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The present paper provides a meta-study of security and defence foresight documents by the Atlantic Alliance, European Union and various official bodies linked to the Defence Ministries of Canada, France, Germany, Italy, Spain, the United Kingdom and United States. It focuses on the political and social trends impacting on defence and military issues. In global terms, the following can be discerned: rivalry among major powers, with armed conflict between some not ruled out entirely; armed non-state actors strengthened by new technologies; global competition for natural resources; extensive demographic imbalances and migration flows; global risks associated with fragile states. In terms of European internal policy, the following trends are identified: population ageing and the challenges associated with immigrant integration; empowerment of interest-based and identity networks. The paper begins by familiarising readers with the characteristics of foresight documents and the methodologies used in their preparation. [ABSTRACT FROM AUTHOR]

For those interested in developing baccalaureate programs in health humanities, this essay draws on our experience of developing a minor in health humanities to share insights on what to expect, strategies that work well, and how to deal with obstacles. These insights range from how to explain the concept of health humanities to stakeholders (faculty, administrators, and community partners) to how to decide where to house a health humanities program. We share our insights in a way that promises to translate well to different institutional contexts. That said, this paper is more relevant for institutional contexts where budgets are stressed and, consequently, proposals to invest in humanities programs are a difficult sell. This paper is divided into sections addressing how to (a) earn institutional support, (b) gain campus buy-in, (c) identify benefits of the proposed program, (d) decide where to house the program, (e) calculate program cost, and (f) secure external funding. We conclude with some final reflections on the current status of our program and why we are committed to health humanities education. [ABSTRACT FROM AUTHOR]

This paper empirically analyses whether worker discouragement is linked to suicide in the United States. This paper argues that discouraged workers might translate their frustration into alcohol or drug consumption rather than committing suicide directly. Based on the linear Granger causality test, this study finds that changes in the number female unemployed workers help to predict changes in female suicide patterns. A 1 % increase in growth in the male unemployment rate with age (45-54) will lead to a 2.8 % increase in the growth of male alcohol-induced deaths. This study finds a nonlinear causality from the female unemployment with age (25-34, 45-54, 50 and over) to drug-induced deaths. These findings suggest the importance of providing treatment for the jobless to reduce the risk for excessive alcohol consumption, drug misuse and suicidal behavior. [ABSTRACT FROM AUTHOR]

Over the last 23 years, the U.S. Securities and Exchange Commission has required over 34,000 companies to file over 165,000 annual reports. These reports, the so-called 'Form 10-Ks,' contain a characterization of a company's financial performance and its risks, including the regulatory environment in which a company operates. In this paper, we analyze over 4.5 million references to U.S. Federal Acts and Agencies contained within these reports to measure the regulatory ecosystem, in which companies are organisms inhabiting a regulatory environment. While individuals across the political, economic, and academic world frequently refer to trends in this regulatory ecosystem, far less attention has been paid to supporting such claims with large-scale, longitudinal data. In this paper, in addition to positing a model of regulatory ecosystems, we document an increase in the regulatory energy per filing, i.e., a warming 'temperature.' We also find that the diversity of the regulatory ecosystem has been increasing over the past two decades. These findings support the claim that regulatory activity and complexity are increasing, and this framework contributes an important step towards improving academic and policy discussions around legal complexity and regulation. [ABSTRACT FROM AUTHOR]

Electricity generation currently is the main industrial source of air emissions in the United States. Both researchers and practitioners are interested in conducting studies to evaluate the ecological performance of this industry, in order to propose solutions to curb emissions of air pollutants and to improve the efficiency of converting fossil resources into electric energy. In this paper, data envelopment analysis (DEA) is used to assess ecological efficiency where air emissions are used as undesirable outputs. Although conventional DEA does not require a priori information on the input and output weights, weight restrictions can be incorporated to reflect a user's preference over the performance metrics, or to refine the DEA results. Adding weight restrictions voids the fact that DEA scores are independent of the units of measurement. To incorporate weight constraints in ecological efficiency assessment, this paper develops a DEA model that is units-invariant when weight restrictions are imposed. Moreover, the proposed model is equivalent to the standard units-invariant DEA model when weight restrictions are not present. [ABSTRACT FROM AUTHOR]

The 2018 House midterm elections were notable for the number of female candidates who ran and for the extraordinary sums of campaign funds these candidates raised. Both were fueled by the women's marches of 2017 and 2018, the #MeToo movement, and intense opposition to Trump (Adkins and Dulio 2020; Herrnson et al. 2020; Jacobson 2019). In this paper, we explore the intersection of these two phenomena. We show that non-incumbent Democrats, particularly women, running in U.S. House races in 2018 were especially successful raising small donations. Examining preliminary data for the 2019–20 cycle, we then show that the new Democratic freshmen elected in 2018—now incumbents—have sustained their small-dollar fundraising efforts, with women again outpacing men. We conclude by discussing the extent to which heightened reliance on small donations may mark a durable shift in fundraising practices and if so, how such a shift might impact the future politics of the House. [ABSTRACT FROM AUTHOR]

This paper examines the association between state religiosity and population mobility during the coronavirus (COVID-19) pandemic. We use first-party geo-behavioral data collected through mobile phone operating systems, global positioning systems, and Wi-Fi signals to assess changes in the average median distance traveled by approximately 15,000,000 devices over eight weeks (February 24–April 13) in the contiguous United States. Robust regression results show that more religious states tend to exhibit higher average mobility scores and slower average declines in mobility. Findings also suggest that state stay-at-home orders have a weaker impact on mobility in more religious states. [ABSTRACT FROM AUTHOR]

