John Brown University

Telomere length is a biomarker of molecular aging that may be impacted by air pollution exposure starting in utero. We aimed to examine the association between prenatal and early life exposure to fine particulate matter (PM

We present a broad notion of norms that can accommodate many of its interdisciplinary variants and offers a framework to ask questions about norm change. Rather than examining community norm change, we focus on changes in the individual's norm representations. These representations can be characterized by six properties (including as context specificity, deontic force, prevalence), and we examine which of the properties change as a result of norm learning and norm teaching. We first review research insights into norm learning based on observation, imitation, and various forms of inference. Then we examine norm learning that results from teaching, specifically teaching by modeling and demonstration, communication and instruction, and evaluative feedback. We finally speculate about how different kinds of norm change in a given community foster different kinds of norm learning in the individual community member.

Prenatal phthalate exposure may influence lung development and lead to wheezing and asthma in childhood, and these associations may vary by sex. Despite ubiquity of exposure, there is limited epidemiologic data on these associations in Latin America.

Becker S.J., Janssen T., Shiller H., DiBartolo E., Fan Y., Souza T., Kelly L.M., Helseth S.A.

Scant research has examined the impact of residential treatment on adolescent behavioral healthcare utilization post-discharge, even though behavioral healthcare utilization is major driver of healthcare costs. In the primary analyses of a pilot randomized trial, Parent SMART - a technology-assisted intervention for parents of adolescents in residential treatment - was found to improve parental monitoring and parent-adolescent communication, reduce adolescent drinking, and reduce adolescent school-related problems, relative to residential treatment as usual (TAU). The goal of this secondary analysis of the pilot randomized trial was to assess the effects of residential treatment and the adjunctive Parent SMART intervention on both the amount and type of subsequent behavioral healthcare utilization.

Griffith C.F., Froman R., Middleton H.

Background: This study investigates compensation structures and earnings differentials among dermatology physician assistants (PAs), focusing on variations in compensation models. Methods: Data from a survey of 346 members of the Pennsylvania Dermatology PAs were analyzed. The primary objectives were to examine the relationship between collections and salary and assess variations in salary based on compensation models. Results: Our findings indicate a significant difference in earnings among dermatology PAs based on compensation models. Specifically, those under a production-based and salary-plus-bonus model demonstrated significantly higher earnings compared with their counterparts on salary alone. Limitations: Our cohort was localized to Pennsylvania. This constraint emphasizes the necessity for additional research to extrapolate findings to dermatology PAs in other states and nationally. Future investigations should also explore factors such as benefits offerings as part of a PA compensation package, not addressed in this study. Conclusions: This research contributes valuable insights into the compensation landscape of dermatology PAs, emphasizing the need for a more extensive examination of factors influencing earnings. The findings underscore the importance of considering compensation models when assessing the broader landscape of health care workforce economics.

The World Health Organization (WHO) encourages countries to provide appropriate vaccinations for children, adolescents, and relevant adult populations. Childhood programme have been the focus of global investments, but recent pandemics have increasingly demonstrated the value of life course vaccination. Our objective is to compare national life course immunization programmatic maturity prior to mass COVID-19 vaccine introduction, the largest adult vaccination programme, globally. As coverage estimates (typically used to assess childhood programmes) are not available for adult vaccinations, this analysis pilots a standardized quantitative metric of programmatic maturity. Through consultation with vaccination experts, we developed a standardized approach to assess national immunization programme maturity across the life course. In accordance with expert input, five vaccines were selected to represent delivery across the life course: diphtheria tetanus toxoid and pertussis (DTP); measles (MCV) second dose; human papillomavirus (HPV) final dose; pneumococcal conjugate (PCV) final dose; and seasonal influenza annual dose. Experts recommended inclusion of the following indicators for each vaccine: a legal mandate (national policy), experience delivering the vaccine (programme duration), and vaccine use (uptake for relevant populations). We developed a metric accordingly that provides up to 5 points per vaccine (“vaccine specific maturity score”) which when summed forms the “life course maturity score”, with a maximum score of 25. We analysed the prevalence of national policies, experience, and use by region and World Bank income group. More than 55% of the 194 WHO Member States had childhood vaccine policies for all three of the vaccines considered (DTP, MCV, and PCV) compared to 60% for HPV (proxy for adolescent vaccination programme) and 52% for seasonal influenza (proxy for adult vaccination programme). Childhood vaccination programmes (e.g., MCV and DTP) had the highest vaccine specific maturity scores, while seasonal influenza and HPV vaccination programmes had much lower scores. The national life course maturity scores ranged from 1 to 23, with a global median of 12 (IQR: 8; 16). The piloted metric provides an overview of the maturity of life course immunization programmes. The metric is structured to be a flexible, rapid resource that can be used to assess other combinations of vaccines across the life course. The findings from this paper provide a baseline of immunization programme maturity for childhood, adolescent, and adult vaccination programmes immediately prior to the COVID-19 vaccine introduction. This maturity score, or adaptations of this approach, could be used to monitor the trajectory of national immunization programme maturity across the life course in the years ahead.

This paper explores the electoral effects of providing information on the educational outcomes of municipal schools when the mayor is running for reelection. We designed and implemented an experiment in Chile whereby we sent 128,033 letters to voters in 400 randomly selected polling stations prior to the 2016 municipal elections. The letters included information on past test scores for local public schools (levels and changes), and either average or maximum outcomes for comparable municipalities. Our findings do not reveal a relevant average impact of the letters, but when they contain poor educational outcomes, voter turnout decreases, translating almost one to one in decreases in votes for the incumbent mayor. Voters respond to educational results in levels and to letters that have average results as a benchmark. The results are especially strong when poor educational outcomes come as bad news to voters. We also find spillover effects in the municipal council election. Overall, our findings suggest that voters hold politicians accountable when faced to certain (but not all) types of information on their performance. JEL Codes: D72, H75, I25.

