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In the light of emerging suggestions that language and motor deficits may co-occur, the literature on specific language impairment (SLI) was reviewed to investigate the prevalence of co-morbidity between SLI and poor limb motor skill in children diagnosed with language impairments. An extensive literature search was undertaken and the subsequent findings evaluated with particular reference to issues surrounding symptom co-occurrence, as well as to theoretical and aetiological accounts of SLI. Clearly substantial co-morbidity exists between SLI and poor motor skill, suggesting that SLI is not a specific disorder of language, but rather that children with SLI experience a broader range of difficulties, of which motor incoordination is one. Current theoretical explanations of SLI do not account fully for such wide-ranging difficulties and it may be useful in the future to focus on a more detailed explanation in terms of shared cognitive processes or neuromaturational delay to understand further the nature of the disorder, to explain it theoretically and to deal with it practically. [ABSTRACT FROM AUTHOR]

This study investigated dependency in survivors of childhood sexual abuse (CSA). The Interpersonal Dependency Inventory (IDI) was administered at intake to 24 men and 85 women seen in therapy at a university-based community mental health clinic. In contrast to findings from earlier studies, no significant gender differences were obtained for IDI whole-scale or subscale scores. Analyses comparing CSA IDI scores with the IDI scores of previously studied groups indicated that among women, CSA survivors obtained higher dependency scores than non-CSA psychiatric patients, community adults, and college students. Findings for men were less consistent. Follow-up analyses revealed that commonly investigated CSA characteristics were unrelated to survivors' dependency scores. Implications of these findings for future research and clinical practice are explored. [ABSTRACT FROM AUTHOR]

Abstract Background Isobaric Tags for Relative and Absolute Quantitation (iTRAQ™) [Applied Biosystems] have seen increased application in differential protein expression analysis. To facilitate the growing need to analyze iTRAQ data, especially for cases involving multiple iTRAQ experiments, we have developed a modeling approach, statistical methods, and tools for estimating the relative changes in protein expression under various treatments and experimental conditions. Results This modeling approach provides a unified analysis of data from multiple iTRAQ experiments and links the observed quantity (reporter ion peak area) to the experiment design and the calculated quantity of interest (treatment-dependent protein and peptide fold change) through an additive model under log transformation. Others have demonstrated, through a case study, this modeling approach and noted the computational challenges of parameter inference in the unbalanced data set typical of multiple iTRAQ experiments. Here we present the development of an inference approach, based on hierarchical regression with batching of regression coefficients and Markov Chain Monte Carlo (MCMC) methods that overcomes some of these challenges. In addition to our discussion of the underlying method, we also present our implementation of the software, simulation results, experimental results, and sample output from the resulting analysis report. Conclusion iQuantitator's process-based modeling approach overcomes limitations in current methods and allows for application in a variety of experimental designs. Additionally, hypertext-linked documents produced by the tool aid in the interpretation and exploration of results.

Traffic-related air pollution is a major concern for perinatal health. Determining causal associations, however, is difficult because high-traffic areas tend to correspond with lower socioeconomic neighborhoods and other environmental exposures. To overcome confounding, we compared pregnant individuals living downwind and upwind of the same high-traffic road. We leveraged vital statistics data for Texas from 2007 to 2016 (n = 3 570 272 births) and computed hourly wind estimates for residential addresses within 500 m of high-traffic roads (ie, annual average daily traffic >25 000 vehicles) (10.9% of births). We matched pregnant individuals predominantly upwind with pregnant neighbors downwind of the same road segment (n = 37 631 pairs). Living downwind was associated with a decrease of 11.6 g (95% CI, -18.01 to -5.21) in term birth weight. No associations were observed with low term birth weight, preterm birth, or very preterm birth. In distance-stratified models, living downwind within 50 m was associated with a decrease of 36.3 g (95% CI, -67.74 to -4.93) in term birth weight and living 51-100 m downwind was associated with an odds ratio of 3.68 (95% CI, 1.71-7.90) for very preterm birth. These results suggest traffic air pollution is associated with adverse birth outcomes, with steep distance decay gradients around major roads. This article is part of a Special Collection on Environmental Epidemiology., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

Individually, the COVID-19 and HIV pandemics have differentially impacted minoritized groups due to the role of social determinants of health (SDoH) in the U.S. Little is known how the collision of these two pandemics may have exacerbated adverse health outcomes. We evaluated county-level SDoH and associations with hospitalization after a COVID-19 diagnosis among people with (PWH) and without HIV (PWOH) by racial/ethnic groups. We used the U.S. National COVID Cohort Collaborative (January 2020-November 2023), a nationally-sampled electronic health record repository, to identify adults who were diagnosed with COVID-19 with HIV (n = 22,491) and without HIV (n = 2,220,660). We aggregated SDoH measures at the county-level and categorized racial/ethnic groups as Non-Hispanic (NH) White, NH-Black, Hispanic/Latinx, NH-Asian and Pacific Islander (AAPI), and NH-American Indian or Alaskan Native (AIAN). To estimate associations of county-level SDoH with hospitalization after a COVID-19 diagnosis, we used multilevel, multivariable logistic regressions, calculating adjusted relative risks (aRR) with 95% confidence intervals (95% CI). COVID-19 related hospitalization occurred among 11% of PWH and 7% of PWOH, with the highest proportion among NH-Black PWH (15%). In evaluating county-level SDoH among PWH, we found higher average household size was associated with lower risk of COVID-19 related hospitalization across racial/ethnic groups. Higher mean commute time (aRR: 1.76; 95% CI 1.10-2.62) and higher proportion of adults without health insurance (aRR: 1.40; 95% CI 1.04-1.84) was associated with a higher risk of COVID-19 hospitalization among NH-Black PWH, however, NH-Black PWOH did not demonstrate these associations. Differences by race and ethnicity exist in associations of adverse county-level SDoH with COVID-19 outcomes among people with and without HIV in the U.S., (© 2024. The Author(s).)

