Lifetime years married held steady for men with a BA degree since 1960 but dropped to lowest level since 1880 for men without a BA.

Trends in life expectancy and marriage patterns work together to determine expected lifetime years married. In 1880, adult life expectancy was short and marriages were more likely to end by death than divorce. Since then, although there have been substantial life expectancy gains in adulthood, marriage has been increasingly delayed or forgone and cohabitation and divorce are far more prevalent. Whether adults today can expect to spend more or fewer years married than in the past depends on the relative magnitude of changes in mortality and marriage. We estimate trends in men's expected lifetime years married (and in other marital statuses) from 1880 to 2019 and by bachelor's degree (BA) status from 1960 to 2019. Our results show a rise in men's expected lifetime years married between 1880 and the Baby Boom era and a subsequent fall. There are large and growing differences by BA status. Men with a BA have had high and relatively stable expected lifetime years married since 1960. For men without a BA, expected lifetime years married has plummeted to lows not seen among men since 1880. Cohabitation accounts for a substantial fraction, although not all, of these declines. Our results demonstrate how increasing inequality in both life expectancy and marriage patterns combine to amplify educational differences in lifetime experiences of coresidential partnerships.

CHANGE AND VARIATION IN U.S. COUPLES' EARNINGS EQUALITY FOLLOWING PARENTHOOD.

In the context of broad increases in gender equality and growing socioeconomic disparities along multiple dimensions of family life, we examine changes in within-family earnings equality following parenthood and the extent to which they have played out differently by education. Our analysis relies on links between rich surveys and administrative tax records that provide high quality earnings data for husbands and wives spanning two years before and up to 10 years following first births from the 1980s to the 2000s in the United States (Survey of Income and Program Participation Synthetic Beta files; N=21,300 couples and 194,100 couple-years). Accounting for time-invariant couple characteristics and year and age fixed effects, we find that wives' share of total couple earnings declines substantially after parenthood and remains lower over the observation window. Cohort changes in within-family earnings equality are modest and concentrated among the earliest cohort of parents, and data provide little evidence of differential change by education. Wives' financial dependence on their husbands increases substantially after parenthood, irrespective of education and cohort. These findings have implications for women's vulnerability, particularly in the U.S. where divorce remains common and public support for families is weak.

Prevalence of childhood mental disorders in high-income countries: a systematic review and meta-analysis to inform policymaking.

QUESTION: Mental disorders typically start in childhood and persist, causing high individual and collective burdens. To inform policymaking to address children's mental health in high-income countries we aimed to identify updated data on disorder prevalence. METHODS: We identified epidemiological studies reporting mental disorder prevalence in representative samples of children aged 18 years or younger-including a range of disorders and ages and assessing impairment (searching January 1990 through February 2021). We extracted associated service-use data where studies assessed this. We conducted meta-analyses using a random effects logistic model (using R metafor package). FINDINGS: Fourteen studies in 11 countries met inclusion criteria, published from 2003 to 2020 with a pooled sample of 61 545 children aged 4-18 years, including eight reporting service use. (All data were collected pre-COVID-19.) Overall prevalence of any childhood mental disorder was 12.7% (95% CI 10.1% to 15.9%; I2=99.1%). Significant heterogeneity pertained to diagnostic measurement and study location. Anxiety (5.2%), attention-deficit/hyperactivity (3.7%), oppositional defiant (3.3%), substance use (2.3%), conduct (1.3%) and depressive (1.3%) disorders were the most common. Among children with mental disorders, only 44.2% (95% CI 37.6% to 50.9%) received any services for these conditions. CONCLUSIONS: An estimated one in eight children have mental disorders at any given time, causing symptoms and impairment, therefore requiring treatment. Yet even in high-income countries, most children with mental disorders are not receiving services for these conditions. We discuss the implications, particularly the need to substantially increase public investments in effective interventions. We also discuss the policy urgency, given the emerging increases in childhood mental health problems since the onset of the COVID-19 pandemic (PROSPERO CRD42020157262).

Community and Academic Physicians Working Together in Integrated Health Care Systems.

