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Hydroxychloroquine (HCQ) and chloroquine (CQ) are well‐established medications used in treating systemic lupus erythematosus and rheumatoid arthritis, as well as skin conditions such as cutaneous lupus erythematosus. In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ/CQ use. Recently, however, the corrected QT interval (QTc)–prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID‐19 infection. This report was undertaken to summarize the current understanding of HCQ/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus‐based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long‐term use of HCQ/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk–benefit assessments are important with regard to prescription of HCQ/CQ. While cardiac toxicity related to HCQ/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases. [ABSTRACT FROM AUTHOR]

Changes in precipitation patterns with climate change could have important impacts on human and natural systems. Zhang et al. (2021, https://doi.org/10.1029/2020gl092293) report trends in daily precipitation patterns over the last five decades in the western United States, focusing on meteorological drought. They report that dry intervals (calculated at the annual or seasonal level) have increased across much of the southwestern U.S., with statistical assessment suggesting the results are statistically robust. However, Zhang et al. (2021, https://doi.org/10.1029/2020gl092293) preprocess their annual (or seasonal) averages to compute 5‐year moving window averages before using established statistical techniques for trend analysis that assume independence about some fixed trend. Here we show that the moving window preprocessing violates that independence assumption and inflates the statistical significance of their trend estimates. This raises questions about the robustness of their results. We conclude by discussing the difficulty of adjusting for spatial structure when assessing time trends in a regional context. Plain Language Summary: A recent paper reports trends in drought in the western United States, in particular increases in drought in the southwestern United States, based on changes in the lengths of time intervals without precipitation. In this "comment" we note that the preprocessing approach used in the paper artificially increases the apparent statistical signal in the data and caution that the evidence for the trends reported is not as strong as presented in the paper. We conclude by discussing the difficulty of estimating trends in a statistically rigorous fashion across multiple weather stations. Key Points: Statistical uncertainty about trends in droughts in the southwestern US is larger than reported in a recent GRL letter [ABSTRACT FROM AUTHOR]

Paciorek and Wehner raise important questions around our use of the Mann‐Kendall nonparametric trend test on smoothed data for analyzing long‐term hydrometeorological trends in Zhang et al. (2021, https://doi.org/10.1029/2020gl092293). We thank them for initiating this important conversation and their gracious cooperation in exploring the issues addressed in their comment. In this reply we confirm the inflation of significant p‐values by our choice to smooth, illustrate the relatively minor impacts on the main conclusions of our paper, and add our voices to those of Paciorek and Wehner in highlighting the lack of methodology for hypothesis testing across multiple stations that have spatial structure (i.e., testing for regionally consistent trends). Plain Language Summary: Our colleagues Drs. Paciorek and Wehner have raised concerns about our paper (Zhang et al., 2021, https://doi.org/10.1029/2020gl092293), which showed widespread increases in the duration of drought events over the last five decades in the western United States. They point out that our decision to smooth the data using a moving average inflated the number of weather stations at which the trends toward longer droughts were deemed significant by a statistical test. We agree with them on this point, and we have recomputed all our results using unsmoothed data to determine the impacts. We find that for most stations and regions, trend magnitudes remained largely unchanged, with many stations nearby one another often suggesting similar trends. Finally, we agree with Paciorek and Wehner that there is a lack of statistical methods to test such coherent regional patterns, and we caution that over‐reliance on p‐values limits the power of regional data to identify important climate trends. Key Points: We agree that smoothing to 5‐year moving windows introduced serial correlation into time series of annual statistics of daily rainfall data, inflating the number of weather stations individually showing significant trends (p < 0.05) with the Mann‐Kendall testRecomputation with unsmoothed values produced substantially the same dry intervals trend magnitude and direction at most stations individually and had only minimal impacts on dry interval trends computed for National Ecological Observatory Network domains using the Regional Kendall testNo perfect statistical approach leverages the capacity of coherent regional patterns among spatially correlated weather stations, and an over‐reliance on p‐values as a binary (significant vs. insignificant) determinant of trends limits the power of regional data [ABSTRACT FROM AUTHOR]

Atmospheric rivers (ARs) significantly impact the hydrological cycle and associated extremes in western continental regions. Recent studies suggest ARs also influence water resources and extremes in continental interiors. AR detection tools indicate that AR conditions are relatively frequent in areas east of the Rocky Mountains. The origin of these ARs, whether from synoptic‐scale waves or mesoscale processes, is unclear. This study uses meteorological composite maps and transects of AR conditions during the four seasons. The analysis reveals that ARs east of the Rockies are associated with long‐wave, baroclinic Rossby waves. This result demonstrates that eastern North American ARs are dynamically similar to their western coastal counterparts, though mechanisms for vertical moisture flux differ between the two. These findings provide a foundation for understanding future climate change and ARs in this region and offer new methods for evaluating climate model simulations. Plain Language Summary: Atmospheric rivers (ARs) are a weather pattern that brings high amounts of atmospheric water and winds in a relatively narrow region. ARs are typically considered a "west coast" phenomenon, largely because the majority of the scientific research on ARs has focused on ARs in western coastal regions: particularly the western United States (US). ARs occur in continental interiors, but there has been some debate about whether these ARs represent the same type of weather as those in western coastal regions. This paper uses two objective methods for identifying ARs and finds times when ARs are present in three locations in the eastern half of the US: Norman, OK, Bloomington, IN, and Washington, DC. Examination of weather conditions during these AR times shows remarkable similarity to conditions associated with west coast ARs. This gives strong evidence that ARs do occur in the eastern half of the US. This result is important because it suggests that ARs may be important for water resources and extreme weather in the eastern half of the US, just as they are in the western US. This result also suggests that ARs may be important for water resources and extremes in other continental interiors. Key Points: Atmospheric rivers (ARs) east of the Rockies are associated with baroclinic wavesWestern coastal ARs and eastern/midwest ARs are dynamically similarSynoptic‐scale uplift, combined with convective instability, provide efficient mechanisms for generating precipitation [ABSTRACT FROM AUTHOR]

