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Summary While animals navigating the real world face a barrage of complex sensory input, their brains have evolved to perceptually compress multidimensional information by selectively extracting the features relevant for survival. For instance, communication signals supporting social interactions in several mammalian species consist of acoustically complex sequences of vocalizations, however little is known about what information listeners extract from such time-varying sensory streams. Here, we utilize female mice’s natural behavioural response to male courtship songs to evaluate the relevant acoustic dimensions used in their social decisions. We found that females were highly sensitive to disruptions of song temporal regularity, and preferentially approached playbacks of intact male songs over rhythmically irregular versions of the songs. In contrast, female behaviour was invariant to manipulations affecting the songs’ sequential organization, or the spectrotemporal structure of individual syllables. The results reveal temporal regularity as a key acoustic cue extracted by mammalian listeners from complex vocal sequences during goal-directed social behaviour. Highlights - Natural behaviour is used to probe how mouse listeners encode vocal sequences - Listeners are highly sensitive to disruptions of the songs’ rhythmic regularity - Female behaviour is invariant to changes in song sequence - Approach behaviour is robust to the removal of syllable spectrotemporal dynamics

Context The long-term risk of type 2 diabetes in adolescents with nonalcoholic fatty liver disease (NAFLD) is unclear. Objective To assess type 2 diabetes risk among adolescents with NAFLD. Design and Setting A nationwide, population-based study of Israeli adolescents who were examined before military service during 1997–2011 and were followed until December 31, 2016. Participants A total of 1 025 796 normoglycemic adolescents were included. Interventions Biopsy or radiographic tests were prerequisite for NAFLD diagnosis. Data were linked to the Israeli National Diabetes Registry. Main Outcome Measures Type 2 diabetes incidence. Results During a mean follow-up of 13.3 years, 12 of 633 adolescents with NAFLD (1.9%; all with high body mass index [BMI] at baseline) were diagnosed with type 2 diabetes compared with 2917 (0.3%) adolescents without NAFLD. The hazard ratio (HR) for type 2 diabetes was 2.59 (95% confidence interval [CI], 1.47–4.58) for the NAFLD vs. the non-NAFLD group after adjustment for BMI and sociodemographic confounders. The elevated risk persisted in several sensitivity analyses. These included an analysis of persons without other metabolic comorbidities (adjusted HR, 2.75 [95% CI, 1.48-5.14]) and of persons with high BMI; and an analysis whose outcome was type 2 diabetes by age 30 years (adjusted HR, 2.14 [95% CI, 1.02-4.52]). The results remained significant when a sex-, birth year-, and BMI-matched control group was the reference (adjusted HR, 2.98 [95% CI, 1.54-5.74]). Conclusions Among normoglycemic adolescents, NAFLD was associated with an increased adjusted risk for type 2 diabetes, which may be apparent before age 30 years.

Background Cognitive function among apparently healthy adolescents has been associated with cardiovascular morbidity and mortality. We examined the relationship between global and subdomain cognitive scores in adolescence and early-onset type 2 diabetes (T2D) in men and women. Methods A nationwide, population-based study of 971,677 Israeli born adolescents (56% men; mean age 17.4 years) who were medically examined and their cognitive performance was assessed before compulsory military service during 1992–2010. Data included global and subdomain cognitive Z-scores (problem-solving, verbal abstraction and categorization, verbal comprehension, and mathematical abilities). Data were linked to the Israeli National Diabetes Registry. The relations between global and subdomain scores and incident T2D was determined using Cox proportional hazard models and logistic regression models. Analyses were conducted separately for men and women. Findings During 16,095,122 person-years, 3,570 individuals developed T2D. After adjustment, those in the low compared to the high quintile of global cognitive Z-score had the highest risk for T2D; HR 2.46, (95% CI 2.10–2.88) for men and 2.33 (95% CI 1.88–2.89) for women. A one-unit lower global cognitive Z-score was associated with 1.41 (95% CI 1.34–1.48) and 1.46 (95% CI 1.36–1.56) increased risks for men and women, respectively. The relationship was noted for the cognitive subdomains scores as well as for the global cognitive score, with no heterogeneity across cognitive subdomains. Interpretation This large nationally representative cohort suggests relationship between global, as well as subdomain cognitive scores in late adolescence, and incident early onset T2D in both sexes, which was independent of socioeconomic status. Funding None.

