions to expand access resulted in late recovery volumes exceeding prepandemic volumes in patients with races other than White. CLINICAL IMPACT. Interventions to support equitable access across facilities serving diverse patient populations may mitigate potential widening disparities in breast cancer diagnosis during the pandemic.

28. Examining Longitudinal Associations Between Future Orientation and Multiple Forms of Youth Violence Perpetration

Future orientation, defined as hopes and aspirations for the future, is gaining promise as a cross-cutting protective factor against youth violence. Much of the research on future orientation and violence to date has used cross-sectional designs, assessed limited violence outcomes, and focused on youth in suburban settings. Seeking to better characterize associations between future orientation and interpersonal violence over time, we assessed how baseline future orientation longitudinally predicted multiple forms of violence among a sample of male youth residing in neighborhoods with concentrated disadvantage across Pittsburgh, PA.

Patient Digital Health Technologies to Support Primary Care Across Clinical Contexts: Survey of Primary Care Providers, Behavioral Health Consultants, and Nurses.

BackgroundThe acceptance of digital health technologies to support patient care for various clinical conditions among primary care providers and staff has not been explored.ObjectiveThe purpose of this study was to explore the extent of potential differences between major groups of providers and staff in primary care, including behavioral health consultants (BHCs; eg, psychologists, social workers, and counselors), primary care providers (PCPs; eg, physicians and nurse practitioners), and nurses (registered nurses and licensed practical nurses) in the acceptance of various health technologies (ie, mobile apps, wearables, live video, phone, email, instant chats, text messages, social media, and patient portals) to support patient care across a variety of clinical situations.MethodsWe surveyed 151 providers (51 BHCs, 52 PCPs, and 48 nurses) embedded in primary care clinics across the United States who volunteered to respond to a web-based survey distributed in December 2020 by a large health care market research company. Respondents indicated the technologies they consider appropriate to support patients’ health care needs across the following clinical contexts: acute and chronic disease, medication management, health-promoting behaviors, sleep, substance use, and common and serious mental health conditions. We used descriptive statistics to summarize the distribution of demographic characteristics by provider type. We used contingency tables to compile summaries of the proportion of provider types endorsing each technology within and across clinical contexts. This study was exploratory in nature, with the intent to inform future research.ResultsMost of the respondents were from urban and suburban settings (125/151, 82.8%), with 12.6% (n=19) practicing in rural or frontier settings and 4.6% (n=7) practicing in rural-serving clinics. Respondents were dispersed across the United States, including the Northeast (31/151, 20.5%), Midwest (n=32, 21.2%), South (n=49, 32.5%), and West (n=39, 25.8%). The highest acceptance for technologies across clinical contexts was among BHCs (32/51, 63%) and PCPs (30/52, 58%) for live video and among nurses for mobile apps (30/48, 63%). A higher percentage of nurses accepted all other technologies relative to BHCs and PCPs. Similarly, relative to other groups, PCPs indicated lower levels of acceptance. Within clinical contexts, the highest acceptance rates were reported among 80% (41/51) of BHCs and 69% (36/52) of PCPs endorsing live video for common mental health conditions and 75% (36/48) of nurses endorsing mobile apps for health-promoting behaviors. The lowest acceptance across providers was for social media in the context of medication management (9.3% [14/151] endorsement across provider type).ConclusionsThe survey suggests potential differences in the way primary care clinicians and staff envision using technologies to support patient care. Future work must attend to reasons for differences in the acceptance of various technologies across providers and clinical contexts. Such an understanding will help inform appropriate implementation strategies to increase acceptability and gain greater adoption of appropriate technologies across conditions and patient populations.

