Academic literature on the topic 'Age 4-7'

AbstractObjectiveThe present study aimed to evaluate the association of 4-year-old children’s dietary patterns with adiposity at 7 years, according to child’s sex, using a conceptual model.DesignProspective cohort study. Diet was assessed using an FFQ. Age- and sex-specific BMI standard deviation scores (Z-scores) were defined according to the WHO. Fat mass percentage (FM%), fat mass index (FMI) and waist-to-height ratio (WHtR) were also considered, converted into Z-scores using sex-specific means and standard deviations of the current sample. Dietary patterns were identified by latent class analysis and their association with adiposity was estimated by linear regression models.SettingPopulation-based birth cohort Generation XXI (Porto, Portugal, 2005–2006).SubjectsChildren (n 3473) evaluated at both 4 and 7 years of age.ResultsThree dietary patterns were identified: high in energy-dense foods (EDF); low in foods typically consumed at main meals and intermediate in snacks (Snacking); and higher in vegetables and fish and lower in EDF (Healthier, reference). The EDF dietary pattern at 4 years of age was positively associated with later BMI only in girls (β=0·075, 95 % CI 0·009, 0·140, P-interaction=0·046). The EDF dietary pattern was also associated with other adiposity indicators only in girls (FMI: β=0·071, 95 % CI 0·000, 0·142; WHtR: β=0·094, 95 % CI 0·023, 0·164). Snacking was not significantly associated with any marker of adiposity in either girls or boys.ConclusionsAlthough dietary patterns and adiposity persisted across the two ages in both sexes, EDF at 4 years of age increased adiposity at 7 years of age only in girls.

The assessment of pain in children has been an enduring theme in the research literature over many decades, with particular focus on how pain can be adequately measured and the extent of under-measurement of pain (American Academy of Pediatrics 2001; Coyne, 2006; McCaffery & Beebe 1989; Subhashini et al., 2009). Definitions of pain, and hence development of pain measurement tools, are often criticised for not addressing the influence of culture and ethnicity on pain (Bates et al., 1993; McCaffery & Beebe 1989; Zinke, 2007), in children, the perception and expression of pain is also affected by cognitive development (Hallström and Elander, 2004). Whilst there has been an increase in the number of children living in the United Kingdom (UK) who do not speak English as their first language, it has been acknowledged that the measurement and management of pain by health service professionals relies predominantly on their experience with English speaking children (RCN, 2009). This study aimed primarily to examine how primary school age children in key stage 1 who speak English as a primary or additional language experience, express, and explain pain. This aim was addressed through three research questions: (1) how do primary school age children in key stage 1 talk about pain? (2) What are the similarities and differences in the language used to talk about pain by children with English as a primary and additional language? (3) Are there differences in the perceptions of pain by children of different age, gender, language background, and country of birth? A second aim was to examine whether language would affect actions taken by final year child health students and nurses working in Minor Injuries Units to manage pain in primary school age children. Study objectives were addressed using a two phase mixed methods design. The first aim was addressed using six focus group interviews with groups of primary school children (aged 4-7) (Phase 1). Two methods were used in the interviews: use of drawings from the Pediatric Pain Inventory (Lollar et al., 1982) to capture the language used by children to describe pain and observation of the children’s placing of pain drawings on red/amber/green paper to denote perceived severity of pain. Following data collection, the vocabulary of each child was assessed using a standardised lexical test (British Picture Vocabulary Score version II - BPVS II) (Dunn et al., 1997). To address the second aim, a factorial survey was conducted (Phase 2) with nurses working in Minor Injuries Units and child health nursing students to determine whether language has an impact on decisions made about the management of children in pain following a minor injury. Phase 1 findings demonstrated that children from English as an Additional Language (EAL) backgrounds used less elaborate language when talking about pain but tended to talk about the pictures prior to deciding where they should be placed. The children’s placement of pain drawings varied according to language background, gender, and age. The calculated language age of English lexical comprehension (BPVS II score) of monolingual children (M=69.85, SD=19.27) was significantly higher than EAL children (M=47.93, SD=14.32; t (32) = 3.60, p =0.001, two-tailed). However, when these differences were explored in terms of year group, the differences remain significant with foundation and year 2 but not with year 1. For the EAL children, there were also significant relationships between BPVS II score and length of stay in the UK (spearman’s rho 0.749, p = 0.33). The Phase 1 findings were used to construct vignettes, describing hypothetical care situations, for Phase 2. Multinomial logistic regression was used to analyse the impact of a child’s age, gender, language, parent’s language, injury mechanism, and reaction to pain on the way in which the child’s pain would be assessed and whether parents or an interpreter would be invited to assist in pain assessment. Findings demonstrated that observing the child’s behaviour is the most significant assessment process that is used to assess EAL children, rather than the Visual Analogue Scale (VAS), which was used with non-EAL children. This is significant as VAS is the mostly widely used tool to assess pain in health care settings. However, VAS is only effective if it can be understood by the child. Further, MIU nurses and child health students were more likely to involve parents who speak English well than those who speak English poorly but would ask for an interpreter if their involvement was necessary. In order for the respondents to explain their decisions, they were asked an open ended question for each vignette. They reported that language and age of children are the most common difficulties they faced during assessment of pain. Therefore, they suggested some solutions, like using an age appropriate tools for assessing younger children. Respondents also identified that using an interpreter is a time consuming process, which might delay the management of pain. In light of the growing numbers of EAL children in the UK; this research has application in a number of contexts. The variation in language would apply if children were reporting their own pain. However, the findings emphasise the need for sufficient time to be allocated to pain assessment to allow an individualised approach. Study findings suggest several factors that may be important in assessing pain in EAL children; these should be explored further in the context of clinicians’ assessment of pain. The implications of the study impact on policy, practice, education, and future research.

