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This article provides a systematic review of the quantitative social science research on broadband Internet technology in rural areas. Specifically, we summarize the literature on 1) rural broadband availability and adoption behaviors and 2) the implications of these behaviors for rural businesses, public policy initiatives, and regional development. In the studies reviewed, rural areas suffer from both lower availability and lower adoption rates compared to their urban counterparts. However, researchers disagree on whether supply frictions inherent to rural areas or heterogeneous demand and adoption behaviors are the major cause of this outcome. Researchers widely agree that high-speed Internet improves economic outcomes of rural areas, whether it is through increases in business activity or in more general economic development measures (e.g. productivity, jobs, income). Impact evaluations of rural broadband policy initiatives produced mixed results, highlighting the need for a better understanding of agents' incentives. This review points to four areas for future research. One, assessments of the long-term impact of broadband on rural economies. Two, analyses of the net effect of broadband on economic development outcomes (e.g. migrants, job creation). Three, assessments of economic development impacts associated with broadband speed. Four, assessments of the efficacy of broadband policies. [ABSTRACT FROM AUTHOR]

This focused issue entitled "Universities and Regional Development" contains three papers. All three papers focus on universities and their involvement in translating research for commercialization, which in turn supports economic development that often extends beyond the local region. [ABSTRACT FROM AUTHOR]

Rising infrastructure costs for water providers and the rising cost of water for households pose several challenges for water providers, policy makers, and the research community. Consumers may utilize several strategies for coping with rising water costs including reduced water use or spending reductions on other household goods and services. To provide a first glance at the link between rising water bills and consumer spending, this study analyzes data from a household survey in the United States to understand how consumers may change spending behavior given various water bill increase scenarios. Results of this analysis provide insights into the demographics of households likely to be affected, the industries that could be affected, and at what bill increase levels these trends are most pronounced. While additional research on this topic is needed, these results suggest a stronger emphasis on long-term water management planning and allocation of resources to building and maintaining water infrastructure may be required. For utilities, this means a consideration of nonrevenue sources of funds to pay for rising water costs and strategies for making water more affordable for customers without deferring infrastructure improvements. [ABSTRACT FROM AUTHOR]

To evaluate actions taken to implement the Telecommunications Act of 1996, the primary goal of which was to foster competition in the industry, the FCC created a standardized form (Form 477) to collect information about broadband deployment and competition in local telephone service. These data represent the best publicly available record of broadband provision in the United States. Despite the potential benefits offered by this database, there are several nuances to these data related to shifting geographies and reporting requirements that uncorrected, prevent them from being used as an uninterrupted time series for longitudinal analyses. Given the analytical challenges associated with the FCC Form 477 data, the purpose of this paper is to present a solution to the fragmented nature of these data which prevents meaningful longitudinal analyses of the digital divide. Specifically, this paper develops and describes a procedure for producing an integrated broadband time series (BITS) for the last decade (2008–2018). This includes the procedures for using these data, their value to social and economic analysis, and their underlying limitations. The core contribution of this paper is the creation of data infrastructure for investigating the evolution of the digital divide. [ABSTRACT FROM AUTHOR]

The ability to pay for water and wastewater services is a growing issue in the developed world. To this point in time, utilities have helped customers grappling with affordability issues using different types of customer assistance programs (CAPs). Income‐based billing approaches differ from CAPs in that bills are structured so as to be affordable for customers at the outset. Recently, the City of Philadelphia implemented an innovative program to work towards resolving the affordability problem in their city using income‐based billing. This tiered assistance program or TAP structures bills for water, wastewater, and stormwater services to program enrollees' income. Given the innovative nature of the program, this paper describes the rollout of TAP and assesses the impact of the program on customers and utility revenues. The paper closes with a critical assessment of TAP and considerations for utilities evaluating the implementation of similar programs. [ABSTRACT FROM AUTHOR]

• Remittances implicated in land system maintenance and transformation. • Remittances and land change seldom a primary focus of research. • Four non-exclusive pathways identified for impacts of remittance expenditures on land systems. • Remittance expenditures associated with six types of land system changes. • Four avenues for future research identified to advance understanding of remittance-land dynamics. Remittances—funds sent by migrants to family and friends back home—are an important source of global monetary flows, and they have implications for the maintenance and transformation of land systems. A number of published reviews have synthesized work on a variety of aspects of remittances (e.g., rural livelihoods, disasters, and economic development). To our knowledge, there are no reviews of work investigating the linkages between remittances and land change, broadly understood. This knowledge gap is important to address because researchers have recognized that remittances flows are a mechanism that helps to explain how migration can affect land change. Thus, understanding the specific roles remittances play in land system changes should help to clarify the multiple processes associated with migration and their independent and interactive effects. To address the state of knowledge about the connection between remittances and land systems, this paper conducts a systematic review. Our review of 51 journal articles finds that the linkages uncovered were commonly subtle and/or indirect. Very few studies looked at the direct connections between receipt of remittances and quantitative changes in land. Most commonly, the relationship between remittances and land change was found to occur through pathways from labor migration to household income to agricultural development and productivity. We find four non-exclusive pathways through which households spend remittances with consequent changes to land systems: (1) agricultural crops and livestock, (2) agricultural labor and technologies, (3) land purchases, and (4) non-agricultural purchases and consumables. In the papers reviewed, these expenditures are linked to various land system change outcomes, including land use change, soil degradation, pasture degradation, afforestation/deforestation/degradation, agricultural intensification/extensification/diversification, and no impact. These findings suggest four avenues for future research. One avenue is the use of the theoretical lens of telecoupling to understand how remittances may produce wider-scale changes in land systems. A second avenue is further examination of the impacts of shocks and disturbances to remittance flows on land change both in migrant sending and in remittance receiving areas. A third avenue is scholarship that examines the extent that household uses of remittances have a "ripple effect" on land uses in nearby interlinked systems. A fourth avenue for future work is the use of spatially explicit modeling that leverages land cover and land use data based on imagery and other geospatial information. [ABSTRACT FROM AUTHOR]