Given projected increases in flood damages, managed retreat strategies are likely to become more widespread. Voluntary buyouts, where governments acquire flood-damaged properties and return the sites to open space, have been the primary form of federally funded retreat in the USA to date. However, little attention has been paid to the cost structure of buyout projects. Using a transaction cost framework, we analyze the costs of activities that comprise floodplain buyouts. Federal data do not distinguish transaction costs, but they do suggest that the cost of purchasing properties often accounts for 80% or less of total project costs. Through a systematic review (n = 1103 publications) and an analysis of government budgets (across n = 859 jurisdiction-years), we find limited sources with relevant cost information, none of which reports transaction costs. The absence of activity-level cost data inhibits more targeted policy reform to support community-driven and efficient buyout programs. Better data collection and reporting can inform more impactful and equitable buyout policy.

The incidence of adolescent hypertension is growing worldwide, mostly in conjunction with the growing obesity prevalence (1,2). Adolescent hypertension was shown to be a risk factor for cardiovascular and renal outcomes later in life, thus promoting current guidelines to screen all pediatric and adolescent population for hypertension (1,3). Here, we elucidate the association of adolescent hypertension and early-onset type 2 diabetes in a nationwide cohort of adolescents. In this population-based, retrospective cohort study we linked the Israeli Defense Forces conscription center database with the Israeli National Diabetes Registry (INDR). One year prior to mandatory military service at age 17 years, Israeli adolescents undergo comprehensive medical evaluation based on their medical history, an interview and physical examination that includes measurements of height, weight, and blood pressure. Included were adolescents who were examined between 1 January 1993 and 31 December 2016. Excluded were those with prior diagnosis of dysglycemia and those with missing baseline height or weight data (3.8% in total). Essential hypertension diagnosis was confirmed by a board-specified nephrologist based on a preexisting diagnosis or screening for hypertension as described previously (1). Briefly, adolescents with blood pressure measurement during the screening assessment of >140/90 mmHg were referred for further investigation. The final diagnosis was made when the average of 10 additional outpatient blood pressure measurements was >140/90 mmHg, when at least 50% of the measurements were above this level, and after exclusion of secondary hypertension. The primary outcome was incident type 2 diabetes as documented by the INDR, which captures all cases of diabetes in Israel with a sensitivity of 95.1% (2). Cox models were applied. Follow-up started at the day of the first medical examination and ended at the date of diabetes diagnosis, 31 December 2016, or death—whichever came first. Due to the previously described …

Background: Current practice in the UK is to plot premature infant anthropometric measurements on Neonatal and Infant Close Monitoring (NICM) reference charts. These charts have several known limitations. The INTERGROWTH-21st Project has recently produced international ante- and postnatal growth standards. Exact knowledge of growth centiles allows clinicians to accurately assess infant nutritional requirements. Objective: To compare target centile measurements between INTERGROWTH-21st and UK NICM growth charts for premature infants. Method: Anthropometric measurements (weight and head circumference) of a convenience sample of neonates born between 24 and 32 weeks of gestation were analysed retrospectively. Measurements were collected across three time points and plotted on both the NICM and INTERGROWTH-21st growth charts. The respective centiles were compared and analysed by paired-sample t test, Wilcoxon rank test analysis, and multilevel mixed-effect linear regression models. Results: Centiles for weight and head circumference measurements of 96 infants plotted on INTERGROWTH-21st charts were significantly greater than their corresponding UK charts at all three time points. For weight, the average difference between the two charts varied from 9.1 to 16.4 centiles. The difference between the two charts was greater for female than male infants by up to 6.9 centiles (95% CI 10.1–3.8). Conclusion: Existing UK NICM reference charts are significantly different to the growth standards of INTERGROWTH-21st. The choice of which growth chart to adopt in the UK could have important consequences on premature infants’ future adult health and therefore requires further prospective observational studies with larger data sets including length measurements and more comprehensive population characteristics.

