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Morton ME, Gibson-Young L, Sandage MJ. Framing Disparities in Access to Medical Speech-Language Pathology Care in Rural Alabama. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2847-2860. [PMID: 36327492 DOI: 10.1044/2022_ajslp-22-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Rural-living residents of Alabama depend on rural hospitals and clinics staffed with physicians and allied health professionals including speech-language pathologists (SLPs). The purpose of the exploratory study was to examine the speech-language pathology workforce in health care facilities in nonmetropolitan Alabama counties to determine potential disparities in access and identify medical SLP deserts for rural Alabamians. METHOD The hospitals, rural health clinics, nursing homes, and rehabilitation centers for each of the 37 nonmetropolitan counties were identified through the 2020 Alabama Department of Public Health directories, and phone surveys were completed to determine medical SLP staffing at each facility. Descriptive statistics and regression analysis were conducted. RESULTS The initial review yielded 229 rural health care facilities with 223 ultimately included in the analysis and 176 facilities completing a phone inquiry (76.68%). Sixty-one (35.88%) reported employing at least one SLP and no facility stated staffing SLP assistants. Linear regression indicated a positive, yet moderate effect size between the reported number of SLPs staffed within each county and specific population of the county (r 2 = .519). Anecdotally, facilities reported difficulty in hiring and retaining SLPs due to rural geographical location. CONCLUSIONS The exploratory findings suggest disparities in access to behavioral communication and swallowing care for rural residents in the state. The methodology employed for data collection and analysis may be applied to other states and U.S. territories, in an effort to frame the issue nationally and support rural health care policy across the United States. Further investigation regarding the cost effectiveness of telepractice, the availability of broadband Internet access, the efficacy of community-based service delivery, and the effectiveness of incentivized rural SLP graduate programs is warranted to mitigate the disparities in access.
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Affiliation(s)
| | | | - Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
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Elma A, Nasser M, Yang L, Chang I, Bakker D, Grierson L. Medical education interventions influencing physician distribution into underserved communities: a scoping review. HUMAN RESOURCES FOR HEALTH 2022; 20:31. [PMID: 35392954 PMCID: PMC8991572 DOI: 10.1186/s12960-022-00726-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/24/2022] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Physician maldistribution is a global problem that hinders patients' abilities to access healthcare services. Medical education presents an opportunity to influence physicians towards meeting the healthcare needs of underserved communities when establishing their practice. Understanding the impact of educational interventions designed to offset physician maldistribution is crucial to informing health human resource strategies aimed at ensuring that the disposition of the physician workforce best serves the diverse needs of all patients and communities. METHODS A scoping review was conducted using a six-stage framework to help map current evidence on educational interventions designed to influence physicians' decisions or intention to establish practice in underserved areas. A search strategy was developed and used to conduct database searches. Data were synthesized according to the types of interventions and the location in the medical education professional development trajectory, that influence physician intention or decision for rural and underserved practice locations. RESULTS There were 130 articles included in the review, categorized according to four categories: preferential admissions criteria, undergraduate training in underserved areas, postgraduate training in underserved areas, and financial incentives. A fifth category was constructed to reflect initiatives comprised of various combinations of these four interventions. Most studies demonstrated a positive impact on practice location, suggesting that selecting students from underserved or rural areas, requiring them to attend rural campuses, and/or participate in rural clerkships or rotations are influential in distributing physicians in underserved or rural locations. However, these studies may be confounded by various factors including rural origin, pre-existing interest in rural practice, and lifestyle. Articles also had various limitations including self-selection bias, and a lack of standard definition for underservedness. CONCLUSIONS Various educational interventions can influence physician practice location: preferential admissions criteria, rural experiences during undergraduate and postgraduate medical training, and financial incentives. Educators and policymakers should consider the social identity, preferences, and motivations of aspiring physicians as they have considerable impact on the effectiveness of education initiatives designed to influence physician distribution in underserved locations.
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Affiliation(s)
- Asiana Elma
- Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Center, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada
| | - Muhammadhasan Nasser
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Laurie Yang
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Irene Chang
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Dorothy Bakker
- Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Center, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada
| | - Lawrence Grierson
- Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Center, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada.
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada.