Background: This paper reports a single-group, pre-post pilot of a peer-learning intervention between community health workers (CHWs) in the USA and Village Health Support Guides (Guides) in Cambodia to improve outcomes for Cambodians with type 2 diabetes (T2D). Method: Two US-based CHWs were trained in a culturally derived cardiometabolic education curriculum called Eat, Walk, Sleep (EWS) and they were also trained in principles of peer learning. They in turn trained five Cambodia-based Guides remotely through videoconference with a phablet in EWS. Finally, Cambodia-based Guides met with 58 patients with diabetes, face-to-face in their villages, monthly for 6 months to deliver EWS. US-based CHWs and Cambodia-based Guides responded to surveys at baseline and post-treatment. Patients responded to surveys and provided blood pressure and blood samples at baseline and post-treatment. Results: For US-based CHWs, scores on all surveys of diabetes knowledge, self-evaluation, job satisfaction, and information technology improved, though no statistical tests were run due to sample size. For Cambodia-based Guides, all scores on these same measures improved except for job satisfaction. For patients, n = 60 consented, 2 withdrew, and 7 were lost to follow-up leaving n = 51 for analysis. In paired t tests, patients showed significantly decreased A1c, decreased systolic and diastolic blood pressures, improved attitudes toward medicines, and a trend for switching from all-white to part-brown rice. No changes were detected in self-reported physical activity, medication adherence, sleep quality, or frequency or amount of rice consumed. Conclusion: If proven effective in a controlled trial, cross-country peer learning could eventually help other diaspora communities. [ABSTRACT FROM AUTHOR]

Informed by the perspectives of two practitioners with over ten years of experience addressing stalking issues and a researcher from the field of violence against women, this paper will highlight the trajectory of the United States' response to intimate partner stalking by first discussing advancements that have been made in stalking laws. This will be followed by the practical challenges that law enforcement and service providers continue to face when encountering this crime, despite this progress. There are four major challenges to addressing intimate partner stalking: a) stalking remains a very misunderstood crime; b) building stalking cases proves challenging; c) service providers may lack the knowledge and/or resources needed to respond to stalking victims effectively; and d) research on stalking is limited. The manuscript concludes with practical recommendations for addressing some of these challenges. [ABSTRACT FROM AUTHOR]

This grounded study investigated the negotiation of authorship by faculty members, graduate student mentors, and their undergraduate protégés in undergraduate research experiences at a private research university in the northeastern United States. Semi-structured interviews using complementary scripts were conducted separately with 42 participants over a 3 year period to probe their knowledge and understanding of responsible authorship and publication practices and learn how faculty and students entered into authorship decision-making intended to lead to the publication of peer-reviewed technical papers. Herein the theoretical model for the negotiation of authorship developed through the analysis of these interviews is reported. The model identifies critical causal and intervening conditions responsible for the coping strategies faculty and students employ, which, in our study, appear to often produce unfortunate consequences for all involved. The undergraduate student researchers and their graduate student mentors interviewed in this study exhibited a limited understanding of authorship and the requirements for authorship in their research groups. The power differential between faculty and students, the students' limited epistemic development, the busy-ness of the faculty, and the faculty's failure to prioritize authorship have been identified as key factors inhibiting both undergraduate and graduate students from developing a deeper understanding of responsible authorship and publication practices. Implications for graduate education and undergraduate research are discussed, and strategies for helping all students to develop a deeper understanding of authorship are identified. [ABSTRACT FROM AUTHOR]

This paper examines how the means through which social benefits are delivered—either through a direct government program, or through a tax expenditure program—affects how citizens view social welfare programs and their beneficiaries. Attitudes toward social spending in the United States are strongly conditioned by both racial considerations and perceptions of the deservingness of recipients. We argue that the political cues given by spending conducted through the tax code differ from those given by direct spending in a way that both de-racializes spending attitudes and changes the lens through which citizens evaluate the deservingness of beneficiaries. Through a series of survey experiments, we demonstrate that social benefits delivered through the tax code are less likely to activate racialized thinking than similar or identical benefits delivered directly. This is true, at least in part, because recipients of tax expenditures are perceived as more deserving than recipients of otherwise identical direct spending. [ABSTRACT FROM AUTHOR]

Policy researchers suggest that governments respond to societal problems with public policy. However, empirical evidence is mixed regarding the effect of problem severity on state policy adoption in diverse policy areas. One possible cause of these inconsistencies may be attributable to the fact that states' other internal characteristics can affect the way problem severity influences state policy adoption. In this paper, I apply Mohr's (1969) organizational innovation theory to the case of state body-worn camera (BWC) legislation. I examine how the interaction of problem severity with factors representing states' obstacles against innovation and resources supporting innovation explains states' adoption of BWC legislation. The results of fuzzy-set qualitative comparative analysis support the importance of considering this interactive effect. Specifically, results suggest that the problem of police use of deadly force against minority residents has led to the adoption of BWC legislation only when strong resistance from police unions is absent, political or socioeconomic resources are present, or both. This study also discusses implications for scholars and policymakers about the important role of police unions in shaping policy related to police practice. [ABSTRACT FROM AUTHOR]

Objectives: Studies generally find no relationship between economic deprivation and terrorist activities, leading to the conclusion that economic conditions have no role in the emergence of terrorist movements. The present paper challenges this conclusion. It argues that collective deprivation affects participation into terrorism, but in different directions depending on the ideology of terrorist movements: far-right terrorism should mobilize more under times of collective deprivation while far-left terrorism should mobilize more under times of collective improvement. Methods: I tested this hypothesis on the PIRUS database about domestic terrorists (N = 1295) in the United States from 1948 to 2016. I analysed whether the proportion of far-right (versus far-left) terrorists in a given year depends on collective deprivation in the US, operationalized through long-term recession of the income and long-term growth of inequality. Results: Hierarchical logistic regression analyses confirmed that far-right terrorism mobilizes more under periods of long-term economic deprivation, while far-left terrorism mobilizes more under improving economic conditions. Besides, the effect of collective deprivation appears to be of socio-tropic nature: it is especially determinant at the national level, rather than at the state or individual level. In contrast, results do not support the view that Islamist terrorism is affected by collective deprivation. Conclusions: The study challenges the view that economic conditions have no role in triggering terrorist mobilization. The differential effect of collective deprivation on far-right and far-left terrorism is compatible with system-justification and backlash theories. Besides, the findings suggest that collective deprivation affects radicalization at an early phase rather than the offending phase. [ABSTRACT FROM AUTHOR]

