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Summary: Background: The prevalence of childhood obesity in the U.S. has increased, likely due to decreased physical activity, increased sedentary behaviour and unhealthy diets. Little is known about the relationships between these factors and weight gain in those under the age of three. Objectives: This study aimed to understand the longitudinal associations of weight gain over 6‐month intervals with child and parent characteristics as children develop from 6 to 36 months. Methods: Mother and infant data were collected at 6‐month intervals from 6 to 36 months. Weight (kg) was the primary outcome variable, and potential explanatory variables included child and parent characteristics, physical activity, motor development, diet and sleep. Structural equation modelling was used to assess associations between explanatory variables and 6‐month weight gain. Results: Weight increased ~1 kg per 6‐month interval (p < 0.001) from 6 to 36 months. Childcare outside of the home at 12 months was associated with 0.272 kg (p = 0.002) greater weight gain at 18 months, while children's physical activity was associated with 0.228 kg (per 2 SD, p = 0.051) less weight gain during the same time period. Mother's TV and screen media use (0.102 kg per hour/day, p = 0.046) and child's intake of high‐energy beverages at 18 months (0.387 kg, p = 0.037) were both associated with greater weight gain at 24 months. Conclusion: Childcare, physical activity, screen media use and high‐energy beverage consumption might affect weight gain at different time points in early childhood. These insights can inform efforts to prevent excessive weight gain and childhood obesity effectively. [ABSTRACT FROM AUTHOR]

Capstone courses have been recommended as a way for pre-service secondary mathematics teachers (PSMT) to connect the mathematics they learn in university to the mathematics they will teach in high schools. However, not much is known about the nature of these courses in the U.S. Through a survey of departments of mathematics and education, the study presented here explored whether such courses were offered to PSMT and, if offered, how the courses were designed. Respondents reported on alignment with CBMS guidelines, curriculum, and assessments among other course logistics. Implications include: few capstone courses align with national guidelines and vary greatly. (Contains 8 tables.)

Effective teamwork is essential in almost every job, and can even mean life, death, or disability in some jobs. Intraoperative neurophysiological monitoring (IONM) is a career in which effective teamwork and accurate communication are of utmost importance, yet it comes with a unique set of challenges in which to achieve those goals. Operating rooms can be very stressful environments, even if a surgical neurophysiologist (SNP) works in the same hospital every day. Often an SNP is required to travel from hospital to hospital and work with different teams each day. In addition, communication with the IONM oversight professional (IONM-P) can be challenging by nature of the telemedicine model which is becoming the most commonly applied IONM model in the United States. It is unfortunate that such critical skills are assumed and are rarely formally trained. In this article, we present evidence-based recommendations for establishing effective team function. We also provide several tools designed to help create effective and efficient teams. Teams cannot function at their best without outstanding communication, so improving teamwork also means improving communication. This article also provides several techniques for excellent communication, regardless of the situation or context. [ABSTRACT FROM AUTHOR]

Background: Sexual assault and heavy alcohol use are prevalent and interrelated public health concerns on university campuses. Surprisingly, however, few alcohol harm reduction interventions address this intersection to help students reduce both personal and community risks for sexual assault in college drinking contexts. Objectives: In the current study, students (ages 18–24) shared strategies they use to protect themselves and others from sexual assault in college drinking contexts, as well as challenges to implementing these strategies. A series of six focus groups were conducted across two universities in the U.S. (N = 35). Participants responded to open-ended questions focused on drinking and sexual assault (e.g., What are some of the things students might do to avoid or address situations where they feel pressured of coerced to hook up or have sex when they do not want to?). Results: Thematic analyses demonstrated students' awareness of protective behavioral and bystander intervention strategies that could help reduce vulnerability to experience sexual assault for themselves or others in drinking contexts. Perceived barriers to using bystander intervention strategies included student's own and friends' heavy drinking (decreased inhibitions, loss of autonomy), ambiguity in deciphering risk (lack of familiarity, minimization, diffusion of responsibility), and gender (gender norms, power imbalances). Conclusions: This study informs the development of interventions that help students identify strategies and overcome barriers to reduce risks for sexual assault in college drinking contexts. [ABSTRACT FROM AUTHOR]

Introduction: Higher Area Deprivation Index (ADI) scores, indicating higher social deprivation, have been associated with more frequent emergency department (ED) utilization. Access to clinical and social services can help prevent inappropriate ED use. A community-based medical school administering a primary and preventive care program focused on the social determinants of health (SDOH) tracks annual ED utilization by its households. This retrospective study determined household ADI scores and evaluated for associations with ED use. Methods: The ADI uses 17 publicly available variables to assign composite scores of social deprivation at the block group level. The Green Family Foundation Neighborhood Health Education Learning Program at Florida International University provides outreach, clinical, and educational services to > 850 disadvantaged households. We conducted Poisson regression to evaluate the association between households' ADI scores and self-reported ED utilization over 2 calendar years. Results: For both the 2018 and 2019 cohorts, independent Poisson regression results indicate that ED visit count is significantly and inversely associated with ADI raw scores and deciles (p < 0.001). Discussion: Based on findings from earlier studies, we had hypothesized a positive, yet reduced association between annual ED utilization and ADI level but surprisingly, we found an inverse association. The combination of providing primary care and connecting with social and behavioral health services as needed appeared to reverse the expected higher ED use at higher ADI scores. Conclusion: Tracking of ED utilization in association with composite, area-based indices such as the ADI may prove useful for other clinical and community health endeavors focused on SDOH. [ABSTRACT FROM AUTHOR]

