ABSTRACT
The article presents a new diagnostic category, Suicide Crisis Syndrome (SCS), which was proposed to the next revision of Diagnostic and Statistical Manual of Mental Disorders (DSM). Study objective: Adaptation of the Suicide Crisis Inventory (SCI-2) on a Russian sample. Participants: 618 responses to an internet-survey were used, the study lasted from June 16, 2020 to April 26, 2021. Age of the participants: 18-99 (.=26.9;SD=12.8). Gender: 451 females (74.2%), 135 males (22.2%), 32 participants preferred not to answer or chose other gender identity. Instruments: Suicide Crisis Inventory (SCI-2), Suicidal Narrative Inventory (SNI), Stressful Life Events Questionnaire, Columbia Suicide Severity Rating Scale (C-SSRS), questions about recent and lifetime suicidal behavior. Results: Confirmatory factor analyses confirmed the five-factor (chi(2)[1420]=5003.56, p<.001, CFI=.99, TLI=.99, RMSEA=.07, SRMR=.06) and one-factor (chi(2)[1430] = 9847.34, p<.001, CFI=.98, TLI=.98, RMSEA=.10, SRMR=.07) solutions of the inventory, with five-factor as a better solution (Delta chi(2)[10] = 4843.78, p <.001). Based on retrospective data (self-reports on suicidal attempts during the last month), SCI-2 showed good diagnostic qualities (AUC=.85, 95% CI [.72;.97]). The cut-off score was established (80), which indicates the presence of acute suicidal risk. Conclusions: Adaptation of the Suicide Crisis Inventory (SCI-2) went well, the instrument is ready for use for clinical and research purposes.
ABSTRACT
During the 2020 election, voting by mail greatly expanded due to concerns with COVID-19. While voting by mail is relatively easy for most individuals, who have United States Postal Service (USPS) residential mail service, it is much more difficult for those with nonstandard mail service. In this article, we examine how decisions made by the USPS in the latter part of the nineteenth and early twentieth centuries have resulted in deeply entrenched structural inequities in the access to mail services on the Navajo Nation in Arizona when compared to rural nonreservation communities. Most (89 percent) of current Post Offices were established during the settler colonial period, during which sites were chosen primarily to advance military objectives and serve the interests of Anglo-American settlers. The resulting inequitable pattern of postal access remains, resulting in inferior mail service on the Navajo Nation and adversely impacting many aspects of life. Post Offices are fewer and farther from each other on reservation communities;there are fewer service hours;and we show in a mail experiment that letters posted on reservations are slower and less likely to arrive. This research fits within the growing body of American political development research on path-dependent processes and "spatial racism" within geography.
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The Covid-19 pandemic has been a major disrupter in the Australian early childhood education (ECE) sector. ECE educators had to respond quickly to frequent surprises and risky challenges. Their stressful, exhausting experiences as they constantly managed change are explored in this paper. The study used an interpretive social constructionist approach to interview six ECE leaders in order to construct a shared understanding of their beliefs and experiences during this time. The results indicate an increased risk of mental and physical health problems, and some impaired service quality. Although the results are indicative of historical treatment, the consequences of government neglect have resulted in a staffing crisis and closed services. Lessons need to be learned in how we treat educators and services if we want future generations of children educated and cared for by resilient educators who are not at risk of feeling they are in "burnout central". © 2023, Western Australian Institute for Educational Research Inc.. All rights reserved.
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The COVID-19 pandemic, and the Tokyo Olympic Games postponement, has created unprecedented challenges for Olympic level athletes. Given the adversity athletes have faced since the World Health Organization (WHO) declared COVID-19 a global pandemic, the construct of psychological resilience is a useful framework for understanding athlete experiences during this time, and is conceptualized by Fletcher and Sarkar as an individual's ability to protect against the negative effect of stressors. The purpose of this research was to explore the experiences of Canadian athletes preparing for the Tokyo summer Olympic Games during the COVID-19 global pandemic. Interviews were conducted with 20 Canadian athletes across individual and team sports. The participants spoke of the multiple ways they were taking care of themselves and developing resilience throughout the pandemic, highlighting the complexity involved with managing an adversity. Four narratives illuminate the athletes' experiences: the critical role of context, the essential nature of social support, the importance of being more than an athlete, and the relevance of learning to reflect on one's life. For these athletes, factors such as Olympic qualification, stage of their career, physical and mental health, and access to resources influenced their experience of the pandemic, demonstrating the importance of both individual and environmental factors when exploring resilience. Importantly, the athletes did not manage this adversity on their own, but received strong support. Therefore, sport psychology consultants can assist an athlete's development of resilience by providing expertise and taking into account an athlete's personal context.
