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Abstract: The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors among US high school students. To better understand the ramifications of changing the YRBSS from paper-and-pencil to Web administration, in 2008 the Centers for Disease Control and Prevention conducted a study comparing these two modes of administration. Eighty-five schools in 15 states agreed to participate in the study. Within each participating school, four classrooms of students in grades 9 or 10 were randomly assigned to complete the Youth Risk Behavior Survey questionnaire in one of four conditions (in-class paper-and-pencil, in-class Web without programmed skip patterns, in-class Web with programmed skip patterns, and “on your own” Web without programmed skip patterns). Findings included less missing data for the paper-and-pencil condition (1.5% vs. 5.3%, 4.4%, 6.4%; p <.001), less perceived privacy and anonymity among respondents for the in-class Web conditions, and a lower response rate for the “on your own” Web condition than for in-class administration by either mode (28.0% vs. 91.2%, 90.1%, 91.4%; p <.001). Although Web administration might be useful for some surveys, these findings do not favor the use of a Web survey for the YRBSS. [Copyright &y& Elsevier]

Functional foods can be considered to be those whole, fortified, enriched or enhanced foods that provide health benefits beyond the provision of essential nutrients (e.g., vitamins and minerals), when they are consumed at efficacious levels as part of a varied diet on a regular basis. Linking the consumption of functional foods or food ingredients with health claims should be based on sound scientific evidence, with the "gold standard" being replicated, randomized, placebo-controlled, intervention trials in human subjects. However, not all foods on the market today that are claimed to be functional foods are supported by enough solid data to merit such claims. This review categorizes a variety of functional foods according to the type of evidence supporting their functionality, the strength of that evidence and the recommended intakes. Functional foods represent one of the most intensively investigated and widely promoted areas in the food and nutrition sciences today. However, it must be emphasized that these foods and ingredients are not magic bullets or panaceas for poor health habits. Diet is only one aspect of a comprehensive approach to good health. [ABSTRACT FROM AUTHOR]

Abstract: In 2005, the Agency for Healthcare Research and Quality established the Effective Health Care (EHC) Program. The EHC Program aims to provide understandable and actionable information for patients, clinicians, and policy makers. The Evidence-based Practice Centers are one of the cornerstones of the EHC Program. Three key elements guide the EHC Program and thus, the conduct of Comparative Effectiveness Reviews by the EPC Program. Comparative Effectiveness Reviews introduce several specific challenges in addition to the familiar issues raised in a systematic review or meta-analysis of a single intervention. The articles in this series together form the current Methods Guide for Comparative Effectiveness Reviews of the EHC Program. [Copyright &y& Elsevier]

Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy. [ABSTRACT FROM AUTHOR]

Focusing on empathic behavior of Iranians, Americans, and Biculturals, this paper investigated how living as a bicultural in a culturally different environment affects situational empathy and intergroup empathy bias. Findings show participants' cultural background and group identity significantly impacted their empathic responsiveness in favor of people with collectivist cultural norms. Further, people raised in a socio-centric/collectivist society reported higher empathy for in-group members compared to those raised in an ego-centric/individualist society. Regardless of nationality, affective empathy was reported higher than cognitive empathy. The same trend was found for individualist cultural norms, especially for biculturals, suggesting there is a global trend of individualism. Implications are discussed. [ABSTRACT FROM AUTHOR]

Abstract This paper, for the first time, presents comparable projections of travel behaviour impacts of the introduction of autonomous vehicles (AVs) into the private car fleet for two countries, namely the USA and Germany. The focus is on fully autonomous vehicles (AVs) which allow drivers to engage in other activities enroute. Two 2035 scenarios – a trend scenario and an extreme scenario – are presented for both study countries. For these projections, we combine a vehicle technology diffusion model and an aspatial travel demand model. Factors that influence AV impact in the behavioural model are mainly new automobile user groups, e.g. travellers with mobility impairments, and altered generalized costs of travel, e.g. due to a lower value of travel time savings for car travel. The results indicate that AV penetrations rates might be higher in Germany (10% or 38% respectively) than in the USA (8% or 29% respectively) due to a higher share of luxury cars and quicker fleet turnover. On the contrary, the increase of vehicle mileage induced by AVs is not higher in Germany (+2.4% or +8.6% respectively) than in the USA (+3.4% or +8.6% respectively). This is mainly due to the lack of mode alternatives and lower fuel costs resulting in a higher share of travel times among the total generalized costs of travel in the USA. These results clearly indicate that context factors shaped by national policy will influence AV adoption and impact on travel demand changes. Based on these results the paper draws policy recommendations which will help to harness the advantages of AVs while avoiding their negative consequences. [ABSTRACT FROM AUTHOR]

Background: Ever since alexithymia was defined in the 1970s, robust associations have been observed between alexithymia and a variety of symptoms of psychopathology. Alexithymia is now widely regarded as an important transdiagnostic risk factor, and it is frequently assessed in clinical and research settings. However, despite this strong interest, it remains unclear exactly why (i.e., by which mechanisms) alexithymia is linked to psychopathology. In this paper, we hypothesise that alexithymia is linked to affective disorder symptoms because alexithymia impairs people's ability to regulate their emotions, and we empirically test this hypothesis.Method: We administered a battery of psychometric measures to 501 adults in the United States, and examined the direct and indirect effects between alexithymia (Perth Alexithymia Questionnaire), emotion regulation ability (Perth Emotion Regulation Competency Inventory), and affective disorder symptoms (Depression Anxiety Stress Scales-21).Results: In the Pearson bivariate correlation matrix, alexithymia, emotion regulation difficulties, and affective disorder symptoms were all significantly correlated. In the modelling of direct and indirect effects, alexithymia was indirectly associated with affective disorder symptoms through emotion regulation difficulties (no significant direct effect).Limitations: Our online survey data were all self-report data and cross-sectional. Future longitudinal work would be beneficial.Conclusions: Our findings support contemporary theorising that alexithymia is linked to affective disorder symptoms via emotion regulation difficulties. These results help to clarify the mechanisms by which alexithymia may predispose people to affective disorder symptoms, and highlight the importance of considering the roles of alexithymia and emotion regulation in case conceptualisations and treatment planning. [ABSTRACT FROM AUTHOR]

In the preceding papers, we have examined the characteristics of shrinking cities in Germany, Japan and the United States, and described the distinctive features of how both the discourse and the policy response to the shrinking cities phenomenon emerged in each country. In this paper, we build on that description to offer a comparative analysis of the phenomenon and the response. We organize this discussion around the same three elements that have animated the preceding work: conditions, discourse, policy and action. While there are significant differences, we find significant common ground between the three countries; in particular, we find that for discourse to lead to action, three steps are required: First, the condition must be identified, second, it must be problematized, and third, the problem must be de-contextualized. Finally, in addition to these steps, a critical element in the movement from discourse to policy is the existence of conditions adequate to create the political will to address the problem. These underlying factors cut across national differences in culture, governmental structure, and policy. [ABSTRACT FROM AUTHOR]

