To Balance or not to Balance: The Federal Budget Deficit

Today, the United States is faced with a national debt of over $4 trillion that continues to grow in astronomical proportions. Under present circumstances, are large deficits detrimental to our economic prosperity as the current consensus seems to indicate, or are they really the public\u27s surplus? Many consider yearly federal deficits harmful to our economic prosperity. Indeed some Americans believe that the U.S. government requires legislation to balance the budget annually. This article explores this conventional view, along with the less popular idea that deficits really do not matter. It will begin with explanation of the federal budget deficit, followed by an analysis of the two conflicting views on budget deficits. The essay will demonstrate that the United States does not need balanced budget legislation, whether ordinary legislation or a more radical amendment to the Constitution

Statistical coherence of primary schooling in population census microdata: IPUMS-International integrated samples compared for fifteen African countries

The IPUMS-International project, now in its fifteenth year, integrates and disseminates population microdata for twenty-two African countries (82 countries world-wide) and the number continues to increase as more National Statistical Offices cooperate with the initiative. Statistical quality is a serious concern both for the producers of the microdata as well as the researchers who use them. This paper applies the intra-cohort comparison method to pairs of integrated (harmonized) samples for fifteen African countries to assess statistical coherence using as a benchmark the proportion completing primary school by single years of birth. Samples for six countries show near perfect coherence (R2 > .9, and regression coefficients ~1.0 +/- <0.08). For a second group of five countries, coefficients are only slightly larger (R2 > 0.6 <0.9). Large deviations from 1.0 characterize samples for only four countries. On the whole, the results suggest that samples for the fifteen countries have considerable utility for socio-demographic analysis

EGF regulates survivin stability through the Raf-1/ERK pathway in insulin-secreting pancreatic β-cells

<p>Abstract</p> <p>Background</p> <p>Postnatal expansion of the pancreatic β-cell mass is required to maintain glucose homeostasis immediately after birth. This β-cell expansion is regulated by multiple growth factors, including glucose, insulin, insulin-like growth factor (IGF-1) and epidermal growth factor (EGF). These mitogens signal through several downstream pathways (AKT, ERK, STAT3, and JNK) to regulate the survival and proliferation of β-cells. Survivin, an oncofetal protein with both pro-proliferative and anti-apoptotic properties, is a known transcriptional target of both IGF-1 and EGF in cancer cells. Here, we analyzed the effects of the β-cell mitogens IGF-1 and EGF on survivin regulation in the established pancreatic β-cell model cell lines, MIN6 and INS-1 and in primary mouse islets.</p> <p>Results</p> <p>In pancreatic β-cells, treatment with glucose, insulin, or EGF increased survivin protein levels at early time points. By contrast, no significant effects on survivin were observed following IGF-1 treatment. EGF-stimulated increases in survivin protein were abrogated in the presence of downstream inhibitors of the Raf-1/MEK/ERK pathway. EGF had no significant effect on <it>survivin </it>transcription however it prolonged the half-life of the survivin protein and stabilized survivin protein levels by inhibiting surviving ubiquitination.</p> <p>Conclusions</p> <p>This study defines a novel mechanism of survivin regulation by EGF through the Raf-1/MEK/ERK pathway in pancreatic β-cells, via prolongation of survivin protein half-life and inhibition of the ubiquitin-mediated proteasomal degradation pathway. This mechanism may be important for regulating β-cell expansion after birth.</p

Radiative corrections to low energy neutrino reactions

We show that the radiative corrections to charged current (CC) nuclear reactions with an electron(positron) in the final state are described by a universal function. The consistency of our treatment of the radiative corrections with the procedure used to extract the value of the axial coupling constant $g_A$ is discussed. To illustrate we apply our results to (anti)neutrino deuterium disintegration and to $pp$ fusion in the sun. The limit of vanishing electron mass is considered, and a simple formula valid for E_{obs}\gsim 1 MeV is obtained. The size of the nuclear structure-dependent effects is also discussed. Finally, we consider CC transitions with an electron(positron) in the initial state and discuss some applications to electron capture reactions.Comment: 23 pages, 5 figure

Learning dispositif and emotional attachment:a preliminary international investigation

