Introduction Hypertension occurs when there is persistent increase in the pressure of blood vessels in the body; this condition affects about 75 million people in the United States (U.S.). Hypertension is a major risk factor for Peripheral Artery Disease (PAD). PAD is a narrowing of the peripheral arteries in legs, stomach, arms and head regions of the body except the heart. Research has shown that hypertension can be life-threatening for patients with PAD. Moreover, research supports an evidence of a low threshold for blood pressure treatment in patients with PAD. Additionally, current American Heart Association guidelines recommend treating hypertension in patients with PAD to reduce the risk of other cardiovascular disease (CVD) comorbidities. In Central Appalachia, the rate of hypertension and the corresponding risk factors is higher than the national average. As such, this study examined the multiple risk factors of hypertension in patients with PAD within the Central Appalachian region. Method The study population consists of patients diagnosed with PAD in a large health system in Central Appalachia from 2008 to 2018. We extracted 13,455 patients with PAD from Electronic Medical Records (EMR) system using ICD- 9 and ICD-10 codes. The outcome variable of the study was hypertension in PAD patients. Explanatory variables included gender, age, and cardiovascular risk factors (myocardial infarction (MI), Body Mass Index (BMI), diabetes mellitus, smoking status, low-density lipoprotein, high-density lipoprotein, triglycerides, and hypercholesterolemia). Multivariable logistic regression was performed to assess the association between risk factors of hypertension in male and female PAD patients. All analyses were performed using SPSS version 24. RESULTS Of the total PAD patients in the study, 45.8% were females and 54.2% were males. Of these patients, 79.1%, 45.7% and 22.6% had hypertension, diabetes and a history of MI, respectively. Upon stratifying based on gender, the odds of hypertension in PAD female patients with a history of MI was approximately 5.4 times (OR: 5.4, CI : 1.80-16.21) and 2.6 times higher with diabetes (OR: 2.6, CI: 1.43-4.83). Whereas in PAD male patients, the odds of hypertension was 3.9 (OR: 2.6, CI: 1.61-9.21) and 2.6 times (OR: 2.6, CI: 1.43-4.83) higher in those with a history of MI and diabetes, respectively. Stratifying by MI, the odds of hypertension in PAD increased by 2.8 times in patients with diabetes (OR: 2.6, CI: 1.75-4.49). Stratifying by diabetes showed that the odds of hypertension in PAD increased by 4.7 times in patients with MI (OR: 4.7, CI: 1.32-17.07). CONCLUSION The study showed that odds of hypertension in PAD patients is increased in the presence of diabetes and history of MI in both genders. Therefore, controlling diabetes and myocardial infarction will have the greatest impact in reducing the likelihood of hypertension leading to decreased morbidity and mortality in patients with PAD.

