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Analysis of Phase 2 data sets by the UIUC/GTRI INFERENCE team for the DARPA TAILOR program. These data sets are INSIGHT, PHITE, HERA, and MASTRE. These are all existing human performance data sets that are a mix of physiological, cognitive, genomic and human performance data.

University of Illinois at Urbana-Champaign

University of Illinois at Urbana-Champaign

Supplemental material, sj-pdf-1-epb-10.1177_2399808320921208 for Classifying settlement types from multi-scale spatial patterns of building footprints by Warren C Jochem, Douglas R Leasure, Oliver Pannell, Heather R Chamberlain, Patricia Jones and Andrew J Tatem in Environment and Planning B: Urban Analytics and City Science

Supplemental material, sj-pdf-1-epb-10.1177_2399808320921208 for Classifying settlement types from multi-scale spatial patterns of building footprints by Warren C Jochem, Douglas R Leasure, Oliver Pannell, Heather R Chamberlain, Patricia Jones and Andrew J Tatem in Environment and Planning B: Urban Analytics and City Science

Patricia D Jones,1,2 Andrew R Scheinberg,3 Valery Muenyi,3 Joselin Gonzalez-Diaz,1 Paul M Martin,1,2 Erin Kobetz2,4 1Department of Medicine, Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, Florida, USA; 2Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA; 3Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA; 4Department of Medicine, Division of Computational Medicine and Population Health, University of Miami Miller School of Medicine, Miami, Florida, USACorrespondence: Patricia D JonesDepartment of Medicine, Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, 1120 NW 14 th Street, Miami, FL 33136, USATel +1 305 243-0779Email pdjones@med.miami.eduBackground: Disparities in hepatocellular carcinoma (HCC) have been partly attributed to low socioeconomic status among minorities. We investigated associations between race, socioeconomic characteristics, geographic characteristics and survival in HCC patients in Florida.Methods: Using the Florida Cancer Data System (FCDS), we analyzed HCC cases diagnosed between 1/1/2004 and 12/31/2013. To ascertain population-level socioeconomic characteristics, we linked FCDS to the 2010–2014 US Census American Community Survey and the 2013 Florida Behavioral Risk Factor Surveillance System. We also estimated patient distance to liver transplant and academic cancer centers. Using Cox proportional hazards, we modeled the association between race and survival.Results: Of 10,852 patients, 13.1% were Black, 67.1% White, 15.7% Hispanic, and 3.2% Asian. At diagnosis, Blacks were younger with more extensive disease, p

International audience

International audience

The National Institute on Aging has taken special efforts to support research endeavors that explore ways to address health disparities. For example, the NIA Health Disparities Research Framework was developed in 2015 to provide a visualization of priority areas in Aging Research. The Framework can help researchers assess advances and potential opportunities for stimulating and supporting rigorous methods to address health disparities in Aging Research among the phases of research. The goal of this symposium is to highlight the different resources and research opportunities that NIA offers to support aging researchers, centers, and institutions for health disparities-related research or programs. Dr. Ron Kohanski will present a concept piece on how laboratory animals might be leveraged to mimic the impact of early life disparities on aging over the life-course, based on research in the hallmarks of aging support by NIA’s Extramural Division of Aging Biology. Dr. Damali Martin will identify the different resources focused on health disparities related research within the Division of Neuroscience. Dr. Lyndon Joseph will discuss the different health disparities research opportunities that are available from the Division of Geriatrics and Clinical Geriatrics. Dr. Frank Bandiera will highlight the different resources and research opportunities that are available to address health disparities within the Division of Behavior and Social Research. These presentations, taken together, will provide important information that bolsters knowledge of resources and research opportunities to address health disparities over the lifecourse and in late life.

