Search

Objectives: In all health system sectors, electronic health information (EHI) is created, used, released, and reused. We examined states' efforts to address EHI uses in law to provide an understanding of the EHI legal environment. Methods: Attorney researchers used WestlawNext to search for EHI-related statutes and regulations of the US states, US territories, and the District of Columbia in effect as of January 2014. The researchers independently catalogued provisions by the EHI use described in the law. Researchers resolved discrepancies through peer review meetings and recorded the consensus codes for each law. Results: This study identified 2364 EHI-related laws representing 49 EHI uses in 54 jurisdictions. A total of 18 EHI uses were regulated by ≥10 jurisdictions. More than 750 laws addressed 2 or more EHI uses. Jurisdictions varied by the number of EHI laws in effect, with a mean of 44 laws. Texas had the most EHI laws (n = 145). Hawaii and South Carolina had the fewest (n = 14 each). Conclusions: The EHI legal landscape is complex. The large quantity and diversity of laws complicate legal analysis, likely delay implementation of public health solutions, and might be detrimental to the development of emerging health information technology. Research is needed to understand the effect of EHI-related laws. [ABSTRACT FROM AUTHOR]

Objective: This review provides guidance and ideas for researchers through a comprehensive and comparative analysis of the present state, trends, and hotspots in the pediatric fracture literature over the past 6 years. Methods: We used Citespace 6.1.R6 software to explore the country/region distribution, institutions, journals, keyword analysis, and co-cited references of the literature from Web of Science core database. Results: There are 6472 pieces of pediatric fracture–related literature, including 2962 from 2017 to 2019 and 3510 from 2020 to 2022. The country with the most papers is the United States, and US institutions and journals also have a pivotal position in this field. Research hotspots for pediatric fractures in 2017–2019: The topic with the most attention is bone mineral density leading to related bone diseases. Treatment for pediatric fractures, including supracondylar humeral fractures, Monteggia fractures, forearm fractures, knee fractures, and ankle fractures in children, is another topic of greater interest. Brain injuries and dental injuries in children due to abuse and trauma are also concerning issues. Research hotspots for pediatric fractures in 2020–2022: comparison with 2017–2019 revealed a relative decrease regarding ankle-related epiphyseal injuries, but there is a higher focus on the epidemiology of fractures in children, risk factors, and reasons for childhood trauma. We have confirmed through literature co-citations that the literature of high interest is also in these aspects. Conclusion: Researchers and clinicians can quickly learn about topics of interest through authoritative journals and highly cited literature and rapidly master the current status and frontiers of the field through study, providing ideas for future work. [ABSTRACT FROM AUTHOR]

This paper uses data from the 2015 Residential Energy Consumption Survey to explore the extent to which renters' electricity use in the United States exceeds that of otherwise similar non-renters. Renting households are found to use approximately 9% more electricity than non-renters when controlling for location, socioeconomic, and many appliance-quantity controls. There are multiple factors that explain this extra electricity use, including inferior energy efficiency of appliances, behavioral factors, differences in bill payment responsibilities, and additional reliance by renters on electric space and water heaters. The paper finds that none of these factors are dominant. The phenomenon of renters' (conditionally) higher electricity use is thus best understood as one that emerges from multiple sources. [ABSTRACT FROM AUTHOR]

Overdiagnosis of Clostridioides difficile (C. difficile) is associated with increased hospital length of stay, antibiotic overuse, unnecessary infection prevention efforts and excess costs. This study evaluated a paper-based bedside C. difficile screening tool on the number of C. difficile laboratory tests performed and number of C. difficile infection (CDI) diagnoses. Nurses used the tool to determine whether stool should be sent for C. difficile testing. The tool provided indications for stool testing. We collected data on the number of C. difficile stool tests performed and CDI diagnoses for nine months before (PreT) and after (PostT) tool implementation in the hospital. We found a 31% reduction in the mean monthly number of C. difficile tests performed (37 PreT to 25 PostT) and a 56% reduction in CDI diagnoses (19 PreT to 8 PostT). This study demonstrates the success of using nurses and a bedside tool to decrease inappropriate C. difficile testing. This intervention has implications for patient management, infection prevention and cost containment. This low-cost paper-based tool may be helpful for the 25% of hospitals in the USA not using clinical decision support in their electronic health record (EHR), as well as for hospitals outside the United States who may not have access to EHRs. [ABSTRACT FROM AUTHOR]

