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Security breaches most often occur due to a cascading effect of failure among security constraints that collectively contribute to overall secure system behavior in a socio-technical environment. Therefore, during security certification activities, analysts must systematically take into account the nexus of causal chains that exist among security constraints imposed by regulatory requirements. Numerous regulatory requirements specified in natural language documents or listed in spreadsheets/databases do not facilitate such analysis. The work presented in this article outlines a stepwise methodology to discover and understand the multidimensional correlations among regulatory requirements for the purpose of understanding the potential for risk due to noncompliance during system operation. Our lattice algebraic computational model helps estimate the collective adequacy of diverse security constraints imposed by regulatory requirements and their interdependencies with each other in a bounded scenario of investigation. Abstractions and visual metaphors combine human intuition with metrics available from the methodology to improve the understanding of risk based on the level of compliance with regulatory requirements. In addition, a problem domain ontology that classifies and categorizes regulatory requirements from multiple dimensions of a socio-technical environment promotes a common understanding among stakeholders during certification and accreditation activities. A preliminary empirical investigation of our theoretical propositions has been conducted in the domain of The United States Department of Defense Information Technology Security Certification and Accreditation Process (DITSCAP). This work contributes a novel approach to understand the level of compliance with regulatory requirements in terms of the potential for risk during system operation. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a serious chronic disease that has reached epidemic proportions in the United States. The consequences of the disease are significant and costly. Managing this condition effectively requires the commitment of all health care providers, including oral health professionals. The purpose of this paper is to provide an overview of diabetes mellitus and specific concepts related to eye care, foot care, oral care, and medication management. Implications for dental hygiene practice and guidelines for providing oral health care working in collaboration with other health care providers are addressed. [ABSTRACT FROM AUTHOR]

This article discusses the links between the doctor of philosophy degree labor market and graduate education in the U.S. While individual economists have examined particular dimensions of doctorate job market, the profession as a group have given relatively little attention to a labor market it is uniquely situated to study. The study of academic labor markets is natural area of inquiry for many labor economists. Economists are plugged into labor markets data and know how to use them to good effect. Many economists are skilled in gathering through survey questionnaires data. In addition, economists as a group demonstrate an ever-growing interest in the economics and the sociology of the profession. However, a key problem has been the lack of strong interest by the American Economic Association in encouraging such investigations. As a result, individuals have had to proceed on their own. On the other hand, research on the labor market imperfections that could be remedied through the actions of individual departments and advanced graduate students about to enter the labor market. Equally important, such research could pinpoint ways of improving the education and training of future doctorate graduates.

Focuses on the US Federal Reserve that is under attack from lawmakers who propose measures designed to increase the accountability of monetary policymakers while preserving the independence of the institution. Removal of the voting power of District Reserve Bank presidents; Absence of an objective for monetary policy; Promotion of the maximum attainable level of employment and output through a stable price level.

Looks at the role of marketing in technology transfer in the United states with reference to the Technology Innovation Act of 1980. References to related studies; Discussion of the connection between technology transfer and marketing; Description of study; Findings.

The Basic Educational Opportunity Grants (BEOG) authorized by the education Amendments of 1972 mark a new era in the financing of higher education, for they signal a larger role for the federal government. However, the grants are funded only for a restricted number of students and in amounts that fall short of financial need, as it is commonly defined. Despite these shortcomings, however, the BEOG program has been hailed by many, including the Carnegie Commission on Higher Education, as an important step toward minimizing the financial obstacles to college admission, improving equity in funding. The BEOG formula may be thought of as a variant of a negative income tax. The maximum grant payable is equivalent to the guaranteed income level. Indications of how BEOG would actually work, when and if funds are made available to all undergraduate classes for the full schedule of benefits specified in the 1972 amendments, are found in regulations prepared by the U.S. Office of Education and published in the Federal Register.

There were several issues that led the American Economic Association's Executive Committee in early 1988 to establish the Commission on Graduate Education in Economics. The commission's purpose was to examine the structure and content of graduate education in economics, and to make whatever recommendations seemed appropriate. Its recommendations are to be directed to the economics profession and particularly to economics departments with Ph.D. programs. Because the commission is an independent body, its recommendations will be the responsibility of its members; neither its findings nor its recommendations will be endorsed by the American Economic Association. Over the past 15 months, the commission has engaged in a variety of projects. Extensive information obtained from economics departments is being analyzed as are the results of a comprehensive set of surveys. In addition, various special studies are in progress. The preliminary results presented in this article are based on surveys of faculty members graduate students in their second year and beyond, and recent Ph.D.s, all of whom were selected from a sample of departments with graduate programs that were among those ranked in the 1982 study by the U.S. National Academy of Sciences.

