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Historically, it has been difficult for students and their families to compare how different colleges and programs improve students' chances of landing a desirable job and earning a good salary. The U.S. Department of Education's 2015 release of student earning data was a major step toward remedying this problem. The data offered by the College Scorecard (CSC) have facilitated the development of a number of different ranking methodologies that attempt to measure the "value" gained from attending different colleges and programs. This article analyzes five CSC-based systems that measure educational return on investment in various ways. There are important differences in how these methodologies balance the costs of college and median earnings of graduates to assign relative value. Limitations in data granularity prevent important analysis, particularly comparisons of how universities perform with members of underserviced demographic groups.

Trajectories of perceived stress from the transition to adulthood (age 25), during young adulthood (age 32), and into midlife (ages 43 and 50) were examined with four waves of longitudinal survey data (N = 688; 49% female, 37% with a university degree, 86% White). We explored how between- and within-person variation in perceived stress was associated with age 50 psychological well-being (life satisfaction and eudaimonic well-being), self-reported physical health, career satisfaction, and intimate partnership satisfaction. Growth curve analyses revealed stress followed a linear decreasing trajectory from the transition to adulthood into midlife with substantial variability underlying the average pattern. Between- and within-person variation in perceived stress was associated with midlife functioning. Those with lower initial levels of and more decline in perceived stress reported better psychological and physical health and higher relationship satisfaction at age 50 compared to those with initially higher perceived stress and less decline over time. Higher than one's own average perceived stress at ages 25, 32, 43, and 50 years was associated with lower psychological and physical health and intimate partnership satisfaction at age 50. These results support key contentions of developmental theory and may prove useful when designing interventions aimed at promoting well-being in midlife.

BackgroundMultisystem inflammatory syndrome in children (MIS-C) is a novel disease that was identified during the COVID-19 pandemic and is characterised by systemic inflammation following SARS-CoV-2 infection. Early detection of MIS-C is a challenge given its clinical similarities to Kawasaki disease and other acute febrile childhood illnesses. We aimed to develop and validate an artificial intelligence algorithm that can distinguish among MIS-C, Kawasaki disease, and other similar febrile illnesses and aid in the diagnosis of patients in the emergency department and acute care setting.MethodsIn this retrospective model development and validation study, we developed a deep-learning algorithm called KIDMATCH (Kawasaki Disease vs Multisystem Inflammatory Syndrome in Children) using patient age, the five classic clinical Kawasaki disease signs, and 17 laboratory measurements. All features were prospectively collected at the time of initial evaluation from patients diagnosed with Kawasaki disease or other febrile illness between Jan 1, 2009, and Dec 31, 2019, at Rady Children's Hospital in San Diego (CA, USA). For patients with MIS-C, the same data were collected from patients between May 7, 2020, and July 20, 2021, at Rady Children's Hospital, Connecticut Children's Medical Center in Hartford (CT, USA), and Children's Hospital Los Angeles (CA, USA). We trained a two-stage model consisting of feedforward neural networks to distinguish between patients with MIS-C and those without and then those with Kawasaki disease and other febrile illnesses. After internally validating the algorithm using stratified tenfold cross-validation, we incorporated a conformal prediction framework to tag patients with erroneous data or distribution shifts. We finally externally validated KIDMATCH on patients with MIS-C enrolled between April 22, 2020, and July 21, 2021, from Boston Children's Hospital (MA, USA), Children's National Hospital (Washington, DC, USA), and the CHARMS Study Group consortium of 14 US hospitals.Findings1517 patients diagnosed at Rady Children's Hospital between Jan 1, 2009, and June 7, 2021, with MIS-C (n=69), Kawasaki disease (n=775), or other febrile illnesses (n=673) were identified for internal validation, with an additional 16 patients with MIS-C included from Connecticut Children's Medical Center and 50 from Children's Hospital Los Angeles between May 7, 2020, and July 20, 2021. KIDMATCH achieved a median area under the receiver operating characteristic curve during internal validation of 98·8% (IQR 98·0-99·3) in the first stage and 96·0% (95·6-97·2) in the second stage. We externally validated KIDMATCH on 175 patients with MIS-C from Boston Children's Hospital (n=50), Children's National Hospital (n=42), and the CHARMS Study Group consortium of 14 US hospitals (n=83). External validation of KIDMATCH on patients with MIS-C correctly classified 76 of 81 patients (94% accuracy, two rejected by conformal prediction) from 14 hospitals in the CHARMS Study Group consortium, 47 of 49 patients (96% accuracy, one rejected by conformal prediction) from Boston Children's Hospital, and 36 of 40 patients (90% accuracy, two rejected by conformal prediction) from Children's National Hospital.InterpretationKIDMATCH has the potential to aid front-line clinicians to distinguish between MIS-C, Kawasaki disease, and other similar febrile illnesses to allow prompt treatment and prevent severe complications.FundingUS Eunice Kennedy Shriver National Institute of Child Health and Human Development, US National Heart, Lung, and Blood Institute, US Patient-Centered Outcomes Research Institute, US National Library of Medicine, the McCance Foundation, and the Gordon and Marilyn Macklin Foundation.