Understanding the regional economic implications of rising water and wastewater services is important, because these services are household necessities. To date, however, there are few (if any) studies examining the link between water costs and indicators of economic vitality such as jobs, output, and regional income. To advance work on this particular topic, this paper proposes a novel methodology that estimates changes in household spending information from the Consumer Expenditure Survey (CES) for a particular change in water prices. This vector of final demand changes is then linked to multi-regional input-output (MRIO) models to estimate the regional economic impacts associated with changes in consumer spending patterns. To demonstrate this methodology, three water price increase scenarios are derived, and associated changes in final demand estimated. [ABSTRACT FROM AUTHOR]

Inner city revitalization efforts centered on fostering new business activity are controversial because they assume that the job creating capacity of new businesses is capable of impacting aggregate employment levels in inner city neighborhoods. Given this controversy, this article examines the link between new business activity and inner city employment growth in Phoenix, Arizona. Analytical results highlight job creation from new business activity but a net negative association between new business activity and employment growth stemming from the loss of jobs from large employers in inner city neighborhoods. This relationship highlights that encouraging new business activity is not necessarily a bad idea for local residents and customers, but should not be viewed as a panacea for all inner city problems. Instead, new business activity should be viewed as one component of multifaceted initiatives to revitalize inner city neighborhoods. [ABSTRACT FROM AUTHOR]

This article reviews sources of uncertainty in broadband provision data from Federal Communications Commission's Form 477 database, which is the largest publicly available broadband database for the United States. This uncertainty analysis reveals that reporting thresholds result in understating of broadband in rural areas serviced by smaller providers in the 1999–2004 ZIP code area dataset. In this same time series, the routine used to aggregate data to larger spatial units (i.e., counties) produces variations in the amount of autocorrelation detected by diagnostic spatial statistics. The amount of autocorrelation in the data also varies with the strategy implemented for interpolating suppressed data. This investigation also highlights the value of a spatial approach to visualizing and analyzing the impact of uncertainty on broadband availability. [ABSTRACT FROM AUTHOR]

There are concerns across government, industry, and academia over the inadequacies of data on broadband Internet connections. These inadequacies are important to consider because government policies and regulations, industry strategies, and scholarly research can be impacted by inaccurate or distorted data. Given that there are ongoing discussions about policy initiatives to improve these data, this article sets out to critically review publicly available data, identify important limitations of these data, and profile studies that have used these data successfully. In this review, the dynamic nature of broadband data will be discussed and the tradeoffs of pursuing further investments to create better databases evaluated. This evaluation suggests a more fruitful research path would be to recognize and work around existing data drawbacks, using the studies profiled in this article as examples, to explore a multitude of issues related to broadband availability, adoption, and use. [ABSTRACT FROM AUTHOR]

Abstract: Despite burgeoning interest in entrepreneurial ecosystems, there is little information on metrics for studying the actors and interconnections within these systems. The increasing availability of data and metrics for characterizing entrepreneurial activity in recent years provide opportunities for analyzing EE in more holistic ways. A critical first step in advancing work on this topic, however, is to critically review the use and limitations of currently available data with a focus on the very recent ecosystems literature, as well as constituent topics such as entrepreneurial heritage and spinoffs, entrepreneurial culture, and studies of emerging ecosystems in peripheral regions. In this review, the problems and prospects of available data are discussed, particularly the spatial scales (national or subnational) at which they are available. The paper closes with a critical discussion of the data needed to move the field forward in the four ecosystem‐related topical areas and answer important questions related to the nuanced geographies of EE at the subnational level. This discussion suggests present gaps may be related to a poverty of data‐sharing efforts rather than a poverty of available data. [ABSTRACT FROM AUTHOR]

In a recent issue of I Critical Care Medicine i , Maharaj et al ([1]) aims to quantify the impact of decisions to withdraw, withhold, or discontinue life-sustaining therapies on mortality in ICU patients. Communication along the continuum of care and at the end of life is a learned and challenging skill which is essential to the humane treatment of our patients. The "withdrawal of care" terminology has been scrutinized ([3], [4]), and alternative accurate phrasing may include withdrawal or discontinuation of life-sustaining or ineffective therapies. [Extracted from the article]

Over the years, research on relocation activity has provided insights about the characteristics of firms and regions that drive relocation. The spatial dimensions of these relocation decisions, however, particularly within states or metropolitan areas, remain an understudied aspect of the relocation literature. There is also little work comparing the destinations of relocations originating from within metropolitan areas compared to relocation activity from other states. Given the theoretical and practical importance of higher resolution, comparative research on relocation activity within metropolitan areas, this article uses both areal and point-based spatial statistics to test hypotheses about similarities and differences in the relocation behavior of locally oriented and out-of-state businesses within the Phoenix, Arizona, metropolitan area. Analytical results highlight distinct differences in the destinations of relocation activity originating from within the metropolitan area compared to out-of-state relocation activity. Intrametropolitan relocations tend to locate in less expensive and racially and ethnically diverse neighborhoods, whereas out-of-state relocations locate in wealthier, well-known locations of the metropolitan area. Out-of-state relocations are also less likely to locate in the downtown core. This suggests that expensive smokestack-chasing efforts directed at attracting businesses from out of state are unlikely to help revitalize the downtown core. [ABSTRACT FROM AUTHOR]

