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Kline, Ronald R. "Resisting Development, Reinventing Modernity: Rural Electrification in the United States before World War II." Environmental Values 11, no. 3 (August 2002): 327–44. http://dx.doi.org/10.1177/096327190201100304.
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The essay examines local resistance to the New Deal rural electrification program in the United States before World War II as a crucial aspect of socio-technical change. Large numbers of farm men and women opposed the introduction of the new technology, did not purchase a full complement of electrical appliances, and did not use electric lights and appliances in the manner prescribed by the goverment modernisers (the Rural Electrification Administration) and manufacturers. These acts of ‘transformative resistance’ helped to shape artefacts and social practices.
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Kitchens, Carl, and Price Fishback. "Flip the Switch: The Impact of the Rural Electrification Administration 1935–1940." Journal of Economic History 75, no. 4 (December 2015): 1161–95. http://dx.doi.org/10.1017/s0022050715001540.
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To isolate the impact of access to electricity on local economies, we examine the impact of the Rural Electrification Administration low-interest loans in the 1930s. The REA provided loans to cooperatives to lay distribution lines to farms and aid in wiring homes. Consequently, the number of rural farm homes electrified doubled in the United States within five years. We develop a panel data set for the 1930s and use changes within counties over time to identify the effect of the REA loans on a wide range of socio-economic measures. The REA loans contributed significantly to increases in crop output and crop productivity and helped stave off declines in overall farm output, productivity, and land values, but they had much smaller effects on nonagricultural parts of the economy. The ex-ante subsidy from the low-interest loans was large, but after the program was completed, nearly all of the loans were fully repaid, and the ultimate cost to the taxpayer was relatively low.
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Golec, Michael J. "Poster power: rural electrification, visualization, and legibility in the United States." History and Technology 29, no. 4 (December 2013): 399–410. http://dx.doi.org/10.1080/07341512.2013.876249.
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Lewis, Joshua. "Infant Health, Women's Fertility, and Rural Electrification in the United States, 1930–1960." Journal of Economic History 78, no. 1 (March 2018): 118–54. http://dx.doi.org/10.1017/s0022050718000050.
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From 1930 to 1960 rural communities, mainly in the U.S. South and Southwest, gained access to electricity. In addition to lights, the benefits included easier clothes washing, refrigeration, and pumped water. This article uses differences in the timing of electricity access across rural counties to study the effects on infant mortality and fertility. Rural electrification led to substantial reductions in infant mortality but had little effect on women's fertility. The increase in electricity access between 1930 and 1960 can account for 15 to 19 percent of the decline in rural infant mortality during this period.
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Manhique, Milagre, Dominique Barchiesi, and Raed Kouta. "Rural Electrification in Mozambique: Challenges and Opportunities." E3S Web of Conferences 294 (2021): 02004. http://dx.doi.org/10.1051/e3sconf/202129402004.
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The International Energy Agency states that access to electricity is an essential condition for sustainable human development, however, it is estimated that approximately 22% of the world population (about 1.6 billion people) does not have access to electricity, a significant part of these people live in rural areas of developing countries in Sub-Saharan Africa, despite the fact that Africa has enormous potential in renewable and non-renewable energy sources. In Mozambique, approximately 50% of the population does not have access to electricity due to the fact that 66.6% of the population lives in rural areas, where the rate of access to electricity is even worse, paradoxically, Mozambique has a significant potential for renewable energy sources equivalent to 23 TW, this potential when combined with factors such as commitment to ensuring access to electricity for all, forecast of population growth and electricity demand, generates huge investment and long term business opportunities in the electricity sector, however, there are economic, social and cultural challenges that constitute uncertainties that should be considered in the decision-making process for investment in rural electrification infrastructure in the specific context of Mozambique and Sub-Saharan Africa in general. This article aims to discuss the possibilities that Mozambique has to guarantee access to electricity for all by 2030 (emanating from United Nations Sustainable Development Goal 7) emphasizing land use plans and education for rural electrification benefits through the use of renewable energy sources.
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Kline, R. R. "Resisting Development, Reinventing Modernity: Rural Electrification in the United States before World War II." Environmental Values 11, no. 3 (August 1, 2002): 327–44. http://dx.doi.org/10.3197/096327102129341118.
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Salka, William M. "Urban-Rural Conflict Over Environmental Policy in the Western United States." American Review of Public Administration 31, no. 1 (March 2001): 33–48. http://dx.doi.org/10.1177/02750740122064820.
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INSHAKOV, A. A. "THE ROLE OF COOPERATIVES IN OVERCOMING RURAL POVERTY (WORLD EXPERIENCE)." EKONOMIKA I UPRAVLENIE: PROBLEMY, RESHENIYA 1, no. 9 (2020): 142–54. http://dx.doi.org/10.36871/ek.up.pr2020.09.01.019.
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Abstract: All over the world, cooperatives have made a significant contribution to sustainable economic development and ensuring stability in the labor market. Cooperatives are owned, managed and served by their members, which allows them to effectively solve economic problems, develop social and human capital, and, at the same time, encourages people to cooperate and help each other. The article is devoted to the definition of the role of cooperative enterprises in the problem of poverty reduction in rural areas. Theoretical views of scientists on the possibilities of cooperative enterprises in solving the problem of rural poverty are considered. The relationship between rural entrepreneurship and poverty is shown. The role of farming in reducing poverty in developing countries is evaluated. Data from surveys of rural residents and representatives of small businesses in foreign countries show that overcoming poverty is impossible without the development of rural infrastructure and a comprehensive state policy. Methods of poverty reduction and successful cooperation practices in China are considered. Using the example of energy cooperatives in the United States and European countries, the possibilities of cooperation in rural electrification were shown.
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Ferguson, Maria. "Washington View: Big ideas for a new day." Phi Delta Kappan 102, no. 5 (January 26, 2021): 61–62. http://dx.doi.org/10.1177/0031721721992570.
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As the United States has begun to make the transition from one presidential administration to the next, organizations with an interest in education have weighed in on what they think the Biden administration should focus on. Maria Ferguson shares recommendations from the Center for American Progress, AASA: The School Superintendents Association, Organizations Concerned About Rural Education, and advocates for social and emotional learning.
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Sanders, Catherine E., Kristin E. Gibson, and Alexa J. Lamm. "Rural Broadband and Precision Agriculture: A Frame Analysis of United States Federal Policy Outreach under the Biden Administration." Sustainability 14, no. 1 (January 1, 2022): 460. http://dx.doi.org/10.3390/su14010460.
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Global food security requires sustainable and resource-efficient agricultural production. Precision agriculture may provide the tools needed to intensify agricultural production while prioritizing sustainability; however, there are barriers such as initial investments, knowledge gaps, and broadband access that may hinder adoption. Many rural areas in the United States lack the appropriate infrastructure for broadband access needed for precision agriculture, indicating government policies are needed to expand broadband access. The purpose of this qualitative research study was to develop a conceptualization of the current frames used by the Biden administration in communications related to rural broadband and precision agriculture. The methodological framework used was frame analysis. Data were initially analyzed inductively for overall gestalt and subsequently analyzed with abductive coding. Five overarching frames were identified during the data analysis process: broadband access and economic issues, garnering support for broadband expansion, urgency and equity surrounding broadband, expanding beyond the rural, and broadband infrastructure and the agricultural sector. The findings revealed broadband access associated with the Biden administration expanded beyond rural areas, recognizing that cities also face broadband access and affordability issues. There was a lack of discourse, however, surrounding rural broadband policy and precision agriculture, which may downplay its importance in agricultural sustainability.
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Oshin, Ola Austin. "Development of Wind Turbine Generator and Solar Hybrid Power System Model for Rural Electrification." Journal La Multiapp 3, no. 4 (August 26, 2022): 131–54. http://dx.doi.org/10.37899/journallamultiapp.v3i4.674.
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The countries that are most energy-consuming, where there are industrial developments, where the energy demand is highest are the advanced and developing countries in the world (Mustafa, 2018). For instance, the average power per capital (watts per person) in the United States is 1,377 Watts. In Canada, it is as high as 1,704 Watts per person and in South Africa; it is 445 Watts per person. The average power per capital in Australia is 1,112 Watts and in New Zealand it is 1,020 W per person. Whereas, the average power per capital (watts per person) in Nigeria is 14 W per person. (Austin, O. O et.al, 2020). Also, power supply in many parts of Africa is erratic and characterized with a lot of faults and outages. In Nigeria, it is estimated that only 40 % of Nigerians are connected to the national grid and the connected population are exposed to frequent power outages (Abubakar et al, 2015, Austin O.A, 2020). Unfortunately, the effects of incessant power supply have destroyed many industrial activities, reduced employment and has increased crime activities in many parts of the continent (Africa). Therefore, in order to provide urgent solution to these problems and satisfy the high energy demand in African residential and industrial environments, electrical energy should be reliable, affordable, effective, and sustainable. This calls for an urgent establishment of alternative Renewable Hybrid Power Supply System which will provide continuous, reliable and effective power supply to the consumers.
