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Background: The gut microbiome is an important determinant of health and disease in preterm infants., Objectives: The objective of this article was to share our current protocol for other neonatal intensive care units to potentially expand their existing protocols, aiming to characterize the relationship between the intestinal microbiome and health outcomes in preterm infants., Methods: This prospective, longitudinal study planned to recruit 160 preterm infants born <32 weeks gestational age or weighing <1,500 g and admitted to one of two Level III/IV neonatal intensive care units. During the neonatal intensive care unit period, the primary measures included events of early life pain/stress, gut microbiome, host genetic variations, and neurobehavioral assessment. During follow-up visits, gut microbiome; pain sensitivity; and medical, growth, and developmental outcomes at 4, 8-12, and 18-24 months corrected age were measured., Discussion: As of February 14, 2020, 214 preterm infants have been recruited. We hypothesize that infants who experience greater levels of pain/stress will have altered gut microbiome, including potential adverse outcomes such as necrotizing enterocolitis and host genetic variations, feeding intolerance, and/or neurodevelopmental impairments. These will differ from the intestinal microbiome of preterm infants who do not develop these adverse outcomes. To test this hypothesis, we will determine how alterations in the intestinal microbiome affect the risk of developing necrotizing enterocolitis, feeding intolerance, and neurodevelopmental impairments in preterm infants. In addition, we will examine the interaction between the intestinal microbiome and host genetics in the regulation of intestinal health and neurodevelopmental outcomes., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The design strategies for flood risk reduction in coastal towns must be informed by the likelihood of flooding resulting from both precipitation and coastal storm surge. This paper discusses various bivariate extreme value methods to investigate the joint probability of the exceedance of thresholds in both precipitation and sea level and estimate their dependence structure. We present the results of the dependence structure obtained using the observational record at Bridgeport, CT, a station with long data records representative of coastal Connecticut. Furthermore, we evaluate the dependence structure after removing the effects of harmonics in the sea level data. Through this comprehensive analysis, our study seeks to contribute to the understanding of the joint occurrence of sea level and precipitation extremes, providing insights that are crucial for effective coastal management. [ABSTRACT FROM AUTHOR]

Working waterfront space is limited, leading to competition for coastal space among different waterfront‐dependent industries as well as non‐waterfront dependent users. Coastal margins will be shrinking as sea levels rise due to climate change, squeezing already scarce port resources, exacerbating competition for these spaces, and generating conflicts. This paper focuses on the competition for waterfront space on the Thames River of Connecticut bordered by the municipalities of New London, Groton, Norwich, Ledyard, and Montville. Emerging wind power in the new Blue Economy looks to reshape port usage in the Thames River. The recent focus on wind generation by the State of Connecticut, coupled with several competitive bidding events for wind‐generated electricity, has augmented demand for port space that will serve as a staging area for this offshore development. Although the development of wind power will occur offshore, Connecticut ports are anticipating port use by wind companies with winning bids. This paper explores the processes by which port space has been (re)allocated and contested, and examines the nature of the ensuing conflicts and outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to highlight how a group of novice principals in Connecticut and New York used relational, dispositional and situational factors to respond to the COVID-19 pandemic crisis. The study aims to support new principals and educational leaders. Design/methodology/approach: Using Mutch's (2015) dispositional, relational and situational framework to guide the inquiry, this paper uses qualitative methods and interviewing in particular to explore the questions of interest. Six novice principals were each interviewed over the 2020–2021 school year, each interview lasting approximately forty-five minutes. Data were analyzed thematically using both deductive coding techniques and cross comparative analysis. Findings: Findings show that novice principals tended to rely on dispositional factors to respond to the crisis. Additionally, novice principals reported limited responses to the situational factors of the crisis due to restricted access and guidance from the district leadership. Research limitations/implications: Due to the small sample size and methodological approach, it may be inappropriate to generalize the findings across all novice principals in all settings. Further research in additional settings and larger samples are encouraged to support the proposed findings. Practical implications: This paper has several implications for districts and leadership preparation programs. Among these is the need for leadership preparation programs to adjust their curricula to train new principals properly. Originality/value: This work fills a gap in the research regarding how new principals respond to a crisis. It also provides insights into practice and possible means to enhance the growing population of new principals entering the educational leadership workforce. [ABSTRACT FROM AUTHOR]