The food versus fuel issue has attracted considerable attention with the rapid growth of global biofuel production. The previous literature examining the interconnectedness between biofuel, fossil fuel and agricultural markets employed futures and spot prices. However, food security needs to be discussed with non‐financial market prices, such as wholesale prices, since retail companies and households usually do not purchase products directly from financial markets, which encompass speculative activities, making them more volatile than non‐financial ones. This paper focuses on non‐financial markets in the United States to investigate the price‐interconnection of biodiesel, highway diesel, crude oil, and soybean, initially applying partial wavelet coherence and the Diebold‐Yilmaz connectedness index to price transmission research on biodiesel, highway diesel, crude oil, and soybean. Our main results are as follows: First, significant coherence between biodiesel and soybean, biodiesel and highway diesel, and highway diesel and crude oil is identified in the short and long term. Second, crude oil and biodiesel prices are found to be net transmitters, while soybean and highway diesel prices are net receivers. Finally, the crude oil market is identified as the source of spillovers among the four markets, and strongly influences the highway diesel market. The previous literature examining the interconnectedness between biofuel, fossil fuel and agricultural markets employed futures and spot prices, while food security needs to be discussed with non‐financial market prices since retail companies and households usually do not purchase products directly from financial markets. This paper focuses on non‐financial markets in the United States to investigate the price‐interconnection of biodiesel, highway diesel, crude oil, and soybean, initially applying partial wavelet coherence and the Diebold‐Yilmaz connectedness index to price transmission research on biodiesel, highway diesel, crude oil, and soybean. Our primary result suggests that biodiesel promotion reinforces a relationship between the prices of soybean and biodiesel. [ABSTRACT FROM AUTHOR]

In 2006, the National Institutes of Health (NIH) initiated the Clinical and Translational Science Awards (CTSAs) as part of the NIH Roadmap Initiative, in order to improve the conduct and impact of NIH's clinical and translational research portfolio. The CTSA program is intended not only to transform the training programs and research infrastructure at individual academic institutions, but also to create a nation-wide collaborative consortium to transform the biomedical research enterprise. In January 2009, the NIH CTSA National Consortium adopted Strategic Goals to maximize the CTSAs' impact on the Nation's healthcare and health. Of these, the CTSA Strategic Goal 4 is to promote the translation of the results of clinical and translational research into practice and public policy. To advance this goal, a committee was constituted to focus on the organization and development of the CTSA Consortium's comparative effectiveness research (CER) capacity, an increasingly important component of research translation into practice and policy. This Committee's Workgroups took on a number of deliverables in service of this objective, including producing this White Paper on how the CTSA Consortium might best facilitate CER, for NIH's Institutes and Centers (ICs), other Federal agencies, outside stakeholders, and the healthcare system overall. This White Paper offers some specific suggestions for how the CTSA Consortium might support this emerging and crucial national effort to generate, synthesize, and disseminate CER in order to improve healthcare decision-making and health outcomes. Important points of reference for this White Paper are two Congressionally mandated reports on CER released at the end of June 2009, one by the Institute of Medicine (IOM) and another by the Federal Coordinating Council for CER (FCC-CER). The definitions of CER by each report, and their recommendations for the CER enterprise, are highly germane to the purpose of this CTSA Consortium White Paper. The CER definition used in the IOM Report was, "The generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist patients, clinicians, purchasers, policy makers, and the public to make informed decisions that will improve health care at both the individual and population levels."… [ABSTRACT FROM PUBLISHER]

Presents information on several papers about hypertension from the U.S. "Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs. Diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial," from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial officers and coordinators; "Primary Prevention of Hypertension: Clinical and Public Health Advisory From the National High Blood Pressure Education Program," from the National High Blood Pressure Education Coordinating Committee; "Prophylactic Treatment of Migraine With an Angiotensin II Receptor Blocker," by E. Tronvik, L. Stovner and G. Helde.

A mass‐conserving method to downscale precipitation from global climate models (GCMs) using sub‐grid‐scale topography and modeled 700‐mb wind direction is presented. Runoff is simulated using a stand‐alone hydrological model, with this and several other methods as inputs, and compared to runoff simulated using historical observations over the western contiguous United States. Results suggest the mitigation of grid‐scale biases is more critical than downscaling for some regions with large wet biases (e.g., the Great Basin and Upper Colorado). In other regions (e.g., the Pacific Northwest) the new method produces more realistic sub‐grid‐scale variability in runoff compared to unadjusted GCM output and a simpler downscaling method. The presented method also brings the runoff centroid timing closer to that simulated with observations for all subregions examined. Plain Language Summary: Due to limitations in computing power which necessitates coarse spatial resolution, climate models do not include many details on mountains and their impact on precipitation. For this reason, it is difficult to estimate the impact of climate change on the availability of water for human consumption in places like the western United States, where mountain snowpack is an important source of water. This paper presents a way to adjust precipitation estimates from climate models by using some simple statistics about nearby mountains and valleys. The adjusted precipitation is then used in a hydrologic model to calculate the runoff that is simulated with different precipitation inputs. Results show that in most cases, the precipitation adjustment improves estimates of the resultant runoff relative to simulations with observed precipitation. The main exceptions are in very dry areas where the climate model produces far too much precipitation. With further work, the proposed adjustment may be integrated into the climate model itself to make it easier for those managing water resources (e.g., controlling reservoir levels) to use the model output to plan and adapt to climate change. Key Points: A mass‐conserving method for downscaling orographic precipitation improves modeled runoff from the CESM2Considering upwind topography further improves modeled runoff compared to simpler adjustmentsNot tuning to individual model grid points makes this method more generalizable than many existing statistical downscaling methods [ABSTRACT FROM AUTHOR]

Economic growth, air pollution, and forest fires in some states in the United States have increased the concentration of particulate matter with a diameter less than or equal to 2.5 μm (PM2.5). Although previous studies have tried to observe PM2.5 both spatially and temporally using aerosol remote sensing and geostatistical estimation, they were limited in accuracy by coarse resolution. In this paper, the performance of machine learning models on predicting PM2.5 is assessed with linear regression (LR), decision tree (DT), gradient boosting regression (GBR), AdaBoost regression (ABR), XGBoost (XGB), k‐nearest neighbors (K‐NN), long short‐term memory (LSTM), random forest (RF), and support vector machine (SVM) using PM2.5 station data from 2017 to 2021. To compare the accuracy of all the nine machine learning models, the coefficient of determination (R2), root mean square error (RMSE), Nash‐Sutcliffe efficiency (NSE), root mean square error ratio (RSR), and percent bias (PBIAS) were evaluated. Among all nine models, the RF (100 decision trees with a max depth of 20) and support vector regression (SVR; nonlinear kernel, degree 3 polynomial) models were the best for predicting PM2.5 concentrations. Additionally, comparison of the PM2.5 performance metrics displayed that the models had better predictive behavior in the western United States than that in the eastern United States. Key Points: We present the prediction of PM2.5 concentrations over the United States using various machine learning (ML) algorithmsWe show ML as a new approach for analyzing large data sets due to the computational speed and easy implementation for massive amounts of dataThe study is important for improving our understanding of the differences among ML algorithms for Earth Science research [ABSTRACT FROM AUTHOR]

The article focuses on the implications on the deportations of long-time U.S. residents to El Salvador and the radical trips that Swedish transnational adoptees must make in order to reestablish their identities with their ancestries. However, such trips have been the source of destabilization for these individuals causing deviance from the original course of action and embracing emigration or adoption. The connection with the culture for which these individuals are embedded have also been lost.