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Michie, Aruna Nayyar. "SYMPOSIUM ON RURAL POVERTY AND PUBLIC POLICY IN THE UNITED STATES." Policy Studies Journal 15, no. 2 (December 1986): 269–72. http://dx.doi.org/10.1111/j.1541-0072.1986.tb00712.x.
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Biryukova, N. А. "The USA and the energy transition of the 21st century: Measures to overcome dependence on China in critical minerals." Moscow University Bulletin of World Politics 14, no. 2 (October 18, 2022): 109–47. http://dx.doi.org/10.48015/2076-7404-2022-14-2-109-147.
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Since the middle of 2010s, international community (developed economies primarily) has been paying increasing attention to the reduction of carbon footprint in the environment by means of large-scale deployment of renewable energy, electrification of transport system and sustainable production of goods. Aspiring to become a global leader of energy transition, the United States of America has already taken a set of measures to stimulate technological growth. Such a challenging task cannot be accomplished without a guaranteed access to the so-called critical minerals. However, the US has encountered growing competition from China in this field. From the beginning of 2000s, China has amassed within its territory a dominant share of global production of critical minerals, acquired access to key foreign extraction centers and thus become virtually a monopolist in the markets. Hence the United States government urgently needs to devise measures to overcome the dependence from China in this regard. The author of the article dwells on the factors which have made the issue of critical minerals (as a recent development of international relations) relevant and politically charged. In its turn, it has led to the securitization of the subject in American official discourse during Trump administration which manifested itself in the ‘mineral security’ concept. The article contains comparative analysis of Trump and Biden administration approaches to navigating the country out of the dependence from China for critical minerals; it also identifies key focus areas of the current US mineral strategy. Respective analysis indicates that Trump administration prioritized bolstering domestic extraction capacity, whereas Biden-Harris administration underscores processing and production segments, mostly due to the pressure from local communities and environmental groups. The author stresses that the Unites States, being unable to contest China’s monopoly as producer and supplier of critical minerals with market instruments, tends to employ human rights discourse to compete with its rival. The ultimate expression of such an approach is Energy Resource Governance Initiative which has been designed to foster high ecological and social standards in global extraction sector. Relying on its partners, the United States intends to use the program to challenge China in commodity markets. The author concludes that despite the effort Washington won’t be able to rid itself of the dependence for Chinese imports in the near future. As for the long-term goals, their achievement is complicated due to both China’s production capacity and experience and insufficient government funding of renewable energy projects in the United States.
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Johnson, Margaret O., Chin-Lin Tseng, Kerry Rowe, Vida A. Passero, Michael J. Kelley, Sara T. Ahmed, and Michael A. Mooney. "QLTI-06. EVALUATING TWO DECADES OF GLIOBLASTOMA CARE IN THE UNITED STATES VETERANS HEALTH ADMINISTRATION." Neuro-Oncology 25, Supplement_5 (November 1, 2023): v246. http://dx.doi.org/10.1093/neuonc/noad179.0944.
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Abstract BACKGROUND The Veterans Health Administration (VHA) provides healthcare for U.S. military Veterans, including specialized care for glioblastoma (GBM). This study aimed to understand patterns of care and outcomes for Veterans with GBM. METHODS We derived a retrospective cohort of U.S. Veterans with histological diagnosis of GBM in 2000-2021 from the VHA cancer registry system (CRS), with follow-up times through May 31, 2022. Data sources were patient-level electronic health records, CRS, and other data from the VHA corporate data warehouse. Using descriptive statistics, we describe demographics, treatments, clinical outcomes, referral patterns, and overall survival (OS). RESULTS We identified 3,802 Veterans with GBM (median per year = 176, range 76-225). Among the 465 veterans diagnosed in 2018-2021, 192 (41%) had unknown IDH mutational status. The median age at diagnosis was 66 years (range 20-101), most were male (97%), non-Hispanic (78%) and white (70%). 32% were considered rural and 2% highly rural. 71% received radiation and 61% (n = 2,301) received systemic therapy with the most common being temozolomide (96%), bevacizumab (16%), and lomustine (6%). First use of Novo-TTF was February 2020 with a total of 25 total users to-date. Between 2018-2021, 57% (range 54-63%) of veterans received cancer-related community referrals (i.e. medical oncology, radiation oncology, or neurosurgery). The yearly rate of palliative care referrals remained ≥40% since 2008 and was highest in 2021 (64%). Median OS was 6.9 months (95% CI:6.6-7.3). CONCLUSIONS Using the largest cohort of Veterans with GBM, we identified gaps in molecular testing data and note a large fraction that received community care referrals. Patterns of cancer-directed therapy appear consistent with best practices, although the unadjusted median OS for Veterans was shorter than reported in other populations. In response to these findings, VHA is developing strategies to improve access, quality and research for Veterans with GBM.
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Sharma, Arjun, and Sanjay Basu. "Does Primary Care Availability Mediate the Relationship Between Rurality and Lower Life Expectancy in the United States?" Journal of Primary Care & Community Health 13 (January 2022): 215013192211254. http://dx.doi.org/10.1177/21501319221125471.
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Introduction: Rural counties in the United States have lower life expectancy than their urban counterparts and comprise the majority of primary care provider (PCP) shortage areas. We evaluated whether PCP availability mediates the relationship between rurality and lower life expectancy. Methods: We performed a mediation analysis on a panel dataset which included county-level estimates (N = 3103) for the years 2010, 2015, and 2017, and on a subset containing only rural counties (N = 1973), with life expectancy as the outcome variable, urbanity as the independent variable, and PCP density as the mediating variable. County-level socio-demographic data were included as covariates. Results and Conclusions: PCP density mediated 10.1% of the relationship between urbanity and life expectancy in rural counties. Increasing PCP density in rural counties with PCP shortages to the threshold of being a non-shortage county (>1 physician/3500 population, as defined by the Health Resources and Services Administration) would be expected to increase mean life expectancy in the county by 26.1 days (95% confidence interval [CI]: 11.4, 49.3) and increasing it to the standards recommended by a Secretarial Negotiated Rulemaking Committee would be expected to increase mean life expectancy by 65.3 days (95% CI: 42.6, 87.5). PCP density is a meaningful mediator of the relationship between urbanity and life expectancy. The mediation effect observed was higher in rural counties compared to all counties. Understanding how PCP density may be increased in rural areas may be of benefit to rural life expectancy.
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Blankenau, J. "Comparing Rural Health and Health Care in Canada and the United States: The Influence of Federalism." Publius: The Journal of Federalism 40, no. 2 (January 6, 2010): 332–49. http://dx.doi.org/10.1093/publius/pjp043.
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Jafari, S. Dale G., Susan J. Appel, and D. Gail Shorter. "Risk Reduction Interventions for Human Papillomavirus in Rural Maryland." Journal of Doctoral Nursing Practice 13, no. 2 (March 20, 2020): 134–41. http://dx.doi.org/10.1891/jdnp-d-19-00047.
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BackgroundHuman papillomavirus (HPV) is largely vaccine preventable. The Healthy People 2020 target goal for vaccine administration is 80%. Current United States (U. S.) rates are far lower primarily because of vaccine hesitancy and lack of provider recommendation.ObjectiveImplement a risk reduction initiative to increase HPV vaccine rates in females aged 12–26 in five rural counties in Maryland.MethodsA convenience sample from a rural community screened an HPV documentary movie, Questionnaire responses pre- and postscreening were surveyed for impact on vaccine readiness. Postscreening focus group comments were analyzed for common themes. Females aged 12–26 from a University Medical Group Women's Health Center located in rural Maryland were targeted. Chart review of immunization records 90 days pre- and postprovider vaccine recommendation demonstrated impact.ResultsPublic awareness events have the potential to impact HPV vaccine hesitancy, but this research did not achieve statistical significance. Direct provider to patient recommendations resulted in a 15% increase in HPV immunizations.ConclusionsEducation of vaccine-eligible individuals should be undertaken.Implications for NursingProviders who recommend administration of the vaccine significantly increase immunization rates.