The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 is a frequently used cancer-specific health-related quality of life (HRQoL) questionnaire. To aid interpretation of data obtained via EORTC QLQ-C30, general population norm data have been published for many countries. However, despite its frequent use in the United States, no normative data by sex and age exist to date. Therefore, this study aimed to generate sex- and age-specific EORTC QLQ-C30 normative data for the United States. Recruitment and data collection were carried out via online panels as part of a larger cross-sectional study. For the recruitment, the sample was stratified by sex and age (18–39, 40–49, 50–59, 60–69, ≥ 70 years) to achieve a balanced distribution, with n = 100 per subgroup. Descriptive statistics are presented by age and age/sex. A total of N = 1009 respondents completed the survey (n = 508 females, n = 501 males). More than two thirds of participants (72.5%) reported at least one health condition, e.g., arthritis (26%). Across EORTC QLQ-C30 scales, women and men 60 years and older reported generally better/higher functioning and better/lower symptom scores compared to the younger age groups. To date, no specific EORTC QLQ-C30 general population normative data have been published for the United States. This paper provides these important normative data, which will greatly support the interpretation of EORTC QLQ-C30 scale scores obtained from US cancer patients, and also enable comparison with European norms. • EORTC QLQ-C30 is a cancer-specific health related quality of life (HRQoL) measure. • HRQoL normative data from US general population was collected (1009 respondents). • EORTC QLQ-C30 look-up tables for the US general population by sex/age are presented. • Participants ≥ 60 years reported overall better functioning than younger age groups. • Results will enhance interpretation and validity from EORTC QLQ-C30 data in the US. [ABSTRACT FROM AUTHOR]

Respondents of online surveys may exhibit some answering behaviors, which lead to inconsistent survey results between online surveys and traditional paper surveys. Extant research has not yet devoted sufficient effort to the mechanisms of different answering behaviors on the inconsistent results, especially in cross-cultural survey contexts. For this reason, this study examines how shirking behavior (i.e., a form of disengaged behavior that the respondents expend insufficient mental effort on the questionnaire) and socially desirable responding result in incomparable responses between online surveys and paper surveys. We especially investigate how the cultural constructs of individualism and collectivism relate to shirking and social desirability. Our results reveal two different pathways leading to inconsistent results across different survey modes. Respondents from collectivistic cultures are more likely to shirking in online surveys. Consequently, they are more likely to provide varying responses than respondents from individualistic cultures. Collectivists are more likely to engage in impression management in paper surveys than in online surveys, while individualists have a greater tendency to provide inflated assessments of their skills and abilities in both survey modes. [ABSTRACT FROM AUTHOR]

Introduction: Previously, a web-based, patient-facing decision aid for lung cancer screening, shouldiscreen.com, was developed and evaluated. An initial evaluation was completed before the Medicare coverage decision and recruited a nondiverse sample of mostly former smokers, limiting the understanding of the potential effectiveness of the tool among diverse populations. This study evaluates shouldiscreen.com among African Americans in Metro Detroit.Methods: Using insights obtained from participatory workshops in this population, content changes to shouldiscreen.com were implemented, and this modified version was evaluated with a before-after study. Measures included knowledge of lung cancer screening, decisional conflict, and concordance between individual preference and screening eligibility. Surveys occurred between April and July 2018. Participants were contacted 6 months after the survey to assess subsequent screening behaviors. Analysis took place in 2019.Results: Data were collected from 74 participants aged 45-77 years, who were current/former smokers with no history of lung cancer. The average knowledge score increased by 25% from 5.7 (SD=1.94) before to 7.1 (SD=2.30) after (out of 13 points). Decisional conflict was halved between before and after. Concordance between individual preference and eligibility for screening increased from 22% (SD=41) to 35% (SD=47). Half of the participants felt uncomfortable answering surveys electronically and requested paper versions.Conclusions: The use of the tool led to small improvements in lung cancer screening knowledge and increased concordance with current recommendations. Additional design modifications and modes of information delivery of these decision aids should be considered to increase their efficacy in helping populations with lower educational attainment and computer literacy. [ABSTRACT FROM AUTHOR]

Objectives People with epilepsy were (PWE) reported to have poorer employment rate. However, the methodologies used differ greatly from one study to another, making global comparison difficult. We aimed to determine the employment rate of PWE globally using a unified definition of employment rate and to summarize the reported positive and negative factors affecting employability in PWE, using a systematic review. Methods All studies reporting employment rate of PWE were independently assessed. Employment rate was recalculated according to the standard definition by the Bureau of Labor statistics (BLS) of United States and the International Labour Organization i.e. employment rate is the percentage of employed person over the labor force. Results Of 95 papers reported on employment status of PWE, adjusted employment rate (aER) was shown to be as low as 14% to as high as 89% with a mean adjusted employment rate of 58%. No significant differences in mean of aER was found between continents, or among Asian countries. Employment rate of people with uncontrolled seizures were reported in 16 papers, with a mean adjusted employed rate of 58%. Psychological factors were less frequently reported as compared to clinical and socio-demographical factors, seen in a total of 25 (26%) out of 97 studies. The positive factors leading to successful career in PWE were understudied and needed to be further explored. Conclusion Employability is multifactorial, including clinical, psychological and social factors. The adjusted employment rate of people with uncontrolled seizures is comparable to those with controlled seizures, supporting the need to explore non-clinical factors. [ABSTRACT FROM AUTHOR]

Heroin overdose, more accurately termed ‘heroin-related overdose’ due to the frequent involvement of other drugs, is the leading cause of mortality among regular heroin users. (Degenhardt et al., 2010) Heroin injectors are at greater risk of hospital admission for heroin-related overdose (HOD) in the eastern United States where Colombian-sourced powder heroin is sold than in the western US where black ‘tar’ heroin predominates. (Unick et al., 2014) This paper examines under-researched influences on HOD, both fatal and non-fatal, using data from a qualitative study of injecting drug users of black tar heroin in San Francisco and powder heroin in Philadelphia Data were collected through in-depth, semi-structured interviews carried out in 2012 that were conducted against a background of longer-term participant-observation, ethnographic studies of drug users and dealers in Philadelphia (2007–12) and of users in San Francisco (1994–2007, 2012). Our findings suggest three types of previously unconsidered influences on overdose risk that arise both from structural socio-economic factors and from the physical properties of the heroin source-types: 1) retail market structure including information flow between users; 2) marketing techniques such as branding, free samples and pricing and 3) differences in the physical characteristics of the two major heroin source forms and how they affect injecting techniques and vascular health. Although chosen for their contrasting source-forms, we found that the two cities have contrasting dominant models of drug retailing: San Francisco respondents tended to buy through private dealers and Philadelphia respondents frequented an open-air street market where heroin is branded and free samples are distributed, although each city included both types of drug sales. These market structures and marketing techniques shape the availability of information regarding heroin potency and its dissemination among users who tend to seek out the strongest heroin available on a given day. The physical characteristics of these two source-types, the way they are prepared for injecting and their effects on vein health also differ markedly. The purpose of this paper is to examine some of the unexplored factors that may lead to heroin-related overdose in the United States and to generate hypotheses for further study. [ABSTRACT FROM AUTHOR]