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This report documents changes in national housing supply and liquidity during the COVID-19 era using a suite of monthly indices, ranging from summary statistics (mean and median time on the market, proportion of homes sold, etc.) to more advanced econometric indices that can address censoring and unobserved heterogeneity. The results indicate a sharp structural break in most of the indices near the start of COVID-19 in March 2020, though each index's most likely break date varies by a few months. The findings suggest that the start of the pandemic saw a supply decrease, followed by an immediate and sustained price increase. Listings became more likely to be withdrawn, but those that sold did so faster relative to pre-COVID-19 levels, indicating a change in the distribution of housing market liquidity. Finally, the results suggest that there were different types of structural breaks, specifically changes in the level, slope, and seasonality of the indices.
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Aims: COVID-19 has had much publicised impacts on cancer diagnosis within Victoria. Statewide there are thought to be over 2000 undiagnosed malignancies since the start of the pandemic, particularly in men andwithin melanoma, prostate cancer and head and neck malignancies. Regional and local patterns of presentation may differ from statewide data and local data suggesting under diagnosis may assist in regional service planning. Method(s): Prior statistical analysis using Victorian Cancer Registry (VCR) data has been used to identify a shortfall in cancer diagnoses. VCR notifications for 2019-2021 inclusive for the Barwon southwest region were utilised for this review. Notifications for the five most common cancers were assessed for major variations in notifications, taking a pragmatic approach to classify a major variation where notifications changed by more than 10% from 2019 levels in either or both of 2020/2021. Result(s): Total notifications did not change significantly from 2019- 21 (3676, 3777, 3731, respectively). Likewise, there were no obvious reductions in notification by sex or in older patients. While breast cancer notifications dropped in 2021 but rebounded in 2022 (424, 348, 453), diagnoses of DCIS increased each year (36, 55, 68). Lung cancer notifications dropped in 2021-22 (336, 249, 269) as did notifications of colorectal cancer (452, 418, 361), while prostate cancer notifications rose (531, 662, 654) and melanoma notifications were fairly consistent (145, 158, 141). Conclusion(s): Using a pragmatic approach to identifying major variations in cancer notifications during the COVID-19 pandemic, regional data suggests a reduction in lung cancer and colorectal cancer diagnoses in our region. Unlike reported statewide data, there was not an obvious drop in notifications of prostate cancer or melanoma. Further analysis of this data may help better identify cohorts with under diagnosis in our region.
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The Covid-19 pandemic has created an opportunity to examine the initial policies developed by Australian, Canadian, English, German, Greek and Irish governments to limit the spread of the virus. This has revealed governments’ conceptualisation of the early childhood sector and its workforce. This paper argues that neoliberal ideology and neoliberal imaginaries have already influenced the early childhood sector globally. During the pandemic, the choices that governments made at the outset of the pandemic has allowed their priorities and underlying ideology to be more transparent. Using an ethnographic methodology, early childhood researchers from each of the six countries, examined their individual governments policy responses and the effects on the early childhood sector during its initial months (between March and June 2020). The authors consider the extent to which this may have implications for the sector in how it should continue its ongoing pursuit of professionalisation of the sector. © 2022, Western Australian Institute for Educational Research Inc.. All rights reserved.