- McMaster Education Research, Innovation and Theory, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Wheat JR, Gardner AJ, Downey LH, Cox MS, Johnson GJ, Guin SM, Leeper JD, Moore CE, Brandon JE. Medical education for African American communities in the rural South: A focus group approach to identify fundamental considerations. J Rural Health 2022. [PMID: 35261082 DOI: 10.1111/jrh.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We sought to understand concerns fundamental to planning medical education specific to rural southern African Americans who are virtually nonexistent in American medical schools. METHODS A diverse multidisciplinary research team conducted this qualitative study with 3 focus groups, including 17 rural medical educators recruited nationwide, 10 African American alumni of a rural medical education pipeline in Alabama, and 5 community and institutional associates of this pipeline. Analysis of recorded transcripts generated themes fitting an ecological model suggesting concerns and intervention foci at individual, community, and institutional levels. FINDINGS Three major themes operating at all ecological levels were: (1) How "rural minority student" is defined, with "rural" often supplanting race to indicate minority status; (2) Multiple factors relate to rural racial minority student recruitment and success, including personal relationships with peers, mentors, and role models and supportive institutional policies and culturally competent faculty; and (3) Challenges to recruitment and retention of rural minority students, especially financial concerns and preparation for medical education. CONCLUSIONS Our findings suggest that individuals, communities, and institutions provide intervention points for planning medical education specific to southern rural African Americans. These spheres of influence project a need for partnership among communities and rural medical educators to affect broad programmatic and policy changes that address the dire shortage of rural African American health professionals to help ameliorate health inequities experienced in their home communities. It is likely that linear thinking and programming will be replaced by integrated, intertwined conceptualizations to reach this goal.
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Affiliation(s)
- John R Wheat
- College of Community Health Sciences, University of Alabama, Tuscaloosa, Alabama, USA
| | - Antonio J Gardner
- Department of Food Science, Nutrition, & Health Promotion, College of Agriculture & Life Sciences, Mississippi State University, Starkville, Mississippi, USA
| | - Laura H Downey
- School of Human Sciences, Mississippi State University, Starkville, Mississippi, USA
| | - Melissa S Cox
- Southern California University Health Sciences, Whittier, California, USA.,Aurora University, Aurora, Illinois, USA
| | - Gwendolyn J Johnson
- Tuskegee University Cooperative Extension Program, Tuskegee University, Tuskegee, Alabama, USA
| | - Susan M Guin
- College of Community Health Sciences, University of Alabama, Tuscaloosa, Alabama, USA
| | - James D Leeper
- College of Community Health Sciences, University of Alabama, Tuscaloosa, Alabama, USA
| | - Cynthia E Moore
- College of Community Health Sciences, University of Alabama, Tuscaloosa, Alabama, USA
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Yan W, Gao X, Wang W, Zhou Z, Zou C, Lu Z. Job satisfaction of graduates of rural oriented medical students training project in Jiangsu Province, China: a cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:9. [PMID: 34980072 PMCID: PMC8722068 DOI: 10.1186/s12909-021-03074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Chinese government has worked out the "Rural Oriented Medical Students Training Project" to address physician maldistribution, which attempted to train physicians for rural areas. The present study attempted to evaluate the job satisfaction of the graduates of this project in Jiangsu Province, China. METHODS Online questionnaires were sent to the graduates of the "Rural Oriented Medical Students Training Project" (group A) and their colleagues, who were rural physicians recruited from different sources (group B). The study was approved by the Ethics Committee of Xuzhou Medical University, and the approval number was 2,018,057. Information on demographic characteristics, work conditions, and self-reported satisfaction was collected to compare the satisfaction differences between the two recruited rural physicians using the Chi-square test and Mann-Whitney U test. Additionally, factors correlated to the satisfaction of group A were assessed using multivariate linear regression. Statistical analysis was performed using SPSS 23.0 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant. RESULTS Group A exhibited moderate satisfaction (2.81 ± 0.687). The satisfaction score from the highest to the lowest was for occupational ecology, life satisfaction, stress, competency, and internal environment. Positive factors related to the satisfaction of group A were area, monthly income, working hours per week, professional title, and post. CONCLUSION The satisfaction of the graduates of the "Rural Oriented Medical Students Training Project" was moderate. Factors related to satisfaction included economic incentives, workload, and professional confidence. Possible solutions for increasing satisfaction should consist of economic support and possible ways to improve the professional identification of these graduates.
