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To assess the predictive value of a pediatric screening tool by linking 2 independent databases: an educational database that includes data from standardized academic assessments administered during kindergarten and a pediatric database that includes screening results.A database that includes results of the Survey of Well-being of Young Children (SWYC) completed during pediatric visits were linked to an educational database that includes STAR Early Literacy examinations in kindergarten. Linear multilevel regression modeling was used to examine if screening results on the developmental and behavioral sections of the most recently completed SWYC form predicted trends in the percentile rank on the STAR exam over the school year, adjusting for potential confounders.Linking the 2 databases resulted in a sample of 586 children who were administered at least one SWYC evaluation between 24 and 48 months and completed at least one STAR Early Literacy examination in kindergarten. The sample represents a diverse population with 55% Hispanic children, 25% Non-Hispanic black children, and 91% of children receiving a subsidized lunch. After adjusting for confounders, children with a positive developmental or behavioral screen had significantly lower percentile ranks on the STAR exam.Early developmental and behavioral screening results predicted performance on the STAR exam in kindergarten. Children with developmental and behavioral concerns may be less ready to enter kindergarten than peers without such concerns. These preliminary findings provide proof-of-principle of the potential utility of developmental screening tools in identifying children with reduced school readiness who may benefit from intervention prior to kindergarten.

To examine the qualitative literature on low-income women's perspectives on the barriers to high-quality prenatal and postpartum care.We performed searches in PubMed, Web of Science, Embase, SocIndex, and CINAHL for peer-reviewed studies published between 1990 and 2021.A systematic review of qualitative studies with participants who were currently pregnant or had delivered within the past 2 years and identified as low-income at delivery.Two reviewers independently assessed studies for inclusion, evaluated study quality, and extracted information on study design and themes.We identified 34 studies that met inclusion criteria, including 23 focused on prenatal care, 6 on postpartum care, and 5 on both. The most frequently mentioned barriers to prenatal and postpartum care were structural. These included delays in gaining pregnancy-related Medicaid coverage, challenges finding providers who would accept Medicaid, lack of provider continuity, transportation and childcare hurdles, and legal system concerns. Individual-level factors, such as lack of awareness of pregnancy, denial of pregnancy, limited support, conflicting priorities, and indifference to pregnancy, also interfered with the timely use of prenatal and postpartum care. For those who accessed care, experiences of dismissal, discrimination, and disrespect related to race, insurance status, age, substance use, and language were common.Over a period of 30 years, qualitative studies have identified consistent structural and individual barriers to high-quality prenatal and postpartum care. Medicaid policy changes, including expanding presumptive eligibility, increased reimbursement rates for pregnancy services, payment for birth doula support, and extension of postpartum coverage, may help overcome these challenges.

To study the association between neighborhood risk and moderate to severe neurodevelopmental impairment (NDI) at 22-26 months corrected age in children born at34 weeks of gestation. We hypothesized that infants born preterm living in high-risk neighborhoods would have a greater risk of NDI and cognitive, motor, and language delays.We studied a retrospective cohort of 1291 infants born preterm between 2005 and 2016, excluding infants with congenital anomalies. NDI was defined as any one of the following: a Bayley Scales of Infant and Toddler Development-III Cognitive or Motor composite score85, bilateral blindness, bilateral hearing impairment, or moderate-severe cerebral palsy. Maternal addresses were geocoded to identify census block groups and create high-risk versus low-risk neighborhood groups. Bivariate and regression analyses were run to assess the impact of neighborhood risk on outcomes.Infants from high-risk (n = 538; 42%) and low-risk (n = 753; 58%) neighborhoods were compared. In bivariate analyses, the risk of NDI and cognitive, motor, and language delays was greater in high-risk neighborhoods. In adjusted regression models, the risks of NDI (OR, 1.43; 95% CI, 1.04-1.98), cognitive delay (OR, 1.62; 95% CI, 1.15-2.28), and language delay (OR, 1.58; 95% CI, 1.15-2.16) were greater in high-risk neighborhoods. Breast milk at discharge was more common in low-risk neighborhoods and was protective of NDI in regression analysis.High neighborhood risk provides an independent contribution to preterm adverse NDI, cognitive, and language outcomes. In addition, breast milk at discharge was protective. Knowledge of neighborhood risk may inform the targeted implementation of programs for socially disadvantaged infants.

Objective Both small for gestational age (SGA) birthweight and pregnancies complicated by maternal hypertension (HTN) are independently associated with poorer childhood learning outcomes, however the relative contribution of each remains unknown. Study design A retrospective cohort was created in which 2014–2017 third grade Rhode Island Department of Education data were linked to Rhode Island Department of Health birth certificate data. The study population was composed of non-anomalous, singleton births between 22- and 42-weeks’ gestation. Reading and math proficiency were compared among four groups: 1) appropriate for gestational age (AGA) and no maternal HTN (referent), 2) AGA with HTN, 3) SGA without HTN and 4) SGA with HTN. Main outcome measures Bivariable and multivariable log-binomial regression were used to examine the association between subject proficiency and pregnancy complication, adjusting for potential confounders. Results Of the 23,097 who met inclusion criteria, 1004 (4%) were AGA with HTN, 1575 (7%) were SGA without HTN and 176 (1%) were SGA with HTN. Overall, when adjusted for maternal age, gestational age, sex and socioeconomic factors, only children born SGA without HTN had reduced reading proficiency (relative risk (RR) 0.86 95% confidence interval (CI) 0.78, 0.92) and math proficiency (RR 0.88 95% CI 0.82, 0.94) compared to children born AGA without HTN. Conclusion In a diverse, statewide cohort, only SGA without HTN was associated with lower reading and math proficiency compared to uncomplicated pregnancies. This suggests that only decreased fetal growth from causes other than HTN is associated with risk of poorer school-age outcomes, and has implications for early resource allocation.