Immigration from one cultural milieu to another has been associated with a greater risk for incident cardio-metabolic morbidity among adults. In this nationwide, population-based, cross-sectional study of data recorded from 1992 to 2016, we assessed the association between body mass index and blood pressure levels among adolescent immigrants, aged 16 to 19 years, of Ethiopian origin, and their secular trend of overweight and obesity. Adolescents of Ethiopian origin were classified as Israeli-born (n=16 153) or immigrants (N=23 487), with stratification by age at immigration. Adolescents whose fathers were at least 3 generations in Israel (n=277 789) served as a comparative group. Hypertensive-range blood pressure values adjusted for age, sex, and height served as outcome. Among adolescents of Ethiopian origin, overweight and obesity (body mass index ≥85th percentile), increased by 2.5 and 4-fold in males and females, respectively, during the study period, compared with a 1.5-fold increase among native Israeli-born males and females. The odds for hypertensive-range measurements increased with the length of residence in Israel: 7.3%, 10.6%, and 14.4% among males who immigrated at ages 12 to 19, 6 to 11.9, and 0 to 5.9 years, respectively; and 11.5%, 16.7%, and 19.3%, respectively, among females. Israeli-born Ethiopians had a significantly higher risk for hypertensive-range measurements at any body mass index level compared with native Israeli-born examinees, after adjusting for sociodemographic factors and health status. In conclusion, among Ethiopian Israeli adolescents, abnormal blood pressure correlates directly with the time-lapse since immigration. Immigrant populations require targeted surveillance and appropriate intervention.

OBJECTIVE The relationship between acute pancreatitis and incident diabetes is unclear. We assessed whether a resolved single event of acute pancreatitis in childhood was associated with incident diabetes in adulthood. RESEARCH DESIGN AND METHODS A nationwide, population-based study of 1,802,110 Israeli adolescents (mean age 17.4 years [range 16–20]) who were examined before compulsory military service between 1979 and 2008 and whose data were linked to the Israeli National Diabetes Registry (INDR). Resolved pancreatitis was defined as a history of a single event of acute pancreatitis with normal pancreatic function at enrollment. Logistic regression analysis was applied. RESULTS Incident diabetes developed in 4.6% of subjects with resolved pancreatitis (13 of 281; none of these cases were identified as type 1 diabetes) and 2.5% among the unexposed group (44,463 of 1,801,716). Resolved acute pancreatitis was associated with incident diabetes with an odds ratio (OR) of 2.23 (95% CI 1.25–3.98) with adjustment for age, sex, and birth year. Findings persisted after further adjustments for baseline BMI and sociodemographic confounders (OR 2.10 [95% CI 1.15–3.84]). Childhood pancreatitis was associated with a diagnosis of diabetes at a younger age, with 92% of diabetes case subjects diagnosed before 40 years of age compared with 47% in the unexposed group (P = 0.002). The association accentuated when the study sample was limited to individuals of unimpaired health or normal BMI at baseline. CONCLUSIONS A history of acute pancreatitis in childhood with normal pancreatic function in late adolescence is a risk factor for incident type 2 diabetes, especially at young adulthood.

Tuberculous pachymeningitis is a rare disease that should be suspected in patients with chronic headaches, focal neurological signs, and magnetic resonance imaging (MRI) findings of dural thickening. We report the case of a 62-year-old male who presented with chronic headaches for over a year, progressive right-sided vision and hearing loss for six months, and progressive dysphagia for a month. On investigation, MRI showed dural thickening, cerebrospinal fluid showed lymphocytic pleocytosis with high protein and normal glucose levels, and biopsy of the dural matter showed necrotizing granulomas with Langhans giant cells. The patient responded well to antitubercular treatment and steroids. Follow-up MRI 24 months later showed almost complete resolution of meningeal enhancement. Though tuberculosis is an uncommon cause of pachymeningitis, it should be considered, as it responds well to treatment.

Background and Purpose: There is a continuous rise in the prevalence of adolescent obesity and incidence of stroke among young adults in many Western countries, but the association between them is unclear. Methods: A nationwide population-based study of 1 900 384 Israeli adolescents (58% men; mean age, 17.3 years) who were evaluated before mandatory military service during 1985 and 2013. Body mass index was classified according to the US Center for Disease Control and Prevention percentiles. Primary outcome was a first stroke event as recorded by the Israeli National Stroke Registry between 2014 and 2018. Cox proportional hazard models were applied. Results: There were 1088 first stroke events (921 ischemic and 167 hemorrhagic; mean diagnosis age, 41.0 years). Adolescent body mass index was significantly associated with a graded increase in the risk for any stroke, ischemic stroke, but less so with hemorrhagic stroke. The hazard ratios for the first ischemic stroke event were 1.4 (95% CI, 1.2–1.6), 2.0 (95% CI, 1.6–2.4), and 3.4 (95% CI, 2.7–4.3) for the 50th to 84th percentile, overweight and obese groups, respectively, after adjustment for sex, age, and sociodemographic confounders with the 5th to 49th body mass index percentile group as the reference. The respective hazard ratios after further adjustment for diabetes status were 1.3 (1.1–1.5), 1.6 (1.3–2.0), and 2.4 (1.9–3.1). Results persisted when the cohort was divided by diabetes status and when ischemic stroke before age 30 was the outcome. Conclusions: High adolescent body mass index was associated with ischemic stroke in young adults with or without diabetes. The rising prevalence of adolescent obesity may increase the future burden of stroke in young adults.