Adults with Developmental Coordination Disorder (DCD), sometimes referred to as dyspraxia, experience difficulties in motor development and coordination, which impacts on all aspects of their daily lives. Surprisingly little is known about the mechanisms underlying the difficulties they experience in the motor domain. In childhood DCD, aspects of oculomotor control have been shown to be altered. The purpose of this study was to determine whether oculomotor differences are present in adults with and without probable DCD. Visual fixation stability, smooth pursuit, and pro-and anti-saccade performance were assessed in 21 adults (mean age 29 years) with probable DCD/dyspraxia (pDCD) and 21 typically-developing (TD) adults (mean age 21 years). Eye tracking technology revealed that oculomotor response preparation in the pro- and anti-saccade tasks was comparable across groups, as was pursuit gain in the slower of the two smooth pursuit tasks. However, adults with pDCD made significantly more saccades away from the fixation target than those without DCD and significantly more anti-saccade errors. Further, compared to TD adults, adults with pDCD demonstrated difficulties in maintaining engagement and had lower pursuit gain in the faster pursuit task. This suggests that adults with pDCD have problems with saccadic inhibition and maintaining attention on a visual target. Since this pattern of results has also been reported in children with DCD, oculomotor difficulties may be persistent for those with DCD across the lifespan. An awareness of the impact of atypical oculomotor control in activities of daily living across the lifespan would support clearer understanding of the causes and impacts of these difficulties for those with DCD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sumner and Hill.)

COVID-19 vaccines have been shown to be effective in preventing severe illness, including among pregnant persons. The vaccines appear to be safe in pregnancy, supporting a continuously favorable overall risk/benefit profile, though supportive data for the U.S. over different periods of variant predominance are lacking. We sought to analyze the association of adverse pregnancy outcomes with COVID-19 vaccinations in the pre-Delta, Delta, and Omicron SARS-CoV-2 variants' dominant periods (constituting 50% or more of each pregnancy) for pregnant persons in a large, nationally sampled electronic health record repository in the U.S. Our overall analysis included 311,057 pregnant persons from December 2020 to October 2023 at a time when there were approximately 3.6 million births per year. We compared rates of preterm births and stillbirths among pregnant persons who were vaccinated before or during pregnancy to persons vaccinated after pregnancy or those who were not vaccinated. We performed a multivariable Poisson regression with generalized estimated equations to address data site heterogeneity for preterm births and unadjusted exact models for stillbirths, stratified by the dominant variant period. We found lower rates of preterm birth in the majority of modeled periods (adjusted incidence rate ratio [aIRR] range: 0.42 to 0.85; p -value range: <0.001 to 0.06) and lower rates of stillbirth (IRR range: 0.53 to 1.82; p -value range: <0.001 to 0.976) in most periods among those who were vaccinated before or during pregnancy compared to those who were vaccinated after pregnancy or not vaccinated. We largely found no adverse associations between COVID-19 vaccination and preterm birth or stillbirth; these findings reinforce the safety of COVID-19 vaccination during pregnancy and bolster confidence for pregnant persons, providers, and policymakers in the importance of COVID-19 vaccination for this group despite the end of the public health emergency.

Previous research in the US has found negative health effects of contamination when it triggers regulatory violations. An important question is whether levels of contamination that do not trigger a health-based violation impact health. We study the impact of drinking water contamination in community water systems on birth outcomes using drinking water sampling results data in Pennsylvania. We focus on the effects of water contamination for births not exposed to regulatory violations. Our most rigorous specification employs mother fixed effects and finds changing from the 10th to the 90th percentile of water contamination (among births not exposed to regulatory violations) increases low birth weight by 12% and preterm birth by 17%.

Policies to decrease low-acuity emergency department (ED) use have traditionally assumed that EDs are a substitute for unavailable primary care (PC). However, such policies can exacerbate ED overcrowding, rather than ameliorate it, if patients use EDs to complement, rather than substitute, their PC use. We tested whether Medicaid managed care enrolees visit the ED for nonemergent and PC treatable conditions to substitute for or to complement PC. Based on consumer choice theory, we modelled county-level monthly ED visit rate as a function of PC supply and used 2012-2015 New York Statewide Planning and Research Cooperative System (SPARCS) outpatient data and non-linear least squares method to test substitution vs complementarity. In the post-Medicaid expansion period (2014-2015), ED and PC are substitutes state-wide, but are complements in highly urban and poorer counties during nights and weekends. There is no evidence of complementarity before the expansion (2012-2013). Analyses by PC provider demonstrate that the relationship between ED and PC differs depending on whether PC is provided by physicians or advanced practice providers. Policies to reduce low-acuity ED use via improved PC access in Medicaid are likely to be most effective if they focus on increasing actual appointment availability, ideally by physicians, in areas with low PC provider supply. Different aspects of PC access may be differently related to low-acuity ED use.