Background: Speaking invitations are used by faculty promotion committees as evidence of external recognition. However, women are underrepresented as speakers at specialty society conferences despite the rise in women physicians. The purpose of this study was to estimate to what extent the gender of session conveners is associated with the gender distribution of invited speakers at SAGES meetings.Methods: A retrospective audit of annual SAGES meeting programs during 2009-2018 was performed. All invited panel speakers, defined as faculty delivering a prepared oral presentation in a session under the organization of one or more chairs, were identified. The gender of speakers and chairs/co-chairs was determined. Hands-on courses, paper sessions, military symposia, mock trials, and jeopardy sessions were excluded. We compared the proportion of all-male panels in sessions with all-male conveners versus sessions with at least one woman convener. Statistical analysis was performed using Chi-square and t tests.Results: There were 3405 speakers and 459 panels identified. After applying inclusion and exclusion criteria, 2836 invited speakers on 402 panels were analyzed. Women represented 15% of all speakers, increasing from 9 to 19% (2009 to 2018). This reflects the rise in the proportion of women overall members (11% in 2010 to 19% in 2018). The proportion of panels with at least one woman convener increased from 12 to 58%. All-male panels represented 40% of all panels (n = 163) and their proportion significantly decreased over time from 50 to 31% (p trend < 0.000). Sessions with all-male conveners had 52% all-male panels, while sessions with at least one woman convener had 19% all-male panels (p < 0.001).Conclusion: The proportion of women invited speakers at the annual SAGES meeting has significantly increased over time. All-male convener sessions were more likely to convene all-male speaker panels. Including a woman chair/co-chair increased the number of women speakers and is a successful strategy to achieve gender balance in conference planning. [ABSTRACT FROM AUTHOR]

The perinatal period involves major developmental transitions which can be conceptualized through a biopsychosocial (BPS; Engel in Science 196:129–136, 1977, 10.1126/science.847460, in The American Journal of Psychiatry 137:535–544, 1980, 10.1176/ajp.137.5.535), systemic (von Bertalanffy, General system theory: Foundations, development, applications, George Braziller, New York, 1968) framework. Thus, no one domain of health in the perinatal period can be understood without exploring how the other domains are both impacted by and impacting the others. As a result of COVID-19, popular media is paying special attention to the biomedical domain of women in the perinatal period as it relates to health outcomes and changes in perinatal healthcare policies; however, considerably less attention is being paid to the other BPS health domains and systemic impacts. This paper will outline U.S. changes in healthcare as a result of the COVID-19 pandemic for individuals, couples, and families within the perinatal period (i.e., family planning and conception, prenatal, labor and delivery, and postpartum) and explore the unique psychosocial, systemic impacts. Recommendations for care, including telehealth and virtual support options, and future directions for research will be provided. [ABSTRACT FROM AUTHOR]

In this paper we solve a long standing open problem for Random Schrödinger operators on L 2 (R d) with i.i.d single site random potentials. We allow a large class of free operators, including magnetic potential, however our method of proof works only for the case when the random potentials satisfy a complete covering condition. We require that the supports of the random potentials cover R d and the bump functions that appear in the random potentials form a partition of unity. For such models, we show that the Density of States (DOS) is m times differentiable in the part of the spectrum where exponential localization is valid, if the single site distribution has compact support and has Hölder continuous m + 1 st derivative. The required Hölder continuity depends on the fractional moment bounds satisfied by appropriate operator kernels. Our proof of the Random Schrödinger operator case is an extensions of our proof for Anderson type models on ℓ 2 (G) , G a countable set, with the property that the cardinality of the set of points at distance N from any fixed point grows at some rate in N α , α > 0 . This condition rules out the Bethe lattice, where our method of proof works but the degree of smoothness also depends on the localization length, a result we do not present here. Even for these models the random potentials need to satisfy a complete covering condition. The Anderson model on the lattice for which regularity results were known earlier also satisfies the complete covering condition. [ABSTRACT FROM AUTHOR]

Objectives: In a context of rising income inequality and policies to improve rights and inclusion for persons with disabilities, this paper examines income inequality trends by household work limitation status in the United States from 1981–2018. Methods: Data comes from the March Supplement of the Current Population Survey using the work limitation disability measure to estimate decomposable Generalized Entropy measures of income inequality, and progressivity of government transfers and disability payments. Results: Over the 1981–2018 period, inequality within the group of households with work limitations has been around 30% higher than inequality within the group of households without work limitations. Both households with and without work limitations have seen a similar 70% rise in income inequality since 1981. Progressivity of government transfers and disability payments increased among households with limitations, but not among other households. Conclusions: Income inequality is higher within the group of households with work limitations compared to other households and has been rising for both groups. Policies aimed to enhance the economic and social participation of persons with disabilities over this period may have mitigated this rising trend. Disability considerations should be part of research and policy on income inequality. [ABSTRACT FROM AUTHOR]

Objectives: In a context of rising income inequality and policies to improve rights and inclusion for persons with disabilities, this paper examines income inequality trends by household work limitation status in the United States from 1981–2018. Methods: Data comes from the March Supplement of the Current Population Survey using the work limitation disability measure to estimate decomposable Generalized Entropy measures of income inequality, and progressivity of government transfers and disability payments. Results: Over the 1981–2018 period, inequality within the group of households with work limitations has been around 30% higher than inequality within the group of households without work limitations. Both households with and without work limitations have seen a similar 70% rise in income inequality since 1981. Progressivity of government transfers and disability payments increased among households with limitations, but not among other households. Conclusions: Income inequality is higher within the group of households with work limitations compared to other households and has been rising for both groups. Policies aimed to enhance the economic and social participation of persons with disabilities over this period may have mitigated this rising trend. Disability considerations should be part of research and policy on income inequality. [ABSTRACT FROM AUTHOR]

Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population. [ABSTRACT FROM AUTHOR]