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Trotman, Janina. "Women Teachers in Western Australian “Bush” Schools, 1900-1939: Passive Victims of Oppressive Structures?" History of Education Quarterly 46, no. 2 (2006): 248–73. http://dx.doi.org/10.1111/j.1748-5959.2006.tb00067.x.
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Demography, distance, and die expansion of settlements created problems for the State Department of Education in Western Australia and other Australian states in the nineteenth and early twentieth centuries. Educational administration in Canada and parts of the United States faced similar issues with regard to the provision of schools. A common response was the establishment of one-teacher rural schools, frequently run by young, and sometimes unclassified, female teachers. In the United States locally elected school boards were the primary source of regulation, but in late nineteenth-century Western Australia such local boards had been stripped of their powers and were answerable to the newly established, highly centralized Education Department. Formal regulated teachers. The masculinized system of the Department and its inspectorate. All the same, however, the local community still exerted informal controls over the lives of teachers working and living in small settlements.
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Walters, Jayme, and Dorothy Wallis. "Characteristics and Organizational Capacity of Nonprofits in Rural, Persistently Poor Southern Counties in the United States." Journal of Public and Nonprofit Affairs 7, no. 3 (December 1, 2021): 390–416. http://dx.doi.org/10.20899/jpna.7.3.390-416.
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The present study focuses on organizational capacity of nonprofits located in rural, persistently poor counties in the South region of the United States, an area of the country that encapsulates the majority of rural poverty. IRS Form 990 data were utilized for recruitment and to obtain demographic characteristics for nonprofits in the area of interest (N=3,530). Emailed and mailed surveys to all qualifying organizations sought to measure organizational capacity. Data from 292 nonprofits were examined in a descriptive analysis. Overall, the participating rural nonprofits scored moderate to high in most dimensions of organizational capacity. Financial management, strategic planning, collaboration, and program planning were strengths in organizational capacity. Evaluation, succession planning, fundraising planning, human resources, and volunteer management were challenges. Study findings provide guidance to capacity builders and funders to guide future training, investments, and policy related to rural nonprofits and communities they serve.
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Chavis, Nicole S., Pamela W. Klein, Stacy M. Cohen, Antigone Dempsey, Heather Hauck, and Laura W. Cheever. "The Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program’s Response to the Opioid Epidemic." Journal of Infectious Diseases 222, Supplement_5 (September 2, 2020): S477—S485. http://dx.doi.org/10.1093/infdis/jiaa230.
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Abstract Background The United States is in the midst of an unprecedented opioid crisis with increasing injection drug use (IDU)-related human immunodeficiency virus (HIV) outbreaks, particularly in rural areas. The Health Resources and Services Administration (HRSA)’s Ryan White HIV/AIDS Program (RWHAP) is well positioned to integrate treatment for IDU-associated HIV infections with treatment for drug use disorders. These activities will be crucial for the “Ending the HIV Epidemic: A Plan for America” (EHE) initiative, in which 7 southern states were identified with rural HIV epidemics. Methods The RWHAP Services Report data were used to assess the IDU population and substance use services utilization among RWHAP clients in 2017, nationally and in the 7 EHE-identified states. THe HRSA held a 1-day Technical Expert Panel (TEP) to explore how RWHAP can best respond to the growing opioid crisis. Results During the TEP, 8 key themes emerged and 11 best practices were identified to address opioid use disorder (OUD) among people with HIV. In 2017, among RWHAP clients with reported age and transmission category, 6.7% (31 683) had HIV attributed to IDU; among IDU clients, 6.3% (1988) accessed substance use services. Conclusions The TEP results and RWHAP data were used to develop implementation science projects that focus on addressing OUD and integrating behavioral health in primary care. These activities are critical to ending the HIV epidemic.
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Walters, Jayme E. "Organizational Capacity of Nonprofit Organizations in Rural Areas of the United States: A Scoping Review." Human Service Organizations: Management, Leadership & Governance 44, no. 1 (November 27, 2019): 63–91. http://dx.doi.org/10.1080/23303131.2019.1696909.
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Pourat, Nadereh, Xiao Chen, Connie Lu, Weihao Zhou, Hank Hoang, and Alek Sripipatana. "Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study." PLOS ONE 15, no. 12 (December 8, 2020): e0242844. http://dx.doi.org/10.1371/journal.pone.0242844.
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Background In the United States, there are nearly 1,400 Health Resources and Services Administration-funded health centers (HCs) serving low-income and underserved populations and more than 600 of these HCs are located in rural areas. Disparities in quality of medical care in urban vs. rural areas exist but data on such differences between urban and rural HCs is limited in the literature. We examined whether urban and rural HCs differed in their performance on clinical quality measures before and after controlling for patient, organizational, and contextual characteristics. Methods and findings We used the 2017 Uniform Data System to examine performance on clinical quality measures between urban and rural HCs (n = 1,373). We used generalized linear regression models with the logit link function and binomial distribution, controlling for confounding factors. After adjusting for potential confounders, we found on par performance between urban and rural HCs in all but one clinical quality measure. Rural HCs had lower rates of linking patients newly diagnosed with HIV to care (74% [95% CI: 69%, 80%] vs. 83% [95% CI: 80%, 86%]). We identified control variables that systematically accounted for eliminating urban vs. rural differences in performance on clinical quality measures. We also found that both urban and rural HCs had some clinical quality performance measures that were lower than available national benchmarks. Main limitations included potential discrepancy of urban or rural designation across all HC sites within a HC organization. Conclusions Findings highlight HCs’ contributions in addressing rural disparities in quality of care and identify opportunities for improvement. Performance in both rural and urban HCs may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.
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Oden, Derek. "Selling Safety: The Farm Safety Movement’s Emergence and Evolution from 1940–1975." Agricultural History 79, no. 4 (October 1, 2005): 412–38. http://dx.doi.org/10.1215/00021482-79.4.412.
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Abstract This paper examines both the farm accident problem and the institutional response it engendered. Farm safety leaders fashioned a largely educational movement to address farm families’ technologically complex environments, since farming’s entrepreneurial nature required a different approach than did efforts in other occupational domains. The nation’s rural policymakers had largely neglected the issue until the Second World War, when they recognized that farm accidents threatened the nation’s wartime mobilization efforts. The farm safety movement was characterized by a cooperative effort, which included the National Safety Council, the United States Department of Agriculture, land grant colleges, and the nation’s rural youth organizations. However, efforts to impose more stringent regulations faced resistance from farmers after the creation of the Occupational Safety and Health Administration.
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Zhang, Pengju, and Ling Zhu. "Does the ACA Medicaid Expansion Affect Hospitals’ Financial Performance?" Public Finance Review 49, no. 6 (November 2021): 779–814. http://dx.doi.org/10.1177/10911421211064676.
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This paper examines the effects of states’ Medicaid expansion under the Affordable Care Act (ACA) on hospitals’ financial performance in the United States. Extending previous studies that primarily focus on the immediate short-term impact of the ACA's Medicaid expansion, we investigate if the fiscal effects persist over a longer-term and if the fiscal effects vary across different hospitals. Using panel data on hospitals from 2011 to 2018, we find that hospitals’ financial performance, as gauged either by Medicaid net revenue and uncompensated care cost or by multiple profitability measures, improves in Medicaid expansion states, and the positive effects continue over time. In addition, there are significant heterogeneities in the fiscal effects across different hospitals. Hospitals’ profitability improves the most in the public sector, rural areas, and less wealthy counties.
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Mitchell, Robert, Patrick Hampton, and Robinson Mambwe. "Teacher Futures: Global Reaction to Teacher Shortages in Rural Locations." IAFOR Journal of Education 10, no. 3 (December 4, 2022): 9–30. http://dx.doi.org/10.22492/ije.10.3.01.
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Upcoming changes in the teacher labor supply will have an impact on nations that provide government-based education for their youth. Faced with a significant global shortfall of educators, most countries have taken steps to incentivize teaching as a profession and ensure that qualified teachers are available to students in all locations – particularly in rural environments. To understand these initiatives more thoroughly, a short-term policy analysis focused on incentives for teacher labor through a lens of governmental policy implementation has been completed. This resulted in a review of the efforts three nations (Australia, the United States and Zambia) have undertaken to ensure a viable and consistent teacher workforce in rural areas. While each nation has specific factors that contribute to current and projected shortages, each also provides unique solutions to assist in resolving this ongoing issue. Through the examination of multiple hiring factors and incentives used in each location, a better understanding of the specific challenges and strategies employed to secure a viable teaching workforce has been developed. Outcomes related to this policy analysis showed commonalities in the lack of developed strategies to prepare rural educators to address teacher shortages in more remote regions. In addition, while education leaders in each country continue to publicly call for additional support for rural teachers – very little legislation or policy implementation has been enacted to bolster this subsection of public education in any of the specified nations. Additional discussion about the long-term concerns regarding rural teacher supply and student equity is also developed.
