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Although substantial attention has focused on efforts by the new Administration to block environmental policies, climate politics have been contentious in the US since well before the election of Donald Trump. In this paper, we extend previous work on empirical examinations of echo chambers in US climate politics using new data collected on the federal climate policy network in summer 2016. We test for the similarity and differences at two points in time in homophily and echo chambers using Exponential Random Graph Models (ERGM) to compare new findings from 2016 to previous work on data from 2010. We show that echo chambers continue to play a significant role in the network of information exchange among policy elites working on the issue of climate change. In contrast to previous findings where echo chambers centered on a binding international commitment to emission reductions, we find that the pre-existing echo chambers have almost completely disappeared and new structures have formed around one of the main components of the Obama Administration’s national climate policy: the Clean Power Plan. These results provide empirical evidence that science communication and policymaking at the elite level shift in relation to the policy instruments under consideration. [ABSTRACT FROM AUTHOR]

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA’s 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households. [ABSTRACT FROM AUTHOR]

Based on coupled networks, taking node load, capacity and load redistribution between two networks into consideration, we propose functionally identical coupled networks, which consist of two networks connected by interlinks. Functionally identical coupled networks are derived from the power grid of the United States, which consists of many independent grids. Many power transmission lines are planned to interconnect those grids and, therefore, the study of the robustness of functionally identical coupled networks becomes important. In this paper, we find that functionally identical coupled networks are more robust than single networks under random attack. By studying the effect of the broadness and average degree of the degree distribution on the robustness of the network, we find that a broader degree distribution and a higher average degree increase the robustness of functionally identical coupled networks under random failure. And SF-SF (two coupled scale-free networks) is more robust than ER-ER (two coupled random networks) or SF-ER (coupled random network and scale-free network). This research is useful to construct robust functionally identical coupled networks such as two cooperative power grids. [ABSTRACT FROM AUTHOR]

Addressing critical global health issues, such as antimicrobial resistance, infectious disease outbreaks, and natural disasters, requires strong coordination and management across sectors. The One Health approach is the integrative effort of multiple sectors working to attain optimal health for people, animals, and the environment, and is increasingly recognized by experts as a means to address complex challenges. However, practical application of the One Health approach has been challenging. The One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) introduced in this paper was designed using a multistage prototyping process to support systematic improvement in multi-sectoral coordination and collaboration to better address complex health concerns through an operational, stepwise, and practical One Health approach. To date, OH-SMART has been used to strengthen One Health systems in 17 countries and has been deployed to revise emergency response frameworks, improve antimicrobial resistance national action plans and create multi agency infectious disease collaboration protocols. OH-SMART has proven to be user friendly, robust, and capable of fostering multi-sectoral collaboration and complex system-wide problem solving. [ABSTRACT FROM AUTHOR]

Are public officials more responsive to requests from affluent or poor constituents? A growing body of evidence suggests that lawmakers are more responsive to the rich when they craft policy. However, some scholars theorize that officials also exhibit a corresponding bias in favor of the poor when they handle casework, essentially giving policy to the rich and services to the poor. In this paper, we test this casework prediction using four experiments in which confederates sent simple requests to state or local officials. In each, our confederates’ reported social classes were randomly assigned and signaled with a brief introductory statement mentioning the sender’s occupation or economic situation. Across our samples, we find precisely-estimated null effects of social class biases: the officials we studied were equally likely to respond regardless of the constituent’s class. These findings raise doubts about whether casework is really a class-biased process. [ABSTRACT FROM AUTHOR]

Understanding trends in the diverse resources provided by large rivers will help balance tradeoffs among stakeholders and inform strategies to mitigate the effects of landscape scale stressors such as climate change and invasive species. Absent a cohesive coordinated effort to assess trends in important large river resources, a logical starting point is to assess our ability to draw inferences from existing efforts. In this paper, we use a common analytical framework to analyze data from five disparate fish monitoring programs to better understand the nature of spatial and temporal trends in large river fish assemblages. We evaluated data from programs that monitor fishes in the Colorado, Columbia, Illinois, Mississippi, and Tallapoosa rivers using non-metric dimensional scaling ordinations and associated tests to evaluate trends in fish assemblage structure and native fish biodiversity. Our results indicate that fish assemblages exhibited significant spatial and temporal trends in all five of the rivers. We also document native species diversity trends that were variable within and between rivers and generally more evident in rivers with higher species richness and programs of longer duration. We discuss shared and basin-specific landscape level stressors. Having a basic understanding of the nature and extent of trends in fish assemblages is a necessary first step towards understanding factors affecting biodiversity and fisheries in large rivers. [ABSTRACT FROM AUTHOR]

Objectives: As gentrification continues in New York City as well as other urban areas, residents of lower socioeconomic status maybe at higher risk for residential displacement. Yet, there have been few quantitative assessments of the health impacts of displacement. The objective of this paper is to assess the association between displacement and healthcare access and mental health among the original residents of gentrifying neighborhoods in New York City. Methods: We used 2 data sources: 1) 2005–2014 American Community Surveys to identify gentrifying neighborhoods in New York City, and 2) 2006–2014 Statewide Planning and Research Cooperative System. Our cohort included 12,882 residents of gentrifying neighborhoods in 2006 who had records of emergency department visits or hospitalization at least once every 2 years in 2006–2014. Rates of emergency department visits and hospitalizations post-baseline were compared between residents who were displaced and those who remained. Results: During 2006–2014, 23% were displaced. Compared with those who remained, displaced residents were more likely to make emergency department visits and experience hospitalizations, mainly due to mental health (Rate Ratio = 1.8, 95% confidence interval = 1.5, 2.2), after controlling for baseline demographics, health status, healthcare utilization, residential movement, and the neighborhood of residence in 2006. Conclusions: These findings suggest negative impacts of displacement on healthcare access and mental health, particularly among adults living in urban areas and with a history of frequent emergency department visits or hospitalizations. [ABSTRACT FROM AUTHOR]

Fish consumption in Mexico is considered low (around 12 kg per person per year) and non-homogeneously distributed across the country. One of the reasons for this situation is the scarcity of wholesale selling sites. In this context, the Mercado del Mar (MM), located in Guadalajara city, Jalisco, is the second biggest wholesale fish market in Mexico, with a distribution of about 500 tons per day and a variety of about 350 different species of fish. In this paper, we argue that MM has accumulated social capital, which is formed from two main resources: buyer and seller relationships, and reputation. Specifically, the MM manages a broad and intensive interaction among business actors and the already achieved reputation allows the MM to adapt to market changes. To validate our hypotheses, an empirical study was conducted in 2015 by means of interviews to fish wholesalers in the MM and a sample of their suppliers and buyers. For simplicity we have only considered fresh water fish. We have followed snow-ball sampling as the survey strategy. Results show that the MM has responded to fish market dynamics organizing a complex network of buyers and suppliers whose relationships can be explained in the form of strong and weak ties. At the same time, reputation has been the central resource to build this social capital and also gives place to market transactions. Additionally, the strategic position of Guadalajara city and the well-connected routes have facilitated fish bulking and distribution in the region. [ABSTRACT FROM AUTHOR]

