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Background: One of the goals of the Multi-site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM) study was to evaluate whether clinicians experienced in diagnosing and caring for patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) recognized the same clinical entity. Methods: We enrolled participants from seven specialty clinics in the United States. We used baseline data (n = 465) on standardized questions measuring general clinical characteristics, functional impairment, post-exertional malaise, fatigue, sleep, neurocognitive/autonomic symptoms, pain, and other symptoms to evaluate whether patient characteristics differed by clinic. Results: We found few statistically significant and no clinically significant differences between clinics in their patients' standardized measures of ME/CFS symptoms and function. Strikingly, patients in each clinic sample and overall showed a wide distribution in all scores and measures. Conclusions: Illness heterogeneity may be an inherent feature of ME/CFS. Presenting research data in scatter plots or histograms will help clarify the challenge. Relying on case–control study designs without subgrouping or stratification of ME/CFS illness characteristics may limit the reproducibility of research findings and could obscure underlying mechanisms. [ABSTRACT FROM AUTHOR]

The article provides information on the Network for Investigation of Delirium: Unifying Scientists (NIDUS) which aims to develop the collaborative network and infrastructure to advance scientific research and train on the causes, mechanisms, outcomes, diagnosis, prevention, and treatment of delirium in older adults. Topics include the renewal of NIDUS as NIDUS II in 2020, structure of NIDUS, and summary of NIDUS-I and NIDUS-II accomplishments.

Background: High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure. Purpose: To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs. Study Design: Systematic review; Level of evidence, 4. Methods: The Cochrane Database of Systematic Reviews, PubMed, Embase, and MEDLINE databases were queried for studies reporting complications associated with HTO with or without concomitant procedures. Data including patient characteristics, procedure type, concomitant procedures, follow-up time, and postoperative imaging were extracted. Rates of intra- and postoperative complications, reoperations, and conversion to arthroplasty were recorded. Results: A total of 71 studies were included for analysis, comprising 7836 patients. The overall intraoperative complication rate during HTO was 5.5% (range, 0%-29.3%), and the overall postoperative complication rate was 6.9% (range, 0%-26.6%). The most common intraoperative complication was lateral hinge fracture (incidence, 9.1%; range, 0%-30.4%) in medially based HTOs and peroneal nerve injury in laterally based HTOs (incidence, 3.2%; range, 0%-8.7%). The overall incidence of neurovascular injury after medially or laterally based HTOs was 1.1% (range, 0%-18.9%). The most common postoperative complication was superficial infection (incidence, 2.2%; range, 0%-13%). Of the included studies, 62 included postoperative radiographic analysis, and among those, the incidence of nonunion was 1.9% (range, 0%-15.5%), loss of correction was 1.2% (range, 0%-34.3%), and implant failure was 1.0% (range, 0%-10.2%). Among studies reporting revision surgeries, the overall reoperation rate was 15.5% (range, 0%-70.7%), with the most common type of reoperation being hardware removal (incidence, 10.0%; range, 0%-60%). Conclusion: Intraoperatively, medially based HTOs are associated with a 1 in 11 risk of lateral hinge fracture and laterally based HTOs with a 1 in 30 risk of peroneal nerve injury. Postoperative complication rates in the range of 10% to 15% can be expected, including infection (2.9%), loss of correction (1.2%), and nonunion (1.9%). Patients should also be counseled that the reoperation rate is approximately 15%, with hardware removal being the most common procedure. [ABSTRACT FROM AUTHOR]

Water resource managers require accurate estimates of the 7-day, 10-year low flow (7Q10) of streams for many reasons, including protecting aquatic species, designing wastewater treatment plants, and calculating municipal water availability. StreamStats, a publicly available web application developed by the United States Geologic Survey that is commonly used by resource managers for estimating the 7Q10 in states where it is available, utilizes state-by-state, locally calibrated regression equations for estimation. This paper expands StreamStats' methodology and improves 7Q10 estimation by developing a more regionally applicable and generalized methodology for 7Q10 estimation. In addition to classical methodologies, namely multiple linear regression (MLR) and multiple linear regression in log space (LTLR), three promising machine learning algorithms, random forest (RF) decision trees, neural networks (NN), and generalized additive models (GAM), are tested to determine if more advanced statistical methods offer improved estimation. For illustrative purposes, this methodology is applied to and verified for the full range of unimpaired, gaged basins in both the northeast and mid-Atlantic hydrologic regions of the United States (with basin sizes ranging from 2–1419 mi2) using leave-one-out cross-validation (LOOCV). Pearson's correlation coefficient (R2), root mean square error (RMSE), Kling–Gupta Efficiency (KGE), and Nash–Sutcliffe Efficiency (NSE) are used to evaluate the performance of each method. Results suggest that each method provides varying results based on basin size, with RF displaying the smallest average RMSE (5.85) across all ranges of basin sizes. [ABSTRACT FROM AUTHOR]

