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National clinical studies improve generalizability when they enroll participants from geographically underserved areas. We assessed representativeness of dentists and patients in the National Dental Practice-Based Research Network (“Network”) by comparing them to national benchmarks for rural/urban and underserved classifications.
Methods:
Analyses compared rural status using Rural-Urban Continuum Codes and Health Provider Shortage Areas (HPSA), practitioner data from the Network’s Enrollment Questionnaire and the American Community Survey (ACS), and patient data from Network clinical studies and the Behavioral Risk Factor Surveillance System (BRFSS).
Results:
The network has similar proportions of dentists in rural areas compared to national estimates from the ACS (8.5% in Network vs. 8.2% nationally) and comparable proportions in HPSA (76.8% in Network vs. 84.0% nationally). The Network’s proportion of patients living in rural areas (33.7%) is much higher than that of Network practitioners (8.5%), and higher than that of the US “dental” population overall from the BRFSS (20.5%).
Conclusions:
The Network not only is effective at engaging a broad dentist base but also engages a comparably higher proportion of rural patients, a group that is often underrepresented in clinical research. BRFSS respondents are a more-selective subset of the population because they report a recent dental visit, yet the Network exceeded even this benchmark in rural representation.
Building operations require about a third of global energy demand and about a quarter of global carbon emissions, not counting the embedded carbon emissions associated with building materials. Cost-effective solutions are available today to reduce those emissions by 75% or more by 2050. But buildings also represent a massive long-term investment, both for individual families and for society at large, and the current pace of renovation needs massive acceleration if those goals are to be met. Accelerating building energy solutions will require changes in policy and regulation, new financial models, and a vast retraining effort for hundreds of millions of construction workers and building professionals as well as billions of building residents all across the globe. This chapter focuses on that education effort, which must be local as well as global, place-based and people-centered, and leverage international agreements as well as use-inspired research. We provide case studies and a roadmap to illustrate the range and scope of the educational efforts required to address the complexity and critical nature of this challenge.
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