We investigate the impact of recent gentrification shocks on minority neighborhoods in the 50 largest US labor markets. We show that household moves from a given neighborhood are concentrated to few destinations with similar minority shares and strong network ties, but those neighborhoods are farther away from downtown. Gentrification affects Black neighborhoods by raising house prices, reducing the proportion of Black households, and increasing the share of movers going to neighborhoods with network ties. However, gentrification has negligible effects on Hispanic neighborhoods. Overall labor market area segregation decreases after a gentrification shock because highly Black neighborhoods become less segregated. [ABSTRACT FROM AUTHOR]

Background: Around half the US population uses dietary supplements (DS), and concomitant use with medications is common. Many DS include bioactive substances that can interact with medications; therefore, accurate tracking is critical for patient safety. Unfortunately, documentation of patients' DS use is often missing or incomplete in the electronic medical record (EMR), leaving patients susceptible to potential adverse events. Novel approaches to assist healthcare professionals (HCPs) in capturing patients' DS use are needed. Objective: To assess HCPs' perspectives on challenges and facilitators of DS documentation in the EMR and their opinions on a proposed mHealth application (app) to aid in DS capture. Methods: HCPs, recruited from professional networks, largely in North Carolina, using purposive sampling, took part in semi-structured interviews. We inquired about HCPs' experiences with DS documentation in the EMR and their opinions about our proposed mHealth app. Interviews were recorded, transcribed, and coded. Thematic analysis included deductive codes based on the interview guide, and inductive codes that emerged during transcript review. Results: HCPs (N = 30) included 60% females, mean age 46 ± 10; 70% White. Pharmacists (20%), nurses (17%), and physicians (17%) were the most represented professions. Years in practice ranged from 3–35 years. Most HCPs were concerned about DS safety and potential supplement-drug interactions, and cited several barriers to accurate EMR DS documentation including time constraints, database inconsistencies, and poor patient-HCP communication about DS. HCPs' views on our proposed mHealth app were generally positive. They expressed that our proposed mHealth app could streamline documentation processes and enhance patient-provider communication. HCPs expressed desire for a high-quality mHealth app that includes access to evidence-based DS information, integrates with the EMR, and does not increase time burdens. Conclusion: HCPs believe documentation of patients' DS use is important but not accurately captured in the EMR. Support was expressed for our proposed barcode-scanning DS mHealth app. [ABSTRACT FROM AUTHOR]

Objective: Though prevalent, weight‐based discrimination is understudied and has been linked to disordered eating behaviors (DEB) among adolescents and adults. Sexual minority populations experience elevated risk of DEB, but little is known about the role of weight discrimination in this elevated risk. Methods: Participants were 1257 sexual minority women and men (ages 18–31 years) in the US Growing Up Today Study cohort. We examined cross‐sectional associations between weight discrimination victimization and three DEB in the past year: unhealthy weight control behaviors, overeating, and binge eating. Generalized estimating equations, adjusted for potential confounders, were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Three in 10 participants (31%) reported weight‐based discrimination victimization. Sexual minority young adults who reported weight‐based discrimination had greater relative prevalence of unhealthy weight control behaviors (PR [95% CI]: 1.92 [1.35, 2.74]), overeating (3.15 [2.24, 4.44]), and binge eating (3.92 [2.51, 6.13]), compared with those who reported no weight‐based discrimination. Associations with overeating and binge eating remained significant after adjusting for BMI. Discussion: The role of weight‐based discrimination, and its intersections with other forms of stressors for sexual minority young adults, must be included in efforts to advance eating disorder prevention for this underserved population. Public Significance: Three in 10 sexual minority young adults in this study had experienced weight‐based discrimination, a common but understudied form of discrimination. Sexual minority young adults who experienced weight‐based discrimination were at greater risk of disordered eating behaviors than those who had not experienced weight‐based discrimination. These findings suggest that weight‐based discrimination may be an important—and preventable—risk factor for disordered eating behaviors among sexual minority young adults. [ABSTRACT FROM AUTHOR]

Though economists have examined labor displacement due to digitization, few have considered the new work and value created. Unlike employment relations that brought workers together on the assembly line or in an office in a previous era, platforms enable a greater, more dispersed, and complex division of labor. New and reconfigured types of labor enabled by platforms create identification and measurement challenges. Previous studies of platforms invariably focused on specific organizational forms such as sharing or gigs. They built taxonomies based on the platform's organization – few considered the scope and scale of platform-enabled value creation. To better understand changing labor arrangements in the 21st century, this article introduces a taxonomy to systematically understand work, employment, and value creation in the platform economy. We consider all of the platform-enabled value creation activities including old work displaced or reorganized to new work created. We provide suggestive evidence for the utility of our framework through case studies of Etsy and Amazon Self-Publishing in the United States. [ABSTRACT FROM AUTHOR]

Anecdotal evidence suggests that young people use the website Twitter as a tool to warn drivers about the locations of sobriety checkpoints. Researchers investigated this claim by independently analyzing the website's content regarding a sample of 10 sobriety checkpoints that were conducted in cities throughout the United States during the weekend of August 26, 2011. Researchers discovered that Twitter content either described one's experience driving through a checkpoint or acted as a warning to others regarding the exact location of a checkpoint. In the study's sample, there was over six times as many warnings as compared to experiences posted on Twitter. The warnings, 81 in total, reached an audience of over 64,000 people. The majority of warnings were made by males and by young people between the ages of 20 to 29 years old. Implications, limitations, and suggestions for future research are described. (Contains 3 tables.)