Academic leadership in undergraduate and graduate medical education requires a specific set of leadership and managerial skills that are unique to academic leadership positions. While leadership development training programs exist for traditional leadership roles such as department chairs, executives, and deans, there are fewer models of leadership training specifically geared for academic leadership positions such as program and clerkship directors, and designated institutional officials. There are academic programs at the national level, but there is sparse literature on the specific decisions required to create such programs locally. With growing regulatory and accreditation requirements as well as the challenges of balancing the clinical and educational missions, effective leadership is needed across the spectrum of academic medicine. To meet this need for the military health care system in the United States, we used Kern's six-step framework for curriculum development to create a 1-week academic leadership course. This paper describes the process of development, implementation, outcomes, and lessons learned following the initial 3 years of courses. Specific discussions regarding who to train, which faculty to use, content, and other elements of course design are reviewed. The course and process outlined in the paper offer a model for other organizations desiring to establish an academic leadership course. [ABSTRACT FROM AUTHOR]

Academic leadership in undergraduate and graduate medical education requires a specific set of leadership and managerial skills that are unique to academic leadership positions. While leadership development training programs exist for traditional leadership roles such as department chairs, executives, and deans, there are fewer models of leadership training specifically geared for academic leadership positions such as program and clerkship directors, and designated institutional officials. There are academic programs at the national level, but there is sparse literature on the specific decisions required to create such programs locally. With growing regulatory and accreditation requirements as well as the challenges of balancing the clinical and educational missions, effective leadership is needed across the spectrum of academic medicine. To meet this need for the military health care system in the United States, we used Kern's six-step framework for curriculum development to create a 1-week academic leadership course. This paper describes the process of development, implementation, outcomes, and lessons learned following the initial 3 years of courses. Specific discussions regarding who to train, which faculty to use, content, and other elements of course design are reviewed. The course and process outlined in the paper offer a model for other organizations desiring to establish an academic leadership course. [ABSTRACT FROM AUTHOR]

The objective 1 of this study was to investigate trends in breast cancer (BC) prediction using machine learning (ML) publications by analysing country, first author, journal, institutional collaborations and co-occurrence of author keywords. The objective 2 was to provide a review of studies on BC prediction using ML and a blood analysis dataset (Breast Cancer Coimbra Dataset [BCCD]), and the objective 3 was to provide a brief review of studies based on BC prediction using ML and patients' fine needle aspirate cytology data (Wisconsin Breast Cancer Dataset [WBCD]). The design of this study was as follows: for objective 1: bibliometric analysis, data source PubMed (2015-2019); for objective 2: systematic review, data source: Google and Google Scholar (2018- 2019); for objective 3: systematic review, data source: Google Scholar (2016-2019). The inclusion criteria for objective 1 were all publication results yielded from the searches. All English papers that had a 'PDF' option from the search results were included for objective 2. A sample of the 'PDF' English papers were included for objective 3. All 116 female patients from the BCCD, consisting of 64 positive BC patients and 52 controls were included in the study for objective 2. For the WBCD, all 699 female patients comprising of 458 with a benign BC tumour and 241 with a malignant BC tumour were included for objective 3. All 2928 publications were included for objective 1. The results showed that the United States of America (USA) produced the highest number of publications (n=803). In total, 2419 first authors contributed towards the publications. Breast Cancer Research and Treatment was the highest ranked journal. Institutional collaborations mainly occurred within the USA. The use of ML for BC screening and detection was the most researched topic. A total of 19 distinct papers were included for objectives 2 and 3. The findings from these studies were never presented to clinicians for validations. In conclusion, the use of ML for BC screening and detection is promising. [ABSTRACT FROM AUTHOR]

