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US state laws vary widely in the treatment of child support under joint custody. While some states require no child support in joint custody cases, other states require fathers with joint custody to pay the same amount as if they had no custody. The economic incentives generated by those custody laws can affect family decisions and the wellbeing of children of divorced parents, both under joint and sole custody. Merging child data from the SIPP with state child support guidelines, we find that economic incentives for joint custody have negative effects on the human capital development and health of children of divorced parents. Custody data together with parental characteristics and time use data suggest that economic incentives for joint custody may limit children's time spent with relatively high-quality mothers, as fathers pursue joint custody in response to the policy. We do not find an effect of economic incentives for joint custody on the probability of divorce and on the wellbeing of children in intact families. Our results are robust to specification changes, and the negative effects of economic incentives for joint custody on the wellbeing of children tend to be larger for girls and for children aged 12 and under.

Jointly financed by the federal government and the states, Medicaid represents the second largest form of public-sector investment in children. Research documents direct positive effects of Medicaid on children’s well-being, but little is known about the effects of Medicaid expansions on the wealth of families with children. Using state variation in Medicaid access during the prenatal and infant period, linked to longitudinal data from the children of National Longitudinal Survey of Youth 79, we ask whether state-level Medicaid generosity is associated with family wealth among families with children and whether these effects vary by parental education and race-ethnicity. We find that greater state-level Medicaid access is associated with a larger total amount held in savings and retirement accounts, as well as in mortgages. These effects are largely driven by non-Hispanic white families, and those with more highly educated mothers.

Artificial water bodies at tropical latitudes have regular or extreme water contributions dependent of climate and interannual variations that result in differences in the physicochemical characteristics of the water; in addition to the climate. They receive peripheral runoff two, according to geomorphology; in the case of Mexican artificial water bodies as Cantera Oriente, they will also depend on the orography that entails changes in the volumes of water. All of this influence in conservative and non-conservative physiochemical components through dilute the water in the rainy season and concentrate it in the dry season. Therefore, this paper estimates the variations of: temperature, conductivity, dissolved oxygen, pH, with nutrients (total phosphorus and nitrogen, chlorophyll “a” and primary production). In the Cantera Oriente all this parameters resulting in an oxic and anoxic condition, as well as a widely variable hypertrophy, depending on the month of year, in addition, anthropogenic sewage runoff must be added.

We show there is a much stronger negative, dynamic relation between changes in economic uncertainty and Treasury yields over weaker economic times since at least 1990. We document this economic-state variation in uncertainty-yield dynamics for weekly and monthly change horizons, for nominal yields and real-yield proxies, for multiple economic-state identification methods, and for different economic uncertainty metrics. We present additional findings that suggest short-term fluctuations in precautionary-savings and consumption-smoothing forces are more impactful on interest rate dynamics during weaker economic times, especially relying on surveys of expected economic growth and inflation. Received February 8, 2019; editorial decision August 24, 2020 by Editor Nikolai Roussanov. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.

For many low-income Medicare beneficiaries, Medicaid provides important supplemental insurance that covers out-of-pocket costs and additional benefits. We examine whether Medicaid participation by low-income adults age 65 and up increased as a result of Medicaid expansions to working-age adults under the Affordable Care Act (ACA). Previous literature documents so-called “welcome mat” effects in other populations but has not explicitly studied older persons dually eligible for Medicare and Medicaid. We extend this literature by estimating models of Medicaid participation among persons age 65 and up using American Community Survey data from 2010 to 2017 and state variation in ACA Medicaid expansions. We find that Medicaid expansions to working-age adults increased Medicaid participation among low-income older adults by 1.8 percentage points (4.4 percent). We also find evidence of an “on-ramp” effect; that is, low-income Medicare beneficiaries residing in expansion states who were young enough to gain coverage under the 2014 ACA Medicaid expansions before aging into Medicare were 4 percentage points (9.5 percent) more likely to have dual Medicaid coverage relative to similar individuals who either turned 65 before the 2014 expansions or resided in non-expansion states. This on-ramp effect is an important mechanism behind welcome mat effects among some older adults.

This article investigates the torque characteristics of a switched flux hybrid magnet memory machine (SF-HMMM) by employing a coupled solution combining a quasi-linear hysteresis model (QLHM) of low coercive force (LCF) magnet and frozen-permeability method (FPM). This provides an in-depth understanding of the torque production of SF-HMMM. The QLHM is utilized to characterize the repetitive remagnetizing/demagnetizing behaviors of LCF permanent magnets (PMs), while the FPM is employed to separate and quantify the torque contributions due to two sets of PMs and armature windings. The machine topology and analysis methodology are described, respectively. The torque segregation results accounting for magnetization state variation are analyzed by the proposed coupled solution. The influence of the LCF PM property on the torque segregation result is investigated to facilitate the establishment of general design guidelines. Finally, the prototype is tested to experimentally validate the theoretical analysis.