Background: Although traffic-related air pollution is largely regulated at the federal level, congestion reduction projects may reduce local traffic and air pollution to levels that create positive co-benefits for population health. In recent years, many urban areas have implemented electronic tolling systems to improve traffic conditions., Objective: Quantify associations between implementing electronic tolling and local changes in traffic and infant health., Methods: Using a population-based birth cohort (Texas, 1999-2016), we calculated residential proximity to the nearest tolled road segment within 5 km (n = 625,279) and examined changes in local traffic before and after toll implementation. Using a difference-in-differences design, we compared four markers of adverse birth outcomes (term birth weight, term low birth weight, preterm birth, very preterm birth) among infants from pregnant people residing < 0.5 km from a road segment before and after the tolls were implemented and compared them to a contemporaneous population of pregnant people residing at 2-5 km., Results: We observed minimal changes in local traffic after the implementation of tolling. Among births within 500 m of a tolled road, we found little evidence of an association between the implementation of tolling and adverse birth outcomes (term birth weight [β: -4.5, 95 % CI: -11.7, 2.6], term low birth weight [OR: 1.00, 95 % CI: 0.89, 1.13], preterm birth [OR: 0.99, 95 % CI: 0.92, 1.05], very preterm birth [OR: 1.00, 95 % CI: 0.84, 1.18]), compared to the contemporaneous control group of births at 2-5 km. In sub-analyses, we found some evidence of a reduced association between toll booth removal and preterm birth (OR: 0.84, 95 % CI: 0.70, 1.01) but not for other outcomes or tolling types., Discussion: In this large population-based retrospective cohort study of births in Texas, we found little evidence that the implementation of tolling was consistently associated with improvements in local infant health outcomes., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mary D. Willis, Lena Harris, Erin J. Campbell, Mira Chaskes, Ethan Sawyer, Max Harleman, Beate Ritz, Elaine L. Hill, Perry Hystad reports financial support was provided by Health Effects Institute., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Traffic-related air pollution (TRAP) is an established health hazard, and roadway construction has the potential to affect TRAP by relieving congestion. The relationship between roadway construction and congestion is of policy importance, but few studies examine it using large samples of construction projects and detailed traffic and air pollution data. We create a dataset of construction projects in Texas and link them to data on air pollution and three variables operationalizing congestion: average annual daily traffic (AADT), AADT per lane, and delay in hours. We use difference-in-difference methods to estimate the effect of widening and intersection improvements on congestion and air pollution. On average over the period during construction, we find that widening increases delay by 42% (95% CI: 30, 56%), but intersection projects do not affect delay. On average and over the first three years post-construction, we find that widening reduces delay by 33% (95% CI: -41, -24%) and reduces NO 2 levels within 500 m by 13% (95% CI: -22, -2%), and intersection projects reduce delay by 52% (95% CI: -65, -35%) and reduce NO 2 levels within 500 m by 12% (95% CI: -18, -5%). These short-term impacts are relevant for understanding the impact of roadway construction on human health., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Perry Hystad reports financial support was provided by Health Effects Institute., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: More than one-third of individuals experience post-acute sequelae of SARS-CoV-2 infection (PASC, which includes long-COVID). The objective is to identify risk factors associated with PASC/long-COVID diagnosis., Methods: This was a retrospective case-control study including 31 health systems in the United States from the National COVID Cohort Collaborative (N3C). 8,325 individuals with PASC (defined by the presence of the International Classification of Diseases, version 10 code U09.9 or a long-COVID clinic visit) matched to 41,625 controls within the same health system and COVID index date within ± 45 days of the corresponding case's earliest COVID index date. Measurements of risk factors included demographics, comorbidities, treatment and acute characteristics related to COVID-19. Multivariable logistic regression, random forest, and XGBoost were used to determine the associations between risk factors and PASC., Results: Among 8,325 individuals with PASC, the majority were > 50 years of age (56.6%), female (62.8%), and non-Hispanic White (68.6%). In logistic regression, middle-age categories (40 to 69 years; OR ranging from 2.32 to 2.58), female sex (OR 1.4, 95% CI 1.33-1.48), hospitalization associated with COVID-19 (OR 3.8, 95% CI 3.05-4.73), long (8-30 days, OR 1.69, 95% CI 1.31-2.17) or extended hospital stay (30 + days, OR 3.38, 95% CI 2.45-4.67), receipt of mechanical ventilation (OR 1.44, 95% CI 1.18-1.74), and several comorbidities including depression (OR 1.50, 95% CI 1.40-1.60), chronic lung disease (OR 1.63, 95% CI 1.53-1.74), and obesity (OR 1.23, 95% CI 1.16-1.3) were associated with increased likelihood of PASC diagnosis or care at a long-COVID clinic. Characteristics associated with a lower likelihood of PASC diagnosis or care at a long-COVID clinic included younger age (18 to 29 years), male sex, non-Hispanic Black race, and comorbidities such as substance abuse, cardiomyopathy, psychosis, and dementia. More doctors per capita in the county of residence was associated with an increased likelihood of PASC diagnosis or care at a long-COVID clinic. Our findings were consistent in sensitivity analyses using a variety of analytic techniques and approaches to select controls., Conclusions: This national study identified important risk factors for PASC diagnosis such as middle age, severe COVID-19 disease, and specific comorbidities. Further clinical and epidemiological research is needed to better understand underlying mechanisms and the potential role of vaccines and therapeutics in altering PASC course., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: To define pregnancy episodes and estimate gestational age within electronic health record (EHR) data from the National COVID Cohort Collaborative (N3C)., Materials and Methods: We developed a comprehensive approach, named Hierarchy and rule-based pregnancy episode Inference integrated with Pregnancy Progression Signatures (HIPPS), and applied it to EHR data in the N3C (January 1, 2018-April 7, 2022). HIPPS combines: (1) an extension of a previously published pregnancy episode algorithm, (2) a novel algorithm to detect gestational age-specific signatures of a progressing pregnancy for further episode support, and (3) pregnancy start date inference. Clinicians performed validation of HIPPS on a subset of episodes. We then generated pregnancy cohorts based on gestational age precision and pregnancy outcomes for assessment of accuracy and comparison of COVID-19 and other characteristics., Results: We identified 628 165 pregnant persons with 816 471 pregnancy episodes, of which 52.3% were live births, 24.4% were other outcomes (stillbirth, ectopic pregnancy, abortions), and 23.3% had unknown outcomes. Clinician validation agreed 98.8% with HIPPS-identified episodes. We were able to estimate start dates within 1 week of precision for 475 433 (58.2%) episodes. 62 540 (7.7%) episodes had incident COVID-19 during pregnancy., Discussion: HIPPS provides measures of support for pregnancy-related variables such as gestational age and pregnancy outcomes based on N3C data. Gestational age precision allows researchers to find time to events with reasonable confidence., Conclusion: We have developed a novel and robust approach for inferring pregnancy episodes and gestational age that addresses data inconsistency and missingness in EHR data., Competing Interests: K.R.B. and S.L. are employees of Palantir Technologies. Y.K. and L.L. are employees of Sema4. M.N.L. is Managing Director of IPQ Analytics, LLC., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Importance: Air pollution presents clear environmental justice issues. However, few studies have specifically examined traffic-related air pollution (TRAP), a source driven by historically racist infrastructure policies, among pregnant individuals, a population susceptible to air pollution effects. How these disparities have changed over time is also unclear but has important policy implications., Objective: To examine changes in TRAP exposure by sociodemographic characteristics among recorded pregnancies over a 20-year period., Design, Setting, and Participants: This population-based birth cohort study used descriptive analysis among pregnant individuals in Texas from 1996 to 2016. All pregnant individuals with valid residential address, socioeconomic, and demographic data were included. Individual-level race and ethnicity, education, and maternal birthplace data were extracted from birth certificates and neighborhood-level household income and historical neighborhood disinvestment (ie, redlining) data were assessed via residential addresses. Data analysis occurred between June 2022 and June 2023., Main Outcomes and Measures: The main outcome, TRAP exposure at residential addresses, was assessed via traffic levels, represented by total and truck-specific vehicle miles traveled (VMT) within 500 m; nitrogen dioxide (no2) concentrations from a spatial-temporal land use regression model (ie, vehicle tailpipe emissions); and National Air Toxic Agency cancer risk index from on-road vehicle emissions. TRAP exposure differences were assessed by sociodemographic indicators over the 1996 to 2016 period., Results: Among 7 043 598 pregnant people (mean [SD] maternal age, 26.8 [6.1] years) in Texas from 1996 to 2016, 48% identified as Hispanic or Latinx, 4% identified as non-Hispanic Asian or Pacific Islander, 12% identified as non-Hispanic Black, and 36% identified as non-Hispanic White. There were differences in TRAP for pregnant people by all sociodemographic variables examined. The absolute level of these disparities decreased from 1996 to 2016, but the relative level of these disparities increased: for example, in 1996, non-Hispanic Black pregnant individuals were exposed to a mean (SD) 15.3 (4.1) ppb of no2 vs 13.5 (4.4) ppb of no2 for non-Hispanic White pregnant individuals, compared with 2016 levels of 6.7 (2.4) ppb no2 for Black pregnant individuals and 5.2 (2.4) ppb of no2 for White pregnant individuals. Large absolute and relative differences in traffic levels were observed for all sociodemographic characteristics, increasing over time. For example, non-Hispanic Black pregnant individuals were exposed to a mean (SD) of 22 836 (32 844) VMT within 500 m of their homes, compared with 12 478 (22 870) VMT within 500 m of the homes of non-Hispanic White pregnant individuals in 2016, a difference of 83%., Conclusions and Relevance: This birth cohort study found that while levels of air pollution disparities decreased in absolute terms over the 20 years of the study, relative disparities persisted and large differences in traffic levels remained, requiring renewed policy attention.