Differences in Out-of-Hospital Cardiac Arrest Management and Outcomes across Urban, Suburban, and Rural Settings

Background Rural prehospital care settings are underrepresented in the out-of-hospital cardiac arrest (OHCA) literature. This study aimed to describe treatment patterns and the odds of a favorable patient outcome (e.g., return of spontaneous circulation (ROSC) or being presumptively alive at the end of the incident) among rural OHCA patients in the U.S. Methods Using the 2018 National Emergency Medical Services Informational System (NEMSIS) dataset, we analyzed OHCA incidents where an emergency medical services (EMS) unit provided cardiopulmonary resuscitation (CPR) and either terminated the resuscitation or completed transport. We excluded traumatic injuries, pediatric patients, and incidents with response time >60 minutes. The primary outcome was ROSC at any time during the EMS incident. The secondary outcome was a binary end-of-event indicator previously described for use in NEMSIS to estimate longer-term outcomes. Multivariable logistic regression was performed for each outcome measure comparing rural, suburban, and urban settings while controlling for key factors. Results A total of 64,489 OHCA incidents were included, with 5,601 (8.9%) in rural settings. Among the full sample of OHCA incidents, ROSC was achieved in 20,578 (33.6%) cases, including 29.2% in rural settings and 34.1% in urban or suburban settings (p < 0.001). Advanced life support units responded to 95.3% of all calls, and a greater proportion of rural OHCA incidents were managed by basic life support units (7.4% vs. 4.2%, p < 0.001). Rural OHCA incidents had longer response times (7.5 vs. 5.9 minutes, p < 0.001), and rural patients were less likely to receive epinephrine (69.3% vs. 73.3%, p < 0.001). Further, EMS clinicians in rural areas were more likely to use mechanical CPR (29.5% vs. 27.6%, p < 0.01) and were less likely to perform advanced airway management (48.5% vs. 54.2%, p < 0.001). Rural patients had lower odds of achieving ROSC than urban patients after controlling for other factors (OR 0.81, 95% CI: 0.75–0.87). Rural patients also had lower odds of having a positive end-of-event outcome (i.e., presumptively alive) after controlling for other factors (OR 0.86, 95% CI: 0.79–0.93). Conclusion In this national sample of EMS-treated OHCAs, rural patients had lower odds of a favorable outcome (e.g., ROSC or presumptively alive) compared to those in urban settings.

Sap flow monitoring of two Australian native tree species in a suburban setting: Implications for tree selection and management

Sap flow, the transport of fluid in the water-conducting xylem tissues of plants, is commonly measured in studies of plant-water relationships by the heat pulse velocity method. Publications have been rare of long-term sap flow measurements for individual trees in a suburban environment. Plant-water relations in urban settings are essential for promoting urban greening where there is a perceived danger to infrastructure and buildings from planting trees in streets on clay sites. The function of residential houses built on reactive clays can be significantly impaired and walls of buildings cracked if considerable amounts of water are extracted from the soil by the root system of a tree or a group of trees in close proximity, leading to localised soil shrinkage settlement. This part of the wider study aimed to monitor sap flow of eight individual Australian native trees from two species using the heat ratio method (HRM) in the field over 12 months. The analysis of monthly sap flow volume showed a similar pattern for all monitored trees, although daily water demand varied substantially. Methods for estimating tree leaf surface area, crown shape and crown volume were investigated and the equation for calculating thermal diffusivity (k) and sap flow velocity on the basis of the HRM was reviewed. It has been proposed that k may vary substantially depending on how thermal conductivity (K) is estimated, which could lead to significant discrepancies for estimations of plant transpiration. Two K models (KHog and KVan) were investigated and it was found that the impact on mean daily sap volume was negligible for the trees in this study.

Contrasting Challenges of Urban, Suburban, and Rural First-Generation College Students to Improve Retention Programs

The success of first-generation college students (FGCS) is critical to higher education’s role in promoting equity and social mobility among underrepresented populations. Although research on FGCS exists, a comprehensive literature review demonstrates an overgeneralization of FGCS characteristics in the presentation of the data. This study reviewed literature from 2000 through 2020 to identify barriers to academic success reported by FGCS in urban, suburban, and rural settings. Findings show varying challenges across settings in three themes: issues arising from academic preparation, issues in persistence, and non-academic influences. The implications of this study guide postsecondary institutions in creating more effective retention programs to address the challenges FGCS faces in a given setting. By illuminating differences in FGCS challenges, this study combats overgeneralizations of a diverse and geographically dispersed population of students.