Problems are discussed in evaluating character state variation in the insect order Thysanoptera, particularly in the family Phlaeothripidae, illustrated by two such problems in the genus Haplothrips Amyot & Serville. The synonymy of Jironiella Retana-Salazar & Soto-Rodriguez with Haplothrips is reconfirmed, and Haplothrips aliakbarii Mirab-balou & Miri is recognised as a new synonym of H. globiceps Bagnall.

Early life stress (ELS) may become embedded into an individual's stress physiology, changing their hypothalamic-pituitary-adrenal (HPA)-axis in an enduring, trait-like fashion. Cortisol is often utilized to investigate HPA-axis function. However, for "trait" cortisol to be a useful construct, it needs to be internally consistent within measurement occasions and show temporal stability of this reliability. These estimates of physiometrics are rarely tested with biological variables such as cortisol. Identifying reliable and stable individual differences in cortisol may be particularly important when examining questions related to the long-term impact of ELS on HPA-axis function. Using confirmatory factor analysis (CFA) to model latent trait cortisol (LTC) may be a useful statistical approach to capture trait-like indexes of HPA-axis functioning. CFA identifies commonalities among repeated cortisol samples to differentiate characteristic patterns (i.e. a trait) from day-to-day or state variation and measurement error. It is unclear whether LTC estimates are stable prospectively, or if ELS is prospectively associated with LTC. Therefore, we derived LTC factors for 84 adolescent girls (ages 10-17 years) using two-morning salivary cortisol samples, collected sequentially for three days at baseline and again at a one-year follow-up. LTC was internally consistent at both assessments and stable over one year. Greater exposure to ELS was associated with lower LTC over a one-year follow-up. Findings support LTC modeling as a useful strategy to estimate trait-like HPA-axis functioning and suggest that exposure to ELS is associated with lower trait-like cortisol.

The Yangtze River Delta (YRD) is one of the regions with the most intensive human activities. The eutrophication of lakes in this area is becoming increasingly serious with consequent negative impacts on the water supply of the surrounding cities. But the spatial-temporal characteristics and driving factors of the trophic state of the lake in this region are still not clearly addressed. In this study, a semi-analytical algorithm for estimating the trophic index (TSI) using particle absorption at 645 nm based on MODIS images is proposed to monitor and evaluate the trophic state of 41 large lakes (larger than 10 km2) in the YRD from 2002 to 2020. The performance of the proposed algorithm is evaluated using an independent dataset. Results showed that the root-mean-square error (RMSE) of the algorithm is less than 6 and the mean absolute percentage error (MAPE) does not exceed 8%, indicating that it can be applied for remotely deriving the TSI in the YRD. The spatial-temporal patterns revealed that there were significantly more lakes with moderate eutrophication in the Lower Yangtze River (LYR) than in the Lower Huaihe River (LHR). The overall average value of the TSI reaches a maximum in summer and a minimum in winter. The TSI value in the YRD over the period 2002–2020 showed a downward trend, especially after 2013. Individually, 33 lakes showed a downward trend and 8 lakes showed an upward trend. Furthermore, marked seasonal and interannual temporal variations can be clearly observed in the LYR and LHR and the sum of the variance contributions of seasonal and interannual components is more than 50%. Multiple linear regression analysis showed that human activities can explain 65% of the variation in the lake TSI in the YRD.

We exploit state variation in licensing laws to study the effect of licensing on occupational choice using a boundary discontinuity design. We find that licensing reduces equilibrium labor supply by an average of 17%-27%. The negative labor supply effects of licensing appear to be strongest for white workers and comparatively weaker for black workers.

In some recent papers, the so called $(H,\rho)$-induced dynamics of a system $\mathcal{S}$ whose time evolution is deduced adopting an operatorial approach, has been introduced. According to the formal mathematical apparatus of quantum mechanics, $H$ denotes the Hamiltonian for $\mathcal{S}$, while $\rho$ is a certain rule applied periodically on $\mathcal{S}$. In this approach the rule acts at specific times $k\tau$, with $k$ integer and $\tau$ fixed, by modifying some of the parameters entering $H$ according to the state variation of the system. As a result, a dynamics admitting an asymptotic equilibrium state can be obtained. Here, we consider the limit for $\tau\rightarrow 0$, so that we introduce a generalized model leading to asymptotic equilibria. Moreover, in the case of a two-mode fermionic model, we are able to derive a relation linking the parameters involved in the Hamiltonian to the asymptotic equilibrium states., Comment: 26 pages, 31 figures. arXiv admin note: text overlap with arXiv:1803.11234