The social functions of urbanized areas are highly dependent on and supported by the convenient access to public transportation systems, particularly for the less privileged populations who have restrained auto ownership. To accurately evaluate the public transit accessibility, it is critical to capture the spatiotemporal variation of transit services. This can be achieved by measuring the shortest paths or minimum travel time between origin-destination (OD) pairs at each time-of-day (e.g. every minute). In recent years, General Transit Feed Specification (GTFS) data has been gaining popularity for between-station travel time estimation due to its interoperability in spatiotemporal analytics. Many software packages, such as ArcGIS, have developed toolbox to enable the travel time estimation with GTFS. They perform reasonably well in calculating travel time between OD pairs for a specific time-of-day (e.g. 8:00 AM), yet can become computational inefficient and unpractical with the increase of data dimensions (e.g. all times-of-day and large network). In this paper, we introduce a new algorithm that is computationally elegant and mathematically efficient to address this issue. An open-source toolbox written in C++ is developed to implement the algorithm. We implemented the algorithm on City of St. George’s transit network to showcase the accessibility analysis enabled by the toolbox. The experimental evidence shows significant reduction on computational time. The proposed algorithm and toolbox presented is easily transferable to other transit networks to allow transit agencies and researchers perform high resolution transit performance analysis. [ABSTRACT FROM AUTHOR]

This paper forecasts the 2016 canine Anaplasma spp. seroprevalence in the United States from eight climate, geographic and societal factors. The forecast’s construction and an assessment of its performance are described. The forecast is based on a spatial-temporal conditional autoregressive model fitted to over 11 million Anaplasma spp. seroprevalence test results for dogs conducted in the 48 contiguous United States during 2011–2015. The forecast uses county-level data on eight predictive factors, including annual temperature, precipitation, relative humidity, county elevation, forestation coverage, surface water coverage, population density and median household income. Non-static factors are extrapolated into the forthcoming year with various statistical methods. The fitted model and factor extrapolations are used to estimate next year’s regional prevalence. The correlation between the observed and model-estimated county-by-county Anaplasma spp. seroprevalence for the five-year period 2011–2015 is 0.902, demonstrating reasonable model accuracy. The weighted correlation (accounting for different sample sizes) between 2015 observed and forecasted county-by-county Anaplasma spp. seroprevalence is 0.987, exhibiting that the proposed approach can be used to accurately forecast Anaplasma spp. seroprevalence. The forecast presented herein can a priori alert veterinarians to areas expected to see Anaplasma spp. seroprevalence beyond the accepted endemic range. The proposed methods may prove useful for forecasting other diseases. [ABSTRACT FROM AUTHOR]

Objective: Heroin use in the United States has reached epidemic proportions. The objective of this paper is to estimate the annual societal cost of heroin use disorder in the United States in 2015 US dollars. Methods: An analytic model was created that included incarceration and crime; treatment for heroin use disorder; chronic infectious diseases (HIV, Hepatitis B, Hepatitis C, and Tuberculosis) and their treatments; treatment of neonatal abstinence syndrome; lost productivity; and death by heroin overdose. Results: Using literature-based estimates to populate the model, the cost of heroin use disorder was estimated to be $51.2 billion in 2015 US dollars ($50,799 per heroin user). One-way sensitivity analyses showed that overall cost estimates were sensitive to the number of heroin users, cost of HCV treatment, and cost of incarcerating heroin users. Conclusion: The annual cost of heroin use disorder to society in the United States emphasizes the need for sustained investment in healthcare and non-healthcare related strategies that reduce the likelihood of abuse and provide care and support for users to overcome the disorder. [ABSTRACT FROM AUTHOR]

Background: Economic inequality in the United States is extreme, but little is known about the national origin of affluent households. Households in the top one percent by total wealth own vastly disproportionate quantities of household assets and have correspondingly high levels of economic, social, and political influence. The overrepresentation of white natives (i.e., those born in the U.S.) among high-wealth households is well-documented, but changing migration dynamics suggest that a growing portion of top households may be immigrants. Methods: Because no single survey dataset contains top wealth holders and data about country of origin, this paper uses two publicly-available data sets: the Survey of Consumer Finances (SCF) and the Survey of Income and Program Participation (SIPP). Multiple imputation is used to impute country of birth from the SIPP into the SCF. Descriptive statistics are used to demonstrate reliability of the method, to estimate the prevalence of immigrants among top wealth holders, and to document patterns of asset ownership among affluent immigrants. Results: Significant numbers of top wealth holders who are usually classified as white natives may be immigrants. Many top wealth holders appear to be European and Canadian immigrants, and increasing numbers of top wealth holders are likely from Asia and Latin America as well. Results suggest that of those in the top one percent of wealth holders, approximately 3% are European and Canadian immigrants, .5% are from Mexico or Cuban, and 1.7% are from Asia (especially Hong Kong, Taiwan, Mainland China, and India). Ownership of key assets varies considerably across affluent immigrant groups. Conclusion: Although the percentage of top wealth holders who are immigrants is relatively small, these percentages represent large numbers of households with considerable resources and corresponding social and political influence. Evidence that the propensity to allocate wealth to real and financial assets varies across immigrant groups suggests that wealth ownership is more global than previous research suggests and that immigrant groups are likely to become more prevalent in top wealth positions in the U.S. As the representation of immigrants in top wealth positions grows, their economic, social, and political influence is likely to increase as well. [ABSTRACT FROM AUTHOR]

How did post-socialist transition and a parallel shift in international labor division restructure regional innovation systems in Central and Eastern Europe? This question is increasingly important, because current EU innovation policy is combined with regional development in Smart Specialization Strategies; however, spatial trends of innovation in Central and Eastern Europe are not fully understood which might lead to less than perfectly efficient policy. In this paper we describe the spatial dynamics of inventor activity in the Czech Republic, Hungary, Poland and Slovakia between 1981 and 2010 –a period that covers both the late socialist era and the post-socialist transition. Cleaning and analyzing the publicly available data from the United States Patent and Trademark Office we illustrate that Central and Eastern European patents made in international co-operations with partners outside the region receive more citations than those Central and Eastern European patents that lack international co-operation. Furthermore, the technological portfolio of the former patents has become increasingly independent from the technological portfolio of the latter class. A town-level analysis of the applicant-inventor ties reveals that inventors have started to work for foreign assignees in those towns where no innovation activity had been recorded before. However, the positive effect does not last long and patenting seems to be only periodic in the majority of these towns. Therefore, innovation policy in Central and Eastern European countries, as well as in other less developed regions, shall foster synergies between international and domestic collaborations in order to decrease regional disparities in patenting. [ABSTRACT FROM AUTHOR]

HIV incidence estimates are used to monitor HIV-1 infection in the United States. Use of laboratory biomarkers that distinguish recent from longstanding infection to quantify HIV incidence rely on having accurate knowledge of the average time that individuals spend in a transient state of recent infection between seroconversion and reaching a specified biomarker cutoff value. This paper describes five estimation procedures from two general statistical approaches, a survival time approach and an approach that fits binomial models of the probability of being classified as recently infected, as a function of time since seroconversion. We compare these procedures for estimating the mean duration of recent infection (MDRI) for two biomarkers used by the U.S. National HIV Surveillance System for determination of HIV incidence, the Aware BED EIA HIV-1 incidence test (BED) and the avidity-based, modified Bio-Rad HIV-1/HIV-2 plus O ELISA (BRAI) assay. Collectively, 953 specimens from 220 HIV-1 subtype B seroconverters, taken from 5 cohorts, were tested with a biomarker assay. Estimates of MDRI using the non-parametric survival approach were 198.4 days (SD 13.0) for BED and 239.6 days (SD 13.9) for BRAI using cutoff values of 0.8 normalized optical density and 30%, respectively. The probability of remaining in the recent state as a function of time since seroconversion, based upon this revised statistical approach, can be applied in the calculation of annual incidence in the United States. [ABSTRACT FROM AUTHOR]