Background: Food access is a global issue, and for this reason, a wealth of studies are dedicated to understanding the location of food deserts and the benefits of urban gardens. However, few studies have linked these two strands of research together to analyze whether urban gardening activity may be a step forward in addressing issues of access for food desert residents. Methods: The Phoenix, Arizona metropolitan area is used as a case to demonstrate the utility of spatial optimization models for siting urban gardens near food deserts and on vacant land. The locations of urban gardens are derived from a list obtained from the Maricopa County Cooperative Extension office at the University of Arizona which were geo located and aggregated to Census tracts. Census tracts were then assigned to one of three categories: tracts that contain a garden, tracts that are immediately adjacent to a tract with a garden, and all other non-garden/non-adjacent census tracts. Analysis of variance is first used to ascertain whether there are statistical differences in the demographic, socio-economic, and land use profiles of these three categories of tracts. A maximal covering spatial optimization model is then used to identify potential locations for future gardening activities. A constraint of these models is that gardens be located on vacant land, which is a growing problem in rapidly urbanizing environments worldwide. Results: The spatial analysis of garden locations reveals that they are centrally located in tracts with good food access. Thus, the current distribution of gardens does not provide an alternative food source to occupants of food deserts. The maximal covering spatial optimization model reveals that gardens could be sited in alternative locations to better serve food desert residents. In fact, 53 gardens may be located to cover 96.4% of all food deserts. This is an improvement over the current distribution of gardens where 68 active garden sites provide coverage to a scant 8.4% of food desert residents. Conclusion: People in rapidly urbanizing environments around the globe suffer from poor food access. Rapid rates of urbanization also present an unused vacant land problem in cities around the globe. This paper highlights how spatial optimization models can be used to improve healthy food access for food desert residents, which is a critical first step in ameliorating the health problems associated with lack of healthy food access including heart disease and obesity. [ABSTRACT FROM AUTHOR]

Of unplanned admissions, 11% were posted on the overnight OR list, 53% were called in by a perioperative team member the day of admission, and 29% appeared to the PICU without any type of communication to the team. B Methods: b Over 45 days, a daily REDCap survey was administered to PICU charge nurses aiming to identify new admissions from the operating room, whether they were considered planned, how the team learned about the new patient admission (overnight OR list, bed reservation email, call from perioperative team day of admission, etc.), and if the intended destination was posted on Epic. B Introduction: b The lack of a standard communication process around anticipated postoperative destination for patients leads to inefficiencies and staffing challenges in the pediatric intensive care unit (PICU). [Extracted from the article]

Relationship Between Spike IgG and Timeframe of MIS-C (r=0.61), Peak Ferritin and Anakinra (r=0.63), and Peak Ferritin and Timeframe of MIS-C (r=0.34). B Conclusions: b The Timing of MIS-C Diagnosis in Relation to the Index of COVID-19 Infection does Vary by Variant with a 6.9 Day Increase in Average Since the Start of the Pandemic. COVID-19 Variant Timeframes Were Defined by Dominant (>50% cases) Strand in the United States (Alpha/Beta/Gamma 1/21/20-6/25/21, Delta 6/26/21-12/17/21, and Omicron 12/18/21-Present). [Extracted from the article]

Background: The fast-changing labor market highlights the need for an in-depth understanding of occupational mobility impacted by technological change. However, we lack a multidimensional classification scheme that considers similarities of occupations comprehensively, which prevents us from predicting employment trends and mobility across occupations. This study fills the gap by examining employment trends based on similarities between occupations. Method: We first demonstrated a new method that clusters 756 occupation titles based on knowledge, skills, abilities, education, experience, training, activities, values, and interests. We used the Principal Component Analysis to categorize occupations in the Standard Occupational Classification, which is grouped into a four-level hierarchy. Then, we paired the occupation clusters with the occupational employment projections provided by the U.S. Bureau of Labor Statistics. We analyzed how employment would change and what factors affect the employment changes within occupation groups. Particularly, we specified factors related to technological changes. Results: The results reveal that technological change accounts for significant job losses in some clusters. This poses occupational mobility challenges for workers in these jobs at present. Job losses for nearly 60% of current employment will occur in low-skill, low-wage occupational groups. Meanwhile, many mid-skilled and highly skilled jobs are projected to grow in the next ten years. Conclusion: Our results demonstrate the utility of our occupational classification scheme. Furthermore, it suggests a critical need for skills upgrading and workforce development for workers in declining jobs. Special attention should be paid to vulnerable workers, such as older individuals and minorities. [ABSTRACT FROM AUTHOR]

Although broadband Internet infrastructure is acknowledged as a key ingredient to competitiveness, an unfortunate aspect of current work is the dominant focus on households. Given the need for more research on the multidimensional relationship between broadband and businesses, or the broadband-business nexus, this study estimates econometric models to evaluate the impact of early broadband availability on future levels of business activity. Model results suggest regions with an early advantage in broadband provision had more business growth than other regions. Model results also highlight long-lasting spatial effects on business activity stemming from broadband spillovers from core hubs to neighboring areas. [ABSTRACT FROM AUTHOR]