More than 11 million Americans reside within 150 meters of a highway, an area of high air pollution exposure. Traffic congestion further contributes to environmental pollution (e.g., air and noise), but its unique importance for population health is unclear. We hypothesized that degraded environmental quality specifically from traffic congestion has harmful impacts on fetal growth. Using a population-based cohort of births in Texas (2015-2016), we leveraged connected vehicle data to calculate traffic congestion metrics around each maternal address at delivery. Among 579,122 births, we found consistent adverse associations between traffic congestion and reduced term birth weight (8.9 grams), even after accounting for sociodemographic characteristics, typical traffic volume, and diverse environmental coexposures. We estimated that up to 1.2 million pregnancies annually may be exposed to traffic congestion (27% of births in the United States), with ~256,000 in the highest congestion zones. Therefore, improvements to traffic congestion may yield positive cobenefits for infant health.

Background: There is a striking geographic variation in drug overdose deaths without a specific drug recorded, many of which likely involve opioids. Knowledge of the reasons underlying this variation is limited. Objectives: We sought to understand the role of medicolegal death investigation (MDI) systems in unclassified drug overdose mortality. Methods: This is an observational study of 2014 and 2018 fatal drug overdoses and U.S. county-level MDI system type (coroner vs medical examiner). Mortality data are from the CDC's National Center for Health Statistics. We estimated multivariable logistic regressions to quantify associations between MDI system type and several outcome variables: whether the drug overdose was unclassified and whether involvement of any opioid, synthetic opioid, methadone, and heroin was recorded (vs unclassified), for 2014 ( N  = 46,996) and 2018 ( N  = 67,359). Results: In 2018, drug overdose deaths occurring in coroner counties were almost four times more likely to be unclassified (OR 3.87, 95% CI 2.32, 6.46) compared to medical examiner counties. These odds ratios are twice as large as in 2014 (difference statistically significant, P  < .001), indicating that medical examiner counties are improving identification of opioids in drug overdoses faster than coroner counties. Conclusions: Accurate reporting of drug overdose deaths depends on MDI systems. When developing state policies and local interventions aimed to decrease opioid overdose mortality, decision-makers should understand the role their MDI system is playing in underestimating the extent of the opioid overdose crisis. Improvements to state and county MDI systems are desirable if accurate reporting and appropriate policy response are to be achieved.