Offshore wind is one of the most fascinating industries in the renewable energy sector and it is experiencing a remarkable growth. Offshore wind energy generation offers an opportunity in the race to decrease the dependence on fossil fuels, reduce green house emissions, increase energy security and create employment opportunities. UK has proven success in offshore wind and has been enjoying the economic benefits of offshore wind since over a decade. Offshore wind energy is an emergent renewable energy industry in the United States. The United States is coping up with the challenges and heading up fast to catch up with the industry. India is still in its infancy stage where the policy frameworks are framed by MNRE government and getting ready with the tools to enter into the offshore market. This paper researches the current situation and trend of offshore wind industries in UK and US, from aspects of policy, grid connections, operation and maintenance and cost reduction and analyses the proper direction and pathways of the industry to India. Therefore this paper highlights the scenario as to how these three countries UK, USA and India, respectively, are enabling offshore wind, to make a vital and sizeable contribution to the low carbon economy. [ABSTRACT FROM AUTHOR]

Background: Increasing knowledge on suicide prevention has been shown to be important for suicide prevention. This paper exams the accomplishment of research on suicide and examine how those research activities contribute to the change of suicide rates.Methods: Data of the publications relating to suicide from 1990 to 2018 were retrieved from the Web of Science and Scopus. Bibliographic information was analyzed and the relationships between suicide rates with the number of publications per million population and the average article citations per year were examined.Results: From 1990 to 2018, globally, publications on suicide have increased significantly. The United States ("USA") had the greatest number of publications. Research collaborations among different countries/regions have been flourishing and multinational centers have become more common than ever. Nonetheless, in some countries/regions with high rates of suicide, suicide research was scarce. It was found that the number of publications per million population and the average article citations per year were negatively correlated with the suicide rates at the global level (r = - 0.96, p < 0.001; r = -0.91, p < 0.001, respectively), but not in the higher SDI regions (r = -0.05, p = 0.81; r = 0.02, p = 0.91, respectively). Furthermore, research focusing on suicide intervention was also relatively limited.Limitation: The origins of the publications were only based on the corresponding authors' regions.Conclusions: There is significant imbalance in the amount of research effort especially in the regions with high suicide rates. In the higher socioeconomic level regions, the quantity and quality of publications sometimes do not transpire in the reduction of suicide rates. A better connection between the fundamental and practical suicide research should be established. More resources should be made available to the low- and middle-income countries/regions with higher suicide risks, then the effect of suicide prevention might be much more significant. [ABSTRACT FROM AUTHOR]

In this paper Qualitative Comparative Analysis (QCA) is used to explore the extent to which states have taken distinct causal paths to higher levels of earnings inequality within the 1980s, 1990s, 2000s. and during the early years of the 2007-09 recession. In these analyses special attention is paid to both the regional unfolding of the processes constituting economic restructuring and whether state institutional arrangements appear to mediate the impacts of inequality-increasing developments. Overall, these analyses suggest that industry and occupational shifts are critical to understanding state and regional experiences; state variation in changes in earnings inequality are, in large part, a story of the continuous playing out of economic restructuring in unique ways in different areas of the country. However, the subnational impact of the growth or decline of particular types of occupations on the earnings distribution is found to be highly contingent, depending on both the types of jobs gained or lost and the institutional and economic context in which those developments occur. It is suggested that the overall contribution of industry shifts to rising inequality may be underemphasized. in part, as a result of a reliance on analytical approaches that are ill-suited to capture the complicated and contingent nature of the impacts of processes such as deindustrialization. These analyses contribute to a growing body of work that employs a distinctly sociological approach in which earnings determination is viewed as multi-level phenomenon. Building on this insight, this paper suggests that changes in subnational levels of inequality may also be usefully conceptualized as an inherently combinatorial phenomenon. [ABSTRACT FROM AUTHOR]

Abstract: Endangered species live inside the world's most densely populated cities. In the United States, the Fish and Wildlife Service is responsible for the protection and recovery of endangered species – wherever those species are found. Unfortunately, very little is known about urban endangered species policy or programs. This paper presents a comparative analysis of the five largest cities in the United States and examines issue of governance around conservation. Cities have a responsibility to steward the environment, but through the 1973 Endangered Species Act, the Fish and Wildlife Service has a legal mandate to protect endangered species throughout the country. Thus, this paper asks: What is the USFWS doing inside cities to recover endangered species? What are cities doing? Conservation is a shared duty but it is not clear that anyone is taking responsibility for urban endangered species. [Copyright &y& Elsevier]

Abstract: Steam Generator Tube Rupture (SGTR) sequences in Pressurized Water Reactors are known to be one of the most demanding transients for the operating crew. SGTR are a special kind of transient as they could lead to radiological releases without core damage or containment failure, as they can constitute a direct path from the reactor coolant system to the environment. The first methodology used to perform the Deterministic Safety Analysis (DSA) of a SGTR did not credit the operator action for the first 30min of the transient, assuming that the operating crew was able to stop the primary to secondary leakage within that period of time. However, the different real SGTR accident cases happened in the USA and over the world demonstrated that the operators usually take more than 30min to stop the leakage in actual sequences. Some methodologies were raised to overcome that fact, considering operator actions from the beginning of the transient, as it is done in Probabilistic Safety Analysis. This paper presents the results of comparing different assumptions regarding the single failure criteria and the operator action taken from the most common methodologies included in the different Deterministic Safety Analysis. One single failure criteria that has not been analysed previously in the literature is proposed and analysed in this paper too. The comparison is done with a PWR Westinghouse three loop model in TRACE code (Almaraz NPP) with best estimate assumptions but including deterministic hypothesis such as single failure criteria or loss of offsite power. The behaviour of the reactor is quite diverse depending on the different assumptions made regarding the operator actions. On the other hand, although there are high conservatisms included in the hypothesis, as the single failure criteria, all the results are quite far from the regulatory limits. In addition, some improvements to the Emergency Operating Procedures to minimize the offsite release from the damaged SG in case of a SGTR are outlined taking into account the offsite dose sensitivity results. [Copyright &y& Elsevier]

Abstract: Using cross-national comparative analysis, this paper discusses the reasons why France has succeeded in partially privatizing its most recently constructed high speed line, while the U.S. has not reached this stage. The authors argue that France, with an interventionist government, diverged from the U.S. during the Great Depression by nationalizing its private railways and regulating competition with highway-based transport, thereby establishing favorable conditions for the future development of high speed trains. The U.S., because of its strong free market orientation, delayed nationalization until 1971, by which time passenger railways were severely weakened, so the U.S. lagged far behind France. After accruing a large public debt on its high speed rail program in the 1980s and 1990s, the French government recently took steps to privatize construction and operations on its Tours–Bordeaux line. Similarly, in the U.S., the State of California is trying to attract private participation on its planned high speed line between San Francisco and Los Angeles. Based on French high speed rail history, this paper argues that, to succeed, California must commit both a high level of public borrowing as well as public guarantees on private borrowing. Public credit is the sine qua non of financing high speed trains. [Copyright &y& Elsevier]