Furstenberg et al. (1995) suggested that one unanticipated consequence of current high levels of divorce might be a "matrilineal tilt" in intergenerational wealth flows. This research uses six waves of the Health and Retirement Survey (1992 to 2002) to investigate this possibility with respect to financial transfers from parents to their adult children. We find that although divorced single fathers continue to make transfers to their adult biological children, remarriage substantially reduces fathers' transfers while it increases mothers' transfers to their biological children. Our findings are consistent with both socio-evolutionary and exchange theories predicting women's vs. men's investments in biological- vs. stepchildren. (Contains 5 tables, 1 figure and 7 notes.)

Social policy in the United States is inconsistent in its treatment of cohabiting-parent households. For example, although welfare policy generally assumes that marital status should not affect the extent to which children benefit from each adult's income, tax policy and the poverty classification assume income pooling among married but not cohabiting parents. Neither assumption has been adequately tested against actual household economic behavior. I use data on couples' money management and expense division from the Fragile Families and Child Wellbeing Study to examine household availability of cohabiting fathers' income. Although their mechanisms for combining income differ, the results suggest that cohabiting parents do generally pool resources, so the income of both parents should be considered in setting family policy.

Lyme disease is the most common vector-borne illness, with more than 476,000 cases annually in the United States and can be challenging to diagnose.1 The presence of erythema migrans is considered diagnostic in patients who live in or have recently traveled to an endemic area. However, serologic testing is recommended if the cause of the skin lesion is unknown and antibiotics have not been administered. Serologic testing is also recommended for early disseminated and late-stage Lyme disease.2 [ABSTRACT FROM AUTHOR]

The Jones Act--the title for a series of laws--is the backbone of American cabotage laws, and yet, it is rarely talked about in mainstream American discourse. The original Jones Act was enacted in 1920, and since 1920, it has not changed to any measurable degree. The Jones Act requires that all domestic maritime shipping--movement of merchandise from one U.S. point to another U.S. point--be completed by ships that are owned by U.S. citizens, operated by U.S. citizen crews, built in the U.S., and flagged by the U.S. These requirements have hampered the American economy, its security, and the maintenance of its merchant marine, even though these are the areas that are supposed to be boosted by the Act. These requirements, along with the numerous expansions and exemptions that litter their enforcement, have warped American shipping standards and their costs. In fact, because of the Jones Act, the U.S. "is ranked as having the most restrictive maritime transport industry among all OECD countries." Now, after over 100 years under a regime that has only hurt the United States, it is time to repeal the Jones Act-- either in its entirety or partially--and bring the U.S. into the 21st Century. [ABSTRACT FROM AUTHOR]

To determine if history of mild traumatic brain injury (mTBI) is associated with advanced or accelerated brain aging among the United States (US) military Service Members and Veterans. Eight hundred and twenty-two participants (mean age = 40.4 years, 714 male/108 female) underwent MRI sessions at eight sites across the US. Two hundred and one participants completed a follow-up scan between five months and four years later. Predicted brain ages were calculated using T1-weighted MRIs and then compared with chronological ages to generate an Age Deviation Score for cross-sectional analyses and an Interval Deviation Score for longitudinal analyses. Participants also completed a neuropsychological battery, including measures of both cognitive functioning and psychological health. In cross-sectional analyses, males with a history of deployment-related mTBI showed advanced brain age compared to those without (t(884) = 2.1, p =.038), while this association was not significant in females. In follow-up analyses of the male participants, severity of posttraumatic stress disorder (PTSD), depression symptoms, and alcohol misuse were also associated with advanced brain age. History of deployment-related mTBI, severity of PTSD and depression symptoms, and alcohol misuse are associated with advanced brain aging in male US military Service Members and Veterans. [ABSTRACT FROM AUTHOR]

Purpose: In this ongoing case series, 33 genetic testing cases are documented in which tests were recommended, ordered, interpreted, or used incorrectly and/or in which clinicians faced challenges related to history/reports provided by patients or laboratories.Methods: An invitation to submit cases of challenges or errors in genetic testing was issued to the general National Society of Genetic Counselors Listserv, the National Society of Genetic Counselors Cancer Special Interest Group members, as part of a case series with Precision Oncology News, and via social media (i.e., Facebook, Twitter, LinkedIn). Deidentified clinical documentation was requested and reviewed when available. Thirty-three cases were submitted, reviewed, and accepted. A thematic analysis was performed. Submitters were asked to approve cases before submission.Results: All cases took place in the United States, involved hereditary cancer testing and/or findings in cancer predisposition genes, and involved medical-grade genetic testing, direct-to-consumer testing, or research genetic testing. In 9 cases, test results were misinterpreted, leading to incorrect screening or risk-reducing procedures being performed/recommended. In 5 cases, incorrect or unnecessary testing was ordered/recommended. In 3 cases, incorrect clinical diagnoses were made, or opportunities for diagnoses were delayed. In 3 cases, errors or challenges arose related to medical intervention after testing or reported genetic diagnosis. In 2 cases, physicians provided incorrect information related to the inheritance pattern of a syndrome. In 2 cases, there were challenges related to the interpretation of genetic variants. In 2 cases, challenges arose after direct-to-consumer testing. One case involved test results that should never have been reported based on sample quality. In 1 case, a patient presented a falsified test result. In 5 cases, multiple errors were made.Discussion: As genetic testing continues to become more complicated and common, it is critical that patients and nongenetics providers have access to accurate and timely genetic counseling information. Even as multiple medical bodies highlight the value of genetic counselors (GCs), tension exists in the genomics community as GCs work toward licensure and Medicare provider status. It is critical that health care communities leverage, rather than restrict, the expertise and experience of GCs so that patients can benefit from, and not be harmed by, genetic testing. In order to responsibly democratize genomics, it will be important for genetics and nongenetic health care providers to collaborate and use alternative service delivery models and technology solutions at point of care. To deliver on the promise of precision medicine, accurate resources and tools must be utilized. [ABSTRACT FROM AUTHOR]