A new mobile monitoring approach to characterize community-scale air pollution patterns and identify local high pollution zones

Urban air pollution is quite complex and exhibits significant spatial variability within communities. Traditional centralized monitoring captures temporal variability as well as the long-term trends of air pollution very well, but mapping spatial variability of air pollution in communities at high resolution would require large number of air quality monitors distributed across the community. Mobile monitoring complements stationary monitoring approaches by measuring pollution levels on accessible road networks in urban communities. This paper presents the application of an integrated mobile measurement and data analysis approach to study community-level air pollution patterns, separate the regional background and local contributions, and identify high pollution zones for black carbon (BC), ultrafine particles (UFP), and fine particulate matter (PM2.5). This study was conducted during different periods from 2017 to 2019 in three California cities (Richmond, Stockton, and Commerce) with diverse community and source characteristics.The study found that traffic was the dominant primary source of air pollution in both urban and suburban settings. Urban areas adjacent to large area sources, such as ports and railyards had increased pollutant enhancements due to either direct or indirect emissions, while suburban areas containing unpaved roads were observed to have large PM2.5 enhancement due to the resuspended dust. The analysis disaggregated the contribution of regional and local sources to local air pollution and found that regional background sources contributed up to 75% of the PM2.5 concentrations, while local sources contributed more than half of BC and UFP. The study suggests that 15–30 repeated measurements may be sufficient to map the general air pollution patterns within the community, while some extreme high pollution zones can be identified with fewer repeats (5–10). These techniques can be used for initial screening of air pollution variability within the community, and help identify priority areas for conducting follow-up long-term air quality measurements. The techniques also informs the relative importance of regional and local actions to reduce community pollutant levels.

People Like Me in Places Like Mine: Authentic Representation in Rural Picturebooks

Librarians serve children in specific locations. As they seek to fulfill the Association for Library Service to Children’s (ALSC) promise to help “children make cross-cultural connections and develop skills necessary to function in a culturally pluralistic society,” they must consider a book’s authenticity and specific geography.Young readers in rural places experience different challenges from those in urban and suburban settings as do rural librarians experience different collection development demands than do those in urban and suburban settings, especially when rural stereotypes dominate in children’s books. Because rural identities are tied to each child’s place, daily rural life may feel different on the coast than on the prairie, or in mountains, woods, wetlands, and deserts. Only 9 percent of the rural US workforce is in agriculture, with 91 percent having livelihoods in service, tourism, government, education, manufacturing, mining, health care, and energy. Yet much children’s literature continues to present settings where family farming dominates the rural economy, neglecting the diversity of rural work.

Patients Found Willing to Answer Routine Question on Firearm Access

Patients Found Willing to Answer Routine Question on Firearm Access

A comparison of deep learning algorithms on image data for detecting floodwater on roadways

Object detection and segmentation algorithms evolved significantly in the last decade. Simultaneous object detection and segmentation paved the way for real-time applications such as autonomous driving. Detection and segmentation of (partially) flooded roadways are essential inputs for vehicle routing and traffic management systems. This paper proposes an automatic floodwater detection and segmentation method utilizing the Mask Region-Based Convolutional Neural Networks (Mask-R-CNN) and Generative Adversarial Networks (GAN) algorithms. To train the model, manually labeled images with urban, suburban, and natural settings are used. The performances of the algorithms are assessed in accurately detecting the floodwater captured in images. The results show that the proposed Mask-R-CNN-based floodwater detection and segmentation outperform previous studies, whereas the GAN-based model has a straightforward implementation compared to other models.