This paper describes a human-centered design approach to investigate unmet adolescent sexual health wants and needs among youth of color in low-income and rural communities in Texas, North Carolina, and Connecticut (n = 149). The approach involved gathering qualitative data through in-depth interviews and other human-centered design activities between April 2016 and August 2016. Data were analyzed using thematic content analysis after each round of data collection. Themes were triangulated across multiple data sources to identify key insights. Results highlighted several important unmet wants and needs. Participants shared that schools were not the preferred place to learn about sexual health and healthy relationships, due to uncomfortable and sometimes even hostile environments. When discussing the potential to use internet- and technology-based sexual health resources, participants expressed concerns over privacy, safety, and credibility of information available. Similarly, participants preferred mobile apps over websites due to the privacy of the experience. Most importantly, key emotions impacting adolescents' access to and use of sexual health resources were identified. Results indicated a preference for consuming story-based information in a text message format that described diverse experiences related to sexual health topics. Together, these findings led to the development of an innovative, mobile health intervention for adolescents, the Real Talk mobile app. This human-centered approach can support researchers and practitioners in strengthening intervention development efforts to improve the reach, adoption, and implementation of sexual health interventions. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic unfolds, every aspect of daily life is being altered in response to the virus. The pandemic has altered secondary education. Classes online, teachers struggling to learn Zoom and make lessons meaningful and relevant to students. Students struggling to make sense of this moment, struggling with mental health issues due to the loss of routine and in many cases contact with adult role models. Unfortunately, in times of crisis such as these some of the most disenfranchized people in society are completely overlooked and forgotten, such as refugees. However, if more teachers were to leverage the social studies potential of current events such as the Coronavirus, greater empathy would be felt for marginalized people more starkly impacted by the pandemic, leading ultimately to a heightened sense of civic engagement among the next generation. The purpose of this paper is to assist teachers in guiding their students through analyzing current events, such as COVID-19's impact on refugees, toward developing civic mindedness. In addition to this, the paper will discuss some of the broader societal impacts the virus is having within the United States, as well as ways in which this event may be viewed as a historical subject in the future. The paper will begin by building the content knowledge of high school social studies teachers through addressing the following question: "What is the difference between a refugee entering the United States now versus one year ago before the COVID-19 pandemic?" Following this, the authors will present an inquiry-based learning segment designed to teach the History correlated to the COVID-19 pandemic to a classroom of secondary education students. The inquiry template follows the standard C3 format utilized by the State of Connecticut. [ABSTRACT FROM AUTHOR]

The aim of this qualitative research paper was to identify how social isolation policies implemented during the COVID-19 pandemic impacted the lives of pregnant women and mothers with opioid use disorder. Between 2020 and 2022, in-depth interviews were conducted with 37 mothers and pregnant women living in the suburbs of Newark, NJ, and New Haven, CT. Participants had to be at least 18 years old, misused or abused opioids in the last 12 months while residing in a suburban location, and pregnant or caring for children aged 12 and younger. We used syndemics theory to guide our grounded theory analysis to identify relationships between social situations, health conditions, and opioid use disorder. Five major themes emerged that were either directly or indirectly impacted by social isolation caused by policies implemented during the COVID-19 pandemic: Relationships, Environment, Services, Drug Use, and Health. Findings from this study reveal new insights into how mothers and their health were impacted by prolonged social isolation policies and offer suggestions for policymakers and service providers to better address future crisis. [ABSTRACT FROM AUTHOR]

We share our collective stories as instructors and graduate students with an interest in decolonial education on how we learned together in a course on Indigenous knowledge systems (IKS). The course occurred in the environmental studies department at a predominantly White graduate school in the Connecticut river basin in the area now known as the USA. The topic of IKS is steadily gaining interest in the environmental education (EE) field, as evidenced by an increase (albeit small) in the number of publications in peer-reviewed journals. At the same time, decolonial educators are looking for ways to teach IKS in an ethical and respectful manner. Our goal for this paper was to share how we grappled with questions around ethics and cultural appropriation. For instance, as decolonial educators who are not Indigenous to communities where we work and reside, can we facilitate lessons on IKS? If so, how can we do it in a manner that honors IKS and knowledge holders, is ethical, respectful and not appropriating? We learned that applying decolonization factors was crucial. Specifically, our work revealed four key decolonization factors: centering programs in Indigenous philosophies of education, privileging Indigenous voices and engaging Elders as experts, promoting Etuptmumk/two-eyed seeing, and employing Indigenous ways of teaching and learning. This paper makes contributions to the environmental education field, particularly decolonial educators who are seeking respectful and ethical ways to engage with Indigenous knowledge systems. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the Recovering Citizenship Learning Collaborative (RCLC), a training, consultation and implementation effort for 13 local mental health authorities and two state hospitals. Design/methodology/approach: The learning collaborative used a Recovering Citizenship approach, which holds that recovery occurs in the context of people's lives in their communities and society, that is, their citizenship. The RCLC was implemented by the Connecticut Department of Mental Health and Addiction Services (DMHAS) in the USA and the Yale Program for Recovery and Community Health along with lived experience leaders. The RCLC supported system change through training DMHAS staff on concepts of recovery and citizenship and developing agency action plans, with the long-term goal of improving citizenship-oriented care at the agency-level and recovery and citizenship-related outcomes for people receiving services. Findings: Lessons learned include the importance of assessing organizational readiness for change, addressing leadership investment and attention to systemic barrier, and offering tools to promote structure and accountability. Next steps are supporting agency action plans through technical assistance, state-wide educational offerings and a resource library. Research limitations/implications: Systemic barriers are considerable and must be addressed before system transformation is possible. Practical implications: The authors are hopeful that the RCLC has been part of overcoming those challenges and can be a tool for building foundations for improving citizen practices and people's citizenship-related outcomes. Social implications: Next steps are sustaining agency action plans, ongoing agency-specific technical assistance, ongoing state-wide educational offerings and a resource library. Originality/value: The RCLC has provided tools and supports to build the foundation for improved citizenship practices and client outcomes at the multiagency system level. [ABSTRACT FROM AUTHOR]

This paper proposes a Lasso-type estimator for a high-dimensional sparse parameter identified by a single index conditional moment restriction (CMR). In addition to this parameter, the moment function can also depend on a nuisance function, such as the propensity score or the conditional choice probability, which we estimate by modern machine learning tools. We first adjust the moment function so that the gradient of the future loss function is insensitive (formally, Neyman orthogonal) with respect to the first-stage regularisation bias, preserving the single index property. We then take the loss function to be an indefinite integral of the adjusted moment function with respect to the single index. The proposed Lasso estimator converges at the oracle rate, where the oracle knows the nuisance function and solves only the parametric problem. We demonstrate our method by estimating the short-term heterogeneous impact of Connecticut's Jobs First welfare reform experiment on women's welfare participation decision. [ABSTRACT FROM AUTHOR]