My Special Aflac Duck is an award-winning social robot for children with cancers. Modelled after Aflac Incorporated's iconic duck mascot, My Special Aflac Duck was developed by social impact agency Carol Cone ON PURPOSE and R&D shop Sproutel to meet the social-emotional needs of paediatric cancer patients during their average 1,000 days of treatment. The initiative, which is part of the broader Aflac Childhood Cancer Campaign, was created to support Aflac's reputational and brand goals, building on more than two decades of commitment to paediatric cancer research and treatment. Additionally, Aflac sought to make a direct patient impact through technology and innovation, moving beyond traditional corporate citizenship to align purpose, values, brand and product in a never-before-seen execution. Readers will learn how Carol Cone ON PURPOSE developed crisp criteria around Aflac's objectives, partnered with Sproutel to develop the duck based on the specific needs of children, launched the initiative to media in an unexpected way, supported roll-out in hospitals across the United States and helped Aflac achieve significant brand and business lifts. [ABSTRACT FROM AUTHOR]

Background and Objectives: Internationally, supervised injection facilities (SIFs) have demonstrated efficacy in reducing rates of overdose and promoting entry into treatment among persons who inject drugs (PWID); however, they remain unavailable in the United States. Early findings examining American PWID illustrate high overall willingness to use SIFs. The current study expands upon this research by examining PWID's likelihood to use SIFs based on services offered (eg, provides clean needles, linkage to treatment programs) and whether known risk factors (prior overdose, homelessness) influence PWID's willingness to use a SIF.Methods: Participants (n = 184) were patients entering short-term inpatient opioid withdrawal management in Massachusetts between May 2018 and February 2019 who reported injection drug use in the prior 30 days. We examined PWID's likelihood to use a SIF if eight unique services were available, and compared if this differed by overdose history and homelessness status using ordered logistic regression and Pearson's χ2 -tests of independence.Results: Participants (34.2 [±8.3 SD] years of age, 68.5% male, 85.9% white, 8.2% Hispanic) reported being most likely to use SIFs that provided safety from police intervention (86.7%), entry into withdrawal management (85.9%), or clean needles (83.2%). Drug works disposal and safety from police were particularly important for PWID with a history of overdose.Conclusion and Scientific Significance: Overall, treatment-seeking PWIDs reported greater willingness to utilize SIFs if particular services were provided. These findings point to features of SIFs that may enhance treatment-seeking PWID's amenability to utilizing these services if such sites open in the United States. (Am J Addict 2021;30:21-25). [ABSTRACT FROM AUTHOR]

The Healthy, Hunger-Free Kids Act of 2010 strengthened nutrition standards for meals and beverages provided through the National School Lunch, Breakfast, and Smart Snacks Programs, affecting fifty million children daily at 99,000 schools. The legislation's impact on childhood obesity is unknown. We tested whether the legislation was associated with reductions in child obesity risk over time using an interrupted time series design for 2003-18 among 173,013 youth in the National Survey of Children's Health. We found no significant association between the legislation and childhood obesity trends overall. For children in poverty, however, the risk of obesity declined substantially each year after the act's implementation, translating to a 47 percent reduction in obesity prevalence in 2018 from what would have been expected without the legislation. These results suggest that the Healthy, Hunger-Free Kids Act's science-based nutritional standards should be maintained to support healthy growth, especially among children living in poverty. [ABSTRACT FROM AUTHOR]

Purpose: This study's purpose was to determine the prevalence of physical, mental, and developmental health conditions among US children and assess the association with urban versus rural residence. Methods: Bivariate/multivariable analyses were conducted with cross‐sectional data for children aged 0‐17 years (N = 71,811) from the 2016‐2017 National Survey of Children's Health. Prevalence estimates of excellent/very good health were derived from parents' qualitative judgments. Parent‐reported health conditions were aggregated by condition type (physical, mental, developmental). Prevalence was determined for condition type and severity. Adjusted risk ratios assessed the effect of residence on having physical, mental, or developmental conditions. Results: Among rural children in the general population, we found lower crude rates of excellent/very good overall health and higher rates of ≥1 physical condition(s) and ≥1 mental condition(s), as well as these 2 conditions in combination with ≥1 developmental condition(s). Rural children in the general population were also more likely to have physical and mental conditions that parents rated as moderate/severe in unadjusted analyses. To a lesser extent, these differences held true for the children with special health care needs. Risk ratios for rural residence were largely nonsignificant in adjusted analyses. Conclusions: While rural children had lower crude rates of parent‐reported excellent/very good health and higher crude rates of parent‐reported or doctor‐diagnosed physical and mental health conditions compared to urban children, the same pattern of urban‐rural differentials was not evident in the adjusted analyses. Compositional and contextual differences in the urban/rural populations suggest that social determinants of health may have accounted for rate disparities in child health conditions. [ABSTRACT FROM AUTHOR]