Introduction: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care. The majority of patients with chronic non-malignant pain (CNMP) are managed by their general practitioner (GP). Recent qualitative studies have examined the issue of opioid prescribing for CNMP from a GP viewpoint. The aim of this study is to identify and synthesise the qualitative literature describing the factors influencing the nature and extent of opioid prescribing by GPs for patients with CNMP in primary care. Methods: MEDLINE, Embase, PsycINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986 to February 2018. The full text of included articles was reviewed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researchers and themes organised using Thematic Network Analysis. Themes were constructed in a hierarchical manner, basic themes informed organising themes which informed global themes. A theoretical model was derived using global themes to explain the interplay between factors influencing opioid prescribing decisions. Results: From 7020 records, 21 full text papers were assessed, and 13 studies included in the synthesis; 9 were from the United States, 3 from the United Kingdom and 1 from Canada. Four global themes emerged: suspicion, risk, agreement and encompassing systems level factors. These global themes are inter-related and capture the complex decision-making processes underlying opioid prescribing whereby the physician both consciously and unconsciously quantifies the risk–benefit relationship associated with initiating or continuing an opioid prescription. Conclusion: Recognising the inherent complexity of opioid prescribing and the limitations of healthcare systems is crucial to developing opioid stewardship strategies to combat the rise in opioid prescription morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: The use of games for social skill development in the classroom is accelerating at a tremendous rate. At the same time, the research surrounding games designed for teaching social skills remains fragmented. This systematic review summarizes the current existing literature on social skill serious games for young people ages 5 to 19 and is the first review of serious games to note the demographic and geographic component of these studies. Method: This review included papers that: evaluated a game designed to teach social skills ; included measurable, quantitative outcomes; have a translation or be published in English; were peer-reviewed; date from January 2010 to May 2020; and have a nonclinical study population between ages of 5 to 19. Keywords were obtained from the CASEL 5 framework. Results: Our findings are mixed but suggest that serious games may improve social skills when used alongside in-person discussion. We also found potential effects of the length of time of gameplay, intervention, and follow-up on social skill serious game effectiveness. Although this review found promising research conducted in East Asian countries and with minority samples in the United States, the majority of social skill serious game research takes place in the United States and Australia, with unreported demographic information and white-majority samples. Conclusions: Due to the limited number of published studies in this area and studies lacking methodological rigor, the effectiveness of using games to teach social skills and the impact of background on social skill learning require further discussion. [ABSTRACT FROM AUTHOR]

While a growing body of research has examined immigrants' health generally, less is known specifically about the impact of immigration policy on the health of Chinese immigrants, the second-largest foreign-born population in the United States. This is due, in part, to the lack of methodologically well-trained, cross-cultural researchers who have both the cultural and linguistic expertise and health knowledge to engage with Chinese immigrant populations. This paper addresses this gap by examining Chinese cross-cultural researchers' roles in the qualitative phase of the Research on ImmiGrant HealTh and State policy (RIGHTS) project, which sought to assess how immigration policies shaped Chinese and other immigrants' experiences in healthcare and other related sectors in California. We used reflexivity to assess Chinese cross-cultural researchers' positionality of insiderness and outsiderness and its influence on the process of data collection (i.e., recruitment, conducting interviews, transcription, and translation). Our reflexivity guides the assessment of the opportunities (e.g., expanding the recruitment pool, engaging participants more effectively in interviews, ensuring data integrity, and discussing heterogeneity within the Chinese immigrant community) and challenges (e.g., the difficulty of recruiting low-income and undocumented immigrants, addressing participants' in-depth thoughts, the time-consuming nature of transcription and translation, and the assessment of power dynamics) in conducting immigrant health research with the Chinese community. These results highlight the need for cross-cultural researchers to help build trusting relationships with ethnic-minority communities, thus gaining new insights and advancing knowledge within the field of ethnic minority health research. These insights can guide future investigations of Chinese and other immigrant communities as research on immigration policy and health expands. [ABSTRACT FROM AUTHOR]