Abstract Background: Over 100 million people in the United States (U.S.) have diagnosed diabetes or pre-diabetes. People with this condition are at an increased risk of Peripheral Arterial Disease (PAD). There is a high prevalence of people with risk factors of diabetes especially in the rural Central Appalachia region. People with diabetes are at a higher risk of developing atherosclerosis, which is the most common cause of PAD. Although about 20–30% of 12 million people affected with PAD in the U.S. have diabetes, little is known about diabetes in PAD patients in Central Appalachia. Therefore, this study aimed to examine the risk factors of diabetes in patients with PAD within the Central Appalachian region. Methods: The study population consisted of patients with PAD with medical comorbidities of Cardiovascular disease (CVD). All patients were admitted to a large health system in Central Appalachia between 2008 and 2018. 13,455 index cases were extracted from the Electronic Medical Records (EMR) using the ICD-9 and ICD-10 codes. With diabetes as the outcome variable under study, the risk factors included Myocardial Infarction (MI) history, hypertension, smoking status and hypercholesterolemia. Socio-demographic variables considered in the study included gender, age, ethnicity and marital status and the covariates were Body Mass Index (BMI), Low density lipoproteins (LDL), High density lipoproteins (HDL), Total Cholesterol, and Triglycerides (TG). Multivariable logistic regression was performed to examine potential risk factors of diabetes in PAD patients. Results: The results showed that BMI {OR =1.056 (CI: 1.039, 1.073)}, HDL {OR =0.980 (CI: 0.965, 0.995)}, TG {OR=1.003 (CI: 1.001, 1.005)}, MI history {OR= 1.375 (CI: 1.111, 1.703)}, hypertension {OR=2.822 (CI: 1.804, 4.415)} and smoking {OR =0.802(CI: 0.641, 1.003)} were significant for diabetes in known PAD. To control for potential confounders, Stratification was used. Among males and females with PAD, diabetes was associated with last BMI, MI, hypertension and TG. HDL seemed to be negatively associated with hypertension and female diabetics while smoking seemed to be negatively associated in males. Upon stratification with hypertension, diabetes in PAD patients was significant with BMI, TG, MI history and HDL. After stratification with MI, diabetes in PAD female patients was associated with BMI, and previous MI history. On the other hand, patients without MI had an elevated TG level and an increased risk of hypertension. Conclusion: CVD risk factors are strongly associated with PAD comorbidities, which are worsened in the presence of diabetes. We suggest that hospitals and health care systems should strongly control for the risk factors of diabetes and adopt a multi-risk-factor approach for improving health outcomes for PAD patients.

Curriculum standards in social studies encourage a curriculum that helps students understand how minority groups and women have historically sought access to equality of opportunity through organization and struggle, as well as a curriculum that supports democratic dialogue and mutual understanding among groups from diverse backgrounds. This study investigated how preservice social studies teachers have experienced efforts to help them understand dimensions of diversity and how these dimensions implicate classroom practices. Their pedagogical intentions were explored using educational criticism and connoisseurship, a humanities-based qualitative methodology that describes, interprets, and evaluates the various dimensions of educational experiences. This investigation followed four preservice social studies teachers and their instructors as they shared their encounters with difference and a diversity education course. Their experiences were rendered as written portraits of their intentions for teaching and learning. These portraits revealed themes of "earnest impotence" and structural obstacles that made truly transformative multicultural education difficult to achieve. Recommendations for curricular enhancements that attend to the "commonplaces" of curriculum are suggested.

Using national data from the Survey of the Status of Social Studies (S4), this study examined the associations between teacher-level and school-level factors as well as testing policy, and the self-reported levels of authority and control over key classroom tasks among secondary school social studies teachers in the context of high-stakes accountability. This research sought to identify the importance of teacher authority in the classroom and how 6-12 social studies educators' professional authority is associated with teachers' professional characteristics (their degree background, teaching experience, and licensure paths), school-related factors (school types, school context, school poverty levels, and minority enrollment levels), and state testing policy. A conceptual framework was developed to guide the selection of specific predictor and control variables and to examine the three theoretically based models through hierarchical multiple regression analysis techniques. The analytic sample included grades 6-12 social studies teachers (N=6,703). Key findings from this study indicated that, as hypothesized, teacher-level characteristics significantly predicted secondary social studies teachers' classroom authority. Self-reported levels of teacher authority were maldistributed across the types of school, school context, school poverty levels, and minority enrollment levels. Greater minority and low-income student enrollments were associated with less authority and control in the classroom. Also, state testing policy significantly predicted social studies teacher authority. Specifically, middle and junior high school teachers who gave state mandated social studies tests reported significantly lower levels of authority and control than those who did not. On the other hand, high school teachers who gave state mandated social studies tests reported significantly higher levels of authority and control than those who did not. Also, teachers who believed that state test results impacted their job security reported lower levels of authority and control than those who did not feel such pressure.