This research investigated the significance of learning dispositif (LD) and emotional attachment (EA) on perceived learning success (LS) across a diaspora of Western, Russian, Asian, Middle Eastern and Chinese student cohorts. Foucault&rsquo;s LD captures the disparate socio-cultural contexts, institutional milieus and more or less didactic teaching styles that moderate learning. EA is a multi-dimensional notion involving affective bonds that emerged in child psychology and spread to marketing and other fields. The sequential explanatory research reviewed the learning and EA literatures and generated an LD&ndash;EA framework to structure the quantitative phase of its mixed investigations. In 2017 and 2018, the research collected 150 responses and used a range of statistical techniques for quantitative analysis. It found that LS varied significantly across cohorts, intimating that dispositifs influence learning. Nonparametric analysis suggested that EA also influenced learning, but regressions were inconclusive. Exploratory techniques hint at a dynamic mix of emotional or cognitive motivations during the student learning journey, involving structural breaks in student/instructor relationships. Cluster analysis identified distinct student groupings, linked to years of learning. Separately, qualitative analysis of open-ended survey questions and expert interviews intimates that frequent teacher interactions can increase EA. The synthesis of quantitative with qualitative results and pedagogical reflection suggests that LD and EA both influence learning in a complex, dynamic system. The key constituents for EA are Affection, Connection, Social Presence (SP), Teaching Presence (TP) and Flow but student emotional engagement is conditioned by the socio-cultural milieu (LD) and associated factors like relationships and trust. Unlike in the Community of Learning framework, in the EA framework Cognitive Presence (CP) is an outcome of the interaction between these EA constituents, associated factors and the socio-cultural milieu. Finally, whilst awareness of culture and emotions is a useful pedagogical consideration, learning mainstays remain inclusive educational systems that identify student needs and support well-designed programmes. Within these, scaffolded modules should include a variety of engaging learning activities with non-threatening formative and trustworthy summative feedback. We acknowledge some statistical study limitations, but its tentative findings make a useful preliminary contribution

Sexuality talk during adolescent health maintenance visits

IMPORTANCE: Physicians may be important sources of sexuality information and preventive services, and one-on-one confidential time during health maintenance visits is recommended to allow discussions of sexual development, behavior, and risk reduction. However, little is known about the occurrence and characteristics of physician-adolescent discussions about sexuality. OBJECTIVE: To examine predictors of time spent discussing sexuality, level of adolescent participation, and physician and patient characteristics associated with sexuality discussions during health maintenance visits by early and middle adolescents. DESIGN, SETTING, AND PARTICIPANTS: Observational study of audio-recorded conversations between 253 adolescents (mean age, 14.3 years; 53% female; 40% white; 47% African American) and 49 physicians (82% pediatricians; 84% white; 65% female; mean age, 40.9 years; mean [SD] duration in practice, 11.8 [8.7] years) coded for sexuality content at 11 clinics (3 academic and 8 community-based practices) located throughout the Raleigh/Durham, North Carolina, area. MAIN OUTCOMES AND MEASURES: Total time per visit during which sexuality issues were discussed. RESULTS One hundred sixty-five (65%) of all visits had some sexual content within it. The average time of sexuality talk was 36 seconds (35% 0 seconds; 30% 1-35 seconds; and 35% ≥ 36 seconds). Ordinal logistic regression (outcome of duration: 0, 1-35, or ≥ 36 seconds), adjusted for clustering of patients within physicians, found that female patients (odds ratio [OR] = 2.58; 95% CI, 1.53-4.36), older patients (OR = 1.37; 95% CI, 1.13-1.65), conversations with explicit confidentiality discussions (OR = 4.33; 95% CI, 2.58-7.28), African American adolescents (OR = 1.58; 95% CI, 1.01-2.48), and longer overall visit (OR = 1.07; 95% CI, 1.03-1.11) were associated with more sexuality talk, and Asian physicians were associated with less sexuality talk (OR = 0.13; 95% CI, 0.08-0.20). In addition, the same significant associations between adolescent, physician, and visit characteristics were significantly associated with greater adolescent participation. CONCLUSIONS AND RELEVANCE: Our study may be the first to directly observe sexuality talk between physicians and adolescents. We found that one-third of all adolescents had annual visits without any mention of sexuality issues; when sexuality talk occurred, it was brief. Research is needed to identify successful strategies physicians can use to engage adolescents in discussions about sexuality to help promote healthy sexual development and decision making. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01040975

How important is the context of an adolescent's first alcoholic drink? Evidence that parental provision may reduce later heavy episodic drinking