Abstract: This paper provides a comparative analysis of the introduction and outcomes of more “market friendly” reforms in Argentina and the United States. Finding several similarities in the early development of the railroad industry in Argentina and in the United States, it continues to provide a detailed review of railroad performance in each country and explains the underlying differences supporting this divergence. Deregulation in the U.S. allowed railroads to recover from near bankruptcy. Nearly every economic variable in the industry indicates that railroads have improved their operations, are more competitive, and are attaining higher levels of financial strength. Privatization of the industry in Argentina yields mixed results. Argentine railroads have been able to improve their operations, increase productivity but are still far from reaching long-term sustainability. Evidence uncovered by this paper suggests that privatization is not a silver bullet for railroad revitalization without a clear transportation policy and the willingness of the government to infuse financial support for infrastructure rehabilitation. The paper concludes by providing several policy alternatives for railroads in the United States and Argentina. [Copyright &y& Elsevier]

Abstract: In the early 21st century, food security has become an urgent public concern, arguably more entangled with social, political and environmental problems at multiple scales now than in the past. This paper examines approaches to food system change emphasizing regionalization, rather than either localization or globalization, to consider framings of food security. An enlarged food security risk frame—one that starts with food safety crises and the threat of agrifood terrorism but also recognizes new, more diffuse threats to food availability likely with global environmental change, provides common ground now for diverse institutional interest in regional food systems models. Combining discursive approaches to food security with territorial and relational conceptualizations of the region and regionalization, the paper develops a comparative analysis of three emerging regionalization initiatives in the United States: 1) work by the Northeast Sustainable Agriculture Working Group (a civil society organization); 2) the U.S. Department of Agriculture''s Know Your Farmer, Know Your Food initiative; and 3) the Walmart Corporation''s Heritage Agriculture initiative. It finds that institutions with markedly different histories, interests and power can align with a widening, ascendant food security risk frame. However, their approaches to regionalization reflect varying combinations of territorial and relational priorities, and suggest uneven implications for other food security concerns, such as community and food access. [Copyright &y& Elsevier]

Abstract: Water-quality standards requiring simultaneous low level effluent N and P concentrations are increasingly common in Europe and the United States of America. Moving bed biofilm reactors (MBBRs) and biologically active filters (BAFs) have been used as post-denitrification biofilm reactors in processes designed and operated for this purpose (Boltz et al., 2010a). There is a paucity of information describing systematic design and operational protocols that will minimize the potential for phosphorus rate-limited conditions as well as a lack of information describing the interaction between these post-denitrification biofilm reactors and unit processes that substantially alter phosphorus speciation (e.g., chemically enhanced clarification). In this paper, a simple mathematical model for estimating the threshold below which P becomes rate-limiting, and the model is presented and evaluated by comparing its predictions with operational data from post-denitrification MBBRs and BAFs. Ortho-phosphorus (PO4–P), which is the dissolved reactive component of total phosphorus, was a primary indicator of P rate-limiting conditions in the evaluated post-denitrification biofilm reactors. The threshold below which PO4–P becomes the rate-limiting substrate is defined:  = 0.0086 g P/g N and  = 0.0013 g P/g COD. Additional analyses indicate when  > 0.0086, and when  < 0.0086. Effluent nitrate–nitrogen plus nitrite–nitrogen concentration from the evaluated post-denitrification biofilm reactors began to rapidly increase when was 0.01, approximately (consistent with the rate-limitation threshold of  < 0.0086 predicted by the mathematical model described in this paper). Depending on the processes used at a given WWTP, optimizing chemically enhanced clarification to increase the amount of PO4–P that remains in the clarifiers effluent stream, dosing phosphoric acid in the MBBR or BAF influent stream, and/or optimizing secondary process EBPR may overcome phosphorus rate-limitations in the biofilm-based post-denitrification process. [Copyright &y& Elsevier]

Abstract: During the entire period of the 2007-2009 global financial crisis, different types of countries showed different characteristics on their economic development process. Comparing the economic development process between different types of countries contributes a lot to get an in-depth understanding of the different impacts of the crisis on national economy. In this paper, the method of Functional Analysis of Variance (FANOVA) is applied to make a comparative study on the economic development process of different types of countries, including the differences on the economic growth rate, the time of the economy recession, the extent of the recession and the recovery situation of the economy. Moreover, the paper performs a dynamic test on the significance of the difference on the economic growth rate during the whole stage. [Copyright &y& Elsevier]

The emerging dual threats of underaged drinking (UAD) and prescription drug misuse (PDM) require sustained prevention efforts across multiple levels of interventions. In response to the continuing proliferation of UAD and PDM among youth and young adults, the Substance Abuse and Mental Health Services Administration (SAMHSA) developed the Partnerships for Success (PFS) program. Across five cohorts funded from 2012 to 2016, PFS created linkages between health care providers, treatment and prevention services providers, government agencies, and nonprofit organizations for the delivery of multiple sets of services (e.g., prevention education, community activities, screening) targeted toward UAD and PDM. This paper reports on the impact of the PFS program on reductions in ethanol and prescription drug poisoning exposures as reported from data in the National Poisoning Data System (NPDS). Across 35 States, communities targeted by PFS interventions were compared to non-targeted communities using a non-equivalent comparison groups design and propensity score weighting. Using propensity-weighted, multilevel latent growth modeling, steeper reductions in ethanol and prescription drug poisoning exposure call rates were observed in States which had a higher proportion of communities participating in PFS. Grantee-level longitudinal analogs to Cohen's d effect sizes ranged from -0.24 to -0.97, whereas PFS' effects on individual communities (net of Statewide effects) were negligible. The study serves as a unique exemplar of using the NPDS to extract community-level intervention effects that might otherwise be "hidden" within epidemiological data while underscoring the cumulative effects of PFS' community-level efforts in stemming the tide on underaged drinking and prescription drug misuse. [ABSTRACT FROM AUTHOR]

Abstract Familial economic hardship, an adverse childhood experience (ACE) that increases children's risk for exposure to additional ACEs, can derail optimal child development. A compelling area with potential for reducing economic hardship and promoting healthy child development is housing. In the US, the largest contributor to family wealth is homeownership, which may contribute to a family's ability to provide their children opportunities to do better than previous generations. The objective of the current study was to examine the influence of homeownership on children's economic outcomes in adulthood. This study used data from two surveys conducted in the US, the National Longitudinal Survey of Youth 1979 (NLSY79) and the NLSY79 Young Adult survey, to examine the association between mothers' homeownership in 1994 and children's economic outcomes 20 years later. Adults whose mothers owned homes in 1994 were over 1.5 times more likely to own homes, attained higher education, and were moderately less likely to receive public assistance in 2014 compared to adults whose mothers did not own homes. This paper highlights the potential of homeownership to break the intergenerational continuity of poverty. Programs that help families purchase affordable housing hold promise in helping ensure children reach their full potential and improving economic outcomes in future generations. Highlights • Preventing economic hardship is critical to assuring children's health and well-being. • Homeownership is the largest contributor to family wealth and economic security. • Mothers' homeownership related to children's economic outcomes 20 years later. • Promoting homeownership may improve economic outcomes in future generations. [ABSTRACT FROM AUTHOR]