Path Loss Modeling: A Machine Learning Based Approach Using Support Vector Regression and Radial Basis Function Models

Path loss prediction models are vital for accurate signal propagation in wireless channels. Empirical and deterministic models used in path loss predictions have not produced optimal results. In this paper, we introduced machine learning algorithms to path loss predictions because it offers a flexible network architecture and extensive data can be used. We introduced support vector regression (SVR) and radial basis function (RBF) models to path loss predictions in the investigated environments. The SVR model was able to process several input parameters without introducing complexity to the network architecture. The RBF on its part provides a good function approximation. Hyperparameter tuning of the machine learning models was carried out in order to achieve optimal results. The performances of the SVR and RBF models were compared and result validated using the root-mean squared error (RMSE). The two machine learning algorithms were also compared with the Cost-231, SUI, Egli, Freespace, Cost-231 W-I models. The analytical models overpredicted path loss. Overall, the machine learning models predicted path loss with greater accuracy than the empirical models. The SVR model performed best across all the indices with RMSE values of 1.378 dB, 1.4523 dB, 2.1568 dB in rural, suburban and urban settings respectively and should therefore be adopted for signal propagation in the investigated environments and beyond.

Performance Analysis of Propagation in VHF Military Tactical Communication System

The main challenge of military tactical communication systems is the accessibility of relevant information on the particular operating environment required for the determination of the waveform's ideal use. The existing propagation model focuses mainly on broadcasting and commercial wireless communication with a highs transceiver antenna that is not suitable for numerous military tactical communication systems. This paper presents a study of the path loss model related to radio propagation profile within the suburban in Kuala Lumpur. The experimental path loss modeling for VHF propagation was collected from various suburban settings for the 30-88 MHz frequency range. This experiment was highly affected by ecological factors and existing wave propagation effects such as reflection, diffraction, scattering, and Doppler effect. Radio propagation performance is evaluated by collecting received power at the allocated substation and comparing it against existing propagation models. The existing propagation model also will be tuned close to the measurement value by identifying the best path loss exponent to perform a suitable model for a suburban area. Theoretical assessments and analysis of the initial measurement stage for radio propagation show the extensive contribution of radio field from potential obstacles at lower VHF frequencies for both short and medium ranges around there. The explanation indicates the standard radio propagation prediction models that are generally reasonable for the suburban area. From the general error analysis, it is seen that, the performance of the LDPL with adjusting path loss exponent is the suitable model since it has least value of error metrics.

Perceived Impact of COVID-19 on Older Adults’ Mental Health and Barriers to Mental Health Care

COVID-19 disproportionately impacted older adults in terms of fatalities, but also increased stress, isolation, and loneliness (Chen, 2020). We examined older adults’ anxiety, depression, and barriers to mental healthcare during the COVID-19 pandemic and their perceptions of these variables prior to the pandemic. Further, we explored whether any perceived changes differed based on geographical location (rural, suburban, urban). Data were collected online between mid-June and mid-July of 2020 from 244 individuals aged 65-82 years (M=68.3, SD=3.5). The sample was primarily White (91%) and female (60%); most (n=119) lived in suburban settings, with 63 in urban and 60 in rural settings. Repeated-measures ANOVAs at alpha=.01 showed that depressive symptoms, measured by the CESD-10 (p<.001), and anxiety symptoms, measured by the GAD-7 (p<.001), increased during the pandemic as did mental healthcare barriers related to transportation (p=.004) and beliefs that depression is a normal part of aging (p<.001). Only transportation concerns differed based on where older adults lived; those in rural (p<.001) and urban (p=.004) settings reported greater transportation barriers than those in suburban settings. No differences over time were found for barriers related to help-seeking (p=.403), stigma (p=.156), knowledge/fear (p=.180), finding a therapist (p=.030), ageism (p=.302), psychotherapist qualifications (p=.265), physician referrals (p=.207), or finances (p=.818). These findings highlight the impact of COVID-19 on older adults’ perceptions of changes in their psychological well-being as well as their experience navigating mental health services.