In this study, university-industry collaborations in China and the USA are analyzed in terms of co-authored publications indexed in the Web of Science (WoS). Results show a wide gap between China and the USA: Chinese universities are much less active in collaborations with industry in terms of either publication productivity or collaboration intensity. In selecting local and foreign industrial partners, however, more variation exists among Chinese universities than among US universities. The US system is domestically oriented more than that of China. In the USA, the intensity of university-industry collaboration is determined by research quality, whereas in China this is not the case. In both China and the USA, distance is not critical for the establishment of domestic university-industry collaboration. A high correlation is found between productivity indicators including total publications and university-industry co-authored publications. However, the productivity indicators are less correlated with the intensity of university-industry collaboration. Large research universities with strong ties to domestic industry play critical roles in both national publication systems. [ABSTRACT FROM AUTHOR]

Whereas past wolf management in the United States was restricted to recovery, managers must now contend with publicly contentious post-recovery issues including regulated hunting seasons. Understanding stakeholder concerns associated with hunting can inform stakeholder engagement, communication, and policy development and evaluation. Social identity theory (SIT) has been used to understand how groups interact, why they conflict, and how collaboration may be achieved. Applying SIT to stakeholder conflicts about wolf hunting may help delineate groups according to their concern about, support for or opposition to the policy choice of hunting wolves. Our objective was to assess concerns about hunting as a tool to resolve conflict in Michigan, using SIT as a framework. We used a mixed-modal sampling approach (e.g., paper, Internet) with wolf hunting-related public meeting participants in March 2013. Survey questions focused on 12 concerns previously identified as associated with hunting as a management tool to resolve conflict. Respondents (n  =  666) cared greatly about wolves but were divided over hunting wolves. Wolf conflicts, use of science in policy decisions, and maintaining a wolf population were the highest ranked concerns. Principle components analysis reduced concerns into three factors that explained 50.7% of total variance; concerns crystallized over justifications for hunting. General linear models revealed a lack of geographic influence on care, fear and support for hunting related to wolves. These findings challenge assumptions about regional differences and suggest a strong role for social identity in driving dichotomized public perceptions in wildlife management. [ABSTRACT FROM AUTHOR]

In order to contribute to conservation planning efforts for golden eagles (Aquila chrysaetos) in the western U.S., we developed nest site models using >6,500 nest site locations throughout a >3,483,000 km2 area of the western U.S. We developed models for twelve discrete modeling regions, and estimated relative density of nest sites for each region. Cross-validation showed that, in general, models accurately estimated relative nest site densities within regions and sub-regions. Areas estimated to have the highest densities of breeding golden eagles had from 132–2,660 times greater densities compared to the lowest density areas. Observed nest site densities were very similar to those reported from published studies. Large extents of each modeling region consisted of low predicted nest site density, while a small percentage of each modeling region contained disproportionately high nest site density. For example, we estimated that areas with relative nest density values <0.3 represented from 62.8–97.8% ( = 82.5%) of each modeling area, and those areas contained from 14.7–30.0% ( = 22.1%) of the nest sites. In contrast, areas with relative nest density values >0.5 represented from 1.0–12.8% ( = 6.3%) of modeling areas, and those areas contained from 47.7–66.9% ( = 57.3%) of the nest sites. Our findings have direct application to: 1) large-scale conservation planning efforts, 2) risk analyses for land-use proposals such as recreational trails or wind power development, and 3) identifying mitigation areas to offset the impacts of human disturbance. [ABSTRACT FROM AUTHOR]

Background: Drug abuse and sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV), remain significant public health concerns in the United States. Youth are at disproportionate risk of drug use and STIs/HIV, yet interventions aimed at improving STI and HIV testing and reducing STI/HIV risk behaviors through technology-based engagement in clinic settings are limited. The purpose of this study was to examine the feasibility and acceptability of Storytelling 4 Empowerment (S4E), a multilevel mobile-health drug abuse and STI/HIV preventive application (app) for clinic settings. We also explored uptake of STI/HIV testing among youth immediately post-intervention. Method: Employing community-based participatory research principles and a multi-method research design, we developed a clinician-facing app, and examined the feasibility and acceptability of S4E among clinicians (n = 6) and youth (n = 20) in an urban youth-centered community health clinic. S4E aimed to improve clinician–youth risk communication and youths’ drug use and STI/HIV knowledge, self-efficacy, and refusal skills. We also explored youths’ uptake of STI and HIV testing. Quantitative data were analyzed by computing mean scores and proportions, and qualitative analyses followed the tenets of content analysis. Results: Among eligible participants, 86.9% of youth and 85.7% of clinicians enrolled in the study, suggesting the feasibility of recruiting participants from the targeted clinic. Most clinicians identified as non-Hispanic white (83%) and female (66.7%). Among the youth, 70% identified as non-Hispanic white, followed by 30% African American, and 50% identified as female with a mean age of 19.6 (SD = 1.5, Range = 16–21). The quantitative findings suggest that the acceptability of S4E is high, as indicated by the Client Satisfaction Questionnaire (mean score = 25.2, SD: 4.8). Immediately post-intervention, all youth who reported past 90-day condomless sex or having never been tested for STIs or HIV in their lifetime, were tested for both STIs and HIV. Qualitative themes revealed four overarching themes, including S4E: (1) faciliated timely, targeted, and tailored prevention and risk reduction strategies; (2) shaped clinician and youth communication and interaction during the clinic visit; (3) may have improved uptake of STI/HIV testing and increased STI/HIV knowledge and self-efficacy; and (4) had high feasibiliy and acceptability among youth and clninicans. Conclusions: Findings suggest the feasibility and acceptability of S4E in an urban community-based health clinic setting. A next important step is to examine the efficacy of S4E in a randomized controlled trial design. [ABSTRACT FROM AUTHOR]

The Medical Monitoring Project (MMP) is an HIV surveillance system that provides national estimates of HIV-related behaviors and clinical outcomes. When first implemented, MMP excluded persons living with HIV not receiving HIV care. This analysis will describe new case-surveillance-based methods to identify and recruit persons living with HIV who are out of care and at elevated risk for mortality and ongoing HIV transmission. Stratified random samples of all persons living with HIV were selected from the National HIV Surveillance System in five public health jurisdictions from 2012–2014. Sampled persons were located and contacted through seven different data sources and five methods of contact to collect interviews and medical record abstractions. Data were weighted for non-response and case reporting delay. The modified sampling methodology yielded 1159 interviews (adjusted response rate, 44.5%) and matching medical record abstractions for 1087 (93.8%). Of persons with both interview and medical record data, 264 (24.3%) would not have been included using prior MMP methods. Significant predictors were identified for successful contact (e.g., retention in care, adjusted Odds Ratio [aOR] 5.02; 95% Confidence Interval [CI] 1.98–12.73), interview (e.g. moving out of jurisdiction, aOR 0.24; 95% CI: 0.12–0.46) and case reporting delay (e.g. rural residence, aOR 3.18; 95% CI: 2.09–4.85). Case-surveillance-based sampling resulted in a comparable response rate to existing MMP methods while providing information on an important new population. These methods have since been adopted by the nationally representative MMP surveillance system, offering a model for public health program, research and surveillance endeavors seeking inclusion of all persons living with HIV. [ABSTRACT FROM AUTHOR]

Downscaled climate projections need to be linked to downscaled projections of population and economic growth to fully develop implications for land, natural resources, and ecosystems for future scenarios. We develop an empirical spatiotemporal approach for jointly projecting population and income at the county scale in the United States that is consistent with neoclassical economic growth theory and overlapping labor markets and that accounts for labor migration and spatial spillovers. Downscaled projections generated for the five Shared Socioeconomic Pathways used to support global scenario analysis generally show growth focused around relatively few centers especially in the southeast and western regions, with some areas in the Midwest and northeast experiencing population declines. Results are consistent with economic growth theory and with historical trends in population change and convergence of per capita personal income across US counties. [ABSTRACT FROM AUTHOR]