Governments face trade-offs in investing in many different inputs to markets in an effort to make them function more smoothly, and often these inputs are managed by bureaucrats with their own priorities. Many of these markets are acutely dependent on all elements of the system functioning well in order to reach a reasonably high level of equilibrium provision (education, public works, infrastructure, etc). In sanitation markets in particular, failure at any level of the supply chain creates downstream effects. In addition, local demand depends on enforcement, education, and spatial correlation. We provide a weakest link theory of agent choices for sanitation markets that demonstrates the difficulties of decentralized decision making and suggests key implications for policy implementation. The theory demonstrates that while the welfare implications of improvements in overall sanitation are substantial, incremental changes in one area may have little to no impact on overall sanitation provision. Our model provides context for thinking about lessons the sanitation literature provides in terms of policy and investment.

Helseth S.A., Micalizzi L., Piper K., Gomez A., Elwy A.R., Becker S.J., Kemp K., Spirito A.

Opioid use (OU) skyrockets as youth transition into young adulthood, indicating adolescence is a critical time for prevention. The juvenile legal system (JLS) presents an ideal setting for OU prevention, as it is the single largest referral source for youth outpatient OU treatment, after self-referral. However, no OU prevention programs have been developed for youth in JLS diversion programs or their families. The current formative study established specific OU prevention needs and preferences of families in JLS programs, to guide future tailored prevention efforts.

Private equity is an increasing presence in US healthcare, with unclear consequences. Leveraging unique data sources and difference-in-differences designs, we examine the largest private equity hospital takeover in history. The affected hospital chain sharply shifts its advertising strategy and pursues joint ventures with ambulatory surgery centers. Inpatient throughput is increased by allowing more patient transfers, and crucially, capturing more patients through the emergency department. The hospitals also manage shorter, less treatment-intensive stays for admitted patients. Outpatient surgical care volume declines, but remaining cases focus on higher complexity procedures. Importantly, behavior changes persist even after private equity divests.

Krentzman A.R., Hoeppner S.S., Hoeppner B.B., Barnett N.P.

Individuals in early recovery face significant biopsychosocial stressors causing a preponderance of negative affect. Novel interventions are needed to improve mood and well-being to support recovery. Positive Recovery Journaling (PRJ) combines elements of positive psychology, behavioral activation, and journaling to emphasize what is going right and to encourage small, positive steps that align with an individual's values to make life in recovery more rewarding and therefore more reinforcing. Our objective was to determine PRJ's feasibility, acceptability, and impact on a set of strengths-based, multidimensional aspects of recovery, including satisfaction with life, happiness with recovery, and commitment to sobriety.

MIF is a ubiquitous protein involved in proinflammatory processes, which undergoes an oxidation-driven conformational change to oxidized (ox)MIF. We demonstrate that hypochlorous acid, produced by neutrophil-released myeloperoxidase (MPO) under inflammatory conditions, effectively oxidizes MIF into the oxMIF isoform, which is specifically recognized by the anti-oxMIF therapeutic antibody, ON104. NMR investigation of MIF oxidized by the MPO system revealed increased flexibility throughout the MIF structure, including at several catalytic and allosteric sites. Mass spectrometry of MPO-oxMIF revealed methionines as the primary site of oxidation, whereas Pro2 and Tyr99/100 remained almost unmodified. ELISA, SPR and cell-based assays demonstrated that structural changes caused by MPO-driven oxidation promoted binding of oxMIF to its receptor, CD74, which does not occur with native MIF. These data reveal the environment and modifications that facilitate interactions between MIF and its pro-inflammatory receptor, and a route for therapeutic intervention targeting the oxMIF isoform.

Hair shedding is common in women, and its management relies on addressing the underlying causes and applying anti-inflammatory or hair growth-stimulating topical preparations. Alpha-1 adrenergic receptor (synephrine) and trace amine-associated receptor (TAAR) agonists may reduce hair shedding, but their combined effects are unknown. This was a prospective, single-center, single-blind, placebo-controlled investigation to assess the efficacy of combined topical synephrine and TAAR agonist (DA-OTC-002) treatment to reduce hair shedding. DA-OTC-002 or placebo (vehicle alone) was applied for 5 minutes to the right and left scalp of each participant, respectively. Hairs were separated from treatment or placebo sides using a consistent brushing pattern. Hairs were removed from each brush, counted, and their numbers compared between sides using the paired t-test. Seventy-six female subjects participated. The average reduction in hair count was 62.5% in the DA-OTC-002-treated area compared with the placebo-treated area, and a 100% reduction was observed in three individuals. Significantly fewer hairs were shed from the treatment group than the control group (t = 13.312, df = 75, p < 0.0001): 36.26 ± 12.74 hairs from the control group and 13.63 ± 11.28 from the treatment group, a mean difference of 22.63 (95% CI 19.25-26.01). No treatment-related adverse events were noted. Combined synephrine and TAAR agonist worked together to prevent hair shedding, even after five minutes of application. Future studies should assess the efficacy of DA-OTC-002 with minoxidil, which although ultimately reducing hair loss is associated with an initial increase in shedding.