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Andrilla, C. Holly A., Davis G. Patterson, Tessa E. Moore, Cynthia Coulthard, and Eric H. Larson. "Projected Contributions of Nurse Practitioners and Physicians Assistant to Buprenorphine Treatment Services for Opioid Use Disorder in Rural Areas." Medical Care Research and Review 77, no. 2 (August 9, 2018): 208–16. http://dx.doi.org/10.1177/1077558718793070.
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The United States is experiencing an opioid use disorder epidemic. The Comprehensive Addiction and Recovery Act allows nurse practitioners (NPs) and physician assistants (PAs) to obtain a Drug Enforcement Administration waiver to prescribe medication-assisted treatment (MAT) for opioid use disorder. This study projected the potential increase in MAT availability provided by NPs and PAs for rural patients. Using workforce and survey data, and state scope of practice regulations, the number of treatment slots that could be provided by NPs and PAs was estimated for rural areas. NPs and PAs are projected to increase the number of rural patients treated with buprenorphine by 10,777 (15.2%). Census Divisions varied substantially in the number of projected new treatment slots per 10,000 population (0.8-10.6). The New England and East South Central Census Divisions are projected to have the largest population-adjusted increase. NPs and PAs have considerable potential to reduce substantial MAT access disparities.
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Steffes, Tracy L. "Solving the “Rural School Problem”: New State Aid, Standards, and Supervision of Local Schools, 1900–1933." History of Education Quarterly 48, no. 2 (May 2008): 181–220. http://dx.doi.org/10.1111/j.1748-5959.2008.00140.x.
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“The greatest educational problem now facing the American people is the Rural School Problem,” argued Minnesota county superintendent Julius Arp in 1918. “There is no defect more glaring today than the inequality that exists between the educational facilities of the urban and rural communities. Rural education in the United States has been so far outstripped by the education of our urban centers, that from an educational standpoint, the country child is left far behind in the struggles of life.” This conceptualization of the Rural School Problem, framed within a larger national discussion about the growing disparity between urban and rural life wrought by industrialization, galvanized a broad based coalition of educators, ministers, farmers, agro-businessmen, sociologists, and social reformers into a robust campaign for rural school reform in the early twentieth century. Often lost in recent education histories which have paid much greater attention to urban school reform, this rural school movement had far-reaching consequences, not only for local school governance in the countryside, but for emerging state administration of education. The Rural School Problem, this article argues, helped to stimulate and legitimate significant new state interventions into local schools and define the forms of state aid, regulation, and bureaucracy in a formative period of state development.
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Shiffman, Catherine Dunn. "Supporting Immigrant Families and Rural Schools: The Boundary-Spanning Possibilities of an Adult ESL Program." Educational Administration Quarterly 55, no. 4 (November 4, 2018): 537–70. http://dx.doi.org/10.1177/0013161x18809344.
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Purpose: There has been a significant increase in the number of immigrant families moving to rural communities across the United States. Yet limited research exists that explores relationships between immigrant families and schools in these communities. Rural school districts are often challenged by insufficient resources, expertise, and infrastructure to respond. Adult English as a second language (ESL) programs can be valuable partners. This article explores how instructors in a regional adult ESL program supported relationships between immigrant families and schools in a rural Virginia school district. Research Methods: A case study was conducted between 2014 and 2015. Data collection included observations of adult ESL classes; semistructured interviews with adult ESL instructors, parents of school-age children, and school district leaders and teachers; open-ended questions on a parent survey; and documents. Findings: Four interrelated practices of the adult ESL instructors facilitated understanding and communication between immigrant families and K-12 educators. Adult ESL instructors disseminated information, explained cultural norms and expectations, coached family-school interactions, and created opportunities to connect families and educators. Supporting conditions included characteristics of the adult ESL classes, district leadership and sense of urgency, and multilayered relationships of professionals and actions of the adult ESL coordinator. Implications for Practice: Given the right conditions, adult ESL programs can be valuable partners for rural education leaders seeking to strengthen engagement with immigrant families. These programs can facilitate linkages between schools and adult ESL learners who are parents or caregivers and can be a professional development resource for building district capacity to engage with immigrant families.
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LeWinn, Kaja Z., Leonardo Trasande, Andrew Law, Courtney K. Blackwell, Traci A. Bekelman, Jessica A. Arizaga, Alexis A. Sullivan, et al. "Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States." JAMA Network Open 6, no. 8 (August 23, 2023): e2330495. http://dx.doi.org/10.1001/jamanetworkopen.2023.30495.
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ImportanceFew population-based studies in the US collected individual-level data from families during the COVID-19 pandemic.ObjectiveTo examine differences in COVID-19 pandemic–related experiences in a large sociodemographically diverse sample of children and caregivers.Design, Setting, and ParticipantsThe Environmental influences on Child Health Outcomes (ECHO) multi-cohort consortium is an ongoing study that brings together 64 individual cohorts with participants (24 757 children and 31 700 caregivers in this study) in all 50 US states and Puerto Rico. Participants who completed the ECHO COVID-19 survey between April 2020 and March 2022 were included in this cross-sectional analysis. Data were analyzed from July 2021 to September 2022.Main Outcomes and MeasuresExposures of interest were caregiver education level, child life stage (infant, preschool, middle childhood, and adolescent), and urban or rural (population <50 000) residence. Dependent variables included COVID-19 infection status and testing; disruptions to school, child care, and health care; financial hardships; and remote work. Outcomes were examined separately in logistic regression models mutually adjusted for exposures of interest and race, ethnicity, US Census division, sex, and survey administration date.ResultsAnalyses included 14 646 children (mean [SD] age, 7.1 [4.4] years; 7120 [49%] female) and 13 644 caregivers (mean [SD] age, 37.6 [7.2] years; 13 381 [98%] female). Caregivers were racially (3% Asian; 16% Black; 12% multiple race; 63% White) and ethnically (19% Hispanic) diverse and comparable with the US population. Less than high school education (vs master’s degree or more) was associated with more challenges accessing COVID-19 tests (adjusted odds ratio [aOR], 1.88; 95% CI, 1.06-1.58), lower odds of working remotely (aOR, 0.04; 95% CI, 0.03-0.07), and more food access concerns (aOR, 4.14; 95% CI, 3.20-5.36). Compared with other age groups, young children (age 1 to 5 years) were least likely to receive support from schools during school closures, and their caregivers were most likely to have challenges arranging childcare and concerns about work impacts. Rural caregivers were less likely to rank health concerns (aOR, 0.77; 95% CI, 0.69-0.86) and social distancing (aOR, 0.82; 95% CI, 0.73-0.91) as top stressors compared with urban caregivers.ConclusionsFindings in this cohort study of US families highlighted pandemic-related burdens faced by families with lower socioeconomic status and young children. Populations more vulnerable to public health crises should be prioritized in recovery efforts and future planning.
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Khan, Waleed A., and Aemal J. Khattak. "Injury Severity of Truck Drivers in Crashes at Highway-Rail Grade Crossings in the United States." Transportation Research Record: Journal of the Transportation Research Board 2672, no. 10 (June 11, 2018): 38–47. http://dx.doi.org/10.1177/0361198118781183.
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The physical and operational characteristics of large trucks distinguish them from other types of vehicles in terms of facility design needs and safety requirements. A critical node in the surface transportation network is the highway-rail grade crossing (HRGC) because it represents a conflict point between different modes of transportation. The focus of this research was to identify factors related to different injury severity levels of truck/truck-trailer drivers in crashes reported at HRGCs. This study utilized a mixed logit model to investigate injury severity of those drivers and relied on 2007–2014 Federal Railroad Administration (FRA) crash and inventory data involving trucks/truck-trailers. Results showed that truck/truck-trailer drivers’ injuries in crashes reported at HRGCs were positively associated with train speed, when train struck the road user (truck/truck-trailer), when the driver “went around crossing gates”, older drivers, crashes reported in rural areas, and crashes at crossings with a minimum crossing angle of 60–90 degrees. Presence of crossbucks, gates, track obstructions, and HRGCs located within 500 feet of a highway were associated with relatively less severe driver injuries. The paper provides recommendations for safety improvements at HRGCs and recommendations for future research.