Xenotransplantation is envisioned as a potential solution to the shortage of organs available for transplant. However, it poses scientific and ethical challenges. This commentary evaluates the key advancements and constraints in xenotransplantation research and proposes prerequisites to ensure that human clinical studies in the United States are conducted safely and ethically. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We used cultural neuropsychology‐informed procedures to derive and validate harmonized scores representing memory and language across population‐based studies in the United States and Mexico. METHODS: Data were from the Health and Retirement Study Harmonized Cognitive Assessment Protocol (HRS‐HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex‐Cog). We statistically co‐calibrated memory and language domains and performed differential item functioning (DIF) analysis using a cultural neuropsychological approach. We examined relationships among harmonized scores, age, and education. RESULTS: We included 3170 participants from the HRS‐HCAP (Mage = 76.6 [standard deviation (SD): 7.5], 60% female) and 2042 participants from the Mex‐Cog (Mage = 68.1 [SD: 9.0], 59% female). Five of seven memory items and one of twelve language items demonstrated DIF by study. Harmonized memory and language scores showed expected associations with age and education. DISCUSSION: A cultural neuropsychological approach to harmonization facilitates the generation of harmonized measures of memory and language function in cross‐national studies. HIGHLIGHTS: We harmonized memory and language scores across studies in the United States and Mexico.A cultural neuropsychological approach to data harmonization was used.Harmonized scores showed minimal measurement differences between cohorts.Future work can use these harmonized scores for cross‐national studies of Alzheimer's disease and related dementias. [ABSTRACT FROM AUTHOR]

Background: With an increasing number of primary anterior cruciate ligament reconstructions (ACLRs), the burden of revision ACLR (rACLR) has also increased. Graft choice for rACLR is complicated by patient factors and the remaining available graft options. Purpose: To examine the association between graft type at the time of rACLR and the risk of repeat rACLR (rrACLR) in a large US integrated health care system registry while accounting for patient and surgical factors at the time of revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Data from the Kaiser Permanente ACLR registry were used to identify patients who underwent a primary isolated ACLR between 2005 and 2020 and then went on to have rACLR. Graft type used at rACLR, classified as autograft versus allograft, was the exposure of interest. Multivariable Cox proportional hazard regression was used to evaluate the risk of rrACLR, with ipsilateral and contralateral reoperation as secondary outcomes. Models included factors at the time of the rACLR (age, sex, body mass index, smoking status, staged revision, femoral fixation, tibial fixation, femoral tunnel method, lateral meniscal injury, medial meniscal injury, and cartilage injury) and a factor from the primary ACLR (activity at injury) as covariates. Results: A total of 1747 rACLR procedures were included. The crude cumulative rrACLR incidence at 8-year follow-up was 13.9% for allograft and 6.0% for autograft. Cumulative ipsilateral reoperation incidence at 8-year follow-up was 18.3% for allograft and 18.9% for autograft; contralateral reoperation cumulative incidence was 4.3% for allograft and 6.8% for autograft. With adjustment for covariates, a 70% lower risk for rrACLR was observed for autograft compared with allograft (hazard ratio [HR], 0.30; 95% CI, 0.18-0.50; P <.0001). No differences were observed for ipsilateral reoperation (HR, 1.05; 95% CI, 0.73-1.51; P =.78) or contralateral reoperation (HR, 1.33; 95% CI, 0.60-2.97; P =.48). Conclusion: The use of autograft at rACLR was associated with a 70% lower risk of rrACLR compared with allograft in this cohort from the Kaiser Permanente ACLR registry. When accounting for all reoperations outside of rrACLR after rACLR, the authors found no significant difference in risk between autograft and allograft. To minimize the risk of rrACLR, surgeons should consider using autograft for rACLR when possible. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the clinical features that moderate a later age at ASD diagnosis in females in a large sample of females with ASD. Within two large and independent ASD datasets (> 20,000 females), females were first diagnosed with ASD 14-months later relative to males. This later age at diagnosis was moderated by a mild or atypical presentation, wherein repetitive behaviors were limited, IQ and language were broadly intact, and recognized symptoms emerged later in development. Females are at risk for a later age at ASD diagnosis and treatment implementation, and modification of early childhood ASD screening methods for females may be warranted. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive abilities have been implicated as predictors of mortality in older adults. This study examines the effects of cognitive training on mortality 20 years post-intervention. Methods: Data come from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial (N = 2802). Participants were cognitively and physically healthy, community-dwelling adults aged 65 and older. Cox proportional hazard models were used to investigate (1) the association between baseline cognition and mortality risk and (2) the effect of ACTIVE cognitive training (memory, reasoning, and speed of processing) on mortality risk 20 years post-intervention. Results: Higher baseline cognition predicted lower mortality risk 20 years post-intervention. No significant effects of ACTIVE cognitive training in memory, reasoning, or speed of processing on mortality risk were observed. Discussion: More work is needed to identify cognitive training interventions that may lead to lower mortality risks in later adulthood. [ABSTRACT FROM AUTHOR]