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Introduction: Data driven management strategies for acute pancreatitis (AP) in pediatrics have been limited. Adult data suggests use of lactated ringers (LR) compared to normal saline (NS) resulted in favorable outcomes. The first management guideline for pediatric patients based on a standardized definition of AP severity was published in 2018;it described the need for early aggressive fluid resuscitation, but had insufficient data to recommend a specific fluid. Objective(s): To evaluate the efficacy of LR as the intravenous fluid (IVF) during the first 48 hours of an AP episode compared with NS. Study Design: A prospective multi-site randomized controlled clinical trial, started in 2016 at Children's Hospital of The King's Daughters, (Clinical Trials.gov NCT03242473), expanded to Children's National Hospital (2017), and to Cincinnati Children's Hospital Medical Center (CCHMC) (2018). Eligible patients (<19 years) diagnosed with first episode of AP were enrolled within 6 hours of presentation and were randomized to either LR or NS. A comprehensive biochemical profile was obtained at admission, and at 24 and 48 hours from time of admission. Vital signs, SIRS status, and signs of complications of AP were monitored. Clinical decisions regarding management (e.g. discharge criteria) were determined by the primary clinical team. Recruitment was stopped in the spring of 2020 due to the SARS-CoV2 pandemic. Primary outcomes were C-Reactive Protein (CRP) values at 24 and 48 hours after admission;secondary outcomes were changes in labs, SIRS status length of stay, time to initation of feeds, and development of severe AP (SAP). Result(s): There were 76 eligible patients (38 LR, 38 NS). There was no significant differences in baseline characteristics or AP etiology for either group (Table 1). There was no significant differences in initial biochemical profile except a slightly elevated anion gap in the LR group (Table 2). There was a higher proportion of patients in the LR group (32%, 12/38) discharged before 48 hours compared to NS (13%, 5/38) (Table 3). The LR group had a significantly higher rate of discharge within the first 72 hours compared to the NS group (p=0.02) (Figure 1a and 1b). In the first 48 hours, there was no difference in the primary or most of the secondary outcomes measured (Table 3). Conclusion(s): Use of LR was associated with a faster rate of discharge in the first 72 hours and had no significant negative outcomes associated with its use. No other significant differences in overall outcomes were identified with the use of LR or NS during hospitalization for AP in this study. This reduction in length of hospitalization has significant implications for patients as well as healthcare expenditures. This data suggests that early resuscitation with LR may be beneficial to recovery, particularly in patients more likely to have mild AP, who may be able to be identified early in the hospital course. Future pediatric AP studies will be required to confirm these findings. (Table Presented).
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The UK Myotonic Dystrophy Patient Registry is a patient self-enrolling online database collecting clinical and genetic information about myotonic dystrophy type 1 (DM1) and type 2 (DM2). The registry was established in May 2012 with support from Muscular Dystrophy UK and the Myotonic Dystrophy Support Group and is coordinated Newcastle University. The registry aims to facilitate academic and clinical research, better characterise and understand DM, and disseminate information relating to upcoming studies and research advancements. The registry is used to capture longitudinal, selfreported data through an online portal available to patients and clinicians. Where specialised clinical or genetic information is required, the neuromuscular specialist involved in the patient's care can be invited to provide some additional information and the patient can select them from a pre-populated list at the registration stage. The registry is a Core Member of the TREAT-NMD Global Registries Network for DM1. Between May 2012 and January 2022, there were 834 patient registrations. On average there are 5 new registrations per month. For those reporting a clinical diagnosis, 96% have DM1 (of which 14% have a diagnosis of congenital DM) and 4% have DM2. Overall, 40% of patients have had genetic confirmation of their condition provided. The registry has previously supported almost 30 research enquiries to date. Since 2020, the registry has facilitated 11 enquiries including an industry enquiry, three COVID-19 surveys, and various surveys capturing information on dysphagia, pregnancy, patient preferences for future treatments and the patient/ caregiver experience. The registry continues to be a versatile, cost-effective research tool, helping facilitate and advance a range of DM research. Additional work continues to be done to improve reporting of genetic information on the registry and there are future data linkage plans between the registry and the Newcastle Research Biobank for Rare and Neuromuscular Diseases.