Representation of women in science drops substantially at each career stage, from early student to senior investigator. Disparities in opportunities for women to contribute to research metrics, such as distinguished speaker events and authorship, have been reported in many fields in the U.S.A. and Europe. However, whether female representation in scientific contributions differs in other regions, such as Latin America, is not well understood. In this study, in order to determine whether female authorship is influenced by gender or institutional location of the last (senior) author or by subfield within ecology, we gathered author information from 6849 articles in ten ecological and zoological journals that publish research articles either in or out of Latin America. We found that female authorship has risen marginally since 2002 (27 to 31%), and varies among Latin American countries, but not between Latin America and other regions. Last author gender predicted female co-authorship across all journals and regions, as research groups led by women published with over 60% female co-authors whereas those led by men published with less than 20% female co-authors. Our findings suggest that implicit biases and stereotype threats that women face in male-led laboratories could be sources of female withdrawal and leaky pipelines in ecology and zoology. Accordingly, we encourage every PI to self-evaluate their lifetime percentage of female co-authors. Female role models and cultural shifts–especially by male senior authors–are crucial for female retention and unbiased participation in science. [ABSTRACT FROM AUTHOR]

Background: Physician Orders for Life-Sustaining Treatment (POLST) programs have expanded rapidly, but evaluating their impact on hospital care is challenging. Objectives: To demonstrate how careful study design can reveal POLST’s impact at hospital admission and why analyses of state registry data are unlikely to capture POLST’s effects. Design: Prospective cohort study. Setting and participants: Adult in-patients with Do Not Intubate and/or Do Not Resuscitate (DNR/I) orders in the electronic medical record at the time of discharge from Johns Hopkins Hospital over 18 months. For patients with unplanned readmissions within 30 days, records were reviewed to determine if a Maryland Medical Order for Life-Sustaining Treatment (MOLST) form was presented and for the time from readmission to a DNR/I order in the EMR. Analyses were stratified by whether patients could communicate or were accompanied by a proxy at readmission. Results: Among 1,507 patients with DNR/I orders at discharge, 124 (8%) had unplanned readmissions, 112 (90%) could communicate or were accompanied by a proxy at readmission, and 12 (10%) could not communicate and were unaccompanied. For patients who were unaccompanied and could not communicate, MOLST significantly decreased the median time from readmission to DNR/I order (1.2 vs 27.1 hours, P = .001), but this association was greatly attenuated among patients who could communicate or were accompanied by a proxy (16.4 vs 25.4 hours P = .10). Conclusion: Among patients who wanted to avoid intubation and/or CPR, MOLST forms were protective when the patient was unaccompanied by a healthcare proxy at admission and could not communicate. Fewer than 10% of patients met these criteria during unplanned readmissions, and state registry data does not allow this sub-population to be identified. [ABSTRACT FROM AUTHOR]

Commercial captive breeding and trade in body parts of threatened wild carnivores is an issue of significant concern to conservation scientists and policy-makers. Following a 2016 decision by Parties to the Convention on International Trade in Endangered Species of Wild Fauna and Flora, South Africa must establish an annual export quota for lion skeletons from captive sources, such that threats to wild lions are mitigated. As input to the quota-setting process, South Africa’s Scientific Authority initiated interdisciplinary collaborative research on the captive lion industry and its potential links to wild lion conservation. A National Captive Lion Survey was conducted as one of the inputs to this research; the survey was launched in August 2017 and completed in May 2018. The structured semi-quantitative questionnaire elicited 117 usable responses, representing a substantial proportion of the industry. The survey results clearly illustrate the impact of a USA suspension on trophy imports from captive-bred South African lions, which affected 82% of respondents and economically destabilised the industry. Respondents are adapting in various ways, with many euthanizing lions and becoming increasingly reliant on income from skeleton export sales. With rising consumer demand for lion body parts, notably skulls, the export quota presents a further challenge to the industry, regulators and conservationists alike, with 52% of respondents indicating they would adapt by seeking ‘alternative markets’ for lion bones if the export quota allocation restricted their business. Recognizing that trade policy toward large carnivores represents a ‘wicked problem’, we anticipate that these results will inform future deliberations, which must nonetheless also be informed by challenging inclusive engagements with all relevant stakeholders. [ABSTRACT FROM AUTHOR]

The maximum entropy model, a commonly used species distribution model (SDM) normally combines observations of the species occurrence with environmental information to predict the geographic distributions of animal or plant species. However, it only produces point estimates for the probability of species existence. To understand the uncertainty of the point estimates, we analytically derived the variance of the outputs of the maximum entropy model from the variance of the input. We applied the analytic method to obtain the standard deviation of dengue importation probability and Aedes aegypti suitability. Dengue occurrence data and Aedes aegypti mosquito abundance data, combined with demographic and environmental data, were applied to obtain point estimates and the corresponding variance. To address the issue of not having the true distributions for comparison, we compared and contrasted the performance of the analytical expression with the bootstrap method and Poisson point process model which proved of equivalence of maximum entropy model with the assumption of independent point locations. Both Dengue importation probability and Aedes aegypti mosquito suitability examples show that the methods generate comparatively the same results and the analytic method we introduced is dramatically faster than the bootstrap method and directly apply to maximum entropy model. [ABSTRACT FROM AUTHOR]

Background: Health literacy (HL) skills are essential to enable self-management and shared decision-making in patients with type 2 diabetes mellitus (T2DM). Limited HL in these patients is associated with poorer outcomes. It is not clear what the burden of limited HL in patients with T2DM across countries and what factors influence it. Methods: A systematic review was conducted according to the PRISMA guidelines. The study protocol was registered with PROSPERO (CRD42017056150). We searched MEDLINE, EMBASE, PsycINFO, CINAHL and ERIC for articles published up to January 2017. Articles that measured HL levels in adult patients with T2DM; that used validated HL tools; and that were reported in English were included. Two reviewers assessed studies for eligibility and quality, and extracted the data. Prevalence of limited HL is calculated from the number of patients with less than adequate HL over the total number of patients with T2DM in the study. Meta-analysis and meta-regression analysis were conducted using the Open Meta-analyst software. Results: Twenty-nine studies involving 13,457 patients with T2DM from seven countries were included. In total, seven different HL measurement tools were used. The prevalence of limited HL ranged from 7.3% to 82%, lowest in Switzerland and the highest in Taiwan. Meta-regression analysis of all included studies showed the country of study (p<0.001), HL tool used (p = 0.002), and the country’s region (p<0.001) contributed to the variation findings. Thirteen studies in the USA measured functional HL. The pooled prevalence of inadequate functional HL among patients with T2DM in the USA was 28.9% (95% CI: 20.4–37.3), with high heterogeneity (I2 = 97.9%, p <0.001). Studies were done in the community as opposed to a hospital or primary care (p = 0.005) and populations with education level lower than high school education (p = 0.009) reported a higher prevalence of limited HL. Conclusion: The prevalence of limited HL in patients with T2DM varied widely between countries, HL tools used and the country’s region. Pooled prevalence showed nearly one in three patients with T2DM in the USA had limited functional HL. Interactions with healthcare providers and educational attainment were associated with reported of prevalence in the USA. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the literature on women’s experiences traveling for abortion and assess how this concept has been explored and operationalized, with a focus on travel distance, cost, delays, and other barriers to receiving services. Background: Increasing limitations on abortion providers and access to care have increased the necessity of travel for abortion services around the world. No systematic examination of women’s experiences traveling for abortion has been conducted; this mixed-methods review provides a summary of the qualitative and quantitative literature on this topic. Methods: A systematic search was conducted using PubMed, Embase, Web of Science, Popline, and Google Scholar in July 2016 and updated in March 2017 (PROSPERO registration # CRD42016046007). We included original research studies that described women’s experiences traveling for abortion. Two reviewers independently performed article screening, data extraction and determination of final inclusion for analysis. Critical appraisal was conducted using CASP, STROBE, and MMAT checklists. Results: We included 59 publications: 46 quantitative studies, 12 qualitative studies, and 1 mixed-methods study. Most studies were published in the last five years, relied on data from the US, and discussed travel as a secondary outcome of interest. In quantitative studies, travel was primarily conceptualized and measured as road or straight-line distance to abortion provider, though some studies also incorporated measures of burdens related to travel, such as financial cost, childcare needs, and unwanted disclosure of their abortion status to others. Qualitative studies explored regional disparities in access to abortion care, with a focus on the burdens related to travel, the impact of travel on abortion method choice, and women’s reasons for travel. Studies generally were of high quality, though many studies lacked information on participant recruitment or consideration of potential biases. Conclusions: Standardized measurements of travel, including burdens associated with travel and more nuanced considerations of travel costs, should be implemented in order to facilitate comparison across studies. More research is needed to explore and accurately capture different dimensions of the burden of travel for abortion services on women’s lives. [ABSTRACT FROM AUTHOR]