Biological control with specialist, nonindigenous, herbivorous insects is an important option for controlling invasive exotic plants in wildlands and nature reserves. It is assumed that biological control agents will reduce the dominance of the target weed, thereby increasing the native diversity of the associated plant community. However, this hypothesis has rarely been tested. We introduced Aphthona nigriscutis into grassland sites infested with the invasive exotic species Euphorbia esula L. on a nature reserve in Montana (U.S.A.). Two sites with better soil had been treated previously with herbicide, whereas two other sites had not. We measured the density and biomass of Euphorbia vegetative and flowering stems and number of native and exotic shrubs, grass-like plants, and forbs in 48 microplots in Aphthona release and control macroplots at each site. After 5 years, Aphthona release was associated with a 33–39% decline in Euphorbia aboveground biomass compared with controls at all sites. Other effects of the biocontrol depended on the site. Biocontrol slowed the recovery of species diversity at the sites previously treated with herbicide but slowed the loss of diversity at sites without a history of herbicide. Biocontrol introduction was not associated with a disproportionate increase in nontarget exotic species. Release of Aphthona caused a decline in the biomass of flowering stems relative to controls at good-soil, previous-herbicide sites but was associated with a relative increase in flower stem mass at poor-soil, no-herbicide sites. Our results suggest that biocontrol reductions in weed dominance will not always be associated with increased species diversity. More emphasis should be placed on conserving desirable communities and less on simple weed control. Monitoring of community-level effects should accompany biocontrol introductions on nature reserves. [ABSTRACT FROM AUTHOR]

The California Spotted Owl (Strix occidentalis occidentalis ) is under consideration for federal protection and has stimulated ecosystem-level management efforts in Sierra Nevada national forests. Because some populations are declining, we used a noninvasive fecal sampling method to estimate stress hormone (i.e., corticosterone) levels within a local population from April to August 2001. Fecal corticosterone levels were similar to those recorded in a previous study of Northern Spotted Owls (S.o. caurina ) ( &xmacr;= 80.1 ng/g dry feces, SE = 75.8). We then used an information-theoretic approach to identify factors that influence fecal corticosterone levels in Spotted Owls. Our best overall model indicated that nonbreeding owls had higher fecal corticosterone levels than breeding owls early in the breeding season and lower levels later in the breeding season. We collected few samples from breeding owls early in the breeding season, however, which may have influenced the results. Management-related factors reflecting habitat condition and proximity to roads were not correlated with fecal corticosterone. However, factors such as field storage method and sample mass were correlated with the amount of measured fecal corticosterone and should be considered in future studies. Sample vials initially stored on ice had higher levels than those stored immediately in liquid N2 (βstorage= 0.269 ln[ng/g], 95% CI = 0.026, 0.512). Hormone metabolites were extracted from extremely small samples (0.01 g) by slightly modifying the assay protocol, but the amount of corticosterone detected increased as the sample mass decreased (βmass=−6.248 ln[ng/g], 95% CI =−8.877, −3.620). Corticosterone levels were significantly higher in 10 cecal samples collected simultaneously with fecal samples (paired difference = 74.7 ng/g, SE = 45.0, p = 0.001 for a paired t test), so care must be taken to avoid contaminating fecal samples with cecal material. Most of the variation was unexplained by our best model ( R 2= 0.24), and additional factors influencing fecal corticosterone levels need to be identified. Therefore, we recommend that well-designed experiments be conducted under controlled conditions to better determine the effect of factors such as sample handling, partial sampling, and diet on fecal corticosterone levels in owls and other birds. [ABSTRACT FROM AUTHOR]

We studied the temporal and spatial patterns in deforestation and community structure of mammals in a fragmented old-growth, temperate rain forest to test the hypothesis that anthropogenic habitat conversion advances in a nonrandom manner across native landscapes, and that its effects on ecological communities are both persistent and predictable. The location is the Hood Canal district of Olympic National Forest, Washington, USA. Deforestation followed the apparently general pattern observed for deforestation of tropical rain forests and other native landscapes, advancing first along low and relatively level valleys, then to areas at higher elevations and along steeper slopes, and eventually to sites more distant from those of initial land conversion and transportation centres. Mammal surveys within this area indicated that this nonrandom advance of deforestation has created relatively steep geographical and topographic gradients in both local and landscape-level factors and, ultimately, in the structure of mammalian communities. The close and likely causal relationship between anthropogenic habitat loss and the ecological dynamics of mammalian communities and dependent species (e.g. spotted owls) indicates that our abilities to understand and eventually reduce the current extinction crisis may rely heavily on our understanding of, and abilities to modify, the manner in which we expand across and transform native landscapes. [ABSTRACT FROM AUTHOR]

Analyzes guidelines and studies related to the prevention and management of hypertension in Americans. Recommendations presented by the U.S. National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure to physicians in managing hypertensive patients; Findings of a study on the effects of a statin-based therapy on patients with hypertension and hypercholesterolemia; Guidelines released by the International Society of Hypertension in Blacks for the management of hypertension in African Americans.

Provides information on the state of intelligent systems research in Ukraine. Research groups listed by the National Academy of Sciences information center; Centers affiliated to the V.M. Glushkov Institute of Cybernetics; List of publications that universities and scientific institutes have throughout the country.

Reports on the effect of the pulp and paper industry's waste sludges containing tetrachlorodibenzo-p-dioxin (TCDD) in spruce-fir forests on wildlife in Maine. Effect of sludge treatment on breeding birds and small mammals; Foliage and ground invertebrates; Recommendations.