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Introduction: Covid infection is associated with an increased rate of thrombosis, up to 50%,1 but the reasons for this are unclear. Rotem is a form of viscoelastic measurement of blood coagulation, allowing graphical representation of the time a clot takes to form (clotting time (CT) and clotting formation time (CFT)), its strength (firmness of the clot after 5 min (A5) and maximum clot firmness (MCF)), and dissolution (maximum lysis (ML). Rotem provides four analyses to each sample: Intem (measure of intrinsic pathway), Extem (extrinsic pathway), Heptem (similar to Intem, excluding heparin effects) and Fibtem (isolating fibrinogen function). In one study, Covid infection was associated with a reduced clotting time and an increased maximum clot firmness overall.2 The same study also suggested a possible increase in Fibtem MCF value for COVID patients, suggesting a strong influence of fibrinogen on the clot. This clinical effectiveness audit was designed to determine if (1) Covid patients in the Royal Surrey County Hospital also displayed increased clotting tendencies compared with patients without, as measured by Rotem and fibrinogen levels, and (2) whether fibrinogen levels correlate with Fibtem MCF levels. Methods: A retrospective data analysis from all Rotem analyses in ICU between June 2020 and February 2021 was performed. To compare coagulation in patients with and without Covid, data were tested for normality using Shapiro-Wilks testing. Normal data were compared by the Student t-test;non-normal data were compared by the Mann-Whitney U-test. A p-value < 0.05 was taken as statistically significant. In the second part, correlation between fibrinogen values and Fibtem MCF values was assessed using a Pearson correlation coefficient. Results: 163 patients had Rotem analyses performed, of whom 12 (7.4%) had a positive Covid test. The median Fibtem A5 in Covid patients was 21 mm compared with 13 mm in non-Covid patients, and median MCF was 25 mm compared with 16 mm, indicating a significant increase in the clot strength by the fibrin component between patients with and without Covid. No other Rotem differences were found. There was also a statistically significant difference between fibrinogen levels in COVID (median 6.2) and non-COVID (median 3.05) patients, suggesting a significant contribution of fibrinogen to clotting in COVID. Finally, the study demonstrated a strong positive correlation between fibrinogen levels, as measured by the laboratory, and corresponding Rotem MCF values in all patients (R2 = 0.8105), and in patients with Covid (R2 = 0.905). Discussion: There was a significant increase in the clot firmness due to the fibrin component, and fibrinogen levels, in patients with Covid infection, compared with those without, consistent with a previous study.2 Rotem measurement of clot strength by fibrin correlated very well with fibrinogen levels. This study suggests that the increase in thrombosis in Covid may be in part related to increased fibrinogen activity. The study may be limited by small numbers of patients, and the heterogeneity of the patients within each group.
ABSTRACT
The U.S. Bureau of Labor Statistics publishes seasonally adjusted Consumer Price Index (CPI) and Producer Price Index (PPI) data monthly. Seasonal adjustment removes within-year seasonal patterns from data. To seasonally adjust data and estimate seasonal patterns of time series, the CPI and PPI use a filter-based approach that employs moving averages of historical data. In 2020, many PPIs and CPIs experienced extreme movements because of the coronavirus disease 2019 (COVID-19) pandemic. For example, the PPI and CPI for gasoline decreased 53.0 percent and 16.5 percent in April 2020, respectively. Because the CPI and PPI use historical data to estimate seasonal patterns, the extreme price movements in 2020 could have adversely affected the capability of the two price programs to accurately estimate seasonally adjusted data. This article explains how the CPI and PPI mitigated the effects of the COVID-19 pandemic on their seasonally adjusted price indexes. Mitigation steps included identifying price indexes whose movements were affected by the pandemic, estimating time series models to quantify these effects, and removing pandemic-related price movements from the data before estimating seasonal patterns.