While it is recognized that the Internet and entrepreneurial opportunity are linked, the majority of studies analyzing business use of the Internet focus on small and medium-sized enterprises (SMEs). To address a need for adoption studies focused on new ventures, which differ from SMEs in terms of organizational stage and number of employees, this study analyzes survey data from entrepreneurs to understand factors that influence the adoption of multiple Internet and social media platforms, and the role of business incubation facilities in providing information technology assistance to these ventures. Regression analysis of survey data reveal that prior entrepreneurial experience was the most important factor in explaining a diverse number of Internet application and social media use. This finding likely stems from differences in cognitive frameworks between novice and experienced entrepreneurs, which impacts their ability to recognize opportunities and respond to technological change. The location of a new venture within a business incubation facility did not help in the diverse use of Internet applications. This result did vary by gender as model results highlighted that women in business incubation facilities were more likely to use a diversity of Internet applications than those not located in these facilities. These findings point to policy implications regarding the implementation of technology training programs for female entrepreneurs, and digital awareness/ training for novice entrepreneurs. [ABSTRACT FROM AUTHOR]

Neonatal growth can have lasting consequences on survival and reproduction. In many taxa, larger, faster growing neonates experience higher survival, reach sexual maturity more rapidly, and achieve higher lifetime fecundity. In contrast to their closest relatives, Lake Erie watersnakes grow slower, mature later, and may delay feeding until after their first hibernation. To determine if Lake Erie watersnakes do indeed delay feeding until after their first hibernation, we compared age class 0 (between birth and first hibernation) and age class 1 (emergence from hibernation and through the first full season) snakes in the field and in the laboratory. In the field, only 0.6% of pre-hibernation neonates were found to contain prey, while 11.9% of post-hibernation neonates contained prey. During captive feeding experiments, the probability of eating was positively correlated with age (binary logistic regression, Wald [ABSTRACT FROM AUTHOR]

Due to the ubiquity of mobile phones around the globe, studies are beginning to analyze their influence on health. Prior work from developed countries highlights negative mental health outcomes related to overuse of mobile phones. However, there is little work on mental health impacts of mobile phone use or ownership in developing countries. This is an important gap to address because there are likely variations in mental health impacts of mobile phones between developing and developed countries, due to cultural nuances to phone use and distinct variations in financial models for obtaining mobile phone access in developing countries. To address this gap, this study analyzes survey data from 92 households in sparse, rural villages in Uganda to test two hypotheses about mobile phone ownership and mental health in a developing country context: (i) Mobile phone ownership is higher among more privileged groups, compared to less privileged groups (ie, wealth and ethnicity); and (ii) mobile phone ownership is positively associated with a culturally-relevant indicator of mental health, ‘feelings of peace’. Results indicate that households with mobile phones had higher levels of wealth on average, yet no significant differences were detected by ethnicity. As hypothesized, mobile phone ownership was associated with increased mental well-being for persons without family nearby (in the District) (p = 0.038) after adjusting for wealth, ethnicity and amount of land for crops and land for grazing. Mobile phone ownership was not significantly associated with increased mental well-being for persons with family nearby. These findings are consistent with studies of mobile phone use in other sub-Saharan African countries which find that phones are important tools for social connection and are thus beneficial for maintaining family ties. One might infer then that this increased feeling of mental well-being for persons located farther from family stems from the ability to maintain family connections. These findings are quite different from work in developed countries where mobile phone use is a source of technology-related stress or technostress. [ABSTRACT FROM AUTHOR]

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA’s 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households. [ABSTRACT FROM AUTHOR]

As we begin to understand who uses particular social media platforms, this user information represents a way forward for understanding the types of research questions for which big data might prove valuable. In this respect, the use of social media data for analyzing entrepreneurial networks represents a promising research domain. Not only does the user profile of social media users overlap substantially with the profile of entrepreneurs, but research highlights that the entrepreneurial process is a fundamentally networked activity. Given this research promise, this study analyzes digitally mediated interactions using Twitter data collected about a variety of actors engaged in entrepreneurial networks for the United States over an eighteen-month period. Analytical results reveal that the hashtags used in this analysis (#smallbiz and #entrepreneur) do capture (albeit not exhaustively) well-known actors in entrepreneurial networks, as well as important subtleties in the geography of locales engaged in these networks. The article closes with an agenda for big data research on entrepreneurship that highlights the important role of geographers in unraveling these networked geographies given the complexities of ground-truthing geographic information from big data sources. [ABSTRACT FROM AUTHOR]

Entrepreneurial ecosystems (EE) consist of interacting components, which foster new firm formation and associated regional entrepreneurial activities. Current work on EE, however, focuses on documenting the presence of system components, which means there is little understanding of interdependencies between EE components and their evolutionary dynamics. To address these issues, the objective of the present study is to develop an evolutionary framework of EE development that integrates important components from prior work and describes how critical elements of an entrepreneurial system interact and evolve over time. The value of this framework in understanding the evolutionary dynamics of EE will be demonstrated by profiling the EE of Phoenix, Arizona. The evolutionary perspective developed is valuable because it provides a sense of how history, culture and the institutional setting impact EE. It also provides stakeholders with action points to help maintain or propel an EE to the next level. This is a distinct improvement over static approaches that provide a list of EE ingredients with no sense of their relative importance over time. The proposed framework may also be used in a comparative context to compare and contrast the evolutionary trajectory of EE to better understand why particular places remain trapped in a specific phase of growth or continue to evolve over time. [ABSTRACT FROM AUTHOR]

This study estimates econometric models to evaluate the linkage between broadband Internet connections and firms in counties across the urban hierarchy within the continental U. S. Industry-related variations in this relationship are also explored using varied definitions of the urban hierarchy. Model results indicate broadband presence in remote areas is not an explanatory factor of establishment presence. Results also suggest the manner in which the urban hierarchy is defined matters. Traditional metropolitan/nonmetropolitan and urban/rural splits of locales are insufficient to capture the geographic and industrial nuances behind this relationship. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including issue related to entrepreneurship, relationship between tourism and housing and relationship between knowledge and innovation across the urban hierarchy.