PurposeSeveral studies have reported sleep disturbances during the COVID-19 virus pandemic. Little data exist about the impact of the pandemic on sleep and mental health among older women with breast cancer. We sought to examine whether women with and without breast cancer who experienced new sleep problems during the pandemic had worsening depression and anxiety.MethodsBreast cancer survivors aged ≥60 years with a history of nonmetastatic breast cancer (n = 242) and frequency-matched noncancer controls (n = 158) active in a longitudinal cohort study completed a COVID-19 virus pandemic survey from May to September 2020 (response rate 83%). Incident sleep disturbance was measured using the restless sleep item from the Center for Epidemiological Studies-Depression Scale (CES-D). CES-D score (minus the sleep item) captured depressive symptoms; the State-Anxiety subscale of the State Trait Anxiety Inventory measured anxiety symptoms. Multivariable linear regression models examined how the development of sleep disturbance affected changes in depressive or anxiety symptoms from the most recent prepandemic survey to the pandemic survey, controlling for covariates.ResultsThe prevalence of sleep disturbance during the pandemic was 22.3%, with incident sleep disturbance in 10% and 13.5% of survivors and controls, respectively. Depressive and anxiety symptoms significantly increased during the pandemic among women with incident sleep disturbance (vs. no disturbance) (β = 8.16, p

BackgroundKawasaki disease (KD) is the leading cause of acquired heart disease in children. The major challenge in KD diagnosis is that it shares clinical signs with other childhood febrile control (FC) subjects. We sought to determine if our algorithmic approach applied to a Taiwan cohort.MethodsA single center (Chang Gung Memorial Hospital in Taiwan) cohort of patients suspected with acute KD were prospectively enrolled by local KD specialists for KD analysis. Our previously single-center developed computer-based two-step algorithm was further tested by a five-center validation in US. This first blinded multi-center trial validated our approach, with sufficient sensitivity and positive predictive value, to identify most patients with KD diagnosed at centers across the US. This study involved 418 KDs and 259 FCs from the Chang Gung Memorial Hospital in Taiwan.FindingsOur diagnostic algorithm retained sensitivity (379 of 418; 90.7%), specificity (223 of 259; 86.1%), PPV (379 of 409; 92.7%), and NPV (223 of 247; 90.3%) comparable to previous US 2016 single center and US 2020 fiver center results. Only 4.7% (15 of 418) of KD and 2.3% (6 of 259) of FC patients were identified as indeterminate. The algorithm identified 18 of 50 (36%) KD patients who presented 2 or 3 principal criteria. Of 418 KD patients, 157 were infants younger than one year and 89.2% (140 of 157) were classified correctly. Of the 44 patients with KD who had coronary artery abnormalities, our diagnostic algorithm correctly identified 43 (97.7%) including all patients with dilated coronary artery but one who found to resolve in 8 weeks.InterpretationThis work demonstrates the applicability of our algorithmic approach and diagnostic portability in Taiwan.