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Bernardini, Judith, and Carol Dacko. "A Survey of Home Visits at Peritoneal Dialysis Centers in the United States." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 18, no. 5 (September 1998): 528–31. http://dx.doi.org/10.1177/089686089801800512.
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Objective To determine the frequency and characteristics of home visits in centers that provide training for peritoneal dialysis (PD). Design Mail survey sent to all dialysis centers in the United States providing home PD, using the Health Care Federal Administration (HCFA) Renal Provider list. Results Surveys were mailed to 1247 centers; 13 were undeliverable, resulting in 1234 surveys successfully delivered; 670 (54%) of those surveyed responded. Of those responding, 525 (78.4%) reported home visits were part of the care of home PD patients: 11% made a single home visit, 52% made an initial home visit with at least one followup visit, and 16% made visits only as needed. No home visits were made by 21% of responding centers. A registered nurse (RN) alone made the home visit in 61% of the centers, while a multidisciplinary team accompanied the RN in 35% of centers; 3% of visits were made by a licensed practical nurse, and 1% by the physician. Half of the visits required 0.5 -1 hour, while 41% required 1 -2 hours. Travel time was most often an hour or less one way. Staff were reimbursed for travel expenses by 90% of the centers. The 525 centers making home visits were not different than the 145 centers not making home visits in number of patients per center, number of RNs, rural or urban location, or affiliation with a university. Interpretation of the HCFA regulations concerning home visits was the most important factor influencing centers making home visits. Conclusions Home visits to continuous ambulatory PD and continuous cycling PD patients in the United States are common. Nearly 80% of centers responding to the survey include home visits in the care of their home peritoneal dialysis patients.
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Bernardini, Judith, and Carol Dacko. "A Survey of Home Visits at Peritoneal Dialysis Centers in the United States." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 18, no. 5 (September 1998): 528–31. http://dx.doi.org/10.1177/089686089801800523.
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Objective To determine the frequency and characteristics of home visits in centers that provide training for peritoneal dialysis (PD). Design Mail survey sent to all dialysis centers in the United States providing home PD, using the Health Care Federal Administration (HCFA) Renal Provider list. Results Surveys were mailed to 1247 centers; 13 were undeliverable, resulting in 1234 surveys successfully delivered; 670 (54%) of those surveyed responded. Of those responding, 525 (78.4%) reported home visits were part of the care of home PD patients: 11% made a single home visit, 52% made an initial home visit with at least one followup visit, and 16% made visits only as needed. No home visits were made by 21% of responding centers. A registered nurse (RN) alone made the home visit in 61% of the centers, while a multidisciplinary team accompanied the RN in 35% of centers; 3% of visits were made by a licensed practical nurse, and 1% by the physician. Half of the visits required 0.5 -1 hour, while 41% required 1 -2 hours. Travel time was most often an hour or less one way. Staff were reimbursed for travel expenses by 90% of the centers. The 525 centers making home visits were not different than the 145 centers not making home visits in number of patients per center, number of RNs, rural or urban location, or affiliation with a university. Interpretation of the HCFA regulations concerning home visits was the most important factor influencing centers making home visits. Conclusions Home visits to continuous ambulatory PD and continuous cycling PD patients in the United States are common. Nearly 80% of centers responding to the survey include home visits in the care of their home peritoneal dialysis patients.
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Bourne, Garrett, Jennifer Bail, John Dell'Italia, Nichole Tanner, Nicholas Maurice, and Devika Govind Das. "Lung cancer screening among women Veterans within the Veterans’ Health Administration." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): 10537. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.10537.
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10537 Background: Despite advancements in survival rates, lung cancer remains the leading cause of cancer-related deaths among women in the United States (US). In response to this challenge, the United States Preventive Services Task Force (USPSTF) issued updated guidelines in 2021 to broaden the pool of eligible candidates for lung cancer screening (LCS). Pioneering initiatives, such as the Lung Cancer Screening Demonstration Project (LCSDP) launched by the Veterans Affairs (VA) in 2012, have played a pivotal role in evaluating the feasibility of implementing Low-Dose Computed Tomography (LDCT) at eight Veterans Affairs Medical Centers (VAMC). Subsequently, the program has undergone substantial expansion. Projections within the veteran community indicate a notable increase in the proportion of women veterans, from 11% in 2023 to an anticipated 18% in 2048. However, scant information is currently available regarding the lung cancer screening patterns within this expanding demographic. Methods: Women veterans ages 55 -80, current or former smokers from 2015- 2021 were identified through the VA corporate data warehouse (CDW). ICD 9/10 codes were used to identify women veterans with a lung cancer diagnosis. Diagnoses were verified via chart review. Data were analyzed using R Studio software. Results: Of the women veterans identified (n=44,342), 10,623 received LCS (24%) and 942 (2%) had a primary diagnosis of lung cancer. In the cohort of 942 women diagnosed, 286 (30%) had received lung cancer. Women veterans diagnosed with lung cancer tended to be aged >65 (55%), white (72%), single (72%), unemployed (71%), and urban dwelling (70%) within the southeastern US (35%). Compared to women veterans who did not receive LCS, those who did had higher rates of localized disease (47% vs 34%) and lower rates of metastatic disease (12% vs 19%). Factors associated with higher rates of LCS included mammography (60% vs 49%), a family history of lung cancer (4% vs 2%) and living in the southeastern US (46% vs 35%). It is to be noted that 23% of the women veterans who were screened lived in rural areas and 18.53% identified as black. 98.9% of the women had reported current or former tobacco use but the data on pack year history was missing in 87.6% of charts. Conclusions: While further progress can be made, it is notable that 24% of women veterans received LCS, surpassing national averages. This discrepancy underscores the potential to advance efforts in establishing a comprehensive and structured lung cancer screening initiative, thereby facilitating the equitable inclusion of historically marginalized groups, particularly minorities and rural populations. The findings emphasize the imperative to overcome existing impediments to nationwide enrollment and retention in LCS. Lastly, the study underscores the necessity for increased resource allocation towards tobacco cessation initiatives as an integral component of the broader expansion strategy.
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Franzen-Castle, Lisa, Michelle Krehbiel, Kerry Elsen, Christine Chasek, and Carol Schwarz. "Using Interagency Partnerships To Establish Neighbor-to-Neighbor Programming: Supporting Rural Mental Health." Journal of Family & Consumer Sciences 114, no. 1 (March 1, 2022): 34–37. http://dx.doi.org/10.14307/jfcs114.1.34.
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The mental health and well-being of rural communities in the United States is a growing and serious concern. Generally, suicide rates are higher and increase more rapidly in rural areas than in urban areas (Ringgenberg et al., 2017; Steelesmith et al., 2019). Studies suggest that isolation, limited socioeconomic opportunity, and sparse access to mental health care may contribute to higher suicide rates (Braun, 2019; Case & Deaton, 2015; Centers for Disease Control and Prevention [CDC], 2018; Hirsch & Cukrowicz, 2014; Substance Abuse and Mental Health Service Administration [SAMHSA], 2020a, 2020b). In a 2019 national sample of rural adults, 75% of respondents said it was important to reduce stigma regarding mental health in the agriculture community, and 45% reported personally experiencing more mental health challenges than they did 1 year ago (American Farm Bureau Federation [AFBF], 2019). According to the U.S. Department of Agriculture, overall U.S. net cash farm income decreased 12% from 2008 to 2018; for Nebraska it decreased more than 30% (Lyons & Litkowski, 2019). Nebraska Extension, based in a rural county, observed a need to help those who might be experiencing stress, anxiety, or a feeling of being overwhelmed, which led to development of a task force on stress and mental health. The purpose of this paper is to describe this rural community's response to increasing awareness of, and support for, mental health and well-being.
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Nguyen, Chi, and Maraki Kebede. "Immigrant Students in the Trump Era: What We Know and Do Not Know." Educational Policy 31, no. 6 (August 16, 2017): 716–42. http://dx.doi.org/10.1177/0895904817723740.
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The 2016 U.S. presidential election marked a time of deep political divide for the nation and resulted in an administrative transition that represented a drastic shift in values and opinions on several matters, including immigration. This article explores the implications of this political transition for immigrants’ K-16 educational experiences during President Trump’s administration. We revisit literature on school choice and the Deferred Action for Childhood Arrivals (DACA)—two policy areas where the most significant changes are expected to occur—as it pertains to immigrant students in the United States. We identify areas where there is limited scholarship, such as the unique educational experiences of various minority immigrant subgroups, the interplay between race and immigration status, and immigrant students in rural areas. Recommendations are made for policy and research.