Engineering programs in the United States have been experimenting with diverse pedagogical approaches to educate future professional engineers. However, a crucial dimension of ethics education that focuses on the values, personal commitments, and meaning of engineers has been missing in many of these pedagogical approaches. We argue that a value-based approach to professional ethics education is critically needed in engineering education, because such an approach is indispensable for cultivating self-reflective and socially engaged engineers. This paper starts by briefly comparing two prevalent approaches to ethics education in science and engineering: professional (teaching professional ethical standards, including codes of ethics) and philosophical (teaching ethical theories and their applications in professional settings). While we acknowledge that both approaches help meet certain ethics education objectives, we also argue that neither of these is sufficient to personally engage students in authentic moral learning. We make the case that it is important to connect ethics education to the heart, which is extensively driven by values, and present a value-based approach to professional ethics education. We provide some classroom practices that cultivate a safe, diverse, and engaging learning environment. Finally, we discuss the implications of a value-based approach to professional ethics education for curriculum design and pedagogical practice, including opportunities and challenges for engineering faculty eager to incorporate value-based inquiry into their classrooms. [ABSTRACT FROM AUTHOR]

The article reports that the presentation of the history of coordinated specialty care (CSC) in the United States in the paper by Read and Kohrt (2021). We applaud the focus on CSC and the thoughtful analysis of important historic antecedents. We also are particularly appreciative of the questions the paper raises about model specifcation and the extent to which fdelity to a particular approach to the model of CSC is actually related to outcomes.

In this paper, we use 2008–2013 American Community Survey data to update and further probe evidence on son preference in the USA. In light of the substantial increase in immigration, we examine this question separately for natives and immigrants. Dahl and Moretti (Review of Economic Studies 75, 1085-1120, 2008) found earlier evidence consistent with son preference in that having a female first child raised fertility and increased the probability that the family was living without a father. We find that for our more recent period, having a female first child still raises the likelihood of living without a father, but is instead associated with lower fertility, particularly for natives. Thus, by the 2008–2013 period, any apparent son preference in fertility decisions appears to have been outweighed by factors such as cost concerns in raising girls or increased female bargaining power. In contrast, some evidence for son preference in fertility persists among immigrants. Immigrant families that have a female first child have significantly higher fertility and are more likely to be living without a father (though not significantly so). Further, gender inequity in source countries is associated with son preference in fertility among immigrants. For both first- and second-generation immigrants, the impact of a female first-born child on fertility is more pronounced for immigrants from source countries with less gender equity. Finally, we find no evidence of sex selection for the general population of natives and immigrants, suggesting that it does not provide an alternative mechanism to account for the disappearance of a positive fertility effect for natives. [ABSTRACT FROM AUTHOR]

This paper uses the SMART Model to analyze the direct economic effects of the US-China tariff war on both China and the US. Based on the three lists of Chinese products subject to additional tariffs imposed under the US Section 301 investigation throughout 2018 and the tariff lists issued by China as a countermeasure, we simulate the trade creation/reduction effects, welfare effects, and trade diversion effects at the detailed product level. According to the simulation results, US imports from China and Chinese imports from the US will be greatly reduced by an estimated $91.46 and $36.71 billion, respectively. US imports will be diverted from China to other markets, specifically, Mexico, Japan and Germany, in most sectors. Chinese imports from the US will be mainly diverted to Brazil, Germany, Japan, Argentina, the United Kingdom and Canada. However, trade between the US and China cannot be completely transferred to alternative suppliers in other countries without additional costs or a loss of utility, which results in a substantial reduction in the total imports and welfare in both the US and China. The sectors with the highest welfare loss in the US are machinery and electrical products. In China, soybeans and automobiles are the most affected sectors and exhibit much higher welfare loss than other sectors. The trade war harms both sides' welfare and could have further adverse effects on global value chains and the multilateral trading system. [ABSTRACT FROM AUTHOR]

Using the case of the USA Renewable Fuel Standard (RFS), this paper contributes to theorizing regarding the factors that affect feedback dynamics of a disruptive technology. Focusing on design elements of the RFS and governance features related to its implementation, it demonstrates the resulting feedback effects on first-generation conventional biofuels and second-generation advanced biofuels. In terms of policy design, the analyses highlight the significance of the calibration of policy instruments and the incorporation of multiple policy goals into a single policy instrument. In terms of implementation procedures, the analyses affirm the significance to feedback dynamics of the regulatory capacity and discretionary authority of administrative agents as well as the influence of interest group coalitions in rulemaking. In the case of second-generation advanced biofuels, the case study also reveals the limits of policy-induced feedback in the presence of regulatory uncertainty and unfavorable financial conditions. [ABSTRACT FROM AUTHOR]

Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America's children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas. [ABSTRACT FROM AUTHOR]

Child birth order (CBO) in the family has received little attention in the field of prevention science. CBO is relevant to early interventionists from a public health perspective, as the most widely disseminated home-visiting program has traditionally targeted mothers and their first-born children. The current paper revisits a previous publication by Shaw et al. (2009) on the effectiveness of the Family Check-Up (FCU) to evaluate CBO (firstborn vs. middle vs. youngest) as a moderator of treatment effects of the FCU in relation to improvements in parenting, maternal depressive symptoms, and child outcomes from ages 2 to 4 in a sample of low-income, ethnically diverse families (N = 709) with multiple children. Results suggest that the FCU elicited improvements in observed parenting from ages 2 to 3 primarily for target children who were the youngest or middle children, but not for firstborns. Findings are discussed in the context of implications for prevention science research, dissemination, and public policy. [ABSTRACT FROM AUTHOR]

Objectives: Twin births have increased in prevalence. Twin births are more likely to have poorer outcomes than singleton births and are more costly. However, although Medicaid paid for approximately half of U.S. births in 2016, little is known specifically about the incidence of twin births and related costs for Medicaid beneficiaries. This paper seeks to expand the knowledge of twin births covered by Medicaid. Methods: We obtained data for singleton (N = 115,568) and twin (N = 3775) Medicaid-covered births in selected geographic areas of four states in 2014 and 2015. States provided linked birth certificates to Medicaid claims data for mothers and infants. We compared health care utilization and Medicaid costs for twins to singletons in the same geographic areas. Results: The prevalence of Medicaid twins in the selected areas of these four states was 3.2% of births, identical to the rate of twins nationwide. Two thirds of Medicaid twins were born preterm, and average gestational age was 34.8 weeks. Mothers of twins had higher rates of C-Sect. (73.6% vs. 32.0% for singletons) and of neonatal intensive care use (45.2% vs. 11.1%). The average length of delivery stay for twins was 12.3 days, vs. 4.1, and the rate of hospital readmissions was almost twice as high. The total cost for mother and infant over the prenatal, delivery, and post-natal period for a pair of twins was $48,479, over two and a half times as high as for singleton births ($18,032). However, when considering the average cost of a single twin vs. a singleton birth, the cost differential is less ($24,239 vs. $18,032, or a ratio of 1.34). Conclusions: Medicaid twins are a fragile population with poorer outcomes and higher service use than singleton infants. Twins contribute substantially to the Medicaid cost of maternity and newborn care. A variety of strategies can be used to improve twin outcomes and reduce costs. [ABSTRACT FROM AUTHOR]