Background: Oil and gas extraction produces air pollutants that are associated with increased risks of hypertension. To date, no study has examined residential proximity to oil and gas extraction and hypertensive conditions during pregnancy. This study quantifies associations between residential proximity to oil and gas development on gestational hypertension and eclampsia., Methods: We utilized a population-based retrospective birth cohort in Texas (1996-2009), where mothers reside <10 km from an active or future drilling site (n = 2 845 144.) Using full-address data, we linked each maternal residence at delivery to assign exposure and evaluate this exposure with respect to gestational hypertension and eclampsia. In a difference-in-differences framework, we model the interaction between maternal health before (unexposed) or after (exposed) the start of drilling activity (exposed) and residential proximity near (0-1, >1-2 or >2-3 km) or far (≥3-10 km) from an active or future drilling site., Results: Among pregnant women residing 0-1 km from an active oil or gas extraction site, we estimate 5% increased odds of gestational hypertension [95% confidence interval (CI): 1.00, 1.10] and 26% increased odds of eclampsia (95% CI: 1.05, 1.51) in adjusted models. This association dissipates in the 1- to 3-km buffer zones. In restricted models, we find elevated odds ratios among maternal ages ≤35 years at delivery, maternal non-Hispanic White race, ≥30 lbs gained during pregnancy, nulliparous mothers and maternal educational attainment beyond high school., Conclusions: Living within 1 km of an oil or gas extraction site during pregnancy is associated with increased odds of hypertensive conditions during pregnancy., (© The Author(s) 2021; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

This study assesses the health risks associated with drinking water contamination using variation in the timing and location of shale gas development (SGD). Our novel dataset, linking health and drinking water outcomes to shale gas activity through water sources, enables us to provide new estimates of the causal effects of water pollution on health and to isolate drinking water as a specific mechanism of exposure for SGD. We find consistent and robust evidence that drilling shale gas wells negatively impacts both drinking water quality and infant health. These results indicate large social costs of water pollution and provide impetus for re-visiting the regulation of public drinking water., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Developmental Coordination Disorder (DCD), also called Dyspraxia, is a common Neurodevelopmental Disorder (NDD) that affects motor coordination with a marked impact on both academic and day-to-day living activities. It is increasingly clear that NDDs such as Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder may present differently in males and females, resulting in underdiagnoses of women and girls., Aims: To consider age and gender differences in the presentation of at-risk and probable DCD., Methods and Procedures: A sample of 1,476 adults aged 16-60 years were surveyed online using the Adult DCD Checklist., Outcomes and Results: Women with at-risk (n = 1 8 6, 1 6. 6 %) or probable DCD (n = 6 4 3, 5 6. 6 %) reported significantly greater gross motor and non-motor difficulties and significantly greater impact on activities and participation, whereas men with at-risk (n = 58,16.3 %) or probable (n = 177,49.9 %), DCD reported significantly greater fine motor difficulties. Emerging adults (aged 16-25 years) with at-risk (n = 65,14.3 %) or probable (293,64.3 %) DCD reported significantly greater non-motor difficulty than adults (aged 26-60+ years) with at-risk (n = 179,17.5 %) or probable (n = 518, 50.8 %) DCD., Conclusions and Implications: Both age and gender differences were found in the presentation of at-risk and probable DCD in adults. This may have implications for the development of future DCD assessment tools and for the training of front-line staff who may encounter individuals with DCD throughout their lives, including teachers, doctors and employers' Human Resources and Occupational Health staff., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Background: Oil and natural gas extraction may produce environmental pollution at levels that affect reproductive health of nearby populations. Available studies have primarily focused on unconventional gas drilling and have not accounted for local population changes that can coincide with drilling activity., Objective: Our study sought to examine associations between residential proximity to oil and gas drilling and adverse term birth outcomes using a difference-in-differences study design., Methods: We created a retrospective population-based term birth cohort in Texas between 1996 and 2009 composed of mother-infant dyads ( n = 2,598,025 ) living < 10 km from an oil or gas site. We implemented a difference-in-differences approach to estimate associations between drilling activities and infant health: term birth weight and term small for gestational age (SGA). Using linear and logistic regression, we modeled interactions between births before (unexposed) or during (exposed) drilling activity and residential proximity near (0-1, 1-2, or 2 - 3 km ) or far ( 3 - 10 km ) from an active or future drilling site, adjusting for individual- and neighborhood-level characteristics., Results: The adjusted mean difference in term birth weight for mothers living 0-1 vs. 3 - 10 km from a current or future drilling site was - 7.3 g [95% confidence interval (CI): - 11.6 , - 3.0 ] for births during active vs. future drilling. The corresponding adjusted odds ratio for SGA was 1.02 (95% CI: 0.98, 1.06). Negative associations with term birth weight were observed for the 1-2 and 2 - 3 km near groups, and no consistent differences were identified by type of drilling activity. Larger, though imprecise, adverse associations were found for infants born to Hispanic women, women with the lowest educational attainment, and women living in cities., Conclusions: Residing near oil and gas drilling sites during pregnancy was associated with a small reduction in term birth weight but not SGA, with some evidence of environmental injustices. Additional work is needed to investigate specific drilling-related exposures that might explain these associations. https://doi.org/10.1289/EHP7678.