Introduction: The large number of heterogeneous instruments in active use for identification of delirium prevents direct comparison of studies and the ability to combine results. In a recent systematic review we performed, we recommended four commonly used and well-validated instruments and subsequently harmonized them using advanced psychometric methods to develop an item bank, the Delirium Item Bank (DEL-IB). The goal of the present study was to find optimal cut-points on four existing instruments and to demonstrate use of the DEL-IB to create new instruments. Methods: We used a secondary analysis and simulation study based on data from three previous studies of hospitalized older adults (age 65+ years) in the USA, Ireland, and Belgium. The combined dataset included 600 participants, contributing 1,623 delirium assessments, and an overall incidence of delirium of about 22%. The measurements included the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria for delirium, Confusion Assessment Method (long form and short form), Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98 (total and severity scores), and Memorial Delirium Assessment Scale (MDAS). Results: We identified different cut-points for each existing instrument to optimize sensitivity or specificity, and compared instrument performance at each cut-point to the author-defined cut-point. For instance, the cut-point on the MDAS that maximizes both sensitivity and specificity was at a sum score of 6 yielding 89% sensitivity and 79% specificity. We then created four new example instruments (two short forms and two long forms) and evaluated their performance characteristics. In the first example short form instrument, the cut-point that maximizes sensitivity and specificity was at a sum score of 3 yielding 90% sensitivity, 81% specificity, 30% positive predictive value, and 99% negative predictive value. Discussion/Conclusion: We used the DEL-IB to better understand the psychometric performance of widely used delirium identification instruments and scorings, and also demonstrated its use to create new instruments. Ultimately, we hope that the DEL-IB might be used to create optimized delirium identification instruments and to spur the development of a unified approach to identify delirium. [ABSTRACT FROM AUTHOR]

Videogames and videogame literacies are an important and growing aspect of education, yet videogaming remains poorly understood and even viewed with suspicion by many who are charged with promoting them. In the case of libraries, such views can lead to insufficient funding and policies that reduce the presence of youth programing that includes videogame play, and, therefore, it is important to understand the factors that support or inhibit videogame programming in libraries. This article presents findings from a national survey of more than 1,000 U.S. librarians in all 50 states to begin to understand the factors that might promote the presence (and absence) of videogame programming; the factors that support and impede the success of such programming; and the literacies that such youth programming might foster. Although this study focuses on videogame programming in libraries, its findings are relevant to anyone who promotes the development of youth literacies. [ABSTRACT FROM AUTHOR]

Objectives To characterize the extent to which brief cognitive assessments administered in the population-representative U.S. Health and Retirement Study (HRS) and its International Partner Studies can be considered to be measuring a single, unidimensional latent cognitive function construct. Methods Cognitive function assessments were administered in face-to-face interviews in 12 studies in 26 countries (N = 155,690), including the U.S. HRS and selected International Partner Studies. We used the time point of the first cognitive assessment for each study to minimize differential practice effects across studies and documented cognitive test item coverage across studies. Using confirmatory factor analysis models, we estimated single-factor general cognitive function models and bifactor models representing memory-specific and nonmemory-specific cognitive domains for each study. We evaluated model fits and factor loadings across studies. Results Despite relatively sparse and inconsistent cognitive item coverage across studies, all studies had some cognitive test items in common with other studies. In all studies, the bifactor models with a memory-specific domain fit better than single-factor general cognitive function models. The data fit the models at reasonable thresholds for single-factor models in 6 of the 12 studies and for the bifactor models in all 12 of the 12 studies. Discussion The cognitive assessments in the U.S. HRS and its International Partner Studies reflect comparable underlying cognitive constructs. We discuss the assumptions underlying our methods, present alternatives, and future directions for cross-national harmonization of cognitive aging data. [ABSTRACT FROM AUTHOR]

Background: Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder-mediators of the effect of migration on health.Methods: We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW.Results: Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models.Conclusions: Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration. [ABSTRACT FROM AUTHOR]

The article by Kocsis and Palermo, published in 2016, examined the findings of research which had assessed the validity of the investigative technique colloquially known as criminal profiling. These findings were subsequently considered within the framework of their relevance to the admissibility of the technique as a form of expert witness evidence. The overall conclusion was that a discrete facet of the profiling technique may satisfy some of the requisite legal criteria for admissibility in jurisdictions within the United States. However, this conclusion was based upon studies which used samples of senior forensic psychiatrists and psychologists as the tested profilers. In this regard, it was noted that this parameter may preclude the generalization of this conclusion to other professional groups who do not possess such qualifications. Accordingly, the present article explores the potential admissibility of law enforcement personnel who are not qualified forensic mental health practitioners tendering expert witness evidence in the nature of criminal profiling. The conclusion of this analysis is that law enforcement personnel who possess suitable expertise in the analytic task of criminal profiling arguably possess an analogous knowledge base akin to the aforementioned senior forensic psychiatrists and psychologists. On this basis, the conclusions in Kocsis and Palermo, published in 2016, may extend to such personnel and their potential to likewise provide expert witness evidence. [ABSTRACT FROM AUTHOR]