The article focuses on the status and prospects of economics major in the U.S. The purpose of the economics major might be ascertained in several different ways. The most obvious approach is to ask faculty members who teach economics courses and set the economics curriculum what they expect the economics major to achieve. Another perhaps less satisfactory method is to ask graduating economics majors what they expected to accomplish from their undergraduate experience. A third approach is to infer these expectations by observing what students learn and how they learn it from being an economics major. Thinking like an economist includes problem-solving and creative skills. Problem-solving skills that emphasize analytical reasoning using the techniques and principles of economics increase understanding of economic behavior and improve a student's ability to predict the consequences of changes in economic forces. The common core also facilitates communication among students and faculty in different fields within economics.

Economic efficiency implies an equating, at the margin, of benefits and costs. The article explores the concept of "efficiency" which is broader than the usual framework and which applies to commodities and services produced and distributed largely outside the private, profit maximizing sector. An assessment of the economic efficiency of producing such a commodity requires the determination of its outputs and the valuation or weighting of these outputs. The principal point is that these weights, in turn, depend on who receives outputs, thus, distributional issues are at the heart of economic efficiency studies involving a wide range of activities undertaken in the governmental and private, nonprofit sectors. One of these activities, the production and distribution of college instruction in economics, illustrates well the significance of this particular approach to the analysis of economic efficiency. The article argues that in analyzing the economic efficiency of instruction, distributional issues, that is, who receive benefits, should be considered explicitly, if not, they will necessarily be considered implicitly. The pervasive failure to include distributional issues in efficiency studies suggests an excessively narrow concept of efficiency.

The article discusses income distribution effect of higher education in the U.S. According to the author, whether and if so, how-to increase resources available to finance higher education is a question raised ever more frequently by educators, legislators and the general public. The vast enrollment growth of the early and middle 1960's, combined with sharp price increases since then, has produced a large and continuing demand for additional resources. At the same time the revenue-generating abilities of institutions of higher education appear not to have kept pace, largely because of other rapidly growing demands on public funds. The result has been a gradually tightening financial squeeze, accentuated by recent federal cutbacks in funds and by reduced generosity on the part of state legislators responding to campus turmoil. Partly, in anticipation of this squeeze and partly in response to it, various proposals have been advanced that would increase resources available for higher education. Among those proposals are an expanded program of state and/or federal institutional grants, income tax credits, contingent repayment student loan programs, larger amounts of conventional student financial aid and the like.

Focuses on the application of foreign language skills as a scholarly tool. Controversy on the doctor of philosophy foreign language requirement on U.S. graduate education; General approach in evaluating the foreign language requirement; Results of the survey on foreign language proficiency.

The many new proposals advanced during the past few years for financing higher education have been promoted, almost without exception, by appealing to their important and favorable equity consequences. What is meant by the term "equity"? To what degree will various proposals help achieve greater equity, however equity is defined? What kinds of side effects might these proposals produce in the process of achieving greater equity? Questions like these are difficult to answer because no systematic framework for analyzing equity and equity effects has evolved. Traditionally, equity has been viewed as a normative matter, and consequently, little attention has been given to developing the tools required to analyze it. The need for answers to the questions posed persists, however, and this paper offers a starting point in the search for answers. It might best be viewed as an essay on equity as applied to the provision and finance of higher education. This paper focuses on undergraduate higher education. While there is jointness in the production of undergraduate education and such activities as graduate and professional education, research, public service, and the array of other activities known as higher education, it is also quite apparent that most undergraduate students are enrolled at institutions almost exclusively concerned with undergraduate teaching. It is not inappropriate, therefore, to concentrate only on undergraduate education. The focus is, moreover, on students rather than instiutions of higher education, because public policy presumably seeks to benefit students by producing more or less higher education. [ABSTRACT FROM AUTHOR]

This article presents the authors views on a commentary on an article about the cost effectiveness of public higher education in the U.S. Pechman and Sharkansky, to whose comments this reply is directed, focus the bulk of their attention on our treatment of the income distributional effects of public higher education. We are pleased to see this emphasis on distributional considerations, for there has been too little work at either the conceptual or empirical level on the distribution of benefits from public expenditure programs. Hence there is need to examine alternative approaches for analyzing the distributive effects of public programs. To review, our approach, as part of a book dealing with the size and distribution of benefits and costs of one public service, higher education, compared the distributional pattern of subsidies for higher education in California with the distribution of state and local taxes. Specifically, we showed for different classes of families - those with no children in public higher education and those with children in each of California's three public systems of higher education - the average family income and the higher education subsidy received.