This paper projects the race between technologically driven increases in crop yields and changing climatic conditions in the central USA, one of the world's most productive agricultural regions. Using the highest, average, and lowest decadal rates of technologically driven increases in crop yields over the 1980 to 2017 period, we develop spatially explicit yield scenarios to the end of the twenty-first century under RCP4.5 and RCP8.5. We find that with static technological innovation, severe climate change will decrease yields by an average of 22.4% (26.1 bu. ac−1) for maize, 27.9% (8.83 bu. ac−1) for soybeans, and 20% (7.14 bu. ac−1) for winter wheat in the central USA; however, with even the lowest rates of technological yield growth, yields increase by an average of 25.0% (40.5 bu. ac−1) for maize and 30.2% (14.2 bu. ac−1) for soybeans. We conclude that technology has the potential to overcome the negative impacts of climate change on the yields of maize, soybeans, and winter wheat in the central USA, but if these increases are to be environmentally sustainable, technological developments must be information-intensive rather than input-intensive. [ABSTRACT FROM AUTHOR]

Dual-energy CT (DECT) has been available for clinical use in the United States for close to 15 years. Although multiple applications in all areas of the body have been described that are only possible with DECT, the adoption into clinical practice has been slow. This paper will attempt to address many of the impediments the author has encountered from his discussions with radiologists across the country. A hopeful outcome would result in more practices adopting more DECT into their CT practices. [ABSTRACT FROM AUTHOR]

Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has recently developed and announced its Masters Program that aims to address existing needs of practicing surgeons for lifelong learning and consists of eight clinical pathways each containing three anchoring procedures. The objective of this study was to select the seminal articles for each anchoring procedure of these pathways using a systematic methodology.Methods: A systematic literature search of Web of Science was conducted for the most cited articles for each of the anchoring procedures of the SAGES Masters pathways. The most relevant identified articles were then reviewed by expert members of the relevant SAGES pathway committees and task forces and the seminal articles chosen for each anchoring procedure using expert consensus.Results: 578 highly cited articles were identified by the original search of the literature and the seminal articles were selected for each anchoring procedure after expert review and consensus. Articles address procedural outcomes, disease pathophysiology, and surgical technique and are presented in this paper.Conclusions: We have identified seminal articles for each anchoring procedure of the SAGES Masters program pathways using a systematic methodology. These articles provide surgeon participants of this program with a great resource to improve their procedure-specific knowledge and may further benefit the larger surgical community by focusing its attention to must-read impactful work that may inform best practices. [ABSTRACT FROM AUTHOR]

Introduction: Prior research has identified psychosocial stress as a risk factor for adverse maternal and infant outcomes for non-Hispanic Black and White women. However, whether psychosocial stress differs in its profile and association with preterm birth across diverse racial–ethnic–nativity groups in the Southeast remains unexamined. Both foreign-born and Hispanic women represent important proportions of new mothers in many Southeastern states. The objective of this paper is to describe the prevalence of categories of prenatal life events among Georgia mothers, the variation across race, ethnicity and nativity, and the association of prenatal stress with prevalence of preterm birth. Methods: We calculated racial–ethnic–nativity specific prevalence of stress categories (emotional/traumatic, financial, or partner-related) with data from the 2012 to 2015 Georgia PRAMS. Maternal race, ethnicity, and nativity were reported on birth certificates. We used logistic regression to examine the association of different categories of stress with preterm birth. We conducted a bias analysis to estimate the potential impact of recall bias on observed associations. Results: The sample was 20.2% foreign born overall, 15.5% non-Hispanic White, 45.7% non-Hispanic Black, 32.3% Hispanic, and 6.5% non-Hispanic other. The prevalence of specific stressors varied by race–ethnicity–nativity. Women who experienced financial stress had a slightly elevated prevalence of preterm birth (prevalence ratio: 1.32 (0.97–1.79)). Discussion: Prenatal and preconception stress were common among women who gave birth between 2012 and 2015 in Georgia and may have implications for preterm and postpartum maternal mental health. [ABSTRACT FROM AUTHOR]

In this paper we consider a system of parabolic reaction–diffusion equations with strong competition and two related scalar reaction–diffusion equations. We show that in certain space periodic media with large periods, there exist periodic, non-constant, non-trivial, stable stationary states. We compare our results with already known results about the existence and nonexistence of such solutions. Finally, we provide ecological interpretations for these results. [ABSTRACT FROM AUTHOR]

Purpose: Patients with low back pain (LBP) rarely have serious underlying pathology but frequently undergo inappropriate imaging. A range of guidelines and red flag features are utilised to characterise appropriate imaging. This scoping review explores how LBP imaging appropriateness is determined and calculated in studies of primary care practice.Methods: This scoping review builds upon a previous meta-analysis, incorporating articles identified that were published since 2014, with an updated search to capture articles published since the original search. Electronic databases were searched, and citation lists of included papers were reviewed. Inclusion criteria were studies assessing adult LBP imaging appropriateness in a primary care setting. Twenty-three eligible studies were identified.Results: A range of red flag features were utilised to determine imaging appropriateness. Most studies considered appropriateness in a binary manner, by the presence of any red flag feature. Ten guidelines were referenced, with 7/23 (30%) included studies amending or not referencing any guideline. The method for calculating the proportion of inappropriate imaging varied. Ten per cent of the studies used the total number of patients presenting with LBP as the denominator, suggesting most studies overestimated the rate of inappropriate imaging, and did not capture where imaging is not performed for clinically suspicious LBP.Conclusion: Greater clarity is needed on how we define and measure imaging appropriateness for LBP, which also accounts for the problem of failing to image when indicated. An internationally agreed methodology for imaging appropriateness studies would ultimately lead to an improvement in the care delivered to patients. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