Coronaviruses cause respiratory and gastrointestinal diseases in diverse host species. Deltacoronaviruses (DCoVs) have been identified in various songbird species and in leopard cats in China. In 2009, porcine deltacoronavirus (PDCoV) was detected in fecal samples from pigs in Asia, but its etiologic role was not identified until 2014, when it caused major diarrhea outbreaks in swine in the United States. Studies have shown that PDCoV uses a conserved region of the aminopeptidase N protein to infect cell lines derived from multiple species, including humans, pigs, and chickens. Because PDCoV is a potential zoonotic pathogen, investigations of its prevalence in humans and its contribution to human disease continue. We report experimental PDCoV infection and subsequent transmission among poultry. In PDCoV-inoculated chicks and turkey poults, we observed diarrhea, persistent viral RNA titers from cloacal and tracheal samples, PDCoV-specific serum IgY antibody responses, and antigen-positive cells from intestines. [ABSTRACT FROM AUTHOR]

In a search for Schumpeterian solutions, the Obama Administration has made venture capital a cornerstone of its Clean Technology policy, adopting a strategy of providing large loan guarantees to a few venture capital financed firms. This article argues that three key conditions are necessary for venture capital to successfully open new economic spaces and then it applies them to assess the viability of venture capital investment in clean technology. The article concludes that large loan guarantees are unlikely to be effective. Other government policies such as SBIR grants, university R&D support, certain (de)regulatory actions, large-scale demonstration projects, and/or procurement decisions can better encourage both incremental and Schumpeterian innovation without distorting the turbulent dynamics of new market creation. This analysis can also be applied to other sector- and market-specific innovation policies. [ABSTRACT FROM AUTHOR]

Venture capital (VC) is a relatively recent addition to the US national system of innovation (NSI). Tracing the history of the VC industry in the US provides an interesting example of how NSIs can add new institutions, and in the process be transformed. The history encompasses important exogenous events, endogenous developments, and actions by individual actors. The story of the development of VC is set in the technological trajectories where it has experienced its greatest success, the information, communications, and biomedical industries. The emergence of VC is intimately related to various government actions, and yet the paper does not attribute a deus ex machina role to government actors. While NSI theory provides the framework, it is also recognized that VC is geographically localized in a few regions, and a regional innovation system perspective is also valuable. [ABSTRACT FROM PUBLISHER]

This article provides a different viewpoint to the article "Sizing the Emerging Global Labor Market," written by Diana Farrell et al. in this issue of Perspectives. The article and the important report Farrell and her colleagues at the McKinsey Global Institute (MGI 2005) completed in late 2005 provide much food for thought regarding offshoring of service jobs. The accompanying article gives only a flavor of the results, while the report contains the most detailed micro-level analysis available of the employment impacts of offshoring upon specific sectors. In contrast to the report's rather muted conclusion regarding the dimensions and implications of services offshoring, a more comprehensive reading suggests a profound transformation of the employment and wage structure for many college-educated Americans is underway. [ABSTRACT FROM AUTHOR]

While venture capital (VC) has become an important element of the twentieth-century US innovation system, few studies have systematically examined the origins and evolution of this financial institution. We take a step in this direction by analyzing the evolution of the early and influential VC firm, American Research & Development Corporation (ARD), in the period that it was independent from 1946 to 1973. We place the creation and subsequent evolution of ARD within its historical context and show how it was an innovation by Boston-area civic elites. Using new historical data, we examine the evolution of ARD's practices over time. We argue that ARD's funding model constrained its functioning as a venture capital firm and contributed to its demise. ARD was a pioneering organization whose business model ultimately failed as a newer organizational model, the limited partnership, was created and had a better fit with the business environment. Nevertheless, ARD has had a lasting imprint on the practice of modern venture capital. [ABSTRACT FROM AUTHOR]

Analyzes the differences in the success of Silicon Valley and Route 128 firms which have been the centers of innovation and commercialization for the electronics, computer and data communication industries in the postwar period. Path-dependent and dominant design explanations of technical and industrial change; Differences in the technological trajectories of the industries underlying the two regions.