While disparities in broadband in rural areas are well documented, little research exists about broadband in tribal communities. This gap means we lack information about the trajectory of broadband deployment in tribal areas. It also means we lack comparative information about the similarities or differences in the trajectory of broadband deployment in tribal areas compared to non-tribal areas (e.g. urban and rural areas). To address this gap in our knowledge, this study utilizes longitudinal tract data constructed from information in the FCC Form 477 database to analyze broadband provision in tribal areas from 2014 to 2020. Empirical results show that rural tribes may be falling further behind the rest of the nation in broadband provision, while metropolitan tribal areas now enjoy better provision levels, on average, than their non-tribal counterparts. Additionally, the nuances of broadband distributions across tribal, rural, and urban areas make clear that a one-size-fits-all policy to aid tribal communities is inappropriate to address these and other related challenges. This is especially true as concerns about the intersection of federal broadband policy with tribal sovereignty and self-determination emerge. • This study is a longitudinal analysis of broadband provision in tribal areas. • Rural tribal areas falling behind rest of the nation in broadband provision. • Metropolitan tribal areas enjoy better provision levels than non-tribal counterparts. • Need for a policy focus on rural, tribal areas. • Customized policies that work in concert with tribal sovereignty needed. [ABSTRACT FROM AUTHOR]

Problems with currently available broadband data sources highlight the pressing need for novel data analytical methods and tools that enable policy makers to explore broadband market dynamics. Given this pressing need, the goal of this paper is to discuss the current state-of-the-art in geovisual analytic tools that could be applied to broadband analysis and demonstrate how these toolkits may be applied to answer important policy questions about the spatio-temporal evolution of broadband markets. [ABSTRACT FROM AUTHOR]

From May 2019-April 2020, there were a total of 11 PIBERT activations and 3.26 DARTs per 200,000 worked hours, and May 2020-April 2021 had 10 PIBERT activations, with 0.83 DARTs per 200,000 worked hours. Inspired by the PBE cohort within Solutions for Patient Safety, we developed a pediatric inpatient behavioral event response team (PIBERT) composed of a pediatric intensivist, pediatric critical care nurse, chaplain, and security. B Introduction: b Patient behavioral events (PBE) contribute to patient and staff harm, job dissatisfaction, increased costs, and turnover. [Extracted from the article]

Remittances are an important source of cash flows for lower-middle income countries, but may also enhance vulnerability to shocks if these financial flows are concentrated among a few sources. We utilize descriptive statistics and panel econometric models estimated via generalized least squares (GLS) to investigate whether remittances are a source of vulnerability for the newly independent states (NIS) arising from the dissolution of the former Soviet Union, who receive a substantial proportion of remittance flows from the Russian Federation. Analytical results reveal remittance inflows from the Russian Federation to the NIS, are more significant than remittance inflows from the Russian Federation to all other countries. Model results also indicate remittances to the NIS are more susceptible to geopolitical and economic shocks affecting the Russian Federation than are remittance inflows to other countries. From a policy perspective, our results suggest policymakers should strive to eliminate barriers to migration between countries to reduce the likelihood of concentrated financial flows, since concentrated remittances sources represent potential exposure to economic and geopolitical shocks of sending countries. [Display omitted] • Investigate remittance network vulnerability when inflows are undiversified. • Focus analysis on newly independent states (NIS) from dissolution of Soviet Union. • Remittances do not enhance economic vitality of NIS relative to other countries. • NIS remittances from the Russian Federation more significant than other countries. • NIS remittances more susceptible to shocks to Russian Federation than other countries. [ABSTRACT FROM AUTHOR]

Pediatric COVID-19 vaccination is effective in preventing COVID-19–related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021–October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ≥2 original monovalent COVID-19 mRNA vaccine doses against COVID-19–related hospitalization and critical illness among U.S. children and adolescents aged 5–18 years, using a case-control design. Too few children and adolescents received bivalent or updated monovalent vaccines to separately evaluate their effectiveness. Most case-patients (persons with a positive SARS-CoV-2 test result) were unvaccinated, despite the high frequency of reported underlying conditions associated with severe COVID-19. VE of the original monovalent vaccine against COVID-19–related hospitalizations was 52% (95% CI = 33%–66%) when the most recent dose was administered <120 days before hospitalization and 19% (95% CI = 2%–32%) if the interval was 120–364 days. VE of the original monovalent vaccine against COVID-19–related hospitalization was 31% (95% CI = 18%–43%) if the last dose was received any time within the previous year. VE against critical COVID-19–related illness, defined as receipt of noninvasive or invasive mechanical ventilation, vasoactive infusions, extracorporeal membrane oxygenation, and illness resulting in death, was 57% (95% CI = 21%–76%) when the most recent dose was received <120 days before hospitalization, 25% (95% CI = –9% to 49%) if it was received 120–364 days before hospitalization, and 38% (95% CI = 15%–55%) if the last dose was received any time within the previous year. VE was similar after excluding children and adolescents with *These senior authors contributed equally to this report. documented immunocompromising conditions. Because of the low frequency of children who received updated COVID-19 vaccines and waning effectiveness of original monovalent doses, these data support CDC recommendations that all children and adolescents receive updated COVID-19 vaccines to protect against severe COVID-19. [ABSTRACT FROM AUTHOR]