This paper mainly investigates a single-period spatial oligopolistic model of electricity generators under uncertain demands. We maximize the β -optimistic value of each generator's uncertain profit function in this game. Emphasis is first put on computing the β -optimistic value of the uncertain profit function through the inverse uncertainty distribution of the uncertain variable in the inverse demand function. We later focus on transforming the single-period spatial oligopolistic game, which is a generalized Nash equilibrium (short for GNE) problem, into a variational inequality problem. Then the model is applied to simulate the transmission price of the electricity system of America, which reveals that our model is effective. [ABSTRACT FROM AUTHOR]

Objectives: Worldwide, depression is one of the most common medical disorders in adolescence. Adolescent depressive symptoms generally increase over time, but many experience decreases after an initial peak. The purpose of this paper was to examine ecological predictors of baseline and change in adolescent depressive symptoms using Maslow's Hierarchy of Needs as a framework. Methods: Adolescents (n = 500; 52% female; baseline age 10–13 years) and their parents living in the northwestern United States completed annual questionnaires over six years. A structural equation model growth curve analysis was conducted to examine how family stressors, neighborhood safety, parent-child connectedness, and youth locus of control predicted adolescent depressive symptoms (baseline and growth). Results: Results demonstrated that adolescent locus of control was associated with lower baseline depressive symptoms (β = −0.27, p < 0.001). Parent-child connectedness (youth-report) was indirectly predictive of baseline depressive symptoms through locus of control (β = −0.06, p < 0.05). Family economic stress was predictive of less growth in depressive symptoms over time (β = −0.20, p < 0.05). General family stressors, neighborhood safety, and parent report of parent-child connectedness were not predictive of adolescent depressive symptoms. In a sensitivity analysis using an autoregressive model, adolescent-report of parent-child connectedness was the most consistently predictive measure of adolescent depressive symptoms. Conclusions: Overall, the results suggest that feelings of family connectedness and control are more important to understanding baseline depressive symptoms than physical, contextual factors. However, some adversity may be healthy and provide adolescents with experiences that slow the growth of depression. [ABSTRACT FROM AUTHOR]

The availability of fossil fuels in the future and the environmental effects such as the carbon footprint of the existing methodologies to produce electricity is an increasing area of concern. In rural areas of under-developed parts of the world, the problem is lack of access to electrification. DC microgrids have become a proven solution to electrification in these areas with demonstrated exceptional quality of power, high reliability, efficiency, and simplified integration between renewable energy sources (principally solar PV) and energy storage. In the United States, a different problem occurs that can be addressed with the same DC microgrid approach that is finding success internationally. In disinvested, underserved communities of with high unemployment and low wages, households contribute a significant portion of their income toward the fixed cost of their electrical utility connection, which by law must be supplied to every household. This paper analyzes a residential DC microgrid in an urban, underserved area that enables the sharing of renewable and stored energy resources between dwellings. The goal of the residential DC microgrid is to drive down to fixed costs of utility-provided electricity to all participants, such that the percentage of utility cost to total household income comes can be made comparable to that of more advantaged communities. A group of renovated dwellings constitute the community which the DC microgrid would serve. The distributed installation of solar panels and battery storage among dwelling locations are optimized based upon varying consumption patterns. Also, consumption patterns during different seasons of the year are considered. Electrical distribution architectures within the dwellings are based upon conventional AC. Each dwelling has a DC interface to the residential microgrid and progressive insertion of DC loads, with associated household DC distribution, is considered. [ABSTRACT FROM AUTHOR]

The aim of the present study was to perform a critical reflection about intervention options for bruxism reduction in children and adolescents. Search was conducted based on the PICO-structured question: "What are the intervention options to reduce bruxism in children/adolescents?". No language, year, or study design restrictions were imposed. Studies reporting interventions to reduce bruxism in children (< 10) and adolescents (10 to 19 years old) were included. Reviews and letters to editors were not included. From 2723 records, 17 papers were included. Included studies were primarily randomized clinical trials performed in Brazil (35.3%) and using different criteria for the diagnosis of bruxism. Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medications (hydroxyzine/trazodone/flurazepam), occlusal splints, orthodontic interventions, and psychological and physical therapy interventions. Reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and in orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis-L) have shown inconclusive results.Conclusions: Several intervention options are available to inhibit or reduce bruxism activity. The respective indication, contraindications, and side effects of each treatment option must be assessed individually and carefully, taking into account that bruxism is not considered a disorder in otherwise healthy individuals.What is known• Biological and psychological factors have been strongly correlated to the development of bruxism• Bruxism prevalence ranging from 6 to 50% in childrenWhat is new• Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medication (Hydroxyzine/ Trazodone/ Flurazepam), occlusal splints, orthodontic interventions, psychological, and physical therapy interventions• A reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis L) show inconclusive results in respect of the reduction in bruxism. [ABSTRACT FROM AUTHOR]

Indigenous communities often face disproportionate challenges across a variety of health domains, and effective prevention strategies are sorely needed. Unfortunately, evidence is scant regarding what approaches are effective for these communities. A common approach is to take an evidence-based practice or program with documented effectiveness in other populations and implement it with Indigenous populations. While a science of intervention adaptation is emerging, there remains little guidance on processes for adaptation that strategically leverage both existing scientific evidence and Indigenous prevention strategies. In this paper, two case studies illustrate promising practices for adaptation, documenting the approaches of two research teams funded under the National Institutes of Health's initiative to support Intervention Research to Improve Native American Health (IRINAH). These teams worked with distinct Indigenous populations in the USA and Canada to culturally adapt the same prevention program, the Iowa Strengthening Families Program for Parents and Youth 10-14. The approaches of these two teams and the programs that resulted are compared and contrasted, and critical elements of adaptation in partnership with Indigenous communities are discussed. [ABSTRACT FROM AUTHOR]