Highlights • In 2005–2017, US states liberalized statutes on cause of death signature authority. • State variation in signature authority contributes to cause of death inaccuracies. • Logistic regressions suggest certifier type influences death certificate accuracy. • Death certificate training is needed across the array of professional certifiers. • Cause of Death Signature Authority database allows for more robust analysis of certification errors., This study utilized a convergent mixed-methods design to examine whether variation in death certificate certifier type predicts the accuracy of cause of death reporting in the US. We analyzed the content of state statutes, amendments, and policies concerning cause of death signature authority in 2005–2017 to create the Cause of Death Signature Authority (CoDSA) database. After merging the CoDSA data with 2005–2017 National Vital Statistics System Multiple Cause of Death Mortality files for adults with cerebral palsy (CP) (N = 29,996), we employed logistic regression models to determine the likelihood that different certifier groups made one particular type of death certification error – inaccurately reporting CP as the underlying cause of death (UCOD). The content analysis provided evidence of significant liberalization of cause of death signature authority, with 23 states expanding signature authority to include physician extenders. Logistic regression analysis revealed differences in UCOD accuracy based on certifier type. Compared to medical examiners, the likelihood of CP being reported as the UCOD, was: 41% higher (CI 1.12, 1.78) for coroners; 25% higher (1.05, 1.49) for mixed-system death investigators; 24% higher (1.08, 1.42) for physicians; and 16% higher (1.00, 1.34) for physician extenders. Inaccuracies limit public health efforts aimed at improving the health and longevity for disadvantaged populations, such as people with CP. Poor performance among cause of death certifiers may indicate systemic problems with death certification that should be addressed with more robust training for all professional groups with signature authority.

Do minimum wages and the earned income tax credit (EITC) mitigate rising "deaths of despair?" We leverage state variation in these policies over time to estimate event study and difference-in-differences models of deaths due to drug overdose, suicide, and alcohol-related causes. Our causal models find no significant effects on drug or alcohol-related mortality, but do find significant reductions in non-drug suicides. A 10 percent minimum wage increase reduces non-drug suicides among low-educated adults by 2.7 percent, and the comparable EITC figure is 3.0 percent. Placebo tests and event-study models support our causal research design. Increasing both policies by 10 percent would likely prevent a combined total of more than 700 suicides each year.

BackgroundAlthough cross-state variation of the opioid epidemic in the United States are well documented in general, little are known about the epidemic in privately insured individuals.ObjectivesTo describe cross-state variation in Opioid Use Disorder (OUD) among privately insured individuals in the US for the years 2005-2015 and investigate demographic differences of OUD patients between a group of hard-hit states and the rest states.MethodsThe MarketScan® Commercial Claims and Encounters database was used to calculate prevalence of opioid use disorder for the 50 states in the US, respectively. We analyzed level and change of OUD prevalence in each state from 2005 to 2015 and identified the states which were affected most by the epidemic. One-sided exact fisher test was used to analyze demographic difference of the epidemic in the hard-hit states and the remaining states.ResultsCross-state variations of the opioid epidemic among privately insured population were substantial, both in terms of severity and acceleration of the epidemic. Demographic patterns of the epidemic were similar across states. The 18-34 age group was the most affected group with the highest prevalence. The 55-64 group experienced the most rapid increase of OUD prevalence, especially in states that suffered most in the epidemic.ConclusionsResults can assist policy makers to design better clinical and policy interventions on the opioid epidemic, especially on privately insured individuals. Drastic increase of OUD prevalence among the 55-64 group might indicate the need to improve prescription drug monitoring programs for chronic pain, especially in states more affected by the epidemic.

BACKGROUND AND OBJECTIVES: Home nursing is essential for children with medical complexity (CMC), but provision varies substantially across states. Our objectives were to quantify state-to-state variability in distribution of posthospitalization home nursing to commercially insured CMC and to rank-order states. METHODS: Retrospective cohort study of hospitalized commercially insured children with ≥1 complex chronic condition from birth to 18 years of age in the Truven MarketScan database. Cohort eligibility criteria were hospital discharge between January 2013 and November 2016 and at least 30 days of follow-up after discharge. Two primary outcome measures were used: receipt of any home nursing within 30 days of hospital discharge (yes or no) and number of days of posthospitalization home nursing (1–30 days). A composite metric encompassing both receipt and quantity was created by evaluating the 95th percentile of days of home nursing (0–30 days). RESULTS: Overall, 9.9% of the sample received home nursing. After we adjusted for patient characteristics, the probability of receiving home nursing varied across states, ranging from 3.4% to 19.2%. Among home nursing recipients, the adjusted median home nursing days across states ranged from 6.6 to 24.5 days. The adjusted 95th percentile of days of home nursing (across the entire of sample, including recipients and nonrecipients of home nursing) ranged from 6.8 to 22.6 days. CONCLUSIONS: We observed striking state-to-state variability in receipt of home nursing and mean number of days of posthospitalization home nursing among commercially insured CMC after adjustment for demographic and clinical differences. This suggests opportunities for state-level improvement.

This paper investigates whether and to what extent the low unemployment insurance (UI) tax base in the United States creates disincentives to hire low-wage workers. Using data from the Current Population Survey and state variation in the UI tax base over 30 years, I estimate that a 10 percent nominal increase in the tax base raises the teenage employment rate by 1.4 percent, and indexing the tax base increases the teenage employment rate by 6 percent. These results offer evidence that the erosion of the UI tax base has reduced the employment of low-wage workers.