The article presents several comments by the authors in response to the book "The American Occupational Structure," by Peter M. Blau and O. Dudley Duncan. According to one of the author, the phenomenon of social mobility has long been recognized as one of great sociological importance, though it is only in recent times that it has begun to be thoroughly and systematically investigated. Its study requires an examination of the system of stratification, and of the effects of a changing technology and economy upon the occupational structure; it leads on to inquiries into the educational system, kinship, and the demo- graphic characteristics of a society; and it bears upon larger debates concerning equality, conflict, the "open-ness" of a society, its political stability, and its capacity for change. The author is concerned about Blau and Duncan's interpretation of the general social consequences of mobility in the U.S. Another author feels that Blau and Duncan have produced an impressive, careful, and thought-provoking piece of research that should serve as a model for future investigations using quantitative multivariate techniques.

This article investigates two important consequences of the military draft system in the U.S. in 1967. They are distributive effects and allocative costs. The first is the impact on the distribution of real output. The second is the impact on the size of that output. Section I examines the consequences at the conceptual level. Section II presents a model underlying the empirical analysis. In Section III an empirical version of the model is developed and some quantitative estimates are derived. Finally, Section IV explores some ramifications of the analysis.

The article presents the report of the Committee on Economic Education of the American Economic Association on economics instruction in the U.S. The committee worked closely with the Joint Council on Economic Education (JCEE) in promoting improved economics instruction at all levels of education. The committee typically meets once each year, and it carries on its activities largely through informal interactions between the chair and the various members. Its work with the JCEE is accomplished in several ways. The chair serves on the Executive Committee of the JCEE Board of Trustees, and the chair works closely with the JCEE president and JCEE director of research on matters of mutual interest. The committee reviewed the condition of the "Journal of Education," based on the annual report of the Journal prepared by its editor, Kalman Goldberg. He reported that the volume and quality of the submissions continue to increase, with the backlog of accepted papers expanding. The Journal should be of particular interest to faculty members whose principal activity is teaching as well as to those who are interested in research on the effectiveness of economics instruction at the college level.

Comments on the development of research and evaluation agenda for Developmental Economic Education Program (DEEP) of the Joint Council on Economic Education (JCEE) in the U.S. Objectives of the JCEE on instructional programs in economics; Determination of DEEP programs and student learning; Quality of the educational program of DEEP; Factors that facilitate the introduction and success of DEEP.

This article presents information on the annual meeting of American Economic Association (AEA). Of particular interest this year were discussions about research on undergraduate and graduate education in economics. Over the years, there has been surprisingly little research on undergraduate education in economics. There was general agreement that the scope of research questions needs to be broadened by a challenging research agenda designed to stimulate the asking of new questions and to enlist additional economists in seeking answers to these questions. Even less attention has been given to graduate education in economics. Economists Kal Goldberg and Bill Becker developed a proposal for a Symposium on Graduate Education in Economics with purposes similar to the undergraduate research agenda. They posed a series of interesting questions on which research might be undertaken, and their hope was to enlist economists not closely linked to economic education to help undertake this research. The proposal called for commissioning a set of four issues papers that would be reviewed by formal discussants and then discussed by the other invitees to the symposium. The intent would be to publish the papers in a forthcoming issue of the "Journal of Economic Education."

This article presents a report of the Committee on Economic Education of the American Economic Association to the U.S. National Bureau of Economic Research. In 1978, the committee continued work on two projects. One is revision of the Test of Understanding College Economics, the revised version should be available for use by instructors and researchers in the 1980-1981 academic year. another is finding ways of expanding professional interest in economic education, broadening the research base and improving the process of dissemination, with particular attention to the Journal of Economic Education. The committee brought to a close the developmental phase of a program to provide more effective training in teaching for new doctors of philosophy in economics. The scope of the Teacher Training Program, sketched out as part of the agenda of the committee prepared in 1972, appeared in the May 1973 Proceedings. The papers and materials prepared for the workshop were tested in pilot teaching programs at the University of Minnesota and the University of Wisconsin-Madison in 1973-1974. In the meantime, development of the materials continued, with revision of the original chapters, preparation of additional chapters and development of videotapes to complement the written materials. Suggestions from participants and participating institutions and the experiences of Planning Committee members invited to take part in the programs sponsored by the various institutions, greatly assisted in this work.

This article presents the report of the Committee on Economic Education of the American Economic Association. In 1978 the Committee continued work on two projects. One is revision of the Test of Understanding College Economics (TUCE); the revised version should be available for use by instructors and researchers in the 1980-81 academic year. Another is finding ways of expanding professional interest in economic education, broadening the research base, and improving the process of dissemination, with particular attention to the Journal of Economic Education. The Committee brought to a close the developmental phase of a program to provide more effective training in teaching for new Ph.D.s in economics. This is marked by the publication of a 438-page Resource Manual for Teacher Training Programs in Economics and the availability of a set of related video-tapes that can be used to give graduate students more systematic exposure to what is known about improving their teaching skills. The Committee hopes that these materials will encourage the establishment of regular training programs in graduate economics departments, so as to improve the teaching done by their graduate teaching assistants and by their Ph.D.s after they assume full-time teaching positions.