Background: The prevalence of motor impairment is high in ADHD, but we do not know if this stems from infancy., Aims: 1) to compare the acquisition of motor milestones across three groups: Typically Developing (TD), Attention Deficit Hyperactivity Disorder (ADHD) and Developmental Coordination Disorder (DCD); 2) to determine the relationship between current motor ability and ADHD characteristics in children with ADHD., Methods and Procedures: The parents of children aged 8-16 years (ADHD, N = 100; DCD, N = 66; TD, N = 40) completed three online questionnaires: Motor milestone questionnaire; Developmental Coordination Disorder Questionnaire (DCDQ'07) (concurrent motor ability); Conners 3 Parent Rating Scale Long Form (ADHD characteristics)., Outcome and Results: When considered as a group, the ADHD group achieved motor milestones within a typical timeframe, despite concurrent motor impairments. Motor ability was not associated with ADHD characteristics. Latent Profile Analysis demonstrated that 56 % of the ADHD group and 48 % of the DCD group shared the same profile of motor milestone achievement, concurrent motor ability and ADHD characteristics., Outcomes and Conclusions: Unlike children with DCD, the motor impairment often observed in ADHD is not evident from infancy. It is also not part of the ADHD phenotype. Individual differences analysis demonstrated the broad heterogeneity of the ADHD phenotype., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Whereas it is plausible that unconventional natural gas development (UNGD) may adversely affect cardiovascular health, little is currently known. We investigate whether UNGD is associated with acute myocardial infarction (AMI)., Methods: In this observational study leveraging the natural experiment generated by New York's ban on hydraulic fracturing, we analyzed the relationship between age- and sex-specific county-level AMI hospitalization and mortality rates and three UNGD drilling measures. This longitudinal panel analysis compares Pennsylvania and New York counties on the Marcellus Shale observed over 2005-2014 (N = 2840 county-year-quarters)., Results: A hundred cumulative wells is associated with 0.26 more hospitalizations per 10,000 males 45-54y.o. (95% CI 0.07,0.46), 0.40 more hospitalizations per 10,000 males 65-74y.o. (95% CI 0.09,0.71), 0.47 more hospitalizations per 10,000 females 65-74y.o. (95% CI 0.18,0.77) and 1.11 more hospitalizations per 10,000 females 75y.o.+ (95% CI 0.39,1.82), translating into 1.4-2.8% increases. One additional well per square mile is associated with 2.63 more hospitalizations per 10,000 males 45-54y.o. (95% CI 0.67,4.59) and 9.7 hospitalizations per 10,000 females 75y.o.+ (95% CI 1.92,17.42), 25.8% and 24.2% increases, respectively. As for mortality rates, a hundred cumulative wells is associated with an increase of 0.09 deaths per 10,000 males 45-54y.o. (95% CI 0.02,0.16), a 5.3% increase., Conclusions: Cumulative UNGD is associated with increased AMI hospitalization rates among middle-aged men, older men and older women as well as with increased AMI mortality among middle-aged men. Our findings lend support for increased awareness about cardiovascular risks of UNGD and scaled-up AMI prevention as well as suggest that bans on hydraulic fracturing can be protective for public health., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Sixteen adults (diagnosed or self-identified as autistic) participated in one of two iterations of a ten-week autistic-led programme, aimed at helping autistic adults learn more about autism within a peer group context. Motivations for taking part in the programme included a desire for: (1) exploration of autism; (2) empowerment; and (3) the development of practical strategies and coping mechanisms. Interviews were conducted upon completion of the programme and again 6 months later. Using thematic analysis, three themes were identified: (1) appreciation of the autistic-led nature of the programme; (2) unity in diversity; and (3) developing a positive, practical outlook on autism. These promising initial results highlight the value of autistic-led peer support for those recently diagnosed/identified as autistic.

Higher education providers are seeing a shift from externally funded support for students with specific learning difficulties (SpLD), to a need to develop more inclusive practices generally. However, the precise needs of students with different SpLD diagnoses is unknown. A total of 367 students in England and Wales (163 students with dyslexia, 50 students with developmental coordination disorder [DCD/"dyspraxia"], 62 students with dyslexia and DCD, and 92 non-SpLD students) completed an online questionnaire to determine: (a) how confident they are with their study-related capabilities, (b) the types of support they access, and (c) their views on current inclusive practices. Students with dyslexia and students with dyslexia/DCD reported lower confidence in their grades and studying than non-SpLD students, and accessed more technology-related support than students with DCD only. Examination accommodations supporting writing were common for all SpLD students. Inclusive practices were perceived positively, although different priorities were seen across groups. The findings demonstrate the complexities inherent in providing effective support for all students at university, with the varied profiles across and within SpLD groups suggesting that an individualized approach is necessary. Practical implications are discussed., (© 2020 John Wiley & Sons Ltd.)