Abstract: The aims of this paper are to compare and contrast the current guidelines involved in the forensic examinations of mobile devices and hard disk drives. The paper then identifies areas of mobile device examinations where current guidelines are different and could be lacking strength and solidity. Guidelines and research into the forensic examination of hard disk drives is much more established when compared to that of mobile devices. Both the United Kingdom and the United States of America have published guidelines for the forensic analysis of mobile devices; these guidelines are examined throughout this paper. In the United Kingdom they are issued by ACPO (Association of Chief Police Officers) Good Practice Guide for Computer-Based Electronic Evidence. In the United States of America these are issued by NIST (National Institute of Standards and Technology). Special Publication 800-101, Guidelines on Cell Phone Forensics. [Copyright &y& Elsevier]

Abstract: It has been frequently acknowledged that results of predictive genetic tests may have implications for relatives as well as for the individual client. Ethicists have noted that an individual’s right to know her genetic risk may conflict with a relative’s right not to know this risk. It is hardly recognised, however, that family members may have a role in the production of test results as well. This article reconstructs the actual process of predictive BRCA-testing in the Netherlands, with a special focus on the roles assigned to clients and families and the expectations about family relationships inscribed in this practice. Fieldwork was carried out in an outpatient clinic for clinical genetics in an academic hospital. Data collection included 11 interviews with members of families, observations of counselling interviews between research participants and their clinical geneticist, and interviews with the 2 clinical geneticists involved in the consultations. It compares this process to the American practice of BRCA-testing. Whereas Dutch practice presupposes active involvement of diseased relatives in the testing process, American practice constitutes the client primarily as an independent individual who may or may not decide to involve her relatives. Moreover, Dutch clients are expected to have a harmonious, open and communicative relationship with their relatives. The American client, in contrast, is supposed to have more distant family relationships. It is argued that an interpretation of these differences in terms of ‘the right to know’ and ‘the right not to know’ misses the point, because the production of informative test results depends on the cooperation of relatives. The differences between Dutch and American practice are more adequately interpreted as implying a preference for unambiguous test results versus a preference for individual independence. The paper shows what is lost when opting for one value at the cost of another and discusses several alternatives to circumvent the value conflict at stake. By opening up for discussion the values implicit in BRCA-testing practices, the paper aims to contribute to debates on the overall desirability of these practices. [Copyright &y& Elsevier]

Abstract: This paper compares two different approaches to calculate the average cross-sectional area of breakup fragments. The first one is described in the NASA standard breakup model 1998 revision. This approach visually classifies fragments into several shapes, and then applies formulae developed for each shape to calculate the average cross-sectional area. The second approach was developed jointly by the Kyushu University and the NASA Orbital Debris Program Office. This new approach automatically classifies fragments into plate- or irregular-shapes based on their aspect ratio and thickness, and then applies formulae developed for each shape to calculate the average cross-sectional area. The comparison between the two approaches is demonstrated in the area-to-mass ratio (A/m) distribution of fragments from two microsatellite impact experiments completed in early 2008. A major difference between the two approaches comes from the calculation of the average cross-sectional area of plates. In order to determine which of the two approaches provides a better description of the actual A/m distribution of breakup fragments, a theoretical analysis in the calculation of the average cross-sectional area of an ideal plate is conducted. This paper also investigates the average cross-sectional area of multi-layer insulation fragments. The average cross-sectional area of 214 multi-layer insulation fragments was measured by a planimeter, and then the data were used to benchmark the average cross-sectional areas estimated by the two approaches. The uncertainty in the calculation of the average cross-sectional area with the two approaches is also discussed in terms of size and thickness. [Copyright &y& Elsevier]

Abstract: This paper uses sequential stochastic dominance procedures to compare the joint distribution of health and income across space and time. It is the first application of which we are aware of methods to compare multidimensional distributions of income and health using procedures that are robust to aggregation techniques. The paper’s approach is more general than comparisons of health gradients and does not require the estimation of health equivalent incomes. We illustrate the approach by contrasting Canada and the US using comparable data. Canada dominates the US over the bottom part of the bi-dimensional distribution of health and income, though not generally over the uni-dimensional distributions of health or income. The paper also finds that welfare for both Canadians and Americans has not unambiguously improved during the last decade over the joint distribution of income and health, in spite of the fact that the uni-dimensional distributions of income have clearly improved during that period. [Copyright &y& Elsevier]

Abstract: This paper presents a summary of the main international and national regulations for geologic storage of carbon dioxide. The international group includes the EU Directives, London Convention, and OSPAR. For the national regulations, three countries were covered in this study: United States, Canada, and Australia. In addition to these regulations, a group of guidelines and best practice manuals were also included in this study. As discussion, although this paper recognizes that current legislations have contributed for the regulation of this technology, it is still necessary the development of new rules in other regions. Industry will not invest in large CCS plants without such regulations because of high CCS costs and large financial risks related to CCS. [Copyright &y& Elsevier]

Abstract: This paper examines the usefulness of metaphors by comparing the assessments of the current economic conditions of the US and Japan made by the countries’ respective monetary policy authorities. In particular, this paper compares the role played by metaphors in creating a technical lexicon for business cycle phases in each language, and presents three main empirical findings. First, in both the US and Japan, metaphors are used in keeping with the business cycle phases with which each economy is faced. Second, many of the verbal, adjectival and adverbial terms can be attributed solely to the mechanical metaphor in the US, while there is no incidence of this use in the case of Japan. Third, there are more metaphoric adjectives or adverbs in the assessments of the US economy than in those of the Japanese economy. These empirical findings can be useful for second language instruction in economics. [Copyright &y& Elsevier]

Summary: Continuous surface of river bathymetry (bed topography) is typically produced by spatial interpolation of discrete point or cross-section data. Several interpolation methods that do not account for spatial trend in river bathymetry produce inaccurate surfaces, thus requiring complex interpolation methods such as anisotropic kriging. Although isotropic methods are unsuitable for interpolating river bathymetry, issues that limit their use remain unaddressed. This paper addresses the issue of effect of spatial trend in river bathymetry on isotropic interpolation methods. It is hypothesized that if the trend is removed from the data before interpolation, the results from isotropic methods should be comparable with anisotropic methods. Data from six river reaches in the United States are used to: (i) interpolate bathymetry data using seven spatial interpolation methods; (ii) separate trend from bathymetry; (iii) interpolate residuals (bathymetry minus trend) by using all seven interpolation methods to get residual surfaces, (iv) add the trend back to residual surfaces; and (v) compare resulting surfaces from (iv) with surfaces created in (i). Quantitative and qualitative comparison of results through root mean square error (RMSE), semi-variograms, and cross-section profiles show that significant improvement (as much as 60% in RMSE) can be accomplished in spatial interpolation of river bathymetry by separating trend from the data. Although this paper provides a new simple way for interpolating river bathymetry by using (otherwise deemed inappropriate) isotropic methods, the choice of trend function and spatial arrangement of discrete bathymetry data play a vital role in successful implementation of the proposed approach. [Copyright &y& Elsevier]

