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Introduction: Mass shootings pose a considerable threat to public safety. This study aims to (1) assess US mass shootings, firearm-related sales, laws, and regional differences from 2015-2021 and (2) investigate changes in mass shootings and firearm sales before and during the Coronavirus Disease 2019 (COVID-19) pandemic. Method(s): A retrospective review of mass shootings, gun sales, and laws regarding the minimum age required to purchase a firearm within the US from 2015-2021. The 10 states/regions with the greatest mean mass shootings/capita from 2015-2021 were selected for further analysis. Result(s): Mass shootings correlated significantly with firearm sales from 2015-2021 nationwide (p< 0.02 for all). The growth in mass shootings, the number killed/injured, and gun sales were greater in 2020 and 2021 compared withthe years prior. The 10 states with the highest mean mass shooting/capita over the study period were Alabama, Arkansas, the District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, South Carolina, and Tennessee. No significant correlation was found between the number of mass shootings/capita and the minimum age to purchase a firearm. Conclusion(s): Firearm sales correlated significantly with mass shootings from 2015-2021. Mass shootings and gun sales increased at greater rates during the COVID-19 pandemic compared withthe years before the pandemic. Mass shootings exhibited inconsistent trends with state gun laws regarding the minimum age to purchase a firearm. Future studies may consider investigating the methods by which firearms used in mass shootings are obtained to further identify targets for prevention.
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Diminished self-care practices and heightened stress of school counselors are continuing problems in education. With role ambiguity, high student-to-counselor ratios, emotional exhaustion, and other factors adding pressure to the roles and responsibilities of school counselors, this study investigated the well-being practiced of Missouri school counselors and the internal and external factors which influence them. Findings demonstrate several ways in which school counselors fail to meet basic well-being benchmarks, examples of positive school principal supports, and systemic counselor role ambiguity, mission creep, and high caseloads that contribute to stress and burnout. These results indicate three levels of decision-making that are paramount to school counselors achieving and sustaining healthy well-being practices--the individual counselor's role in self-care and professional advocacy;the school leader's approach to defining the counselor's role and promoting a healthy workplace culture;and the ways in which policymakers affect systemic change.
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Adolescents' interactions with friends were severely disrupted during stay-at-home orders associated with the COVID-19 pandemic. The current study (N = 144, 49% female, 80% European American) considered adolescents' perceptions of this disruption and the implications of the disruption for their emotional adjustment. Adolescents reported that not seeing friends was the most distressing consequence of the pandemic. Compared to before the pandemic, adolescents reported a large decrease in in-person interactions with friends, which was related to loneliness. There was a small increase in online interactions, which could counteract the effects of fewer in-person interactions, but only if the interactions felt socially connected. Online interactions lacking social connection were related to greater loneliness and depressive symptoms.
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Dendrobium sulcatum Lindl or "Ueang Jampa-Nan” (Orchidaceae family) is widely dis-tributed in Thailand and Laos. It is classified in the genus Dendrobium, which is used in both traditional Chinese medicine and Ayurvedic medicine for health enhancement and anti-aging. The purpose of this study was to investigate the phytochemical constituents and bioefficacy of stems, leaves and flowers from D. sulcatum for cosmetic and cosmeceutical applications. Phenolic and flavonoid contents were tested for the phytochemical evaluation. The antioxidant (DPPH, FRAP and ABTS assays), anti-lipid peroxidation, antiglycation, anti-inflammatory and anti-tyrosinase properties were assessed for their bioefficacy. The results showed that the extracts of stem and leaf had higher total phenolic content than that of the flower, and the leaf extract had the highest flavonoid content. The antioxidant, anti-lipid peroxidation and anti-inflammatory activities of the extracts were greater in those from the stem and leaf compared with that of the flower. The leaf extract exhibited the greatest antiglycation property. The results of anti-tyrosinase analysis of the extracts showed that the leaf and flower exhibited potent activities with a percentage inhibition greater than 70% (at a concentration of 50 µg/mL). In conclusion, these findings suggest that the ethanolic extracts from different parts of D. sulcatum are promising sources of natural active ingredients for further cosmetic and cosmeceutical products.