Periodontitis is associated with elevated C-reactive protein (CRP) levels. Although the coexistence of periodontitis and elevated CRP levels may heighten the risk of mortality, previous studies have not confirmed their synergistic effect. Understanding this interaction is crucial for identifying potential interventions to reduce mortality risk in individuals with periodontitis. This study aimed to assess the synergistic effects of periodontitis and elevated CRP levels on mortality in 7,938 adult individuals who participated in the National Health and Nutrition Examination Study 2001-2004. The association of periodontitis status and CRP levels with mortality was assessed using a survey-weighted Cox model. The interactive effect was estimated; the synergistic effect of CRP levels and periodontitis status on mortality was assessed using the relative excess risk due to interaction (RERI). Periodontitis was diagnosed in 1,065 (13.4%) participants. Compared with the participants without periodontitis and possessing CRP levels of ≤ 0.5 mg/dL, those with periodontitis (hazard ratio [HR], 1.38) or CRP levels of > 0.5 mg/dL (HR 1.23) had higher HRs. The participants with both periodontitis and CRP levels of > 0.5 mg/dL had the highest HR of 2.01. The additive scale interactive effect of the periodontal status and CRP levels, measured using RERI 0.41 (-0.07, 0.95), was positive and nearly significant in the total population. The synergy between the periodontal status and CRP levels was more prominent in the participants aged ≥60 years than that in younger individuals. Periodontitis with high CRP levels may indicate a high mortality rate, indicating the importance of active monitoring and intensive management of periodontitis and inflammatory markers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The Next Generation Accountable Care Organization (NGACO) model (active during 2016-21) tested the effects of high financial risk, payment mechanisms, and flexible care delivery on health care spending and value for fee-for-service Medicare beneficiaries. We used quasi-experimental methods to examine the model's effects on Medicare Parts A and B spending. Sixty-two ACOs with more than 4.2 million beneficiaries and more than 91,000 practitioners participated in the model. The model was associated with a $270 per beneficiary per year, or approximately $1.7 billion, decline in Medicare spending. After shared savings payments to ACOs were included, the model increased net Medicare spending by $56 per beneficiary per year, or $96.7 million. Annual declines in spending for the model grew over time, reflecting exit by poorer-performing NGACOs, improvement among the remaining NGACOs, and the COVID-19 pandemic. Larger declines in spending occurred among physician practice ACOs and ACOs that elected population-based payments and risk caps greater than 5 percent.

The United States is facing a surge in the aging population, which will increase the demand for services and supports that allow older adults to age independently. This study assessed the size and value of the volunteer labor force in two home- and community-based programs funded under the Older Americans Act (OAA). Using publicly available program data for fiscal years 2015-2019, we calculated the annual contribution of volunteers, based on the total number of volunteer hours and share of labor effort, and estimated the economic value of volunteers in these OAA programs. In fiscal year 2019, volunteers contributed a total value of $1.7 billion in the OAA Title III program and $14.0 million in the Title VII long-term care ombudsman program. These results highlight the value of volunteers in OAA programs and the need for policies to support volunteers in the aging services network.

Purpose To develop an artificial intelligence (AI) model for the diagnosis of breast cancer on digital breast tomosynthesis (DBT) images and to investigate whether it could improve diagnostic accuracy and reduce radiologist reading time. Materials and Methods A deep learning AI algorithm was developed and validated for DBT with retrospectively collected examinations (January 2010 to December 2021) from 14 institutions in the United States and South Korea. A multicenter reader study was performed to compare the performance of 15 radiologists (seven breast specialists, eight general radiologists) in interpreting DBT examinations in 258 women (mean age, 56 years ± 13.41 [SD]), including 65 cancer cases, with and without the use of AI. Area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and reading time were evaluated. Results The AUC for stand-alone AI performance was 0.93 (95% CI: 0.92, 0.94). With AI, radiologists' AUC improved from 0.90 (95% CI: 0.86, 0.93) to 0.92 (95% CI: 0.88, 0.96) ( P = .003) in the reader study. AI showed higher specificity (89.64% [95% CI: 85.34%, 93.94%]) than radiologists (77.34% [95% CI: 75.82%, 78.87%]) ( P < .001). When reading with AI, radiologists' sensitivity increased from 85.44% (95% CI: 83.22%, 87.65%) to 87.69% (95% CI: 85.63%, 89.75%) ( P = .04), with no evidence of a difference in specificity. Reading time decreased from 54.41 seconds (95% CI: 52.56, 56.27) without AI to 48.52 seconds (95% CI: 46.79, 50.25) with AI ( P < .001). Interreader agreement measured by Fleiss κ increased from 0.59 to 0.62. Conclusion The AI model showed better diagnostic accuracy than radiologists in breast cancer detection, as well as reduced reading times. The concurrent use of AI in DBT interpretation could improve both accuracy and efficiency. Keywords: Breast, Computer-Aided Diagnosis (CAD), Tomosynthesis, Artificial Intelligence, Digital Breast Tomosynthesis, Breast Cancer, Computer-Aided Detection, Screening Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Bae in this issue.