PurposeProspective human data are lacking regarding safety, efficacy, and immunologic impacts of different radiation doses administered with combined PD-L1/CTLA-4 blockade.Patients and methodsWe performed a multicenter phase II study randomly assigning patients with metastatic microsatellite stable colorectal cancer to repeated low-dose fractionated radiation (LDFRT) or hypofractionated radiation (HFRT) with PD-L1/CTLA-4 inhibition. The primary endpoint was response outside the radiation field. Correlative samples were analyzed using multiplex immunofluorescence (IF), IHC, RNA/T-cell receptor (TCR) sequencing, cytometry by time-of-flight (CyTOF), and Olink.ResultsEighteen patients were evaluable for response. Median lines of prior therapy were four (range, 1-7). Sixteen patients demonstrated toxicity potentially related to treatment (84%), and 8 patients had grade 3-4 toxicity (42%). Best response was stable disease in 1 patient with out-of-field tumor shrinkage. Median overall survival was 3.8 months (90% confidence interval, 2.3-5.7 months). Correlative IF and RNA sequencing (RNA-seq) revealed increased infiltration of CD8+ and CD8+/PD-1+/Ki-67+ T cells in the radiation field after HFRT. LDFRT increased foci of micronuclei/primary nuclear rupture in two subjects. CyTOF and RNA-seq demonstrated significant declines in multiple circulating immune populations, particularly in patients receiving HFRT. TCR sequencing revealed treatment-associated changes in T-cell repertoire in the tumor and peripheral blood.ConclusionsWe demonstrate the feasibility and safety of adding LDFRT and HFRT to PD-L1/CTLA-4 blockade. Although the best response of stable disease does not support the use of concurrent PD-L1/CTLA-4 inhibition with HFRT or LDFRT in this population, biomarkers provide support that both LDFRT and HFRT impact the local immune microenvironment and systemic immunogenicity that can help guide future studies.

BackgroundPrior comparisons of chemotherapy adverse events (AEs) by age and performance status (PS) are limited by the traditional maximum grade approach, which ignores low-grade AEs and longitudinal changes.Materials and methodsTo compare fatigue and neuropathy longitudinally by age (

South African learner achievement remains poor, despite large investment in schooling over the last two decades. Literature and research findings offer no single explanation or solution. In this article, the authors explored the relative contribution of specific language factors such as the role of home- and school-language equivalence, cultural and economic capital, and other school and classroom factors to Science achievement. The analysis identified specific language and/or contextual factors having the biggest influence on learner achievement. This was achieved through secondary analysis of South African Grade Nine (N = 12,000) data from the Trends in International Mathematics and Science Study (TIMSS) 2011. Multiple-regression modelling using contextual and achievement data suggested that home- and school-language equivalence and how frequently learners used the school language at home were strongly associated with the Science achievement results of Grade Nine learners in South Africa. Several other language factors that could be seen as cultural capital, beyond broader economic capital, some classroom-related contextual conditions and selected school-level factors, also showed strong influences. It is concluded that language, teacher training, and broader economic policy changes and their thorough implementation are required to address these concerns.

This document has been prepared to guide practitioners on project investigation, recycling strategy selection, pavement structural design, environmental life cycle and life cycle cost assessment, mix design, and construction of in-place pavement recycling projects on flexible pavements in California. It provides information specific to California conditions to supplement the California Highway Design Manual (HDM), specification documents, and other available design guides.The main changes and updates to the 2017 version of the guide (UCPRC-GL-2017-04) include the following:• Updates to terminology used for in-place recycling• Updates to the project investigation chapter, including alignment with the new Caltrans site investigation guide, which was under review at the time of writing this guide• Updates throughout the guide to include cold central plant recycling (CCPR) • Inclusion of mechanistic-empirical design procedures (CalME) in the design chapter • Updates to the mix design chapter to align with the new California Test Method (CT-315) for mix design for partial depth recycling• Inclusion of a provisional laboratory procedure for mix designs for full-depth recycling with cement (FDR-C)• Updates to the construction chapter to align with recent specification changes

This study examined how family context at age 18 (parent-adolescent conflict, parental support, parent education) predicted between-person variation in subjective well-being (SWB; depressive symptoms and self-esteem) trajectories from age 18 to 50 years. Timing of leaving home, getting married, and becoming a parent were explored as life transitions linking family context to within-person variation in SWB. The sample consisted of 604 participants residing in a western Canadian city at age 18 (50% female; 15% with non-White ethnic origin; 29% had at least one university-educated parent) and tracked for up to 32 years. Results of conditional latent curve models with structured residuals revealed that, amid a general increase in SWB from adolescence into midlife, those with lower parent-adolescent conflict and higher parent support had higher SWB at age 18, a between-person difference largely maintained to age 50. Parents' higher education also predicted higher self-esteem, sustained into midlife. Across analyses, transition timing inconsistently predicted within-person fluctuations in SWB, with on-time transitions associated with better than typical SWB. The most robust predictors of SWB at the within-person level were marital and parental status; getting married and becoming a parent were associated with better than typical SWB at ages 25, 43, and 50 years. Family context variables were generally not associated with transition timing, and there were no indirect associations from family context to within-person variation in SWB. Results suggest that family context influences one's well-being trajectory, but forming one's own family results in positive deviations from that path.