Demand response (DR) program empowers the dynamic prices to actively optimize the consumption. This optimized consumption plays a vital role in resolving the complex operation and reliability issues in the electricity market. The human behavior aspect of consumers explained by several models that have been reported in the literature. These models depend on the classical utility factor. The effect of price on the consumer's decision in the field of energy efficiency and reduction of consumption based on behavioral characteristics are two important aspects of DR programs. In absence of such characteristics, results become non‐viable. In this paper, the footprint of two time‐based DR programs is explored on the peak reduction namely; Real‐Time Pricing (RTP) and Peak Time Rebate (PTR). Artificial Neural Network (ANN) based topologies for two DR programs are proposed. The proposed topologies employ variation in demand and price, subsequently for simulating an online DR simulator. Demand before and after the RTP and PTR was calculated and compared with four ANN‐based DR topologies namely; Radial Basis Function Neural Network‐Demand Response (RBFN‐DR), Feedforward Backprop‐Demand Response (FFBP‐DR), Layer Recurrent‐Demand Response (LR‐DR), and Generalized Regression‐Demand Response (GR‐DR). The proposed models are tested on three test cases. The first case tested on hourly data of New England ISO of Connecticut on August 18, 2014, the second case tested on hourly data of the same system on August 18, 2020, and the third case tested on hourly residential data of test smart grid. By assessing the results from all three test cases, depicted that RBFN‐DR proved its efficacy by giving better results for both price‐based programs namely; RTP and PTR. [ABSTRACT FROM AUTHOR]

In this paper we propose a statistical modeling framework that contributes to advancing methods for modeling insurance policy premium in the actuarial literature. Specification of separate frequency and severity models, accounting for territorial risk and performing accurate inference, are some of the challenges an actuary faces while modeling policy premium. Policy premiums are characterized to follow a semi-continuous probability distribution, featuring a non-zero probability at zero along with a positive continuous support. Interpretability is a concern when quantifying unobserved risks premiums face from spatial variation. Commonly used strategies in the literature are known to successfully quantify this risk, but do not necessarily produce interpretable estimates. Resorting to frequency-severity models leaves the actuary indecisive about the specification of covariates and spatial effects. The novelty of our proposed approach lies in the development of a parsimonious and interpretable zero-adjusted modeling framework that allows for joint estimation of the effect of policy and individual characteristics on the mean premium and dispersion, while quantifying spatial variability in the mean model. The developed methods are applied to a database featuring premiums arising from the collision coverage in insurance policies for motor vehicles within the state of Connecticut, USA, for the year 2008. [ABSTRACT FROM AUTHOR]

Purpose: Vaccine effectiveness (VE) studies are often conducted after the introduction of new vaccines to ensure they provide protection in real-world settings. Control of confounding is often needed during the analyses, which is most efficiently done through multivariable modeling. When many confounders are being considered, it can be challenging to know which variables need to be included in the final model. We propose an intuitive Bayesian model averaging (BMA) framework for this task. Patients and Methods: Data were used from a matched case–control study that aimed to assess the effectiveness of the Lyme vaccine post-licensure. Cases were residents of Connecticut, 15– 70 years of age with confirmed Lyme disease. Up to 2 healthy controls were matched to each case subject by age. All participants were interviewed, and medical records were reviewed to ascertain immunization history and evaluate potential confounders. BMA was used to systematically search for potential models and calculate the weighted average VE estimate from the top subset of models. The performance of BMA was compared to three traditional single-best-model-selection methods: two-stage selection, stepwise elimination, and the leaps and bounds algorithm. Results: The analysis included 358 cases and 554 matched controls. VE ranged between 56% and 73% and 95% confidence intervals crossed zero in < 5% of all candidate models. Averaging across the top 15 models, the BMA VE was 69% (95% CI: 18– 88%). The two-stage, stepwise, and leaps and bounds algorithm yielded VE of 71% (95% CI: 21– 90%), 73% (95% CI: 26– 90%), and 74% (95% CI: 27– 91%), respectively. Conclusion: This paper highlights how the BMA framework can be used to generate transparent and robust estimates of VE. The BMA-derived VE and confidence intervals were similar to those estimated using traditional methods. However, by incorporating model uncertainty into the parameter estimation, BMA can lend additional rigor and credibility to a well-designed study. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic highlighted the weaknesses of the U.S. national food system, with grocery store shelves emptied in March and April 2020 and COVID outbreaks reported throughout the summer of 2020 at meat processing plants across the country. Fleetingly, Americans turned to local farms to ensure they could access food safely in a time of uncertainty. This paper examines the economies of community that formed around local farms and how direct engagements between consumers and producers in the face of the pandemic deepened these economic structures that often put community well-being above profits. Within a capitalist system that prioritizes efficient mass production, economies of community illustrate that solidarity can improve local food system resilience. Based on qualitative and quantitative research carried out in the summer of 2020 in New London County in southeastern Connecticut, this research draws on ethnographic interviews with small-scale farmers who developed innovative ways to feed some of their community's most vulnerable members. Community economies show that we should not only depend on standardized large-scale farms and giant retail distribution; the American food system needs to continue to cultivate smallscale local production in order to improve resilience and food access. At present, the sustainability of producing and distributing food occurs at the farmer's expense. The government needs to support local food producers so they can continue to play an integral part in community well-being. [ABSTRACT FROM AUTHOR]