Background: Since the 1990s, extensive regulations to reduce traffic-related air pollution (TRAP) have been implemented, yet the effectiveness of these regulations has not been assessed with respect to improving infant health. In this study, we evaluate how infant health risks associated with maternal residences near highways during pregnancy have changed over time., Methods: We created a population-based retrospective birth cohort with geocoded residential addresses in Texan metropolitan areas from 1996 through 2009 (n = 2 259 411). We compared term birthweight (37-42 weeks of gestation) among maternal residences <300 m from a highway (high TRAP exposure) (n = 394 346) and 500-3500 m from a highway (comparison group) (n = 1 865 065). We implemented linear regressions to evaluate interactions between high TRAP exposure and birth year, adjusting for demographics, socioeconomic status and neighbourhood context. In addition, we used propensity score matching to further reduce residual confounding., Results: From 1996 to 2009, outdoor NO2 decreased by 51.3%, based on regulatory monitoring data in Texas. Among pregnant women who resided in the high TRAP zone during pregnancy, interaction terms between residential location and birth year show that birthweight increased by 1.1 g [95% confidence interval CI): 0.7, 1.5) in unadjusted models and 0.3 g (95% CI: 0.0, 0.6) in matched models. Time-stratified models also show decreasing impacts of living in high TRAP areas on birthweight when comparing infants born in 1996-97 with 2008-09. Sensitivity analyses with alternative exposure and control groups show consistent results., Conclusions: Infant health risks associated with maternal residence near highways have reduced over time, paralleling regulatory measures to improve exhaust pipe emissions., (© The Author(s) 2020; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

It is a cliché of self-help advice that there are no problems, only opportunities. The rationale and actions of the BSHS in creating its Global Digital History of Science Festival may be a rare genuine confirmation of this mantra. The global COVID-19 pandemic of 2020 meant that the society's usual annual conference - like everyone else's - had to be cancelled. Once the society decided to go digital, we had a hundred days to organize and deliver our first online festival. In the hope that this will help, inspire and warn colleagues around the world who are also trying to move online, we here detail the considerations, conversations and thinking behind the organizing team's decisions.

Social distancing measures have been imposed across the United States in order to stem the spread of COVID-19. We quantify the reduction in the doubling rate, by state, that is associated with this intervention. Using the earlier of K-12 school closures and restaurant closures, by state, to define the start of the intervention, and considering daily confirmed cases through April 23, 2020, we find that social distancing is associated with a statistically-significant ( p  < 0.01) reduction in the doubling rate for all states except for Nebraska, North Dakota, and South Dakota, when controlling for false discovery, with the doubling rate averaged across the states falling from 0.302 (0.285, 0.320) days -1 to 0.010 (-0.007, 0.028) days -1 . However, we do not find that social distancing has made the spread subcritical. Instead, social distancing has merely stabilized the spread of the disease. We provide an illustration of our findings for each state, including estimates of the effective reproduction number, R , both with and without social distancing. We also discuss the policy implications of our findings., (© 2020 John Wiley & Sons, Ltd.)

Background and Aims: A substantial share of fatal drug overdoses is missing information on specific drug involvement, leading to under-reporting of opioid-related death rates and a misrepresentation of the extent of the opioid epidemic. We aimed to compare methodological approaches to predicting opioid involvement in unclassified drug overdoses in US death records and to estimate the number of fatal opioid overdoses from 1999 to 2016 using the best-performing method., Design: This was a secondary data analysis of the universe of drug overdoses in 1999-2016 obtained from the National Center for Health Statistics Detailed Multiple Cause of Death records., Setting: United States., Cases: A total of 632 331 drug overdose decedents. Drug overdoses with known drug classification comprised 78.2% of the cases (n = 494 316) and unclassified drug overdoses (ICD-10 T50.9) comprised 21.8% (n = 138 015)., Measurements: Known opioid involvement was defined using ICD-10 codes T40.0-40.4 and T40.6, recorded in the set of contributing causes. Opioid involvement in unclassified drug overdoses was predicted using multiple methodological approaches: logistic regression and machine learning techniques, inclusion/exclusion of contributing causes of death and inclusion/exclusion of county-level characteristics. Having selected the model with the highest predictive ability, we calculated corrected estimates of opioid-related mortality., Findings: Logistic regression and random forest models performed similarly. Including contributing causes substantially improved predictive accuracy, while including county characteristics did not. Using a superior prediction model, we found that 71.8% of unclassified drug overdoses in 1999-2016 involved opioids, translating into 99 160 additional opioid-related deaths, or approximately 28% more than reported. Importantly, there was a striking geographic variation in undercounting of opioid overdoses., Conclusions: In modeling opioid involvement in unclassified drug overdoses, highest predictive accuracy is achieved using a statistical model-either logistic regression or a random forest ensemble-with decedent characteristics and contributing causes of death as predictors., (© 2020 Society for the Study of Addiction.)

Objectives: Clear and efficient communication between nursing staff and medical providers is an essential component of healthcare delivery. At McLean Hospital, there is an inconsistency in utilization of alphanumeric paging, with many individuals communicating primarily via numeric-only pages that can cause difficulty in triaging importance of pages and lead to disruptions in care. This quality improvement project sought to improve communication between nursing staff and residents by decreasing the number of difficult to triage pages sent to the psychiatrist-on-call at a stand-alone academic psychiatric hospital., Methods: Pages were analyzed during two discrete month-long periods before and after the implementation of a standardized paging protocol, which included an updated online template asking the individual sending the page to include specific information (urgency of page, identifying information of patient, contact information, and name of sender) and dissemination of information on its use., Results: The implementation of this protocol resulted in a statistically significant decrease in the percentage of pages that were difficult to triage (22.1 to 15.0%; p < 0.05). Examining specific units in the hospital revealed significant variation of change, with as much as 40% reduction to as large as an 11% increase in difficult to triage pages., Conclusions: The decrease in the percentage of difficult to triage pages suggests that a standard paging protocol can improve delivery of patient care by minimizing interruptions with low-priority pages and may improve quality of communication between nursing staff and physicians on-call, ultimately improving quality of care provided and bettering the resident learning environment.