This paper involves an examination of skilled manual work in the modern paper industry. The data were collected at five mills in three countries -- the UK, Australia and the USA. The questions were formulated in order to probe four theories of skilled work. The results suggest that the distinction between skilled and nonskilled work is a fundamental feature of occupational differentiation in all five plants. They also reveal that there are intra-skilled conflicts over relative pay and demarcation lines and that these are affected by the wider socio-political environment. [ABSTRACT FROM AUTHOR]

This paper is written in response to the paper "How green is blue hydrogen?" by R. W. Howarth and M. Z. Jacobson. It aims at highlighting and discussing the method and assumptions of that paper, and thereby providing a more balanced perspective on blue hydrogen, which is in line with current best available practices and future plant specifications aiming at low CO2 emissions. More specifically, in this paper, we show that: (i) the simplified method that Howarth and Jacobson used to compute the energy balance of blue hydrogen plants leads to significant overestimation of CO2 emissions and natural gas (NG) consumption and (ii) the assumed methane leakage rate is at the high end of the estimated emissions from current NG production in the United States and cannot be considered representative of all‐NG and blue hydrogen value chains globally. By starting from the detailed and rigorously calculated mass and energy balances of two blue hydrogen plants in the literature, we show the impact that methane leakage rate has on the equivalent CO2 emissions of blue hydrogen. On the basis of our analysis, we show that it is possible for blue hydrogen to have significantly lower equivalent CO2 emissions than the direct use of NG, provided that hydrogen production processes and CO2 capture technologies are implemented that ensure a high CO2 capture rate, preferably above 90%, and a low‐emission NG supply chain. [ABSTRACT FROM AUTHOR]

Presents analysis of two research in hypertension. Effect of lifestyle modification on blood pressure; Prevalence of hypertension in the U.S.

Most people in the United States agree they want some income inequality but debate exactly how much is fair. High‐status people generally prefer more inequality than low‐status individuals. Here we examine how much preferences for inequality are (or are not) driven by self‐interest. Past work has generally investigated this idea in two ways: The first is by stratifying preferences by income, and the second is by randomly assigning financial status within lab‐constructed scenarios. In this paper, we develop a method that combines both experimental control and the social experience of inequality—a simulated society experiment. Across two experiments (N = 138, observations = 690), participants voted on the distribution of rewards—first behind a veil of ignorance, and then when they were randomly assigned a status within a game of chance. Status varied repeatedly across five rounds, allowing us to measure dynamic preferences. Under the veil of ignorance, people preferred inequality favoring the top status. When the veil of ignorance disappeared, self‐interest immediately influenced inequality preferences. Those who randomly landed in top positions were satisfied with the status quo established under the veil of ignorance, whereas those who randomly landed in bottom positions wanted more equality. Yet these preferences were not stable; decisions about the optimal level of inequality changed according to changes in social status. Our results also showed that, when inequality grows in a society, preferences regarding inequality become polarized by social status. Individuals in low‐status positions, particularly, tend to demand more equality. [ABSTRACT FROM AUTHOR]

This paper investigates dynamic changes in instrumental (i.e., work‐related) tie‐seeking patterns and the structure of a communication network following a downsizing event—whereby many employees are simultaneously eliminated from a network. Our analysis spans a two‐year period and applies a resource‐ and network‐change approach to examine how survivors develop revised resource‐acquisition strategies while repositioning themselves after a downsizing. Our results demonstrate that two temporary logics of tie formation—a suspension of within‐unit homophily and a preference for seeking ties with long‐tenured employees—help employees acquire betweenness centrality during the disruption period. Specifically, we find that disruption initiates a transitional period after downsizing in which new tie‐making logics are employed, including seeking out ties with long‐tenured employees and employees outside of one's department. We observed post‐disruption, during the stabilization period after downsizing, where logics used for tie‐making in the disruption period were abandoned, pre‐disruption tie‐making logics were resumed, and betweenness centrality remained relatively constant. We discuss the theoretical and managerial implications of these results and suggest future research directions. [ABSTRACT FROM AUTHOR]

Priority for solid organ transplant generally does not consider the underlying cause of the need for transplantation. This paper argues that a distinctive set of factors justify assigning lower priority to willfully unvaccinated individuals who require transplant as a result of suffering from COVID‐19. These factors include the personal responsibility of the patients for their own condition and the public outrage likely to ensue if willfully unvaccinated patients receive organs at the expense of vaccinated ones. The paper then proposes a three‐prong test for similar deviations from the current allocation standard that incorporates patient responsibility, foreseeability and avoidability, and the frequency of the occurrence. [ABSTRACT FROM AUTHOR]

Introduction: The United States has been unsuccessful in containing the rapid spread of COVID‐19. The complex epidemiology of the disease and the fragmented response to it has resulted in thousands of ways in which spread has occurred, creating a situation where each community needs to create its own local, context‐specific learning model while remaining compliant to county or state mandates. Methods: In this paper, we demonstrate how cross sector collaborations can use the Cynefin Framework, a tool for decision‐making in complex systems, to guide community response to the COVID‐19 pandemic. Results: We explore circumstances under which communities can inhabit each of the four domains of systems complexity represented in the Cynefin framework: simple, complicated, chaotic, and complex, and describe the decision‐making process in each domain that balances health, economic, and social well‐being. Conclusion: This paper serves as a call to action for the creation of community learning systems to improve community resilience and capacity to make better‐informed decisions to address complex public health problems during the pandemic and beyond. [ABSTRACT FROM AUTHOR]

The differential impact of the COVID‐19 pandemic on communities of color in the United States along with the civil unrest taking place in 2020 in response to the killing of unarmed Black men and women by the police have increased awareness of the structural racism pervading US society. These developments have reraised the issue of reparations for Black Americans, usually proposed in the context of providing financial compensation for the injustices of slavery to the descendants of those who were enslaved. This paper will discuss the systematic racial inequality and structural racism in US society that have significantly disadvantaged racial and ethnic minorities while giving advantages to white Americans, which most recently have resulted in significantly higher mortality and morbidity among Black, Hispanic, and Native Americans during the pandemic. The paper will conceptualize reparations within the context of theories of reparative justice. It will also consider whether reparations are owed, and if so, by whom, to whom, and in what form. The final section will offer a proposal for collective reparations to the Black community and other people of color. [ABSTRACT FROM AUTHOR]