Changes to the United States kidney allocation system targeted at reducing organ discard have failed to improve organ utilization. High Kidney Donor Profile Index kidneys continue to be discarded at high rates as a result of the regulatory and financial barriers to widespread utilization of these organs. However, there are potential changes to clinical practice that could improve organ utilization. Expediting the time from initial offer to final organ acceptance would reduce cold ischemic time and should improve utilization. Implementation of procurement biopsy standards to avoid biopsy of low risk organs may prevent organ discards due to inaccurate data or excessive cold ischemia time. Further, standardization of procurement biopsy pathological interpretation coupled with electronic accessibility would enable early acceptance of difficult to transplant organs. These changes to allocation practice patterns are vital given proposals to expand the geographic sharing of deceased donor kidneys. Implementation of new allocation policies must be evaluated to ensure they result in higher transplant rates and acceptable post‐transplant outcomes. [ABSTRACT FROM AUTHOR]

Background: Teaching hospitals typically pioneer investment in new technology and cultivate workforce characteristics generally associated with better quality, but the value of this extra investment is unclear.Objective: Compare outcomes and costs between major teaching and non-teaching hospitals by closely matching on patient characteristics.Design: Medicare patients at 339 major teaching hospitals (resident-to-bed (RTB) ratios ≥ 0.25); matched patient controls from 2439 non-teaching hospitals (RTB ratios < 0.05).Participants: Forty-three thousand nine hundred ninety pairs of patients (one from a major teaching hospital and one from a non-teaching hospital) admitted for acute myocardial infarction (AMI), 84,985 pairs admitted for heart failure (HF), and 74,947 pairs admitted for pneumonia (PNA).Exposure: Treatment at major teaching hospitals versus non-teaching hospitals.Main Measures: Thirty-day all-cause mortality, readmissions, ICU utilization, costs, payments, and value expressed as extra cost for a 1% improvement in survival.Key Results: Thirty-day mortality was lower in teaching than non-teaching hospitals (10.7% versus 12.0%, difference = - 1.3%, P < 0.0001). The paired cost difference (teaching - non-teaching) was $273 (P < 0.0001), yielding $211 per 1% mortality improvement. For the quintile of pairs with highest risk on admission, mortality differences were larger (24.6% versus 27.6%, difference = - 3.0%, P < 0.0001), and paired cost difference = $1289 (P < 0.0001), yielding $427 per 1% mortality improvement at 30 days. Readmissions and ICU utilization were lower in teaching hospitals (both P < 0.0001), but length of stay was longer (5.5 versus 5.1 days, P < 0.0001). Finally, individual results for AMI, HF, and PNA showed similar findings as in the combined results.Conclusions and Relevance: Among Medicare patients admitted for common medical conditions, as admission risk of mortality increased, the absolute mortality benefit of treatment at teaching hospitals also increased, though accompanied by marginally higher cost. Major teaching hospitals appear to return good value for the extra resources used. [ABSTRACT FROM AUTHOR]

Tar spot on corn, caused by the fungus (Phyllachora maydis Maubl. [Phyllachorales: Phyllachoraceae]), is an emerging disease in the United States. In 2018 and 2019, significant but localized epidemics of tar spot occurred across the major corn producing region of the Midwest. After being first detected in 2015, tar spot was detected in 135 and 139 counties where the disease was not previously detected in 2018 and 2019, respectively, and is now established across 310 counties across the United Sates. Foliage with signs (stromata) of P. maydis and symptoms of tar spot were collected from 128 fields in 2018 and 191 fields in 2019, across seven states. Samples were assessed for severity of fungal stromata (percent leaf area covered with stromata) on foliage and the incidence of fisheye lesions (proportion of lesions with fisheye symptoms) associated with fungal stromata. Stromatal severity on samples in 2018 ranged from 0.5 to 67% and incidence of fisheye lesions ranged from 0 to 12%, whereas in 2019, stromatal severity ranged from 0.1 to 35% and incidence of fisheye lesions ranged from 0 to 80%, with 95% of samples presenting less than 6% incidence of fisheye lesions. Tar spot has spread substantially from where it was first reported in the United States. Collaborative efforts to monitor the spread and educate clientele on management are essential as this disease spreads into new areas. [ABSTRACT FROM AUTHOR]

Introduction: The Harmonized Cognitive Assessment Protocol (HCAP) Project is a substudy within the Health and Retirement Study (HRS), an ongoing nationally representative panel study of about 20,000 adults aged 51 or older in the United States. The HCAP is part of an international research collaboration funded by the National Institute on Aging to better measure and identify cognitive impairment and dementia in representative population-based samples of older adults, in the context of ongoing longitudinal studies of aging in high-, middle-, and low-income countries around the world. Methods: The HCAP cognitive test battery was designed to measure a range of key cognitive domains affected by cognitive aging (including attention, memory, executive function, language, and visuospatial function) and to allow harmonization and comparisons to other studies in the United States and around the world. The HCAP included a pair of in-person interviews, one with the target HRS respondent (a randomly selected HRS sample member, aged 65+) that lasted approximately 1 h and one with an informant nominated by the respondent that lasted approximately 20 min. The final HRS HCAP sample included 3,496 study subjects, representing a 79% response rate among those invited to participate. Conclusion: Linking detailed HCAP cognitive assessments to the wealth of available longitudinal HRS data on cognition, health, biomarkers, genetics, health care utilization, informal care, and economic resources and behavior will provide unique and expanded opportunities to study cognitive impairment and dementia in a nationally representative US population-based sample. The fielding of similar HCAP projects in multiple countries around the world will provide additional opportunities to study international differences in the prevalence, incidence, and outcomes of dementia globally with comparable data. Like all HRS data, HCAP data are publicly available at no cost to researchers. [ABSTRACT FROM AUTHOR]