The Hispanic Paradox in birth outcomes is well documented for the US as a whole, but little work has considered geographic variation underlying the national pattern. This inquiry is important given the rapid growth of the Hispanic population and its geographic dispersion. Using birth records data from 2014 through 2016, we document state variation in birthweight differentials between US-born white women and the three Hispanic populations with the largest numbers of births: US-born Mexican women, foreign-born Mexican women, and foreign-born Central and South American women. Our analyses reveal substantial geographic variation in Hispanic immigrant-white low birthweight disparities. For example, Hispanic immigrants in Southeastern states and in some states from other regions have reduced risk of low birthweight relative to whites, consistent with a "Hispanic Paradox." A significant portion of Hispanic immigrants' birthweight advantage in these states is explained by lower rates of smoking relative to whites. However, Hispanic immigrants have higher rates of low birthweight in California and several other Western states. The different state patterns are largely driven by geographic variation in smoking among whites, rather than geographic differences in Hispanic immigrants' birthweights. In contrast, US-born Mexicans generally have similar or slightly higher odds of low birthweight than whites across the US. Overall, we show that the Hispanic Paradox in birthweight varies quite dramatically by state, driven by geographic variation in low birthweight among whites associated with white smoking disparities across states.

Many advantages make electrolytic in-process dressing (ELID) grinding desirable for cutting hard and brittle material with high surface requirements. The self-electrolytic in-process dressing property in ELID grinding is also largely responsible for the shorter wear life and lower forming accuracy of the grinding wheel. In ELID grinding, except for traditional mechanical wear, the electrolytic oxidation wear also adds more uncertainties to the wear velocity of the grinding wheel. To date, few investigations focused on the grinding wheel wear life characterization in ELID cut-in grinding of ball bearing raceway. In this study, the wear life characterization of the grinding wheel during ELID grinding was quantitatively simulated by a moving normal distribution curve of the grit state variation. As all types of cutting grits wear out, so did the normal distribution curve, showing movement towards the grinding wheel center. With the normal distribution curve moving towards the grinding wheel center, a local acceleration and local deceleration in moving velocities occurred. It is the diversity of the moving speed of the normal distribution curve that provides a quantitative description to understand the wear life characterization of the ELID grinding wheel. Some experimental results can easily explain this new proposed perspective. This new perspective can also be extended to predict the forming accuracy and surface topography of the bearing raceway during ELID grinding.

This paper is focused on change in shrinkage, GSM, Wales per Inch and Course per Inch due to structure and count variation and state variation. This work was carried out with 12 samples of single jersey, single lacoste and weft lock knit fabrics of different counts which were scoured with NaOH. After pretreatment process the samples were tested for widthwise shrinkage, width, GSM, Wales per Inch and Course per Inch and compared between different states like grey state and finished state. The result obtained in this research indicated that physical properties like structures with tuck stitch possess higher value of widthwise shrinkage, width, GSM and Wales per Inch and Course per Inch value lowers prominently in those structures having float or miss stitches. In both cases i.e. grey state and RFD state values of those properties are high in coarser yarn and low in finer yarn. During project knitted fabrics specification along with machine specification and major factors which are necessary to calculate different types of variation and variables on which the whole fabric construction depends were managed to watch carefully. Main efforts were to develop a dependable way so that the resulting fabric specifications with required configuration can be easily visualized and be forecasted. A great emphasization was provided to the adjustable points on which fabric GSM, stitch length, fabric width and shrinkage percentage directly or indirectly depends.

According to the Supplemental Poverty Measure, state-level poverty rates range from a low of less than 10 percent in Iowa to a high of more than 20 percent in California. We seek to account for these differences using a theoretical framework proposed by Brady, Finnigan, and Hubgen (2017), which emphasizes the prevalence of poverty risk factors as well as poverty penalties associated with each risk factor. We estimate state-specific penalties and prevalences associated with single motherhood, low education, young households, and joblessness. We also consider state variation in the poverty risks associated with living in a black household and a Hispanic immigrant household. Brady et al. (2017) find that country-level differences in poverty rates are more closely tied to penalties than prevalences. Using data from the Current Population Survey, we find that the opposite is true for state-level differences in poverty rates. Although we find that state poverty differences are closely tied to the prevalence of high-risk populations, our results do not suggest that state-level antipoverty policy should be solely focused on changing "risky" behavior. Based on our findings, we conclude that state policies should take into account cost-of-living penalties as well as the state-specific relationship between poverty, prevalences, and penalties.