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PurposeThe global spread of coronavirus brought the economy to a screeching halt as entrepreneurs faced constraints in their ability to transact business. Mandatory shutdowns of businesses, travel restrictions and other measures were taken. This study aimed to explore adaptations of small businesses for surviving in such a turbulent environment.Design/methodology/approachThe authors conducted exploratory research with detailed interviews with 15 small business owners from various industries in rural communities in the Midwestern United States.FindingsThe study revealed a variety of strategic responses and highlighted creativity and flexibility in coping with uncertainty. Business owners adapted their strategies regarding processes, products and target customers to remain flexible and reallocate resources to meet ever-changing demands. Some created and strengthened relationships with other business owners, clients, customers and the community. Several showed optimism for the long-term, whereas others viewed survival as contingent on a speedy return to normalcy.Research limitations/implicationsA modest sample of fifteen small business owners were interviewed in similar communities in the Midwest using snowball sampling. With a larger sample size and more variance in age and gender, interview responses may be more diverse and potentially more generalizable. However, the current research may provide some unique insights for younger, up-and-coming entrepreneurs in smaller cities and communities regarding some effective small business and community response to uncertainty and change.Originality/valueThe coronavirus pandemic provided a unique environment to gain insight into entrepreneurial adaptation to unpredictable crisis situations and highlights the importance of assessing and adjusting business strategies to constantly changing demands. The authors also present an emergent theoretical process model of small business adaptive responses to uncertainty that summarizes the major themes derived from the interview responses.
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According to the 2021 Behavioral Risk Factor Surveillance Survey, with an obesity prevalence rate of 37-2% in adults, Missouri continues to outpace the national average of 33-9%. The model described at https://wwwhealthiermo. org/-the Foundational Public Health Services (FPHS)-aims to assure six core public health programmatic areas are available through every public health agency: chronic disease prevention, communicable disease control, environmental public health,;injury prevention, maternal, child and family health, and linkages to medical, behavioral, and community resources. With funding from the Centers for Disease Control and Prevention (CDC), DHSS will lead an effort over the next four to five years to conduct a cost analysis for full implementation of the FPHS model statewide, as well as an accountability measure planning effort with a diverse group of stakeholders inclusive of county and state policymakers. DHSS Chief Medical Officer Heidi Miller, MD, MSMA member and an internal medicine physician with extensive experience with uninsured, Medicaid and underinsured populations, joined DHSS as the department's first Chief Medical Officer in January 2023- Dr. Miller will provide medical guidance and expertise to DHSS programs, serve as the liaison with medical associations and providers, be instrumental in program and protocol development, and continue to build and implement the vision of an integrated public health and healthcare system.
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The first year of the COVID-19 pandemic in 2020 was associated with an "anthropause" in many industries, initially reducing greenhouse gas emissions and other negative anthropogenic influences. However, outdoor recreation has exploded in popularity in response to closures of indoor recreation options, increased free time, and/or increased levels of stress. We tested for the effects of the COVID-19 pandemic on the sale of fishing licenses in Wisconsin and on vehicle counts that were observed at public lake access points in Vilas County, Wisconsin, in 2020. In the summer of 2020, fishing license sales in Wisconsin, USA, increased, particularly among first-time license purchasers for whom cumulative sales in 2020 increased by 71% and 35% compared with the previous 5-year average for Wisconsin residents and nonresidents, respectively. Changes in the vehicle counts at lake access points in the summer of 2020 varied considerably by lake. However, lakes with greater proportions of public shoreline experienced pandemic-associated increases in lake visitors. Our results suggest that the distribution of recreational fishing effort in Wisconsin changed during the pandemic, potentially placing additional harvest pressures on hot spot inland lakes.
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Promoting local food systems is crucial to providing a more viable economy, eco-friendly production, and equal opportunities for producers, consumers, and communities. Meat processors are critical to local meat producers and the meat supply chain. However, various barriers have restricted small-scale meat processors and challenged the lo-cal meat supply chain. Although local food systems have gained enormous scholarly attention, little attention has been devoted to specifically exploring the meat processing sector. This study investigated the characteristics and challenges of small-scale (<750 employees) and very-small-scale (<200 employees) meat processors in Missouri. Twenty-six meat processors participated in an online survey through Qualtrics, a mail survey, or a structured phone interview between May 2021 and March 2022. We identified the characteristics and constraints related to their businesses. The analysis revealed that 76% of meat processors perceived that their business was in better or much better condition than before the COVID-19 pandemic, reflecting their adaptability to the disrupted meat supply chain. However, small-scale meat processing facilities were limited by the labor shortage, complicated regulations and high regulatory compliance costs, a lack of consistent supply, and limited access to tools and equipment. More integrated work is needed to aid smaller processors in positively impacting the local community and environment through locally sourced meat production. This study contains helpful implications for state-level policymaking, extension programs, and future re-search directions.