This paper investigates the sources of growth in manufacturing productivity in Cote D’Ivoire, Ethiopia and Tanzania in comparison with the case of Bangladesh. Based on the analysis of establishment census data since the mid-1990s, it finds that reallocation of market share between firms contributed substantially to productivity growth in each of the four countries, although to a varying extent. In Ethiopia, the impact of market share reallocations among survivors tended to be larger than those associated with increases in within-plant productivity. In addition, plant closure (or exit) boosted productivity more than new plant openings (or entry) did in the sense that the relative productivity of survivors (or continuing plants) was higher relative to that of closing plants (or exit cases) than it was relative to the productivity of newly opening plants (or new entrants). Reallocation of market share plays an important role in raising aggregate productivity in Côte d’Ivoire as well. But the pattern here is opposite to that in Ethiopia in that in Côte d’Ivoire entering (or newly opening) plants have larger impact on aggregate productivity growth than closing (or exiting) plants. Unlike the case with Cote D’Ivoire and of Ethiopia, the reallocation of market share among surviving plants is a smaller source of manufacturing productivity growth in Tanzania than the new plant openings and plant closure. The data suggest that the reallocation of market share among surviving plants and exiting plants has larger impact on productivity growth in Bangladesh than the productivity gap between new plants and survivors, as in the case of Ethiopia.

This paper uses plant-level, panel data from the Ethiopian manufacturing census to estimate the effects of demand-side and supply-side factors on industrywide aggregate productivity. The paper focuses on the effects of three factors: (1) local market size, (2) the value of transportation costs that firms incur in selling to customers outside their market, and (3) licensing fees needed to enter the market. Identification is based on a model of production under monopolistic competition, which enables interpreting the estimated coefficients of a reduced form, dynamic productivity equation. The paper analyzes 11 industries in Ethiopia over 2000 to 2010. Several interesting results emerge. In the most parsimonious specification, the estimated coefficients are consistent with all three predictions of the model—but only for one industry: cinder blocks. In this industry, the expansion of the local market boosts industrywide total factor revenue productivity, while increases in transport costs and licensing fees reduce it. The picture is somewhat mixed in the other 10 industries but broadly consistent with the predictions of the model.

International audience

International audience

The research problem underlying this study concerns the potential of a mainstream secondary school to offer an inclusive and equitable experience of education for Aboriginal and Torres Strait Islander (Indigenous) students. The research explores how Indigenous students experience education at St Mary’s Catholic College, Cairns. Three specific research questions frame the organisation of this study: - How do Indigenous students experience teaching and learning at St Mary’s? - How do Indigenous parents experience the education of their children at St Mary’s? - How do Indigenous students and their parents experience the implementation of inclusivity policies at St Mary’s? This study adopts an interpretivist paradigm that is underpinned by constructionist epistemology. Data are analysed from the theoretical standpoint of symbolic interactionism. A case study methodology organises the choice of data-gathering strategies. These are document analysis, focus group interviews and in-depth, individual interviews. This study’s participants are purposively selected from four stakeholder groups: Indigenous students, Indigenous parents, Indigenous support staff and non-Indigenous teachers. In total, 54 stakeholders were participants. The research generates seven conclusions that add to new knowledge, practice and policy concerning how Indigenous students experience education at St Mary’s. First, St Mary’s Indigenous students consider their identification as Indigenous to be irrelevant to their engagement in the learning process or to their achievement of learning outcomes. Further, they argue that a serious focus on school academic work is not inconsistent with honouring Indigenous culture and values. Second, St Mary’s Indigenous students consider teachers’ non-Indigenous backgrounds to be no disadvantage to their learning. Instead, Indigenous students value the presence of differing cultural identities in the classroom for what they contribute to the learning experience. Similarly, Indigenous parents consider a paucity in the number of Indigenous teachers at St Mary’s will not negatively influence their children’s academic outcomes. Instead, they believe interactions with non-Indigenous teachers to be beneficial learning experiences for their children. Third, Indigenous parents believe that their decision to enrol their children at St Mary’s is a way of ensuring their positive futures. This decision may incur criticism that is supposedly justified by cultural identification values, from extended family members. St Mary’s Indigenous parents consider the defining and dividing of closely related people in order to maintain boundaries of inclusion and exclusion to be harmful for and divisive of Indigenous people. Fourth, Indigenous families consider St Mary’s to be an authentic, supportive and engaging place for all school community members. Parents noted that the school’s respect of Indigenous peoples and cultures reflected a fundamental characteristic of Catholic education. They value the policies and practices of inclusive education that honour their cultural identities and enable them to experience belonging to an authentic community. Fifth, Indigenous students consider it more educationally advantageous that teachers identify and address their individual learning needs rather than employ specific pedagogies considered to be preferred by Indigenous students in general. They are appreciative of reflective educators who adopt a variety of pedagogies in order to communicate authentically with all students. Sixth, ongoing professional development that challenges teachers to become knowledgeable about the different ways of learning that are equally legitimate and appropriate in diverse teaching contexts is needed at St Mary’s. This professional development would encourage teachers to employ a wide range of pedagogies that ensures quality relationships and communication with Indigenous students. Seventh, St Mary’s Indigenous support staff form an essential relationship between Indigenous students and their families, non-Indigenous teachers and the College leadership. This relationship allows for a better understanding of cultural differences that encourages positive learning outcomes for all students. Non-Indigenous teachers’ valuing of Indigenous aides and elders as co-educators in the classroom is essential for the successful implementation of inclusive education policies.