Introduction Flavors can mask the harshness of tobacco and make it appealing to young people. This study assessed flavored and menthol tobacco product sales at the national and state levels. Methods Universal Product Code tobacco sales data collected by Nielsen were combined for convenience stores and all-outlets-combined during October 22, 2011-January 9, 2016. Products were characterized as flavored, menthol, or non-flavored/non-menthol. Total unit sales, and the proportion of flavored and menthol unit sales, were assessed nationally and by state for seven tobacco products. Joinpoint regression was used to assess trends in average monthly percentage change. Results Nationally, the proportion of flavored and menthol sales in 2015 was as follows: cigarettes (32.5% menthol), large cigars (26.1% flavored), cigarillos (47.5% flavored, 0.2% menthol), little cigars (21.8% flavored, 19.4% menthol), chewing tobacco (1.4% flavored, 0.7% menthol), moist snuff (3.0% flavored, 57.0% menthol), and snus (88.5% menthol). From 2011 to 2015, sales increased for flavored cigarillos and chewing tobacco, as well as for menthol cigarettes, little cigars, moist snuff, and snus. Sales decreased for flavored large cigars, moist snuff, and snus, and for menthol chewing tobacco. State-level variations were observed by product; for example, flavored little cigar sales ranged from 4.4% (Maine) to 69.3% (Utah) and flavored cigarillo sales ranged from 26.6% (Maine) to 63.0% (Maryland). Conclusions Menthol and flavored sales have increased since 2011, particularly for the products with the highest number of units sold, and significant state variation exists. Efforts to restrict flavored tobacco product sales could reduce overall U.S. tobacco consumption. Implications Flavors in tobacco products can mask the harshness of tobacco and make these products more appealing to young people. This is the first study to assess national and state-level trends in flavored and menthol tobacco product sales. These findings underscore the importance of population-based interventions to address flavored tobacco product use at the national, state, and local levels. Additionally, further monitoring of flavored and menthol tobacco product sales can inform potential future regulatory efforts at the national, state, and local levels.

The number of intensive longitudinal studies that investigate affective experiences at the within-person rather than the between-person level is rapidly increasing. This paradigmatic shift comes with new challenges, such as questions revolving around how to measure within-person affect variation or more fundamental questions about the reliability and validity of constructs at the within-person level. We provide a review of substantive research published in Emotion since 2005, which revealed that to date no consensus has been established on measurement instruments for assessing within-person affective experiences. Our review also showed that researchers who are interested in within-person affect variation sometimes rely on measurement instruments that were established at the between-person level, which we think should be reconsidered. Finally, reliability estimates of state variation have been developed but are not comprehensively reported in studies on within-person affect variation. The purpose of this article is therefore to alert the reader to these issues and to highlight relevant criteria for selecting items and measurement instruments when studying within-person affect variation in intensive longitudinal studies. We recommend establishing common standards for measuring within-person affect variation and drawing from a common pool of instruments, which would allow direct comparison of results across studies. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Do minimum wages and the EITC mitigate rising “deaths of despair?” We leverage state variation in these policies over time to estimate event study and difference-in-differences models of deaths due to drug overdose, suicide, and alcohol-related causes. Our causal models find no significant effects on drug or alcohol-related mortality, but do find significant reductions in non-drug suicides. A 10 percent minimum wage increase reduces non-drug suicides among low-educated adults by 2.7 percent; the comparable EITC figure is 3.0 percent. Placebo tests and event-study models support our causal research design. Increasing both policies by 10 percent would likely prevent a combined total of more than 700 suicides each year.

Background Diagnosis and treatment of acute or impending compartment syndrome (ACS) remains a clinical challenge. ACS is a clinical diagnosis, and may be associated with variation in its definition, as well as individual threshold for fasciotomy. We examined regional and state variation in rates of lower extremity fasciotomy associated with operatively managed tibia fractures. Methods A total of 313,344 surgically treated tibia fractures were identified via Current Procedural Terminology (CPT) codes using PearlDiver, a private-payer medical record database. Data from the PearlDiver database was compared to the National Trauma Data Bank trauma registry data to corroborate calculated fasciotomy rates. Results The aggregate United States fasciotomy rate derived from PearlDiver was 2.57%. State fasciotomy rates were wide-ranging (0.03%–11.86%) with an average state rate of 2.22% (n = 47, SD = 2.27). Conclusions There was significant state-to-state variation in the use of fasciotomy during operative management of tibial fractures. Various factors may have contributed to the observed difference of state fasciotomy rates. Level of evidence This is a Level III epidemiological study retrospectively comparing geographic rates of fasciotomy during operative management of tibia fractures.

Objectives To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences. Study design Observational study using cross-sectional surveys. Methods Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. Results Unadjusted rates of no preventive dental care ranged 9.0–26.8% (mean 17.5%), with little impact of adjusting (10.3–26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1–14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7–10.7%). Child, family and community factors explained ∼¼ of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. Conclusion Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health.

Background:. As the national opioid epidemic escalates, rates of the Hepatitis C (HCV) infection have similarly risen. Surgeons exposed intraoperatively secondary to sharp instrument or needle-sticks are affected both socioeconomically and physically. Current treatment strategies involve antiretroviral agents that have not been universally available. This study evaluates the current risk of surgeon exposure to HCV. Methods:. CDC data regarding state-by-state HCV diagnosis reporting were combined with the plastic surgery workforce data from the ASPS. Proxy variables for exposure risk to HCV were generated for each state and compared. Results:. West Virginia plastic surgeons were found to have a significantly elevated risk of exposure (60.0 versus 18.7, P < 0.0001). Their exposure risk is a notable outlier compared with the rest of the country (Risk >3 × IQR + 75th percentile). Similarly, states within the Ohio Valley were found to be at increased risk (34.8 versus 16.0, P = 0.05). States most heavily burdened by the opioid crisis were found to be at an increased risk for HCV exposure (40.8 versus 13.6, P = 0.0003). Conclusions:. Plastic surgeons employed in states within the Ohio Valley were found to be at an increased risk of exposure to HCV. Plastic surgeons operating in states severely impacted by the opioid crisis were found to be at an increased risk of exposure. These findings underscore the importance of reducing the risk in the operating room and the need for better data collection to better understand this association and mitigate the risk to the operating surgeon.