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Affiliation(s)
- Wenjun Yan
- Department of General Practice, School of Public Health, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
| | - Xiuyin Gao
- Department of General Practice, School of Public Health, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Wei Wang
- Department of General Practice, School of Public Health, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Zhengyu Zhou
- West-City Central Hospital, Lianyungang, 222100, Jiangsu, China
| | - Chao Zou
- Ma-an Community Health Centre, Nanjing, 211500, Jiangsu, China
| | - Zhaojun Lu
- Second Clinical Medical College, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
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Shen Y, Huang X, Li H, Chen E, Kong Y, Yu J, Liu X, Mobarak SA, Zuo Y. Early outcomes of a rural-oriented physician education programme against rural physician shortages in Guangxi province: a prospective cohort study. BMJ Open 2021; 11:e049274. [PMID: 34493517 PMCID: PMC8424837 DOI: 10.1136/bmjopen-2021-049274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to investigate early outcomes of one of the first medical undergraduate education programmes with a goal of mitigating severe rural physician shortages in China, which was developed by Guangxi Medical University (GXMU) and was called the Rural-oriented Free Tuition Medical Education (RTME)-GXMU programme. DESIGN A prospective cohort study comprising a baseline investigation and follow-up research was conducted to dynamically observe the evolution of the RTME-GXMU programme that began since 2010. PARTICIPANTS 380 RTME-GXMU graduates and 383 non-RTME-GXMU graduates from GXMU who completed trainings between 2015 and 2018 were recruited in the baseline investigation. Among them, 285 RTME-GXMU and 283 non-RTME-GXMU graduates responded to the follow-up research. MAIN OUTCOME MEASURES Graduate practice location, registered specialty, passing rate of the National Medical Licensing Examination (NMLE), specialty of residency programme and contract compliance for the RTME-GXMU graduates. RESULTS By the end of 2018, 100% of the 2015 RTME-GXMU graduates enrolled in this study practised in rural township health centres and registered themselves as general practitioners (GPs). All the RTME-GXMU graduates had completed or were attending residency programmes of general practice (GP). The above data stood in stark contrast to that of the non-RTME-GXMU graduates among whom as few as 1.06% worked in rural areas, 2.13% registered as GPs and less than 3% chose GP residency programmes. No significant differences were detected on passing rates of the NMLE between the two groups. Only one RTME-GXMU graduate broke the contract and dropped off the programme. CONCLUSIONS The RTME-GXMU programme has achieved encouraging early outcomes. Reduced entry score and proper usage of urban primary care institutions are two key approaches contributing to these positive early results.
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Affiliation(s)
- Ying Shen
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Xing Huang
- Division of Teaching Affairs, Guangxi Medical University, Nanning, Guangxi, China
| | - Hong Li
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Enran Chen
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Yan Kong
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Jia Yu
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Siam Ai Mobarak
- The Department of Cardiology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Yanli Zuo
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
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Wheat JR, Leeper JD. Pipeline Programs Can Support Reforms in Medical Education: A Cohort Study of Alabama's Rural Health Leaders Pipeline to Engage Community Leaders. J Rural Health 2020; 37:745-754. [PMID: 33155725 PMCID: PMC8518361 DOI: 10.1111/jrh.12531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose To demonstrate for county leaders the utility of rural pipelines to gain physicians and produce health professionals. Methods This cohort study, 1993‐2018, aggregated 1,051 students in the Rural Health Leaders Pipeline to their home counties (N = 67) to study the relationship between county participation in pipeline programs and outcomes of family physicians gained and health professionals produced. Additional county demographics were included. We conducted descriptive, bivariate, and multivariable linear regression analyses controlling for poverty, race, and rurality. Findings All 67 Alabama counties participated with means of 9.6 Rural Health Scholars, 2.7 Rural Minority Health Scholars, 3.4 Rural Medical Scholars, 67% rural population, 29.7% Black population, and 21.5% under poverty. Best regression model for gaining family physicians included Rural Medical Scholars involved (b = 0.24, P < .001) with R2 0.30, indicating a county gained 1 family physician for 4 students. Best model for health professionals included Rural Health Scholars involved (b = 0.20, P < .001) with R2 0.31, indicating production of 1 health professional for 5 students. Best model for any professional included Rural Health Scholars involved (b = 0.23, P < .001) with R2 0.35, indicating 1 professional produced for 4 students. Conclusions Rural pipeline programs can be useful tools in medical education reform to benefit counties with the gain of family physicians and production of health professionals. Local public officials could use these findings, eg, 1 family physician gained for every 4 students a county involved in the pipeline, to advocate that health professional education employ such pipelines.
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Affiliation(s)
- John R Wheat
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - James D Leeper
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
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Holst J. Increasing Rural Recruitment and Retention through Rural Exposure during Undergraduate Training: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176423. [PMID: 32899356 PMCID: PMC7503328 DOI: 10.3390/ijerph17176423] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022]
Abstract
Objectives: Ensuring nationwide access to medical care challenges health systems worldwide. Rural exposure during undergraduate medical training is promising as a means for overcoming the shortage of physicians outside urban areas, but the effectiveness is widely unknown. This integrative review assesses the effects of rural placements during undergraduate medical training on graduates’ likelihood to take up rural practice. Methods: The paper presents the results of a longitudinal review of the literature published in PubMed, Embase, Google Scholar and elsewhere on the measurable effects of rural placements and internships during medical training on the number of graduates in rural practice. Results: The combined database and hand search identified 38 suitable primary studies with rather heterogeneous interventions, endpoints and results, mostly cross-sectional and control studies. The analysis of the existing evidence exhibited predominantly positive but rather weak correlations between rural placements during undergraduate medical training and later rural practice. Beyond the initial scope, the review underpinned rural upbringing to be the strongest predictor for rural practice. Conclusions: This review confirms that rural exposure during undergraduate medical training to contributes to recruitment and retention in nonurban settings. It can play a role within a broader strategy for overcoming the shortage of rural practitioners. Rural placements during medical education turned out to be particularly effective for rural-entry students. Given the increasing funding being directed towards medical schools to produce graduates that will work rurally, more robust high-quality research is needed.