This paper identifies and estimates the impact of firm entry and exit on plant-level productivity in Ethiopia as part of a selection mechanism that might be driving aggregate productivity growth in cities. Specifically, the paper investigates how firms’ entry and exit contribute to the pace of factor reallocation and total factor productivity growth within industries—and whether these processes occur in higher numbers and rates in larger cities. The analysis is carried out using establishment census data from Ethiopia that cover the period from year 2000 to 2010. Importantly, these data include information on plants’ physical outputs and their prices, which allows distinguishing between revenue-based measures of total factor productivity (TFPR) and those based on physical productivity (TFPQ). The analysis reveals that these two measures generate very different results under imperfect competition, suggesting that physical productivity measures (TFPQ) are better suited to examining firm dynamics when local producers have some degree of market power. In addition, the findings show that less productive (higher cost) firms are more likely to exit than their more productive (lower cost) rivals—but the analysis controls for producers’ transport costs. This is consistent with the probability of firm exit being higher when transport costs are lower.

The National Academy of Clinical Biochemistry (NACB) has developed consensus-based guidelines for the laboratory evaluation and monitoring of patients with specified disorders for two decades. In 1997, the NACB recognized the need to standardize the process of guideline development and promulgated its first Standard Operating Procedure (SOP) for this purpose. In 2010, the American Association of Clinical Chemistry (AACC) and NACB created the Evidence-Based Laboratory Medicine Committee (EBLMC). Among other roles, this group was given responsibility to provide oversight of clinical practice guideline development in accordance with SOP guidance and using currently accepted good practices. In 2011, the U.S. Institute of Medicine (IOM) published two reports of relevance: 'Clinical Practice Guidelines We Can Trust' and 'Finding What Works in Health Care - Standards for Systematic Reviews.' These reports were created as part of a response to a legislative mandate from the U.S. Congress requesting that steps be taken to implement recommendations from lOM's report on 'Knowing What Works in Health Care' (2008). The latest revision of the laboratory medicine practice guidelines (LMPG) SOP was in part driven by these reports. NACB continues to develop LMPGs at a rate of roughly one per year through standard processes detailed in its 2014 revision of the SOP. This article describes the NACB and EBLMC experience in developing LMPGs with a focus on the evolution and use of the latest SOP. AACC and NACB have established a solid track record in collaboratively working with many clinical societies and professional organizations on clinical practice guideline development. Presently, three LMPG's are in various stages of development and all with the collaboration of other clinical/professional groups. The practices and tools being used for current LMPGs in progress are also highlighted in the context of the challenges that presently exist for effective clinical practice guideline development in the U.S.