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Introduction: Data driven management strategies for acute pancreatitis (AP) in pediatrics have been limited. Adult data suggests use of lactated ringers (LR) compared to normal saline (NS) resulted in favorable outcomes. The first management guideline for pediatric patients based on a standardized definition of AP severity was published in 2018;it described the need for early aggressive fluid resuscitation, but had insufficient data to recommend a specific fluid. Objective: To evaluate the efficacy of LR as the intravenous fluid (IVF) during the first 48 hours of an AP episode compared with NS. Study Design: A prospective multisite randomized controlled clinical trial, started in 2016 at Children's Hospital of The King's Daughters, (Clinical Trials.gov NCT03242473), expanded to Children's National Hospital (2017), and to Cincinnati Children's Hospital Medical Center (CCHMC) (2018). Eligible patients (<19 years) diagnosed with first episode of AP were enrolled within 6 hours of presentation and were randomized to either LR or NS. A comprehensive biochemical profile was obtained at admission, and at 24 and 48 hours from time of admission. Vital signs, SIRS status, and signs of complications of AP were monitored. Clinical decisions regarding management (e.g. discharge criteria) were determined by the primary clinical team. Recruitment was stopped in the spring of 2020 due to the SARS-CoV2 pandemic. Primary outcomes were C-Reactive Protein (CRP) values or changes in CRP and SIRS;secondary outcomes were changes in labs, length of stay, and development of severe AP (SAP). Results: There were 76 eligible patients (38 LR, 38 NS). There was no significant differences in baseline characteristics or AP etiology for either group (Table 1). There were no significant differences in initial biochemical profiles except a slightly elevated anion gap in the LR group (Table 2). There was a higher proportion of patients in the LR group (32%, 12/38) discharged before 48 hours compared to NS (13%, 5/38) (Table 3). The LR group had a significantly higher rate of discharge within the first 72 hours compared to the NS group (p=0.02) (Figure 1). In the first 48 hours, there was no difference in the primary or most of the secondary outcomes measured (Table 3). Conclusion: Use of LR was associated with a faster rate of discharge in the first 72 hours. This reduction in length of hospitalization has significant implications for patients as well as healthcare expenditures. This data suggests that early resuscitation with LR may be beneficial to recovery, particularly in patients more likely to have mild AP, who may be able to be identified early in the hospital course. No other significant differences in overall outcomes were identified with the use of LR or NS during hospitalization for AP in this study. Future pediatric AP studies will be required to confirm these findings.(Table Presented)(Table Presented)(Table Presented) (Figure Presented)
ABSTRACT
The relationship between early childhood education and care (ECEC, birth to 8 years), children’s lifelong learning trajectory and the economy is undisputed. This relationship was particularly apparent during the COVID-19 pandemic. Using an auto-ethnographical study, this chapter discusses government responses across 10 countries: Australia, Canada, Chile, Denmark, England, Germany, Greece, Ireland, Italy and Portugal reveal much about the perceptions of children and their early childhood professionals from a political, social and economic stance. The chapter interrogates how government responses situate children and early childhood professionals within the educational landscape in the countries studied and asks how it shapes early childhood education in particular. It illustrates that Governments overall, in the countries studied, did not recognise ECEC as fundamental to the educational continuum. In looking to the future, we question how early childhood education should develop to prepare children for the times we live in so that children are able to flourish and shape future societies with confidence and purpose. Finally, we ask whether the pandemic could possibly see the dawn of a new era in knowledge and understanding of the centrality of Early Childhood Education and Care. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Background: Colorectal cancer (CRC) mortality is disproportionately higher in Appalachian counties of Kentucky than in non-Appalachian regions. Part of the mortality gap can be explained by lower screening rates in Appalachian counties. Researchers at Markey Cancer Center partnered with primary care clinics in eastern Kentucky to address this disparity by identifying strategies to implement evidence-based interventions (EBIs) to improve CRC screening and follow-up in Appalachian Kentucky. Methods: Members of the research team conducted formative research activities to identify multilevel barriers to CRC screening. A menu of EBIs was then created to address these barriers, and clinic champions selected EBIs that were feasible in their respective practices. However, because of restrictions during COVID-19, clinics experienced multiple changes to workflow and operations, necessitating modifications to program activities. Over a series of virtual meetings, clinic champions selected adaptations that could allow clinics to continue promoting CRC screening in their practices despite COVID-related limitations. Results: Changes in clinic staffing and workflow resulting from COVID-19 included provider furloughs, a state-mandated pause in elective procedures, mandatory parking lot visits for many in-person visits, and an increase in telehealth. Among our clinic partners, total in-person visits were reduced by nearly half from first to second quarter of 2020, whereas telehealth visits were 23 times higher, though telehealth visits were cut in half by third quarter. To match these changing modes of practice, clinics adapted creative strategies for communicating CRC screening recommendations to patients, including shifting from paper to digital educational tools, promoting screening via telehealth visits, and prioritizing recommendations for stool-based tests over colonoscopy for average-risk patients. As a result, orders for FIT and FIT-DNA were 2 and 3 times higher, respectively, from second to third quarter of 2020. Conclusion: Rural primary care clinics in Appalachia continue to promote CRC screening despite the multiple challenges related to COVID-19. One relevant reference for clinicians is the National Colorectal Cancer Roundtable's playbook for reigniting CRC screening during COVID-19, a document that promotes stool-based screening for average-risk patients. While elective procedures remain backlogged in rural areas due to state regulations, research partners should emphasize the need to prioritize stool-based CRC screening for average-risk populations and reserve scheduling colonoscopies for high-risk individuals or those with abnormal stool-based test results. While our clinical partners had previously focused on a “colonoscopy first” approach to screening, our findings suggest that our clinic partners increased orders for stool-based CRC tests. Nevertheless, continued outreach is needed to ensure CRC screening rates remain optimal.