Background: Racial/ethnic disparities in rates of influenza vaccinations in the US remain an issue even among those with access, no out-of-pocket costs, and after adjusting for confounders. We used an approach called the Oaxaca-Blinder (OB) decomposition method to ascertain the contribution of covariates individually and in aggregate to the racial disparity in influenza vaccination. Methods: We included members > = 18 years of age as of 05/01/2014 with continuous enrollment through 04/30/2015. Influenza vaccination was defined by diagnosis, procedure, or medication codes, or documentation in the immunization table. Characteristics were reported by race. Logistic regression models estimated the odds of vaccination associated with: (1) race; and (2) covariates stratified by race. The Oaxaca-Blinder (OB) method calculated the contribution of covariates to the difference or disparity in vaccination between Blacks and Whites. Results: We found that among adults, 44% were vaccinated; 55% were Black; and 45% were White. Black members have 42% lower odds of vaccination than White members. The contribution of the differences in the average value of the study covariates between Black and White members (the OB covariate effect) accounted for 29% of the racial disparity. The contributions to the total White-Black disparity in vaccination included: age (16%), neighborhood median income (11%), and registration on the online patient portal (13%). The contribution of the differences in how the covariates impact vaccination (OB coefficient effect) accounted for 71% of the disparity in vaccination between Blacks and Whites. Conclusion: In conclusion, equalizing average covariate values in Blacks and Whites could reduce the racial disparity in influenza vaccination by 29%. For health system vaccine campaigns, improving registration on the patient portal may be a target component of an effective system-level strategy to reduce racial disparities in vaccination. Additional information on patient-centered factors could further improve the value of the OB approach. [ABSTRACT FROM AUTHOR]

Background: Migration of physicians has been a cause for global concern. In China, reforms of the higher education and healthcare systems have led to a shortage of postgraduate training positions relative to the number of medical graduates. Medical graduates opt for non-clinical roles or move abroad to pursue further training and practice opportunities. The impact of this physician migration is not known. This study quantifies where Chinese migrant physicians to the U.S. were educated, where they went to practice, and how these trends have changed over time. Methods: We combined data on physician characteristics from the 2008 and 2017 American Medical Association Physician Masterfiles with demographic information from the Educational Commission for Foreign Medical Graduates. Using a repeated cross-sectional approach, we reviewed the available data, including citizenship at entry to medical school, medical school attended, practice specialty, and practice location. Results: The number of Chinese-educated physicians (CEPs) to the United States (US) has increased over the past 10 years, from 3,878 in 2008 to 5,355 in 2017 (+38.1%). The majority held Chinese citizenship at entry to medical school (98.4% vs 97.1%) with the remainder being citizens of other East Asian nations. Of the Chinese citizens identified in 2008, 913 (19.3%) attended medical school outside of China; in 2017, 376 (6.7%) attended medical school outside of China, representing a decrease of 58.8%. Overall, in 2017, four Chinese medical schools provided 32.1% of all Chinese-educated physicians in the US. Over 50% of the CEPs were practicing in Internal Medicine, Anatomic/ Clinical Pathology, Anesthesiology, Family Medicine or Neurology. Compared with all IMGs, CEPs are more likely to be Anatomic/ Clinical Pathologists and Anesthesiologists. CEPs were concentrated in several states, including New York, California and Massachusetts. In 2017, a lower proportion of CEPs in the US healthcare workforce were in residency training, compared to 2008 (13.2% vs 22.8%). Conclusions: Unlike trends from some other South Asian countries, the number of CEPs in the US has increased over the past 10 years. Migration trends may vary depending on citizenship and country of medical school training. The majority of Chinese-educated graduates come to the US from relatively few medical schools. Fewer CEPs currently in residency training might indicate lower success rates in securing GME training in the US. [ABSTRACT FROM AUTHOR]

Accurate species delimitation and description are necessary to guide effective conservation of imperiled species, and this synergy is maximized when multiple data sources are used to delimit species. We illustrate this point by examining Drymarchon couperi (Eastern Indigo Snake), a large, federally-protected species in North America that was recently divided into two species based on gene sequence data from three loci and heuristic morphological assessment. Here, we re-evaluate the two-species hypothesis for D. couperi by evaluating both population genetic and gene sequence data. Our analyses of 14 microsatellite markers revealed 6–8 genetic population clusters with significant admixture, particularly across the contact zone between the two hypothesized species. Phylogenetic analyses of gene sequence data with maximum-likelihood methods suggested discordance between mitochondrial and nuclear markers and provided phylogenetic support for one species rather than two. For these reasons, we place Drymarchon kolpobasileus into synonymy with D. couperi. We suggest inconsistent patterns between mitochondrial and nuclear DNA are driven by high dispersal of males relative to females. We advocate for species delimitation exercises that evaluate admixture and gene flow in addition to phylogenetic analyses, particularly when the latter reveal monophyletic lineages. This is particularly important for taxa, such as squamates, that exhibit strong sex-biased dispersal. Problems associated with over-delimitation of species richness can become particularly acute for threatened and endangered species, because of high costs to conservation when taxonomy demands protection of more individual species than are supported by accumulating data. [ABSTRACT FROM AUTHOR]

Brazilians are a rapidly increasing Latino immigrant group in the United States (US), yet little research has examined factors influencing physical activity (PA) levels and behaviors of children growing up in Brazilian immigrant families. This information is needed to develop culturally sensitive interventions tailored to this population. Therefore, this qualitative study explored PA parenting practices used by Brazilian immigrant mothers living in the US. Thirty-seven Brazilian immigrant mothers with at least one child between the ages of 2 and 5 years participated in 1of 7 focus group discussions. Thematic analysis identified seven parenting practices that mothers employ that may encourage or facilitate physical activity their preschool-aged children's PA including: 1) modeling PA; 2) engaging and being physically active with child; 3) providing logistic support; 4) encouraging, praising, and offering motivational support; 5) watching, supervising, and teaching children how to engage in PA; 6) monitoring and setting limits to child's screen time; and 7) prompting child to be physically active. In addition, analysis identified four parenting practices that may discourage or inhibit children's PA including: 1) modeling of sedentary behaviors; 2) having rules and restrictions due to safety- and weather-related concerns; 3) limiting child's outdoor time due to parental time constraints; and 4) restricting child's outdoor and play time as punishment. Furthermore, analyses demonstrated that social contextual factors (e.g., income, housing, neighborhood safety, etc.) influence mothers' PA parenting practices and consequently, their children's PA. This is the first qualitative study, to our knowledge, to explore PA parenting practices of Brazilian-born immigrant mothers living in the US. Future research should further explore PA parenting practices of Brazilian immigrant parents including quantifying PA parenting practices that encourage and discourage PA, as well as examining the influence of fathers' PA parenting practices on young children's PA. [ABSTRACT FROM AUTHOR]