Introduction: The emergent field of learning health systems (LHSs) has been rapidly evolving as the concept continues to be embraced by researchers, managers, and clinicians. This paper reports on a scoping review and bibliometric analysis of the LHS literature to identify key topic areas and examine the influence and spread of recent research. Methods: We conducted a scoping review of LHS literature published between January 2016 and May 2020. The authors extracted publication data (eg, journal, country, authors, citation count, keywords) and reviewed full‐texts to identify: type of study (empirical, non‐empirical, or review), degree of focus (general or specific), and the reference used when defining LHSs. Results: A total of 272 publications were included in this review. Almost two thirds (65.1%) of the included articles were non‐empirical and over two‐thirds (68.4%) were from authors in the United States. More than half of the publications focused on specific areas, for example: oncology, cardiovascular care, and genomic medicine. Other key topic areas included: ethics, research, quality improvement, and electronic health records. We identified that definitions of the LHS concept are converging; however, many papers focused on data platforms and analytical processes rather than organisational and behavioural factors to support change and learning activities. Conclusions: The literature on LHSs remains largely theoretical with definitions of LHSs focusing on technical processes to reuse data collected during the clinical process and embedding analysed data back into the system. A shift in the literature to empirical LHS studies with consideration of organisational and human factors is warranted. [ABSTRACT FROM AUTHOR]

The authors announce the creation of a new feature and the call for papers to be included in a future issue of the periodical. The initial theme selected entails the improvement of efficiency and value in health care which is set to improve the quality of American Healthcare System. This theme issue is supported by the Agency for Healthcare Research and Quality (AHRQ).

Functional regions capturing local socioeconomic dynamics are a framework for territorial statistics and policy‐making. The usefulness of such statistics and policies depends on the adequateness of the regions used in the analysis. Several authors have adopted the modularity quality function to drive their regionalization methods. This function, originally devised for non‐spatial data, has limitations particularly relevant in this context. The paper discusses these limitations and illustrate them using real data for the United States. The results warn against using standard modularity to assess or optimize the quality of a functional delineation, and advocate for available alternatives that consider the spatial nature of functional regionalization. [ABSTRACT FROM AUTHOR]

Background: Melasma is an acquired melanogenesis dysfunction resulting in chronic hyperpigmentation commonly affecting the face and other frequently sun‐exposed areas of the body. Melasma typically presents in women of reproductive age and can significantly impact self‐esteem, negatively affecting one's quality of life. In the United States, melasma is often treated with application of topical agents that interfere with melanin synthesis, lasers, or chemical peels; however, in some East Asian countries, oral tranexamic acid (TXA) is widely administered to alleviate hyperpigmentation during and after childbirth. TXA is currently only FDA‐approved to treat hypermenorrhea and reduce blood loss in surgery but may offer women in the United States an additional therapeutic option to treat melasma. Aims: The aim of this paper is to evaluate the safety and baseline efficacy of oral transmexic acid as a treatment for melasma. Methods: We retrospectively surveyed 42 patients of Fitzpatrick skin types III‐VI that were prescribed 650 mg of TXA ½ tablet to be taken twice daily by mouth. Results: We found majority of patients saw noticeable improvement in their melasma. Of the 42 patients, only seven experienced side effects. The side effects noted were headaches, malaise and nausea, gastrointestinal upset, congestion, numbness in legs, hypomenorrhea, and hypermenorrhea. Patients who experienced unpleasant side effects discontinued taking oral TXA and were relieved of their symptoms. No long‐term side effects were discovered, and the side effects experienced may be due to other confounding factors. Conclusion: From this data, we concluded oral TXA is a safe and effective treatment option for patients with persistent melasma. [ABSTRACT FROM AUTHOR]

Managing wildlife populations in the face of global change requires regular data on the abundance and distribution of wild animals, but acquiring these over appropriate spatial scales in a sustainable way has proven challenging. Here we present the data from Snapshot USA 2020, a second annual national mammal survey of the USA. This project involved 152 scientists setting camera traps in a standardized protocol at 1485 locations across 103 arrays in 43 states for a total of 52,710 trap‐nights of survey effort. Most (58) of these arrays were also sampled during the same months (September and October) in 2019, providing a direct comparison of animal populations in 2 years that includes data from both during and before the COVID‐19 pandemic. All data were managed by the eMammal system, with all species identifications checked by at least two reviewers. In total, we recorded 117,415 detections of 78 species of wild mammals, 9236 detections of at least 43 species of birds, 15,851 detections of six domestic animals and 23,825 detections of humans or their vehicles. Spatial differences across arrays explained more variation in the relative abundance than temporal variation across years for all 38 species modeled, although there are examples of significant site‐level differences among years for many species. Temporal results show how species allocate their time and can be used to study species interactions, including between humans and wildlife. These data provide a snapshot of the mammal community of the USA for 2020 and will be useful for exploring the drivers of spatial and temporal changes in relative abundance and distribution, and the impacts of species interactions on daily activity patterns. There are no copyright restrictions, and please cite this paper when using these data, or a subset of these data, for publication. [ABSTRACT FROM AUTHOR]

This paper examines the persistent effects of eliminating tariffs on Mexican imports, following the implementation of the North American Free Trade Agreement (NAFTA), on Americans' human capital investment. We leverage quasi‐experimental changes in tariffs on Mexican imports across birth cohorts and within states. We show that NAFTA increases the probability of ever attending college and earning a degree. These results, however, mask important heterogeneous effects within the sample. We find white Americans drive these positive effects. In contrast, the educational attainment of racial and ethnic minorities, especially men, shrank under NAFTA, decreasing their probability of graduating from high school. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Gawrieh et al papers. To view these articles, visit https://doi.org/10.1111/apt.17849 and https://doi.org/10.1111/apt.17886 [ABSTRACT FROM AUTHOR]

In the summer of 1861, the United States embarked on its first widespread use of paper money: the Demand Notes of 1861. Although their convertibility into gold ended at the end of that year, they remained acceptable for tariff payment at a par with gold coin while they were gradually replaced with paper money that did not share this provision, the Greenbacks. We present daily observations of exchange rates between the Notes, Greenbacks, and gold for the extended period during which they simultaneously circulated. These exchange rates substantiate our revisionist notion that the Notes were replaced because the tariff provision prevented them from generating sufficient seigniorage for wartime needs. ( JEL E42, N12, N22) [ABSTRACT FROM AUTHOR]