Palliative care and medical-legal partnership are complementary disciplines dedicated to integrating care to treat the whole patient and intervening before a legal or medical issue is at a crisis point. In this paper, we discuss the founding and operations of the Yale Palliative Medical Legal Partnership, give examples of typical cases, explain special considerations in this area of law, and propose areas for further research. [ABSTRACT FROM AUTHOR]

In 2020, Connecticut became the first U.S. state to require all public high schools to offer Black and Latinx studies. This monumental decision has raised a fair amount of concern over what constitutes effective and conscionable teaching practices for Black and Latinx studies at the classroom level. In this paper, I propose several teaching strategies, all grounded in critical, dialectical, and responsive theories of pedagogical praxis. I deliberate on the strengths and potential weaknesses of each approach with equal attention, and at the end of each section I offer some examples of how these strategies can be applied in the classroom. I conclude by restating how important Black and Latinx studies are in facilitating the reimagining of educational practice and classroom pedagogies throughout Connecticut. [ABSTRACT FROM AUTHOR]

Background: Although Good Samaritan laws (GSLs) have been widely adopted throughout the United States, their efficacy in individual states is often unknown. This paper offers an approach for assessing the impact of GSLs and insight for policy-makers and public health officials who wish to know whether they should expect to see outcomes from similar policy interventions.Methods: Utilizing a system dynamics (SD) modeling approach, the research team conducted a policy evaluation to determine the impact of GSLs on opioid use disorder (OUD) in Connecticut and evaluated the GSL based upon the following health outcomes: (1) emergency department (ED) visits for overdose, (2) behavioral changes of bystanders, and (3) overdose deaths.Results: The simulation model suggests that Connecticut's GSL has not yet affected overdose deaths but has resulted in bystander behavioral changes, such as increased 911 calls for overdose. ED visits have increased as the number of opioid users has increased.Conclusions: The simulation results indicate that the number of opioid-related deaths will continue to increase and that the GSL alone cannot effectively control the crisis. However, the SD approach that was used will allow policymakers to evaluate the effectiveness of the GSL over time using a simulation framework. This SD model demonstrates great potential by producing simulations that allow policymakers to assess multiple strategies for combating the opioid crisis and select optimal public health interventions. [ABSTRACT FROM AUTHOR]

To support public health policymakers in Connecticut, we developed a flexible county-structured compartmental SEIR-type model of SARS-CoV-2 transmission and COVID-19 disease progression. Our goals were to provide projections of infections, hospitalizations, and deaths, and estimates of important features of disease transmission and clinical progression. In this paper, we outline the model design, implementation and calibration, and describe how projections and estimates were used to meet the changing requirements of policymakers and officials in Connecticut from March 2020 to February 2021. The approach takes advantage of our unique access to Connecticut public health surveillance and hospital data and our direct connection to state officials and policymakers. We calibrated this model to data on deaths and hospitalizations and developed a novel measure of close interpersonal contact frequency to capture changes in transmission risk over time and used multiple local data sources to infer dynamics of time-varying model inputs. Estimated epidemiologic features of the COVID-19 epidemic in Connecticut include the effective reproduction number, cumulative incidence of infection, infection hospitalization and fatality ratios, and the case detection ratio. We conclude with a discussion of the limitations inherent in predicting uncertain epidemic trajectories and lessons learned from one year of providing COVID-19 projections in Connecticut. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of gentamicin and steroids in patients with Meniere's disease (MD). Methods: The study protocol was structured in accordance with the Population, Intervention, Comparison and Outcome (PICO) framework. We used "Endnote" (Thomson ResearchSoft; Stanford, Connecticut, the United States) to retrieve database documents. A systematic literature search of Web of Science and PubMed Database through May 2020 was conducted using specific search terms. Inclusion criteria, exclusion criteria, vertigo improvement, and exact hearing changes were defined. Review Manager 5.3 (Cochrane) was used for data analysis. Results: A total of 80 articles were searched from Web of Science and 23 articles were searched from PubMed database. After further reviewing the specific points of the inclusion criteria and exclusion criteria, 9 papers were finally selected. Intratympanic gentamicin (ITG) was superior to intratympanic steroid (ITS) in reducing the number of vertigo attacks (odds ratio (OR) 3.08, 95% confidence intervals (CI) [2.05–3.65]), probability (P) < 0.01). As for hearing improvement, we did the analysis twice. With all the studies included, the odds of hearing improvement (by "x") was 0.31 among patients receiving gentamicin compared to those treated by steroids (OR 0.31, 95% CI [0.16–0.61]). But after removing one study with outlying results from the analysis, this effect disappeared. Hearing loss of ITG and ITS was not statistically significant (P = 0.29). Conclusions: ITG is superior to ITS in reducing the number of vertigo attacks in the treatment of MD (P < 0.01); the impact on hearing is more heterogeneous in the studies. Overall, there was no clear difference between ITG and ITS on hearing improvement and on hearing loss. [ABSTRACT FROM AUTHOR]