OBJECTIVE: To examine best practices and policies for effectively merging community and academic physicians in integrated health care systems. METHODS: Deans of US allopathic medical schools were systematically interviewed between February and June 2017 regarding growth in their faculty practice plan (FPP), including logistics and best practices for integration of community physicians. RESULTS: The survey was completed by 107 of 143 (74.8) of US medical school deans approached. Of these institutions, 73 met criteria for final analysis (research-based medical schools with FPPs of >300 physicians). Most academic medical center-based FPPs have increased in size over the last 5 years, with further growth anticipated via adding community physicians (85%). Because of disparate practice locations, integration of community and academic physicians has been slow. When fully integrated, community physicians predominantly have a clinical role with productivity incentives. Deans report that cultural issues must be addressed to avoid conflict. Consensus exists that transparent clinical work requirements for all FPP members, clearly defined productivity incentives, additional promotion tracks, and early involvement of department chairs and other leaders enhances trust and creates better synergy among all physician providers. CONCLUSION: Findings from this study should help guide FPPs, academic medical center leaders, chief medical officers, and professional and trade organizations in working toward positive physician synergy in consolidated health care organizations. Work and cultural considerations must be addressed to honor distinct talents of each physician group, facilitating smooth transition from disparate groups to healthy synergy.

Opportunity and change in occupational assortative mating.

This article documents how opportunity and change in the U.S. occupational structure shaped patterns of occupational assortative mating between 1970 and 2015-2017. Trends in occupational assortative mating have often been cited as potentially contributing to the rise in economic inequality-the idea that doctors increasingly marry doctors instead of nurses-thereby exacerbating the concentration of resources among advantaged households. Previous estimates of trends in occupational assortative mating are now decades old and their impact on household inequality has not been quantified. Our results show large-scale change. The prevalence of dual-professional couples nearly tripled between 1970 and 2015-2017. Changes were especially large among particular occupational combinations. For instance, male doctors have become increasingly likely to be married to female doctors, and male lawyers to female lawyers. Almost all of the changes in occupational assortative mating patterns, however, are accounted for by changes in the distributions of spouses' occupations, for example, the rise of women in professional occupations. Because of this, the contribution of occupational assortative mating to the rise in economic inequality has been small. In the absence of any association between spouses' occupations, observed increases in household earnings inequality would have been reduced by 5%. Although this is a small portion of overall changes in inequality, it is much larger than prior estimates of the effects of educational assortative mating on inequality, which recent studies have estimated to be essentially zero.

Changes in Couples' Earnings Following Parenthood and Trends in Family Earnings Inequality.

The growing economic similarity of spouses has contributed to rising income inequality across households. Explanations have typically centered on assortative mating, but recent work has argued that changes in women's employment and spouses' division of paid work have played a more important role. We expand this work to consider the critical turning point of parenthood in shaping couples' division of employment and earnings. Drawing on three U.S. nationally representative surveys, we examine the role of parenthood in spouses' earnings correlations between 1968 and 2015. We examine the extent to which changes in spouses' earnings correlations are due to (1) changes upon entry into marriage (assortative mating), (2) changes between marriage and parenthood, (3) changes following parenthood, and (4) changes in women's employment. Our findings show that increases in the correlation between spouses' earnings prior to 1990 came largely from changes between marriage and first birth, but increases after 1990 came almost entirely from changes following parenthood. In both instances, changes in women's employment are key to increasing earnings correlations. Changes in assortative mating played little role in either period. An assessment of the aggregate-level implications points to the growing significance of earnings similarity after parenthood for rising income inequality across families.

The Demography of Families: A Review of Patterns and Change.

The authors review demographic trends and research on families in the United States, with a special focus on the past decade. They consider the following several topics: (a) marriage and remarriage, (b) divorce, (c) cohabitation, (d) fertility, (e) same-gender unions, (f) immigrant families, and (g) children's living arrangements. Throughout, the authors review both overall trends and patterns as well as those by social class and race-ethnicity. The authors discuss major strands of recent research, emphasizing emerging themes and promising directions. They close with a summary of central patterns and trends and conclude that recent trends are not as uniform as they tended to be in earlier decades, making the description of family change increasingly complex.