ObjectivesTo determine the safety, tolerability, pharmacokinetics, and immunomodulatory effects of a 6-week course of atorvastatin in patients with acute Kawasaki disease with coronary artery (CA) aneurysm (CAA).Study designThis was a Phase I/IIa 2-center dose-escalation study of atorvastatin (0.125-0.75 mg/kg/day) in 34 patients with Kawasaki disease (aged 2-17 years) with echocardiographic evidence of CAA. We measured levels of the brain metabolite 24(S)-hydroxycholesterol (24-OHC), serum lipids, acute-phase reactants, liver enzymes, and creatine phosphokinase; peripheral blood mononuclear cell populations; and CA internal diameter normalized for body surface area before atorvastatin treatment and at 2 and 6 weeks after initiation of atorvastatin treatment.ResultsA 6-week course of up to 0.75 mg/kg/day of atorvastatin was well tolerated by the 34 subjects (median age, 5.3 years; IQR, 2.6-6.4 years), with no serious adverse events attributable to the study drug. The areas under the curve for atorvastatin and its metabolite were larger in the study subjects compared with those reported in adults, suggesting a slower rate of metabolism in children. The 24-OHC levels were similar between the atorvastatin-treated subjects and matched controls.ConclusionsAtorvastatin was safe and well tolerated in our cohort of children with acute Kawasaki disease and CAA. A Phase III efficacy trial is warranted in this patient population, which may benefit from the known anti-inflammatory and immunomodulatory effects of this drug.

BackgroundOlder patients with non-small cell lung cancer (NSCLC) are often not prescribed standard therapy. It is important to know which older patients would be candidates for aggressive therapy based on their prognosis, and to develop a model that can help determine prognosis.MethodsData on older patients (≥70 years) enrolled on 38 NCI cooperative group trials of advanced NSCLC from 1991 to 2011 were analyzed. Multivariable Cox PH model was built with a stepwise selection. We derived a prognostic score using the estimated Cox PH regression coefficient. We then calculated the area under receiver operating characteristic (ROC) curve of survival in the testing set.ResultsThe final analysis included 1467 patients, who were randomly divided into a training (n = 963) and a testing set (n = 504). The prognostic risk score was calculated as: 3 (if male) + 3 (if PS = 1) + 8 (if PS = 2) + 11 (if initial stage = IV) + 4 (if weight loss). Patients were classified into two prognostic groups: good (0-8) and poor (≥9). The median survival in the two groups in the testing set were 13.15 (95% CI, 10.82-15.91) and 8.52 months (95% CI, 7.5-9.63), respectively. The model had area under the 1-year and 2-year ROCs (0.6 and 0.65, respectively) that were higher than existing models.ConclusionsMale gender, poor performance status, distant metastases and recent weight loss predict for poor overall survival (OS) in older patients with advanced NSCLC. This study proposes a simple prognostic model for older adults with advanced NSCLC.

There is long-standing scientific interest in understanding purposeful movement by animals and humans. Traditionally, collecting data on individual moving entities was difficult and time-consuming, limiting scientific progress. The growth of location-aware and other geospatial technologies for capturing, managing and analyzing moving objects data are shattering these limitations, leading to revolutions in animal movement ecology and human mobility science. Despite parallel transitions towards massive individual-level data collected automatically via sensors, there is little scientific cross-fertilization across the animal and human divide. There are potential synergies from converging these separate domains towards an integrated science of movement. This paper discusses the data-driven revolutions in the animal movement ecology and human mobility science, their contrasting worldviews and, as examples of complementarity, transdisciplinary questions that span both fields. We also identify research challenges that should be met to develop an integrated science of movement trajectories.