• Vaccination with Adt.24 confers protection against FMD for six months. • Partial protection was demonstrated after six months. • Virus neutralizing titers do not correlate to protection. • Anti-FMDV antibody secreting cells are not detected in peripheral blood after 5 weeks following vaccination with Adt.A24. Foot-and-mouth disease (FMD) is a highly contagious viral infection of cloven hooved animals that continues to cause economic disruption in both endemic countries or when introduced into a formally FMD free country. Vaccines that protect against clinical disease and virus shedding are critical to control FMD. The replication deficient human adenovirus serotype 5 (Ad5) vaccine vector expressing empty FMD virus (FMDV) capsid, AdtFMD, is a promising new vaccine platform. With no shedding or spreading of viral vector detected in field trials, this vaccine is very safe to manufacture, as there is no requirement for high containment faciitites. Here, we describe three studies assessing the proportion of animals protected from clinical vesicular disease (foot lesions) following live-FMDV challenge by intradermolingual inoculation at 6 or 9 months following a single vaccination with the commercial AdtFMD vaccine, provisionally licensed for cattle in the United States. Further, we tested the effect of vaccination route (transdermal, intramuscular, subcutaneous) on clinical outcome and humoral immunity. Results demonstrate that a single dose vaccination in cattle with the commercial vaccine vector expressing capsid proteins of the FMDV strain A24 Cruzeiro (Adt.A24), induced protection against clinical FMD at 6 months (100% transdermal, 80% intramuscular, and 60% subcutaneous) that waned by 9 months post-vaccination (33% transdermal and 20% intramuscular). Post-vaccination serum from immunized cattle (all studies) generally contained FMDV specific neutralizing antibodies by day 14. Anti-FMDV antibody secreting cells are detected in peripheral blood early following vaccination, but are absent after 28 days post-vaccination. Thus, the decay in antibody mediated immunity over time is likely a function of FMDV-specific antibody half-life. These data reveal the short time span of anti-FMDV antibody secreting cells (ASCs) and important performance characteristics of needle-free vaccination with a recombinant vectored subunit vaccine for FMDV. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the prevalence of opioid use disorder (OUD) among parents who are living with children and their receipt of treatment, which could reduce the harmful effects of OUD on families.Methods: We used 2015-2017 cross-sectional national survey data to estimate prevalence and treatment of opioid use disorder and other substance use disorders (SUD) among parents living with children.Results: An estimated 623,000 parents with opioid use disorder are living with children, and less than one-third of these parents received treatment for illicit drug or alcohol use at a specialty facility or doctor's office. Treatment rates were even lower among the more than 4,000,000 parents estimated to have other SUDs.Conclusion: Many parents in both groups have concurrent mental health issues, including suicidal thoughts and behavior. Primary care practices can play a critical role in screening and facilitating treatment initiation. [ABSTRACT FROM AUTHOR]

Objective: To compare access at community health centers (CHCs) vs private offices (non-CHCs) under the Affordable Care Act.Data Source: Ten state primary care audit conducted in 2012/2013 and 2016.Study Design: CHCs and non-CHCs were called. We calculated difference in differences comparing CHCs vs non-CHCs by caller insurance type.Principal Findings: In both rounds, Medicaid and uninsured callers had higher appointment rates at CHC than non-CHCs. CHC appointment rates significantly increased between 2012/2013 and 2016 for both employer-sponsored and Medicaid callers, with no significant wait time changes. Appointment rates increased (13.5% points, P < 0.001) and wait times decreased (-5.7 days, P = 0.017) at CHCs relative to non-CHCs for employer-sponsored insurance.Conclusion: Appointment availability at CHCs improved after ACA implementation, without increased wait times. [ABSTRACT FROM AUTHOR]

Discusses the recruitment, hiring and assessment of student workers in academic libraries. Matching the right student with the job needs; Orientation, training, job description, pay scales, supervision and retention of student workers; Provision for award and recognition.

Many Americans regard Silicon Valley and Route 128 as symbols of America's economic and technological success; they are held out as models for the rest of the American economy. But their success is misleading. In fact, the U.S. microelectronics industry is too fragmented; very few start-ups ever become large enough to compete effectively in global markets. More importantly, because these firms have not been able to develop close working relationships with their customers, who are primarily traditional manufacturing companies, the latter continue to slip further behind. The innovations of America's high-tech firms are not being diffused throughout the rest of the American economy. [ABSTRACT FROM AUTHOR]

Childhood mental, behavioral, and developmental disorders (MBDDs) are associated with adverse outcomes that can persist into adulthood (1,2). Pediatric clinical settings are important for identifying and treating MBDDs (3). Early identification and treatment of MBDDs can promote healthy development for all children (4), especially those living in poverty who are at increased risk for MBDDs (3,5) but might have reduced access to care (6). CDC analyzed data from the 2016 National Survey of Children's Health (NSCH) on MBDDs, risk factors, and use of federal assistance programs (e.g., Supplemental Nutrition Assistance Program [SNAP]) to identify points to reach children in poverty. In line with previous research (3,6), compared with children in higher-income households, those in lower-income households more often had ever received a diagnosis of an MBDD (22.1% versus 13.9%), and less often had seen a health care provider in the previous year (80.4% versus 93.8%). Among children living below 200% of the federal poverty level (FPL) who did not see a health care provider in the previous year, seven of 10 were in families receiving at least one public assistance benefit. Public assistance programs might offer collaboration opportunities to provide families living in poverty with information, co-located screening programs or services, or connection to care. [ABSTRACT FROM AUTHOR]

Objectives: Disability evaluation is complex. The association between mild traumatic brain injury (mTBI) history and VA service-connected disability (SCD) ratings can have implications for disability processes in the civilian population. We examined the association of VA SCD ratings with lifetime mTBI exposure in three models: any mTBI, total mTBI number, and blast-related mTBI. Methods: Participants were 492 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans from four US VA Medical Centers enrolled in the Chronic Effects of Neurotrauma Consortium study between January 2015 and August 2016. Analyses entailed standard covariate-adjusted linear regression models, accounting for demographic, military, and health-related confounders and covariates. Results: Unadjusted and adjusted results indicated lifetime mTBI was significantly associated with increased SCD, with the largest effect observed for blast-related mTBI. Every unit increase in mTBI was associated with an increase in 3.6 points of percent SCD. However, hazardous alcohol use was associated with lower SCD. Conclusions: mTBI, especially blast related, is associated with higher VA SCD ratings, with each additional mTBI increasing percent SCD. The association of hazardous alcohol use with SCD should be investigated as it may impact veteran health services access and health outcomes. These findings have implications for civilian disability processes. [ABSTRACT FROM AUTHOR]