Perineuronal net expression in the brain of a hibernating mammal.

During hibernation, mammals like the 13-lined ground squirrel cycle between physiological extremes. Most of the hibernation season is spent in bouts of torpor, where body temperature, heart rate, and cerebral blood flow are all very low. However, the ground squirrels periodically enter into interbout arousals (IBAs), where physiological parameters return to non-hibernating levels. During torpor, neurons in many brain regions shrink and become electrically quiescent, but reconnect and regain activity during IBA. Previous work showed evidence of extracellular matrix (ECM) changes occurring in the hypothalamus during hibernation that could be associated with this plasticity. Here, we examined expression of a specialized ECM structure, the perineuronal net (PNN), in the forebrain of ground squirrels in torpor, IBA, and summer (non-hibernating). PNNs are known to restrict plasticity, and could be important for retaining essential connections in the brain during hibernation. We found PNNs in three regions of the hypothalamus: ventrolateral hypothalamus, paraventricular nucleus (PVN), and anterior hypothalamic area. We also found PNNs throughout the cerebral cortex, amygdala, and lateral septum. The total area covered by PNNs within the PVN was significantly higher during IBA compared to non-hibernating and torpor (P < 0.01). Additionally, the amount of PNN coverage area per Nissl-stained neuron in the PVN was significantly higher in hibernation compared to non-hibernating (P < 0.05). No other significant differences were found across seasons. The PVN is involved in food intake and homeostasis, and PNNs found here could be essential for retaining vital life functions during hibernation.

Six decades of preventing and treating childhood anxiety disorders: a systematic review and meta-analysis to inform policy and practice.

QUESTION: Anxiety disorders are the most prevalent childhood mental disorders. They also start early and persist, causing high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders? METHODS: We sought randomised controlled trials (RCTs) evaluating interventions addressing anxiety problems in young people. We identified RCTs by searching CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science. Thirty-three RCTs met inclusion criteria-evaluating 8 prevention programmes, 12 psychosocial treatments and 7 pharmacological treatments. We then conducted meta-analyses by intervention type. FINDINGS: For prevention, the cognitive-behavioural therapy (CBT) programme Coping and Promoting Strength stood out for reducing anxiety diagnoses. For psychosocial treatment, 9 CBT interventions also reduced diagnoses: Cool Kids; Cool Little Kids Plus Social Skills; Coping Cat; Coping Koala; One-Session Treatment; Parent Education Program; Skills for Academic and Social Success; Strongest Families and Timid to Tiger. Successful CBT interventions were used with children ranging from pre-schoolers to teens in homes, communities/schools and clinics. For pharmacological treatment, selective-serotonergic-reuptake-inhibitors (SSRIs) significantly improved symptoms. Fluoxetine stood out for also reducing post-test diagnoses, but caused adverse events. Meta-analyses indicated strongest effects for CBT (Log OR=0.95; 95% CI, 0.69 to 1.21) and SSRI treatments (1.57; 1.09 to 2.06). CONCLUSIONS: CBT is effective for preventing and treating childhood anxiety-across a range of ages and formats. Fluoxetine is also an effective treatment but side effects must be managed. CBT prevention and treatment interventions should be made widely available, adding fluoxetine in severe cases.

Comprehensive history of 3-year and accelerated US medical school programs: a century in review.