An increasing number of diseases can be offered treatments that are transformative if administered in a timely manner. However, many of these diseases are currently not included in the newborn screening programs because they lack sensitive and specific metabolic biomarkers, and detection of children at increased risk relies on genetic methods. Type 1 diabetes (T1D) constitutes a potential example of such disease.Between April 2018 and November 2020, over 15500 babies were enrolled into ‘INGR1D’ (Investigating Genetic Risk for T1D), a research study to identify newborns with an increased genetic risk of T1D. This project, performed as part of a T1D primary prevention study (the Primary Oral Insulin Trial, POInT), has helped to pioneer the integration of genetic screening into the NHS Newborn Blood Spot Screening Programme (NBSSP) for consenting mothers, without affecting the screening pathway. The use of prospective consent to perform personalised genetic testing on samples obtained through the routine NBSSP represents a novel mechanism for clinical genetic research in the UK and provides a model for further population based genetic studies in the newborn.This project builds on the UK’s role as a world leader in genomic medicine, e.g. through its inception and completion of the 100 000 Genomes Project, and its subsequent ambition to map 5 million further genomes over the next 5 years.Our aim is therefore to describe the methodology used by INGR1D as a way to demonstrate how a successful research and clinical trial tool can be integrated into a national screening programme, with the potential for the tool to be developed to incorporate multiple diseases with genetic markers without altering the screening pathway.

Context Thyroid hormones play a key role in systemic metabolism, yet the relationship between thyroid dysfunction and risk for type 2 diabetes is unclear. Objective To assess type 2 diabetes risk in adulthood among adolescents with thyroid disorders. Design and Setting A nationwide, population-based study of Israeli adolescents who were examined before military recruitment during 1988 to 2007 and were followed until December 31, 2016. Participants 1 382 560 adolescents (mean age 17.3 years). Interventions The diagnosis of thyroid disorders was based on recent thyroid function tests. Data were linked to the Israeli National Diabetes Registry. Cox proportional hazard models were applied. Main Outcome Measures Type 2 diabetes incidence. Results During a mean follow-up of 18.5 years, 1.12% (69 of 6,152) of adolescents with thyroid disorders were diagnosed with type 2 diabetes vs 0.77% of adolescents without thyroid disorders. The hazard ratio (HR) for type 2 diabetes was 2.3 (95% CI, 1.8-2.9) among those with thyroid disorders, after adjustment for sex, birth-year, body mass index, and sociodemographic confounders. The increased diabetes risk was observed in both men and women, with the presence or absence of obesity, and in the absence of other health conditions and was associated with different types of thyroid disorders. It was also similar when the outcome was defined as type 2 diabetes diagnosed at or before the age of 30 years (HR 2.3, 95% CI, 1.5-3.5). Conclusions Thyroid disorders diagnosed in adolescence are a risk factor for early-onset type 2 diabetes in both men and women.

Water quality trading (WQT) programs aim to efficiently reduce pollution through market-based incentives. However, WQT performance is uneven, while several programs have found frequent use, many experience operational barriers and low trading activity. What factors are associated with WQT existence, prevalence, and operational stage? In this paper, we present and analyze the most complete database of WQT programs in the United States (147 programs/policies), detailing market designs, trading mechanisms, traded pollutants, and segmented geographies in 355 distinct markets. We use hurdle models (joint binary and count regressions) to evaluate markets in concert with demographic, political, and environmental covariates. We find that only one half of markets become operational, new market establishment has declined since 2013, and market existence and prevalence has nuanced relationships with local political ideology, urban infrastructure, waterway and waterbody extents, regulated environmental impacts, and historic waterway impairment. Our findings suggest opportunities for better projecting program need and targeting program funding.

Rapid progress in technologies such as calcium imaging and electrophysiology has seen a dramatic increase in the size and extent of neural recordings. Even so, interpretation of this data requires considerable knowledge about the nature of the representation and often depends on manual operations. Decoding provides a means to infer the information content of such recordings but typically requires highly processed data and prior knowledge of the encoding scheme. Here, we developed a deep-learning framework able to decode sensory and behavioral variables directly from wide-band neural data. The network requires little user input and generalizes across stimuli, behaviors, brain regions, and recording techniques. Once trained, it can be analyzed to determine elements of the neural code that are informative about a given variable. We validated this approach using electrophysiological and calcium-imaging data from rodent auditory cortex and hippocampus as well as human electrocorticography (ECoG) data. We show successful decoding of finger movement, auditory stimuli, and spatial behaviors – including a novel representation of head direction - from raw neural activity.

