Guidelines for Avoiding Pitfalls When Drafting Juvenile Curfew Laws: A Legal Analysis

Curfew laws seek to provide general protection to youth and adults by restricting the times that children of certain ages are allowed to occupy public places or streets. These laws often contain exemptions for youth accompanied by an adult, responding to an emergency, or traveling to or from school, work, or a religious service, among others. However, the actual language used and exemptions included vary by locality. As a result, courts have reached different results—several courts upheld curfew laws as constitutional, while others overturned these laws. Although not the original reason behind juvenile curfew enactment, several studies have found that juvenile curfew laws reduce other youth health consequences. For example, studies have shown that the enactment of a juvenile curfew law reduces juvenile traffic injuries and fatalities, pediatric transports and pediatric trauma transports, and the volume of juvenile trauma cases. Given that these laws have public health benefits and continue to be enacted across the country, this article will provide guidance for policymakers on how to propose and draft these laws to avoid problems in other similar statutes that resulted in them being overturned. A four-step framework by Harold Lasswell for understanding the creation of a policy called “The Policy Cycle” is used as structure for this article

Hospital Community Benefits After the ACA: Partnerships for Community Health Improvement

Examines states' and localities' efforts to promote community health and systemic change through collaborations focused on community health needs assessments, priority setting, strategic planning, and the implementation of health improvement initiatives

Individualized decision aid for diverse women with lupus nephritis (IDEA-WON): A randomized controlled trial.

BackgroundTreatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis.Methods and findingsIn a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization. We hypothesized that the co-primary outcomes of decisional conflict and informed choice regarding immunosuppressive medications would improve more in the decision aid group. Of 301 randomized women, 298 were analyzed; 47% were African-American, 26% Hispanic, and 15% white. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of <$40,000, and 36% had a high school education or less. Compared with the provision of the ACR lupus pamphlet (n = 147), participants randomized to the decision aid (n = 151) had (1) a clinically meaningful and statistically significant reduction in decisional conflict, 21.8 (standard error [SE], 2.5) versus 12.7 (SE, 2.0; p = 0.005) and (2) no difference in informed choice in the main analysis, 41% versus 31% (p = 0.08), but clinically meaningful and statistically significant difference in sensitivity analysis (net values for immunosuppressives positive [in favor] versus negative [against]), 50% versus 35% (p = 0.006). Unresolved decisional conflict was lower in the decision aid versus pamphlet groups, 22% versus 44% (p < 0.001). Significantly more patients in the decision aid versus pamphlet group rated information to be excellent for understanding lupus nephritis (49% versus 33%), risk factors (43% versus 27%), medication options (50% versus 33%; p ≤ 0.003 for all); and the ease of use of materials was higher in the decision aid versus pamphlet groups (51% versus 38%; p = 0.006). Key study limitations were the exclusion of men, short follow-up, and the lack of clinical outcomes, including medication adherence.ConclusionsAn individualized decision aid was more effective than usual care in reducing decisional conflict for choice of immunosuppressive medications in women with lupus nephritis.Trial registrationClinicaltrials.gov, NCT02319525

Automated deep learning segmentation of high-resolution 7 T postmortem MRI for quantitative analysis of structure-pathology correlations in neurodegenerative diseases

Postmortem MRI allows brain anatomy to be examined at high resolution and to link pathology measures with morphometric measurements. However, automated segmentation methods for brain mapping in postmortem MRI are not well developed, primarily due to limited availability of labeled datasets, and heterogeneity in scanner hardware and acquisition protocols. In this work, we present a high resolution of 135 postmortem human brain tissue specimens imaged at 0.3 mm$^{3}$ isotropic using a T2w sequence on a 7T whole-body MRI scanner. We developed a deep learning pipeline to segment the cortical mantle by benchmarking the performance of nine deep neural architectures, followed by post-hoc topological correction. We then segment four subcortical structures (caudate, putamen, globus pallidus, and thalamus), white matter hyperintensities, and the normal appearing white matter. We show generalizing capabilities across whole brain hemispheres in different specimens, and also on unseen images acquired at 0.28 mm^3 and 0.16 mm^3 isotropic T2*w FLASH sequence at 7T. We then compute localized cortical thickness and volumetric measurements across key regions, and link them with semi-quantitative neuropathological ratings. Our code, Jupyter notebooks, and the containerized executables are publicly available at: https://pulkit-khandelwal.github.io/exvivo-brain-upennComment: Preprint submitted to NeuroImage Project website: https://pulkit-khandelwal.github.io/exvivo-brain-upen

Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US Adults

Emerging but limited evidence suggests that alcohol consumption has increased during the COVID-19 pandemic. This study assessed: (1) whether drinking behaviors changed during the pandemic; and, (2) how those changes were impacted by COVID-19-related stress. We conducted a cross-sectional online survey with a convenience sample of U.S. adults over 21 years in May 2020. We conducted adjusted linear regressions to assess COVID-19 stress and alcohol consumption, adjusting for gender, race, ethnicity, age, and household income. A total of 832 responded: 84% female, 85% White, and 72% ages 26–49. Participants reported consuming 26.8 alcohol drinks on 12.2 of the past 30 days. One-third of participants (34.1%) reported binge drinking and 7.0% reported extreme binge drinking. Participants who experienced COVID-19-related stress (versus not) reported consuming more drinks (β = 4.7; CI (0.2, 9.1); p = 0.040) and a greater number of days drinking (β = 2.4; CI (0.6, 4.1); p = 0.007). Additionally, 60% reported increased drinking but 13% reported decreased drinking, compared to pre-COVID-19. Reasons for increased drinking included increased stress (45.7%), increased alcohol availability (34.4%), and boredom (30.1%). Participants who reported being stressed by the pandemic consumed more drinks over a greater number of days, which raises concerns from both an individual and public health perspective

U.S. Parents’ Reports of Assisting Their Children with Distance Learning during COVID-19

COVID-19 has caused increased stress among U.S. adults, with many reporting concerns assisting their children with distance learning due to school closures. This study surveyed U.S. parents–most of whom were middle-aged, White, affluent, and female–to learn what types of distance learning activities parents engaged in with their children during COVID-19; whether these types of activities varied by the child’s age; and whether there was an association between engaging in these activities and stress. Most parents engaged in Monitoring, Teaching or Technology support activities with their children. Although these activities varied by child’s age, parents who reported engaging in any distance learning activity reported increased stress

Alcohol consumption during the COVID-19 pandemic: a cross-sectional survey of US adults.

Emerging but limited evidence suggests that alcohol consumption has increased during the COVID-19 pandemic. This study assessed: (1) whether drinking behaviors changed during the pandemic; and, (2) how those changes were impacted by COVID-19-related stress. We conducted a cross-sectional online survey with a convenience sample of U.S. adults over 21 years in May 2020. We conducted adjusted linear regressions to assess COVID-19 stress and alcohol consumption, adjusting for gender, race, ethnicity, age, and household income. A total of 832 responded: 84% female, 85% White, and 72% ages 26-49. Participants reported consuming 26.8 alcohol drinks on 12.2 of the past 30 days. One-third of participants (34.1%) reported binge drinking and 7.0% reported extreme binge drinking. Participants who experienced COVID-19-related stress (versus not) reported consuming more drinks (β = 4.7; CI (0.2, 9.1); = 0.040) and a greater number of days drinking (β = 2.4; CI (0.6, 4.1); = 0.007). Additionally, 60% reported increased drinking but 13% reported decreased drinking, compared to pre-COVID-19. Reasons for increased drinking included increased stress (45.7%), increased alcohol availability (34.4%), and boredom (30.1%). Participants who reported being stressed by the pandemic consumed more drinks over a greater number of days, which raises concerns from both an individual and public health perspective