Herpes simplex virus 2 (HSV-2) is a large double-stranded DNA virus that causes genital sores when spread by sexual contact and is a principal cause of viral encephalitis in newborns and infants. Viral glycoproteins enable virion entry into and spread between cells, making glycoproteins a prime target for vaccine development. A truncated glycoprotein D2 (gD2) vaccine candidate, recently tested in the phase 3 Herpevac Trial for Women, did not prevent HSV-2 infection in initially seronegative women. Some women who became infected experienced multiple recurrences during the trial. The HSV US7, US8, and US9 genes encode glycoprotein I (gI), glycoprotein E (gE), and the US9 type II membrane protein, respectively. These proteins participate in viral spread across cell junctions and facilitate anterograde transport of virion components in neurons, prompting us to investigate whether sequence variants in these genes could be associated with frequent recurrence. The nucleotide sequences and dN/dS ratios of the US7-US9 region from viral isolates of individuals who experienced multiple recurrences were compared with those who had had a single episode of disease. No consistent polymorphism(s) distinguished the recurrent isolates. In frequently recurring isolates, the dN/dS ratio of US7 was low while greater variation (higher dN/dS ratio) occurred in US8, suggesting conserved function of the former during reactivation. Phylogenetic reconstruction of the US7-US9 region revealed eight strongly supported clusters within the 55 U.S. HSV-2 strains sampled, which were preserved in a second global phylogeny. Thus, although we have demonstrated evolutionary diversity in the US7-US9 complex, we found no molecular evidence of sequence variation in US7-US9 that distinguishes isolates from subjects with frequently recurrent episodes of disease. [ABSTRACT FROM AUTHOR]

Most of future population growth will take place in the world’s cities and towns. Yet, there is no well-established, consistent way to measure either urban land or people. Even census-based urban concepts and measures undergo frequent revision, impeding rigorous comparisons over time and place. This study presents a new spatial approach to derive consistent urban proxies for the US. It compares census-designated urban blocks with proxies for land-based classifications of built-up areas derived from time-series of the Global Human Settlement Layer (GHSL) for 1990–2010. This comparison provides a new way to understand urban structure and its changes: Most land that is more than 50% built-up, and people living on such land, are officially classified as urban. However, 30% of the census-designated urban population and land is located in less built-up areas that can be characterized as mainly suburban and peri-urban in nature. Such insights are important starting points for a new urban research program: creating globally and temporally consistent proxies to guide modelling of urban change. [ABSTRACT FROM AUTHOR]

While many studies on tribal water resources of individual tribal lands in the United States (US) have been conducted, the importance of tribal water resources at a national scale has largely gone unrecognized because their combined totals have not been quantified. Thus, we sought to provide a numerical estimate of major water budget components on tribal lands within the conterminous US and on USGS hydrologic unit codes (HUC2) regions. Using existing national-scale data and models, we estimated mean annual precipitation, evapotranspiration, excess precipitation, streamflow, and water use for the period 1971–2000. Tribal lands represent about 3.4 percent of the total land area of the conterminous US and on average account for 1.9 percent of precipitation, 2.4 percent of actual evapotranspiration, 0.95 percent of excess precipitation, 1.6 percent of water use, and 0.43 percent of streamflow origination. Additionally, approximately 9.5 and 11.3 percent of US streamflow flows through or adjacent as boundaries to tribal lands, respectively. Streamflow through or adjacent to tribal lands accounts for 42 and 48 percent of streamflow in the Missouri region, respectively; and for 86 and 88 percent in the Lower Colorado region, respectively. On average, 5,600 million cubic meters of streamflow per year was produced on tribal lands in the Pacific Northwest region, nearly five times greater than tribal lands in any other region. Tribal lands in the Great Lakes, Missouri, Arkansas-White-Red, and California regions all produced between 1,000 and 1,400 million cubic meters per year. [ABSTRACT FROM AUTHOR]

Introduction: Flavored e-cigarettes are enticing to new users and established cigarette smokers using e-cigarettes to quit smoking due to the wide variety of flavor options. However, specific flavor combinations that are popular among e-cigarette users are understudied. Recently, the Deeming rule extended the US Food and Drug Administration’s authority over all tobacco products, including e-cigarettes. Methods: The Population Assessment of Tobacco and Health Study Wave 2 data were analyzed to assess the prevalence of self-reported flavor categories that are used individually and in combination with other flavor categories among past 30-day youth and adult e-cigarette users in the US. Results: Most youth and adult participants reported using a flavored e-cigarette. Reporting an individual flavor category was more common than reporting a combination of flavor categories. Fruit flavor was the most common flavor category reported among youth, and ‘menthol/mint’ was most common among adults. Fruit and candy/other sweets were the most common flavor categories reported together among both youth and adult past 30-day e-cigarette users. Conclusions: The use of flavored e-cigarettes is very popular among youth and adults. Most consumers reported using a single flavor category, although some consumers did use a combination of flavor categories. Preference for menthol/mint among adults may represent a carryover from associations with tobacco cigarettes. Typically, sweeter flavors, such as fruit, were among the most popular flavor categories reported, both individually and in combination with other flavors, while more bitter flavors (i.e.: clove/spice) were less common. Implications: This study identified predominant flavor categories among past 30-day youth and adult e-cigarette users. Findings indicate that the wide variety of flavors available and the freedom to “mix-and-match” flavors may maintain use of e-cigarettes among youth and adults, and future research should focus on the composition of the ENDS liquid/vapor to disentangle the contributions of sweeteners and flavorants. [ABSTRACT FROM AUTHOR]

Elevated population levels of white-tailed deer (Odocoileus virginianus Zimmerman) can drastically alter forest ecosystems and negatively impact society through human interactions such as deer vehicle collisions. It is currently difficult to estimate deer populations at multiple scales ranging from stand, county, state, and regional levels. This presents a challenge as natural resource managers develop silvicultural prescriptions and forest management practices aimed at successfully regenerating tree species in the face of deer browsing. This study utilized measurements of deer browse impact from the new tree regeneration indicator developed by the United States Department of Agriculture Forest Service Forest Inventory and Analysis (FIA) program. Seedling and sapling abundance and other plot-level characteristics were analyzed across three states (Michigan, Minnesota, and Wisconsin) in the Great Lakes Region of the United States. Socio-environmental datasets (Lyme disease cases, deer vehicle collisions, and deer density estimates) were used in conjunction with FIA data to determine their predictive power in estimating deer browse impacts by county. Predictions from random forests models indicate that using Lyme disease case reports, the number of deer-vehicle collisions, deer density estimates, and forest inventory information correctly predicted deer browse impact 70–90% of the time. Deer-vehicle collisions per county ranked highly important in the random forests for predicting deer browse impacts in all three states. Lyme disease cases ranked high in importance for the Lake States combined and for Minnesota and Wisconsin, separately. Results show the effectiveness of predicting deer browse impacts using a suite of freely available forest inventory and other socio-environmental information. [ABSTRACT FROM AUTHOR]