A bibliometric analysis was performed using a machine learning bibliometric methodology in order to evaluate the research trends in locally advanced rectal cancer treatment between 2000 and 2020. Information regarding publication outputs, countries, institutions, journals, keywords, funding, and citation counts was retrieved from Scopus database. During the search process, a total of 2370 publications were identified. The vast majority of papers originated from the United States of America, reflecting also its research drive in the collaboration network. Neoadjuvant treatment was the topic most studied in the highly cited studies. New keywords, including neoadjuvant chemotherapy, multiparametric magnetic resonance imaging, circulating tumor DNA, and genetic heterogeneity, appeared in the last 2 years. The quantity of publications on locally advanced rectal cancer treatment since 2000 showed an evolving research field. The 'new' keywords explain where research is presently heading. [ABSTRACT FROM AUTHOR]

Increasingly popular in qualitative and mixed-methods research design, visual timelines help organize participants' life histories with an emphasis on temporality and the context in which important life events and experiences take place. Often, research using timelines focuses on individual participants. Yet, we know that life events, experiences, and decisions that individuals highlight in life history and narrative forms of research are relational in nature. Dyadic interviews allow for participant interaction, exploration of relationality, and the potential for increased breadth and depth in data collection. Recently, LGBTQ+ researchers have begun to evaluate dyadic approaches to timeline research. This paper describes a dyadic approach to timeline development designed to be combined with dyadic narrative interviews. We explain the data elicitation process, utility and value derived from the approach, and detail the development of post hoc linear, graphic timelines. This complementary approach leverages the strengths of dyadic narrative interviews and visual qualitative data synthesis and analysis to explore shared lives in context, highlighting their value as applied in research focused on a sample of sexual minority female couples (a community in which particular types of health disparities have been documented) from across the United States engaged in a series of clinically intensive shared decisions. [ABSTRACT FROM AUTHOR]

A bibliometric analysis was performed using a machine learning bibliometric methodology in order to evaluate the research trends in locally advanced rectal cancer treatment between 2000 and 2020. Information regarding publication outputs, countries, institutions, journals, keywords, funding, and citation counts was retrieved from Scopus database. During the search process, a total of 2370 publications were identified. The vast majority of papers originated from the United States of America, reflecting also its research drive in the collaboration network. Neoadjuvant treatment was the topic most studied in the highly cited studies. New keywords, including neoadjuvant chemotherapy, multiparametric magnetic resonance imaging, circulating tumor DNA, and genetic heterogeneity, appeared in the last 2 years. The quantity of publications on locally advanced rectal cancer treatment since 2000 showed an evolving research field. The 'new' keywords explain where research is presently heading. [ABSTRACT FROM AUTHOR]

This paper investigates the possibility of the implementation of Genetic Programming (GP) algorithm on a publicly available COVID-19 data set, in order to obtain mathematical models which could be used for estimation of confirmed, deceased, and recovered cases and the estimation of epidemiology curve for specific countries, with a high number of cases, such as China, Italy, Spain, and USA and as well as on the global scale. The conducted investigation shows that the best mathematical models produced for estimating confirmed and deceased cases achieved R2 scores of 0.999, while the models developed for estimation of recovered cases achieved the R2 score of 0.998. The equations generated for confirmed, deceased, and recovered cases were combined in order to estimate the epidemiology curve of specific countries and on the global scale. The estimated epidemiology curve for each country obtained from these equations is almost identical to the real data contained within the data set [ABSTRACT FROM AUTHOR]

This paper investigates the causal effects of oil price fluctuations on United States' financial markets using daily oil price and financial market data from 2011 to 2016. To address endogeneity, we follow the heteroscedasticity-based identification strategy by Rigobon (2003) and instrument for changes in oil prices with exogenous shocks on current and future oil supply. We find that a decline in oil price negatively affected markets after 2014 when oil price was very low, but not before 2014 when the price was relatively high. These novel findings suggest oil price level could affect the impact of a decrease in oil prices on financial markets. [ABSTRACT FROM AUTHOR]