Twenty-first century high school students' learning experience in an online setting is no longer limited by a time-constrained schedule, lack of resources, teachers' formalities, and restrictions affecting learning progressions. The list of benefits to the virtual learning experience is vast, however, there are substantial pitfalls and ambiguities that must be resolved. One of the pitfalls for social studies educators is their ability to properly measure whether or not students are gaining prudent civic competences, skills, and dispositions. The mission of social studies education is the acquisition of civic knowledge, but more importantly, the overall development of a lifelong caring, active, and educated citizenry. Yet, online high school social studies instructors are faced with a quandary when attempting to find optimal and indirect techniques toward achieving this end. Through a review of literature, fostering effective discussions in online courses allows students to indirectly learn and practice democratic processes authentically. This current qualitative research study is a discourse analysis that attempts to understand how students' civic identities are constructed and presented through structured, weekly asynchronous discussion forums in five online high school social studies courses in Florida. The examination of students' language-in-use in relation to civic identity construction and/or exhibition is a crucial element for virtual social studies instructors to consider when attempting to understand how young people are civically (and politically) connected to their communities in a digital age; in present times and in the future. This study's four major findings were: (1) students revealed utilitarian and social justice elements within their civic identities; (2) students' showed an eagerness to question and analyze society and the government; (3) the data revealed concrete instances of civic identity exhibition along with civic engagement testimonies; and (4) the interactions that transpired within the discussion forums were a vehicle for civic identity development. The majority of these students did not display an achieved civic identity status due to their lack of an advanced historical and political knowledge base; however, knowledge and skills only comprise a portion of one's civic identity. In addition, results showed that students need to engage in more self-reflection or self-discovery activities, more opportunities to experience an authentic connection with their community through activities like service-learning projects, and more time spent on developing sound 21st century democratic skills. Attention to civic identity construction and enactment as a goal of virtual high school social studies instruction could be a promising target so educators can understand how students see themselves as important members of their communities. Thus, a high school virtual social studies curriculum and course must be empowering; focused on students' self-development while maintaining a rigorous, meaningful, open, and flexible design. Virtual social studies teachers should use numerous pedagogical strategies to empower students to discover and achieve their talents and purposes in life as a tool for accomplishing democratic goals and commitments necessary for our nation's advancement.

ABSTRACT Although immigrants are an integral part of the nation's founding and history, it is unclear how they have been historically portrayed in children's and young adults' American trade books, especially at the turn of the 20th century. This study offers a critical and comparative analysis focusing on the historical evolution, depiction of immigrants, and authors' perspectives of selected trade books written during two peak United States immigration eras (1880-1930 and 1980-2010s). Utilizing a discourse analysis approach, this study examined how first-generation immigrants were portrayed in selected trade books and how various themes and representations may have affected students and the social studies curriculum. After studying 98 books, it was determined that in both peak immigration eras, first-generation immigrants were depicted as inferior to native-born Americans. Although the time period and countries of origin changed, the issues that immigrants faced and the problems they experienced were similar; first-generation immigrants were scorned, harshly criticized, and viewed as inferior not only by Americans, but also by fellow immigrants who were members of other cultures. Overall, the books left out the immigration experience, and were mostly tales of assimilation and mistreatment in the United States. Because children's ideas and understandings of people and cultural groups are formed by what they learn from others and by the media, it is important that books which portray immigrants and their experience provide accurate and meaningful representations of these individuals. Although many of these books reviewed in this study are considered classics and offer an immense amount of valuable information about historical events which can benefit the social studies curriculum, teachers should be wary of serious overt and covert criticism of ethnicities before introducing them in the classroom. There is a need for literature that sends positive messages about accepting those from other countries and that focuses on how first-generation immigrants helped shape America. Teachers should use trade books in the classroom as they can help children read about history. However, new books need to be written about immigrants. Future research should look into effective ways to use the existing body of trade book literature in the classroom, investigate if (and to what degree) trade books were or are used in schools, compare trade books' portrayal of immigrants to that of textbooks' portrayal, and examine how immigrants were portrayed during the time periods (1940-1970) not covered in this study.