Within the context of major medical education curricular reform ongoing in the United States, a subset of schools has re-initiated accelerated (3-year) medical education. It would be helpful for education leaders to pause and consider historical reasons such accelerated medical schools were started, and then abandoned, over the last century to proactively address important issues. As no comprehensive historical review of 3-year medical education exists, we examined all articles published on this topic since 1900. In general, US medical educational curricula began standardizing into 4-year programs in the early 1900s through contributions from William Osler, Abraham Flexner, and establishment of the American Medical Association (AMA) Council of Medical Education (CME). During WWII (1939-1945), accelerated 3-year medical school programs were initiated as a novel approach to address physician shortages; government incentives were used to boost the number of 3-year medical schools along with changed laws aiding licensure for graduates. However, this quick solution generated questions regarding physician competency, resulting in rallying cries for oversight of 3-year programs. Expansion of 3-year MD programs slowed from 1950s to 1960s until federal legislation was passed between the 1960s and the 1970s to support training healthcare workers. With renewed government financial incentives and stated desire to increase physician numbers and reduce student debt, a second rapid expansion of 3-year medical programs occurred in the 1970s. Later that decade, a second decline occurred in these programs, reportedly due to discontinuation of government funding, declining physician shortage, and dissatisfaction expressed by students and faculty. The current wave of 3-year MD programs, beginning in 2010, represents a 'third wave' for these programs. In this article, we identify common societal and pedagogical themes from historical experiences with accelerated medical education. These findings should provide today's medical education leaders a historical context from which to design and optimize accelerated medical education curricula.

Hukou intermarriage and social exclusion in China.

Hukou is a key marker of status in contemporary China. Urban hukou status confers large economic benefits such as preferential access to good schools, prestigious occupations, and state-subsidized welfare benefits. As such, trends in hukou intermarriage convey important but underappreciated information about social mobility in China. This article examines trends in hukou intermarriage between 1958 and 2008. We find that hukou intermarriage is surprisingly common and has grown steadily since 1985. Hypotheses derived from Western contexts do little to explain this trend. Increased education, economic inequality, and availability each fail to explain trends as predicted in prior work. A common hypothesis is that increased inequality should reduce intermarriage by making it more costly to "marry down." We find the opposite-increasing inequality is associated with increasing hukou intermarriage, particularly between urban men and rural women, which is consistent with the hypothesis that the costs of marrying down may be outweighed by the incentives to marry up in this context. Our results also suggest hukou conversion plays a key role in increased intermarriage. These findings highlight the uniqueness of the Chinese context and suggest that standard hypotheses about assortative mating may not be applicable in contexts with strong state-controlled social boundaries.

Time-variable medical education innovation in context.

BACKGROUND: Medical education is undergoing robust curricular reform with several innovative models emerging. In this study, we examined current trends in 3-year Doctor of Medicine (MD) education and place these programs in context. METHODS: A survey was conducted among Deans of U.S. allopathic medical schools using structured phone interview regarding current availability of a 3-year MD pathway, and/or other variations in curricular innovation, within their institution. Those with 3-year programs answered additional questions. RESULTS: Data from 107 institutions were obtained (75% survey response rate). The most common variation in length of medical education today is the accelerated 3-year pathway. Since 2010, 9 medical schools have introduced parallel 3-year MD programs and another 4 are actively developing such programs. However, the total number of students in 3-year MD tracks remains small (n=199 students, or 0.2% total medical students). Family medicine and general internal medicine are the most common residency programs selected. Benefits of 3-year MD programs generally include reduction in student debt, stability of guaranteed residency positions, and potential for increasing physician numbers in rural/underserved areas. Drawbacks include concern about fatigue/burnout, difficulty in providing guaranteed residency positions, and additional expense in teaching 2 parallel curricula. Four vignettes of alternative innovative and relevant curricular initiatives are also presented in order to place 3-year MD programs in a broader context of medical education reform in the U.S. CONCLUSION: Three-year MD pathways are the most common accelerated alternative available at a small number of medical schools for highly selected students. Long-term evaluation of these programs will be essential to determine if these programs are meeting their goals (e.g., increasing the number of physicians in rural/underserved areas). Benefits and shortcomings of such programs should be carefully examined when considering this approach, or others described, as part of MD curricular options designed to individualize medical education.

Fifty years of preventing and treating childhood behaviour disorders: a systematic review to inform policy and practice.