Assessing Frontline Personnel’s Recognition of and Response to Cases of Abuse in Later Life

Abuse in later life is experienced by 10% of adults over age 60 (Acierno et al., 2010). Unfortunately, it is estimated that for every one reported case, around 20 remain unreported (APA, 2012). A primary reason for this disparity is the absence of training provided to professionals working at the frontline of elder abuse, such as law enforcement professionals, health care professionals, and aging and victim service providers (e.g., Rose et al., 2016). This leaves the workforce best positioned to intervene in cases of abuse in later life lacking knowledge around what constitutes the different types of abuse and what they should do if they suspect abuse (Rosen et al., 2018). A critical first step to developing the evidence-based training needed to reconcile this gap is to gain a better understanding of the current landscape within this workforce. This qualitative study explored the knowledge and attitudes towards abuse in later life as well as current practices and policies for reporting abuse among law enforcement professionals (n = 1), health care professionals (n = 2), and aging (n = 5) and victim (n = 4) service providers. Participants (N = 12) represented urban (n = 4), suburban (n = 5), and rural settings (n = 2). Themes emerging from the focus groups highlight a number of barriers to identifying and reporting abuse for professionals in each discipline. Our findings also provide strong evidence of the need to intervene and diminish the impact ageist attitudes and behaviors can have on older adults.

Health Care Provider Characteristics Associated With Colorectal Cancer Screening Preferences and Use

ObjectiveTo assess health care provider (HCP) preferences related to colorectal cancer (CRC) screening overall, and by HCP and patient characteristics. Participants and MethodsWe developed a survey based on the Theoretical Domains Framework to assess factors associated with CRC screening preferences in clinical practice. The survey was administered online November 6 through December 6, 2019, to a validated panel of HCPs drawn from US national databases and professional organizations. The final analysis sample included 779 primary care clinicians (PCCs) and 159 gastroenterologists (GIs). ResultsHCPs chose colonoscopy as their preferred screening method for average-risk patients (96.9% (154/159) for GIs, 75.7% (590/779) for PCCs). Among PCCs, 12.2% (95/779) preferred multi-target stool DNA (mt-sDNA), followed by fecal immunochemical test (FIT), (7.3%; 57/779) and guaiac-based fecal occult blood test (gFOBT) (4.8%; 37/779). Preference among PCCs and GIs generally shifted toward noninvasive screening options for patients who were unable to undergo invasive procedures; concerned about taking time from work; unconvinced about need for screening; and refusing other screening recommendations. Among PCCs, preference for mt-sDNA over FIT and gFOBT was less frequent in larger compared with smaller clinical practices. Additionally, preference for mt-sDNA over FIT was more likely among PCCs with more years of clinical experience, higher patient volumes (> 25/day), and practice locations in suburban and rural settings (compared to urban). ConclusionBoth PCCs and GIs preferred colonoscopy for CRC screening of average-risk patients, although PCCs did so less frequently and with approximately a quarter preferring stool-based tests (particularly mt-sDNA). PCCs’ preference varied by provider and patient characteristics. Our findings underscore the importance of informed choice and shared decision-making about CRC screening options.

Asking Teens about Their Writing Lives: The Writing Identity Work of Youth

ABSTRACT Framed by theories of youth, culture, identity studies, and literacy identity formation, this article examines how youth articulate themselves as writers. Using interview transcripts, analysis explored writing identity from the perspective of teens in urban, suburban, and rural settings. Findings from this qualitative study suggest that youth used various cultural artifacts, both conceptual and material, to feel and/or seem like a writer within multiple contexts. Specifically examined are the ways in which teens negotiated various identities as writers, including whether and how they drew on specific artifacts to embrace, resist and negotiate the following: (a) standardization, (b) meaning and relevance, (d) support, and (d) identities. In particular, findings illustrated the significance of spaces that provided opportunities for students to both feel and seem like a writer, and highlighted the nuanced ways in which seeming and feeling like a writer are shaped by social and cultural factors. Implications point to providing teens more opportunities to engage in the identity work of writers within multiple spaces, where support, choice, and time to talk about how society conceptualizes writing and what writing means to them are present.