Developmental coordination disorder (DCD) is a neurodevelopmental condition affecting motor coordination in children and adults. Here, EEG signals elicited by visual and tactile stimuli were recorded while adult participants with and without probable DCD (pDCD) performed a motor task. The task cued reaching movements towards a location in visible peripersonal space as well as an area of unseen personal space. Event-related potentials elicited by visual and tactile stimuli revealed that visual processing was strongly affected by movement preparation in the pDCD group, even more than in controls. However, in contrast to the controls, tactile processing in unseen space was unaffected by movement preparation in the pDCD group. The selective use of sensory information from vision and proprioception is fundamental for the adaptive control of movements, and these findings suggest that this is impaired in DCD. Additionally, the pDCD group showed attenuated motor rhythms (beta: 13-30 Hz) over sensorimotor regions following cues to prepare movements towards unseen personal space. The results reveal that individuals with pDCD exhibit differences in the neural mechanisms of spatial selection and action preparation compared to controls, which may underpin the sustained difficulties they experience. These findings provide new insights into the neural mechanisms potentially disrupted in this highly prevalent disorder., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: Examine whether individual, geographic, and economic phenotypes predict missing data on specific drug involvement in overdose deaths, manifesting inequities in overdose mortality data, which is a key data source used in measuring the opioid epidemic., Materials and Methods: We combined national data sources (mortality, demographic, economic, and geographic) from 2014-2016 in a multi-method analysis of missing drug classification in the overdose mortality records (as defined by the use of ICD-10 T50.9 on death certificates). We examined individual disparities in decedent-level multivariate logistic regression models, geographic disparities in spatial analysis (heat maps), and economic disparities in a combination of temporal trend analyses (descriptive statistics) and both decedent- and county-level multivariate logistic regression models., Results: Our analyses consistently found higher rates of unclassified overdoses in decedents of female gender, White race, non-Hispanic ethnicity, with college education, aged 30-59 and those from poorer counties. Despite the fact that unclassified drug overdose death rates have reduced over time, gaps persist between the richest and poorest counties. There are also striking geographic differences both across and within states., Discussion: Given the essential role of mortality data in measuring the scale of the opioid epidemic, it is important to understand the individual and community inequities underlying the missing data on specific drug involvements. Knowledge of these inequities could enhance our understanding of the opioid crisis and inform data-driven interventions and policies with more equitable resource allocations., Conclusion: Multiple individual, geographic, and economic disparities underlie unclassified overdose deaths, with important implications for public health informatics and addressing the opioid crisis., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Based on calculations using all-listed diagnoses, the Agency for Healthcare Research and Quality (AHRQ) reports increasing national trends in opioid-related hospitalizations. It is unclear whether the reported increases are attributable to increases in available diagnosis fields. We leveraged increases in available diagnosis fields, ie, diagnosis recordability, in 2 states to examine their effects on opioid-related hospitalizations, graphically and with nonlinear least squares. Hospitalization data from Texas (1999-2011, N = 36 593 049) and New York (2005-2015Q3, N = 27 582 208) were aggregated to quarter-year in each state. Opioid-related hospitalizations were identified using the same International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Diagnosis Codes as AHRQ. In Texas, the increase in diagnosis recordability resulted in a 29.9% discrete shift in the number of recorded opioid diagnoses and a 3-fold increase in the slope. In New York, a smaller discrete shift (3.1%) and a 3-fold increase in the slope were identified, although a more pronounced change in the trend occurred 5 years earlier (slope change from flat to increasing). Increases in recordability lead to a broader definition of opioid-related hospitalizations, if all-listed diagnoses are used; we found that more hospitalizations are identified using the postchange definition than with the prechange definition (9.7% more in Texas and 4.9% more in New York after 4 years). We conclude that reported increases in opioid-related hospitalizations are partially attributable to increases in diagnosis recordability. Cross-state and temporal comparisons of opioid-related hospitalization rates based on all-listed diagnoses can misrepresent the true relative extent of opioid-related hospital use and therefore of the opioid epidemic., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In typical infants, the achievement of independent locomotion has a positive impact on the development of both small-scale and large-scale spatial cognition. Here we investigated whether this association between the motor and spatial domain: (1) persists into childhood and (2) is detrimental to the development of spatial cognition in individuals with motor deficits, namely, individuals with attention deficit hyperactivity disorder (ADHD) and individuals with Williams syndrome (WS). Despite evidence of a co-occurring motor impairment in many individuals with ADHD, little is known about the developmental consequences of this impairment. Individuals with WS demonstrate impaired motor and spatial competence, yet the relationship between these two impairments is unknown. Typically developing (TD) children ( N = 71), individuals with ADHD ( N = 51), and individuals with WS ( N = 20) completed a battery of motor tasks, a measure of independent exploration, and a virtual reality spatial navigation task. Retrospective motor milestone data were collected for the ADHD and WS groups. Results demonstrated a relationship between fine motor ability and spatial navigation in the TD group, which could reflect the developmental impact of the ability to manually manipulate objects, on spatial knowledge. In contrast, no relationships between the motor and spatial domains were observed for the ADHD or WS groups. Indeed, while there was evidence of motor impairment in both groups, only the WS group demonstrated an impairment in large-scale spatial navigation. The motor-spatial relationship in the TD, but not the ADHD and WS groups, suggests that aspects of spatial cognition can develop via a developmental pathway which bypasses input from the motor domain.

Many techniques have been proposed to address the problem of increased lateral adiposity in patients undergoing mastectomy, however, there is no standard approach. This cosmetic deformity at the lateral end of the mastectomy scar, also known as a dog ear, is especially common in obese patients. This defect can be unsightly and uncomfortable. We describe a technique for creating a winged incision to eliminate the dog ear deformity. The Angel Wings Incision results in tissue flaps that create a smooth body contour upon closure in patients with increased lateral adiposity. The technique is reproducible, aesthetically pleasing, and improves patient satisfaction., (© 2019 Wiley Periodicals, Inc.)