Introduction: Respondent‐driven sampling (RDS) has been an effective sampling strategy for HIV research in many settings, but has had limited success among some youth in the United States. We evaluated a modified RDS approach for sampling Black and Latinx sexual and gender minority youth (BLSGMY) and explored how lived experiences and social contexts of BLSGMY youth may impact traditional RDS assumptions. Methods: RDS was implemented in three US cities, Baltimore, Philadelphia and Washington DC, to engage BLSGMY aged 15 to 24 years in HIV prevention or care intervention trials. RDS was modified to include targeted seed recruitment from venues, Internet and health clinics, and provided options for electronic or paper coupons. Qualitative interviews were conducted among a sub‐sample of RDS participants to explore their experiences with RDS. Interviews were coded using RDS assumptions as an analytic framework. Results: Between August 2017 and October 2019, 405 participants were enrolled, 1670 coupons were distributed, with 133 returned, yielding a 0.079 return rate. The maximum recruitment depth was four waves among seeds that propagated. Self‐reported median network size was 5 (IQR 2 to 10) and reduced to 3 (IQR 1 to 5) when asked how many peers were seen in the past 30 days. Qualitative interviews (n = 27) revealed that small social networks, peer trust and targeted referral of peers with certain characteristics challenged network, random recruitment, and reciprocity assumptions of RDS. HIV stigma and research hesitancy were barriers to participation and peer referral. Other situational factors, such as phone ownership and access to reliable transportation, reportedly created challenges for referred peers to participate in research. Conclusions: Small social networks and varying relationships with peers among BLSGMY challenge assumptions that underlie traditional RDS. Modified RDS approaches, including those that incorporate social media, may support recruitment for community‐based research but may challenge assumptions of reciprocal relationships. Research hesitancy and situational barriers are relevant and must be addressed across any sampling method and study design that includes BLSGMY in the United States. [ABSTRACT FROM AUTHOR]

Productive discourse regarding the role of racism and colonialism in conservation is growing but still limited. Inadequate recognition of these powerful forces has significantly impeded socially just conservation efforts. This paper integrates multiple disciplinary perspectives to discuss historical conservation practices in the United States and abroad to reveal challenges with moving beyond traditional approaches to conservation that perpetuate systemic racism and colonialism. Using urban greening (e.g., tree planting) in the United States as an example, we show how these challenges manifest as White ideals of nature, power disparities, and displacement and exclusion. We then put forth an agenda for antiracist, anticolonial urban conservation and urban greening. This agenda uses the tripartite environmental justice framework (i.e., distributional, recognition, and procedural justice) as a starting point, integrating and adapting more critical views of contemporary environmental justice to highlight specific policies and practices that can be applied to many conservation problems. [ABSTRACT FROM AUTHOR]

Investigates competition and microenvironmental modification in an Alaskan postfire boreal forest. Establishment of seedlings by white spruce and paper birch in patches dominated by horsetail and bluestem; Reduction of survivorship, growth and nitrogen accumulation in the presence of aboveground vegetation.

This paper analyzes the effects of pore pressure rate for a spring‐block system that is a simple model of a laboratory experiment. Pore pressure is increased at a constant rate in a remote reservoir, and slip is governed by rate and state friction. The frequency of rapid slip events increases with the increase of a nondimensional pressure rate that is the ratio of the time scale of frictional sliding to that for pressure increase. As the pressure rate increases, the more rapid increase of pore pressure on the slip surface quickly stabilizes slip events due to rate and state friction. Rate and state and pressure rate effects interact in a limited range of pressure rate and diffusivity. This range includes pressure rates and diffusivities representative of recent laboratory experiments. Plain Language Summary: Recent field observations have identified fluid injection as an important factor in causing the dramatic increase of earthquakes in the central United States, and recent laboratory experiments have observed effects of fluid pressure rate on frictional sliding. This paper studies a simple model of a laboratory experiment: a block resting on a frictional surface and pulled by a spring. The frictional resistance to sliding depends on the rate and history of sliding. Fluid pressure is increased at a constant rate at a distance remote from the surface. The paper calculates the types and characteristics of rapid slip events and their dependence on the pressure rate and how fast fluid can diffuse from the reservoir to the frictional surface. Key Points: Rapid slip events occur during the duration of a representative experiment in a limited range of pressure rate and diffusivityAbove a certain pressure rate slip events are strongly damped by a rapid decrease of effective stressInteraction between fluid diffusion and pressure rate affects the type, frequency, and magnitude of slip events [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has had a disproportionate impact on the health of Black Americans, Latinx or Hispanic Americans, and American Indians. These disparities are deeply unjust, in part, because they are the causal result of racism at both the interpersonal and structural levels. This paper argues, however, that establishing a causal connection between racism and health disparities is not the only way to explain the injustice of these disparities. The COVID‐19 health disparities are arguably unjust because health equity is a "free‐standing" demand of justice, an obligation of reparative justice, a remedy to structural injustice, and part of dismantling pernicious racial concepts. Identifying multiple accounts of injustice may lower the evidentiary bar for our normative claims and help us to identify alternative policy pathways for ending health inequity. [ABSTRACT FROM AUTHOR]

Racism has resulted in significant disproportionality and disparity in the US child welfare system. Being Black is not an inherent risk factor for child abuse and neglect yet Black children are almost twice as likely to be victims of substantiated abuse and neglect claims compared to other racial groups. Addressing the disproportionality within the child welfare system due to systemic racism falls squarely under the purview of bioethics. In this paper, we briefly review the impact of racism on child welfare. We then discuss some ethical considerations that mandatory healthcare reporters should think through when determining whether to report potential abuse and neglect. Specifically, we discuss the need for a broader consideration of what constitutes harm. We then present a hypothetical composite case to illuminate where and how bias can enter the process of referral to child protective services (CPS). We encourage thoughtful reporting with consideration of social and historical context and alternative explanations for worrisome findings. We recommend using evidence, avoiding assumptions by seeking clarification from families and ensuring internal consistency. When contemplating CPS referral, medical providers should feel empowered to ask questions if there is concern for potential bias. The ultimate goal is to protect children from harm. If there are clear safety concerns—they must be addressed. However, in the many cases where the safety concern is less tangible, we need to expand our considerations of the harms that can befall children, especially children of color. [ABSTRACT FROM AUTHOR]

For the past forty years, United States school districts have increasingly hired mathematics specialists to support the teaching and learning of mathematics. Despite the prevalence of this professional development structure, this is a relatively new research topic for the mathematics education field. In this paper, we report findings from an exploration of literature between 1981 and 2018 to examine the role of mathematics specialists (MSs). In particular, we examine: (a) MS positioning across research; (b) historical trends of school‐based MS research; and (c) orientations of school‐based MSs within research. Using the McGatha and Rigelman framework as an analytic lens, we found that beyond the positions identified in their framework (coach, intervention specialist, teacher), there were four additional MS positionings within the research (learner, other p‐12 stakeholder, university stakeholder, unknown). Ultimately, we forward an expansion to the McGatha and Rigelman framework to include these new categories, as well as contextual descriptions and working definitions to support future research in more accurately and robustly capturing the ways in which MSs are investigated and reported on in research. [ABSTRACT FROM AUTHOR]