Engineering remains the least gender diverse of the science, technology, engineering and mathematics fields. Chemical engineering (ChE) and electrical engineering (EE) are exemplars of relatively high and low gender diversity, respectively. Here, we investigate departmental, institutional, and regional factors associated with gender diversity among BS graduates within the US, 2010–2016. For both fields, gender diversity was significantly higher at private institutions (p < 1x10-6) and at historically black institutions (p < 1x10-5). No significant association was observed with gender diversity among tenure-track faculty, PhD-granting status, and variations in departmental name beyond the standard “chemical engineering” or “electrical engineering”. Gender diversity among EE graduates was significantly decreased (p = 8x10-5) when a distinct degree in computer engineering was available; no such association was observed between ChE gender diversity and the presence of biology-associated degrees. States with a highly gender diverse ChE workforce had a significantly higher degree of gender diversity among BS graduates (p = 3x10-5), but a significant association was not observed for EE. State variation in funding of support services for K-12 pupils significantly impacted gender diversity of graduates in both fields (p < 1x10-3), particularly in regards to instructional staff support (p < 5x10-4). Nationwide, gender diversity could not be concluded to be either significantly increasing or significantly decreasing for either field.

We conduct a resume field experiment in all U.S. states to study how state laws protecting older workers from age discrimination affect age discrimination in hiring for retail sales jobs. We relate the difference in callback rates between old and young applicants to state variation in age and disability discrimination laws. These laws could boost hiring of older applicants, although they could have the unintended consequence of deterring hiring if they increase termination costs. In our preferred estimates that are weighted to be representative of the workforce, we find evidence that there is less discrimination against older men and women in states where age discrimination law allows larger damages, and more limited evidence that there is lower discrimination against older women in states where disability discrimination law allows larger damages. Our clearest result is that these laws do not have the unintended consequence of lowering callbacks for older workers.

We exploit state variation in licensing laws to study the effect of licensing on occupational choice using a boundary discontinuity design. We find that licensing reduces equilibrium labour supply by an average of 17–27 per cent.

The study's objective was to investigate whether attention-deficit hyperactivity disorder (ADHD) diagnoses from 2003 to 2011 were associated with either public school consequential accountability reforms initiated by the No Child Left Behind (NCLB) Act, particularly for low-income children, or with state psychotropic medication laws that prohibit public schools from recommending or requiring medication use.Logistic regression difference-in-differences models were estimated with repeated U.S. and state-representative cross-sections of responses to the 2003, 2007, and 2011 National Survey of Children's Health. Each wave included approximately 35,000 public school children between ages six and 13.From 2003 to 2007, the change in adjusted diagnostic prevalence was 2.8 percentage points higher for children ages six to 13 in households with incomes ≤185% of the federal poverty level residing in states first exposed to consequential accountability through NCLB (from 8.5% to 13.2%), compared with demographically similar children residing in other states (from 10.2% to 12.1%). From 2003 to 2011, the change in adjusted diagnostic prevalence was 2.2 percentage points lower for children ages six to 13 residing in states with a psychotropic medication law (from 8.1% to 7.8%), compared with children residing in other states (from 8.1% to 10.1%).NCLB-initiated consequential accountability reforms were associated with more ADHD diagnoses among low-income children, consistent with increased academic pressures from NCLB for this subgroup. In contrast, psychotropic medication laws were associated with fewer ADHD diagnoses, because they may indirectly reduce diagnoses via restrictions on recommending or requiring medication use. Future research should investigate whether children most affected by these policies are receiving appropriate diagnoses.

An optimal control problem for a system described by a singular nonlinear equation of elliptic type with an inclusion phase constraint is considered. Necessary optimality conditions are obtained by varying system states.

Medicaid reimbursements are determined by each state and are subject to variability. We sought to quantify this variation for commonly performed inpatient orthopaedic procedures.The 10 most commonly performed inpatient orthopaedic procedures, as ranked by the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, were identified for study. Medicaid reimbursement amounts for those procedures were benchmarked to state Medicare reimbursement amounts in 3 ways: (1) ratio, (2) dollar difference, and (3) dollar difference divided by the relative value unit (RVU) amount. Variability was quantified by determining the range and coefficient of variation for those reimbursement amounts.The range of variability of Medicaid reimbursements among states exceeded $1,500 for all 10 procedures. The coefficients of variation ranged from 0.32 (hip hemiarthroplasty) to 0.57 (posterior or posterolateral lumbar interbody arthrodesis) (a higher coefficient indicates greater variability), compared with 0.07 for Medicare reimbursements for all 10 procedures. Adjusted as a dollar difference between Medicaid and Medicare per RVU, the median values ranged from -$8/RVU (total knee arthroplasty) to -$17/RVU (open reduction and internal fixation of the femur).Variability of Medicaid reimbursement for inpatient orthopaedic procedures among states is substantial. This variation becomes especially remarkable given recent policy shifts toward focusing reimbursements on value.