The H-2 MHC of mice encodes two functional class II heterodimeric proteins: AαAβ (A) and EαEβ (E). While failure to express the A protein has not been reported, a significant proportion of of H-2 haplotypes In both Inbred and wild mice do not express E proteins. We and others have previously characterized the molecular basis for defective E expression in haplotypes from Mus domestlcus (b, f, q, s, from inbred strains) and Af. castaneus (w17, wild-derived) species, identifying six distinct defects in the genes for Eα or Eβ. In this report we have extended these studies to other E- haplotypes, Including several from f-haplotype-bearlng M. domesticus mice (w29, w57, w302) and one derived from the Asian species M. bactrianus (w301). Analyses at the protein, RNA and DNA levels were employed to Identify the defects in the genes for Ea and Eb. At least one new defect was identified that prevents Eβ expression in a t-associated H-2 haplotypes (w57), bringing the number of distinct mutations causing the Eβ phenotype to seven. Another t-associated haplotype, w302, was found to share the same Eβ defect with mice of the inbred q haplotype and of the w17 haplotype from Af. castaneus, while its Ea gene contains the deletion carried also by the Inbred b and s haplotypes and by a number of wild haplotypes. The mutations in the Ea and Eb genes of the w301 haplotype from M. bactrianus were found to be Identical to those of the Inbred f haplotype. This indicates that the origin of the mutations in the Eb genes of the q, w17 and w302 haplotypes and in the Ea and Eb genes of the f and w301 haplotypes, predated speciation within Mus, thought to have occurred ∼0.35-1 million years ago. Their maintenance in mouse populations suggests that in certain conditions the failure to express EαEβ proteins may be advantageous and selected for

International audience

Antisense oligonucleotides (ASOs) have potential as anti-cancer agents by specifically modulating genes involved in tumorigenesis. However, little is known about ASO biodistribution and tissue pharmacokinetics (PKs) in humans, including whether sufficient delivery to target tumor tissue may be achieved. In this preliminary study in human subjects, we used combined positron emission and computed tomography (PET-CT) imaging and subsequent modeling analysis of acquired dynamic data, to examine the in vivo biodistribution and PK properties of LY2181308 - a second generation ASO which targets the apoptosis inhibitor protein survivin. Following radiolabeling of LY2181308 with methylated carbon-11 ([11C]methylated-LY2181308), micro-doses (11C]methylated-LY2181308 was observed in tumors (mean=32.5ng*h /mL, per mg administered intravenously). Highest uptake was seen in kidney and liver and lowest uptake was seen in lung and muscle. One patient underwent repeat analysis on day 15 of multiple dose therapy, during administration of LY2181308 (750mg), when altered tissue PKs and a favorable change in biodistribution was seen. [11C]methylated-LY2181308 exposure increased in tumor, lung and muscle, whereas renal and hepatic exposure decreased. This suggests that biological barriers to ASO tumor uptake seen at micro-doses were overcome by therapeutic dosing. In addition, 18F-labeled fluorodeoxyglucose (FDG) scans carried out in the same patient before and after treatment showed up to 40% decreased tumor metabolism. For the development of anti-cancer ASOs, the results provide evidence of LY2181308 tumor tissue delivery and add valuable in vivo pharmacological information. For the development of novel therapeutic agents in general, the study exemplifies the merits of applying PET imaging methodology early in clinical investigations.

Although exercise impacts quality of life in patients with inflammatory bowel disease, little is known about its role in disease activity. Among patients with inflammatory bowel disease in remission, we aimed to evaluate the association between exercise and subsequent active disease.We performed a prospective study using the Crohn's and Colitis Foundation of America Partners' internet-based cohort of individuals with self-reported inflammatory bowel disease. We identified participants in remission, defined as short Crohn's disease activity index150 or simple clinical colitis activity index ≤2. The primary exposure was exercise status, measured using the validated Godin leisure-time activity index. The primary study outcome, assessed after 6 months, was active disease defined using the above disease activity index thresholds. We used bivariate and multivariate analyses to describe the independent association between exercise and risk of active disease.We identified 1308 patients with Crohn's disease (CD) and 549 with ulcerative or indeterminate colitis (UC/IC) in remission, of whom 227 (17.4%) with CD and 135 (24.6%) with UC/IC developed active disease after 6 months. Higher exercise level was associated with decreased risk of active disease for CD (adjusted risk ratio: 0.72, 95% confidence interval: 0.55-0.94) and UC/IC (adjusted risk ratio: 0.78, 95% confidence interval: 0.54-1.13).In patients with CD in remission, those with higher exercise levels were significantly less likely to develop active disease at 6 months. In patients with UC/IC in remission, patients with higher exercise levels were less likely to develop active disease at 6 months; however this was not statistically significant.

There is no histologic classification system to determine prognoses of patients with alcoholic hepatitis (AH). We identified histologic features associated with disease severity and created a histologic scoring system to predict short-term (90 day) mortality.