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Ndaguba, Emeka A., Anthony Okarah, Chijioke Hope Ukanwah, Godwin Nebo, and Solomon U. Ndaguba. "Factors limiting the gains of MDGs in the Democratic Republic of the Congo: KEY DETERMINANT AND PITFALLS FOR FRAGILE STATES." Africa’s Public Service Delivery and Performance Review 4, no. 4 (December 1, 2016): 639. http://dx.doi.org/10.4102/apsdpr.v4i4.146.
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The Human Development Index in 2013 ranked Democratic Republic of the Congo 186th out of 187 in the United Nations Development Programme. The categorization came as a result of the deteriorating conflict that pushed the country towards a failed state realm. According to the 2015 Fragility Index of thePeaceFund, Democratic Republic of the Congo was among the nations ranked on the high alert (highly vulnerable andvolatile), consequently to as a result of non-provision of basic services. In addition to the deteriorating growth and development trajectory, infrastructural and systems failures have unabatedly limited service provision, resulting in inadequacies in humanitarian interventions. The study aims to evaluate the gains of MDGs in Democratic Republic of the Congo, taking into cognizance key deliverables, pitfalls, and prospects for development in fragile states. The study uses thematic reviews cushioned with elements of quantitative approach in providing answers to the study. On surface value, the study shows that 72% of rural households live in abject poverty. Additionally, more than 40% of children in rural areas suffer from chronic malnutrition, hunger and squalor. The study contends that without sustainable public institutions, systems and structure in the administration of services, DRC could likely remain in unending retrogression.
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Marks, Suzanne M., Alexey Clara, Amy Parker Fiebelkorn, Xuan Le, Paige A. Armstrong, Stephanie Campbell, Judith Mendel Van Alstyne, et al. "Influenza Vaccination in Health Centers During the Coronavirus Disease 2019 Pandemic—United States, 7–27 November 2020." Clinical Infectious Diseases 73, Supplement_1 (July 15, 2021): S92—S97. http://dx.doi.org/10.1093/cid/ciab318.
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Abstract Background Influenza vaccination is the most effective way to prevent influenza and influenza-associated complications including those leading to hospitalization. Resources otherwise used for influenza could support caring for patients with coronavirus disease 2019 (COVID-19). The Health Resources and Services Administration (HRSA) Health Center Program serves 30 million people annually by providing comprehensive primary healthcare, including influenza vaccination, to demographically diverse and historically underserved communities. Because racial and ethnic minority groups have been disproportionately affected by COVID-19, the objective of this analysis was to assess disparities in influenza vaccination at HRSA-funded health centers during the COVID-19 pandemic. Methods The Centers for Disease Control and Prevention and HRSA analyzed cross-sectional data on influenza vaccinations from a weekly, voluntary health center COVID-19 survey after addition of an influenza-related question covering 7–11 November 2020. Results During the 3-week period, 1126 of 1385 health centers (81%) responded to the survey. Most of the 811 738 influenza vaccinations took place in urban areas and in the Western US region. There were disproportionately more health center influenza vaccinations among racial and ethnic minorities in comparison with county demographics, except among non-Hispanic blacks and American Indian/Alaska Natives. Conclusions HRSA-funded health centers were able to quickly vaccinate large numbers of mostly racial or ethnic minority populations, disproportionately more than county demographics. However, additional efforts might be needed to reach specific racial populations and persons in rural areas. Success in influenza vaccination efforts can support success in severe acute respiratory syndrome coronavirus 2 vaccination efforts.
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Shalowitz, David I., Peiyin Hung, Whitney E. Zahnd, and Jan Eberth. "Pre-pandemic geographic access to hospital-based telehealth for cancer care in the United States." PLOS ONE 18, no. 1 (January 31, 2023): e0281071. http://dx.doi.org/10.1371/journal.pone.0281071.
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Importance Little is known about US hospitals’ capacity to ensure equitable provision of cancer care through telehealth. Objective To conduct a national analysis of hospitals’ provision of telehealth and oncologic services prior to the SARS-CoV-2 pandemic, along with geographic and sociodemographic correlates of access. Design, setting, and participants Retrospective cross-sectional analysis with Geographic Information Systems mapping of 1) 2019 American Hospital Association (AHA) Annual Hospital Survey and IT Supplement, 2) 2013 Urban Influence Codes (UIC) from the United States Department of Agriculture, 3) 2018 Area Health Resources Files from the Health Services and Resources Administration (HRSA). Interventions Hospitals were categorized by telehealth and oncology services availability. Counties were classified as low-, moderate-, or high-access based on availability of hospital-based oncology and telehealth within their boundaries. Main outcomes and measures Geospatial mapping of access to hospital-based telehealth for cancer care. Generalized logistic mixed effects models identified associations between sociodemographic factors and county- and hospital-level access to telehealth and oncology care. Results 2,054 out of 4,540 hospitals (45.2%) reported both telehealth and oncology services. 272 hospitals (6.0%) offered oncology without telehealth, 1,369 (30.2%) offered telehealth without oncology, and 845 (18.6%) hospitals offered neither. 1,288 out of 3,152 counties with 26.6 million residents across 41 states had no hospital-based access to either oncology or telehealth. After adjustment, rural hospitals were less likely than urban hospitals to offer telehealth alongside existing oncology care (OR 0.27; 95% CI 0.14–0.55; p < .001). No county-level factors were significantly associated with telehealth availability among hospitals with oncology. Conclusions and relevance Hospital-based cancer care and telehealth are widely available across the US; however, 8.4% of patients are at risk for geographic barriers to cancer care. Advocacy for adoption of telehealth is critical to ensuring equitable access to high-quality cancer care, ultimately reducing place-based outcomes disparities. Detailed, prospective, data collection on telehealth utilization for cancer care is also needed to ensure improvement in geographic access inequities.
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Smith, Matthew, Samuel Towne, Angelica Herrera-Venson, Kathleen Cameron, Scott Horel, Marcia Ory, Chelsea Gilchrist, Ellen Schneider, Casey DiCocco, and Shannon Skowronski. "Delivery of Fall Prevention Interventions for At-Risk Older Adults in Rural Areas: Findings from a National Dissemination." International Journal of Environmental Research and Public Health 15, no. 12 (December 10, 2018): 2798. http://dx.doi.org/10.3390/ijerph15122798.
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Falls incidence rates and associated injuries are projected to increase among rural-dwelling older adults, which highlights the need for effective interventions to prevent falls and manage fall-related risks. The purpose of this descriptive study was to identify the geospatial dissemination of eight evidence-based fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Chi, Otago Exercise Program) across the United States (U.S.) in terms of participants enrolled, workshops delivered, and geospatial reach. These dissemination characteristics were compared across three rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas; and, non-metro areas not adjacent to metro areas). Data were analyzed from a national repository of 39 Administration for Community Living (ACL) grantees from 2014–2017 (spanning 22 states). Descriptive statistics were used to assess program reach, delivery-site type, and completion rate by rurality. Geographic information systems (GIS) geospatially represented the collective reach of the eight interventions. Of the 45,812 participants who attended a fall prevention program, 12.7% attended workshops in non-metro adjacent areas and 6.6% attended workshops in non-metro non-adjacent areas. Of the 3755 workshops delivered (in over 550 unique counties), most were delivered in senior centers (26%), residential facilities (20%), healthcare organizations (13%), and faith-based organizations (9%). On average, the workshop attendance/retention rates were consistent across rurality (~70%). Findings highlight the need to diversify the delivery infrastructure for fall prevention programs to adequately serve older adults in rural areas. Ongoing efforts are needed to offer sustainable technical assistance and to develop scalable clinical-community referral systems to increase fall prevention program participation among rural-dwelling older adults.
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Garrett, Valery. "Substance Abuse Treatment in Southern California: The History and Significance of the Antelope Valley Rehabilitation Centers." Journal of Policy History 8, no. 2 (April 1996): 181–205. http://dx.doi.org/10.1017/s089803060000511x.