There's a paucity of robust normal fractional limb and organ volume standards from a large and diverse ethnic population. The Fetal 3D Study was designed to develop research and clinical applications for fetal soft tissue and organ volume assessment. The NICHD Fetal Growth Studies (2009-2013) collected 2D and 3D fetal volumes. In the Fetal 3D Study (2015-2019), sonographers performed longitudinal 2D and 3D measurements for specific fetal anatomical structures in research ultrasounds of singletons and dichorionic twins. The primary aim was to establish standards for fetal body composition and organ volumes, overall and by maternal race/ethnicity, and determine whether these standards vary for twins versus singletons. We describe the study design, methods, and details about reviewer training. Basic characteristics of this cohort, with their corresponding distributions of fetal 3D measurements by anatomical structure, are summarized. This investigation is responsive to critical data gaps in understanding serial changes in fetal subcutaneous fat, lean body mass, and organ volume in association with pregnancy complications. In the future, this cohort can answer critical questions regarding the potential influence of maternal characteristics, lifestyle factors, nutrition, and biomarker and chemical data on longitudinal measures of fetal subcutaneous fat, lean body mass, and organ volumes., (Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2024.)

Background: Recent studies have reported the association between air pollution exposure and reduced kidney function. However, it is unclear whether air pollution is associated with an increased risk of acute kidney injury (AKI)., Objectives: To address this gap in knowledge, we investigated the effect estimates of long-term exposures to fine particulate matter [PM ≤ 2.5 μ m in aerodynamic diameter ( PM 2.5 )], nitrogen dioxide ( NO 2 ), and ozone ( O 3 ) on the risk of first hospital admission for AKI using nationwide Medicare data., Methods: This nationwide population-based longitudinal cohort study included 61,300,754 beneficiaries enrolled in Medicare Part A fee-for-service (FFS) who were ≥ 65 years of age and resided in the continental United States from the years 2000 through 2016. We applied Cox-equivalent Poisson models to estimate the association between air pollution and first hospital admission for AKI., Results: Exposure to PM 2.5 , NO 2 , and O 3 was associated with increased risk for first hospital admission for AKI, with hazard ratios (HRs) of 1.17 (95% CI: 1.16, 1.19) for a 5 - μ g / m 3 increase in PM 2.5 , 1.12 (95% CI: 1.11, 1.13) for a 10 -ppb increase in NO 2 , and 1.03 (95% CI: 1.02, 1.04) for a 10 -ppb increase in summer-period O 3 (June to September). The associations persisted at annual exposures lower than the current National Ambient Air Quality Standard., Discussion: This study found an association between exposures to air pollution and the risk of the first hospital admission with AKI, and this association persisted even at low concentrations of air pollution. Our findings provide beneficial implications for public health policies and air pollution guidelines to alleviate health care expenditures and the disease burden attributable to AKI. https://doi.org/10.1289/EHP10729.