The authors develop a general model of local-level bargaining in the multi-plant firm. According to this model, when the parent firm has the ability to allocate production differentially across plants, the local union may be motivated to work with local management to reduce production costs and increase profitability, in order to increase plant employment or minimize reductions in plant employment. A case study using data from General Motors' Lansing Grand River Assembly (LGRA) and United Auto Workers Local 652, collected in part from interviews conducted in 2003--2008, shows how the parties established a joint responsibility system of collective bargaining that encouraged the union to reduce production costs and increase profitability by accepting responsibilities traditionally borne by management. The authors also demonstrate that General Motors, consistent with budget, capacity, and political constraints, invested in LGRA and assigned new product to LGRA, thus supporting the hypothesized incentive structure. [ABSTRACT FROM AUTHOR]

In the mid-1980s, Japanese firms strongly challenged American dominance of the semiconductor industry. A large literature arose to suggest that, in order to survive, American firms needed to adopt the capabilities and strategies of the Japanese. Recently, American firms have indeed surged back to regain a strong position in the industry. This essay attempts to collect some of the lessons for strategy research of that American resurgence. We argue that, although some of the American response did consist in changing or augmenting capabilities, most of the renewed American success is in fact the result not of imitating superior Japanese capabilities but rather of taking good advantage of a set of capabilities developed in the earlier heyday of American dominance. [ABSTRACT FROM AUTHOR]

In an emergency department (ED) sample, we investigated the concordance between identification of suicide-related visits through standardized comprehensive chart review versus a subset of 3 specific chart elements: ICD-9-CM codes, free-text presenting complaints, and free-text physician discharge diagnoses. The method for this study was review of medical records for adults (≥18 years) at 8 EDs across the United States. A total of 3,776 charts were reviewed. A combination of the 3 chart elements (ICD-9-CM, presenting complaints, and discharge diagnoses) provided the most robust data with 85% sensitivity, 96% specificity, 92% PPV, and 92% NPV. These findings highlight the use of key discrete fields in the medical record that can be extracted to facilitate identification of whether an ED visit was suicide-related. [ABSTRACT FROM AUTHOR]

Detection of clusters of Legionnaires’ disease, a leading waterborne cause of pneumonia, is challenging. Clusters vary in size and scope, are associated with a diverse range of aerosol-producing devices, including exposures such as whirlpool spas and hotel water systems typically associated with travel, and can occur without an easily identified exposure source. Recently, jurisdictions have begun to use SaTScan spatio-temporal analysis software prospectively as part of routine cluster surveillance. We used data collected by the Active Bacterial Core surveillance platform to assess the ability of SaTScan to detect Legionnaires’ disease clusters. We found that SaTScan analysis using traditional surveillance data and geocoded residential addresses was unable to detect many common Legionnaires’ disease cluster types, such as those associated with travel or a prolonged time between cases. Additionally, signals from an analysis designed to simulate a real-time search for clusters did not align with clusters identified by traditional surveillance methods or a retrospective SaTScan analysis. A geospatial analysis platform better tailored to the unique characteristics of Legionnaires’ disease epidemiology would improve cluster detection and decrease time to public health action. [ABSTRACT FROM AUTHOR]

The article discusses the antitrust in the digital age in which voices along the whole of the political spectrum are calling for heightened scrutiny of American information-technology companies including Amazon, Apple and Facebook. Also discussed is the Chicago School which insisted that antitrust must be grounded in economic theory, which privileges the well-being of consumers as much as that of producers.