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Purpose: To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as "positive deviants" with regard to COVID-19 infections and staffing shortages. Methods: Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these "positive outliers." A result-based educational program was designed to describe their actions and staff reactions. Results: Exemplar leaders used transformational leadership style. Top reasons for their success were as follows: (1) trusting and supportive staff relationships;(2) positive presence and communication;and (3) use of consistent staffing assignments. Strong statewide participation was noted in the educational programs.
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Background: While lung cancer is a leading cause of death in the U.S., annual lung cancer screening (LCS) rates remain low at 12.7%. The WUSTL research group began a community intervention to increase LCS called I-STEP (Increasing Screening Through Engaging Primary Care Providers) to address this quality gap. A customizable Toolkit was administered to a collaborative of six hospital systems in Missouri and Illinois, encompassing LCS eligibility and follow up guidelines, navigating LCS referral, and smoking cessation. The COVID-19 pandemic prompted brief suspension of screening, with lingering effects on LCS delivery and I-STEP implementation. Method(s): This was a step-wedged cluster randomized control trial from January 2019 - March 2021. Six hospital systems sequentially entered a three-month training phase, followed by I-STEP implementation into primary care settings. Primary outcomes were mean number of screenings and mean percent change in LCS from baseline. Data were collated into a dashboard. Analyses compared outcomes within I-STEP sites pre- and post- intervention. To investigate whether I-STEP sites recovered screening numbers during the pandemic, we compared I-STEP sites to six comparator hospitals within the collaborative that did not participate in the intervention. Result(s): Mean LCS increased by 63% amongst I-STEP sites (130.8 to 212). Mean screenings increased significantly from pre- to post-intervention phases within I-STEP sites (p = 0.0272). Across I-STEP sites and comparator hospitals, mean LCS increased significantly following emergence of the pandemic in March 2020 (p = 0.0002, LSM difference -72.0, 95% CI [-100.9, -43]) - data adjusted for the three-month period in which LCS was suspended. Findings were similar for mean percent change in LCS. There was no difference in outcomes between I-STEP and comparator sites. Conclusion(s): I-STEP implementation successfully increased mean LCS from pre-intervention baseline. Findings suggest a possible effect of the I-STEP intervention in promoting increased LCS amidst the pandemic.
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Background: In the setting of COVID-19, hypertension, diabetes, and obesity are postulated to contribute to adverse outcomes. Among different ethnic groups in the United States of America, African Americans have a higher incidence of the above conditions. It is hypothesised that the African American population in the United States may bear a disproportionate burden of COVID-19-related mortality. Purpose(s): Evaluate the correlation between African American ethnicity and incidence of COVID-19-related mortality. Method(s): COVID-19-related fatalities reported for Oregon, Missouri, and Georgia between the 6th February and 30th April 2020 were obtained from state health departments. These states were selected due to similarities in the social distancing measures implemented but differences in their African American population (32.4% Georgia, 11.8% Missouri, 2.2% Oregon). Fatalities in each state were analysed using the Cox proportional hazard regression analysis. Result(s): Of the reported fatalities in Georgia, Missouri, and Oregon, 51.0%, 38.0%, and 4.0% were in African Americans, respectively. This corresponds to a 2.1 to 2.8-fold increase in the risk of COVID-19-related mortality in African Americans as compared to all other ethnicities. The incidence of African American fatalities for the total population of each state ranged from 0.12 to 3.22 deaths/population/mile2. As compared to Oregon, the risk of COVID-19-related mortality was significantly higher in Georgia (hazard ratio (HR)=4.4;p<0.001) and Missouri (HR=2.2;p=0.001) at the alpha=0.05 level, proportional to the increased population of African Americans. Conclusion(s): Initial results show that African American ethnicity may significantly contribute to an overall incidence of COVID-19-related mortality.