Background: Recent studies have identified the association of environmental stressors with reduced kidney function and the development of kidney disease. While residential greenness has been linked to many health benefits, the association between residential greenness and the development of kidney disease is not clear. We aimed to investigate the association between residential greenness and the development of kidney disease., Methods: We performed a longitudinal population-based cohort study including all fee-for-service Medicare Part A beneficiaries (aged 65 years or older) in Massachusetts (2000-2016). We assessed greenness with the annual average Enhanced Vegetation Index (EVI) based on residential ZIP codes of beneficiaries. We applied Cox-equivalent Poisson models to estimate the association between EVI and first hospital admission for total kidney disease, chronic kidney disease (CKD), and acute kidney injury (AKI), separately., Results: Data for 1,462,949 beneficiaries who resided in a total of 644 ZIP codes were analyzed. The total person-years of follow-up for total kidney disease, CKD, and AKI were 9.8, 10.9, and 10.8 million person-years, respectively. For a 0.1 increase in annual EVI, the hazard ratios (HRs) were 0.95 (95% CI: 0.93 to 0.97) for the first hospital admission for total kidney disease, and the association was more prominent for AKI (HR: 0.94 with 95% CI: 0.92 to 0.97) than CKD (HR: 0.98 with 95% CI: 0.95-1.01]). The estimated effects of EVI on kidney disease were generally more evident in White beneficiaries and those residing in metropolitan areas compared to the overall population., Conclusions: This study found that higher levels of annual residential greenness were associated with a lower risk of the first hospital admission for kidney diseases. Results are consistent with the hypothesis that higher residential greenness benefits kidney patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To characterize and evaluate the estimation of oxygen saturation measured by a wrist-worn reflectance pulse oximeter during sleep., Methods: Ninety-seven adults with sleep disturbances were enrolled. Oxygen saturation was simultaneously measured using a reflectance pulse oximeter (Galaxy Watch 4 [GW4], Samsung, South Korea) and a transmittance pulse oximeter (polysomnography) as a reference. The performance of the device was evaluated using the root mean squared error (RMSE) and coverage rate. Additionally, GW4-derived oxygen desaturation index (ODI) was compared with the apnea-hypopnea index (AHI) derived from polysomnography., Results: The GW4 had an overall RMSE of 2.3% and negligible bias of -0.2%. A Bland-Altman density plot showed good agreement between the GW4 and the reference pulse oximeter. RMSEs were 1.65 ± 0.57%, 1.76 ± 0.65%, 1.93 ± 0.54%, and 2.93 ± 1.71% for normal (n = 18), mild (n = 21), moderate (n = 23), and severe obstructive sleep apnea (n = 35), respectively. The data rejection rate was 26.5%, which was caused by fluctuations in contact pressure and the discarding of data less than 70% of saturation. A GW4-ODI ≥5/h had the highest ability to predict AHI ≥15/h with sensitivity, specificity, accuracy, and area under the curve of 89.7%, 64.1%, 79.4%, and 0.908, respectively., Conclusions: This study evaluated the estimation of oxygen saturation by the GW4 during sleep. This device complies with both Food and Drug Administration and International Organization for Standardization standards. Further improvements in the algorithms of wearable devices are required to obtain more accurate and reliable information about oxygen saturation measurements., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Transnational immigration has increased since the 1950s. In countries such as the United States, immigrants now account for > 15 % of the population. Although differences in health between immigrants and nonimmigrants are well documented, it is unclear how environmental exposures contribute to these disparities., Objectives: We summarized current knowledge comparing immigrants' and nonimmigrants' exposure to and health effects of environmental exposures., Methods: We conducted a title and abstract review on articles identified through PubMed and selected those that assessed environmental exposures or health effects separately for immigrants and nonimmigrants. After a full text review, we extracted the main findings from eligible studies and categorized each article as exposure-focused, health-focused, or both. We also noted each study's exposure of interest, study location, exposure and statistical methods, immigrant and comparison groups, and the intersecting socioeconomic characteristics controlled for., Results: We conducted a title and abstract review on 3,705 articles, a full text review on 84, and extracted findings from 50 studies. There were 43 studies that investigated exposure (e.g., metals, organic compounds, fine particulate matter, hazardous air pollutants) disparities, but only 12 studies that assessed health disparities (e.g., mortality, select morbidities). Multiple studies reported higher exposures in immigrants compared with nonimmigrants. Among immigrants, studies sometimes observed exposure disparities by country of origin and time since immigration. Of the 50 studies, 43 were conducted in North America., Discussion: The environmental health of immigrants remains an understudied area, especially outside of North America. Although most identified studies explored potential exposure disparities, few investigated subsequent differences in health effects. Future research should investigate environmental health disparities of immigrants, especially outside North America. Additional research gaps include the role of immigrants' country of origin and time since immigration, as well as the combined effects of immigrant status with intersecting socioeconomic characteristics, such as race/ethnicity, income, and education attainment. https://doi.org/10.1289/EHP9855.

Objective: The aim of the study was to investigate the feasibility of using administrative data to screen adverse events in Korea., Methods: We used a diagnosis-related groups claims data set and the information of the checklist of healthcare quality improvement (a part of the value incentive program) to verify adverse events in fiscal year 2018. Adverse events were identified using patient safety indicator (PSI) clusters and a present on admission indicator (POA). The PSIs consisted of 19 clusters representing subcategories of adverse events, such as hospital-acquired infection. Among the adverse events identified using PSI clusters, "POA = N," which means not present at the time of admission, was only deemed as the case in the final stage. We compared the agreement on the occurrence of adverse events from claims data with a reference standard data set (i.e., checklist of healthcare quality improvement) and presented them by PSI cluster and institution., Results: The cases of global PSI for any adverse event numbered 27,320 (2.32%) among all diagnostic codes in 2018. In terms of institutional distribution, considerable variation was observed throughout the clusters. For example, only 13.2% of institutions (n = 387) reported any global PSI for any adverse event throughout the whole year. The agreement between the reference standard and the claims data was poor, in the range of 2.2% to 10.8%, in 3 types of adverse events. The current claims data system (i.e., diagnostic codes coupled to POA indicators) failed to capture a large majority of adverse events identified using the reference standard., Conclusions: Our results imply that the coding status of International Classification of Diseases, Tenth Revision, codes and POA indicators should be refined before using them as quality indicators., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