International audience; NUCLEUS is an experiment conceived for the detection of thecoherent elastic neutrino nucleus scattering. The experiment will be carried out in the nuclear power plant of Chooz-B in France that provides an intense flux of anti-neutrinos.The aim of NUCLEUS is to perform a very precise measurement of the coherent elastic scattering below 100 eV by employing extremely sensitive cryogenic detectors based on CaWO$_4$ and Al$_2$O$_3$ target crystals.At present, the NUCLEUS apparatus is in commissioning phaseat the Underground Laboratory of the Technical University Munich, where - after its installation and the first measurement phase - the experiment will be fully tested. Thereafter the entire apparatus will be moved to the reactor site at Chooz.

PURPOSE: While the association between income and depression is well established, less explored is the relation between wealth and depression, particularly among low-income adults. We studied the relation between two types of assets—savings and home ownership—and probable depression to understand how access to different assets may shape depression among low-income US adults. METHODS: STUDY SAMPLE: We conducted a serial cross-sectional, observational study with 12,019 adults with low-income in the United States using National Health and Nutrition Examination Survey (NHANES) data from 2007–2016. MEASURES: We measured probable major depressive disorder (MDD) with impairment using the Patient Health Questionnaire-9. Low savings was defined as having $5,000 or less in family savings. STATISTICAL ANALYSIS: We estimated adjusted and unadjusted prevalence, odds ratios, and predicted probability of probable MDD across asset groups. RESULTS: Of low-income US adults, 5.4% had probable MDD with impairment, 85.9% had low savings, and 54.9% rented their home. Persons with low savings had 2.34 (95% CI 1.44–3.79) times the odds of having probable MDD relative to those with high savings. Home owners had 2.14 (95% CI 1.20–3.86) and home renters had 3.65 (95% CI 1.45–9.20) times the odds of having probable MDD if they had low savings relative to high savings. CONCLUSION: Family savings and home ownership are associated with lower burden of depression among low-income adults in the US.

Burn injury represents a substantial burden of disease in resource-limited settings. Kenya has no formal trauma system and referral practices for burn injuries are not well understood. The purpose of this study was to determine the factors associated with burn injury referrals in rural Kenya. A retrospective chart review was conducted for patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in southwest Kenya. Bivariate analysis compared referred and non-referred patients. Multivariable logistic regression was used to assess the association between burn severity and odds of referral adjusting for age, sex, insurance, time from injury to arrival, and estimated travel time from home to hospital. The study included 171 patients with burn injury; 11 patients were excluded due to missing referral data. Of the 160 patients, 31.9% (n = 51) were referred. Referral patients had higher average total body surface area burn (23.1 ± 2.4% vs 11.1 ± 1.2%, P < .001), were more likely to have full-thickness burns (41.3% vs 25.5%, P = .05), and less likely to present to the referral hospital within 24 hours after injury (47.8% vs 73.0%, P = .005). Referral patients had longer travel time to hospital (90+ min: 52.9% vs 22.0%, P < .001). Odds of referral increased 1.62 times (95% confidence interval: 1.19–2.22) for every 10% increase in total body surface area burn. Without a coordinated trauma system, referrals represent a substantial portion of burn injury patients at a hospital in rural Kenya. Referred patients present with more severe burns and experience delays to presentation.

The coronavirus disease 2019 (COVID-19) pandemic has been accompanied by an increase in depression in U.S. adults. Previous literature suggests that having assets may protect against depression. Using a nationally representative longitudinal panel survey of U.S. adults studied in March and April 2020 and in March and April 2021, we found that (i) 20.3% of U.S. adults reported symptoms of persistent depression in Spring 2020 and Spring 2021, (ii) having more assets was associated with lower symptoms of persistent depression, with financial assets—household income and savings—most strongly associated, and (iii) while having assets appeared to protect persons—in particular those without stressors—from symptoms of persistent depression over the COVID-19 pandemic, having assets did not appear to reduce the effects of job loss, financial difficulties, or relationship stress on symptoms of persistent depression. Efforts to reduce population depression should consider the role played by assets in shaping risk of symptoms of persistent depression.

The inverse relation between income and depression is well established. Less is understood about the relation between wealth and depression. We therefore conducted a scoping review to answer the question: What is known from the existing literature about the relation between wealth and depression?We searched for studies and articles in Medline (via PubMed), Embase, PsycINFO, PsycArticles, EconLit, and SocINDEX from inception through July 19, 2020. Ninety-six articles were included in our review. Key article characteristics were year of publication, sample size, country, study design, definition of depression, definition of wealth, and association between wealth and depression. Thirty-two longitudinal articles were included in a detailed charted review.Depression was defined in a relatively standard manner across articles. In contrast, definitions and measurements of wealth varied greatly. The majority of studies in the full review (n = 56, 58%) and half of the studies in the longitudinal charted review (n = 16, 50%) reported an inverse relation between wealth and depression. The longitudinal charted review showed that (1) macro-economic events influenced depression, (2) wealth status influenced depression across the lifecourse, (3) wealth protected against depression in the face of stressors such as job loss, (4) subjective or psychosocial factors such as perception of wealth, relative comparison, and social status modified the relation between wealth and depression, and (5) savings interventions were successful in reducing depression and varied by context.These findings suggest that wealth should be included in our consideration of the forces that shape mental health.