Background: Several single‐site alcohol treatment clinical trials have demonstrated efficacy for immediate‐release (IR) gabapentin in reducing drinking outcomes among individuals with alcohol dependence. The purpose of this study was to conduct a large, multisite clinical trial of gabapentin enacarbil extended‐release (GE‐XR) (HORIZANT®), a gabapentin prodrug formulation, to determine its safety and efficacy in treating alcohol use disorder (AUD). Methods: Men and women (n = 346) who met DSM‐5 criteria for at least moderate AUD were recruited across 10 U.S. clinical sites. Participants received double‐blind GE‐XR (600 mg twice a day) or placebo and a computerized behavioral intervention (Take Control) for 6 months. Efficacy analyses were prespecified for the last 4 weeks of the treatment period. Results: The GE‐XR and placebo groups did not differ significantly on the primary outcome measure, percentage of subjects with no heavy drinking days (28.3 vs. 21.5, respectively, p = 0.157). Similarly, no clinical benefit was found for other drinking measures (percent subjects abstinent, percent days abstinent, percent heavy drinking days, drinks per week, drinks per drinking day), alcohol craving, alcohol‐related consequences, sleep problems, smoking, and depression/anxiety symptoms. Common side‐effects were fatigue, dizziness, and somnolence. A population pharmacokinetics analysis revealed that patients had lower gabapentin exposure levels compared with those in other studies using a similar dose but for other indications. Conclusions: Overall, GE‐XR at 600 mg twice a day did not reduce alcohol consumption or craving in individuals with AUD. It is possible that, unlike the IR formulation of gabapentin, which showed efficacy in smaller Phase 2 trials at a higher dose, GE‐XR is not effective in treating AUD, at least not at doses approved by the U.S. Food and Drug Administration for treating other medical conditions. Gabapentin enacarbil extended‐release (GE‐XR) (HORIZANT) at 600 mg twice a day did not reduce alcohol consumption or craving in individuals with alcohol use disorder, including the primary outcome – the percentage of subjects with no heavy drinking days (PSNHDD). There was no significant difference between GE‐XR and placebo on PSNHDD across trial months and across the entire maintenance period (Weeks 2 to 25) (all ps > 0.05). [ABSTRACT FROM AUTHOR]

Policy PointsPatients with low socioeconomic status (SES) experience poorer survival rates after diagnosis of breast cancer, even when enrolled in Medicare and Medicaid.Most of the difference in survival is due to more advanced cancer on presentation and the general poor health of lower SES patients, while only a very small fraction of the SES disparity is due to differences in cancer treatment.Even when comparing only low‐ versus not‐low‐SES whites (without confounding by race) the survival disparity between disparate white SES populations is very large and is associated with lower use of preventive care, despite having insurance. Context: Disparities in breast cancer survival by socioeconomic status (SES) exist despite the "safety net" programs Medicare and Medicaid. What is less clear is the extent to which SES disparities affect various racial and ethnic groups and whether causes differ across populations. Methods: We conducted a tapered matching study comparing 1,890 low‐SES (LSES) non‐Hispanic white, 1,824 black, and 723 Hispanic white women to 60,307 not‐low‐SES (NLSES) non‐Hispanic white women, all in Medicare and diagnosed with invasive breast cancer between 1992 and 2010 in 17 US Surveillance, Epidemiology, and End Results (SEER) regions. LSES Medicare patients were Medicaid dual‐eligible and resided in neighborhoods with both high poverty and low education. NLSES Medicare patients had none of these factors. Measurements: 5‐year and median survival. Findings: LSES non‐Hispanic white patients were diagnosed with more stage IV disease (6.6% vs 3.6%; p < 0.0001), larger tumors (24.6 mm vs 20.2 mm; p < 0.0001), and more chronic diseases such as diabetes (37.8% vs 19.0%; p < 0.0001) than NLSES non‐Hispanic white patients. Disparity in 5‐year survival (NLSES − LSES) was 13.7% (p < 0.0001) when matched for age, year, and SEER site (a 42‐month difference in median survival). Additionally, matching 55 presentation factors, including stage, reduced the disparity to 4.9% (p = 0.0012), but further matching on treatments yielded little further change in disparity: 4.6% (p = 0.0014). Survival disparities among LSES blacks and Hispanics, also versus NLSES whites, were significantly associated with presentation factors, though black patients also displayed disparities related to initial treatment. Before being diagnosed, all LSES populations used significantly less preventive care services than matched NLSES controls. Conclusions: In Medicare, SES disparities in breast cancer survival were large (even among non‐Hispanic whites) and predominantly related to differences of presentation characteristics at diagnosis rather than differences in treatment. Preventive care was less frequent in LSES patients, which may help explain disparities at presentation. [ABSTRACT FROM AUTHOR]

The article comments on the article "The Evolution of Unjust-Dismissal Legislation in the United States," by Alan B. Krueger. This article cites the claim of Krueger, wherein he said that employer groups in some states actually support and sponsor unjust-dismissal laws. Moreover, the differences between the original bill and the amended bill are enumerated in this paper. In addition, it criticizes Krueger for concluding that employers and employer organizations have generally supported or sponsored unjust-dismissal legislation.

This study examines the propensity of unions to allocate resources to organizing activity. The author hypothesizes that as a union increases its extent of organization, the need of its members for organizing services declines relative to their need for representation services and also the costs of organizing are more likely to exceed its benefits. Consequently, the percentage of a union's resources devoted to organizing is expected to vary inversely with the extent to which the union has organized its primary jurisdiction. Data limitations prevent a direct test of this hypothesis, but a model based on this reasoning is used to predict differences across labor unions in the number of NLRB representation elections per 1000 union members. An analysis of relevant data for 1972- 78 tends to support the model. [ABSTRACT FROM AUTHOR]

Passenger transit companies in many cities are now municipally owned, and the trend to municipal ownership has accelerated in the past decade. As a result, city governments are faced with serious marketing problems for the transportation services they are selling. City-owned transit systems have inherited the marketing problems of the earlier private companies. Here is a discussion of how these problems evolved and the implications for the cities and citizens involved. [ABSTRACT FROM AUTHOR]

The article discusses how World War II and government control of production has affected the consuming habits of civilians. The author first points out the role of the consumer during a war economy, and shows how the needs of the war effort overrule the needs of the consumer as stated by the U.S. Office of Civilian Requirements. The determination of civilian requirements estimates is then described with the idea that a commodity is needed for the war effort when lack of that commodity would hinder the effort. He then discusses how the Office of Civilian Requirements made the estimates and how the allocation of these materials for civilian use was determined.