The purpose of this study was to describe and explain the perspectives of five secondary social studies educators who identified with teaching for social justice. The following research questions guided the study: How do educators who identify with social justice perceive teaching for social justice?; In what ways do educators who identify with social justice facilitate a social justice education?; What experiences prompt educators to teach for social justice in the classroom?; In what ways are educators challenged and rewarded while facilitating a social justice curriculum within the secondary social studies classroom? This qualitative study employed semi-structured interview questions and was conceptually-framed within critical pedagogy. The study provided participants the opportunity to: (1) explore their own perspectives on social justice as both a theory and pedagogy, (2) reflect on the qualities they bring to the classroom regarding social justice, and (3) familiarize others with challenges and rewards as they relate to teaching for social justice. While the study served to further investigate the overarching theme of teaching for social justice, findings revealed: commonalities in how participants define and interpret social justice as both a content and a pedagogy and how they facilitate a social justice approach in the classroom; similarities in the influential power of experiences in the lives of participants and the role these experiences played in both their personal and professional lives; the idea of exposure in that content and people with whom participants were exposed influenced their personal interpretations and understandings; teaching for social justice is not always implemented easily and without challenge, yielding courage and the commitment to stand up for what one believes. While critics argue against this framework and point out its vague and under theorized meaning, the study serves to argue that teaching for social justice is inclusive and practical in nature and serves to promote equity and justice. Included within the study are implications based on the findings and the researcher's interpretations providing recommendations for other researchers, social studies educators that may want to frame future research on similar topics, and recommendations for social studies teacher education programs on implementing and facilitating teaching for social justice.

With the passing of the No Child Left Behind Act of 2001 and subsequent high-stakes tests, including the Florida Comprehensive Assessment Test (FCAT), literacy has become top priority in the field of education (Florida Department of Education [FDOE], no date a; NCLB, 2002). Though social studies was not mentioned in NCLB, nor is it tested by the FCAT, social studies teachers are expected to teach literacy skills in their classrooms. Social studies teachers' accountability for literacy enhancement is evidenced by the fact that some states, including Florida, now require social studies teachers to complete a course in reading integration to qualify for teaching certification in that state (Stilwell, 1999). Integrating reading into the content areas is commonly referred to as content area reading. By using content area reading, social studies teachers implement teaching strategies, methods, and techniques that foster their students' comprehension of the texts and other materials used in their course (Alvermann & Phelps, 2002; Billmeyer & Barton, 2002; Tovani, 2000). Though there are many benefits to content area reading, social studies teachers have resisted implementing content area reading for decades (Carnine, 2000; Daisey & Shroyer, 1993; Jacobs & Wade, 1981; Moore, 1983; Nourie & Lenski, 1998; Ratekin, Simpson, Alvermann, & Dishner, 1985; Richardson, Anders, Tidwell, & Lloyd, 1991; Stewart & O'Brien, 1989; Vaughan, 1977). Furthermore, research suggests that content area reading courses are often associated with heightened resistance to implementing content area reading (Nourie & Lenski, 1998; Stewart & O'Brien, 1989). In order for a content area reading course to impact the classroom practices social studies teacher in the intended ways, the course instructor must be sensitive to the process of change that the student is engaged in and recognize the causes of resistance to change. The Concerns-Based Adoption Model (CBAM) is a framework that provides tools by which the process of change and resistance to change can be evaluated and better understood. This study was designed to examine the characteristics surrounding the process of change as social studies teachers learned about and implemented content area reading into the social studies curriculum.