Objectives: Determine if mild traumatic brain injury (mTBI) history is associated with balance disturbances. Setting: Chronic Effects of Neurotrauma Consortium (CENC) centres. Participants: The CENC multi-centre study enrols post-9/11 era Service Members and Veterans with combat exposure. This sample (n = 322) consisted of enrolees completing initial evaluation by September 2016 at the three sites conducting computerized dynamic post-urography (CDP) testing. Design: Observational study with cross-sectional analyses using structural equation modelling. Main Measures: Comprehensive structured interviews were used to diagnose all lifetime mild traumatic brain injuries (mTBIs). The outcome, Sensory Organization Test (SOT), was measured on CDP dual-plate force platform. Other studied variables were measured by structured interviews, record review and questionnaires. Results: The overall positive/negative mTBI classification did not have a significant effect on the composite equilibrium score. However, the repetitive mTBI classification showed lower scores for participants with ≥ 3 mTBI versus 1-2 lifetime mTBIs. For repetitive mTBI, pain interference acted as a mediator for the indirect effect, and a direct effect was evident on some sensory condition equilibrium scores. Conclusion: These findings show that repeated mTBI, partially mediated by pain, may lead to later balance disturbances among military combatants. Further study of CDP outcomes within this accruing cohort is warranted. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate whether differences in tap water and other beverage intake explain differences in inadequate hydration among US adults by race/ethnicity and income. Methods. We estimated the prevalence of inadequate hydration (urine osmolality ≥ 800 mOsm/kg) by race/ethnicity and income of 8258 participants aged 20 to 74 years in the 2009 to 2012 National Health and Nutrition Examination Survey. Using multivariable regression models, we estimated associations between demographic variables, tap water intake, and inadequate hydration. Results. The prevalence of inadequate hydration among US adults was 29.5%. Non-Hispanic Blacks (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI] = 1.17, 1.76) and Hispanics (AOR = 1.42; 95% CI = 1.21, 1.67) had a higher risk of inadequate hydration than did non-Hispanic Whites. Lower-income adults had a higher risk of inadequate hydration than did higher-income adults (AOR = 1.23; 95% CI = 1.04, 1.45). Differences in tap water intake partially attenuated racial/ethnic differences in hydration status. Differences in total beverage and other fluid intake further attenuated sociodemographic disparities. Conclusions. Racial/ethnic and socioeconomic disparities in inadequate hydration among US adults are related to differences in tap water and other beverage intake. Policy action is needed to ensure equitable access to healthy beverages. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) has been identified as a risk factor for Parkinson's disease (PD). Motor dysfunction among TBI-exposed elders without PD has not been well characterized. We sought to determine whether remote TBI is a risk factor for motor dysfunction on exam and functionally relevant motor dysfunction in day-to-day life among independently living elders without PD.Methods: This is a cross-sectional cohort study of independently living retired military veterans aged 50 or older with (n = 78) and without (n = 85) prior TBI-all without diagnosed PD. To characterize multidimensional aspects of motor function on exam, the Unified Parkinson's Disease Rating Scale (UPDRS) Motor Examination was performed by a board-certified neurologist and used to calculate a modified UPDRS (mUPDRS) global motor score and four domain scores (tremor, rigidity, bradykinesia, and posture/gait). Functionally relevant motor dysfunction was assessed via self-report of falls within the past year.Results: In analyses adjusted for demographics and comorbidities that differed between groups, compared with veterans without TBI, those with moderate-to-severe TBI were more likely to have fallen in past year (33% vs. 14%, risk ratio 2.5 [95% confidence interval 1.1-5.4]), had higher (worse) mUPDRS global motor (p = .03) and posture/gait scores (p = .02), but not higher tremor (p = .70), rigidity (p = .21), or bradykinesia scores (p = .22). Mild TBI was not associated with worse motor function.Conclusions: Remote moderate-to-severe TBI is a risk factor for motor dysfunction-defined as recent falls and impaired posture/gait-among older veterans. TBI-exposed older adults may be ideal candidates for aggressive fall-screening and prevention strategies. [ABSTRACT FROM AUTHOR]

Background More than 14 million children in the United States attend summer camp annually, yet little is known about the food environment in day camps. Objective Our aim was to describe the nutritional quality of meals served to, brought by, and consumed by children attending summer day camps serving meals and snacks, and to describe camp water access. Design We conducted a cross-sectional study. Participants/settings Participants were 149 children attending five summer camps in Boston, MA, in 2013. Main outcome measures Foods and beverages served were observed for 5 consecutive days. For 2 days, children’s dietary intake was directly observed using a validated protocol. Outcome measures included total energy (kilocalories) and servings of different types of foods and beverages served and consumed during breakfast, lunch, and snack. Statistical analyses performed Mean total energy, trans fats, sodium, sugar, and fiber served per meal were calculated across the camps, as were mean weekly frequencies of serving fruits, vegetables, meat/meat alternates, grains, milk, 100% juice, sugar-sweetened beverages, whole grains, red/highly processed meats, grain-based desserts, and salty snacks. Mean consumption was calculated per camper per day. Results Camps served a mean (standard deviation) of 647.7 (134.3) kcal for lunch, 401.8 (149.6) kcal for breakfast, and 266.4 (150.8) kcal for snack. Most camps served red/highly processed meats, salty snacks, and grain-based desserts frequently, and rarely served vegetables or water. Children consumed little (eg, at lunch, 36.5% of fruit portions, 35.0% of meat/meat alternative portions, and 37.6% of milk portions served) except for salty snacks (66.9% of portions) and grain-based desserts (64.1% of portions). Sugar-sweetened beverages and salty snacks were frequently brought to camp. One-quarter of campers drank nothing throughout the entire camp day. Conclusions The nutritional quality of foods and beverages served at summer day camps could be improved. Future studies should assess barriers to consumption of healthy foods and beverages in these settings. [ABSTRACT FROM AUTHOR]