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Affiliation(s)
- Jens Holst
- Department of Nursing and Health Sciences, Fulda University of Applied Sciences, Leipziger Strasse 123, D-36037 Fulda, Germany
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Senteio CR, Akincigil A. Illuminating Racial Inequity in Diabetes Control: Differences Based on Gender and Geography. J Racial Ethn Health Disparities 2020; 8:704-711. [DOI: 10.1007/s40615-020-00830-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/25/2020] [Accepted: 07/23/2020] [Indexed: 01/19/2023]
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Shipman SA, Wendling A, Jones KC, Kovar-Gough I, Orlowski JM, Phillips J. The Decline In Rural Medical Students: A Growing Gap In Geographic Diversity Threatens The Rural Physician Workforce. Health Aff (Millwood) 2019; 38:2011-2018. [DOI: 10.1377/hlthaff.2019.00924] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Scott A. Shipman
- Scott A. Shipman is director of primary care initiatives and clinical innovations at the Association of American Medical Colleges (AAMC), in Washington, D.C
| | - Andrea Wendling
- Andrea Wendling is director of rural health in the Department of Family Medicine, Michigan State University, in Boyne City
| | - Karen C. Jones
- Karen C. Jones, now retired, was a research analyst in the Workforce Studies unit, AAMC, when this work was performed
| | - Iris Kovar-Gough
- Iris Kovar-Gough is a research librarian at the Michigan State University College of Human Medicine, in East Lansing
| | | | - Julie Phillips
- Julie Phillips is assistant dean for student career and professional development in the Office of Student Affairs and Services, Michigan State University; and an associate professor at the Sparrow-Michigan State University Family Medicine Residency Program, in Lansing
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Wheat J, Brandon J, Cox M, Thomas S, Guin S, Leeper J. Teaching Medical Students in the Rural Setting Long Term: Physicians' Attitudes and Perceptions. South Med J 2019; 112:526-530. [PMID: 31583412 DOI: 10.14423/smj.0000000000001023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The University of Alabama School of Medicine Tuscaloosa Regional Campus conducted a 2-month block in rural family practice, but committed to expanding to an 8-month longitudinal rural curriculum. We wanted to explore how rural physicians feel about teaching students in a prolonged rural preceptorship. METHODS We brainstormed with colleagues, reviewed the literature, and conducted two focus groups supplemented by five interviews with rural physicians. The focus groups explored satisfaction and dissatisfaction in teaching, medical school and community support, evaluation of preceptors, and the sharing of information between students and preceptors. The analysis sought common themes among study participants and colleagues. RESULTS Twenty-one study participants included 19 family physicians, 15 in private practice. Eleven had taught medical students. Our key finding, combining four themes, was that a satisfactory context within which to teach medical students long term in rural sites depends on the optimization of the roles of preceptors, students, communities, and educational institutions. There were comments addressing each of these roles. This finding cannot be generalized beyond the study group because of the qualitative methodology using a convenience sample. CONCLUSIONS These physicians' concerns foment hypotheses about engaging rural physicians in their own unique local networks involving preceptors, students, community, and educational institutions to conduct satisfactory long-term medical education in rural sites. We recommend investigations to substantiate a prevalence among rural physicians of concern about the four roles and to describe various contexts in which these roles produce satisfactory long-term preceptorships, perhaps as best practices in different settings.
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Affiliation(s)
- John Wheat
- From the University of Alabama College of Community Health Sciences, Tuscaloosa, and College of Agriculture and Life Sciences, Mississippi State University, Starkville
| | - John Brandon
- From the University of Alabama College of Community Health Sciences, Tuscaloosa, and College of Agriculture and Life Sciences, Mississippi State University, Starkville
| | - Melissa Cox
- From the University of Alabama College of Community Health Sciences, Tuscaloosa, and College of Agriculture and Life Sciences, Mississippi State University, Starkville
| | - Scott Thomas
- From the University of Alabama College of Community Health Sciences, Tuscaloosa, and College of Agriculture and Life Sciences, Mississippi State University, Starkville
| | - Susan Guin
- From the University of Alabama College of Community Health Sciences, Tuscaloosa, and College of Agriculture and Life Sciences, Mississippi State University, Starkville
| | - James Leeper
- From the University of Alabama College of Community Health Sciences, Tuscaloosa, and College of Agriculture and Life Sciences, Mississippi State University, Starkville
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