International audience; Coherent elastic neutrino-nucleus scattering (CE$\nu$NS), detected for the frst time more than 40 years after its prediction, represents an experimental challenge because of its signature: a single nuclear recoil with energy in the range of 10 eV to a few 10’s keV on average. One of the main features of CE$\nu$NS is its cross section, around two orders of magnitude higher compared with the inverse $\beta$ decay. BASKET (Bolometers At Sub keV Energy Threshold) project aims at investigating cryogenic calorimeters for the CE$\nu$NS detection, able to maintain the background level below the expected signature while being operated in above ground conditions in close vicinity to a nuclear reactor. The main requirements for such detectors are a low enough energy threshold of O(10 eV), and a fast signal rise time in the range of 0.1–1 ms to achieve good timing resolution and hence good mitigation of pile-up events. In this article, we report on the frst tests of a prototype detector coupling a Li$_$2WO$_4$ crystal to a magnetic metallic calorimeter (MMC) thermal sensor

Background The COVID-19 pandemic and its consequences have been associated with an increase in poor population mental health. We assessed how depressive symptoms changed among U.S. adults over the course of the COVID-19 pandemic and identified the key risk factors for these symptoms. Methods Longitudinal panel study of a nationally representative group of U.S. adults ages 18 years and older surveyed in March-April 2020 (Time 1; N=1441) and March-April 2021 (Time 2; N=1161) in the COVID-19 and Life Stressors Impact on Mental Health and Well-being study (CLIMB). The Patient Health Questionnaire-9 (PHQ-9) was used to define elevated depressive symptoms (cut-off ≥10) and depressive symptoms score (0-27). Findings The prevalence of elevated depressive symptoms persisted from 27.8% in 2020 (95% CI: 24.9, 30.9) to 32.8% in 2021 (95% CI: 29.1, 36.8). Over time, the central drivers of depressive symptoms were low household income, not being married, and experiencing multiple stressors during the COVID-19 pandemic. The odds ratio of elevated depressive symptoms for low income relative to high income persons increased from 2.3 (95% CI: 1.2, 4.2) in 2020 to 7.0 (95% CI: 3.7, 13.3) in 2021. Fewer people reported experiencing 4 or more COVID-19 stressors in 2021 than in 2020 (47.5% in 2020 vs 37.1% in 2021), but the odds ratio of elevated depressive symptoms associated with 4 or more stressors relative to 1 stressor or less increased from 1.9 (95% CI: 1.2, 3.1) in 2020 to 5.4 (95% CI: 3.2, 9.2) in 2021. Interpretation The burden of depressive symptoms in the U.S. adult population increased over the course of the COVID-19 pandemic. Mental health gaps grew between populations with different assets and stressor experiences during the COVID-19 pandemic. Funding CLIMB Time 1 was sponsored by the Rockefeller Foundation-Boston University 3-D Commission. CLIMB Time 2 was sponsored by the de Beaumont Foundation.

Rates of vaginal birth after cesarean delivery have decreased and cesarean delivery rates have increased in the last 2 decades. Evidence on short-term neonatal outcomes is available, but data on long-term childhood outcomes following vaginal birth after cesarean delivery are insufficient. Long-term childhood outcome data are essential in decision-making regarding mode of delivery.This study aimed to evaluate the association between delivery mode and long-term educational outcomes of the children of pregnant individuals with a previous cesarean delivery.This was a retrospective cohort study linking Rhode Island third-grade education data from 2014 to 2017 to birth certificate data. Data were obtained from a statewide database using Department of Education data, and were linked to Department of Health birth certificate data. Participants were children of multiparous women who were term, singleton births without congenital anomalies. Children delivered by primary cesarean delivery were excluded. The exposure was mode of delivery classified as vaginal birth after cesarean delivery, repeated cesarean delivery, or repeated vaginal birth. The primary outcome was children's third-grade reading and math proficiency. Bivariate analyses were conducted to assess differences in demographic variables. Bivariable and multivariable log-binomial regression was used to examine the association between subject proficiency and predictors including mode of delivery, maternal education, sex, child race or ethnicity, and lunch subsidy.Of the 10,923 children who met the inclusion criteria, 2.0% were delivered by vaginal birth after cesarean delivery, 22.0% by repeated cesarean delivery, and 76.0% by repeated vaginal delivery. After adjustment for confounders, there was no difference in reading proficiency (adjusted risk ratio, 0.98; 95% confidence interval, 0.84-1.15) or math proficiency (adjusted risk ratio, 0.99; 95% confidence interval, 0.84-1.15) between those born by vaginal birth after cesarean delivery and those born by repeated cesarean delivery. There was no difference found in either proficiency between children born by repeated vaginal birth and those born by repeated cesarean delivery (reading: adjusted risk ratio, 0.97; 95% confidence interval, 0.93-1.01; math: adjusted risk ratio, 0.97; 95% confidence interval, 0.92-1.02).In comparison with repeated cesarean delivery, both vaginal birth after cesarean delivery and repeated vaginal birth were not associated with differences in educational outcomes. This may aid in counseling about long-term safety outcomes regarding vaginal birth after cesarean delivery and may assist in shared decision-making when selecting between trial of labor after cesarean delivery and repeated cesarean delivery.