After being sued for inequity and inadequacy in school funding, many states in the US have reformed their education aid formulas but have still faced many criticisms. Using Connecticut as an example, this paper shows how to design a more equitable and adequate aid formula with tools to win broad support from communities and lawmakers. It develops a measure of the gap between education cost and revenue capacity as an indicator for each district's need for state aid. Both education cost and revenue capacity are estimated using school district characteristics that are outside the direct control of local officials at any given point in time. This paper shows that Connecticut school districts have a wide range of cost-capacity gaps, due to disparities in cost factors and property tax base, and therefore have different needs for state aid. While larger-gap districts, on average, received more state aid per pupil than smaller-gap districts, many districts --especially the largest-gap ones-- received less aid than they needed to close their cost-capacity gaps. Further analysis suggests that inadequate school funding could have a negative impact on student test performance. As a potential solution, this paper proposes a gap-based formula to allocate state aid and includes tools to make the formula more attractive to a wide range of school districts. The policy simulations show that the gap-based formulas can align aid with the gaps better than the existing formula does. However, applying tools to increase the formula's attractiveness to small-gap districts would compromise the ability of state aid to eliminate inequity and inadequacy and would often require a larger state aid pool. This paper expands the academic community's knowledge about the US education equity and adequacy by examining Connecticut's school funding for the first time under the regression-based cost-capacity gap approach. This analysis can be relevant and useful for other states facing similar issues, as it provides a practical, step-by-step roadmap how to apply the sufficiently general research method and formula design to an individual state.

This paper examines how in-service teachers enrolled in an MA in TESOL program demonstrated critical language awareness (CLA) as they designed and implemented ethnographic action research projects anchored in funds of knowledge. The action research project aimed to introduce teachers to school-based ethnographic research and to provide an opportunity to incorporate community funds of knowledge into their unit plans. Drawing from program documents such as the in-service teachers' research proposals, papers, and unit plans, the study highlights how awareness of the intersections of language and local power dynamics in their schools informed their decision-making about their research and curricular designs. At each stage of the research process, the teachers narrated how they restructured their interactional roles within established classroom routines, school-playtime, community, and family-school events for purposes of inquiring about student and family funds of knowledge. By integrating theories of funds of knowledge and CLA, the analysis shows how teacher understandings of sociopolitical and sociolinguistic contexts shaped which, how, and whose knowledge became resources (or not) in their curricular plans. The study suggests the benefit of professional development that includes CLA for purposes of supporting teachers as they aim to incorporate and leverage funds of knowledge of students, families, and communities in their curricula.

Purpose: This paper aims to highlight how a group of novice principals in Connecticut and New York used relational, dispositional and situational factors to respond to the COVID-19 pandemic crisis. The study aims to support new principals and educational leaders. Design/methodology/approach: Using Mutch's (2015) dispositional, relational and situational framework to guide the inquiry, this paper uses qualitative methods and interviewing in particular to explore the questions of interest. Six novice principals were each interviewed over the 2020-2021 school year, each interview lasting approximately forty-five minutes. Data were analyzed thematically using both deductive coding techniques and cross comparative analysis. Findings: Findings show that novice principals tended to rely on dispositional factors to respond to the crisis. Additionally, novice principals reported limited responses to the situational factors of the crisis due to restricted access and guidance from the district leadership. Research limitations/implications: Due to the small sample size and methodological approach, it may be inappropriate to generalize the findings across all novice principals in all settings. Further research in additional settings and larger samples are encouraged to support the proposed findings. Practical implications: This paper has several implications for districts and leadership preparation programs. Among these is the need for leadership preparation programs to adjust their curricula to train new principals properly. Originality/value: This work fills a gap in the research regarding how new principals respond to a crisis. It also provides insights into practice and possible means to enhance the growing population of new principals entering the educational leadership workforce.

• Using probe data, we estimated the traffic density information on limited access highways. • We used a mixed effect binomial model to link the odds of speeding to traffic density, roadway characteristics, and COVID-19 phases. • We analyzed and compared speeding in two U.S. states, Maine, and Connecticut. • We found that a better level of service such as A, or B (low density) results in higher odds of speeding. • We found that speeding substantially increased during COVID-19 stay-at-home orders and continued to happen even one year after the orders. Stay-at-home orders - imposed to prevent the spread of COVID-19 - drastically changed the way highways operate. Despite lower traffic volumes during these times, the rate of fatal and serious injury crashes increased significantly across the United States due to increased speeding on roads with less traffic congestion and lower levels of speed enforcement. This paper uses a mixed effect binomial regression model to investigate the impact of stay-at-home orders on odds of speeding on urban limited access highway segments in Maine and Connecticut. This paper also establishes a link between traffic density and the odds of speeding. For this purpose, hourly speed and volume probe data were collected on limited access highway segments for the U.S. states of Maine and Connecticut to estimate the traffic density. The traffic density was then combined with the roadway geometric characteristics, speed limit, as well as dummy variables denoting the time of the week, time of the day, COVID-19 phases (before, during and after stay-at-home order), and the interactions between them. Density, represented in the model as Level of Service, was found to be associated with the odds of speeding, with better levels of service such as A, or B (low density) resulting in the higher odds that drivers would speed. We also found that narrower shoulder width could result in lower odds of speeding. Furthermore, we found that during the stay-at-home order, the odds of speeding by more than 10, 15, and 20 mph increased respectively by 54%, 71% and 85% in Connecticut, and by 15%, 36%, and 65% in Maine during evening peak hours. Additionally, one year after the onset of the pandemic, during evening peak hours, the odds of speeding greater than 10, 15, and 20 mph were still 35%, 29%, and 19% greater in Connecticut and 35% 35% and 20% greater in Maine compared to before pandemic. [ABSTRACT FROM AUTHOR]