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The purpose of this qualitative narrative study was to explore career satisfaction and mobility intentions of Missouri public high school principals after 3 or more years in the profession who served during the COVID-19 pandemic. The framework of this study was based on Bandura's (1977) Social Learning Theory and Herzberg et al.'s (1959) Two-factor Theory. Participants in this study included nine high school principals who served in Missouri public school districts, one from each of the RPDC regions across the state of Missouri. With research questions one, key themes associated with satisfactory experiences include change, collaboration, connection, helping and learning, problem- solving, and students overcoming challenges. Conversely, key themes associated with unsatisfactory experiences include pandemic related guidelines and challenges, student academic concerns, and staffing struggles, community turmoil, and work-life balance. For research question two, key themes related to overall mobility intentions amid the pandemic include passion and commitment, connections, managing people, workload, and support. In relation to workplace conditions, key themes included prioritization and time management, delegation, and an inability to balance. In relation to emotional aspects of the work, key themes included support, health, and hobbies. Exploring answers to the research questions, the researcher was provided invaluable insight into the perceptions of high school principal to portray their individual lived experiences concerning career satisfaction and mobility intentions. Approximately half the participants represented in the study were considering leaving the position, however the reasons were more personal related rather than pandemic related. Overall, when considering career satisfaction, while most spoke to the challenges, of the public high school principals represented in the study seemed energized and/or indifferent to the added stress and strain of the pandemic. Participants enjoy their career as a high school principal and are focused on meeting the challenges head on. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The relationships between math anxiety and other variables such as students' motivation and confidence have been extensively studied. The main purpose of the present study was to employ a machine learning approach to provide a deeper understanding of variables associated with math anxiety. Specifically, we applied classification and regression tree models to weekly survey data of science, technology, engineering, and mathematics (STEM) students enrolled in calculus. The tree models accurately identified that the level of confidence is the primary predictor of math anxiety. Students with low levels of confidence expressed high levels of math anxiety. The academic level of students and the number of weekly hours studied were the next two predictors of math anxiety. The junior and senior students had lower math anxiety. Also, those with a higher number of hours studied were generally less anxious. Weekly tree diagrams provided a detailed analysis of the interrelations between math anxiety and variables including academic level, number of hours studied, gender, motivation, and confidence. We noticed that the nature of such interrelations can change during the semester. For instance, in the first week of the semester, confidence was the primary factor, followed by academic level and then motivation. However, in the third week, the order of the interrelation changed to confidence, academic level, and course level, respectively. In summary, decision tree models can be used to predict math anxiety and to provide a more detailed analysis of data associated with math anxiety.
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The current COVID-19 pandemic has largely impacted the academic performance of several college students. The present study is concerned with the effects of the COVID-19 pandemic on students pursuing a STEM (science, technology, engineering, and mathematics) degree. We collected weekly survey data (w=9) of students (n=53) taking calculus courses during the COVID-19 pandemic. Using the self-reported survey data, we investigated the temporal variations in the levels of anxiety, motivation, and confidence of STEM students. Studies on temporal changes to math anxiety are scarce. The present work aims to fill this gap by analyzing longitudinal survey data associated with math anxiety. Furthermore, using descriptive and inferential statistical methods such as one-way ANOVA, we analyzed the data with respect to gender and academic level. Our results indicated that male and freshman/sophomore (F/Sp) STEM students had higher levels of increased anxiety due to COVID-19. Female and F/Sp STEM students had higher levels of motivation, whereas junior/senior (J/S) and male students exhibited higher levels of confidence. Time series analysis of the data indicated that the levels of motivation and confidence significantly dropped toward the end of the semester, whereas the level of anxiety increased in all groups. Also, the use of math resources (such as tutoring and supplemental instruction) has significantly reduced during the COVID-19 pandemic.
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Recent constraints due to the coronavirus pandemic created a need for extreme health protocols while maintaining accountability for the critical tasks of teaching and learning. This was a predicament regardless of student age or grade placement. Teacher education programs quickly faced dilemmas connecting matriculating undergraduates to PK-12 schools to satisfy clinical or practicum experiences. Similarly, PK-12 public school districts faced challenging decisions regarding student learning options ranging from completely virtual or completely in-person to hybrid learning environments. Missouri district leadership and a Midwestern university teacher education program collaborated to provide virtual one-on-one teaching sessions for primary grade children in grades 1-3 during the AY 20-21 clinical experience. Although health and safety protocols limited opportunities for interactions, teacher candidate (TC) survey responses indicated the interactions were meaningful and added value to their experience as a prospective teacher. This experience will be the basis for future reactions to interruptions in clinical preparation field experiences. Using this model universities and school districts may build a collaborative foundation to provide virtual teaching opportunities for TCs whether it be in response to health concerns, inclement weather or other as yet unidentified interference to teaching and learning.