Global food security and agricultural land management represent two urgent and intimately related challenges that humans must face. We quantify the changes in the global agricultural land footprint if the world were to adhere to the dietary guidelines put forth by the United States Department of Agriculture (USDA), while accounting for the land use change incurred by import/export required to meet those guidelines. We analyze data at country, continental, and global levels. USDA guidelines are viewed as an improvement on the current land-intensive diet of the average American, but despite this our results show that global adherence to the guidelines would require 1 gigahectare of additional land—roughly the size of Canada—under current agricultural practice. The results also show a strong divide between Eastern and Western hemispheres, with many Western hemisphere countries showing net land sparing under a USDA guideline diet, while many Eastern hemisphere countries show net land use increase under a USDA guideline diet. We conclude that national dietary guidelines should be developed using not just health but also global land use and equity as criteria. Because global lands are a limited resource, national dietary guidelines also need to be coordinated internationally, in much the same way greenhouse gas emissions are increasingly coordinated. [ABSTRACT FROM AUTHOR]

Theoretical approaches suggest that gender inequity increases men’s health risks. Previous findings from the United States support this contention, however only a small number of health outcomes have been explored. This study extends the range of health outcomes examined by using a cross-sectional, multilevel analysis to investigate whether measures of state-level gender inequity are predictors of men’s self-rated health. Data were derived primarily from the Behavioral Risk Factor Surveillance System and the full-case data set included 116,594 individuals nested within 50 states. Gender inequity was measured with nine variables: higher education, women’s reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and gross domestic product per capita. In fully adjusted models for all-age men the reproductive rights (OR 1.06 95% CI 1.01–1.11), abortion provider access (OR 1.11 95% CI 1.05–1.16) and earnings (OR 1.06 95% CI 1.02–1.12) measures all predicted an increased risk of men reporting poorer self-rated health for each 1 standard deviation increase in the gender inequity z-score. The most consistent effect was seen for the 65+ age group where the reproductive rights (OR 1.09 95% CI 1.03–1.16), abortion provider access (OR 1.15 95% CI 1.09–1.21), elected office (OR 1.06 95% CI 1.01–1.11) and earnings (OR 1.10 95% CI 1.04–1.16) measures all showed a significant effect. These findings provide evidence that some aspects of gender inequity increase the risk of poorer self-rated health in men. The study contributes to a growing body of literature implicating gender inequity in men’s health patterns. [ABSTRACT FROM AUTHOR]

Objectives: Limited studies have investigated geographic accessibility to a nearby community pharmacy for elderly which is an essential determinant of the access to medications and pharmacy services. This research identified pharmacy deserts and investigated availability of different types of community pharmacies and their services for elderly enrolled in a State Pharmaceutical Assistance Program (SPAP). Methods: The state of Pennsylvania in the US was used as a case to demonstrate the geographic accessibility to community pharmacy and services for elderly enrolled in SPAP. The locations of community pharmacies and households of elderly enrolled in SPAP were derived from Pharmaceutical Assistance Contract for the Elderly programs’ database. The street addresses were geocoded and the distance to a nearby community pharmacy was calculated for study sample using the haversine formula. The demographic and geographic data were aggregated to Census Tracts and pharmacy deserts were identified using the predefined criteria. Descriptive statistical analysis was used to determine whether there are statistical differences in the socio-demographic profiles and distribution of different types of community pharmacies and their services in pharmacy deserts and non-deserts. This research used hot spot analyses at county level to identify clusters of pharmacy deserts, areas with high concentration of different racial/ethnic groups and clusters of high densities of chain and independent pharmacies. Results: The Spatial analysis revealed that 39% and 61% Census Tracts in Pennsylvania were pharmacy deserts and non-deserts respectively (p < 0.001). Pharmacy deserts were found to have significantly more females, married and white elderly and fewer blacks and Hispanics compared to pharmacy non-deserts. Pharmacy deserts had significantly fewer chain and independent pharmacies and less delivery and 24-hour services in pharmacies than pharmacy non-deserts. Hot spot analyses showed that clusters of pharmacy deserts were more concentrated in southcentral, northwest and northeast regions of the state which represent rural areas and overlapped with clusters of high concentration of white individuals. Conclusions: The findings suggest that urban-rural inequality, racial/ethnic disparity and differences in availability of pharmacies and their services exist between pharmacy deserts and non-deserts. The methodological approach and analyses used in this study can also be applied to other public health programs to evaluate the coverage and breadth of public health services. [ABSTRACT FROM AUTHOR]

In the first decades of the 20th century, political actors diagnosed the incubation of a crisis in the Chilean schooling process. Low rates of enrollment, literacy, and attendance, inefficiency in the use of resources, poverty, and a reduced number of schools were the main factors explaining the crisis. As a response, the Law on Compulsory Primary Education, considering mandatory for children between 6 and 14 years old to attend any school for at least four years, was passed in 1920. Using data from Censuses of the Republic of Chile from 1920 and 1930, reports of the Ministry of Justice, the Ministry of Education, and the Statistical Yearbooks between 1895 and 1930, we apply machine learning techniques (clustering and decision trees) to assess the impact of this law on the Chilean schooling process between 1920 and 1930. We conclude that the law had a positive impact on the schooling indicators in this period. Even though it did not overcome the differences between urban and rural zones, it brought about a general improvement of the schooling process and a more efficient use of resources and infrastructure in both big urban centers and small-urban and rural zones, thereby managing the so-called crisis of the Republic. [ABSTRACT FROM AUTHOR]

In an Ultrafast Extreme Event (or Mini Flash Crash), the price of a traded stock increases or decreases strongly within milliseconds. We present a detailed study of Ultrafast Extreme Events in stock market data. In contrast to popular belief, our analysis suggests that most of the Ultrafast Extreme Events are not necessarily due to feedbacks in High Frequency Trading: In at least 60 percent of the observed Ultrafast Extreme Events, the largest fraction of the price change is due to a single market order. In times of financial crisis, large market orders are more likely which leads to a significant increase of Ultrafast Extreme Events occurrences. Furthermore, we analyze the 100 trades following each Ultrafast Extreme Events. While we observe a tendency of the prices to partially recover, less than 40 percent recover completely. On the other hand we find 25 percent of the Ultrafast Extreme Events to be almost recovered after only one trade which differs from the usually found price impact of market orders. [ABSTRACT FROM AUTHOR]

We test the hypothesis that prehistoric Native American land use influenced the Euro-American settlement process in a South Carolina Piedmont landscape. Long term ecological studies demonstrate that land use legacies influence processes and trajectories in complex, coupled social and ecological systems. Native American land use likely altered the ecological and evolutionary feedback and trajectories of many North American landscapes. Yet, considerable debate revolves around the scale and extent of land use legacies of prehistoric Native Americans. At the core of this debate is the question of whether or not European colonists settled a mostly “wild” landscape or an already “humanized” landscape. We use statistical event analysis to model the effects of prehistoric Native American settlement on the rate of Colonial land grants (1749–1775). Our results reveal how abandoned Native American settlements were among the first areas claimed and homesteaded by Euro-Americans. We suggest that prehistoric land use legacies served as key focal nodes in the Colonial era settlement process. As a consequence, localized prehistoric land use legacies likely helped structure the long term, landscape- to regional-level ecological inheritances that resulted from Euro-American settlement. [ABSTRACT FROM AUTHOR]

Objective: We identified potential geographic “hotspots” for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an “end of the epidemic” stage, while HCV is in a continuing, high prevalence (> 50%) stage. Methods: We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011–2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential “hotspots” for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk—passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk—injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. Results: Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. Discussion: For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US. [ABSTRACT FROM AUTHOR]