This paper investigates the interaction between energy consumption and oil shocks in the U.S. from 1974 to 2018 using monthly data. Its contributions rely on the double disaggregation of energy consumption and oil shocks in a time-varying context. Oil shocks are disaggregated into oil supply, oil demand and aggregated demand shocks following the method of Kilian (2009). Energy consumption is disaggregated according to the production source in distinguishing between renewable and non-renewable energy consumption (hydropower, geothermal, wood, waste, coal, natural gas and petroleum). The impulse response function results show that renewable energy consumption responds the most to aggregate demand and oil supply shocks while for non-renewable energy consumption, it is oil demand shocks. The dynamic connectedness results show that oil supply and demand shocks spillover the most to hydropower consumption while aggregate demand shocks spillover the less. However, these relationships change over time and recommend the flexibility of energy policies. [ABSTRACT FROM AUTHOR]

Understanding the information-seeking preferences and Internet access habits of the target audiences for a patient portal is essential for successful uptake. The resource must deliver culturally and educationally appropriate information via technology that is accessible to the intended users and be designed to meet their needs and preferences. Providers must consider multiple perspectives when launching a portal and make any needed adjustments once the launch is underway. We report results of a study of 270 parents and caregivers of paediatric patients in a major health system during the process of implementing a patient portal. Through a 26-question paper-and-pencil survey, data were collected on participant demographics, Internet access and use, health information–seeking behaviours, health literacy, and potential use of a patient portal. Results indicate a positive attitude towards portal use but also suggest that low health literacy may be a key issue to portal adoption. [ABSTRACT FROM AUTHOR]

The U.S. Clean Power Plan stipulates a state-specific performance-based CO2 emission standard, delegating states with considerable flexibility for using either a tradable performance-based or a mass-based permit program. This paper analyzes these two standards under imperfect competitive. We limit our attention to (1) short-run analyses and (2) a situation in which all states are subject to the same type of standard. We show that while the cross-subsidy inherent in the performance- based standard might effectively reduce power prices, it could also inflate energy consumption. A dominant firm with a relatively clean endowment under the performance-based standard would be able to manipulate the electricity market as well as to elevate permit prices, which might worsen market outcomes compared to its mass-based counterpart. On the other hand, the "cross-subsidy" could be the dominant force leading to a higher social welfare if the leader has a relatively dirty endowment. [ABSTRACT FROM AUTHOR]

This paper studies the effect of oil price shocks on U.S. state-level unemployment rates. First, using a test of symmetry, I evaluate whether the relationship between oil prices and state unemployment rates is symmetric. I find no evidence against the null of symmetry after accounting for data mining. Second, I use a symmetric structural VAR model to analyze the effect of oil supply shocks, aggregate demand shocks and oil-specific demand shocks on state unemployment. I find that an adverse supply shock triggers increases in unemployment, whereas a positive aggregate demand shock reduces the unemployment rate across most U.S. states. I also show that oil-specific demand shocks have little effect on state unemployment. Finally, I dig into the historical contribution of the various oil shocks to the changes in state unemployment rates during the shale boom period. I find that aggregate demand shocks contributed the most to the change of unemployment. [ABSTRACT FROM AUTHOR]