In the 1990s, New Zealand's curriculum for the compulsory schooling sector was to undergo complete revision following the administrative reforms of the 1980s. The development of each new curriculum document followed a business model in which the Ministry of Education put the development process out for competitive tender. The successful bidders were to complete their tasks to strict Ministry guidelines and under the scrutiny of the Ministry's Curriculum Review Committee and the Minister's Policy Advisory Group. After the completion of a draft version, public consultation and school trials, a final curriculum document would be prepared and mandated as the legal curriculum requirements for New Zealand government-funded schools. The process that the fifth document, Social Studies in the New Zealand Curriculum, was to undergo proved to be elongated and controversial. As such, it provides a case study through which to examine, critique and theorise the nature of curriculum construction at a macro-level, in this case, at a national level. This study of the development of Social Studies in the New Zealand Curriculum illuminates three broad themes in curriculum construction - context, complexity and contestation. These themes arise from the literature and are reinforced by the study's findings. The study set out to: provide detailed description and analysis of an example of curriculum construction; use the selected case study to demonstrate the importance of the broader contexts within which curriculum construction occurs; problematise the notion of curriculum construction by highlighting the complexities in and around the process; articulate the contested nature of selecting and presenting curriculum contents; and provide insights into the personal and affective side of involvement in a macrolevel curriculum construction process. There are three main sources of data - the process itself, the products (three versions of Social Studies in the New Zealand Curriculum) and the people involved. A range of data gathering methods is used from primarily historical and ethnographic research within a qualitative framework. The main data gathering tools are archival research, document analysis and open-ended interviewing. As the data are mainly textual--either as original documents or created texts, as in interview transcripts-analytic strategies include content, thematic, semiotic and discourse analysis. Social constructionism (Burr, 1995) provides a unifying theoretical approach to frame the research design and analysis. In this dissertation, the background to the study, the findings and the discussion are interwoven and presented through three story strands - institutional, contextual and personal. The institutional strand aims to tell "what happened". The contextual strand aims to explain "why things happened as they did", "in what circumstances" and "why this might be important". The personal strand aims to give more prominence to the role of individuals in such a process, that is, "who was involved, how did individuals impact upon curriculum construction and how did the process impact upon them?" The layout of the dissertation also highlights the interwoven and complex nature of the ideas being explored. It is necessary to push the boundaries of a more traditional format to keep the notions of complexity and contestation to the fore. This manifests itself in the way that the chapter headings are based around the three story strands, the literature is integrated throughout the study and multi-layered stories and multiple interpretations are given. Within this framework, the usual features of a conventional research report - background, context, literature, theoretical underpinnings, methodological choices, findings and discussion - are still to be found but some liberty is taken to "open up the complications that [would] have been smoothed over" (Stronach & MacLure, 1997, p. 5) in more traditional dissertations. The findings are analysed and presented in a variety of ways - as a chronology and a set of critical incidents to outline the process, as textual and visual analysis to examine the products, and through personal stories to illuminate the experiences of the people involved. Theorising from the data is problematised by using a range of theoretical explanations before proffering a synthesised model of curriculum construction as a multidimensional process. The findings from this study form two clusters - those that relate to the specific case study (the development of Social Studies in the New Zealand Curriculum) and those that provide deeper understanding of the broader nature of curriculum construction. The two sets of findings also demonstrate the interrelated nature of the three data sources - the process, the products and the people. In relation to the specific case study, there is clear evidence of the acceptance of social studies as a curriculum area in New Zealand with its own identity and integrity. The study also documents the historical development of social studies as a curriculum area and provides a detailed account of the contested nature of the development of the current social studies curriculum statement Social Studies in the New Zealand Curriculum. The other finding, relating specifically to the New Zealand context but which should give heart to practitioners everywhere, is the resilience of committed educators when faced with opposing ideological forces determined to undermine their position. This is exemplified in this case study by the social studies community's ability to reclaim control over the contents of the curriculum despite strong opposition from the Business Roundtable and other neo-liberal and neo-conservative forces. What is also revealed is that in order to achieve an acceptable outcome, a