Purpose: The Patient Protection and Affordable Care Act (ACA) expanded coverage to roughly 12 million individuals by mid-2014 and 20 million by 2016, raising concern about the capacity of the primary care system to absorb these individuals. We set out to determine how justified the concern was.Methods: We used an audit design in which simulated patients called primary care practices seeking new-patient appointments in 10 diverse states (Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas) from November 2012 through March 2013 and from May 2014 through July 2014, before and after the major ACA insurance expansions. Callers were randomly assigned to scripts specifying either private or Medicaid insurance and called only offices identified as "in network" for each plan.Results: We completed 5,385 private insurance and 4,352 Medicaid calls in 2012-2013 and 2,424 private insurance and 2,474 Medicaid calls in 2014. Overall appointment rates for private insurance remained stable from 2012 (84.7%) to 2014 (85.8%) with Massachusetts and Pennsylvania experiencing significant increases. Overall, Medicaid appointment rates increased 9.7 percentage points (57.9% to 67.6%) with substantial variation by state. Across all callers, median wait times for those obtaining an appointment were 7 days in 2012 and 5 days in 2014, but the difference was not statistically significant.Conclusions: Contrary to widespread concern, we find no evidence that the millions of individuals newly insured through the ACA decreased new-patient appointment availability across 10 states as shown by stable wait times and appointment rates for private insurance as of mid-2014. [ABSTRACT FROM AUTHOR]

Background: Non-contrast head computer tomography (CT) is widely used to evaluate eligibility of patients after acute traumatic brain injury (TBI) for clinical trials. The NINDS Common Data Elements (CDEs) TBI were developed to standardize collection of CT variables. The objectives of this study were to train research assistants (RAs) to rate CDEs and then to evaluate their performance. The aim was to assess inter-rater reliability (IRR) of CDEs between trained RAs and a neurologist and to evaluate applicability of CDEs in acute and sub-acute TBI to test the feasibility of using CDE CT ratings in future trials and ultimately in clinical practice. The second aim was to confirm that the ratings of CDEs reflect pathophysiological events after TBI. Methods and results: First, a manual was developed for application of the CDEs, which was used to rate brain CTs (n= 100). An excellent agreement was found in combined kappas between RAs on admission and on 24-hour follow-up CTs (Iota = 0.803 and 0.787, respectively). Good IRR (kappa > 0.61) was shown for six CDEs on admissions and for seven CDEs on follow-up CTs. Low IRR (kappa < 0.4) was determined for five CDEs on admission and for four CDEs on follow-up CT. Combined IRR of each assistant with the neurologist were good on admission (Iota = 0.613 and 0.787) and excellent on follow-up CT (Iota = 0.906 and 0.977). Second, Principal Component Analysis (PCA) was applied to cluster the rated CDEs (n= 255) and five major components were found that explain 53% of the variance. Conclusions: CT CDEs are useful in clinical studies of TBI. Trained RAs can reliably collect variables. PCA identifies CDE clusters with clinical and biologic plausibility. Abbreviations:RA, research assistant; CT, Cranial Tomography; TBI, Traumatic Brain Injury; CDE, Common Data Elements; IRR, inter-rater reliability; PCA, Principal Component Analysis; GCS, Glasgow Coma Scale; R, rater; CI, confidence interval; CCC, Concordance correlation coefficient; IVH, Intraventricular haemorrhage; DCA, Discriminant Component analysis; SAH, Subarachnoid Haemorrhage [ABSTRACT FROM AUTHOR]

Turbidity is a water quality parameter that is known to adversely affect aquatic systems, however the causes of turbid water are often elusive. We present results of a study designed to constrain the source of particulate matter in a coastal embayment that has suffered from increased turbidity over past decades. Our approach utilized monitoring buoys to quantify turbidity at high temporal resolution complemented by geochemical isotope analysis of suspended sediment samples and meteorological data. Results reveal a complex system in which multiple sources are associated with particulate matter. Weight of evidence demonstrates that phytoplankton productivity in the water column, however, is the dominant source of particulate matter associated with elevated turbidity in Salem Harbor, Massachusetts. Allochthonous matter from the watershed was observed to mix into the pool of suspended particulate matter near river mouths, especially in spring and summer. Resuspension of harbor surface sediments likely provides additional particulates in the regions of boat moorings, especially during summer when recreational boats are attached to moorings. Our approach allows us to constrain the causes of turbidity events in this embayment, is helping with conservation efforts of environmental quality in the region, and can be used as a template for other locations. [ABSTRACT FROM AUTHOR]

West Nile virus (WNV) is a major cause of mosquito-borne illness in the United States. Human disease ranges from mild febrile illness to severe fatal neurologic infection. Adults aged >60 years are more susceptible to neuroinvasive disease accompanied by a high mortality rate or long-lasting neurologic sequelae. A chimeric live attenuated West Nile virus vaccine, rWN/DEN4Δ30, was shown to be safe and immunogenic in healthy adults aged 18-50 years. This study evaluated rWN/DEN4Δ30 in flavivirus-naive adults aged 50-65 years and found it to be safe and immunogenic. Outbreaks of WNV infection tend to be unpredictable, and a safe and effective vaccine will be an important public health tool. [ABSTRACT FROM AUTHOR]