Objective This paper identifies general properties of language style in social media to help identify areas of need in disasters. Background In the search for metrics of need in social media data, much of the existing literature ignores processes of language usage. Psychological concepts, such as narrative breach, Gricean maxims, and lexical marking in cognition, may assist the recovery of disaster-relevant metrics from altered patterns of word prevalence. Method We analyzed several hundred thousand location-specific microblogs from Twitter for Hurricane Sandy, Oklahoma tornadoes, and the Boston Marathon bombing along with a fantasy football control corpus, examining the relative frequency of words in 36 antonym pairs. We compared the ratio of words within these pairs to the corresponding ratios recovered from an online word norm database. Results Partial rank correlation values between observed antonym ratios demonstrate consistent patterns across disasters. For Hurricane Sandy data, 25 antonym pairs have moderate to large effect sizes for discrepancies between observed and normative ratios. Across disasters, 7 pairs are stable and meet effect size criteria. Sentiment analysis, supplementary word frequency counts with respect to disaster proximity, and examples support a "breach" account for the observed results. Conclusion Lexical choice between antonyms, only somewhat related to sentiment, suggests that social media capture wide-ranging breaches of normal functioning. Application Antonym selection contributes to screening tools based on language style for identifying relevant content and quantifying disruption using social media without the a priori specification of content keywords. [ABSTRACT FROM AUTHOR]

This Armed Forces & Society issue is on women in the contemporary armed forces in the United States and other nations to include the South African National Defense Force and the Australian Defense Force. This issue contains a collection of nine papers, each reviewing a current aspect of women serving in the military since the post–Vietnam War Era. There are also two review essays of Megan Mackenzie’s book, Beyond the Band of Brothers: The US Military and the Myth That Women Can’t Fight. An overview of changing laws and the expanding role of women in the military is provided in this introduction, as well as summaries of the nine articles, and comments on the two book reviews mentioned above. [ABSTRACT FROM AUTHOR]

Using a multi-regional input-output (MRIO) framework, we estimate the direct and indirect carbon dioxide (CO2) content of consumption across regions of the United States. We improve on existing estimates by accounting for emissions attributable to domestically and internationally imported goods using data describing bilateral trade between U.S. states and with international countries and regions. This paper presents two major findings. First, attributing emissions to states on a consumption basis leads to very different state-level emissions responsibilities than when attributed on a production basis; for example, California's emissions are over 25 percent higher. Second, heterogeneity of emissions across trading partners significantly affects the indirect emissions intensity of consumption (kg of carbon per $ of consumption), so regional differences in intensity across the U.S. go well beyond direct energy consumption. These findings have implications for evaluating the distributional impacts of national climate policies and for understanding differing incentives to implement state-level policies. [ABSTRACT FROM AUTHOR]

Residential weatherization programs have become a major component of U.S. energy policy. Through these programs, households receive heavily subsidized energy efficiency upgrades as well as informational and behavioral treatments designed to encourage conservation. While previous work demonstrates that weatherization programs provide sizable energy savings, all have measured the composite effect of efficiency upgrades and behavioral treatments. In this paper, we present the first estimates which disentangle the energy savings provided by each of the individual interventions. Our results reveal that the actual energy savings achieved by the efficiency upgrades are substantially smaller than exante, engineering predictions. Moreover, we present evidence that the energy savings provided by the simple behavioral interventions can exceed the savings resulting from the much more costly efficiency upgrades. [ABSTRACT FROM AUTHOR]

Solar photovoltaic (PV) system prices in the United States display considerable heterogeneity both across geographic locations and within a given location. Such heterogeneity may arise due to state and federal policies, differences in market structure, and other factors that influence demand and costs. This paper examines the relative importance of such factors on equilibrium solar PV system prices in the United States using a detailed dataset of roughly 100,000 recent residential and small commercial installations. As expected, we find that PV system prices differ based on characteristics of the systems. More interestingly, we find evidence suggesting that search costs and imperfect competition affect solar PV pricing. Installer density substantially lowers prices, while regions with relatively generous financial incentives for solar PV are associated with higher prices. [ABSTRACT FROM AUTHOR]