curriculum construction process needs both consultation and critique. Social Studies in the New Zealand Curriculum is all the stronger as a product because of the depth of the surrounding debate and this, in turn, strengthened the credibility of both the curriculum area and its supporters. The findings that relate to broader notions of curriculum construction either confirm key themes from the literature, expand upon some that are less explicit or offer new insights. The three touchstones of this study - context, complexity and contestation - were constantly reinforced through the gathering and analysis of the data, and confirmed by the findings. That curriculum construction is subject to a range of contextual factors - historical, social, cultural, political, economic and/or educational; that the process is complex and multi-layered; that the process is highly political and contested; and that the process and products are influenced by powerful individuals and groups both inside and outside the process, are all strongly confirmed by, and even consolidated in, this study. Notions alluded to in the literature that find stronger expression in this study relate to the nature of contestation throughout the process of curriculum construction. A model using Bourdieu's notions of field, capital and habitus (after Bourdieu and Passeron, 1977) allows stronger articulation of features such as polarisation, factionalisation, the forging of alliances and the fluid status of participants. The data reveal the curriculum construction process in a constant state of flux and subject to much serendipity. The findings also strengthen the notion that the products of a curriculum construction process are not ends in themselves but reveal much about the nature of the contestation and, indeed, lay the groundwork for future contested interpretations. New insights that arise from this study include an articulation of the strategies, such as compromise, contingency and expediency, that participants use to achieve their ends. These are often at the expense of participants' underpinning principles or adherence to particular curriculum development models. Significant insights come from the in-depth investigation of the emotional side of curriculum construction. The data reveal that the struggle for control over curriculum contents is an emotionally-charged process; that participants in the process wrestle with the differences between their own personal platforms, their ideological influences, the groups they represent and the requirements of the task; that contestation occurs between those setting and those completing the task, especially in relationship to professional decision-making and intellectual ownership; and that no consideration is given to the emotional cost of involvement in such large-scale curriculum construction processes. In summary, context shapes the unique nature of curriculum construction processes and products. If an understanding of these factors is tempered with an awareness of the complex and multi-dimensional nature of curriculum construction this will strengthen the process and could lessen the negative effects of ideologically-motivated or emotionally-charged involvement in the process. Finally, as contestation in curriculum construction is unavoidable in such high-stakes processes, consultation and critique should be seen as opportunities (rather than threats), to enhance the credibility of the final product.

This thesis is a quantitative study of distributive justice between generations or age groups. It is theoretically informed by a synchronic generation approach and John Rawls’s theory of justice-as-fairness. The empirical part compares the economic positions of, and public spending on, children, adults and the elderly in 16 European countries. The theoretical part is used as a platform for the empirical analysis. In addition to Rawls, a discussion of distributive justice includes the classical theories of Plato and Aristotle and more recent utilitarian, egalitarian and desert-based theories. The synchronic generation approach is presented and compared to diachronic approaches to studies of generational relations. The synchronic approach is theorized by scholars working in the tradition of the social studies of childhood. The chapter on methods identifies children, adults and the old by way of age brackets, it presents indicators of public spending and income, and it points out empirical applications of equality, equal opportunity and the difference principle. The techniques of analyses are presented; descriptive analysis and OLS regression. The explanatory variables vary, but in all cases include economic performance, age structure and a modified version of Esping-Andersen`s classification of welfare states (Social Democratic, Conservative, Liberal and Southern European). Six research questions are answered in the empirical part, using official statistics from Eurostat, OECD and Statistics Norway. Over the past few decades there is an extensive growth on spending on the elderly, but spending on family and children does not decline. Multivariate analyses indicate that the size of old age and family and child benefits vary across welfare regimes. The Social Democratic and Conservative welfare states are more egalitarian and have lower poverty rates compared to the Liberal and Southern European welfare states. These regime variances are also seen in multivariate analyses of child poverty and old age poverty. Risk factors for child poverty are parental unemployment, children living with single parents, young parents, ethnic parents, and low educated parents. A multivariate analysis points to a link between the size of family and child benefits and fertility rates. / Children`s welfare: money, time and space