Multisystem inflammatory syndrome in children (MIS-C) is a serious postinfectious immune dysregulation associated with coronavirus disease 2019 that may present with severe and life-threatening cardiovascular dysfunction, hemodynamic instability, shock, and multisystem organ failure. Optimal treatment is unknown. Current standard of care consists of nonspecific anti-inflammatory and antithrombotic therapies. Interventions that target MIS-C's distinctive clinical features and immunophenotype are indicated. Remestemcel-L, an investigational mesenchymal stromal cell therapy, is a promising candidate for treatment of MIS-C because of its beneficial anti-inflammatory, immunomodulatory, endothelial function and vascular stabilizing effects, which align well with the pathophysiology of MIS-C. Here, we present the first two patients with life-threatening MIS-C ever treated with remestemcel-L under an expanded access program. Both were previously healthy children without any indication of previous coronavirus disease 2019 infection or exposure. They presented with severe clinical illness including myocardial dysfunction, hemodynamic instability, hypotension, acute kidney injury, and shock. At the time of hospital admission, both had negative polymerase chain reaction (PCR) test results and positive serology results for severe acute respiratory syndrome coronavirus 2. Both children received standard of care MIS-C treatment. Although the patients showed some clinical improvement, left ventricular ejection fraction remained reduced and inflammatory biomarkers remained significantly elevated. When treated with two intravenous doses of remestemcel-L separated by 48 hours, rapid normalization of left ventricular ejection fraction, notable reductions in biomarkers of systemic and cardiac inflammation, and improved clinical status occurred. Neither child experienced adverse effects associated with remestemcel-L administration. This treatment appears promising as a novel immunomodulatory cellular therapy for children with clinically significant cardiovascular manifestations of MIS-C. [ABSTRACT FROM AUTHOR]

Automation continues to be a disruptive force in the workforce. In particular, new automated technologies are projected to replace many mid-skill jobs, potentially displacing millions of workers. Career planning agencies and other organizations can help support workers if they are able to effectively identify optimal transition occupations for displaced workers. We drew upon the 24.2 Occupational Information Network (O*NET) Database to conduct two related studies that identify alternate occupations for truck drivers, who are at risk of job loss due to the adoption of autonomous vehicles. In Study 1, we statistically compared the jobs that we identified based on different search methods using O*NET classifications based on their similarity to the knowledge, skills, values, and interests held by truck drivers. In Study 2, we conducted a survey of truck drivers to evaluate their perceptions of the occupations identified as objectively similar to their occupation. Results indicate that optimal transition occupations may be identified by searching for occupations that share skills as well as the same work activities/industry as a given occupation. These findings hold further implications for career planning organizations and policymakers to ease workforce disruption due to automation. [ABSTRACT FROM AUTHOR]

Background: Increased breast density augments breast cancer risk and reduces mammography sensitivity. Supplemental breast MRI screening can significantly increase cancer detection among women with dense breasts. However, few women undergo this exam, and screening is consistently lower among racially minoritized populations. Implementation strategies informed by behavioral economics ("nudges") can promote evidence-based practices by improving clinician decision-making under conditions of uncertainty. Nudges directed toward clinicians and patients may facilitate the implementation of supplemental breast MRI. Methods: Approximately 1600 patients identified as having extremely dense breasts after non-actionable mammograms, along with about 1100 clinicians involved with their care at 32 primary care or OB/GYN clinics across a racially diverse academically based health system, will be enrolled. A 2 × 2 randomized pragmatic trial will test nudges to patients, clinicians, both, or neither to promote supplemental breast MRI screening. Before implementation, rapid cycle approaches informed by clinician and patient experiences and behavioral economics and health equity frameworks guided nudge design. Clinicians will be clustered into clinic groups based on existing administrative departments and care patterns, and these clinic groups will be randomized to have the nudge activated at different times per a stepped wedge design. Clinicians will receive nudges integrated into the routine mammographic report or sent through electronic health record (EHR) in-basket messaging once their clinic group (i.e., wedge) is randomized to receive the intervention. Independently, patients will be randomized to receive text message nudges or not. The primary outcome will be defined as ordering or scheduling supplemental breast MRI. Secondary outcomes include MRI completion, cancer detection rates, and false-positive rates. Patient sociodemographic information and clinic-level variables will be examined as moderators of nudge effectiveness. Qualitative interviews conducted at the trial's conclusion will examine barriers and facilitators to implementation. Discussion: This study will add to the growing literature on the effectiveness of behavioral economics-informed implementation strategies to promote evidence-based interventions. The design will facilitate testing the relative effects of nudges to patients and clinicians and the effects of moderators of nudge effectiveness, including key indicators of health disparities. The results may inform the introduction of low-cost, scalable implementation strategies to promote early breast cancer detection. Trial registration: ClinicalTrials.gov NCT05787249. Registered on March 28, 2023. [ABSTRACT FROM AUTHOR]

Background Clinical differences between critical illness from influenza infection vs coronavirus disease 2019 (COVID-19) have not been well characterized in pediatric patients. Methods We compared demographics, clinical characteristics, and outcomes of US children (aged 8 months to 17 years) admitted to the intensive care or high-acuity unit with influenza or COVID-19. Using mixed-effects models, we assessed the odds of death or requiring life support for influenza vs COVID-19 after adjustment for age, sex, race and Hispanic origin, and underlying conditions including obesity. Results Children with influenza (n = 179) were younger than those with COVID-19 (n = 381; median, 5.2 years vs 13.8 years), less likely to be non-Hispanic Black (14.5% vs 27.6%) or Hispanic (24.0% vs 36.2%), and less likely to have ≥1 underlying condition (66.4% vs 78.5%) or be obese (21.4% vs 42.2%), and a shorter hospital stay (median, 5 days vs 7 days). They were similarly likely to require invasive mechanical ventilation (both 30.2%), vasopressor support (19.6% and 19.9%), or extracorporeal membrane oxygenation (2.2% and 2.9%). Four children with influenza (2.2%) and 11 children with COVID-19 (2.9%) died. The odds of death or requiring life support in children with influenza vs COVID-19 were similar (adjusted odds ratio, 1.30; 95% confidence interval,.78–2.15; P =.32). Conclusions Despite differences in demographics and clinical characteristics of children with influenza or COVID-19, the frequency of life-threatening complications was similar. Our findings highlight the importance of implementing prevention measures to reduce transmission and disease severity of influenza and COVID-19. [ABSTRACT FROM AUTHOR]