In this paper, we describe mating patterns in the USA from 1964 to 2017 and measure the impact of changes in marital preferences on between-household income inequality. We rely on the recent literature on the econometrics of matching models to estimate complementarity parameters of the household production function. Our structural approach allows us to measure sorting along multiple dimensions and to effectively disentangle changes in marital preferences and in demographics, addressing concerns that affect results from existing literature. We answer the following questions: Has assortativeness increased over time? Along which dimensions? To what extent can the shifts in marital preferences explain inequality trends? We find that, after controlling for other observables, assortative mating in education has become stronger. Moreover, if mating patterns had not changed since 1971, the 2017 Gini coefficient between married households would be 6% lower. We conclude that about 25% of the increase in between-household inequality is due to changes in marital preferences. Increased assortativeness in education positively contributes to the rise in inequality, but only modestly. [ABSTRACT FROM AUTHOR]

At the request of French Regulatory Authorities, a new formulation of Levothyrox® was licensed in France in 2017, with the objective of avoiding the stability deficiencies of an existing licensed formulation. Before launching the new formulation, an average bioequivalence (ABE) trial was conducted, having enrolled 204 subjects and selected for interpretation a narrow a priori bioequivalence range of 0.90-1.11. Bioequivalence was concluded. In a previous publication, we questioned the ability of an ABE trial to guarantee the switchability within patients of the new and old levothyroxine formulations. It was suggested that the two formulations should be compared using the conceptual framework of individual bioequivalence. The present paper is a response to those claiming that, despite the fact that ABE analysis does not formally address the switchability of the two formulations, future patients will nevertheless be fully protected. The basis for this claim is that the ABE study was established in a large trial and analyzed using a stringent a priori acceptance interval of equivalence. These claims are questionable, because the use of a very large number of subjects nullifies the implicit precautionary intention of the European guideline when, for a Narrow Therapeutic Index drug, it recommends shortening the a priori acceptance interval from 0.80-1.25 to 0.90-1.11. [ABSTRACT FROM AUTHOR]

This paper examines the forecasting skill of eight Global Climate Models from the North-American Multi-Model Ensemble project (CCSM3, CCSM4, CanCM3, CanCM4, GFDL2.1, FLORb01, GEOS5, and CFSv2) over seven major regions of the continental United States. The skill of the monthly forecasts is quantified using the mean square error skill score. This score is decomposed to assess the accuracy of the forecast in the absence of biases (potential skill) and in the presence of conditional (slope reliability) and unconditional (standardized mean error) biases. We summarize the forecasting skill of each model according to the initialization month of the forecast and lead time, and test the models' ability to predict extended periods of extreme climate conducive to eight 'billion-dollar' historical flood and drought events. Results indicate that the most skillful predictions occur at the shortest lead times and decline rapidly thereafter. Spatially, potential skill varies little, while actual model skill scores exhibit strong spatial and seasonal patterns primarily due to the unconditional biases in the models. The conditional biases vary little by model, lead time, month, or region. Overall, we find that the skill of the ensemble mean is equal to or greater than that of any of the individual models. At the seasonal scale, the drought events are better forecast than the flood events, and are predicted equally well in terms of high temperature and low precipitation. Overall, our findings provide a systematic diagnosis of the strengths and weaknesses of the eight models over a wide range of temporal and spatial scales. [ABSTRACT FROM AUTHOR]

Compositional variations in GaAs based ternary alloys have exhibited wide range alterations in electronic properties. In the present paper, first-principles study of GaAsxSb1 – x ternary alloys have been presented and discussed. Density functional theory (DFT) computation based on the full-potential (linearized) augmented plane-wave (FP-LAPW) method has been utilized to calculate the Density of States (DOS) and the band structure of ternary alloys GaAsxSb1 – x (x = 0, 0.25, 0.50, 0.75, 1). The calculations were performed using the exchange-correlation energy functional from Perdew, Burke, and Ernzerhof, a generalized-gradient approximation (GGA-PBE) and Becke–Johnson exchange potential with local-density approximation (BJLDA) available within the framework of WIEN2k code. As compared to PBE, the results obtained from BJLDA are in close agreement with other experimental works. The DOS results show a reduction in bandgap as the Sb fraction is increased in GaAsxSb1 – x ternary alloys. The bandgap obtained by PBE and BJLDA are found to deviate from Vegard's law, i.e., it doesn't vary linearly with composition. However, the bandgap obtained by BJLD is found to closely match Vegard's law when the bowing parameter is considered. [ABSTRACT FROM AUTHOR]

Statistical methods for inference on spatial extremes of large datasets are yet to be developed. Motivated by standard dimension reduction techniques used in spatial statistics, we propose an approach based on empirical basis functions to explore and model spatial extremal dependence. Based on a low-rank max-stable model, we propose a data-driven approach to estimate meaningful basis functions using empirical pairwise extremal coefficients. These spatial empirical basis functions can be used to visualize the main trends in extremal dependence. In addition to exploratory analysis, we describe how these functions can be used in a Bayesian hierarchical model to model spatial extremes of large datasets. We illustrate our methods on extreme precipitations in eastern USA. Supplementary materials accompanying this paper appear online [ABSTRACT FROM AUTHOR]

When analyzing knowledge production, the evidence suggests that within the USA, foreign-born researchers exhibit more productivity than their domestic counterparts. Previous literature indicates that productivity differences can be explained by higher academic ability and the selection of more research-oriented fields among foreign-born. In this study, we use individual data from the restricted-access version of the Survey of Doctoral Recipients between 1995 and 2003 to extend this notion and compare knowledge production, in terms of papers presented, articles published, patent applications, and patents granted, of foreign-born and domestic PhD recipients. Our results strongly support the notion that foreign-born researchers, and especially naturalized US citizens, outperform their domestic counterparts in all four of our measures of knowledge production. We show that while aspects associated with academic training, quality of the school, occupation mismatch, and fields of study, among others, play a role in productivity differentials, they only account for a small proportion of the variability. We develop a theoretical a model to show that non-directly observable aspects associated with non-academic ability of foreign-born and a better match between the student and the PhD program, associated with differing opportunity costs of attending the program, may explain the results. Different specifications and robustness checks are conducted to provide support to our theory. [ABSTRACT FROM AUTHOR]