Transfer of development rights (TDR) programs shift development intensity between land parcels. Jurisdictions, most commonly local municipal or county governments, employ TDR to protect resources such as farmland or historical properties and to encourage infill and redevelopment where deemed appropriate. However, while championed by economists and others seeking to reduce conflicts between land development and preservation, TDR program adoption has varied widely across the US. What demographic, economic, or environmental factors are associated with TDR program establishment? This paper describes a census of 375 TDR programs in the United States, documenting primary program attributes and adoption year and categorizing their functions and typology. Using logistic regression, we analyze program spatial patterns and factors predicting program implementation. We find that areas that are coastal, more liberal, have higher home values, in home-rule states, and in states with state-wide growth management programs, are all significantly more likely to implement TDR programs.

Increases in extreme weather events have caused extensive flooding across the United States. In response, federal, state, and local governments have broadened their flood mitigation strategies to include acquisition and demolition of flood-damaged homes (&ldquo, buyouts&rdquo, ). Little work has documented or analyzed the range of strategies for funding buyouts. Federal programs provide the bulk of funding, but these programs are often slow. Also, state and local governments struggle to meet cost-match requirements. We present and analyze a nationwide census of buyout funding programs (n = 34), which draw on five primary funding mechanisms. We find that state and local governments are using a range of traditional and innovative financial mechanisms, including municipal/green bonds, revolving loan funds, local option sales taxes, and stormwater utility fees, as viable tools for funding buyouts. These tools may promote more autonomy from federal government mitigation programs, and ultimately, faster buyout processes.

Floodplain buyouts—the acquisition and removal of flood-damaged homes—have become increasingly important in federal disaster policy. However, there has been little research on how buyouts f...

Severe obesity among children and adolescents is a significant global public health concern. The prevalence has markedly increased over the last decades, becoming common in many countries. Overwhelming rates of obesity among youth have prompted efforts to identify an evidence-based immediate- and long-term cardiometabolic risk factor profile in childhood-onset severe obesity, and to highlight gaps that require further investigation. The PubMed database was systematically searched in accordance with PRISMA guidelines. The search yielded 831 results, of which 60 fulfilled stringent criteria and were summarized in this review. The definition of severe obesity was variable, with only one half the publications using the definition BMI > 120% of the 95th percentile. Point estimates of the prevalence of at least one cardiometabolic risk factor in children with severe obesity reportedly range from 67 to 86%. Cross-sectional studies indicate that children and adolescents with severe obesity are at greater risk than those with mild obesity for type 2 diabetes, hypertension, fatty liver disease and dyslipidemia, already at childhood and adolescence. Robust epidemiological data on the long-term risk and actual point estimates in adulthood are lacking for these diseases as well as for other diseases (coronary heart disease, stroke, chronic kidney disease and cancer). Recent longitudinal studies indicate an increased risk for cardiomyopathy, heart failure, cardiovascular mortality and all-cause mortality in adulthood for adolescents with severe obesity compared to those with mild obesity. Given the alarming increase in the prevalence of severe obesity, the persistence of adiposity from childhood to adulthood and the precarious course of young adults with chronic comorbidities, the economic and clinical services burden on the healthcare system is expected to rise.

Urban development relies on many factors to remain viable, including infrastructure, services, and government provisions and subsidies. However, in situations involving federal or state level policy, development responds not just to one regulatory signal, but also to multiple signals from overlapping and competing jurisdictions. The 1982 U.S. Coastal Barrier Resources Act (CoBRA) offers an opportunity to study when and how development restrictions and economic disincentives protect natural resources by stopping or slowing urban development in management regimes with distributed authority and responsibility. CoBRA prohibits federal financial assistance for infrastructure, post-storm disaster relief, and flood insurance in designated sections (CoBRA units) of coastal barriers. How has CoBRA’s removal of these subsidies affected rates and types of urban development? Using building footprint and real estate data (n = 1,385,552 parcels), we compare density of built structures, land use types, residential house size, and land values within and outside of CoBRA units in eight Southeast and Gulf Coast states. We show that CoBRA is associated with reduced development rates in designated coastal barriers. We also demonstrate how local responses may counteract withdrawal of federal subsidies. As attention increases towards improving urban resilience in high hazard areas, this work contributes to understanding how limitations on infrastructure and insurance subsidies can affect outcomes where overlapping jurisdictions have competing goals.