Abstract: Aeroelastic coefficients (flutter derivatives) of bridge decks are routinely extracted from wind tunnel section model experiments for the assessment of performance against wind loading. Two distinct methods, developed over the years, are usually employed for this purpose (free or forced vibration). Even though advantages and disadvantages of each technique have been highlighted by numerous researchers, few examples of a systematic comparison of the experimental results are available in the literature. The significance of this study is related to the evaluation of an extended set of experimental data on flutter derivatives, and includes the analysis and interpretation of the differences recorded through the two methods. The motivation for this work emerged from the United States–Japan Benchmark Study on Bridge Flutter Derivatives that Iowa State University (ISU) in the United States and the Public Works Research Institute (PWRI) in Japan, initiated in 2002. Tests were designed to cover a wide range of solid cross sections, from bluff (rectangular prisms) to streamlined, in particular considering the current trend of engineers to use aerodynamically-designed girders for bridges with longer spans. In this paper, a systematic analysis and a comparison of laboratory results of flutter derivatives obtained at both institutions were performed. In a companion paper, a sensitivity study was performed to examine the implications of the perceived dissimilarities among flutter-derivative data sets on the aeroelastic instability of long-span bridges (single-mode and coupled-mode). [Copyright &y& Elsevier]

Abstract: In the US, there is a long tradition of toll roads, beginning with the Lancaster Turnpike that was built at the end of the 18th century connecting Philadelphia and Lancaster. There are currently more than 300 toll facilities in the US, which is probably the largest number of toll facilities in the world. These facilities represent a wide range of conditions, from hypercongested facilities in large metropolitan areas such as New York City to toll highways in rural areas. The toll structures are equally diverse, ranging from multi-tier price structures with frequent user, carpool, and time of day discounts; to simpler structures in which the only differentiation is made on the basis of the number of axles per vehicle. The toll rates are typically set by the agencies that operate or own the toll facilities. The rules or formulas by which these tolls are determined are not generally available to the public, though it is safe to say that toll decisions are made taking into account technical considerations, as well as the all important criterion of political acceptability. However, data on toll rates and how they change by vehicle types and by some other attributes are readily available. The overall objective of this paper is to analyze the toll data from various facilities across the US to gain insight into the overall factors affecting the tolls. A more specific objective is to assess—though in a rather approximate fashion—if the tolls by vehicle type, relative to each other, are appropriate and consistent with economic theory. This is achieved by comparing tolls to approximate indicators of road space consumption and pavement deterioration. The literature review confirmed that this is the first time such research has been conducted which is an important first step toward an analysis of the efficiency of current toll policies. The analyses in this paper are based on a random sample of all toll facilities across the US. The toll dataset, which include toll rates for passenger cars, busses, and three different truck types, is assembled mainly from the available information on the web sites of various toll agencies. After cleaning the data, the authors used econometric modeling to estimate a set of ordinary least squares (OLS) regression models that express tolls as functions of independent variables. Three families of models were estimated: linear models, models based on expansions of Taylor series, and models based on piece-wise linear approximations to non-linear effects. The resulting models were analyzed to identify the salient features of current toll policies towards different vehicle types. [Copyright &y& Elsevier]

Shared decision making is a process in which patients are involved as active partners with the clinician in clarifying acceptable medical options and in choosing a preferred course of clinical care. Shared decision making offers a way of individualizing recommendations, according to patients'' special needs and preferences, when some patients may benefit from an intervention but others may not. This paper clarifies how the U.S. Preventive Services Task Force (USPSTF) envisions the application of shared decision making in the execution of screening and chemoprevention. Unlike conventional USPSTF reports, this paper is neither a systematic review nor a formal recommendation. Instead, it is a concept paper that includes a commentary on the current thinking and evidence regarding shared decision making.Although the USPSTF does not endorse a specific style of decision making, it does encourage informed and joint decisions. This means that patients should be informed about preventive services before they are performed, and that the patient–clinician partnership is central to decision making. The USPSTF suggests that clinicians inform patients about preventive services for which there is clear evidence of net benefit, and, if time permits, about other services with high visibility or special individual importance. Clinicians should make sure that balanced, evidence-based information about the service (including the potential benefits and harms, alternatives, and uncertainties) is available to the patient if needed. For preventive services for which the balance of potential benefits and harms is a close call, or for which the evidence is insufficient to guide a decision for or against screening, clinicians should additionally assist patients in determining whether individual characteristics and personal preferences favor performing or not performing the preventive service.The USPSTF believes that clinicians generally have no obligation to initiate discussion about services that have either no benefit or net harm. Nonetheless, clinicians should be prepared to explain why these services are discouraged and should consider a proactive discussion for services with high visibility or special individual importance or for services for which new evidence has prompted withdrawal of previous recommendations. [Copyright &y& Elsevier]

Introduction: Communities That Care, refined and tested for more than 25years, offers a step-by-step coalition-based approach to promote well-being and prevent risk behaviors among youth. Communities That Care guides coalitions to identify and prioritize underlying risk and protective factors; set specific, measurable community goals; adopt tested, effective prevention programs to target selected factors; and implement chosen programs with fidelity. Communities That Care has been implemented in a variety of communities, but has only recently begun to be systematically evaluated in diverse, urban communities.Methods: This paper presents a process evaluation of Communities That Care implementation within a Midwestern ethnically diverse, urban community. In-depth surveys of 25 black male youth aged 8-14years and their caregivers were conducted to determine the degree to which coalition-selected priorities aligned with the experience of black families. Implementation and survey data were collected in 2014-2017 and analyzed in 2017-2018.Results: Roughly 30% of youth reported ever being bullied or bullying someone else on school property; this aligned with the coalition's decision to focus on positive social skills and bullying prevention. Additional data aligned with the coalition's intent to expand its community action plan to encompass other priorities, including family transitions and mobility. For example, roughly one third of caregivers went on welfare and one third of families moved to a new home or apartment in the past year.Conclusions: In communities whose residents have experienced historical and current inequities, an effective community prevention plan may need to address structural as well as social determinants of well-being among youth and their families.Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Objective: To explore the sexual and reproductive health (SRH) behaviors, health insurance coverage and use of SRH services of women in the United States (U.S.) by nativity, disaggregated by race and ethnicity.Study Design: We analyzed publicly available and restricted data from the National Survey of Family Growth to assess differences and similarities between foreign-born and U.S.-born women, both overall and within Hispanic, non-Hispanic (NH) white, NH black and NH Asian groups.Results: A larger proportion of foreign-born women than U.S.-born women lacked health insurance coverage. Foreign-born women utilized SRH services at lower rates than U.S.-born women; this effect diminished at the multivariate level, although race and ethnicity differences remained. Overall, foreign-born women were less likely to pay for SRH services with private insurance than U.S.-born women. Foreign-born women were less likely to use the most effective contraceptive methods than U.S.-born women, with some variation across race and ethnicity: NH white and NH black foreign-born women were less likely to use highly effective contraceptive methods than their U.S.-born counterparts, but among Hispanic women, the reverse was true.Conclusion: Our findings demonstrate that the SRH behaviors, needs and outcomes of foreign-born women differ from those of U.S-born women within the same race/ethnic group.Implications: This paper contributes to the emergent literature on immigrants in the U.S. by laying the foundation for further research on the SRH of the foreign-born population in the country, which is critical for developing public health policies and programs to understand better and serve this growing and diverse population. [ABSTRACT FROM AUTHOR]