OBJECTIVE This research aims to take an in-depth look into the child, housing, and neighborhood characteristics associated with Providence children's likelihood of having elevated blood lead levels (BLLs). DESIGN AND SETTING The 2019 Providence, Rhode Island, Property Tax Assessor's database, containing each property owner's address, was geocoded and spatially joined with the 2017-2019 blood lead tests for children aged 0 to 6 years from the Rhode Island Department of Health. MAIN OUTCOME MEASURES The prevalence of elevated BLLs (≥5 μg/dL) overall, as well as by property type, number of properties owned, owner occupancy, assessed value, and neighborhood rates of old housing and poverty, was computed. We assessed the relationship between having elevated BLLs and these housing and neighborhood characteristics, adjusting for gender, age at test, and test method. RESULTS We found that, compared with children living in properties with landlords who owned only one property, children living in properties with landlords who owned 4 or more properties had lower odds of having elevated BLLs (odds ratio = 0.98; 95% confidence interval, 0.97-0.99). The proportion of houses built pre-1950 in the neighborhood was associated with increased odds of elevated BLLs. There was no significant association between owner-occupancy status and property type with children having elevated BLLs. CONCLUSIONS Children living in properties with landlords who owned 4 or more properties were less likely to have elevated BLLs. This association may suggest that the current lead legislation is having some impact, but public health efforts should address lead exposure in properties that are currently exempt from the law.

Background: Overweight and obesity in children is a public health crisis in the United States. Although evidence-based interventions have been developed, such programs are difficult to access. Dissemination of evidence-based pediatric weight management interventions (PWMIs) to families from diverse low-income communities is the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) projects. Methods: The goal of the Rhode Island CORD 3.0 project is to adapt the evidence-based PWMI, JOIN for ME, for delivery among diverse families from low-income backgrounds and to test it in a hybrid effectiveness-implementation trial design in which the aims are to examine implementation and patient-centered outcomes. Children between the ages of 6 and 12 years with BMI ≥85th percentile and a caregiver will be recruited through two settings, a federally qualified health center, which serves as a patient-centered medical home, or low-income housing. Dyads will receive a remotely delivered group-based intervention that is 10 months in duration and includes 16 weekly sessions, followed by 4 biweekly and 4 monthly meetings. Assessments of child and caregiver weight status and child health-related quality of life will be conducted at baseline, and at 4 and 10 months after the start of intervention. Implementation outcomes assessing intervention acceptability, adoption, feasibility, fidelity, and penetration/reach will be collected to inform subsequent dissemination. Conclusions: If the adapted version of the JOIN for ME intervention can be successfully implemented and is shown to be effective, this project will provide a model for a scalable PWMI for families from low-income backgrounds. ClinicalTrials.gov no. NCT04647760.

Objectives To analyze the distribution of patient-centered medical homes (PCMHs) among US adolescents, and to examine whether disparities exist among subgroups. Study design Data on adolescents ages 12-17 years (n = 34 601) from the 2011-2012 National Survey of Children's Health were used in this cross-sectional study to determine what proportion had access to a PCMH. Multivariable logistic regression was used to calculate the odds of having a PCMH, adjusting for sociodemographic characteristics and special health care needs. Comparisons were made to distribution of PCMH in 2007. Results Although most US adolescents had a usual source of care (91%), only about one-half (51%) had access to a PCMH. Disparities in the prevalence of PCMHs were seen by race/ethnicity, poverty, and having special health care needs. There were lower adjusted odds in having a PCMH for Hispanic (aOR, 0.56; 95% CI, 0.45-0.68) and black adolescents (aOR, 0.55; 95% CI, 0.46-0.66) compared with white adolescents. Those living below 4 times the poverty level had lower adjusted odds of PCMH access. Adolescents with 3-5 special health care needs had lower adjusted odds (aOR, 0.43; 95% CI, 0.35-0.52) of having a PCMH compared with adolescents without any special health care needs. Other than receiving family centered care, every component of PCMH was slightly lower in 2011-2012 compared with 2007. Conclusions PCMH access was lower among minorities, those living in poverty, and those with multiple special health care needs. These disparities in PCMH access among these typically underserved groups call for further study and interventions that would make PCMHs more accessible to all adolescents.

Background. Timely access to pediatric specialty care continues to be a pervasive issue. We aimed to identify factors associated with unmet pediatric specialty care needs by assessing the association with maternal level of education. Methods. A sample was extracted from the 2011-2012 National Survey of Children’s Health, which identified a subset of patients with unmet specialty care needs. Logistic regression models determined the strength of association between our sample and maternal level of education. Results. An estimated 12.5% of US children had unmet specialty care needs. Independent of confounding variables, children with mothers educated at a level of high school or less were 41% more likely to have unmet specialty care needs compared to those with mothers who were educated at a level greater than high school. Conclusions. Maternal level of education can be used as a risk factor to assess whether a child will have unmet specialty care needs.