After more than a century of research and debate, the scientific community has yet to reach agreement on the principal causes of racialized disparities in population health. This debate currently centers on the degree to which "race residuals" are a result of unobserved differences in the social context or unobserved differences in population characteristics. The comparative study of native and foreign-born Black populations represents a quasi-experimental design where race is "held constant". Such studies present a unique opportunity to improve our understanding of the social determinants of population health disparities. Since native and foreign-born Black populations occupy different sociocultural locations, and since populations with greater African ancestry have greater genetic diversity, comparative studies of these populations will advance our understanding of the complex relationship between sociocultural context, population characteristics and health outcomes. Therefore, we offer a conceptual framing for the comparative study of native and foreign-born Blacks along with a review of 208 studies that compare the mental and physical health of these populations. Although there is some complexity, especially with respect to mental health, the overall pattern is that foreign-born Blacks have better health outcomes than native-born Blacks. After reviewing these studies, we conclude with suggestions for future studies in this promising area of social and medical research.

We report on the sequencing of 74,348 SARS-CoV-2 positive samples collected across the United States and show that the Delta variant, first detected in the United States in March 2021, made up the majority of SARS-CoV-2 infections by July 1, 2021 and accounted for >99.9% of the infections by September 2021. Not only did Delta displace variant Alpha, which was the dominant variant at the time, it also displaced the Gamma, Iota, and Mu variants. Through an analysis of quantification cycle (Cq) values, we demonstrate that Delta infections tend to have a 1.7× higher viral load compared to Alpha infections (a decrease of 0.8 Cq) on average. Our results are consistent with the hypothesis that the increased transmissibility of the Delta variant could be due to the ability of the Delta variant to establish a higher viral load earlier in the infection as compared to the Alpha variant., Competing Interests: A.B., S.L., E.T.C., S.W., D. Wyman, A.D.R., H.M., T.C., S.J., K.M.S.B., F.T., K.T., J.N., J.M.R., E.S., X.W., D. Wong, D.B., M.L., J.T.L., M.I., N.L.W., and W.L. are employees of Helix., (© 2022 The Author(s).)

BackgroundMore than 1500 variants in the ATP-binding cassette, sub-family A, member 4 (ABCA4), locus underlie a heterogeneous spectrum of retinal disorders ranging from aggressive childhood-onset chorioretinopathy to milder late-onset macular disease. Genotype-phenotype correlation studies have been limited in clinical applicability as patient cohorts are typically small and seldom capture the full natural history of individual genotypes. To overcome these limitations, we constructed a genotype-phenotype correlation matrix that provides quantifiable probabilities of long-term disease outcomes associated with specific ABCA4 genotypes from a large, age-restricted patient cohort.MethodsThe study included 112 unrelated patients at least 50 years of age in whom 2 pathogenic variants were identified after sequencing of the ABCA4 locus. Clinical characterization was performed using the results of best corrected visual acuity, retinal imaging, and full-field electroretinogram testing.ResultsFour distinct prognostic groups were defined according to the spatial severity of disease features across the fundus. Recurring genotypes were observed in milder prognoses, including a newly defined class of rare hypomorphic alleles. PVS1 (predicted null) variants were enriched in the most severe prognoses; however, missense variants were present in a larger-than-expected fraction of these patients. Analysis of allele combinations and their respective prognostic severity showed that certain variants, such as p.(Gly1961Glu), and both rare and frequent hypomorphic alleles, were "clinically dominant" with respect to patient phenotypes irrespective of the allele in trans.ConclusionThese results provide much-needed structure to the complex genetic and clinical landscape of ABCA4 disease and add a tool to the clinical repertoire to quantitatively assess individual genotype-specific prognoses in patients.FUNDINGNational Eye Institute, NIH, grants R01 EY028203, R01 EY028954, R01 EY029315, P30 19007 (Core Grant for Vision Research); the Foundation Fighting Blindness USA, grant no. PPA-1218-0751-COLU; and Research to Prevent Blindness.