Scientometrics is a popular statistical application providing data revealing publication trends and patterns in a certain academic field. A quite limited number of studies investigating scientometric features of health and religion literature have been reported in academic literature. The present study aims to present a holistic analysis of health literature related to Shamanism, Paganism and Spirituality. To the best of our knowledge, this is the first study in this field. All data of this analysis were yielded from Web of Science databases. All documents produced between 1975 and 2017 were included. In Shamanism and health field, a total of 157 documents were found, and the USA covering 35.67% of all the literature was the leading country. University of California System (USA) was the most contributor institution. Our search on Paganism and health literature retrieved 51 published documents, and the most productive institution was National Dong Hwa University from Taiwan. A total of 7862 documents were detected in Spirituality and health literature, and the most prolific author in this field was Koenig HG with 82 papers. Journal of Religion and Health was noted to be the predominant academic source in health literature related to ancient beliefs. The number of the publications produced in Spirituality and health literature was greater than total number of all documents published in health literature related to Abrahamic religions, Dharmic religions, Shamanism and Paganism. [ABSTRACT FROM AUTHOR]

America faces a series of intersecting problems that relate to health inequities, failing schools, and an inadequate science, technology, engineering, and math (STEM) workforce, particularly in cities and among low-income Black and Latino youth. Here, we propose a solution, namely reforming secondary school education to include mandatory exposure to population thinking instruction to address these overlapping issues. Public health education has expanded in recent decades in undergraduate education, though it has yet to become an integral component of high school curricula. In this paper, we make the case that all youth should gain exposure to the skills of population thinking through public health education initiated in high school. We further provide a rationale for this approach drawn from multiple youth development frameworks and the community schools movement for honing youth critical thinking skills and problem solving relating to individual and community health, policy, and activism. [ABSTRACT FROM AUTHOR]

Each year, many young professionals forego advanced education in the traditional doctoral programs of medicine, law, and philosophy in favor of pursuing a PhD or professional doctorate in bioethics or healthcare ethics that is offered by several major institutes of higher education across the United States. These graduates often leverage their degrees into careers within the broader field of bioethics. As such, they represent a growing percentage of professional bioethicists in both academia and healthcare nationwide. Given the significant role that doctoral bioethics programs play in the training of future professional bioethicists, it is imperative that programs conferring bioethics degrees are attuned to the knowledge and skills students will need as they transition to professional positions, especially where this training substantially differs from more traditional doctoral degree tracks. Yet, even given this need, there is nothing in the professional literature regarding doctoral bioethics graduates' perspectives or the overall efficacy of a bioethics doctorate as compared to more traditional doctoral degree tracks for future professional bioethicists. This paper then gives the perspective of five recent doctoral bioethics graduates on the utility of a bioethics doctorate and areas where the doctorate prepared or underprepared them in their roles as early-career professional bioethicists. [ABSTRACT FROM AUTHOR]

Images of students in overseas settings have become a common feature of university websites in the USA, as universities employ bold visual imagery to encourage student participation in study abroad programs and to market the university more broadly. In this paper, we analyze the content of this visual material, reporting on an extensive analysis of 2000 screenshots from the websites of 39 leading U.S. research universities. We focus on three recurring visual categories of meaning that show up across the cases: images of students jumping, horizon-gazing, and standing with their arms open wide. We extend prior analyses of how marketing imagery commodifies study abroad, arguing that these images must also be situated within the cultural context of elite American higher education, where college is not only seen as a utilitarian or academic pursuit, but is also—or perhaps mostly—understood as a time of fun, maturation, personal discovery, and self-transformation. This work makes a methodological contribution toward the use of visual imagery in higher education research and also advances theoretical studies of how the meaning of study abroad is constructed and communicated. [ABSTRACT FROM AUTHOR]

In this paper, we explore the relationships that individuals have with their communities. This work was prepared as part of the ASA Data Expo '13 sponsored by the Graphics Section and the Computing Section, using data provided by the Knight Foundation Soul of the Community survey. The Knight Foundation in cooperation with Gallup surveyed 43,000 people over 3 years in 26 communities across the United States with the intention of understanding the association between community attributes and the degree of attachment people feel towards their community. These include the different facets of both urban and rural communities, the impact of quality education, and the trend in the perceived economic conditions of a community over time. The goal of our work is to facilitate understanding of why people feel attachment to their communities through the use of an interactive and web-based visualization. We will explain the development and use of web-based interactive graphics, including an overview of the R package Shiny and the JavaScript library D3, focusing on the choices made in producing the visualizations and technical aspects of how they were created. Then we describe the stories about community attachment that unfolded from our analysis. [ABSTRACT FROM AUTHOR]

Purpose: Gestational surrogacy (GS) has been researched in multiple qualitative studies. In contrast, quantitative aspects of the practice are conspicuously understudied. The present article assesses and compares the incidence of GS in the USA and Israel, two industrialized countries that have maintained active commercial surrogacy practice, for over two decades. Method: The article is a secondary analysis of GS figures published by the Israeli Parliament's Centre for Research and Information (2018) and by the USA's Centers for Disease Control (2016) and related professional publications. Each dataset is analyzed in reference to the respective country, so as to devise local incidence scores that are then juxtaposed in inter-country comparison. Results: The incidence of GS rises steeply in both countries. Though US surrogates are contracted by local and international, heterosexual and gay, and partnered and single intended parents, the relative incidence of GS is lower in the USA than in Israel, where only local heterosexual couples could contract a gestational surrogate. An exceptionally high rate of multiple births was observed in both settings, suggesting some overlooking of professional recommendations for elective single-embryo transfer. Conclusion: GS incidence appears to resemble the ratio between the countries' respective fertility rates. The paper underscores two main risks facing gestational surrogates: the risk of not conceiving and not being paid and the risk of carrying a multiple pregnancy, which is extremely prevalent in GS pregnancies, and sustaining the short- and long-term health complications that are more prevalent in such pregnancies. [ABSTRACT FROM AUTHOR]