The search for reliable tools to assess potential deleterious reactions in sulfide-bearing aggregates, is driven by recent field structure damage involving such types of aggregates. The paper presents a new test scheme with detailed procedures and limit criteria. Five aggregates, including pyrrhotite-bearing reactive ones (Connecticut and MSK 0.9), an alkali-silica reactive low-sulfur limestone (Spratt), a non-reactive control (PKA), and a low-sulfide aggregate (MSK 0.2), were used to manufacture concrete specimens that were subjected to the proposed test. The limit criterion, based on modulus of elasticity loss (RMoE), effectively distinguishes non-reactive, reactive, and potentially reactive aggregates. The scheme's reliability is validated against an existing protocol involving sulfur determination and mortar bar expansion testing. Four of five aggregates exhibit similar potential sulfide reactivity. Despite excessive mortar bar expansion, MSK 0.2, with traces of pyrrhotite, shows non-reactive behavior in concrete specimens after electrochemical treatment. The proposed test scheme offers a practical and timely tool for assessing sulfide-bearing aggregate reactivity before concrete production. [ABSTRACT FROM AUTHOR]

In a 2023 sequential explanatory mixed-methods study in four US states, we identified barriers and facilitators experienced by Vaccines for Children (VFC) program providers in reporting vaccination data to state immunization information systems (IISs). We found the following: VFC providers value accurate, robust, and widely used IISs. IIS reporting is easier with but does not require an electronic health record. Negative interactions with IISs and VFC officials and limited practice capacity are barriers to reporting. The COVID-19 pandemic highlighted the need for a nationwide vaccination database. (Am J Public Health. 2024;114(6):569–574. https://doi.org/10.2105/AJPH.2024.307638) [ABSTRACT FROM AUTHOR]

Individuals with autism spectrum disorder (ASD) engage in less physical activity than typically-developing peers. This can result in serious negative consequences for individual well-being and may contribute to the physical, behavioral, and emotional challenges associated with ASD. This study explored the potential benefits of trainer-led, individualized, physical fitness sessions specialized for ASD. Eleven individuals (ages 7–24 years) with ASD were assessed at baseline and following 15 fitness sessions. Participants demonstrated improvements in core and lower-body strength and reductions in restricted and repetitive patterns of behavior, along with non-significant but marked reductions in issues with daytime sleepiness. Results suggest the merit of specialized fitness programs and emphasize the need for larger and more rigorous research studies on this topic. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is a common sequela in individuals with a diagnosis of head and neck cancer. However, the prevalence and predicting factors for pretreatment dysphagia have not been well identified in the literature. A priori knowledge of the presence of a pretreatment dysphagia is advantageous and can have clinically significant implications for management of this patient population. The ability to predict pretreatment dysphagia in this population would allow more targeted interventions and potential improvements in clinical outcomes. Participants: This pilot study investigated the prevalence and predicting factors of pretreatment dysphagia in 67 veterans with head and neck cancer through the West Haven, CT, Veterans Affairs cancer database. Method: Data for this study were acquired via retrospective medical record review. Results: The prevalence of pretreatment dysphagia in our sample was found to be 49.3%. Age and pretreatment percutaneous endoscopic gastrostomy placement were found to have a statistically significant relationship with pretreatment dysphagia. Stage of cancer diagnosis and the diagnosis of pretreatment dysphagia were found to have a statistically significant relationship with posttreatment dysphagia. Conclusions: Findings offer important preliminary data and clinical considerations about this issue and serve as a foundation for future research. There are a limited number of factors associated with pretreatment dysphagia, and clinicians should consider a conservative referral approach when considering the need for dysphagia assessment prior to the initiation of oncologic treatment. [ABSTRACT FROM AUTHOR]

• Despite reform efforts, the juvenile justice system is permeated with inequities. • Partnering with stakeholders, we developed an integrated model of juvenile justice. • The model layers public health, socioecological and restorative justice frameworks. • Applied examples illustrate how this approach can benefit youth and communities. • Recommendations for engaging in community-driven reform efforts are provided. Approaches to juvenile justice have undergone significant change in recent years, shifting away from retributive models and toward greater focus on rehabilitation and recognition of the unique developmental needs of youth. However, the juvenile justice system is still permeated with significant challenges, including the overrepresentation of vulnerable youth, particularly youth of color, and limited community-based interventions for youth at risk for justice involvement. Current models of juvenile justice do not fully address the needs of at-risk and justice involved youth, and have struggled to effectively reduce racial and ethnic disparities within the system, suggesting there is a need for a model that is better able to conceptualize and respond to youths' needs. The purpose of this paper is to describe the Integrated Model of Juvenile Justice (IMJJ), a novel conceptual approach to juvenile justice reform, which integrates the public health, social-ecological, and restorative justice models. We worked collaboratively with justice system stakeholders in Connecticut to develop the IMJJ, which proposes that juvenile justice practice must take into account and provide for youths' multi-level needs. Through an applied example, this paper describes how the IMJJ can be utilized to target youth offending and promote equitable treatment of youth in the juvenile justice system. Recommendations for justice system stakeholders are provided and implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Alcohol-associated liver disease is currently the leading cause of liver transplantation and liver deaths both in Europe and the United States. Efficacious treatments exist for alcohol use disorder, but they are seldomly prescribed for patients who need them. Besides, the presence of liver cirrhosis can complicate pharmacological treatment choices. In this review, we discuss established and innovative treatment strategies to treat unhealthy alcohol use in patients with alcohol-associated liver disease. We also describe the experience of our own institutions, Hospital Universitari Germans Trias i Pujol in Badalona (Spain) and Yale-New Haven Health and Yale Medicine (Connecticut. United States of America). [ABSTRACT FROM AUTHOR]