Objective: To analyze the contribution of the teaching of entrepreneurship, in the development of the entrepreneurial potential of Business Administration majors on a higher level education institution. Method: The study was divided in two stages: in the first stage, a descriptive and documentary research was carried out, with a qualitative approach. Subsequently, a quantitative study was carried out by means of a survey. The data collection instrument used was proposed by Carland, Carland and Hoy (1992), called Carland Entrepreneurship Index (CEI). Originality/Relevance: The research deepens a discussion about the entrepreneurial potential and teaching of entrepreneurship in higher education, evidencing decisive empirical factors for the formation of new managers-entrepreneurs. Results: The methodological mechanisms demonstrated the existence of congruent knowledge between the tested model and the contents disseminated in the classroom. Thus, the contribution to the entrepreneurial training of students in the decreasing requirements of identification of entrepreneurial potential, micro-entrepreneurs and macro-entrepreneurs. Theoretical / methodological contributions: The study contributes to the literature by pointing out, through the empirical propositions, that the content in the student training process exerts a guiding function in the construction of behaviors aimed at entrepreneurial education. Social/management contributions: The findings in the field were salutary to direct the pedagogical management and the teaching staff regarding the interdisciplinarity of contents of entrepreneurial training in the nuclei of basic training, complementary, Contents of Quantitative Studies and their Technologies and Complementary Training Contents, as established by the National Curricular Guidelines of the Graduate Program in Administration., Objetivo: analisar a contribuição do ensino de empreendedorismo para o desenvolvimento do potencial empreendedor dos estudantes de Administração de uma Instituição de Ensino Superior. Método: o estudo foi dividido em duas etapas: (1) uma pesquisa descritiva e documental, com abordagem qualitativa; e (2) um estudo quantitativo, por meio de uma survey. O instrumento de coleta de dados utilizado foi proposto por Carland, Carland e Hoy (1992), denominado de Carland Entrepreneurship Index (CEI).Originalidade/Relevância: a pesquisa aprofunda a discussão acerca do potencial empreendedor e do ensino de empreendedorismo, no âmbito da Educação Superior, evidenciando fatores empíricos decisivos para a formação de novos gestores empreendedores.Resultados: os mecanismos metodológicos mostraram a existência de conhecimentos congruentes entre o modelo testado e os conteúdos disseminados em sala de aula, evidenciando, com isso, a contribuição para a formação empreendedora dos estudantes, nos quesitos decrescentes de identificação de potencial empreendedor, tanto para micro quanto para macroempreendedores.Contribuições teóricas/metodológicas: o estudo contribui com a literatura, ao sinalizar, por meio das proposições empíricas, que a integralização de conteúdos, no processo da formação do estudante, exerce uma função balizadora na construção de comportamentos voltados à educação empreendedora.Contribuições sociais/para a gestão: os achados em campo foram salutares ao direcionamento da gestão pedagógica e da equipe docente, no que diz respeito à interdisciplinaridade de conteúdos de formação empreendedora, nos núcleos de formação básica, complementar e no conteúdo dos estudos quantitativos e de suas tecnologias, conforme as Diretrizes Curriculares Nacionais do curso de Graduação em Administração.

OBJECTIVE Type 2 diabetes (T2D) is increasingly diagnosed at younger ages. We investigated the association of adolescent obesity with incident T2D at early adulthood. RESEARCH DESIGN AND METHODS A nationwide, population-based study evaluated 1,462,362 adolescents (59% men, mean age 17.4 years) during 1996–2016. Data were linked to the Israeli National Diabetes Registry. Weight and height were measured at study entry. Cox proportional models were applied. RESULTS During 15,810,751 person-years, 2,177 people (69% men) developed T2D (mean age at diagnosis 27 years). There was an interaction among BMI, sex, and incident T2D (Pinteraction = 0.023). In a model adjusted for sociodemographic variables, the hazard ratios for diabetes diagnosis were 1.7 (95% CI 1.4–2.0), 2.8 (2.3–3.5), 5.8 (4.9–6.9), 13.4 (11.5–15.7), and 25.8 (21.0–31.6) among men in the 50th–74th percentile, 75th–84th percentile, overweight, mild obesity, and severe obesity groups, respectively, and 2.2 (1.6–2.9), 3.4 (2.5–4.6), 10.6 (8.3–13.6), 21.1 (16.0–27.8), and 44.7 (32.4–61.5), respectively, in women. An inverse graded relationship was observed between baseline BMI and mean age of T2D diagnosis: 27.8 and 25.9 years among men and women with severe obesity, respectively, and 29.5 and 28.5 years among low-normal BMI (5th–49th percentile; reference), respectively. The projected fractions of adult-onset T2D that were attributed to high BMI (≥85th percentile) at adolescence were 56.9% (53.8–59.9%) and 61.1% (56.8–65.2%) in men and women, respectively. CONCLUSIONS Severe obesity significantly increases the risk for incidence of T2D in early adulthood in both sexes. The rise in adolescent severe obesity is likely to increase diabetes incidence in young adults in coming decades.