The author discusses the impact made upon "traditional" societies by U.S. and comparable Western business operations. Traditional societies are defined as having low education and health standards, low per capita gross national product, minimal economic infrastructure, inadequate government, and are generally based on subsistence farming. He feels that Western corporations entering such developing countries are "revolutionary" because they encourage a meritocracy as opposed to a more rigid caste system in which benefits are derived through a chance of birth.

The article discusses the ethical aspects of U.S. capitalism in the 1960's. There is conflict in the U.S. between Calvinist and Judeo-Christian ethics. The Calvinist ethic in combination with economic theories concerning competition dominated U.S. culture from 1620-1930. The theme of Judeo-Christian ethics combined with personal work and economics has dominated since 1930. Calvinistic values are in conflict with the idea of corporate social responsibility. In the political spectrum conservatives are seen as Calvinists and liberals are associated with the Judeo-Christian ethic.

This article focuses on the difficulties faced by the transportation industry due to government regulations. In recent years, there have been ample indications that all is not well in the transportation industry. Carrier financial difficulties are followed quickly by criticism of the government role in the transportation industry. The close regulation of the industry for seventy five years leads to the conclusion that government controls and activities in this economic sector are more relevant and important than they would be in a non-utility industry, and proposals for reform typically include suggestions that the federal government do something. The problem is that the kind of government regulation applied to transportation is an awkward fit, unsuited for the economic conditions of the industry. Rate control in the transportation industry has existed on the federal level for seventy-five years, starting with the first Interstate Commerce Act in 1887. Initial legislation provided for control over maximum prices and discrimination against selected railroad customers. The initial rationale behind price fixing in transportation was fear of monopoly.

Objectives (1) To determine the relationship of incident delirium during hospitalization with 90-day mortality; (2) to identify potential in-hospital mediators through which delirium increases 90-day mortality. Design Analysis of data from Project Recovery, a controlled clinical trial of a delirium prevention intervention from 1995 to 1998 with follow-up through 2000. Setting Large academic hospital. Participants Patients ≥70 years old without delirium at hospital admission who were at intermediate-to-high risk of developing delirium and received usual care only. Measurements (1) Incident delirium; (2) potential mediators of delirium on death including use of restraining devices (physical restraints, urinary catheters), development of hospital acquired conditions ( HACs) (falls, pressure ulcers), and exposure to other noxious insults (sleep deprivation, acute malnutrition, dehydration, aspiration pneumonia); (3) death within 90 days of admission. Results Among 469 patients, 70 (15%) developed incident delirium. These patients were more likely to experience restraining devices (37% vs 16%, P < .001), HACs (37% vs 12%, P < .001), other noxious insults (63% vs 49%, P = .03), and 90-day mortality (24% vs 6%, P < .001). The inverse probability weighted hazard of death due to delirium was 4.2 (95% CI = 2.8-6.3) in bivariable analyses, increased in a graded manner with additional exposures to restraining devices, HACs, and other noxious insults, and declined by 10.9% after addition of these potential mediator categories, providing evidence of mediation. Conclusion Restraining devices, HACs, and additional noxious insults were more frequent among patients with delirium, increased mortality in a graded manner, and were responsible for a significant percentage of the association of delirium with death. Additional efforts to prevent potential downstream mediators through which delirium increases mortality may help to improve outcomes among hospitalized older adults. [ABSTRACT FROM AUTHOR]

Objective: Spontaneous coronary artery dissection (SCAD) is a rare and potentially lethal cause of myocardial infarction (MI). The purpose of our study was to estimate the prevalence and maternal outcomes of pregnancies complicated by SCAD.Materials and Methods: A population-based cohort study on all births identified in the Healthcare Cost and Utilization Project from 2008 to 2012. Disease prevalence was calculated and logistic regression was used to estimate the adjusted odds ratio (aOR) for risk factors and different maternal complications.Results: A total of 4 363 343 pregnancy-related discharges were evaluated. 79 cases of SCAD were identified resulting in a prevalence of 1.81 per 100 000 pregnancies. The mean maternal age at the time of diagnosis was 33.4 years (±5.2). Chronic hypertension (aOR, 2.67; 95% CI 1.18 to 6.03), lipid profile abnormalities (aOR, 48.22; 95% CI 24.25 to 95.90), chronic depression (aOR, 3.56; 95% CI 1.43 to 8.83) and history of migraine (aOR, 3.93; 95% CI 1.52 to 10.17) were associated with an elevated risk for SCAD. MI was diagnosed in 66 (85.5%) cases of SCAD with anterior and subendocardial territories being the most common locations. Thirty one patients (40%) with SCAD underwent angioplasty with the majority receiving stents, which was associated with a longer hospital stay than those treated conservatively or with bypass.Conclusions: SCAD is a rare aetiology of MI; risk factors and outcomes are illustrated in the current study. The puerperium is an important period for the development of pregnancy-related SCAD. Careful evaluation of pregnant and postpartum women with chest pain is warranted, especially if these risk factors are identified. [ABSTRACT FROM AUTHOR]