Background Falls represent the leading cause of nonfatal unintentional injuries among children in the United States. Although unintentional injury risks have been studied, neighborhood impact on falls remains underexplored. This study examined the association of neighborhood attributes with rates of fall-related injuries. Methods This is a retrospective study of children who presented to emergency departments within a statewide hospital network for fall-related injuries between 2005 and 2014. Patients’ home addresses were geocoded to identify US Census block groups (BGs). Average annual fall rates were computed for each BG. A neighborhood risk index was constructed using 8 socioeconomic BG measures (education, crowding, vacancy, renter occupancy, poverty, family structure, race/ethnicity, and housing age). Public outdoor recreational facilities in each BG were enumerated. Linear regression analysis was used to assess the association of neighborhood risk and recreational facilities with fall rates. Results From 2005 to 2014, there were 139,986 unintentional injury emergency department visits; of these, 42,691 (30%) were for falls. The largest proportion of falls were among males (58%), children ages 1 to 4 years (39%), non-Hispanic whites (59%), and children with public health insurance (53%). Higher quintiles of neighborhood risk were associated with higher annual fall rates compared to the lowest quintile of risk: quintile 2, β = 0.44, 95% confidence interval (CI), 0.20–0.68; quintile 3, β = 0.85, 95% CI, 0.61–1.10; quintile 4, β = 1.11, 95% CI, 0.85–1.37; quintile 5, β = 1.57, 95% CI, 1.29–1.85. The presence of public outdoor recreational facilities was not associated with fall rates (β = 0.01; 95% CI, –0.14 to 0.15). Conclusion Neighborhood-level socioeconomic characteristics are associated with higher fall-related injuries. Injury prevention programs could be tailored to address these neighborhood risks.

To evaluate third-grade reading and math proficiency for children born to adolescent women compared with those born to non-adolescent women.A statewide, retrospective cohort study was conducted in Rhode Island using third-grade year-end examination data from 2014 to 2017 as part of a statewide initiative to improve third grade reading levels. Children's third-grade reading and math proficiencies were compared between those born to nulliparous adolescent women (age 15-19 at the time of delivery), and nulliparous women 20 years or older at delivery. Bivariate analyses were conducted to compare maternal and child characteristics between adolescent and non-adolescent groups. Multivariable logistic regression was used to examine the association between having an adolescent mother and being proficient in reading and math after adjusting for lunch subsidy, core city residence, child race/ethnicity and sex.Of the 8,248 children meeting the inclusion criteria, 20% were born to adolescent women and the remaining 80% were born to non-adolescent women. After adjusting for potential confounders, children born to adolescent women were significantly less likely to be proficient in both reading (adjusted risk ratio (aRR) 0.77, 95% confidence interval (CI): 0.71-0.83) and math (aRR 0.78, 95% CI: 0.72-0.85).Children born to adolescent women had significantly lower rates of reading and math proficiency when compared with children of non-adolescent women. These children may benefit from additional resources focused on early academic performance in order to address disparities in reading and math proficiency.

This study seeks to better understand the relationship between the physical activity environment and child overweight/obesity in Rhode Island.Using geographic information systems (GIS), this study calculated distances from residences to physical activity resources to assess the relationship distance has with childhood overweight/obesity.Mean distances in high-risk towns ranged from 0.61 to 3.15 miles compared to physical activity resources in low-risk towns, where distances ranged from 1.25 to 7.43 miles. For each additional mile to reach the closest indoor facility, there is a 0.41 (95% CI: -0.78, -0.03) percentage point decrease in the child overweight/obesity rate. Conclusion: High-risk block groups and towns have higher rates of child overweight/obesity and show shorter distances to physical activity resources. This study demonstrates that simply having physical activity structures in place is not enough to reduce child overweight/obesity and further research should examine the quality and usage patterns of these resources.

A θ oscillation analysis based on the observed antineutrino rates at the Double Chooz far and near detectors for different reactor power conditions is presented. This approach provides a so far unique simultaneous determination of θ and the total background rates without relying on any assumptions on the specific background contributions. The analysis comprises 865 days of data collected in both detectors with at least one reactor in operation. The oscillation results are enhanced by the use of 24.06 days (12.74 days) of reactor-off data in the far (near) detector. The analysis considers the ν¯ interactions up to a visible energy of 8.5 MeV, using the events at higher energies to build a cosmogenic background model considering fast-neutrons interactions and Li decays. The background-model-independent determination of the mixing angle yields sin(2θ) = 0.094 ± 0.017, being the best-fit total background rates fully consistent with the cosmogenic background model. A second oscillation analysis is also performed constraining the total background rates to the cosmogenic background estimates. While the central value is not significantly modified due to the consistency between the reactor-off data and the background estimates, the addition of the background model reduces the uncertainty on θ to 0.015. Along with the oscillation results, the normalization of the anti-neutrino rate is measured with a precision of 0.86%, reducing the 1.43% uncertainty associated to the expectation. [Figure not available: see fulltext.], We acknowledge the support of the CEA, CNRS/IN2P3, the computer centre CC-IN2P3 and LabEx UnivEarthS in France; the Max Planck Gesellschaft, the Deutsche Forschungsgemeinschaft DFG, the Transregional Collaborative Research Center TR27, the excellence cluster “Origin and Structure of the Universe” and the Maier-Leibnitz-Laboratorium Garching in Germany; the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT) and the Japan Society for the Promotion of Science (JSPS) in Japan; the Ministerio de Economía, Industria y Competitividad (SEIDI-MINECO) under grants FPA2016-77347-C2-1-P and MdM-2015-0509 in Spain; the Department of Energy and the National Science Foundation and Department of Energy in the United States; the Russian Academy of Science, the Kurchatov Institute and the Russian Foundation for Basic Research (RFBR) in Russia; the Brazilian Ministry of Science, Technology and Innovation (MCTI), the Financiadora de Estudos e Projetos (FINEP), the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), the São Paulo Research Foundation (FAPESP) and the Brazilian Network for High Energy Physics (RENAFAE) in Brazil.