QUESTION: Oppositional defiant and conduct disorders (ODD and CD) start early and persist, incurring high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders? STUDY SELECTION AND ANALYSIS: We sought randomised controlled trials (RCTs) evaluating interventions addressing the prevention or treatment of behaviour problems in individuals aged 18 years or younger. Our criteria were tailored to identify higher-quality RCTs that were also relevant to policy and practice. We searched the CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science databases, updating our initial searches in May 2017. Thirty-seven RCTs met inclusion criteria-evaluating 15 prevention programmes, 8 psychosocial treatments and 5 medications. We then conducted narrative synthesis. FINDINGS: For prevention, 3 notable programmes reduced behavioural diagnoses: Classroom-Centered Intervention; Good Behavior Game; and Fast Track. Five other programmes reduced serious behaviour symptoms such as criminal activity. Prevention benefits were long term, up to 35 years. For psychosocial treatment, Incredible Years reduced behavioural diagnoses. Three other interventions reduced criminal activity. Psychosocial treatment benefits lasted from 1 to 8 years. While 4 medications reduced post-test symptoms, all caused important adverse events. CONCLUSIONS: Considerable RCT evidence favours prevention. CLINICAL IMPLICATIONS: Effective prevention programmes should therefore be made widely available. Effective psychosocial treatments should also be provided for all children with ODD/CD. But medications should be a last resort given associated adverse events and given only short-term evidence of benefits. Policymakers and practitioners can help children and populations by acting on these findings.

Clinical genetics and outcome of left ventricular non-compaction cardiomyopathy.

AIMS: In this study, we aimed to clinically and genetically characterize LVNC patients and investigate the prevalence of variants in known and novel LVNC disease genes. INTRODUCTION: Left ventricular non-compaction cardiomyopathy (LVNC) is an increasingly recognized cause of heart failure, arrhythmia, thromboembolism, and sudden cardiac death. We sought here to dissect its genetic causes, phenotypic presentation and outcome. METHODS AND RESULTS: In our registry with follow-up of in the median 61 months, we analysed 95 LVNC patients (68 unrelated index patients and 27 affected relatives; definite familial LVNC = 23.5%) by cardiac phenotyping, molecular biomarkers and exome sequencing. Cardiovascular events were significantly more frequent in LVNC patients compared with an age-matched group of patients with non-ischaemic dilated cardiomyopathy (hazard ratio = 2.481, P = 0.002). Stringent genetic classification according to ACMG guidelines revealed that TTN, LMNA, and MYBPC3 are the most prevalent disease genes (13 patients are carrying a pathogenic truncating TTN variant, odds ratio = 40.7, Confidence interval = 21.6-76.6, P < 0.0001, percent spliced in 76-100%). We also identified novel candidate genes for LVNC. For RBM20, we were able to perform detailed familial, molecular and functional studies. We show that the novel variant p.R634L in the RS domain of RBM20 co-segregates with LVNC, leading to titin mis-splicing as revealed by RNA sequencing of heart tissue in mutation carriers, protein analysis, and functional splice-reporter assays. CONCLUSION: Our data demonstrate that the clinical course of symptomatic LVNC can be severe. The identified pathogenic variants and distribution of disease genes-a titin-related pathomechanism is found in every fourth patient-should be considered in genetic counselling of patients. Pathogenic variants in the nuclear proteins Lamin A/C and RBM20 were associated with worse outcome.

Lamins and nesprin-1 mediate inside-out mechanical coupling in muscle cell precursors through FHOD1.

LINC complexes are crucial for the response of muscle cell precursors to the rigidity of their environment, but the mechanisms explaining this behaviour are not known. Here we show that pathogenic mutations in LMNA or SYNE-1 responsible for severe muscle dystrophies reduced the ability of human muscle cell precursors to adapt to substrates of different stiffness. Plated on muscle-like stiffness matrix, mutant cells exhibited contractile stress fibre accumulation, increased focal adhesions, and higher traction force than controls. Inhibition of Rho-associated kinase (ROCK) prevented cytoskeletal defects, while inhibiting myosin light chain kinase or phosphorylation of focal adhesion kinase was ineffective. Depletion or inactivation of a ROCK-dependent regulator of actin remodelling, the formin FHOD1, largely rescued morphology in mutant cells. The functional integrity of lamin and nesprin-1 is thus required to modulate the FHOD1 activity and the inside-out mechanical coupling that tunes the cell internal stiffness to match that of its soft, physiological-like environment.

Trends in Economic Homogamy: Changes in Assortative Mating or the Division of Labor in Marriage?

