How Does Your Kindergarten Classroom Affect Your Earnings? Evidence From Project STAR

In Project STAR, 11,571 students in Tennessee and their teachers were randomly assigned to classrooms within their schools from kindergarten to third grade. This paper evaluates the long-term impacts of STAR by linking the experimental data to administrative records. We first demonstrate that kindergarten test scores are highly correlated with outcomes such as earnings at age 27, college attendance, home ownership, and retirement savings. We then document four sets of experimental impacts. First, students in small classes are significantly more likely to attend college and exhibit improvements on other outcomes. Class size does not have a significant effect on earnings at age 27, but this effect is imprecisely estimated. Second, students who had a more experienced teacher in kindergarten have higher earnings. Third, an analysis of variance reveals significant classroom effects on earnings. Students who were randomly assigned to higher quality classrooms in grades K-3 – as measured by classmates' end-of-class test scores – have higher earnings, college attendance rates, and other outcomes. Finally, the effects of class quality fade out on test scores in later grades but gains in non-cognitive measures persist.

Wildlife Underpass Use and Environmental Impact Assessment: A Southern California Case Study

Environmental planners often rely on transportation structures (i.e., underpasses, bridges) to provide connectivity for animals across developed landscapes. Environmental assessments of predicted environmental impacts from proposed developments often rely on literature reviews or other indirect measures to establish the importance of wildlife crossings. Literature-based evaluations of wildlife crossings may not be accurate, and result in under-estimation of impacts or establishment of inappropriate mitigation measures. To investigate the adequacy of literature-based evaluations, we monitored wildlife use of a freeway underpass that had been identified as critically important to wildlife connectivity, and which was evaluated in an environmental review document. Photographs were obtained from a network of trail cameras over 3 years. Six mid- to large-sized native mammal species used the underpass and two other mammal species were photographed near the underpass but not using it. American badger (Taxidea taxus) was photographed at a higher rate in the underpass than in the surrounding area. Gray fox (Urocyon cinereoargenteus) was rarely detected in the underpass relative to surrounding habitats, whereas the absence of mule deer (Odocoileus hemionus) in the underpass was unexpected, given relatively frequent detection in adjacent habitats. These results differed from the environmental assessment in that American badger was listed as potentially present while mule deer were expected to use the underpass. Results underscore importance of gathering data to document wildlife use of corridors, because some species do not or rarely take advantage of apparently suitable corridors, while others may be present when assumed to be absent

Clinical outcomes and response to treatment of patients receiving topical treatments for pyoderma gangrenosum: a prospective cohort study

Background: pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. Objective: to estimate the effectiveness of topical therapies in the treatment of PG. Methods: prospective cohort study of UK secondary care patients with a clinical diagnosis of PG suitable for topical treatment (recruited July 2009 to June 2012). Participants received topical therapy following normal clinical practice (mainly Class I-III topical corticosteroids, tacrolimus 0.03% or 0.1%). Primary outcome: speed of healing at 6 weeks. Secondary outcomes: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality-of-life; treatment failure and recurrence. Results: Sixty-six patients (22 to 85 years) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28/66 (43.8%) of ulcers healed by 6 months. Median time-to-healing was 145 days (95% CI: 96 days, ∞). Initial ulcer size was a significant predictor of time-to-healing (hazard ratio 0.94 (0.88;80 1.00); p = 0.043). Four patients (15%) had a recurrence. Limitations: No randomised comparator Conclusion: Topical therapy is potentially an effective first-line treatment for PG that avoids possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p<0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p<0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark

Owner-Level Taxes and Business Activity

In some classes of models, taxes at the owner level are "neutral" and have no effect on firm activity. However, this tax neutrality is sensitive to assumptions and no longer holds in more complex models. We review recent research that incorporates greater complexity in studying the link between taxes and business activity - particularly entrepreneurship. Dividend taxes on owners of large firms affect firm activity in models that include agency conflicts between owners and managers. Similarly, after incorporating entrepreneurs' occupational choice into the model, taxes are no longer neutral. By forsaking lucrative alternative careers, skilled entrepreneurs tend to have high opportunity costs, which make the choice of attempting to start a business of first order importance. Moreover, in models where it is assumed that capital flows across borders without cost, taxes on domestic business owners do not alter business activity because foreign capital seamlessly compensates for tax-induced declines in investments. This theoretical notion is contradicted by the strong "home bias" observed in business ownership, in particular for small firms and startups without easy access to international capital markets. Recent empirical work has emphasized that taxes have heterogeneous effects on mature firms, entrepreneurial startups, and owner-managed small firms. Lowering dividend taxes on firms with dispersed ownership has been shown to shift capital from mature firms into rapidly growing firms. Moreover, capital gains taxation tends to reduce the number of innovative startups and diminish venture capital activity, while high owner-level taxes encourage small business activity and non-entrepreneurial self-employment because such firms have more opportunities to avoid or evade taxes. To obtain efficient incentives in entrepreneurial startups, contractual terms are required that ex ante guarantee that all providers of critical inputs, especially equity constrained entrepreneurs, are entitled to a share of the resulting capital value firm. Unless properly designed, owner-level taxes prevent such ex ante contracting and thus lower the likelihood of eventual success

A Prospective Analysis of Quality of Life Data and Clinical Toxicity as a Function of Radiation Dose and Volume in Stage I Lung Cancer Patients after SBRT

Background: Stereotactic body radiation therapy (SBRT) is an appropriate treatment option for patients with stage I non-small cell lung cancer (NSCLC) who are not surgical candidates. As these patients often present with significant co-morbidities, quality of life (QOL) outcomes are especially important. Objectives: To use a validated patient reported quality of life (QOL) assessment tool to measure clinical toxicity and patient reported quality of life (QOL) outcomes up to 36 months after SBRT in stage I NSCLC patients based on pre-treatment dosimetric parameters and tumor volumes. Methods: Fifty-six stage I NSCLC patients treated with SBRT (12 Gy x 4) were prospectively monitored for symptoms including cough, dyspnea, fatigue, and pneumonitis. Symptoms were measured at baseline (before treatment), immediately after treatment and 3, 6, 12, 18, 24, and 36 months post-treatment. Toxicity was graded from zero to five following the Charlson comorbidity and toxicity index. Quality of life was determined using the previously-validated Functional Assessment of Cancer Therapy-Trial Outcome Index (FACT-TOI) Lung questionnaire which incorporated three subscale endpoints: lung subscale (LSC), physical well-being (PWB) and functional well-being (FWB). Dosimetric parameters, including the mean lung radiation dose (MLD), and the volume of normal lung receiving at least 5, 10, 13 or 20 Gy (V5, V10, V13, and V20) were obtained from the treatment plan. Pearson correlation and student t-test analyses were used to measure correlations and distinguish between lung metrics with QOL and clinical toxicities. Results: SBRT produced minimal toxicities. QOL (TOI, LSC, PWB, or FWB) at 3, 6, 12 and 24 months post-treatment were significantly correlated with V5, V10, V13, V20, or MLD. Radiation pneumonitis showed mild positive but statistically significant (P \u3c 0.05) correlation with V20. Moreover, FWB at 3 months showed mild negative correlation with dyspnea. Conclusions: Lung SBRT treatment for patients with NSCLC, using a 12 Gy x 4 dose regimen, was well tolerated with minimal toxicity observed. A validated patient related quality of life assessment tool was used to identify the dosimetric parameters most crucial for treatment planning. Further follow-up is recommended