Harnessing changes in funding for a voucher program that subsidizes consumers’ use of child care services at private providers, this study quantifies effects on local markets’ service capacity and prices. We also estimate how increased funding effects provider entry rate, exit rate, and highly rated provider market share. The evidence shows that an additional $100 in private voucher funding per local young child would 1) raise the number of private-provider slots by 0.026per local young child, 2) raise average prices by $0.56 per week, mainly driven by a price increase among incumbent providers, and 3) induce new provider entry to the market by 0.4 percentage points. The estimates imply a highly elastic supply elasticity of 10.7. Thus an increase in public funding and subsequent increase in demand is expected to result in expansion of available slots accompanied by a limited increase in price.

Objectives: To characterize the relationship between positive early childhood experiences (PECEs) and school readiness, and assess whether the PECEs-school readiness relationship was robust to and/or differed across levels of adverse childhood experiences (ACEs). Methods: We analyzed national data on children ages 3-5 from 2016 to 2020 (n = 26 871) to examine associations between key PECE domains (nurturing relationships, home learning opportunities, safe and stable environments, and family routines) with being on track for school readiness, defined using a pilot, multidimensional measure called “healthy and ready to learn”. Weighted univariate, bivariate, and multivariable analyses were conducted to generate nationally representative estimates. Multivariable models adjusted for sociodemographic factors and were assessed both with and without cumulative ACE exposure. Results: Two-fifths of children were healthy and ready to learn. Exposure to PECEs was associated with higher school readiness, irrespective of relative ACE exposure. Compared with those with low PECEs, children with moderate (aOR, 2.19; 95% CI, 1.86-2.58) and high (aOR, 4.37; 95% CI, 3.58-5.34) PECEs had greater odds for being healthy and ready to learn, net of both sociodemographic factors and ACE exposure. Significant associations were robust across demographic groups (eg, race and ethnicity), ACE levels, and ACE types (eg, parental incarceration). Conclusions: Increasing PECEs correspond with greater likelihood of possessing capacities key for school functioning, even amidst ACEs. In concert with efforts to ameliorate early life trauma, caregivers, health care providers, educators, and systems can consider boosting PECEs to foster healthy development in childhood and beyond.

Scholars have documented harm associated with positive stereotypes about groups that experience inequality. We surveyed five samples from the United States to explore antecedents to dominant group endorsement of positive stereotypes about women, gay men, Asian Americans, Black Americans, and Native Americans. We found more liberal participants, and those with more close contact with members of these groups, were more internally motivated to respond without prejudice, which was then associated with greater endorsement of positive stereotypes about women, gay men, Black Americans, and Native Americans. In contrast, more conservative participants were more likely to believe in system legitimacy, which was then associated with greater endorsement of positive stereotypes about women and Asian Americans. We theorize that positive stereotypes are used by dominant group members in divergent ways, sometimes to legitimate inequality and other times with concern about inequality. The latter likely involves naivety regarding the harmful nature of positive stereotypes.

BACKGROUND Household food insecurity is associated with poor dietary intake in the general population, but little is known about this association in persons with diabetes. OBJECTIVE We examined the degree of adherence to the dietary reference intakes and 2020-2025 Dietary Guidelines for Americans overall and according to food security status and diabetes type among youth and young adults (YYA) with youth-onset diabetes. DESIGN /Participants/Setting: The SEARCH for Diabetes in Youth study includes 1,197 YYA with type 1 diabetes (T1D, mean age: 21 years ± 5) and 319 YYA with type 2 diabetes (T2D, 25 years ± 4). Participants (or parents if <18 years) completed the USDA Household Food Security Survey Module, wherein ≥3 affirmations indicate food insecurity. MAIN OUTCOME MEASURES Diet was assessed via food frequency questionnaire and compared to age- and sex-specific dietary reference intakes for 10 nutrients and dietary components (calcium, fiber, magnesium, potassium, sodium, vitamins C, D, E, added sugar, saturated fat). STATISTICAL ANALYSES PERFORMED Median regression models controlled for sex- and type-specific means for age, diabetes duration, and daily energy intake. RESULTS Prevalence of guideline adherence was overarchingly poor, with <40% of participants meeting recommendations for 8 of 10 nutrients and dietary components; however, higher adherence (>47%) was observed for vitamin C and added sugars. YYA with T1D who were food insecure were more likely to meet recommendations for calcium, magnesium, and vitamin E (p<0.05), and less likely for sodium (p<0.05) than those food secure. In adjusted models, YYA with T1D who were food secure had closer median adherence to sodium (p=0.002) and fiber (p=0.042) guidelines than those food insecure. No associations were observed in YYA with T2D. CONCLUSIONS Food insecurity is associated with lesser adherence to fiber and sodium guidelines in YYA with T1D, which may lead to diabetes complications, and other chronic diseases.