Octavio Carvajal-Zarrabal1, Dulce María Barradas-Dermitz2, Zaida Orta-Flores2, Patricia Margaret Hayward-Jones1, Cirilo Nolasco-Hipólito3, M Guadalupe Aguilar-Uscanga2, Anilú Miranda-Medina2, Kopli Bin Bujang31University of Veracruz, Veracruz, Mexico; 2Veracruz Institute of Technology, Veracruz, Mexico; 3University of Malaysia Sarawak, Kuching, MalaysiaAbstract: Using MEDLINE and SCOPUS databases, a review of the literature from the pioneering study of 1991 until 2010 was performed on the effects on biological models of Hibiscus sabdariffa L. roselle calyx, its extracts mainly in polar solvents, or pure components found in extracts, as well as their possible relationship to these effects. Three relevant effects on lipid metabolism, antihypertensive activity, and apoptosis were observed. Our chronological review of the studies mentioned in the literature provides another opportunity to see how humans compile scientific knowledge of a chemical structure–physiological activity relationship starting from an ethnobotanical–ethnopharmagognosy contribution. The chemical components that are the main active principles in the physiological activities of Hibiscus sabdariffa L. calyx are anthocyanins and polyphenols (protocatechuic acid and quercetin). Advances have also been made in the elucidation of action mechanisms. Additionally, it has become clear that the lack of standardization in terms of chemical components of the material arising from Hibiscus sabdariffa L. used in testing on biological models imposes limits on the possibility of carrying out comparative analyses between studies. Fortunately, more recent studies are overcoming this obstacle by reporting component concentrations of assumed active principles; however, complete analysis of the extract, if this is to be considered as a therapeutic agent, is not commonly reported in the aforesaid studies. If one of the eventual scenarios for Hibiscus sabdariffa L. calyx is as a therapeutic agent in communities with economic limitations, then studies of a pharmacological nature should guarantee the effectiveness, safety, and tolerability of this material, which is widely accepted to be associated with chemical complexity, thus making this knowledge necessary.Keywords: anthocyanins, phenolic, polyphenolic compounds, lipid metabolism, antihypertensive, apoptosis, safe effective herbal therapeutic product

To identify care-related factors associated with increased incidence of hospital-acquired pressure ulcers (HAPU)

Literature on responsibility of adult children for aging parents reflects lack of conceptual clarity. We examined filial concepts across five cultural groups: African-, Asian-, Euro-, Latino-, and Native Americans. Data were randomly divided for scale development (n = 285) and cross-validation (n = 284). Exploratory factor analysis on 59 items identified three filial concepts: Responsibility, Respect, and Care. Confirmatory factor analysis on a 12-item final scale showed data fit the three-factor model better than the single factor solution despite substantial correlations between the factors (.82, .82 for Care with Responsibility and Respect, and .74 for Responsibility with Respect). The scale can be used in cross-cultural research to test hypotheses that predict associations among filial values, filial caregiving, and caregiver health outcomes.

International audience; Objectives: Post-traumatic hypopituitarism is well described among adult traumatic brain injury survivors. We aimed to determine the prevalence and clinical significance of pituitary dysfunction after head injury in childhood. Design: Retrospective exploratory study. Patients: 33 survivors of accidental head injury (27 males). Mean (range) age at study was 13.4y (5.4-21.7y) and median (range) interval since injury, 4.3y (1.4-7.8y). Functional outcome at study: 15 good recovery, 16 moderate disability, two severe disability. Measurements: Early morning urine osmolality and basal hormone evaluation were followed by the GnRH and insulin tolerance (n=25) or glucagon tests (if previous seizures, n=8). Subjects were not primed. Head injury details were extracted from patient records. Results: No subject had short stature (mean height SD score +0.50, range -1.57 to +3.00). Sub-optimal GH responses (Conclusions: No clinically significant endocrinopathy was identified amongst survivors of accidental childhood TBI, although minor pituitary hormone abnormalities were observed.

To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period.Prospective cohort study.Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged.Hip fracture patients aged 65 and older who underwent surgery for hip fracture.A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission.In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3-3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1-4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8-2.3) and 1.3 (95% CI=0.8-2.1), respectively.Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.