Background Pfizer-BioNTech COVID-19 vaccine received emergency use authorization for persons ≥ 16 years in December 2020 and for adolescents 12–15 years in May 2021. Despite the clear benefits and favorable safety profile, vaccine uptake in adolescents has been suboptimal. We sought to assess factors associated with COVID-19 non-vaccination in adolescents 12–18 years of age. Methods Between June 1, 2021 and April 29, 2022, we assessed factors associated with COVID-19 non-vaccination in hospitalized adolescents ages 12–18 years enrolled in the Overcoming COVID-19 vaccine effectiveness network. Demographic characteristics and clinical information were captured through parent interviews and/or electronic medical record abstraction; COVID-19 vaccination was assessed through documented sources. We assessed associations between receipt of the COVID-19 vaccine and demographic and clinical factors using univariate and multivariable logistic regression and estimated adjusted odds ratios (aOR) for each factor associated with non-vaccination. Results Among 1665 hospitalized adolescents without COVID-19, 56% were unvaccinated. Unvaccinated adolescents were younger (median age 15.1 years vs. 15.4 years, p  < .01) and resided in areas with higher social vulnerability index (SVI) scores (median 0.6 vs 0.5, p  < .001) than vaccinated adolescents. Residence in the Midwest [aOR 2.60 (95% CI: 1.80, 3.79)] or South [aOR 2.49 (95% CI: 1.77, 3.54)] US census regions, rarely or never receiving influenza vaccine [aOR 5.31 (95% CI: 3.81, 7.47)], and rarely or never taking precautions against COVID-19 [aOR 3.17 (95% CI: 1.94, 5.31)] were associated with non-vaccination against COVID-19. Conclusions Efforts to increase COVID-19 vaccination of adolescents should focus on persons with geographic, socioeconomic, and medical risk factors associated with non-vaccination. [ABSTRACT FROM AUTHOR]

Background It is unclear how acute coronavirus disease 2019 (COVID-19)-directed therapies are used in children with life-threatening COVID-19 in US hospitals. We described characteristics of children hospitalized in the intensive care unit or step-down unit (ICU/SDU) who received COVID-19-directed therapies and the specific therapies administered. Methods Between March 15, 2020 and December 27, 2020, children <18 years of age in the ICU/SDU with acute COVID-19 at 48 pediatric hospitals in the United States were identified. Demographics, laboratory values, and clinical course were compared in children who did and did not receive COVID-19-directed therapies. Trends in COVID-19-directed therapies over time were evaluated. Results Of 424 children in the ICU/SDU, 235 (55%) received COVID-19-directed therapies. Children who received COVID-19-directed therapies were older than those who did not receive COVID-19-directed therapies (13.3 [5.6-16.2] vs 9.8 [0.65-15.9] years), more had underlying medical conditions (188 [80%] vs 104 [55%]; difference = 25% [95% CI: 16% to 34%]), more received respiratory support (206 [88%] vs 71 [38%]; difference = 50% [95% CI: 34% to 56%]), and more died (8 [3.4%] vs 0). Of the 235 children receiving COVID-19-directed therapies, 172 (73%) received systemic steroids and 150 (64%) received remdesivir, with rising remdesivir use over the study period (14% in March/April to 57% November/December). Conclusion Despite the lack of pediatric data evaluating treatments for COVID-19 in critically ill children, more than half of children requiring intensive or high acuity care received COVID-19-directed therapies. [ABSTRACT FROM AUTHOR]

The article informs that Pfizer-BioNTech vaccine, currently authorized for persons aged ≥5 years, provides a high level of protection against severe COVID-19 in persons aged 12–18 years. It is noted taht Vaccine effectiveness against multisystem inflammatory syndrome in children, which can occur 2–6 weeks after SARS-CoV-2 infection, has remained uncharacterized.

This article describes a scalar field topology (SFT)‐based methodology for the interactive characterization and analysis of hotspots for density fields defined on a regular grid. In contrast to the common approach of simply identifying hotspots as areas that exceed a chosen density threshold, SFT provides various data abstractions—such as the merge tree and the Morse complex—to characterize hotspots and their boundaries at multiple scales. Moreover, SFT enables the ranking of hotspots based on analyst‐defined importance measures, which also makes it possible to explore hotspots using a level‐of‐detail approach. We present a visual analytics system to support analysts in hotspot analysis and abstraction using SFT, and we demonstrate the merit of the proposed SFT‐based methodology on two crime datasets. [ABSTRACT FROM AUTHOR]