Choice of instructional language is influenced by both previous and current perceptions of the value of a given language. For many South African learners, this has contributed to their education being presented either partially or entirely in a second or third language. This effectively limits their cultural capital and educational opportunities. The negative impact of non-equivalence between home language and instructional language is arguably more influential for linguistically dense school subjects, for example Science more so than Mathematics. The Trends in International Mathematics and Science Study (TIMSS) 2015 data allows exploration of the relationship between language non-equivalence and academic achievement as well as its differential association across subjects. The current paper also aims to investigate this relative to the impact of other contextual factors on Science and Mathematics achievement. Secondary analysis was performed on South African Grade 9 TIMSS 2015 country data using multiple regression procedures. Variables related to language were included in modelling at the learner, teacher and school levels. Results indicated that learner-level factors greatly outweighed those from the teacher and school levels. In line with expectations, resource availability as well as home language and instructional language equivalence significantly predicted Mathematics and Science achievement. Furthermore, the impact of language equivalence was higher in Science achievement. These results indicate that improvement of the processes leading to instructional language proficiency, be it at learner, teacher or school level, will contribute to higher academic achievement amongst South African learners and indeed for international second-language learners. With regard to classroom Science teaching and learning, it is also motivated that teachers need to be cognisant of the continuing impact of language for learners as they may need to incorporate innovative techniques and/or guidance.

Rooted in commitment theory, this study examines dedication, perceived investments, and felt constraint, three unique aspects of commitment, in midlife using data gathered from a sample of 224 adults surveyed at ages 43 and 50 years. Positive and negative dimensions of couple relations (partner supportiveness and the extent to which one's partner is demanding and critical, referred to as strain) assessed longitudinally and midlife-specific circumstances, including being in a first marriage or remarriage and parental and empty nest status, were examined as predictors of commitment at age 50. Latent change score modeling revealed partner support and strain as robust predictors of commitment. Higher levels of partner support at age 43 and a more gradual intraindividual decrease in support between ages 43 and 50 predicted higher dedication and perceived investments and less felt constraint at age 50. Higher age 43 levels of partner strain predicted more perceived investments and felt constraint at age 50, while a more rapid increase in strain predicted less dedication and more felt constraint. Being in a first or remarriage, being a parent, or having an empty nest did not predict commitment. These results highlight the importance of initial levels and changes in couple relations for shaping midlife commitment.

Machine learning is an important applied research area in particle physics, beginning with applications to high-level physics analysis in the 1990s and 2000s, followed by an explosion of applications in particle and event identification and reconstruction in the 2010s. In this document we discuss promising future research and development areas in machine learning in particle physics with a roadmap for their implementation, software and hardware resource requirements, collaborative initiatives with the data science community, academia and industry, and training the particle physics community in data science. The main objective of the document is to connect and motivate these areas of research and development with the physics drivers of the High-Luminosity Large Hadron Collider and future neutrino experiments and identify the resource needs for their implementation. Additionally we identify areas where collaboration with external communities will be of great benefit.

The optic tectum (TeO), or superior colliculus, is a multisensory midbrain center that organizes spatially orienting responses to relevant stimuli. To define the stimulus with the highest priority at each moment, a network of reciprocal connections between the TeO and the isthmi promotes competition between concurrent tectal inputs. In the avian midbrain, the neurons mediating enhancement and suppression of tectal inputs are located in separate isthmic nuclei, facilitating the analysis of the neural processes that mediate competition. A specific subset of radial neurons in the intermediate tectal layers relay retinal inputs to the isthmi, but at present it is unclear whether separate neurons innervate individual nuclei or a single neural type sends a common input to several of them. In this study, we used in vitro neural tracing and cell-filling experiments in chickens to show that single neurons innervate, via axon collaterals, the three nuclei that comprise the isthmotectal network. This demonstrates that the input signals representing the strength of the incoming stimuli are simultaneously relayed to the mechanisms promoting both enhancement and suppression of the input signals. By performing in vivo recordings in anesthetized chicks, we also show that this common input generates synchrony between both antagonistic mechanisms, demonstrating that activity enhancement and suppression are closely coordinated. From a computational point of view, these results suggest that these tectal neurons constitute integrative nodes that combine inputs from different sources to drive in parallel several concurrent neural processes, each performing complementary functions within the network through different firing patterns and connectivity.