Contains fulltext : 153313.pdf (Publisher’s version ) (Open Access) Hypothalamic-pituitary-adrenal (HPA)-axis dysregulation is a prominent finding in more severe Major Depressive Disorder (MDD), and is characterized by increased baseline cortisol levels at awakening (BCL), blunted cortisol awakening response (CAR) and increased area under the cortisol curve (AUC). Selective serotonin reuptake inhibitors (SSRIs) appear to normalize HPA-axis dysfunction, but this is hardly investigated longitudinally. We studied salivary BCL, CAR and AUC at awakening and 30min thereafter. We compared measurements in initially drug-free MDD-patients with healthy controls (HCs) at study-entry. In patients, we repeated measures after 6 and 12 weeks' treatment with the SSRI paroxetine. Non-responding patients received a randomized dose-escalation after six weeks' treatment. We found no significant study-entry differences in BLC, CAR or AUC between MDD-patients (n=70) and controls (n=51). In MDD-patients, we found general decreases of BCL and AUC during paroxetine treatment (p

Prior studies have reported that community health centers perform as well as other sites of care, despite serving more vulnerable patient populations. However, there is little prior study of geographic variation in quality outcomes and disparities in outcomes in this setting. Quantifying geographic variation is important so as to target quality improvement efforts and funding and to learn from states where total quality is highest and racial/ethnic disparities are lowest.To estimate between-state variation in hypertension, diabetes, and pregnancy outcomes and racial/ethnic disparities in these outcomes for health center patients.Using data on all US health centers from 2010 to 2014 (N=1047 health centers/year, or 21.2 million patients in 2014), we used linear regression models to estimate adjusted quality outcomes and racial/ethnic disparities in quality outcomes by state for hypertension control, diabetes control, and normal birthweight.We found wide variation in both outcomes and racial/ethnic disparities in outcomes between states for patients seen at health centers. For instance, between states, the mean proportion of patients with hypertension control ranged from 58% to 70% for white patients, from 49% to 64% for black patients, and from 53% to 74% for Hispanic patients (P0.001). Racial/ethnic disparities in outcomes ranged from negative or nonsignificant in some states to positive in others.Wide variation in health center patient outcomes and disparities in outcomes is observed between states. This variation suggests that policymakers should target funding and interventions to underperforming states, and identify determinants of high quality in higher performing states.

Criteria for quantitatively describing the state and state variation of a living organism in various conditions are proposed using a set of its measurable characteristics (indicators, properties). The measurable indicators (of diff erent origin and dimensionality) of an organism converted into a dimensionless form relative to their control values are combined into a single integral indicator showing relative deviation averaged over all the indicators. This integral indicator is useful to compare the results of diff erent experiments. If the range of normal variability (reference range) is known for each indicator involved, the second integral indicator is proposed to be calculated as the normalized relative deviation from the middle of all reference ranges (in percentage) averaged over all the indicators. The calculation is performed in such a way that the range 0–100 % of this deviation of an indicator corresponds to the normal variability (where 0 corresponds to the middle of the reference range, 100 % – to its lower or upper limit), while the values over > 100 % represent a pathological response. The normalized relative deviation from the middle of all reference ranges (in percentage) averaged over all the indicators is an assessment of the state of a living organism (based on the given set of indicators) relative to the range of normal variability. The application of the suggested approach is illustrated by an example of a toxicological experiment.

Objectives. To examine state variation in minimum stocking requirements for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)–authorized small food retailers. Methods. We obtained minimum stocking requirements for 50 states and the District of Columbia in 2017 from WIC Web pages or e-mail from the state WIC agency. We developed a coding protocol to compare minimum quantities and varieties required for 12 food and beverage categories. We calculated the median, range, and interquartile range for each measure. Results. Nearly all states set minimum varieties and quantities of fruits and vegetables, 100% juice, whole grain–rich foods, breakfast cereal, milk, cheese, eggs, legumes, and peanut butter. Fewer states set requirements for canned fish, yogurt, and tofu. Most measures had a large range in minimum requirements (e.g., $8–$100 of fruits and vegetables, 60–144 oz of breakfast cereal). Conclusions. WIC-participating retailers must adhere to very different minimum stocking requirements across states, which may result in disparities in food and beverage products available to WIC recipients. Public Health Implications. The results provide benchmarks that can inform new local, state, and federal program and policy efforts to increase healthy food availability in retail settings.