We present a search for signatures of neutrino mixing of electron anti-neutrinos with additional hypothetical sterile neutrino flavors using the Double Chooz experiment. The search is based on data from 5 years of operation of Double Chooz, including 2 years in the two-detector configuration. The analysis is based on a profile likelihood, i.e.\ comparing the data to the model prediction of disappearance in a data-to-data comparison of the two respective detectors. The analysis is optimized for a model of three active and one sterile neutrino. It is sensitive in the typical mass range $5 \cdot 10^{-3} $ eV$^2 \lesssim \Delta m^2_{41} \lesssim 3\cdot 10^{-1} $ eV$^2$ for mixing angles down to $\sin^2 2\theta_{14} \gtrsim 0.02$. No significant disappearance additionally to the conventional disappearance related to $\theta_{13} $ is observed and correspondingly exclusion bounds on the sterile mixing parameter $\theta_{14} $ as function of $ \Delta m^2_{41} $ are obtained., Comment: accepted for publication by EPJC

Background COVID-19 and related containment policies have caused or heightened financial stressors for many in the USA. We assessed the relation between assets, financial stressors and probable depression during the COVID-19 pandemic. Methods Between 31 March 2020 and 13 April 2020, we surveyed a probability-based, nationally representative sample of US adults ages 18 and older using the COVID-19 and Life stressors Impact on Mental Health and Well-being survey (n=1441). We calculated the prevalence of probable depression using the Patient Health Questionnaire-9 (cut-off ≥10) and exposure to financial stressors by financial, physical and social assets categories (household income, household savings, home ownership, educational attainment and marital status). We estimated adjusted ORs and predicted probabilities of probable depression across assets categories and COVID-19 financial stressor exposure groups. Results We found that (1) 40% of US adults experienced COVID-19-related financial stressors during this time period; (2) low assets (OR: 3.0, 95% CI 2.1 to 4.2) and COVID-19 financial stressor exposure (OR: 2.8, 95% CI 2.1 to 3.9) were each associated with higher odds of probable depression; and (3) among persons with low assets and high COVID-19 financial stressors, 42.7% had probable depression; and among persons with high assets and low COVID-19 financial stressors, 11.1% had probable depression. Persons with high assets and high COVID-19 financial stressors had a similar prevalence of probable depression (33.5%) as persons with low assets and low COVID-19 financial stressors (33.5%). The more assets a person had, the lower the level of probable depression. Conclusion Populations with low assets are bearing a greater burden of mental illness during the COVID-19 pandemic.

This study examined how proximity to food sources differed at the block group and town level, stratified by socioeconomic risk, and how the average distance to a food source was associated with child overweight and obesity rates in Rhode Island.Eight correlated variables from the 2014-2018 American Community Survey were used to measure high and low socioeconomic risk at the block group and town level. Linear regression models were used to assess the association between mean driving distance to food sources and prevalence of child overweight and obesity.All food sources were closer to residences in the high-risk group than the low-risk group at the block group and town level. Convenience stores, sit-down restaurants, and snack and beverage stores showed the largest associations with prevalence of overweight and obesity.Efforts to better understand the food environment are needed to address overweight and obesity among youth.

Burn injury continues to cause significant morbidity and mortality in the US pediatric population. Many studies using inpatient samples have found a relationship between low socioeconomic status (SES) and burn injury. The purpose of our study was to evaluate the association between SES and the likelihood of admission for Emergency Department (ED) visits for pediatric burn injury.A retrospective database review of pediatric ED visits for burn injury from a statewide hospital system, from January 1, 2005 to December 31, 2014. SES was assigned using an eight factor Neighborhood Risk Index (NRI) created from census block group data, with a higher score indicative of lower SES. The outcome measure was ED visits admitted to inpatient care.We analyzed a sample of 1845 pediatric ED visits for burn injuries. Most visits were discharged from the ED (88.4%) while 10.5% were admitted to inpatient care and 1.0% were transferred to another hospital. In a multivariable logistic regression model, patients from high risk areas (75th percentile NRI) had 1.58 higher odds of inpatient admission compared to patients from low risk areas (75th percentile NRI; 95% CI: 1.08-2.30), after adjusting for age, gender, ethnicity, distance to the hospital, and previous ED visit for burn injury in the past 30 days. In addition, for every 1-mile increase in distance, a child's likelihood of admission increased by 6% (95% CI: 4-9%).Children with a burn injury from the highest risk socioeconomic areas in Rhode Island had a higher likelihood of inpatient admission. Further research is needed to determine what factors associated with socioeconomic status impact this finding.