Green stormwater infrastructure (GI) is gaining traction as a viable complement to traditional “gray” infrastructure in cities across the United States. As cities struggle with decisions to replace deteriorating stormwater infrastructure in the face of looming issues such as population growth and climate change, GI may offer a cost-effective, efficient, and sustainable approach. However, decision makers confront challenges when integrating GI within city plans, including uncertainties around GI capacity and maintenance, resistance to collaboration across city governance, increasingly inflexible financing, accounting practices that do not incorporate the multiple values of GI, and difficulties in incorporating ecological infrastructure into stormwater management. This paper presents an ecosystem services framework for assessing the context-specific needs of decision makers, while considering the strengths and limitations of GI use in urban stormwater management. We describe multiple dimensions of the planning system, identify points of intervention, and illustrate two applications of our framework – Durham, North Carolina and Portland, Oregon (USA). In these case studies, we apply our ecosystem services framework to explicitly consider tradeoffs to assist planning professionals who are considering implementation of GI. We conclude by offering a research agenda that explores opportunities for further evaluations of GI design, implementation, and maintenance in cities.

Planners often divisively advocate densification in developed areas. This article investigates the possibility that framing densifying development in positive ways may reduce conflict around greater density in developed urban areas of the United States. We use an online survey that asks verified voters in local elections ( n = 772) to describe their feelings toward a hypothetical densifying infill development in their neighborhoods before and after reading various framing statements. In particular, we consider the impact of these statements when they originate among planners versus when they originate among lay community experts. We use regression analyses to explore how reactions to the development relate to demographic characteristics and other aspects of respondents’ identities, and find that, while positive framing generally improves perceptions of the development regardless of its source, these effects are limited among respondents expressing concern about specific development impacts, among particular income groups, and in some neighborhood types.

Coastal communities are crafting adaptation strategies to confront sea level rise (SLR). Unfortunately, cost–benefit analyses that assess SLR risks often fail to capture important political and social feedbacks. For example, adaptation measures (e.g., beach nourishment) can trigger greater development, undermining the value of adaptation infrastructure, incentivizing development, and increasing risks. We integrate diverse literature and data to develop a hypothesis and system dynamics model of coastal community responses to SLR. We apply the model to two U.S. communities, showing how political influence drives trajectories of infrastructure provision, cost, and vulnerability. We find that delayed feedbacks between perceived SLR risk and infrastructure investments mediate relationships between political capital, migration, and economic development. Community wealth and political influence may only delay the overshoot and collapse of its population and economy, as the “virtuous cycles” linking growth with infrastructure investment give way to “vicious cycles” of mounting infrastructure costs, political resistance to additional investment, and greater vulnerability. Copyright © 2018 System Dynamics Society

Digital tools play an important role in supporting front-line health workers who deliver primary care. This paper explores the current state of efforts undertaken to move away from single-purpose applications of digital health towards integrated systems and solutions that align with national strategies. Through examples from health information systems, data and health worker training, this paper demonstrates how governments and stakeholders are working to integrate digital health services. We emphasize three factors as crucial for this integration: development and implementation of national digital health strategies; technical interoperability and collaborative approaches to ensure that digital health has an impact on the primary care level. Consolidation of technologies will enable an integrated, scaleable approach to the use of digital health to support health workers. PURPOSE As this edition explores a paradigm shift towards harmonization in primary healthcare systems, this paper explores complementary efforts undertaken to move away from single-purpose applications of digital health towards integrated systems and solutions that align with national strategies. It describes a paradigm shift towards integrated and interoperable systems that respond to health workers' needs in training, data and health information; and calls for the consolidation and integration of digital health tools and approaches across health areas, functions and levels of the health system. It then considers the critical factors that must be in place to support this paradigm shift. This paper aims not only to describe steps taken to move from fractured pilots to effective systems, but to propose a new perspective focused on consolidation and collaboration guided by national digital health strategies.