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Substance abuse treatment has been a topic of ongoing debate in the United States since at least the 1960s, when the country witnessed the development of several promising new treatment approaches. Although costs to society in connection with substance abuse point to a continuing need for an effective treatment system, there is only a general understanding of the field. Several factors make it difficult to comprehend the treatment structure: the field is comprised of a sprawling combination of public and private facilities, it strives to treat many types of addicts, and it employs a variety of treatment approaches. While there are general studies that attempt to describe the system and its components, few inquiries probe the inside of specific treatment facilities to discern their evolution, mission, and effectiveness. This article, which examines the Antelope Valley Rehabilitation Centers (AVRCs), is one such analysis. Located in rural areas sixty miles from downtown Los Angeles, the AVRCs are Los Angeles County's only directly operated treatment centers. The two centers, at Acton and Warm Springs, are not only the first and fourth largest substance abuse hospitals in the country, but they serve a population larger than that of forty-two states, making them an excellent lens through which to view a portion of the substance abuse treatment system.
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Anstett, Danielle, Audra Smallfield, Dean Vlahaki, and W. Ken Milne. "Door-to-antibiotic time for pneumonia in a rural emergency department." CJEM 12, no. 03 (May 2010): 207–11. http://dx.doi.org/10.1017/s1481803500012252.
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ABSTRACTObjective:The Joint Commission on Accreditation of Healthcare Organizations recommends that patients admitted to hospital with pneumonia receive their first dose of antibiotics within 6 hours of presenting to the emergency department (ED). Previous research in the United States indicates that rural hospitals may be better at achieving this benchmark than urban centres. This particular quality indicator has not yet been evaluated in Canada. The purpose of this study was to determine whether the target door-to-antibiotic (DTA) time of 6 hours or less could be met in a rural ED.Methods:We conducted a retrospective chart review of patients admitted to hospital with a diagnosis of pneumonia. Descriptive data for each case was collected, including demographic and timeline information. We analyzed DTA time, antibiotic type, route of administration, hospital length of stay and disposition at discharge.Results:We reviewed a total of 320 charts from Apr. 1, 2003, to Mar. 31, 2008. The final sample consisted of 143 patients (50.3% women) whose median age was 79 years. The median DTA time was 151 minutes and 81.8% of patients received their first dose of antibiotics within 6 hours. Patients received antibiotics either orally (47.6%), intravenously (47.6%) or both (4.8%). Single-agent respiratory fluoroquinolones were used 71.4% of the time. Median length of hospital stay was 4 days; most patients were discharged home (79.7%), 11 died, 11 were transferred and 7 were discharged to a nursing home.Conclusion:A DTA time of 6 hours or less is achievable in a rural ED.
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Godfred-Cato, Shana, S. Nicole Fehrenbach, Megan R. Reynolds, Romeo R. Galang, Dan Schoelles, Lessely Brown-Shuler, Braeanna Hillman, et al. "2018 Zika Health Brigade: Delivering Critical Health Screening in the U.S. Virgin Islands." Tropical Medicine and Infectious Disease 5, no. 4 (November 9, 2020): 168. http://dx.doi.org/10.3390/tropicalmed5040168.
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In 2017, Hurricanes Irma and Maria caused significant damage to the United States Virgin Islands (USVI), heightening the challenges many residents faced in accessing adequate healthcare and receiving recommended Zika virus screening services. To address this challenge, the USVI Department of Health (DOH) requested technical assistance from the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the American Academy of Pediatrics (AAP) to organize a health brigade to bring needed medical care to an underserved population. It also established the development of important partnerships between federal and private partners as well as between clinical providers and public health entities such as the Epidemiology & Disease Reporting, Maternal Child Health (MCH), and Infant and Toddlers Programs within the DOH, and local clinicians. This health brigade model could be replicated to ensure recommended evaluations are delivered to populations that may have unmet medical needs due to the complexity of the conditions and/or rural location.
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Arvonen, Vesa, Samuel N. Kibocha, Tapio S. Katko, and Pekka Pietilä. "Features of Water Cooperatives: A Comparative Study of Finland and Kenya." Public Works Management & Policy 22, no. 4 (June 22, 2017): 356–77. http://dx.doi.org/10.1177/1087724x17715267.
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There are several ways of arranging rural water supply. One of these is through water cooperatives that have been established to provide water supply, irrigation, and/or sewerage services. Water cooperatives are found in developed countries such as Finland, Denmark, Austria, Canada, and United States, and in developing countries in South America, such as Bolivia and Chile. Water cooperatives or their equivalent organizations that exist in Kenya are called self-help water projects. Yet, surprisingly little attention has been paid to this option even in countries with rich tradition of cooperatives in other sectors. In this study, Finland and Kenya were selected for a comparative analysis of the identified features of water cooperatives. Best practices observed in the features with differences could be shared between the two countries.
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Hatfield, Michael, Catherine Cahill, Peter Webley, Jessica Garron, and Rebecca Beltran. "Integration of Unmanned Aircraft Systems into the National Airspace System-Efforts by the University of Alaska to Support the FAA/NASA UAS Traffic Management Program." Remote Sensing 12, no. 19 (September 23, 2020): 3112. http://dx.doi.org/10.3390/rs12193112.
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Over the past decade Unmanned Aircraft Systems (UAS, aka “drones”) have become pervasive, touching virtually all aspects of our world. While UAS offer great opportunity to better our lives and strengthen economies, at the same time these can significantly disrupt manned flight operations and put our very lives in peril. Balancing the demanding and competing requirements of safely integrating UAS into the United States (US) National Airspace System (NAS) has been a top priority of the Federal Aviation Administration (FAA) for several years. This paper outlines efforts taken by the FAA and the National Aeronautics and Space Administration (NASA) to create the UAS Traffic Management (UTM) system as a means to address this capability gap. It highlights the perspectives and experiences gained by the University of Alaska Fairbanks (UAF) Alaska Center for Unmanned Aircraft Systems Integration (ACUASI) as one of the FAA’s six UAS test sites participating in the NASA-led UTM program. The paper summarizes UAF’s participation in the UTM Technical Capability Level (TCL1-3) campaigns, including flight results, technical capabilities achieved, lessons learned, and continuing challenges regarding the implementation of UTM in the NAS. It also details future efforts needed to enable practical Beyond-Visual-Line-of-Sight (BVLOS) flights for UAS operations in rural Alaska.
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Gately, Megan, Dylan Waller, Emily Metcalf, and Lauren Moo. "FINDINGS FROM HIGH USERS OF VIDEO TELEHEALTH TO DELIVER OCCUPATIONAL THERAPY SERVICES DURING COVID-19." Innovation in Aging 6, Supplement_1 (November 1, 2022): 598. http://dx.doi.org/10.1093/geroni/igac059.2234.
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Abstract Occupational therapy (OT) helps older adults improve their ability to perform day-to-day tasks. Veterans Health Administration (VHA) is the single largest employer of occupational therapy (OT) practitioners in the United States and a forerunner in telehealth. As a result of COVID, OT video visits increased by nearly 2000% from 2019 to 2020. To ascertain barriers and facilitators to this shift in care delivery, we conducted interviews between January and April 2021 with OT practitioners (N=27) who were high users of VA Video Connect (VVC), VHA’s videoconferencing software. OT participants were from rural and urban settings, and had completed an average of 536 VVC appointments each in 2020. Participants used VVC to deliver a variety of OT services, including mental health groups and home safety interventions. Facilitators to VVC included, a) Patient characteristics, such as positive perceptions of VVC and technological skill, b) OT clinician characteristics, like flexibility, level of experience, and desire to increase patient access to care, and, c) VHA’s telehealth infrastructure. Barriers included, a) Patients’ lack of familiarity or skills with technology, particularly older patients, b) challenges translating traditionally hands-on care to video, and c) unreliable internet connectivity, particularly for rural patients. This study broadens our understanding of video telehealth service delivery for care which has historically been delivered in brick-and-mortar settings. Understanding challenges and enablers to video telehealth highlights opportunities to increase access to those who face barriers, such as older, rural patients.
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Dexter, Kimberly Bailey, and Caroline Sutter. "Assessing the Quality of a Telemental Health Training Initiative for Social Work Students to Reduce the Workforce Mental Health Crisis in the Child and Adolescent Population." CNS Spectrums 28, no. 2 (April 2023): 240–41. http://dx.doi.org/10.1017/s1092852923001724.