With an increasing awareness of the disparate impact of COVID-19 on historically marginalized populations and acts of violence on Black communities in 2020, academic health centers across the United States have been prioritizing antiracism strategies. Often, medical students and residents have been educated in the concepts of equity and antiracism and are ready to tackle these issues in practice. However, faculty are not prepared to respond to or integrate antiracism topics into the curriculum. Leaders in faculty affairs, education, diversity, and other departments are seeking tools, frameworks, expertise, and programs that are best suited to meet this imminent faculty development need. In response to these demands for guidance, the authors came together to explore best practices, common competencies, and frameworks related to antiracism education. The focus of their work was preparing faculty to foster antiracist learning environments at traditionally predominantly White medical schools. In this Scholarly Perspective, the authors describe their collaborative work to define racism and antiracism education; propose a framework for antiracism education for faculty development; and outline key elements to successfully build faculty capacity in providing antiracism education. The proposed framework highlights the interplay between individual learning and growth and the systemic and institutional changes needed to advance antiracist policies and practices. The key elements of the framework include building foundational awareness, expanding foundational knowledge on antiracism, embedding antiracism education into practice, and dismantling oppressive structures and measuring progress. The authors list considerations for program planning and provide examples of current work from their institutions. The proposed strategies aim to support all faculty and enable them to learn, work, and educate others in an antiracist learning environment., (Copyright © 2021 by the Association of American Medical Colleges.)

The United States has the highest numbers of confirmed cases and deaths during the novel coronavirus disease 2019 (COVID-19) pandemic. Previous studies reported that urban residents are more vulnerable to the spread and mortality of COVID-19 than rural residents. However, the pathways through which urban environments affect COVID-19 spread and mortality are unclear. We collected daily data on the number of confirmed cases and deaths of COVID-19 from Mar. 01 to Nov. 16, 2020 for all 91 counties in New York, New Jersey, and Connecticut in the United States. We calculated the COVID-19 incidence %, daily reproduction number, and mortality %, then estimated the associations with urban environment indicators using regression models. COVID-19 outcomes were generally highest in areas with high population density, and this pattern was evident in the early period of epidemic. Among the area-level demographic variables, the percentage of Black or Hispanic residents showed the strongest positive association with COVID-19 outcomes. Higher risk of COVID-19 outcomes was also associated with higher percentage of overcrowded households, uninsured people, and income inequality. The percent elderly, sex ratio (the ratio of males to females), and greenness were negatively associated with risk of COVID-19 outcomes. The results of this study could indicate where resources are most needed., Competing Interests: Declaration of competing interest None., (Copyright © 2021. Published by Elsevier B.V.)

The highly transmissible B.1.1.7 variant of SARS-CoV-2, first identified in the United Kingdom, has gained a foothold across the world. Using S gene target failure (SGTF) and SARS-CoV-2 genomic sequencing, we investigated the prevalence and dynamics of this variant in the United States (US), tracking it back to its early emergence. We found that, while the fraction of B.1.1.7 varied by state, the variant increased at a logistic rate with a roughly weekly doubling rate and an increased transmission of 40%-50%. We revealed several independent introductions of B.1.1.7 into the US as early as late November 2020, with community transmission spreading it to most states within months. We show that the US is on a similar trajectory as other countries where B.1.1.7 became dominant, requiring immediate and decisive action to minimize COVID-19 morbidity and mortality., Competing Interests: Declaration of interests N.L.W., A.B., E.T.C., K.M.S.B., S.W., C.R.-G., E. Sandoval, T.C., X.W., J.N., J.M.R., G.L., D.W., D.B., M.L., M.I., S.J., J.T.L., and W.L. are employees of Helix. K. Gietzen, B.S., J.A., K.H., J.L., E.d.F., and P.G.F. are employees of Illumina. J.N., C.R.-G., and M.L. own stock in ILMN. K.G.A. has received consulting fees for advising on SARS-CoV-2, variants, and the COVID-19 pandemic., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Discordant variant classifications among public databases is one of the well-documented limitations when interpreting the pathogenicity of variants. The aim of this study is to investigate the level of germline variant misannotation from the Human Gene Mutation Database (HGMD) and the annotation concordance between databases., Methods: We used a total of 188,106 classified variants (disease-causing mutations [n = 179,454] and polymorphisms [n = 8652]) in 6466 genes from the HGMD. All variants were reanalyzed based on the American College of Medical Genetics and Genomics (ACMG) guidelines and compared to ClinVar database variants., Results: When variants were classified based on the ACMG guidelines, misclassification was observed in 3.47% (2289/65,896) of variants. The overall concordance between HGMD and ClinVar was 97.62% (52,499/53,780) of variants studied., Conclusion: Variants in databases must be used with caution when variant pathogenicity is interpreted. This study reveals the frequency of misannotation of the HGMD variants and annotation concordance between databases in depth., (© American Society for Clinical Pathology 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)