Objectives. Close, frequent contact between children and care providers in child-care centers presents many opportunities to spread human noroviruses. We compared state licensing regulations for child-care centers with national guidelines written to prevent human noroviruses. Methods. We reviewed child-care licensing regulations for all 50 U.S. states and the District of Columbia in effect in June 2015 to determine if these regulations fully, partially, or did not address 14 prevention practices in four topic areas: (1) hand hygiene, (2) exclusion of ill people, (3) environmental sanitation, and (4) diapering. Results. Approximately two-thirds (8.9) of the 14 practices across all state regulations were partially or fully addressed, with few (2.6) fully addressed. Practices related to exclusion of ill people and diapering were fully addressed most often, while practices related to hand hygiene and environmental sanitation were fully addressed least often. Conclusion. Regulations based on guidelines for best practices are one way to prevent the spread of human noroviruses in child-care facilities, if the regulations are enforced. Our findings show that, in mid-2015, many state child-care regulations did not fully address these guidelines, suggesting the need to review these regulations to be sure they are based on best practices [ABSTRACT FROM AUTHOR]

When does Congress repeal laws enacted by prior generations? Although the substantial body of work on policy creation provides tentative explanations, we believe repeals represent an alternative way of examining the effects of congressional organization on legislative behavior. In this paper, we develop hypotheses based on both the conditional nature of party power and the location of pivot points, and test these hypotheses with a new data set of repeals from 1877 to 2012. We find that the largest effects on Congress’s capacity to repeal legislation are variation in the majority’s positive agenda control and shifts in the gridlock interval. We also find that when the majority claims control of both chambers after a long stretch in the minority, there is an increased likelihood of repeal beyond what is predicted by conditional party government alone. Because the partisan factors in our model have the largest substantive effects, and because repeals do not occur automatically in productive Congresses, we characterize repeals as long-term contests between two great “teams” over the location of the status quo. [ABSTRACT FROM AUTHOR]

Objective. We assessed the practices of U.S. population-based birth defects surveillance programs in addressing current and emergent public health needs. Methods. Using the CDC Strategic Framework considerations for public health surveillance (i.e., lexicon and standards, legal authority, technological advances, workforce, and analytic capacity), during 2012 and 2013, we conducted a survey of all U.S. operational birth defects programs (n=43) soliciting information on legal authorities, case definition and clinical information collected, types of data sources, and workforce staffing. In addition, we conducted semi-structured interviews with nine program directors to further understand how programs are addressing current and emergent needs. Results. Three-quarters of birth defects surveillance programs used national guidelines for case definition. Most birth defects surveillance programs (86%) had a legislative mandate to conduct surveillance, and many relied on a range of prenatal, postnatal, public health, and pediatric data sources for case ascertainment. Programs reported that the transition from paper to electronic formats was altering the information collected, offering an opportunity for remote access to improve timeliness for case review and verification. Programs also reported the growth of pooled, multistate data collaborations as a positive development. Needs identified included ongoing workforce development to improve information technology and analytic skills, more emphasis on data utility and birth defects-specific standards for health information exchange, and support to develop channels for sharing ideas on data interpretation and dissemination. Conclusion. The CDC Strategic Framework provided a useful tool to determine the birth defects surveillance areas with positive developments, such as multi-state collaborative epidemiologic studies, and areas for improvement, such as preparation for health information exchanges and workforce database and analytic skills. Our findings may inform strategic deliberations for enhancing the effectiveness of birth defects surveillance programs. [ABSTRACT FROM AUTHOR]

This paper examines how financial deregulation and the partisan underpinnings of deregulation shaped the path of income inequality in the United States. Using time-series data from 1914 to 2010, we assess the effect of partisan politics on financial deregulation and, in turn, the effect of deregulation on income inequality. We find that financial deregulation has generally declined when Democrats attain more power in Washington and that deregulation has contributed to rising inequality. We also learn that the partisan effect on deregulation has diminished since the early 1980s, suggesting that one way partisan politics has contributed to the recent rise in inequality is related to convergence on matters of financial deregulation. We explore several potential explanations for this post–1980 partisan convergence, finding evidence supporting the idea that globalization, the increasing availability of credit, and shifts in campaign finance were contributing factors. [ABSTRACT FROM AUTHOR]