Key Points Question Does academic achievement differ in children delivered by induction at term compared with those whose mothers were managed expectantly? Findings In this cohort study, there were no differences in third-grade reading and math scores among children delivered by induction at 39 or 40 weeks compared with those whose mothers were expectantly managed past those gestational ages. Meaning These findings suggest that labor induction at term does not appear to be associated with poorer test scores when those children are in third grade., This cohort study evaluates the educational outcomes of children born by induction at 39 or 40 weeks of gestation compared with those whose mothers were expectantly managed past those gestational ages., Importance Although labor induction at 39 weeks of gestation has been shown to reduce the number of cesarean deliveries, compared with expectant management, without increasing neonatal morbidity in nulliparous, low-risk women, the association between induction at 39 weeks and longer-term childhood cognitive outcomes is not certain. Objective To evaluate educational outcomes of children born by induction at 39 or 40 weeks compared with those whose mothers were expectantly managed beyond those weeks. Design, Setting, and Participants This statewide cohort study was conducted in Rhode Island. The participants included children of nulliparous women who were born at 39 weeks of gestation or later and then completed third-grade math and reading tests during the 2014 to 2017 academic year. Data analysis was performed from July 2019 to October 2019. Exposures Induction of labor compared with expectant management. Main Outcomes and Measures Third-grade math and reading test scores and proficiency (based on achievement level) among children born after induction in the 39th or 40th week were compared with scores for those who remained in utero beyond that same gestational week. The hypothesis was that induction in the 39th or 40th week would not be associated with differences in math or reading scores or proficiency compared with expectant management past the 39th or 40th week of gestation. Results Of the 6393 children meeting the inclusion criteria (mean [SD] age, 8.00 [0.22] years; 3208 boys [50.2%]; 376 [5.8%] black; 1280 [22.0%] Hispanic), 455 were delivered by induction in the 39th week and 610 were delivered by induction in the 40th week. There were no differences in mean math or reading test scores or in the frequency of math or reading proficiency between children delivered by induction at 39 or 40 weeks compared with those whose mothers were expectantly managed (overall mean [SD] math score, 744 [33]; overall mean [SD] reading score, 743 [38]; 2945 children [46%] achieved proficiency in math and 2833 [44%] achieved proficiency in reading). After adjusting for plausible confounders (race/ethnicity, maternal education, hypertension, diabetes, and socioeconomic status), induction continued to be associated with similar proficiency in math and reading compared with expectant management. For children born by induction at 39 weeks, the adjusted relative risks were 1.07 (95% CI, 0.97-1.18) for math proficiency and 0.98 (95% CI, 0.88-1.08) for reading proficiency. For children born by induction at 40 weeks, the adjusted relative risks were 0.97 (95% CI, 0.88-1.08) for math proficiency and 0.98 (95% CI, 0.89-1.08) for reading proficiency. Conclusions and Relevance These findings suggest that the offspring of nulliparous women for whom labor is induced at 39 or 40 weeks have similar third-grade educational outcomes compared with the offspring of mothers who underwent expectant management past those gestational ages.

Neonatal intensive care unit graduates residing in high-risk neighborhoods were at increased risk of emergency department use and had higher rates of social/environmental risk factors. Distances to primary care provider and emergency department did not contribute to emergency department use. Knowledge of neighborhood risk is important for preventative service reform.

Objectives To investigate the association of residential mobility with flourishing among school-age children. Methods Data from the 2011/2012 National Survey of Children's Health were used to examine parent/caregiver-reported information on flourishing and residential mobility for children age 6-17 (N = 63,333). Residential mobility was the number of times the child moved categorized as: none, 1-2, and 3+. Children who were reported to show interest/curiosity, finish tasks, stay calm/in control, care about doing well in school, and do all homework were coded as flourishing. Sex-specific multivariable models were used to model the relative risk of mobility on flourishing. Interactions of mobility with age and poverty were tested. Results Among US school-age children, 22% had no moves, 39% had 1-2 moves and 39% had 3+ moves in their lifetime. Nearly half (45%) were flourishing. Both boys and girls who moved 3+ times were less likely to flourish compared to children with no moves. Among poor boys moving 3+ times was associated with less flourishing (aRR 0.83, 95% CI 0.71, 0.98) with no association for non-poor boy. Among girls the pattern was reversed (aRR 0.88, 95% CI 0.81, 0.95 for non-poor girls and no association for poor girls). Conclusions for Practice Residential mobility may lead to lower rates of flourishing. The patterns, when stratified by age or poverty, are different for boys and girls.

Objective To assess the impact of assignment to a Medicaid-focused versus mixed managed care plan on continuity of Medicaid coverage. Data sources 2011-2016 Medicaid claims from a Northeastern state. Study design Following the exit of a Medicaid managed care insurer, Medicaid administrators prioritized provider networks in reassigning enrollees, but randomly assigned beneficiaries whose providers were equally represented in the two plans. We leveraged the natural experiment created by random plan assignment and conducted an instrumental variable analysis. Data collection We analyzed Medicaid claims for 12,083 beneficiaries who were members of the exiting Blue Cross Blue Shield plan prior to January 1, 2011. Principal findings Managed care plan type did not significantly impact continuous enrollment in the Medicaid program. Greater outpatient utilization and the presence of a special need among children were associated with longer enrollment in Medicaid. Conclusions Managed care plans did not differ in their capacity to keep Medicaid beneficiaries continuously enrolled in coverage, despite differences in plan features.