STUDY QUESTION: Which genetic factors regulate female propensity for giving birth to spontaneous dizygotic (DZ) twins? SUMMARY ANSWER: We identified four new loci, GNRH1, FSHR, ZFPM1, and IPO8, in addition to previously identified loci, FSHB and SMAD3.

<p>Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is characterized by recurring episodes of thrombotic microangiopathy causing ischemic organ impairment. Blacks are overrepresented in iTTP cohorts in the United States but racial disparities in iTTP outcomes and response to therapy have not been studied. Using the United States Thrombotic Microangiopathy (USTMA) Consortium iTTP Registry, we evaluated the impact of race on mortality and relapse-free survival (RFS) in confirmed iTTP in the US from 1995 to 2020. We separately examined the impact of rituximab therapy and presentation with newly diagnosed (de novo) or relapsed iTTP on RFS by race. 645 participants with 1308 iTTP episodes were available for analysis. Acute iTTP mortality did not differ by race. When all episodes of iTTP were included, Black race was associated with shorter RFS [hazard ratio (HR) of 1.60 (95% CI 1.16-2.21)]; the addition of rituximab to corticosteroids improved RFS in White [HR 0.37 (95% CI 0.18-0.73)] but not Black patients [HR 0.96 (95% CI 0.71-1.31)]. In de novo iTTP, rituximab delayed relapse, but Blacks had shorter RFS than Whites regardless of treatment. In relapsed iTTP, rituximab significantly improved RFS in White but not Black patients. Race affects overall relapse risk and response to rituximab in iTTP. Black patients may require closer monitoring, earlier retreatment, and alternative immunosuppression following rituximab treatment. How race, racism, and the social determinants of health contribute to the disparity in relapse risk in iTTP deserve further study.</p>

Using the transatlantic relación of Diego Portichuelo de Ribadeneyra (1657) as an example, this chapter tracks some of the ways in which several religious passengers narrated their experience crossing the Atlantic Ocean in the Spanish West Indies fleets during the sixteenth and the seventeenth centuries. Of particular importance here are the ways in which Portichuelo de Ribadeneyra manipulates time in order to achieve different aesthetic effects. By playing with and disturbing chronology while simultaneously modulating the narrative voice, the writer manages to swerve the discourse of his narrative away from bare historical facts in favor of a more subjective expression of the travails and potential catastrophes of early modern saltwater sailing. By altering temporalities in this way, Portichuelo de Ribadeneyra creates a text that is much more than an explanation of ‘what went wrong’ on his maritime voyage from Peru to Spain.

Undergraduates’ distress has increased dramatically since the COVID-19 pandemic’s onset, raising concerns for academic achievement. Yet little is known about the mechanisms by which pandemic-relate...

Natural killer cells mediate cytolysis of transformed cells and are currently used as an adoptive cellular therapy to treat cancer. Infection with human cytomegalovirus has been shown to expand a subset of "adaptive" NK cells, expressing the activation receptor NKG2C, that have preferred functional attributes distinct from conventional NK cells. Because NKG2C delivers a strong activating signal to NK cells, we hypothesized that NKG2C could specifically trigger NK cell-mediated antitumor responses. To elicit a tumor-directed response from NKG2C(+) NK cells, we created an anti-NKG2C/IL-15/anti-CD33 killer engager, called NKG2C-KE, that directs NKG2C(+) cells to target CD33(+) cells, and tumor associated antigen expressed by acute myelogenous leukemia cells. The NKG2C-KE induced specific degranulation, interferon-γ production and proliferation of NKG2C-expressing NK cells from patients who reactivated cytomegalovirus after allogeneic transplantation. The NKG2C-KE was also tested in a more homogeneous system using induced pluripotent stem cell derived NK cells (iNK) that have been engineered to express NKG2C at high levels. The NKG2C-KE triggered iNK cell-mediated cytotoxicity against CD33(+) cells and primary AML blasts. The NKG2C-KE specific interaction with adaptive NK and NKG2C(+) iNK cells represents a new immunotherapeutic paradigm that uniquely engages highly active NK cells to induce cytotoxicity against AML through redirected targeting.