This article provides information on research about the labor market in the U.S. Researchers are analyzing various issues and factors related to labor market such as effects of a computer-based occupational information system on career choices among high school seniors in eight states and the occupational mobility of scientists, engineers and technicians through the use of the National Science Foundation-Bureau of the Census. Using data from the Current Population Survey, researcher Robert Aronson is developing comparisons of the self-employed and other labor-force participants.

The author of this article is not angry. But he is deadly serious in questioning the significance of much of modern marketing. He believes that many aspects of the field of marketing are both irrelevant and unethical. Is he right or wrong? [ABSTRACT FROM AUTHOR]

The use and development of the investigative tool colloquially known as criminal profiling has steadily increased over the past five decades throughout the world. Coupled with this growth has been a diversification in the suggested range of applications for this technique. Possibly the most notable of these has been the attempted transition of the technique from a tool intended to assist police investigations into a form of expert witness evidence admissible in legal proceedings. Whilst case law in various jurisdictions has considered with mutual disinclination the evidentiary admissibility of criminal profiling, a disjunction has evolved between these judicial examinations and the scientifically vetted research testing the accuracy (i.e., validity) of the technique. This article offers an analysis of the research directly testing the validity of the criminal profiling technique and the extant legal principles considering its evidentiary admissibility. This analysis reveals that research findings concerning the validity of criminal profiling are surprisingly compatible with the extant legal principles. The overall conclusion is that a discrete form of crime behavioural analysis is supported by the profiler validity research and could be regarded as potentially admissible expert witness evidence. Finally, a number of theoretical connections are also identified concerning the skills and qualifications of individuals who may feasibly provide such expert testimony. [ABSTRACT FROM AUTHOR]

Objective: Standardized, reproducible, and feasible quantification of β-cell function (BCF) is necessary for the evaluation of interventions to improve insulin secretion and important for comparison across studies. We therefore characterized the responses to, and reproducibility of, standardized methods of in vivo BCF across different glucose tolerance states.Research Design and Methods: Participants classified as having normal glucose tolerance (NGT; n = 23), prediabetes (PDM; n = 17), and type 2 diabetes mellitus (T2DM; n = 22) underwent two standardized mixed-meal tolerance tests (MMTT) and two standardized arginine stimulation tests (AST) in a test-retest paradigm and one frequently sampled intravenous glucose tolerance test (FSIGT).Results: From the MMTT, insulin secretion in T2DM was >86% lower compared with NGT or PDM (P < 0.001). Insulin sensitivity (Si) decreased from NGT to PDM (∼50%) to T2DM (93% lower [P < 0.001]). In the AST, insulin secretory response to arginine at basal glucose and during hyperglycemia was lower in T2DM compared with NGT and PDM (>58%; all P < 0.001). FSIGT showed decreases in both insulin secretion and Si across populations (P < 0.001), although Si did not differ significantly between PDM and T2DM populations. Reproducibility was generally good for the MMTT, with intraclass correlation coefficients (ICCs) ranging from ∼0.3 to ∼0.8 depending on population and variable. Reproducibility for the AST was very good, with ICC values >0.8 across all variables and populations.Conclusions: Standardized MMTT and AST provide reproducible and complementary measures of BCF with characteristics favorable for longitudinal interventional trials use. [ABSTRACT FROM AUTHOR]

Objective: Few epidemiological studies have included Hispanics with the evaluation of the effects of cigarette smoking and breast cancer. We examined the relationship between cigarette smoking, ethnicity, and breast cancer risk using data from the Breast Cancer Health Disparities Study (BCHDS). Materials and Methods: The BCHDS is a consortium of three population-based case-control studies, including U.S. non-Hispanic whites (NHWs) (1,525 cases; 1,593 controls), U.S. Hispanics/Native Americans (1,265 cases; 1,495 controls), and Mexican women (990 cases; 1,049 controls). Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Breast cancer risk was elevated among Mexican former smokers (OR 1.43, 95% CI 1.04-1.96) and among those who smoked ≥31 years (OR 1.95, 95% CI 1.13-3.35), compared to never smokers. In addition, Mexican former smokers with a history of alcohol consumption had increased breast cancer risk (OR 2.30, 95% CI 1.01-5.21). Among NHW premenopausal women, breast cancer risk was increased for smoking ≥20 cigarettes per day (OR 1.61, 95% CI 1.07-2.41). Conclusion: Our findings suggest the possibility of ethnic differences with the associations between cigarette smoking and breast cancer risk. [ABSTRACT FROM AUTHOR]