Landscape connectivity is integral to the persistence of metapopulations of wide ranging carnivores and other terrestrial species. The objectives of this research were to investigate the landscape characteristics essential to use of areas by lynx and bobcats in northern New England, map a habitat availability model for each species, and explore connectivity across areas of the region likely to experience future development pressure. A Mahalanobis distance analysis was conducted on location data collected between 2005 and 2010 from 16 bobcats in western Vermont and 31 lynx in northern Maine to determine which variables were most consistent across all locations for each species using three scales based on average 1) local (15 minute) movement, 2) linear distance between daily locations, and 3) female home range size. The bobcat model providing the widest separation between used locations and random study area locations suggests that they cue into landscape features such as edge, availability of cover, and development density at different scales. The lynx model with the widest separation between random and used locations contained five variables including natural habitat, cover, and elevation—all at different scales. Shrub scrub habitat—where lynx’s preferred prey is most abundant—was represented at the daily distance moved scale. Cross validation indicated that outliers had little effect on models for either species. A habitat suitability value was calculated for each 30 m2 pixel across Vermont, New Hampshire, and Maine for each species and used to map connectivity between conserved lands within selected areas across the region. Projections of future landscape change illustrated potential impacts of anthropogenic development on areas lynx and bobcat may use, and indicated where connectivity for bobcats and lynx may be lost. These projections provided a guide for conservation of landscape permeability for lynx, bobcat, and species relying on similar habitats in the region. [ABSTRACT FROM AUTHOR]

Background: The growing shale gas (“fracking”) industry depends on a mobile workforce, whose influx could have social impacts on host communities. Sexually transmitted infections (STIs) can increase through sexual mixing patterns associated with labor migration. No prior studies have quantified the relationship between shale gas activity and rates of three reportable STIs: chlamydia, gonorrhea, and syphilis. Methods: We conducted a longitudinal, ecologic study from 2000–2016 in Ohio, situated in a prolific shale gas region in the United States (US). Data on reported cases of chlamydia, gonorrhea, and syphilis by county and year were obtained from the Ohio Department of Health. All 88 counties were classified as none, low, and high shale gas activity in each year, using data from the Ohio Department of Natural Resources. Annual rate ratios (RR) and 95% confidence intervals (95% CIs) were calculated from mixed-effects Poisson regression models evaluating the relationship between shale gas activity and reported annual STI rates while adjusting for secular trends and potential confounders obtained from the US Census. Results: Compared to counties with no shale gas activity, counties with high activity had 21% (RR = 1.21; 95%CI = 1.08–1.36) increased rates of chlamydia and 19% (RR = 1.27; 95%CI 0.98–1.44) increased rates of gonorrhea, respectively. No association was observed for syphilis. Conclusion: This first report of a link between shale gas activity and increased rates of both chlamydia and gonorrhea may inform local policies and community health efforts. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is a risk factor for all-cause mortality in the United States, but the evidence from China is limited. We investigate whether prognosis of CKD (mortality) differs between the two countries. In particular, we sought to compare the strength of association between CKD stage and all-cause mortality, by country. Methods: Mortality-linked data from China National Survey of Chronic Kidney Disease (urban population, n = 25,269) and US NHANES (2005–2010, n = 15,209) for adults >20 years old were analyzed. The Chinese cohort was followed until Dec 31, 2013, while the NHANES cohort until Dec 31, 2011. CKD was defined by eGFR <60ml/min/1.73m2 or albuminuria (defined as ACR ≥30mg/g). Weighted Cox models were used to evaluate the association between the two CKD indicators and mortality. Both stratified and combined models (with country interactions) were explored. Results: The Chinese sample had a lower proportion of eGFR<60 ml/min/1.73m2 (3.7% vs. 6.9%) and albuminuria (7.6% vs. 9.0%), compared to the US. Higher rates of mortality were observed with higher stages of CKD in both countries. HRs for mortality in the more advanced CKD categories reached 2.18 (1.14–4.15) in China and 1.66 (1.18–2.32) in the US in the absence of albuminuria, and 2.30 (1.13–4.68) and 3.04 (2.33–3.96) in the presence of albuminuria. No significant interactions were detected between country and these categories. Conclusion: The association between albuminuria and reduced eGFR and all-cause mortality was similar in both countries, with albuminuria being associated with the larger effect size compared to lower eGFR. [ABSTRACT FROM AUTHOR]

Population wellbeing, an aggregate measure of positive mental, physical, and emotional health, has previously been used as a marker of community thriving. We examined whether several community measures of wellbeing, and their change since 2012, could be used to understand electoral changes that led to the outcome of the 2016 United States presidential election. We found that areas of the US which had the largest shifts away from the incumbent party had both lower wellbeing and greater drops in wellbeing when compared with areas that did not shift. In comparison, changes in income were not related to voting shifts. Well-being may be more useful in predicting and understanding electoral outcomes than some more conventional voting determinants. [ABSTRACT FROM AUTHOR]

Since 1976, the United States has seen over 1,400 judicial executions, and these have been highly concentrated in only a few states and counties. The number of executions across counties appears to fit a stretched distribution. These distributions are typically reflective of self-reinforcing processes where the probability of observing an event increases for each previous event. To examine these processes, we employ two-pronged empirical strategy. First, we utilize bootstrapped Kolmogorov-Smirnov tests to determine whether the pattern of executions reflect a stretched distribution, and confirm that they do. Second, we test for event-dependence using the Conditional Frailty Model. Our tests estimate the monthly hazard of an execution in a given county, accounting for the number of previous executions, homicides, poverty, and population demographics. Controlling for other factors, we find that the number of prior executions in a county increases the probability of the next execution and accelerates its timing. Once a jurisdiction goes down a given path, the path becomes self-reinforcing, causing the counties to separate out into those never executing (the vast majority of counties) and those which use the punishment frequently. This finding is of great legal and normative concern, and ultimately, may not be consistent with the equal protection clause of the U.S. Constitution. [ABSTRACT FROM AUTHOR]

We propose a diffusion process to describe the global dynamic evolution of credit operations at a national level given observed operations at a subnational level in a sovereign country. Empirical analysis with a unique dataset from Brazilian federate constituents supports the conclusions. Despite the heterogeneity observed in credit operations at a subnational level, the aggregated dynamics at a national level were accurately described by the proposed model. Results may guide management of public finances, particularly debt manager authorities in charge of reaching surplus targets. [ABSTRACT FROM AUTHOR]

Climate and weather have been linked to criminal activity. The connection between climatological conditions and crime is of growing importance as we seek to understand the societal implications of climate change. This study describes the mechanisms theorized to link annual variations in climate to crime in California and examines the effect of drought on statewide crime rates from 2011–2015. California has suffered severe drought since 2011, resulting in intensely dry winters and several of the hottest days on record. It is likely that the drought increased economic stress and shifted routine activities of the population, potentially increasing the likelihood of crime. We used a synthetic control method to estimate the impact of California’s drought on both property and violent crimes. We found a significant increase in property crimes during the drought, but no effect on violent crimes. This result was robust to several sensitivity analyses, including a negative control. [ABSTRACT FROM AUTHOR]

The United States is undergoing a demographic shift in which White Americans are predicted to comprise less than 50% of the US population by mid-century. The present research examines how exposure to information about this racial shift affects perceptions of the extent to which different racial groups face discrimination. In four experiments, making the growing national racial diversity salient led White Americans to predict that Whites will face increasing discrimination in the future, compared with control information. Conversely, regardless of experimental condition, Whites estimated that discrimination against various racial minority groups will decline. Explorations of several psychological mechanisms potentially underlying the effect of the racial shift information on perceived anti-White discrimination suggested a mediating role of concerns about American culture fundamentally changing. Taken together, these findings suggest that reports about the changing national demographics enhance concerns among Whites that they will be the victims of racial discrimination in the future. [ABSTRACT FROM AUTHOR]