Egypt and Tunisia are perceived to have high levels of inequality, yet based on standard measures, inequality in these two countries is not unusually high. In this study we explore a different dimension of inequality in Egypt and Tunisia by using a more complete measure of income and decomposing inequality by income sources (factor components). We find that higher-income households have more income sources than lower-income ones. Informal wage work and earnings from household enterprises are more common in Egypt than Tunisia, while formal wage work, pensions, and social assistance are more common in Tunisia. Social assistance does little to offset income inequality in either country. Enterprise earnings (in Egypt) and agricultural earnings (in Tunisia) as well as rent and other capital income in both countries play a large role in inequality. High inequality in these non-wage income sources and unequal access to income sources tied to wealth and capital may help explain why inequality is perceived to be high.

Federal funding from the Child Care and Development Fund (CCDF) enables states to offset the cost of child care for eligible low-income families to support parental employment and promote healthy child development. The federal government sets a benchmark for provider payment rates in order to ensure that low-income families have access to child care settings comparable to those available to non-CCDF families. In order to meet this “equal access” objective, states need reliable information and valid methods to estimate benchmark prices in local child care markets. Although all 50 states face the challenge of meeting the federal benchmark, limited research on best practices is available to guide them. This case study of Colorado's child care market prices highlights key challenges to states in using survey data to set provider payment rates, offering policy and practice implications for sampling, collecting price data, and estimating valid child care benchmark prices.

Parents' selections of child care arrangements involve complex decisions made in the context of child and family needs, resources and constraints. This study analyzed data from a survey of low-income parents to examine the factors associated with the type of care arrangement used most often. We employed Bayesian estimation methods to account for the interrelated nature of parental employment and child care decisions. We incorporated parental preferences for characteristics of child care to predict the type of care setting based on a factor analysis of parent responses about the importance of different care characteristics. We found that latent factors that were associated with a higher probability of working, or of working more hours, also increased the probability of using centers or family child care, and decreased the likelihood of using family, friend or neighbor (informal) care. In concordance with the existing literature, low-income families in Minnesota were more likely to use informal care for infants (relative to preschool-age children), and households with more educated parents were more likely to use centers. Hispanic families were less likely to use any form of non-parental care. Given the potential of high-quality child care to increase the well-being and developmental trajectories of low-income children, understanding parents' decisions about child care and employment is fundamental to improving child and family outcomes.

Indoor concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and carbon monoxide (CO) were measured across 16 urban public schools in three different seasons. Exceedance of the WHO guidelines for indoor air was observed, mainly for the hourly average NO2 concentrations. Seasonal variability was statistically significant for indoor NO2 and CO concentrations, with higher exposures in fall and winter. An extensive list of potential factors at the outdoor environment, school, and room level that may explain the variability in indoor exposure was examined. Factors with significant contributions to indoor exposure were mostly related to the outdoor pollution sources. This is evidenced by the strong associations between indoor concentration of CO and NO2 and factors including outdoor PM2.5 and NO2 concentrations, including length of the nearby roads and the number of nearby industrial facilities. Additionally, we found that poor conditions of the buildings (a prevalent phenomenon in the studied urban area), including physical defects and lack of proper ventilation, contributed to poor air quality in schools. The results suggest that improving building conditions and facilities as well as a consideration of the school surroundings may improve indoor air quality in schools.

<p>Background: Immune thrombotic thrombocytopenic purpura (iTTP) is a potentially fatal hematologic disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, and ischemic organ impairment. The incidence of iTTP is higher among African-Americans (AA), however, differences in presentation and outcomes have not been fully investigated. In a multi-center cohort of patients with iTTP from the United States Thrombotic Microangiopathy (USTMA) Consortium, we tested the hypothesis that AA race is an independent predictor of poor outcomes including iTTP related mortality and relapse.</p>

This study proposes new family-centered measures of access to early care and education (ECE) services with respect to quantity, cost, and quality and uses them to assess disparities in access across locations and socio-demographic groups in Minnesota. These measures are distance-based and use available geographic data to account for the fact that families can cross arbitrary administrative boundaries, such as census tract or ZIP code lines, and thus better reflect the real experiences of families than conventional area-based measures. Combining synthetic family locations simulated from Census demographic and geographic data and information on ECE provider locations, we calculate travel time between the locations of families with young children and ECE providers to measure families’ access to providers of different types. The results yield a map of areas with low and high relative ECE access. The average family in Minnesota lives in a location where there are nearly two children for every nearby slot of licensed capacity, however, access to ECE supply varies considerably at the local level. The supply measure can also serve as a weight useful in computing family-centered measures of ECE quality and access costs, incorporating both prices and travel costs, to further characterize the local ECE market from the perspective of families. Improving the measures of variation in families’ access to ECE quantity, cost, and quality is valuable as policymakers consider expansions to public supports for early learning and ECE entrepreneurs decide where to invest.