Pfizer-BioNTech COVID-19 vaccine is authorized for use in children and adolescents aged 12-15 years and is licensed by the Food and Drug Administration (FDA) for persons aged ≥16 (1). A randomized placebo-controlled trial demonstrated an efficacy of 100% (95% confidence interval [CI] = 75.3%-100%) in preventing outpatient COVID-19 in persons aged 12-15 years (2); however, data among adolescents on vaccine effectiveness (VE) against COVID-19 in real-world settings are limited, especially among hospitalized patients. In early September 2021, U.S. pediatric COVID-19 hospitalizations reached the highest level during the pandemic (3,4). In a test-negative, case-control study at 19 pediatric hospitals in 16 states during June 1-September 30, 2021, the effectiveness of 2 doses of Pfizer-BioNTech vaccine against COVID-19 hospitalization was assessed among children and adolescents aged 12-18 years. Among 464 hospitalized persons aged 12-18 years (179 case-patients and 285 controls), the median age was 15 years, 72% had at least one underlying condition, including obesity, and 68% attended in-person school. Effectiveness of 2 doses of Pfizer-BioNTech vaccine against COVID-19 hospitalization was 93% (95% CI = 83%-97%), during the period when B.1.617.2 (Delta) was the predominant variant. This evaluation demonstrated that 2 doses of Pfizer-BioNTech vaccine are highly effective at preventing COVID-19 hospitalization among persons aged 12-18 years and reinforces the importance of vaccination to protect U.S. youths against severe COVID-19. [ABSTRACT FROM AUTHOR]

In response to resident feedback and in an effort to promote wellness, we developed monthly resident debriefing sessions after the pediatric ICU rotation. Free text responses regarding residency wellness efforts, personal resident well-being efforts, coping strategies, and most and least helpful aspects of debriefings were examined for themes and categorized. We recommend incorporating scheduled debriefings around critical care rotations to promote resident wellbeing. [Extracted from the article]

There is currently no way to diagnose a rejection before a change in serum creatinine. This had led some to start doing SB, but little data exist on the utility and safety of SB in pediatric patients. There is also little known on practice patterns of pediatric nephrologists. A retrospective review of pediatric kidney transplant SB between January 2013 and January 2017 at a single center was performed. A survey went to the PedNeph email list. There were 47 SB; 15 at 6 months, 12 at 1 year, 13 at 2 years, and 7 at 3 years. There were 3 minor (1 gross hematuria and 2 hematomas) and no major complications. On 6-month SB, 1 had SC 1A ACR (6.7%) with no BR ACR. On the 12-month SB, there were 5 with SCBR ACR (41.7%) and 1 with SC AMR (8.3%). On the 2-year SB, there were 4 that had SCBR ACR (30.8%), and 1 with SC AMR (7.7%). On the 3-year SB, 1 had chronic transplant glomerulitis (14.3%). The survey showed that 34.3% of pediatric nephrologists perform SB. SB can be performed safely. By early identification of histological lesions, SB gives us an opportunity for individualized immunosuppressive regimens that may prevent chronic allograft dysfunction and improve long-term graft outcome. [ABSTRACT FROM AUTHOR]

A five-year site investigation was conducted at a former chemical plant in Nanjing, China. The main contaminants were 1,2,4-trichlorobenzene (TCB) reaching concentrations up to 7300 μg/L, dichlorobenzene (DCB) isomers, monochlorobenzene (MCB), and benzene. Over time, these contaminants naturally attenuated to below regulatory levels under anaerobic conditions. To confirm the transformation processes and to explore the mechanisms, a corresponding laboratory microcosm study was completed demonstrating that 1,2,4-TCB was dechlorinated to 1,2-DCB, 1,3-DCB, and 1,4-DCB in approximately 2%/10%/88% molar proportions. The DCB isomers were dechlorinated via MCB to benzene, and, finally, benzene was degraded under prevailing sulfate-reducing conditions. Dechlorination could not be attributed to known dechlorinators Dehalobacteror Dehalococcoides, while anaerobic benzene degradation was mediated by microbes affiliated to a Deltaproteobacterium ORM2, previously associated with this activity. Unidentified organic compounds, possibly aromatic compounds related to past on-site production processes, were fueling the dechlorination reactions in situ. The microcosm study confirmed transformation processes inferred from field data and provided needed assurance for natural attenuation. Activity-based microcosm studies are often omitted from site characterization in favor of rapid and less expensive molecular surveys. However, the value of microcosm studies for confirming transformation processes, establishing electron balances, assessing cocontaminant inhibition, and validating appropriate monitoring tools is clear. At complex sites impacted by multiple compounds with poorly characterized transformation mechanisms, activity assays provide valuable data to incorporate into the conceptual site model to most effectively inform remediation alternatives [ABSTRACT FROM AUTHOR]

We obtained data on network level and individual hospital bundle compliance and monthly CLABSI rates from 01/12 to 12/21. Reliable bundle performance is the mainstay of CLABSI prevention despite an unclear relationship between bundle reliability and outcomes. B Introduction: b Implementation of best practice evidence-based guidelines (bundles) has been shown to decrease Central Line-Associated Blood Stream Infections (CLABSI). [Extracted from the article]

The Solutions for Patient Safety (SPS) quality improvement collaborative has organized a cohort of children's hospitals focused on reduction of colorectal SSI by implementing four prevention factors: preoperative chlorhexidine bathing, proper antibiotic selection and timing, use of surgical closing protocol, and appropriate bowel preparation (antibiotic and/or mechanical). B Introduction: b Surgical Site Infections (SSI) are a major contributor to increased patient morbidity and mortality, with an estimated mortality rate of 3%. B Results: b Overall compliance with each prevention factor in the 52 colorectal surgeries includes: Preoperative chlorhexidine bathing 90%, mechanical bowel preparation 58%, antibiotic bowel preparation 56%, combined antibiotic and mechanical bowel preparation 44%, antibiotic prophylaxis 44%, and sterile closing protocol 2%. [Extracted from the article]