Rising rates of childhood obesity over the past 2 decades have spurred a number of public- and private-sector initiatives aimed at halting or even reversing this trend. Recognizing common interests in this issue, the Centers for Disease Control and Prevention, NIH, and the Robert Wood Johnson Foundation began conversations about creating a formal collaboration aimed at accelerating efforts to address childhood obesity by coordinating research agendas and providing support for evidence-building activities. The National Collaborative on Childhood Obesity Research (NCCOR) was launched in February 2009, and the U.S. Department of Agriculture joined in 2010. Using the model provided by other previously successful collaborations, such as the Youth Tobacco Cessation Collaborative, NCCOR has emphasized several principles suggested by Petrovich as key elements for successful partnerships: (1) delineate a common purpose by identifying key knowledge gaps in the field; (2) create a shared identity around that common purpose; (3) develop structures for democratic and respectful collaboration so as to strategically coordinate efforts for maximum national impact; (4) identify effective leaders capable of articulating challenges in the field and inspiring a commitment of minds and the resolve to address identified needs; (5) facilitate continuous knowledge exchange and synthesis to keep the field informed; and (6) support assessment of progress and feedback loops for ensuring continual progress. This paper examines how NCCOR has used these principles to help build the field of research, evaluation, and surveillance for childhood obesity prevention and management. [ABSTRACT FROM AUTHOR]

Background: There is significant interest in comparing countries on many different indicators of social problems and policies. Cross-national comparisons of drug prevalence and policies are often hampered by differences in the approach used to reach respondents and the methods used to obtain information in national surveys. The paper explores how much these differences could affect cross-country comparisons.Methods: This study reports prevalence of drug use according to the most recent national household survey and then adjusts estimates as if all national surveys used the same methodology. The analysis focuses on European countries for which the European Monitoring Centre for Drugs and Drug Addiction reports data, the United States, Canada, and Australia. Adjustment factors are based on US data.Findings: Adjusting for modality differences appears likely to modestly affect the rankings of countries by prevalence, but to an extent that could be important for comparisons. For example, general population surveys suggest that the US had some of the highest cannabis and cocaine prevalence rates circa 2012, but this is partially driven by the use of a modality known to produce higher prevalence estimates. This analysis shows that country rankings are partly an artifact of the mode of interview used in national general population surveys.Conclusions: Our preliminary efforts suggest that cross-national prevalence comparisons, policy analyses and, other projects such as estimating the global burden of disease could be improved by adjusting estimates from drug use surveys for differences in modality. Research is needed to create more authoritative adjustment factors. [ABSTRACT FROM AUTHOR]

Empirical evidence points to a persistent Black-White racial gap in police-caused homicides. Some scholarship treats the gap as denoting criminal justice exposure either in terms of involvement in crime or living in a high-crime context. By contrast, health scholarship typically points to the importance of racism including the attitudes, institutional practices, and overall structures that operate to privilege one group over another. Still, given the demographics of US society, the Black-White racial contrast overlooks the 25% of Americans who are neither Black nor White: Native Americans, Latinos, and Asians. The question of how the groups should be organized vis-a-vis the current Black-White model and theories arises. An answer is not straightforward. There is a rank-ordering to the groups' mortality rates as well as an exponential increase in the number of possible comparisons. In this paper we systematically review the literature on race and police-caused homicide with a particular focus on studies that attempt to move beyond the Black-White model. We find that studies on race and police-caused homicide either make no comparison between the groups, or, alternatively, use a White-non-White, a Black-non-Black, and/or a Black-Native American-Latino vs. White-Asian comparison. We use data on group-specific mortality rates to examine the strengths and limits of each of these practices. The limits are the selection of counterfactual gaps, the selection of smaller gaps, and/or the omission of larger gaps. To address these limits, we propose that a Black-Native American vs. Latino-White-Asian model best captures the higher and lower mortality rates in police-caused homicide data. • Mortality rates from police-caused homicide vary by race and ethnicity. • The Black group has the highest rate followed by the Native American, Latino, White and Asian groups. • The literature makes one of several contrasts between these groups. • These are White-non-White; Black-non-Black, or Black-Native American-Latino vs. White-Asian. • Black-Native American vs. Latino-White-Asian contrast best reflects the groups' mortality rates. [ABSTRACT FROM AUTHOR]

This paper analyzes empirical differences in adoption services of public and private agencies. The empirical investigation includes cross-sectional time series aggregated data for the 50 states within the United States from 1996 to 2010 with detailed statistical analysis of the period from 2000 through 2010 for which consistent and comprehensive data exists. Under private agencies, only 11.6 months elapse from the time the courts terminate the natural parents' custody until the child is adopted, while with public agencies the same process lasts for 16 months. Furthermore, during the decade from 1996 to 2006 private agencies completed more adoptions than public agencies. However, the performance gap in favor of private agencies was eliminated in 2006 and in the following years. The results suggest that privatization of adoption of young and healthy children did not show an advantage for private services. However, transitioning adoption services to private agencies for older children or children with complex special needs, improves the adoption services compared with those of public agencies. Subsidization especially improves the adoption of older children and of all children with special needs while it appears to be statistically insignificant or implied as unnecessary for healthy babies. [ABSTRACT FROM AUTHOR]

Background and Aims: Although much has been written about the conventional cardiovascular risk factor correlates of the extent of coronary artery calcification (CAC), few studies have been carried out on symptomatic patients. This paper assesses the potential ability of risk factors to associate with an increasing CAC score.Methods: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and the USA. All had conventional cardiovascular risk factor assessment and CT scanning for CAC scoring.Results: Among all patients, male sex (OR = 4.85, p<0.001) and diabetes (OR = 2.36, p<0.001) were the most important risk factors of CAC extent, with age, hypertension, dyslipidemia and smoking also showing a relationship. Among patients with CAC, age, diabetes, hypertension and dyslipidemia were associated with an increasing CAC score in males and females, with diabetes being the strongest dichotomous risk factor (p<0.001 for both). These results were echoed in quantile regression, where diabetes was consistently the most important correlate with CAC extent in every quantile in both males and females. To a lesser extent, hypertension and dyslipidemia were also associated in the high CAC quantiles and the low CAC quantiles respectively.Conclusion: In addition to age and male sex in the total population, diabetes is the most important correlate of CAC extent in both sexes. [ABSTRACT FROM AUTHOR]

Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI. [ABSTRACT FROM AUTHOR]