Variation in Medicaid policies among states may lead to differences in coverage for complex treatments. This article uses hematopoietic cell transplantation (HCT), an established treatment for patients with hematologic cancers, as a case study to highlight state variation in Medicaid coverage of complex oncology treatments.Information on HCT coverage benefits for 2012 was collected from state Medicaid Web sites and was compared with recommended HCT benefits developed by multiple stakeholders. Coverage was reviewed for five categories: one, transplantation procedure; two, donor search; three, prescriptions; four, clinical trials; and five, patient food, lodging, and transportation. Coverage was coded on a three-point scale for each category for each state. States were ranked by the number of variables for which they met recommended benefits criteria (maximum rank score, 5).Detailed information on Medicaid coverage was available for 47 states. No state provided the recommended coverage benefits in all five categories. Prescription coverage most often met the recommended criteria, whereas only a small number of states provided clinical trial coverage for HCT. There was substantial variation in Medicaid coverage for HCT by state.Findings highlight substantial variation in Medicaid coverage for HCT by state, which may increase disparities in access for already medically underserved populations.

In this article, the author studies the effects of the minimum wage on immigration. He develops an analytical framework in which immigration is a function of the expected wage in the region of destination. In the analysis, the author exploits the state variation in expected wages stemming from the changes in the U.S. federal minimum wage during 1996–1997 and 2007–2009. The author addresses endogeneity between immigration and the expected wage using an instrumental variable approach. His results provide consistent evidence that the policy induced a sizeable flow of low-skilled immigrants to the United States in both periods. This pull is attributable to the minimum wage increasing immigrants' wages without harming their potential employment outcomes. The author corroborates these findings by showing that the policy did not have any impact on the flow of high-skilled immigrants. The effect on low-skilled immigration is also found when the interstate mobility of immigrants is considered. Finally, changes in the minimum wage only attracted legal immigrants, while undocumented immigrants were not affected.

Vanadium oxide (VOx) thin films with and without in situ AlN layer were grown on single crystal sapphire substrates by pulsed laser deposition (PLD) with V2O5 target. The significant structure and morphology transforms resulted from the insertion of in-situ AlN layer were observed by X-ray diffraction (XRD) and field-emission scanning electron microscope (FESEM). To interpret the mechanism behind these phenomena, the valence state variation of vanadium (V) in VOx films induced by in-situ AlN layer was investigated by X-ray photoelectron spectroscopy (XPS) analyses. The results indicated that the valence state of V become more complicated and VOx films with the mixed V valence state of V5+,V4+and V3+ were obtained due to the introduction of AlN interfacial stress layer. Our achievements will be helpful for understanding the physical mechanism behind the exotic characteristics of VOx films induced by stress layer.

The economic value of family caregiving, by any measure, dwarfs actual expenditures on formal long-term services and supports (LTSS). This presentation discusses new estimates of the number of caregivers, intensity of caregiving, and the total economic value of family caregiving in 2017 in the United States, and in every state, the District of Columbia, Puerto Rico, and the Virgin Islands, based on a meta-analysis of recent nationally representative surveys of family caregivers. Previous analyses of this type have found that the total economic value of family caregiving has increased steadily from $350 billion in 2005 to $470 billion in 2013. State variation in the incidence, intensity, and economic value of caregiving will be discussed, and key predictors of this variation will be identified.

States vary in their overall rates of nursing home deficiency citations as well as deficiencies for actual harm or jeopardy (Harrington et al., 2018). Civil Money Penalty (CMP) fines collected by the Centers for Medicare and Medicaid Services (CMS) are one enforcement action imposed to promote nursing home compliance with regulations. Collected CMP funds are redistributed to states for the sole purpose of improving nursing home resident care and quality of life through reinvestment in quality improvement projects. Using CASPER data available for US skilled nursing homes in 2015 and 2016 through the CMS QCOR database we examined the distribution of quality of care (QOC) and quality of life (QOL) deficiencies and CMP enforcement action across states. Guided by the systems framework for evaluating nursing home quality (Unruh & Wan, 2004) we further explored how contextual factors such as state spending for nursing home care, structural characteristics of facilities in states, and inadequate care processes indicated by deficiencies contribute to CMP enforcement actions and fines. Findings indicate that 27% of enforcement actions resulting in a CMP between 2015 and 2016 were imposed for a QOL deficiency while 61.7% represented QOC deficiencies. QOL deficiencies represented only 8% of the highest severity deficiency category but 81.7% of enforcement actions for QOC were for those causing immediate harm or jeopardy. QOC deficiencies are a focus of enforcement actions as they represent critical care processes influencing resident basic needs for hydration, ambulation, skin integrity and care for other special physical and behavioral needs.

Federal waivers to state governments from conditions attached to grants-in-aid and other programs have become a critical factor in U.S. intergovernmental relations, yet no systematic empirical analysis has considered which factors make some states more likely to receive waivers. This article presents results of model estimations of time-series panel data that use as dependent variables measures of waivers to federal Medicaid and education policy from 1991 to 2008. Different factors influence the waivers states receive to different federal programs, suggesting that the waiver process varies greatly from policy to policy. These results do suggest that scholars of future waiver processes look to the capacity of each state's government and the relative size of populations the federal program most affects. Copyright 2013, Oxford University Press.