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Teaching a field experience course during a pandemic resulted in unique challenges because preservice teachers could not visit classrooms like they would in a traditional field experience. This article is a self-study exploration of the tensions experienced by a doctoral student teaching an elementary math and science field experience in a fully online setting during the height of the COVID - 19 pandemic. To substitute for a lack of available elementary school children, preservice teacher acted as substitutes for children during lesson rehearsals. Preservice teachers were usually poor substitutes for actual children when evaluating the extent to which the pandemic field experience mimicked traditional field experience. Instructional videos were frequently used in an attempt to provide meaningful opportunities for preservice teachers to engage in classroom practices. The perceived usefulness of instructional videos by preservice videos varied based on the type of video that was used.
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The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.
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American football poses unique challenges to protecting the health of athletes both on and off the field. While off-field activities likely pose the greatest risk of COVID-19 transmission among members of the same team, on-field activities may pose transmission risks from one team to another. The findings of this study suggest that, when used in well-ventilated outdoor environments, helmet modifications combining upper and lower visors may help reduce on-field respiratory transmission risks with relatively minimal effects on athletic performance. These findings may offer practical insights to team physicians and athletic trainers as they seek strategies to protect athletes against on-field transmission of COVID-19 in the weeks and months ahead.
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Epidemiological modeling is used, under certain assumptions, to represent the spread of a disease within a population. Information generated by these models can then be applied to inform public health practices and mitigate risk. To provide useful and actionable preparedness information to administrators and policy makers, epidemiological models must be formulated to model highly localized environments such as office buildings, campuses, or long-term care facilities. In this paper, a highly configurable agent-based simulation (ABS) framework designed for localized environments is proposed. This ABS provides information about risk and the effects of both pharmacological and non-pharmacological interventions, as well as detailed control over the rapidly evolving epidemiological characteristics of COVID-19. Simulation results can inform decisions made by facility administrators and be used as inputs for a complementary decision support system. The application of our ABS to our research lab environment as a proof of concept demonstrates the configurability and insights achievable with this form of modeling, with future work focused on extensibility and integration with decision support.
Subject(s)
COVID-19 , COVID-19/epidemiology , Computer Simulation , Forecasting , Health Facilities , Humans , Systems AnalysisABSTRACT
Among the many striking features of the COVID 19 pandemic is the geographic heterogeneity of its incidence and its disproportionate effects on low income people. We examine links between individual risk and COVID 19 outcomes in the federal context in Mexico characterized by high socioeconomic and political heterogeneity. Using highly detailed individual mobility data for five Mexican cities, we document the relationship between local income and education factors and the behaviors associated with COVID 19 risk after the national lockdown: staying home, going to work, and going other places. While low income people are disproportionately likely to contract COVID 19 and die from illnesses associated with COVID 19 in Mexico, we find very mixed evidence that people living in low income urban census blocs are engaging in observably riskier behaviors. Both before and after the national lockdown, people in low income locations spend more time at home and less time going other places, suggesting a lower overall risk of contracting the virus based on voluntary movement. However, people in low income and less educated places appear to shift their movement less in response to Mexico’s national lockdown. Less educated people, in particular, show much less change in their movement patterns in response to the lockdown. At the same time, we find enormous variance between cities and in some cities such as Mexico City and Ecatepec people in low income places changed their behavior more after the lockdown. Understanding the reasons for these income and education differences in outcomes is crucial for policy responses–whether the government should focus on educating individuals about their behavior, or whether the response requires a much more difficult overhaul of societal protections. Copyright © 2021 Rogers, Zeng, Marx, Poynor and Lu.