I consider a contest between scholars on the basis of three popular indices of citation. There exist equilibria in which there are more and better‐quality papers in the total citations contest than in the h‐index contest. In some cases, the total citations contest yields the same quality of papers but more papers than the Euclidean contest. As the cost of writing a paper increases,the h‐index is inferior to the total citations index in both the quality and quantity of papers. This result is partly driven by how the number of papers constrains how the h‐index counts citations. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Gawrieh et al papers. To view these articles, visit https://doi.org/10.1111/apt.17849 and https://doi.org/10.1111/apt.17871 [ABSTRACT FROM AUTHOR]

As science becomes increasingly cross‐disciplinary and scientific models become increasingly cross‐coupled, standardized practices of model evaluation are more important than ever. For normally distributed data, mean squared error (MSE) is ideal as an objective measure of model performance, but it gives little insight into what aspects of model performance are "good" or "bad." This apparent weakness has led to a myriad of specialized error metrics, which are sometimes aggregated to form a composite score. Such scores are inherently subjective, however, and while their components may be interpretable, the composite itself is not. We contend that, a better approach to model benchmarking and interpretation is to decompose MSE into interpretable components. To demonstrate the versatility of this approach, we outline some fundamental types of decomposition and apply them to predictions at 1,021 streamgages across the conterminous United States from three streamflow models. Through this demonstration, we hope to show that each component in a decomposition represents a distinct concept, like "season" or "variability," and that simple decompositions can be combined to represent more complex concepts, like "seasonal variability," creating an expressive language through which to interrogate models and data. Plain Language Summary: Models are essential scientific tools for explaining and predicting phenomena ranging from weather and climate, to health outcomes, to economic development, to the origins of the universe, and testing competing models is one of the most basic scientific activites. Yet, how scientists evaluate and justify their models can be inconsistent or even arbitrary. Traditionally, one performance metric—such as mean squared error—is used to identify the best model, but one metric provides little insight into what aspects of a model are "good" or "bad." This paper proposes a basic language for expressing different aspects of a model's performance. On one hand, this is useful for determining which aspects of model may require revision, but it also allows the modeler to separate out the best elements among several models and combine them to form an ensemble, analogous to how an audio engineer mixes together multiple tracks to form the best rendition of a musical piece. Key Points: Mean squared error (MSE) is an objective but somewhat enigmatic measure of model performanceMSE can be decomposed into components that quantify specific aspects of model performance, such as bias and varianceMixing components among models yields a form of ensemble prediction [ABSTRACT FROM AUTHOR]

Distortion‐induced fatigue cracking is a concern for many aging steel bridges in the United States. Human visual inspections to characterize fatigue cracks have many drawbacks including inconsistencies in identification, significant time and monetary costs, and safety risks posed to the lives of both inspectors and the traveling public due to lane closures. Digital image correlation (DIC) is a vision‐based technology which has shown promise for identifying and characterizing fatigue cracks. Three‐dimensional DIC measurements can capture full‐field displacements and strains, allowing for detection and characterization of both in‐plane and distortion‐induced fatigue cracks. This paper describes an experimental study in which a half‐scale steel girder to crossframe subassembly was subjected to distortion‐induced fatigue loading to produce multiple geometrically complex cracks. A DIC‐based crack characterization methodology was applied to quantify the cracks, which was successful at characterizing cracks propagating in the girder web but struggled to characterize horizontal cracks. Additional work is needed to improve the accuracy of the DIC‐based crack characterization methodology to use as an automated bridge inspection tool. [ABSTRACT FROM AUTHOR]

Presents the Milbank Memorial Fund's call for proposals for papers that explore the facts, folklore, politics, and future of entitlements. Significance of entitlements to the future of American families; Entitlements as third trail of American politics.

Classifying images using supervised machine learning (ML) relies on labeled training data—classes or text descriptions, for example, associated with each image. Data‐driven models are only as good as the data used for training, and this points to the importance of high‐quality labeled data for developing a ML model that has predictive skill. Labeling data is typically a time‐consuming, manual process. Here, we investigate the process of labeling data, with a specific focus on coastal aerial imagery captured in the wake of hurricanes that affected the Atlantic and Gulf Coasts of the United States. The imagery data set is a rich observational record of storm impacts and coastal change, but the imagery requires labeling to render that information accessible. We created an online interface that served labelers a stream of images and a fixed set of questions. A total of 1,600 images were labeled by at least two or as many as seven coastal scientists. We used the resulting data set to investigate interrater agreement: the extent to which labelers labeled each image similarly. Interrater agreement scores, assessed with percent agreement and Krippendorff's alpha, are higher when the questions posed to labelers are relatively simple, when the labelers are provided with a user manual, and when images are smaller. Experiments in interrater agreement point toward the benefit of multiple labelers for understanding the uncertainty in labeling data for machine learning research. Plain Language Summary: After hurricanes and storms, pictures taken from a plane can be used to observe how the coast was impacted. A single flight might take thousands of pictures. If a computer could automatically analyze the pictures, then a person would not need to look at them one‐by‐one. To teach a computer to analyze images, we need many pictures and many labels that describe what is visible in each picture. But where do we get those labels? Typically, a coastal scientist labels the pictures by sorting them into folders or typing codes into a spreadsheet. But does every coastal scientist label pictures the same way? Some labeling questions are easy to answer, and scientists mostly agree ("Is this image all water?"). Other labeling questions are harder to answer, and cause disagreement ("Was there damage to buildings?"). This paper is about how well scientists agree when labeling the same pictures, and how we can improve agreement among scientists. We try some experiments and offer a few ideas on how to improve agreement. We suggest writing very clear questions, using smaller images, and having a comprehensive manual. It turns out that having a manual with examples—and reading the manual!—really helps. Key Points: We measure agreement among coastal scientists labeling the same sets of poststorm imagesCoastal scientists agree more when rating landforms, less when labeling inferred processesIterating on questions, providing documentation, and using smaller image sizes all increase agreement [ABSTRACT FROM AUTHOR]

