Pediatric Cushing disease: disparities in disease severity and outcomes in the Hispanic and African-American populations.

BackgroundLittle is known about the contribution of racial and socioeconomic disparities to severity and outcomes in children with Cushing disease (CD).MethodsA total of 129 children with CD, 45 Hispanic/Latino or African-American (HI/AA) and 84 non-Hispanic White (non-HW), were included in this study. A 10-point index for rating severity (CD severity) incorporated the degree of hypercortisolemia, glucose tolerance, hypertension, anthropomorphic measurements, disease duration, and tumor characteristics. Race, ethnicity, age, gender, local obesity prevalence, estimated median income, and access to care were assessed in regression analyses of CD severity.ResultsThe mean CD severity in the HI/AA group was worse than that in the non-HW group (4.9±2.0 vs. 4.1±1.9, P=0.023); driving factors included higher cortisol levels and larger tumor size. Multiple regression models confirmed that race (P=0.027) and older age (P=0.014) were the most important predictors of worse CD severity. When followed up a median of 2.3 years after surgery, the relative risk for persistent CD combined with recurrence was 2.8 times higher in the HI/AA group compared with that in the non-HW group (95% confidence interval: 1.2-6.5).ConclusionOur data show that the driving forces for the discrepancy in severity of CD are older age and race/ethnicity. Importantly, the risk for persistent and recurrent CD was higher in minority children

Long-Term Care Policy: Where Are We Going?

Millions of Americans suffer from physical or mental conditions that make it difficult for them to live fully independent lives. These are the frail elderly, disabled and chronically ill persons of all ages, and many mentally ill or mentally retarded persons. They need help to manage daily activities, whether they live in their own homes or in nursing homes. Such care can be extremely expensive, since it often must be provided for many years, even a lifetime. Today, those costs are met largely by the individuals themselves or by their families and by public programs for low-income persons. For many years, persons in the U.S. in need of long-term care have struggled along with a patchwork system of private financing, insufficient state and federal funding, and limited private insurance. But today there is a new awareness and a new public focus on the difficulties that disabled and chronically ill Americans face in obtaining and paying for long-term care services. This report examines the background of the long-term care issue and the debate that has developed in Congress on how to address concerns about the financing and availability of long-term care

Inside the metropolis: the articulation of Spanish metropolitan areas into local labor markets

In this article, we delimit local labor markets (LLMs) in order to analyze the internal structure and organization of Spanish metropolitan areas. LLMs are defined as self-contained and cohesive areas in terms of commuting flows. Unlike the conventional approach to polycentrism based on the analysis of commuting flows that begins with the identification of subcenters, our analytical strategy does assume any a priori structure and is compatible with the relationship between places of work and residence having other locational and spatial organization patterns. The analysis is performed at three different scales of detail linked to three self-containment levels for the LLMs delimited and three population groups (total, males, and females). The results show that metropolitan areas are complex, fuzzy, multidimensional spaces, where the conditions of spatial organization are manifested in different ways depending on the parameters and variables used.This work was supported by the Spanish Ministry of Economy and Competitiveness [grant numbers CSO2011-29943-C03-01, CSO2011-29943-C03-02, CSO2014-55780-C3-1-P, and CSO2014-55780-C3-2-P (National R&D&I Plan)]

Valuation of Government Policies and Projects

Governments play a central role in the allocation of capital and risk in the economy. Evaluating the cost to taxpayers of government investments requires an assumption about the government’s cost of capital. Governments often take their borrowing rate to be their cost of capital, which implicitly treats the market risk associated with their activities as having no cost to taxpayers. This article reviews the theoretical and practical rationale for treating market risk as a cost to governments, presents an interpretive review of the growing literature that applies the concepts and tools of modern finance to evaluating the costs of government policies and projects and suggests directions for future research. Examples considered include deposit insurance, Fannie Mae and Freddie Mac, the Federal Reserve’s emergency lending facilities, student loans, real infrastructure investments, and public pension plans

Enhancing Credibility of Chemical Safety Studies: Emerging Consensus on Key Assessment Criteria

Objectives: We examined the extent to which consensus exists on the criteria that should be used for assessing the credibility of a scientific work, regardless of its funding source, and explored how these criteria might be implemented. Data sources: Three publications, all presented at a session of the 2009 annual meeting of the Society for Risk Analysis, have proposed a range of criteria for evaluating the credibility of scientific studies. At least two other similar sets of criteria have recently been proposed elsewhere. Data extraction/synthesis: In this article we review these criteria, highlight the commonalities among them, and integrate them into a list of 10 criteria. We also discuss issues inherent in any attempt to implement the criteria systematically. Con c l u s i o n s: Recommendations by many scientists and policy experts converge on a finite list of criteria for assessing the credibility of a scientific study without regard to funding source. These criteria should be formalized through a consensus process or a governmental initiative that includes discussion and pilot application of a system for reproducibly implementing them. Formal establishment of such a system should enable the debate regarding chemical studies to move beyond funding issues and focus on scientific merit

Scientific and Legal Perspectives on Science Generated for Regulatory Activities

This article originated from a conference that asked “Should scientific work conducted for purposes of advocacy before regulatory agencies or courts be judged by the same standards as science conducted for other purposes?” In the article, which focuses on the regulatory advocacy context, we argue that it can be and should be. First, we describe a set of standards and practices currently being used to judge the quality of scientific research and testing and explain how these standards and practices assist in judging the quality of research and testing regardless of why the work was conducted. These standards and practices include the federal Information Quality Act, federal Good Laboratory Practice standards, peer review, disclosure of funding sources, and transparency in research policies. The more that scientific information meets these standards and practices, the more likely it is to be of high quality, reliable, reproducible, and credible. We then explore legal issues that may be implicated in any effort to create special rules for science conducted specifically for a regulatory proceeding. Federal administrative law does not provide a basis for treating information in a given proceeding differently depending on its source or the reason for which it was generated. To the contrary, this law positively assures that interested persons have the right to offer their technical expertise toward the solution of regulatory problems. Any proposal to subject scientific information generated for the purpose of a regulatory proceeding to more demanding standards than other scientific information considered in that proceeding would clash with this law and would face significant administrative complexities. In a closely related example, the U.S. Environmental Protection Agency considered but abandoned a program to implement standards aimed at “external” information