Background In Georgia an estimated 32% of blacks and 28% of whites have high blood pressure. In 2004 the rate of death from stroke in Georgia was 12% higher than the national average, and blacks in the state have a 1.4 times greater rate of death from stroke than that of whites. Context The Georgia legislature funds the Stroke and Heart Attack Prevention Program (SHAPP) to provide treatment and medications for indigent Georgians. The median rate of blood pressure (BP) control among SHAPP enrollees is approximately 60%, compared with the national average of 35%. Methods SHAPP was evaluated through interviews with key health care and administrative staff and through focus groups of patients in two clinics. Consequences Outcomes for patients were increased knowledge of their BP and improved compliance with taking medication and keeping clinic appointments. Interpretation Successful components of SHAPP include an easy enrollment process; affordable medication; use of evidence-based, documented protocols and patient tracking systems; routine follow-up of patients; and effective communication between staff and patients. Challenges and recommendations for improvement are identified.

International audience; OBJECTIVES: Predicting the outcome of seriously ill patients is a challenging problem for clinicians.METHODS: One alternative to clinical trials is to analyse existing patient data in an attempt to predict the several outcomes, and to suggest therapies. In this paper we use decision tree techniques to predict the outcome of head injury patients. The work is based on patient data from the Edinburgh Royal Infirmary which contains both background (demographic) data and temporal (physiological) data.RESULTS: The focus of this paper is the discussion of the anomalous cases in the decision trees with the domain experts (the clinicians).CONCLUSIONS: These analyses led to the detection of several situations where both the data analysis and patient data collection should be enhanced, which in turn should lead to improved patient care.

This paper proposes a new instrument for institutional quality—-the salary of colonial governors—-to investigate whether variations in the quality of British colonial rule continue to have an impact on the economic performance of former colonies. Governors’ salaries provide a good source of exogenous variation because the ranking of salaries across the British Empire remained relatively fixed from the late nineteenth century onwards. Perhaps most important, this instrument varies widely across colonies with historically low rates of European settlement—that is, most countries in today’s developing world. Using a two-stage least squares estimation procedure, I find that colonies with higher paid governors developed better institutions (and higher per capita income) than colonies with lower paid governors.

Improving quality and patient safety, containing costs and delivering value-for-money are the key drivers of change in the delivery of healthcare and have stimulated a shift from an activity-based service to a service based on patient-outcomes. The delivery of an outcomes-based healthcare agenda requires that the real value of laboratory medicine to all stakeholders be understood, effectively defined and communicated. The value proposition of any product or service is the link between the provider and the needs of the customer describing the utility of the product or service in terms of benefit to the customer. The framework of a value proposition for laboratory medicine provides the core business case that drives key activities in the evolution and maintenance of high quality healthcare from research through to adoption and quality improvement in an established service. The framework of a value proposition for laboratory medicine is described. The content is endorsed by IFCC and WASPaLM. Refereed/Peer-reviewed

Cities in Sub-Saharan Africa are experiencing rapid population growth. Yet their economic growth has not kept pace. Why? One factor might be low capital investment, due in part to Africa’s relative poverty: Other regions have reached similar stages of urbanization at higher per capita GDP. This study, however, identifies a deeper reason: African cities are closed to the world. Compared with other developing cities, cities in Africa produce few goods and services for trade on regional and international markets To grow economically as they are growing in size, Africa’s cities must open their doors to the world. They need to specialize in manufacturing, along with other regionally and globally tradable goods and services. And to attract global investment in tradables production, cities must develop scale economies, which are associated with successful urban economic development in other regions. Such scale economies can arise in Africa, and they will—if city and country leaders make concerted efforts to bring agglomeration effects to urban areas. Today, potential urban investors and entrepreneurs look at Africa and see crowded, disconnected, and costly cities. Such cities inspire low expectations for the scale of urban production and for returns on invested capital. How can these cities become economically dense—not merely crowded? How can they acquire efficient connections? And how can they draw firms and skilled workers with a more affordable, livable urban environment? From a policy standpoint, the answer must be to address the structural problems affecting African cities. Foremost among these problems are institutional and regulatory constraints that misallocate land and labor, fragment physical development, and limit productivity. As long as African cities lack functioning land markets and regulations and early, coordinated infrastructure investments, they will remain local cities: closed to regional and global markets, trapped into producing only locally traded goods and services, and limited in their economic growth.