This paper studies the development of renewable energy (RE) in the U.S. by examining the capacity to generate electricity from renewable sources. RE capacity exhibits a U-shaped relationship with per capita income, similar to other metrics for environmental quality (EQ). To explain this phenomenon, I consider several of the environmental Kuznets curve theories that describe the relationship between income and environmental quality (Y-EQ), including evolving property rights, increased demand for improved EQ, and changing economic composition. The results fail to provide support for the Y-EQ theories. I further consider the alternative hypothesis that increases in unemployment lead to increases in relative RE capacity, suggesting that promoting RE projects as a potential job creator is one of the main drivers of RE projects. The results imply that lagged unemployment is a significant predictor of relative RE capacity, particularly for states with a large manufacturing share of GDP. [ABSTRACT FROM AUTHOR]

Context: Public health policies are designed for specific subsets of the population. Evidence that a policy is effectively designed should be based on whether it effectively addresses its mission. A critical factor is determining whether utilization patterns reflect the mission and the efficacy of public health policies, particularly during early stages of implementation. We assert that utilization patterns can be effectively assessed using geographic information systems (GIS).Objective: This paper uses the Silver Alert program, a recently implemented public health policy, as a case for how and why GIS can be used to examine utilization patterns.Design: GIS are employed to visualize and spatially analyze a new health policy--North Carolina's Silver Alert policy. We use visualized data and spatial statistics to assess utilization patterns and mission adherence.Results: Results show disproportionate utilization patterns of the Silver Alert policy. In particular, an outstanding number of Silver Alerts were used in Wake County and its surrounding counties, which are both the political and media center of North Carolina. Other counties, including populous counties, had few if any alerts.Conclusion: Findings suggest that the North Carolina's Silver Alert policy needs to be adjusted to more effectively address its mission. We identify several factors that need further examination prior to a statewide evaluation. From this case study, we propose ways future programs, particularly the introduction of the Affordable Care Act (ACA) in 2014, might use GIS to examine utilization patterns as a means to better understand whether and in what ways the health care needs of the public are being met with such a policy. [ABSTRACT FROM AUTHOR]

An emerging body of literature has highlighted the significance of breastmilk oligosaccharides and dietary fibers in complementary weaning foods for the development of the infant's microbiome that has both short- and long-term health implications. This review highlights the newborns' consumption of fiber and oligosaccharides as directly linked to the mother's diet, and that current dietary recommendations for pregnant mothers in the United States and globally fall short in both addressing the importance of dietary fiber intake for enhancing mother's health and establishing the developing infant microbiome. Although limited in data, there is suggestion for maternal dietary interventions to include healthy fibers as an effective means of promoting infant health via modification of breast milk composition. This paper argues that there is an urgent need for a two-fold national policy that addresses the significance of fiber in breastfeeding mothers' diets and modifies the dietary recommendations accordingly, and provides a paid parental leave, which would enable mothers to not only breastfeed for at least six months, but to also effectively follow the dietary recommendations needed to support breast milk quality that is linked to their infants' health. [ABSTRACT FROM AUTHOR]

This Armed Forces & Society symposium on the ethics of senior officer resignation in the United States includes a collection of four papers, each looking at principled resignation in different ways. Two authors, Dubik and Snider, believe principled resignation of senior military officers is sometimes justified, especially in wartime, where their inherent morals clash with their professional demands; these senior officer's ability to resign in protest distinguishes their service to this nation between stewards and servants. Conversely, Feaver and Kohn believe principled resignation is almost never justified as this action weakens the military profession and ultimately threatens national security. Further, the disastrous effects increase the ever present friction and mistrust in the civil-military process. Each author answers the question in the context of current American civil military relations and it is their hope that this symposium will lead to further discussions, research, and policies regarding the ethics surrounding the issue. [ABSTRACT FROM AUTHOR]

The article discusses the healthcare industry. Topics discussed include paper on ignoring adverse effects (AEs) by Golder and colleagues, statement of the U.S. Food and Drug Administration (FDA) and the pharmaceutical giants on problems emerged after prescriptions are dispensed and issues over execution of clinical trials.