Objective: To shorten the Patient Engagement In Research Scale (PEIRS) to its most essential items and evaluate its measurement properties for assessing the degree of patients' and family caregivers' meaningful engagement as partners in research projects. Methods: A prospective cross‐sectional web‐based survey in Canada and the USA, and also paper‐based in Canada. Participants were patients or family caregivers who had engaged in research projects within the last 3 years, were ≥17 years old, and communicated in English. Extensive psychometric analyses were conducted. Results: 119 participants: 99 from Canada, 74 female, 51 aged 17‐35 years and 50 aged 36‐65 years, 60 had post‐secondary education, and 74 were Caucasian/white. The original 37‐item PEIRS was shortened to 22 items (PEIRS‐22), mainly because of low inter‐item correlations. PEIRS‐22 had a single dominant construct that accounted for 55% of explained variance. Analysis of PEIRS‐22 scores revealed the following: (1) acceptable floor and ceiling effects (<15%), (2) internal consistency (ordinal alpha = 0.96), (3) structural validity by fit to a Rasch measurement model, (4) construct validity by moderate correlations with the Public and Patient Engagement Evaluation Tool, (5) good test‐retest reliability (ICC2,1 = 0.86) and (6) interpretability demonstrated by significant differences among PEIRS‐22 scores across three levels of global meaningful engagement in research. Conclusions: The shortened PEIRS is valid and reliable for assessing the degree of meaningful patient and family caregiver engagement in research. It enables standardized assessment of engagement in research across various contexts. Patient or public contribution: A researcher‐initiated collaboration, patient partners contributed from study conception to manuscript write‐up. [ABSTRACT FROM AUTHOR]

The vulnerability of Positioning, Navigation, and Timing (PNT) services derived from Global Navigation Satellite Systems (GNSS) makes having a resilient and accurate Alternative PNT (APNT) based on high‐power terrestrial radio sources necessary. The L‐band is very crowded spectral real estate with GNSS, Distance Measuring Equipment (DME) and Air Traffic Control Beacon System (ATCRBS) signals occupying the band from 900–1600 MHz. Thus, as getting new signal and spectrum for APNT would be difficult, we must leverage existing transmissions and infrastructure. The ∼660 Automatic Dependent Surveillance‐Broadcast (ADS‐B) ground stations in the United States represent significant infrastructure that can be leveraged for APNT. However, as ADS‐B was designed for surveillance, it does not inherently possess features necessary to support APNT goals. This paper describes and demonstrates techniques for using ADS‐B Universal Access Transceiver (UAT) signals for PNT. We develop methods to use all ground UAT signals to provide robust, multi‐frequency pseudoranges. We examine the ranging and positioning performance of the UAT signal on the ground and in flight, to demonstrate its ranging accuracy, and hence the timing and synchronization of the station. We demonstrate and analyze navigation using UAT signals, as well as the intra‐system interference challenges of using multiple UAT stations. [ABSTRACT FROM AUTHOR]

Across disciplines, there is great anticipation that evolving cell therapies may finally provide a therapeutic option for conditions in dire need. These conditions are typically complex and their pathophysiology incompletely understood, hindering the development of robust preclinical models and the precise assessment of therapeutic effects in human studies. This article provides an overview of the status of cell therapy investigations in two common neurodevelopmental disorders, cerebral palsy and autism spectrum disorder. Challenges facing this line of study, including inherent heterogeneity, knowledge gaps, and unrealistic expectations, are discussed. Much progress has been made in the past decade, but to definitively determine if cell therapies have a role in the treatment of neurodevelopmental disorders, both fields will need to evolve together. WHAT THIS PAPER ADDS: The safety profile of reported cell therapies in children with neurodevelopmental disorders is encouraging. Efficacy trials in cerebral palsy and autism spectrum disorder are ongoing in the United States and Asia. Unresolved issues pertain to the properties of the cells being studied and the characteristics of the neurodevelopmental conditions themselves. [ABSTRACT FROM AUTHOR]

Objective: To analyze perioperative complications, resource consumption, and inpatient mortality of patients who receive total joint arthroplasty (TJA) with a concomitant diagnosis of a primary hypercoagulable state (PHS). The following questions were posed in the present paper. First, do patients undergoing TJA with PHS have increased risk of deep venous thrombosis (DVT), pulmonary embolism (PE), and periprosthetic joint infection (PJI)? Second, what other in‐hospital complications are more likely among PHS patients undergoing TJA? Third, do TJA patients with PHS usually consume greater in‐hospital resources? Fourth, do PHS patients suffer higher mortality rates compared to non‐PHS patients? Finally, have PHS patients received proper anticoagulant management in past arthroplasties? Methods: The National Inpatient Sample (NIS) database for the years between 2003 and 2014 was searched to identify patients undergoing primary TJA. Patients with PHS were identified with the ICD‐9‐CM code 289.81. The χ2‐test, the Pearson test, and adjusted multivariate regression analysis were performed to evaluate the difference and odds ratios between the positive and negative diagnosis groups. Results: From 2003 to 2014, a total of 2,044,356 patients were identified in the NIS as undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) in the United States. A total of 4664 patients (0.2%) were identified as having PHS. Compared with the non‐PHS group, TJA patients with PHS had a higher risk of DVT (THA: odds ratio [OR] = 8.343, 95% CI: 5.362–12.982, P < 0.001; TKA: OR = 4.712, 95% CI: 3.560–6.238, P < 0.001) but did not have increased risk of PE (THA: OR = 1.306, 95% CI: 0.48–3.555, P = 0.602; TKA: OR = 1.143, 95% CI: 0.687–1.903), and only PHS patients in the THA group had higher risks of inpatient mortality (OR = 3.184, 95% CI: 1.348–7.522, P = 0.008) and periprosthetic joint infection (OR = 3.343, 95% CI: 1.084–10.879, P = 0.036). In addition, PHS patients had extended length of stay, higher total costs, and increased risks of certain other complications, such as peripheral vascular disease, hemorrhage, and thrombophlebitis. Conclusion: In the present study, PHS patients had higher risks of DVT, greater in‐hospital resource consumption, and certain other perioperative complications. However, PHS was not associated with increased risk of PE in TJA patients in the United States between 2003 and 2014. While potential hazards of PHS have already been recognized, the present study revealed additional concerns and demonstrated that further improvements in the perioperative management of patients with hereditary hypercoagulable disorders are essential. [ABSTRACT FROM AUTHOR]

In recent years many countries all over the world adopted a variety of preservation tools and market‐oriented solutions to contain land consumption. Among these countries Italy slowly began to incorporate the principles of the free market into the urban planning programmes. The United States Transfer of development rights programmes (TDR) represent a reference point for a market‐based approach in the field of environmental preservation policies. In this paper we compared the criteria successfully adopted by the US TDR programmes to the specifications adopted by the municipal plans of three important Italian cities (Milan, Rome and Florence) and we discussed their efficacy to control the urban growth. [ABSTRACT FROM AUTHOR]