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Rates of burnout among clinicians have been exacerbated by the COVID-19 (COVID)pandemic. A survey of Missouri primary care professionals at federally qualified health centers was conducted during a COVID surge in August 2021 to assess burnout, stress, and job satisfaction as well as if respondents had sought assistance for burnout or attended resiliency training. Despite respondents reporting rates of burnout (56%) that exceed those reported nationally (48%), only 17% sought help for burnout. Most (81%) had not attended resiliency training;of those who did, 16% said sessions "make me feel less alone," while an equivalent number found sessions not useful, identifying an absence of resources within their organization. Comments focused on the need for dedicated time to receive support, including time to seek assistance during working hours, time to take breaks, and time for self-care. The data suggest one path forward to remediate burnout: provide the workforce with time to access support. Copyright 2022 by the Missouri State Medical Association.
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Purpose>The authors examined the impact of the Market Facilitation Program (MFP) and Coronavirus Food Assistance Program (CFAP) payments to United States agricultural producers on non-real estate agricultural loans.Design/methodology/approach>The authors used quarterly, state-level commercial bank data from 2016–2020 to estimate dynamic panel models.Findings>The authors found MFP and CFAP payments not associated with the percentage of non-real estate agricultural loans with payments over 90 days late. However, these payments associated with the percentage of non-real estate agricultural loans with payments between 30 and 89 days late. The available data utilized cannot consider when producers received the actual payment and what they specifically did with those funds.Originality/value>The contribution of this study is for US policymakers and agricultural lenders. The findings could be helpful in designing and implementing future ad hoc payment programs and provide an understanding of potential shortcomings of the current safety net for agricultural producers in the Farm Bill. Additionally, findings can assist agricultural lenders in predicting the impact of ad hoc payments on their distressed loan portfolios.
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Background. Mask mandates have been a widely used public health tool during the COVID-19 pandemic, but how to optimize their impact in the setting of concurrent but spontaneous population-level behavior changes due to rising case counts is not known. This study aimed to examine how earlier or later mask mandate implementation in the context of spontaneous behavior change would have affected transmission of SARS-CoV-2 and severe COVID-19 outcomes in the St. Louis, Missouri area. Methods. Our model utilized aggregated hospitalization and death data for St. Louis city and county residents admitted to nearly all hospitals in the metropolitan area. We first fit a real-life model to estimate changes in transmission after the July 3, 2020 mask mandate, and then created counterfactual scenarios in which 1) 10%, 25%, and 50% of the changes were attributed to the mandate (as opposed to spontaneous behavior change) and 2) the mandate was implemented 3 or 7 days earlier, or 7 or 14 days later. We used an SEIR (Susceptible-Exposed-Infectious-Recovered) model framework and fit models in R. Results. Assuming that 50% of increased masking was due to the mandate, implementing a mandate 7 days earlier was associated with a reduction from 12,685 (IQR: 10,463-16,560) to 12,294 (10,296-15,205) cumulative hospitalizations by September 30, while a 2-week delay was associated with an increase to 13,277 (10,808-17,908) hospitalizations. Trends were similar, but with reduced magnitude, when assuming that 10% or 25% of increased masking was due to the mandate (Figure). Depending on whether 10%, 25%, or 50% of increased masking was due to the mandate, implementing the mandate 1 week early was associated with a return to baseline (June 26) hospital census 1-7 days earlier, while delaying the mandate by 2 weeks led to a 2-12 day delay in return to baseline. Hospital census and cumulative deaths in the real-life (baseline) model and under 12 counterfactual scenarios which vary mask mandate timing (3 or 7 days earlier, or 7 or 14 days delayed) and percentage of increase in masking that is attributed to the mask mandate (Panels A-B: 10%, Panels C-D: 25%, and Panels E-F: 50%). As more of the increase in masking is attributed to the mandate, the costs of delaying the mandate and the benefits of earlier implementation increase. While differences in hospital census are most apparent several weeks after the mandate, differences in deaths gradually become more apparent over time. Conclusion. Impact of a mask mandate depends on both timing and percent of increased masking that is attributed to the mandate. Implementing a mandate even a few days earlier is associated with fewer cumulative hospitalizations and earlier return to baseline, but the overall duration of implementation is slightly longer. Given wide variations in public behavior, locally-tailored models are essential for estimating the impact of interventions and informing the local public health response.
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An MSMA-backed prior authorization bill will be sponsored in 2022 that's similar to a Texas law passed earlier this year. Under the new law, Texas doctors with a 90% approval rate or higher for a particular service are exempted from prior authorization requirements for that service. Marijuana Since legislation that would allow recreational marijuana use in Missouri has traditionally seen little support in the state legislature, an initiative petition has been submitted that would change the current Missouri law via constitutional amendment.