The growing economic resemblance of spouses has contributed to rising inequality by increasing the number of couples in which there are two high- or two low-earning partners. The dominant explanation for this trend is increased assortative mating. Previous research has primarily relied on cross-sectional data and thus has been unable to disentangle changes in assortative mating from changes in the division of spouses' paid labor-a potentially key mechanism given the dramatic rise in wives' labor supply. We use data from the Panel Study of Income Dynamics (PSID) to decompose the increase in the correlation between spouses' earnings and its contribution to inequality between 1970 and 2013 into parts due to (a) changes in assortative mating, and (b) changes in the division of paid labor. Contrary to what has often been assumed, the rise of economic homogamy and its contribution to inequality is largely attributable to changes in the division of paid labor rather than changes in sorting on earnings or earnings potential. Our findings indicate that the rise of economic homogamy cannot be explained by hypotheses centered on meeting and matching opportunities, and they show where in this process inequality is generated and where it is not.

Enhanced oxidative capacity of ground squirrel brain mitochondria during hibernation.

During hibernation, thirteen-lined ground squirrels (Ictidomys tridecemlineatus) regularly cycle between bouts of torpor and interbout arousal (IBA). Most of the brain is electrically quiescent during torpor but regains activity quickly upon arousal to IBA, resulting in extreme oscillations in energy demand during hibernation. We predicted increased functional capacity of brain mitochondria during hibernation compared with spring to accommodate the variable energy demands of hibernation. To address this hypothesis, we examined mitochondrial bioenergetics in the ground squirrel brain across three time points: spring (SP), torpor (TOR), and IBA. Respiration rates of isolated brain mitochondria through complex I of the electron transport chain were more than twofold higher in TOR and IBA than in SP (P < 0.05). We also found a 10% increase in membrane potential between hibernation and spring (P < 0.05), and that proton leak was lower in TOR and IBA than in SP. Finally, there was a 30% increase in calcium loading in SP brain mitochondria compared with TOR and IBA (P < 0.01). To analyze brain mitochondrial abundance between spring and hibernation, we measured the ratio of copy number in a mitochondrial gene (ND1) vs. a nuclear gene (B2M) in frozen cerebral cortex samples. No significant differences were observed in DNA copies between SP and IBA. These data show that brain mitochondrial bioenergetics are not static across the year and suggest that brain mitochondria function more effectively during the hibernation season, allowing for rapid production of energy to meet demand when extreme physiological changes are occurring.

Genome editing in maize directed by CRISPR-Cas9 ribonucleoprotein complexes.

Targeted DNA double-strand breaks have been shown to significantly increase the frequency and precision of genome editing. In the past two decades, several double-strand break technologies have been developed. CRISPR-Cas9 has quickly become the technology of choice for genome editing due to its simplicity, efficiency and versatility. Currently, genome editing in plants primarily relies on delivering double-strand break reagents in the form of DNA vectors. Here we report biolistic delivery of pre-assembled Cas9-gRNA ribonucleoproteins into maize embryo cells and regeneration of plants with both mutated and edited alleles. Using this method of delivery, we also demonstrate DNA- and selectable marker-free gene mutagenesis in maize and recovery of plants with mutated alleles at high frequencies. These results open new opportunities to accelerate breeding practices in a wide variety of crop species.

Trends in Relative Earnings and Marital Dissolution: Are Wives Who Outearn Their Husbands Still More Likely to Divorce?

As women's labor-force participation and earnings have grown, so has the likelihood that wives outearn their husbands. A common concern is that these couples may be at heightened risk of divorce. Yet with the rise of egalitarian marriage, wives' relative earnings may be more weakly associated with divorce than in the past. We examine trends in the association between wives' relative earnings and marital dissolution using data from the 1968-2009 Panel Study of Income Dynamics. We find that wives' relative earnings were positively associated with the risk of divorce among couples married in the late 1960s and 1970s, and that this was especially true for wives who outearned their husbands, but this was no longer the case for couples married in the 1990s. Change was concentrated among middle-earning husbands and those without college degrees, a finding consistent with the economic squeeze of the middle class over this period.