New tools are being deployed to address the continued decline of species at risk of becoming threatened or endangered. One approach receiving increased attention is the habitat exchange, or the use of a market-based, landscape-scale approach to protect or restore habitat in one place to offset impacts elsewhere. Although considerable resources have been devoted to the establishment of habitat exchanges over the past several years, actual implementation of transactions through habitat exchanges have been limited. As we argue here, important lessons have been slow to translate to habitat exchanges from other planning arenas. We briefly outline how the decision sciences, particularly structured decision making, and other planning processes − such as those governing electricity infrastructure development − can provide examples to facilitate the use of habitat exchanges as a viable and scalable conservation tool. We emphasize the challenge of translating theory to application, and note the importance of cross-fertilization of knowledge and experience across traditional disciplinary bounds.

Rapid progress in technologies such as calcium imaging and electrophysiology has seen a dramatic increase in the size and extent of neural recordings. Even so, interpretation of this data often depends on manual operations and requires considerable knowledge about the nature of the representation. Decoding provides a means to infer the information content of such recordings but typically requires highly processed data and prior knowledge of the encoding scheme. Here, we developed a deep-learning-framework able to decode sensory and behavioural variables directly from wide-band neural data. The network requires little user input and generalizes across stimuli, behaviours, brain regions, and recording techniques. Once trained, it can be analysed to determine elements of the neural code that are informative about a given variable. We validated this approach using data from rodent auditory cortex and hippocampus, identifying a novel representation of head direction encoded by putative CA1 interneurons.

Shoreline armoring, which involves the installation of hardened structures to protect coastal property, dramatically alters shoreline composition and resulting ecological functions. Accelerating hazard threats to growing coastal communities compounds this problem, creating demand for more armoring. We examine whether designation by the U.S. Coastal Barrier Resources Act (CBRA) – enacted to disincentivize urban development on hazardous coastal barriers – is associated with lower propensities to armor shorelines. In designated areas, CBRA removes access to federally-subsidized flood insurance, infrastructure subsidies, and disaster assistance. Using logistic regression modeling, we examine armoring at the parcel scale across the State of Florida (USA), controlling for CBRA designation, land use, and local population density. Our findings reveal a significant negative relationship between CBRA designation and the odds of armoring, particularly for residential and vacant properties. As coastal areas grapple with increasing impacts from coastal hazards, removal of public subsidies may be an effective non-regulatory method for maintaining the ecological and protective benefits of natural shorelines.

We assess pathways for integrating the ecosystem services concept into American land use and environmental planning. Ecosystem services are the beneficial products that functioning ecosystems provide to human society. Building on Ian McHarg's influential ecological planning work, we argue that ecosystem service-based planning frameworks may improve our understanding of the consequences of planned actions in urban-ecological systems. Using evaluations of four diverse and innovative comprehensive plans, we examine how ecosystem service information can enhance plan specificity, investment strategies, and prioritization for policy implementation. Finally, we present a research agenda for evaluating how the use of ecosystem services in planning could improve assessment and communication of planning tradeoffs and outcomes.

Ecosystem services are a powerful tool for land-use and environmental planning, which can help decision makers better understand the tradeoffs between different development scenarios. However, there is limited guidance about how ecosystem services should be used in the land-use and environmental planning context. While existing plan quality guidance for sustainability recognizes benefits of ecosystems by promoting conservation and green infrastructure, it fails to provide specific direction on the type of ecosystem service information to collect and how it should be incorporated into land-use planning processes. We explore this gap by using criteria from American Planning Association (APA) Sustaining Places guidance to analyze two comprehensive plans: Damascus, Oregon, which uses ecosystem services as an organizing framework, and Cincinnati, Ohio, which has received recognition for advancing the science and art of planning. In addition, we compare the extent to which the plans incorporate ecosystem services (both concepts and language) into their goal setting, fact base, policies, and public participation process. We find that incorporating ecosystem services into land-use planning may help achieve sustainability goals by elevating the importance of conservation and providing a lens to link multiple community objectives. APA rewards these attributes of Damascus’ plan, but fails to identify the plan’s strong ecosystem service strategies or weak analysis of ecosystem service information. Based on these findings, we propose additional metrics to help practitioners incorporate ecosystem services into comprehensive plans.