Purpose: Rehabilitation intervention descriptions often do not explicitly identify active ingredients or how those ingredients lead to changes in patient functioning. The Rehabilitation Treatment Specification System (RTSS) provides guidance to identify the critical aspects of any rehabilitation therapy and supported the development of standardly named ingredients and targets in voice therapy (Rehabilitation Treatment Specification System for Voice Therapy [RTSS-Voice]). This study sought to test the content validity of the RTSS-Voice and determine if the RTSS-Voice can be used to identify commonalities and differences in treatment (criterion validity) across clinicians in everyday clinical practice. Method: Five speech-language pathologists from different institutions videotaped one therapy session for 59 patients diagnosed with a voice or upper airway disorder. Specifications were created for each video, and iterative rounds of revisions were completed with the treating clinician and two RTSS experts until consensus was reached on each specification. Results: All 59 sessions were specified without the addition of any targets or ingredients. There were two frequent targets: (a) increased volition and (b) decreased strained voice quality. There were three frequent ingredients: (a) information regarding the patient's capability and motivation to perform a therapeutic behavior, (b) knowledge of results feedback, and (c) opportunities to practice voicing with improved resonance and mean airflow. Across sessions treating vocal hyperfunction, there was large variability across clinicians regarding the types and number of treatment components introduced, types of feedback provided, and vocal practice within spontaneous speech and negative practice. Conclusions: The RTSS and the RTSS-Voice demonstrated strong content validity, as they comprehensively characterized 59 therapy sessions. They also demonstrated strong criterion validity, as commonalities and differences were identified in everyday voice therapy for vocal hyperfunction across multiple clinicians. Future work to translate RTSS principles and RTSS-Voice terms into clinical documentation can help to understand how clinician and patient variability impacts outcomes and bridge the research--practice gap. [ABSTRACT FROM AUTHOR]

Objectives: Highly effective direct-acting antiviral medications have made it feasible to achieve elimination of hepatis C virus (HCV), including for people with HIV and HCV coinfection. The Centers for Disease Control and Prevention offers guidance for a laboratory surveillance–based HCV viral clearance cascade, which allows public health departments to track the outcomes of people with HCV based on the following steps: ever infected, virally tested, initial infection, and cured or cleared. We examined the feasibility of this approach among people with HIV and HCV coinfection in Connecticut. Methods: We matched an HIV surveillance database, which included cases from the enhanced HIV/AIDS Reporting System as of December 31, 2019, and the HCV surveillance database, the Connecticut Electronic Disease Surveillance System, to define a cohort of coinfected people. We used HCV laboratory results obtained from January 1, 2016, through August 3, 2020, to determine HCV status. Results: Of 1361 people who were ever infected with HCV as of December 31, 2019, 1256 (92.3%) received HCV viral testing, 865 of 1256 people tested (68.9%) were HCV infected, and 336 of 865 infected people (38.8%) were cleared or cured. People who had undetectable HIV viral loads at most recent HIV test (<200 copies/mL) were more likely than those with detectable HIV viral loads to achieve HCV cure (P =.02). Conclusions: A surveillance-based approach that includes data based on the Centers for Disease Control and Prevention HCV viral clearance cascade is feasible to implement, can help track population-level outcomes longitudinally, and can help identify gaps to inform HCV elimination strategies. [ABSTRACT FROM AUTHOR]

Worldwide, amphibians are experiencing high rates of decline. Large-scale, long-term studies of amphibians are crucial for uncovering potential causes of the declines; however, such long-term studies remain rare, particularly for salamanders. In this study, we monitored populations of Spotted Salamanders (Ambystoma maculatum) in 90 Connecticut, USA, ponds. Populations were divided between an inland, undeveloped landscape monitored for up to 23 yr and a coastal, developed landscape monitored for up to 9 yr. We measured the density of egg masses (number of egg masses per unit of search effort) each year at each pond for a total of 1392 pond-years of sampling effort and asked how egg mass densities and breeding probability relate to local environmental and climatic conditions. In the undeveloped landscape, average egg mass densities have declined by ∼30% over the course of 2 decades. The presence of salamander breeding activity was positively associated with spring pond depth, and pond depth itself has declined by ∼20% during the survey period. We also found that egg mass density was related to road proximity and developed land cover: egg mass densities tended to be higher in ponds near roads and in ponds with less development within a 200-m buffer. In the developed landscape, egg mass densities showed a nonsignificant declining trend from 2014 to 2022 and salamander breeding activity was positively associated with higher canopy cover and larger pond surface area. Our findings suggest that even in a protected landscape with increasing forest cover, spotted salamander egg mass densities are declining at a rate of 1.6%/yr. Decreasing pond depths are likely linked to decreased water yield as forests grow, which could affect pond hydroperiods (aquatic larval habitat) as well as forest soil moisture levels (adult habitat). Overall, increasing development may continue to negatively affect habitat of Spotted Salamanders and it is possible that forest maturation also has a negative influence on salamanders—an effect not documented previously. [ABSTRACT FROM AUTHOR]