Policymakers are increasingly interested in reducing healthcare costs and inefficiencies through innovative payment strategies. These strategies may have heterogeneous impacts across geographic areas, potentially reducing or exacerbating geographic variation in healthcare spending. In this paper, we exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market. Using Medicare claims, we find that while providers in more competitive markets had higher average costs in the pre-reform period, these markets experienced larger proportional reductions in treatment intensity and costs after the reform relative to less competitive markets. This led to a convergence in spending across geographic areas. We find that much of the reduction in provider costs is driven by greater exit of "high-cost" providers in more competitive markets. [ABSTRACT FROM AUTHOR]

Background Context: Over the course of the last decade, interest in the use of large data repositories for clinical research in orthopedic and spine surgery has grown substantially. Detractors maintain that the clinical relevance of research conducted using large registries is limited, and that the academic influence of such studies is minimal. Such contentions have not been empirically evaluated.Purpose: This study sought to perform a systematic review of spinal research conducted using the National Surgical Quality Improvement Program (NSQIP).Study Design: This is a systematic review.Outcome Measures: Impact factor (IF) of the journal of publication and number of citations of published articles conducted using the NSQIP.Methods: Orthopedic and spine-specific NSQIP articles published from January 1, 2007 to July 31, 2015, were identified through a query of PubMed or Medline, Embase, Web of Science, and Scopus. Articles were classified by journal of publication, year of publication, study topic, study purpose, and method of statistical analysis. Spine surgical publications were compared with other orthopedic research conducted using the NSQIP. The primary dependent variables for the purposes of statistical testing were IF of the journal in which the article was published and the number of citations for each publication. Negative binomial regression was used to evaluate the characteristics of papers associated with increased IF and number of citations.Results: Of the 1,525 articles identified in the initial search, 114 studies were considered eligible for inclusion in the systematic review. The average IF for the journals publishing orthopedic NSQIP articles was 2.75 (standard deviation [SD] 1.22, range 0-5.28), whereas it was 2.52 (SD 0.81, range 1.38-5.28) for spinal research. The average number of citations per article was 6.08 (SD 10.9, range 0-69) and 6.4 (SD 12.0, range 0-69) for spine-specific studies. Following negative binomial regression, only IF (regression coefficients [RC] 0.31; 95% confidence intervals [CI] 0.08, 0.55) and the year of publication (RC -1.29; 9% CI -1.64, -0.95) were found to have a statistically significant association with number of citations. Among spine-specific research articles, only the year of publication was found to influence the number of citations (RC -1.29; 95% CI -1.94, -0.64).Conclusions: Our findings indicate that the academic impact of orthopedic and spine surgical research conducted using NSQIP is highly variable, with most publications found to have relatively low impact. As our evaluation of study characteristics associated with high-impact publications and increased citations were unable to uncover factors that are likely translatable, we suggest following research design guidelines that highlight best practices when using large datasets for orthopedic research. [ABSTRACT FROM AUTHOR]

This paper examines the extensive margin of selection into employer-sponsored health insurance (ESHI) using data from the Medical Expenditures Panel Survey 2001-2010 and 2014-2016 and the National Longitudinal Survey of Youth'97 in 2010. Controlling for a large set of firm and job characteristics, I find that before the implementation of the Affordable Care Act (ACA) in 2014, workers aged 25-40 who declined ESHI and remained privately uninsured had significantly higher health risk than those who enrolled. No correlation between health and insurance take-up is found in the 41-64 age group. These results are partly explained by differences in income and Medicaid crowding out ESHI for high risk workers. The paper sheds light on the characteristics of uninsured workers, their incentives for declining insurance and the interaction between private and public health insurance. The allocation of ESHI remained unchanged after the ACA was introduced due to the provisions' counteracting effects. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the invariance of the factor structure of the Drinking Motives Questionnaire Revised (DMQ-R) between Portuguese and US university students. Following tests of factor model invariance we further evaluated cross-cultural differences in (1) mean levels of the four motives, and (2) the association of the four motives with weekly drinking, peak drinking, and binge drinking among college students from the United States and Portugal. Participants were 983 undergraduate students (67% female) from the US (N=515) and Portugal (N=468). Participants completed a confidential online (US) or paper and pencil (Portugal) survey. Results of a CFA demonstrated that the four-factor model of the DMQ-R was invariant with respect to factor loadings, factor variances, and factor covariances across the two countries. Mean differences in ratings of drinking motives were found, with US students ranking all motives higher than Portuguese students. However, rank order of motives (social>enhancement>coping>conformity) were equivalent across countries. Support for convergent validity was demonstrated by significant associations between drinking motives and alcohol consumption for men and women of both samples. Results support the factorial invariance and convergent validity of the DMQ-R across US and Portuguese college students, making it a trustworthy means of assessing college students' drinking motives, and a useful instrument for clinical and research purposes, both within and across cultures. [ABSTRACT FROM AUTHOR]

Aims: There are numerous risk or screening scores for the prediction of type-2 diabetes mellitus (DM). In contrast, few scores are available for preDM. In this paper, we compare the two screening scores from the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) that can be used for DM as well as preDM.Methods: Adult participants (N=9391) without known DM from the National Health and Nutrition Examination Surveys 2009-12 were included. We fitted the factors/items in the ADA and CDC scores in logistic regression with the outcomes of undiagnosed DM, preDM, and combination, and assessed the association and discrimination accuracy. We also evaluated the suggested cutpoints that define high risk individuals. We mimicked the original models/settings but also tested various deviations/modifications often encountered in practice.Results: Both scores performed well and robustly, while the ADA score performed somewhat better (e.g., AUC=0.77 for ADA and 0.73-0.74 for CDC for DM; 0.72-0.74 and 0.70-0.71 for preDM). The same predictors and scoring rules seem to be reasonably justified with different cutpoints for DM and preDM, which can make usage easier and consistent. Some factors such as race and HDL/LDL cholesterols may be useful additions to health education.Conclusions: Current DM education and screening focus on the prevention and management of DM. The ADA and CDC scores could further help when we identify individuals at high risk for preDM, and teach the importance of preDM during which lifestyle intervention can be effective and urgently needed. [ABSTRACT FROM AUTHOR]

While migrants are widely believed to be positively selected on health, there has been very little empirical exploration of the actual health differential between migrants and non-migrants. This paper explored: 1) the extent of health selection by comparing US immigrants from 19 sending countries to their non-migrating counterparts still residing in the countries of origin; 2) country-level correlates of health selection; and 3) whether country-level health selection accounted for differences in self-rated health between immigrants and US-born Whites. We combined nationally-representative international data with data from US immigrants from the 2003–2007 Current Population Survey. The health selectivity measure was the Net Difference Index (NDI), which compares the distribution of self-rated health between migrants and non-migrants. We calculated Spearman correlation and bivariate regression coefficients between the NDI and economic, health, distance, and migration characteristics of the sending countries. We used generalized estimating equation models to examine the association between country-level health selection and immigrants' current self-rated health. We found immigrants from South America to show the most positive health selection. Health selection was significantly correlated with visa mode of entry, where family networks decrease, but work-related networks increase health selection. There was little evidence that country-level health selection explained differences in the self-rated health of US immigrants relative to US-born Whites. Our findings do not support the idea that country-level health selection underlies the “healthy immigrant effect”. [ABSTRACT FROM AUTHOR]