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AbstractIntroductionDelayed access to mental health services (MHS) has become a crisis in the United States. Children have the highest disproportionate rates of delayed psychiatric services in comparison to adults. There are greater demands for mental health professionals than the workforce can supply. Social workers (SW) have been identified as essential stakeholders for children needing access to mental health services. The shortage of social workers is more profound than nurses, especially in rural and underserved areas. Therefore, the Institute of Medicine (IOM) has recommended all educational institutions incorporate telemental health (TMH) training into interprofessional students’ curriculums.Target PopulationThe delays in MHS are directly related to the shortage of mental health professionals especially for nursing but is it is more apparent in social work. The United States Health Resource and Service Administration (HRSA) have projected there is a greater demand for mental health clinicians than the workforce is able to supply. Social workers are essential providers for navigating our nation’s mental health system. They can also train to become licensed mental health therapists. HRSA predicts by 2025 the demand for SWs will be 157,760. However, the estimated supply will be 147,500 resulting in a shortage of approximately 10,260 social workers. Children have the greatest risk for lack of access amongst mental health patients in the U.S. An estimated 13–20 % of children in the United States have a diagnosable mental illness. Twenty-one percent of that amount are children who reside in rural or underserved areas. Strikingly, only 7% of children living in rural or underserved areas will receive a mental health appointment.PurposeThe purpose of the George Mason University initiative was to develop a telemental health training model that would be incorporated into social work students’ curriculum and meet the IOMs’ recommendation. The GMU Population Health Center Initiative sought to identify how SW students, trained as TMH providers could be the resolution to the workforce shortage crisis.MethodsThis project design was a quality improvement initiative to assess social work students’ perception of the telemental health training. The CTiBS framework was used to determine the level of competency SW students achieved upon completion of the TMH training. The Activity Theory was used as the methodological framework to assess social work students’ readiness of change, engagement, and TMH technology.ResultsAfter reviewing quantitative data, 70% participants (n=7) declared novice competency. The remaining 30% (n=3) affirmed proficiency (SD= 0.46, V=0.21). Sixty percent (n=6) participants declared they would consider becoming TMH providers. Sixty percent (n=6) of the trainees stated they were satisfied with the training and would consider providing TMH services upon graduation (SD= 0.49, V=0.24). Ninety percent (n=9) of trainees stated they could successfully conduct a TMH visit and would consider working in rural and underserved areas (SD= 0.30, V=0.09). One hundred percent (n=10) of the participants stated the TMH training was a beneficial skill for their profession.ConclusionOne hundred percent of the participants found TMH training beneficial and ninety percent would use it to conduct visits for children upon graduation. The workforce crisis will not improve unless the IOM recommendations are adapted by educational institutions. A telemental health-prepared labor force will help to reduce the rates of mental health disparities in children.FundingNo Funding
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Deyo-Svendsen, Mark, Matthew Cabrera Svendsen, James Walker, Andrea Hodges, Rachel Oldfather, and Meghna P. Mansukhani. "Medication-Assisted Treatment for Opioid Use Disorder in a Rural Family Medicine Practice." Journal of Primary Care & Community Health 11 (January 2020): 215013272093172. http://dx.doi.org/10.1177/2150132720931720.
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Opioid use disorder (OUD) is a cause of significant morbidity and mortality in the United States. Although efforts are being made to limit access to prescription opioids, the use of heroin and synthetic opioids as well as death due to opioid overdose has increased. Medication-assisted treatment (MAT) is the pairing of psychosocial intervention with a Food and Drug Administration (FDA)–approved medication (methadone, buprenorphine plus naltrexone) to treat OUD. MAT has resulted in reductions in overdose deaths, criminal activity, and infectious disease transmission. Access to MAT in rural areas is limited by shortages of addiction medicine-trained providers, lack of access to comprehensive addiction programs, transportation, and cost-related issues. Rural physicians express concern about lack of mentorship and drug diversion as reasons to avoid MAT. The prescribing of MAT with buprenorphine requires a Drug Enforcement Agency (DEA) waiver that can easily be obtained by Family Medicine providers. MAT can be incorporated into the outpatient practice, where patient follow-up rates and number needed to treat to effect change are similar to that of other chronic medical conditions. We describe a case of opioid overdose and a suggested protocol for the induction of MAT with buprenorphine/naloxone (Suboxone) for OUD in a rural family medicine outpatient practice. Treatment access is facilitated by utilizing the protocol, allowing office staff work to the extent allowed by their licensure, promoting teamwork and minimizing physician time commitment. We conclude that improved access to MAT can be accomplished in a rural family medicine outpatient clinic by staff that support and mentor one another through use of a MAT protocol.
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Solimeo, Samantha, and Bret Hicken. "STAKEHOLDER PERSPECTIVES ON DESIGN, IMPLEMENTATION, AND SUSTAINMENT OF SERVICES FOR OLDER VETERANS." Innovation in Aging 3, Supplement_1 (November 2019): S755. http://dx.doi.org/10.1093/geroni/igz038.2772.
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Abstract A majority of United States Veterans are older adults, compelling healthcare systems such as Veterans Health Administration to attend to their unique needs when designing and implementing programs for workforce development and service delivery. In this symposium authors will present findings from four studies examining how older Veterans’ needs and preferences affect implementation and sustainment in a variety of settings. Presenters demonstrate how: 1) understanding Veterans’ perspectives and preferences for measuring functional status may inform the improvement of care coordination in the primary care setting; 2) the role of population characteristics in implementation of geriatric patient centered medical home teams (i.e., GeriPACTs); 3) the interaction of patient, provider, and delivery system information needs in limiting sustainment of diverse initiatives to improve osteoporosis screening and management for Veterans; and 4) the factors affecting transferability and sustainment of rural and geriatrics-focused quality improvement initiatives beyond local settings. Beyond their focus on how older adults’ needs are reflected or shape implementation, the studies illustrate the application of qualitative data to clinical practice and workforce development.
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Szymanski, Jeff. "Jet engines, wind turbines, and AI: community reactions to new sounds." INTER-NOISE and NOISE-CON Congress and Conference Proceedings 269, no. 1 (July 14, 2024): 1135–37. http://dx.doi.org/10.3397/nc_2024_0152.
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When jet engine-powered commercial aircraft started flying in and out of airports in the mid-20th century, surrounding communities-often in rural areas-were exposed to unprecedented sound levels. A straight line can be drawn from the reactions of those communities to today's Federal Aviation Administration (FAA) airport acoustical requirements. Community reactions to utility-scale wind energy facilities in the late 20th and early 21st centuries led to a bevy of local legislation around the United States, some of which has been insightful and helpful. More recently, society's ever-increasing demand for bits and bytes is introducing suburban areas to data centers-campuses of multi-story buildings requiring access to high volumes of cool air, fast Internet connections, and megawatts of electricity. Community reactions to the resulting environmental sound levels are again driving regulation and legislation. In all these cases, community reactions have driven the narrative. Instead of responding to community reactions, the noise control engineering community and their clients could be more proactive-the professionals could lead the narrative. Ideas about how to achieve this level of proactivity are discussed.
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Lee, Chang Seop. "Process of Establishment and Disbandment of The Agricultural Extension Service In USArmy Military Government in South Korea." Institute of History and Culture Hankuk University of Foreign Studies 90 (May 31, 2024): 77–122. http://dx.doi.org/10.18347/hufshis.2024.90.77.
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This study explores establishment and disbandment of The Agricultural Extension Service In USArmy Military Government in South Korea and reviews Political and social meaning. To do so, we analyzed the US Army Military Government in Korea (USAMGIK) documents and memorandum of South Korean agricultural officials, including the U.S. military's response to agricultural issues, discussions on the establishment of the Agricultural Extension Service and activities. A comparative study was also conducted with the agricultural policies of the Syngman Rhee regime to identify the characteristics of the Agricultural Improvement Service and the Agricultural Extension Service that USArmy Military Government established. The results of this study are as follows. First, The process of creation of the Agricultural Extension Service was a manifestation of new values that countered coloniality. But We can also see the reaction of countering the tendency. Second, the newly created agricultural experiment organization achieved a qualitative strengthening of rural leaders along with a quantitative strengthening, including the expansion of rural leaders, which laid the foundation for the achievements of the Agricultural Extension Service. Third, the establishment of Syngman Rhee's regime brought about a major change in the perspective and operation of agricultural extension, which led to the atrophy and disappearance of the Agricultural Extension Service and the emergence of the legacy of colonial agriculture into the mainstream of Korean agricultural administration. The creation and activities of the Agricultural Extension Service were process of the spread of American values that emphasized procedural democracy. Not only that, The establishment of The Agricultural Extension Service was in line with the Cold War goals of the United States. It was therefore likely to be promoted by the USArmy Military Government’s rural stabilization policy. But this was qualitatively different from colonial agrarianism in that modern values based on democracy were spread to rural society.