Objective: This study examined the extent to which a retrospective measure of parental provision of the first alcoholic beverage was related to current heavy episodic drinking and current responsible drinking practices. Sample: 608 14- to 17-year-olds from the 2007 Australian National Drug Strategy Household Survey. Measures: Source of first alcoholic beverage (friends/parents/others), source of current alcohol, age of onset of alcohol use, current responsible drinking practices, and proportion of current friends who drink. Results: Binary logistic and multiple regression procedures revealed that parental provision of an adolescent's first alcoholic beverage predicted lower current heavy episodic drinking, and responsible drinking mediated this association. Discussion: The results suggested that for adolescents who become alcohol users, parental provision of the first drink may reduce subsequent alcohol-related risks compared to introduction to alcohol by friends and other sources. Alcohol-related risks remain significant for adolescents who consume alcohol, independent of who is the provider. Copyright (C) 2012 S. Karger AG, Base

Ancillary health effects of climate mitigation scenarios as drivers of policy uptake: a review of air quality, transportation and diet co-benefits modeling studies

Background: Significant mitigation efforts beyond the Nationally Determined Commitments (NDCs) coming out of the 2015 Paris Climate Agreement are required to avoid warming of 2 °C above pre-industrial temperatures. Health co-benefits represent selected near term, positive consequences of climate policies that can offset mitigation costs in the short term before the beneficial impacts of those policies on the magnitude of climate change are evident. The diversity of approaches to modeling mitigation options and their health effects inhibits meta-analyses and syntheses of results useful in policy-making. Methods/Design: We evaluated the range of methods and choices in modeling health co-benefits of climate mitigation to identify opportunities for increased consistency and collaboration that could better inform policy-making. We reviewed studies quantifying the health co-benefits of climate change mitigation related to air quality, transportation, and diet published since the 2009 Lancet Commission 'Managing the health effects of climate change' through January 2017. We documented approaches, methods, scenarios, health-related exposures, and health outcomes. Results/Synthesis: Forty-two studies met the inclusion criteria. Air quality, transportation, and diet scenarios ranged from specific policy proposals to hypothetical scenarios, and from global recommendations to stakeholder-informed local guidance. Geographic and temporal scope as well as validity of scenarios determined policy relevance. More recent studies tended to use more sophisticated methods to address complexity in the relevant policy system. Discussion: Most studies indicated significant, nearer term, local ancillary health benefits providing impetus for policy uptake and net cost savings. However, studies were more suited to describing the interaction of climate policy and health and the magnitude of potential outcomes than to providing specific accurate estimates of health co-benefits. Modeling the health co-benefits of climate policy provides policy-relevant information when the scenarios are reasonable, relevant, and thorough, and the model adequately addresses complexity. Greater consistency in selected modeling choices across the health co-benefits of climate mitigation research would facilitate evaluation of mitigation options particularly as they apply to the NDCs and promote policy uptake

Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study

Background: Emotional distress often causes patients with cancer and their family caregivers (FCGs) to avoid end-of-life discussions and advance care planning (ACP), which may undermine quality of life (QoL). Most ACP interventions fail to address emotional barriers that impede timely ACP. Aim: We assessed feasibility, acceptability, and preliminary effects of a mindfulness-based intervention to facilitate ACP for adults with advanced-stage cancer and their FCGs. Design: A single-arm pilot was conducted to assess the impact of a 6-week group mindfulness intervention on ACP behaviors (patients only), QoL, family communication, avoidant coping, distress, and other outcomes from baseline (T1) to post-intervention (T2) and 1 month later (T3). Participants: Eligible patients had advanced-stage solid malignancies, limited ACP engagement, and an FCG willing to participate. Thirteen dyads (N = 26 participants) enrolled at an academic cancer center in the United States. Results: Of eligible patients, 59.1% enrolled. Attendance (70.8% across 6 sessions) and retention (84.6% for patients; 92.3% for FCGs) through T3 were acceptable. Over 90% of completers reported high intervention satisfaction. From T1 to T3, patient engagement more than doubled in each of 3 ACP behaviors assessed. Patients reported large significant decreases in distress at T2 and T3. Family caregivers reported large significant improvements in QoL and family communication at T2 and T3. Both patients and FCGs reported notable reductions in sleep disturbance and avoidant coping at T3. Conclusions: The mindfulness intervention was feasible and acceptable and supported improvements in ACP and associated outcomes for patients and FCGs. A randomized trial of mindfulness training for ACP is warranted

2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant)

Since the 1995 publication of its Core Cardiovascular Training Statement (COCATS),1 the American College of Cardiology (ACC) has played a central role in defining the knowledge, experiences, skills, and behaviors expected of all clinical cardiologists upon completion of training. Subsequent updates have incorporated major advances and revisions—both in content and structure—including, most recently,