Introduction: The United States is currently facing an opioid overdose crisis. Research suggests that multiple interventions are needed to reduce overdose deaths including increasing access and retention to medications to treat opioid use disorders (MOUD, i.e., methadone, buprenorphine, and naltrexone) and increasing the distribution and use of naloxone, a medication that can reverse the respiratory depression that occurs during opioid overdoses. However, barriers to MOUD initiation and retention persist and discontinuations of MOUD carry a heightened risk of overdose. Many times, MOUD is not sought as a first line of treatment by people with opioid use disorder (OUD), many of whom seek treatment from medically managed withdrawal (detox) programs. Among those who do initiate MOUD, retention is generally low. The present study examines the treatment experiences of people who use opioids in three states, Connecticut, Kentucky, and Wisconsin. Methods: We conducted in-depth interviews with people who use opioids in a rural, urban, and suburban area of three states: Connecticut, Kentucky and Wisconsin. Data analysis was collaborative and key themes were identified through multiple readings, coding of transcripts and discussion with all research team members. Results: Results reveal a number of systemic issues that reduce the likelihood that people initiate and are retained on MOUD including the ubiquity of detox as a first step in drug treatment, abstinence requirements and requiring patients to attend group treatment. MOUD-related stigma was a significant factor in the kinds of treatment participants chose and their experiences in treatment. Conclusions: Interventions to reduce MOUD stigma are needed to encourage MOUD as a first course of treatment. Eliminating abstinence-based rules for MOUD treatment may improve treatment retention and decrease overdose risk. [ABSTRACT FROM AUTHOR]

In Town A, a real estate developer appears before the municipal landuse board in pursuit of a special permit. The developer has a strong relationship with the members of the board and appears before them multiple times each year. The board grants the special permit even though the developer failed to present enough facts to give the board a reason that was not arbitrary or capricious. An interested neighbor brings suit against the developer and the municipal board in court, challenging the board's special permit grant. If Town A is in Massachusetts, the judge will conduct a trial de novo and hear facts that were not presented to the municipal board. If Town A is in Connecticut, the judge is limited to considering the facts that were presented to the municipal board. Therefore, if the developer presents facts that provide a non-arbitrary or non-capricious reason for the board's decision, then in Massachusetts, the judge will not disturb the board's grant of a special permit and in Connecticut, the judge will reject the grant and find that the board's decision was arbitrary and capricious on the facts before it. In this scenario, the applicable standard of review has a direct impact on the result of the appeal. Like Connecticut, a plurality of the states apply a very deferential standard to municipal land-use appeals, while a minority of states, including Massachusetts and Vermont, do not. A trial de novo in these circumstances weakens the authority of municipal government and creates a theoretical advantage for parties with more financial resources and experience. Technological advances alleviate concerns over the record produced by the municipal board and grant municipal boards the tools required to create a record upon which the judicial body hearing the appeal may rely. This article will investigate the standards applied in the New England states (Massachusetts, Connecticut, Vermont, Rhode Island, and New Hampshire) and consider the consequences of allowing, or even requiring, the court to conduct a trial de novo when hearing a municipal land-use appeal. The article will then call for legislatures in states that allow for, or require, a trial de novo to amend their statutory provisions, which provide for appeals of municipal land-use board decisions, to restrict judges from hearing the matter de novo and to limit consideration of the matter to the facts originally presented before the municipal board. [ABSTRACT FROM AUTHOR]

The US Supreme Court's ruling in Dobbs v. Jackson Women's Health Organization has potentially profound implications for contraception. Contraceptives came up frequently in oral arguments and constitutional protections for abortion and birth control are fundamentally linked (Griswold v. Connecticut, 381 US 479, 1965). Moreover, in recent decisions (Burwell v. Hobby Lobby Stores, Inc. 573 US 682, 2014) the court has endorsed the position of some religious groups that certain forms of contraception are "abortifacients," essentially a form of abortion. This legal blurring of distinct scientific boundaries between abortion and birth control provides legal pathways for birth control restrictions. That said, in the immediate wake of Dobbs, policy change on birth control has been limited, media coverage on the risks posed to birth control have been scarce, and public support of birth control access has remained robust. We review the current landscape of birth control politics and policy after Dobbs, including state and federal policy responses, elite rhetoric, interest group advocacy, media coverage, and public opinion. Our analysis contributes to an emerging literature on birth control politics and policy. [ABSTRACT FROM AUTHOR]

• A framework for characterizing inundation depth (ID) during compound events is presented. • Relative importance of surge and inland flows in controlling flood ID is quantified. • A new topographic index is introduced to capture the variability of flood ID from river to coast. • With the index areas are identified where compound events are more prominent. Storm surge and river runoff can result in compound flooding in coastal areas. The impact of these events can be more significant than that generated by each component individually. This paper describes a framework for characterizing flooding during compound events and quantifying the relative importance of surge and river flows in controlling inundation depth (ID). For the analysis, we considered 1051 simulations of historical flood events covering about 40 years in Connecticut (CT), USA, and several simulated storms associated with synthetic climate scenarios. We simulated river discharge time series for each event using a physically based distributed hydrological model and retrieved the storm surge from tidal stations. These time series are used as upstream and downstream boundary conditions in 2D hydrodynamic simulation. We focused the analysis on seven locations along the coast of Connecticut covered by LiDAR-derived 1 m DEM. To capture the variability of inundation characteristics over the full-scale gradient from river to coast, we introduced a new topographic index, D-Index, that distinguishes topologic variabilities. Results from this study highlight that there is a correlation of ID to different drivers in distinct categories of the D-Index, which can correctly label the main source of hazard, either coast, river, or compound. We identified thresholds of standard deviation (σ) of the D-Index to identify areas where ID strongly correlates with either flow peak and volume, surge peak, or a combination of both. The study also shows that it is possible to use the results obtained from the 1 m analysis to generalize the findings for the entire CT coast to derive zones dominated by surge, river flow, or the compound effect of the two. This study can help coastal communities better understand the risk of the compound impacts of coastal storms, which is essential for increasing climate resilience. [ABSTRACT FROM AUTHOR]

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