The development of low-threshold detectors for the study of coherent elastic neutrino-nucleus scattering and for the search for light dark matter necessitates methods of low-energy calibration. We suggest this can be provided by the nuclear recoils resulting from the $\gamma$ emission following thermal neutron capture. In particular, several MeV-scale single-$\gamma$ transitions induce well-defined nuclear recoil peaks in the 100 eV range. Using the FIFRELIN code, complete schemes of $\gamma$-cascades for various isotopes can be predicted with high accuracy to determine the continuous background of nuclear recoils below the calibration peaks. We present a comprehensive experimental concept for the calibration of CaWO$_4$ and Ge cryogenic detectors at a research reactor. For CaWO$_4$ the simulations show that two nuclear recoil peaks at 112.5 eV and 160.3 eV should be visible above background simply in the spectrum of the cryogenic detector. Then we discuss how the additional tagging for the associated $\gamma$ increases the sensitivity of the method and extends its application to a wider energy range and to Ge cryogenic detectors., Comment: 21 pages, 8 figures

Borexino is a 280-ton liquid scintillator detector located at the Laboratori Nazionali del Gran Sasso (LNGS), Italy and is one of the two detectors that has measured geoneutrinos so far. The unprecedented radio-purity of the scintillator, the shielding with highly purified water, and the placement of the detector at a 3800 m w.e. depth have resulted in very low background levels and has made Borexino an excellent apparatus for geoneutrino measurements. The new update of the Borexino geoneutrino measurement, using the data obtained from December 2007 to April 2019, has been presented. Enhanced analysis techniques, adopted in this measurement, have been also presented (poster presentation #39 by S. Kumaran). The updated statistics and the new elaborate analysis have led to more than a factor two increase in exposure ((1.12 ± 0.05) × 1032 protons × yr) when compared to the latest Borexino result from 2015. The resulting geoneutrino signal of 47.0 − 7.7 + 8.4 ( stat ) − 1.9 + 2.4 ( sys ) TNU has − 17.2 + 18.3 % total precision. The geological interpretations of this measurement have been discussed. In particular, the 99% C.L. observation of the mantle signal by exploiting the relatively well-known lithospheric contribution, the estimation of the radiogenic heat, as well as the comparison of these results to the predictions based on different geological models. The upper limits on the power of a hypothetical georeactor that might be present at different locations inside the Earth have been set.

Borexino is a 280-ton liquid scintillator detector located at the Laboratori Nazionali del Gran Sasso (LNGS), Italy and is one of the two detectors that has measured geoneutrinos so far. The unprecedented radio-purity of the scintillator, the shielding with highly purified water, and the placement of the detector at a 3800 m w.e. depth have resulted in very low background levels and have made Borexino an excellent apparatus for geoneutrino measurements. The analysis techniques of the latest geoneutrino results with Borexino were presented using the data obtained from December 2007 to April 2019, corresponding to an exposure of (1.12 ± 0.05) × 1032 protons × yr. Enhanced analysis techniques, such as an increased fiducial volume, improved veto for cosmogenic backgrounds, extended energy and coincidence time windows, as well as a more efficient α/β particle discrimination have been adopted in this measurement. The updated statistics and these elaborate resulted in a geoneutrino signal of 47.0 − 7.7 + 8.4 ( stat ) − 1.9 + 2.4 ( sys ) TNU with − 17.2 + 18.3 % total precision.

Coherent elastic neutrino–nucleus scattering ($$\hbox {CE}\nu \hbox {NS}$$ CEνNS ) offers a unique way to study neutrino properties and to search for new physics beyond the Standard Model. Nuclear reactors are promising sources to explore this process at low energies since they deliver large fluxes of anti-neutrinos with typical energies of a few MeV. In this paper, a new-generation experiment to study $$\hbox {CE}\nu \hbox {NS}$$ CEνNS is described. The NUCLEUS experiment will use cryogenic detectors which feature an unprecedentedly low-energy threshold and a time response fast enough to be operated under above-ground conditions. Both sensitivity to low-energy nuclear recoils and a high event rate tolerance are stringent requirements to measuring $$\hbox {CE}\nu \hbox {NS}$$ CEνNS of reactor anti-neutrinos. A new experimental site, the Very-Near-Site (VNS), at the Chooz nuclear power plant in France is described. The VNS is located between the two 4.25 $$\hbox {GW}_{\mathrm {th}}$$ GWth reactor cores and matches the requirements of NUCLEUS. First results of on-site measurements of neutron and muon backgrounds, the expected dominant background contributions, are given. In this paper a preliminary experimental set-up with dedicated active and passive background reduction techniques and first background estimations are presented. Furthermore, the feasibility to operate the detectors in coincidence with an active muon veto at shallow overburden is studied. The paper concludes with a sensitivity study pointing out the physics potential of NUCLEUS at the Chooz nuclear power plant.

BACKGROUND AND OBJECTIVES:Pediatric surveillance of young children depends on providers’ assessment of developmental milestones, yet normative data are sparse. Our objectives were to develop new norms for common milestones to aid in clinical interpretation of milestone attainment.METHODS:We analyzed responses to the developmental screening form of the Survey of Well-being of Young Children from 41 465 screens across 3 states. Associations between developmental status and a range of child characteristics were analyzed, and norms for individual questions were compared to guidelines regarding attainment of critical milestones from the Centers for Disease Control and Prevention (CDC).RESULTS:A contemporary resource of normative data for developmental milestone attainment was established. Lower developmental status was associated with child age in the presence of positive behavioral screening scores (P < .01), social determinants of health (P < .01), Medicaid (P < .01), male sex (P < .01), and child race (P < .01). Comparisons between Survey of Well-being of Young Children developmental questions and CDC guidelines reveal that a high percentage of children are reported to pass milestones by the age at which the CDC states that “most children pass” and that an even higher percentage of children are reported to pass milestones by the age at which the CDC states that parents should “act early.” An interactive data visualization tool that can assist clinicians in real-time developmental screening and surveillance interpretation is also provided.CONCLUSIONS:Detailed normative data on individual developmental milestones can help clinicians guide caregivers’ expectations for milestone attainment, thereby offering greater specificity to CDC guidelines.