Thesis (B.Sc)--University of Hong Kong, 1994.
"A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, 29th April, 1994." Also available in print.

Children's competence in performing fundamental movement skills (FMS) is positively associated with physical activity levels, health-related fitness and healthier weight status. The early years of primary school provide a crucial platform for children to develop FMS. It has been recommended that teachers become more involved in assessing children's FMS so that they can subsequently support their development of these skills more effectively. However, there is a shortage of FMS assessment tools available for teachers to use within primary schools. To address this shortfall, this research programme was conducted to develop a movement assessment tool (MAT) for primary school teachers to assess the FMS of children aged 4-7 years old. Qualitative and quantitative research methods were implemented across four studies. In the initial three studies, the perspectives of primary school teachers and experts from the field of children's movement development and primary school Physical Education were sought to establish recommendations for the format of the MAT and to establish its content. Based on these findings, a prototype of the MAT was developed. In the final study, a Mixed-Methods Research design was implemented with primary school teachers to evaluate the feasibility of the MAT prototype being used in lesson time. Until now, there has been a paucity of literature discussing teacher-oriented assessment of children's FMS. Therefore, the original contribution to knowledge presented in this thesis is the detailed understanding of how teachers should assess young children's FMS in school settings. The findings of Study One signify that teachers perceive a need for a MAT that is simple to use, quick to administer, and that provides valuable feedback to guide future teaching and learning. In Study Two, three dichotomous dilemmas emerged from the data in relation to assessing children's FMS competence. These dilemmas relate to the intended purpose of the assessment, the nature of its implementation and the context that it will be used. Study Three established content validity for the movement tasks within the assessment of FMS for children aged 4-7 years. The findings of Study Four revealed that the MAT is feasible for teachers to implement within PE lessons and teachers reported improvements in their awareness of assessing children's FMS as a result of using the MAT. The overall findings present a MAT that allows primary school teachers to assess the FMS competence of children aged 4-7 years old within PE lessons. Considering the shortage of teacheroriented MATs, this protocol may be attractive to teachers as it enables them to better understand and support children's development of FMS.

Previous psychological literature has shown mathematics anxiety in older populations to have an association with many factors, including an adverse effect on task performance. However, the origins of mathematics anxiety have, until recently, received limited attention. It is now accepted that this anxiety is rooted within the early educational years, but research has not explored the associated factors in the first formal years of schooling. Based on previous focus groups with children aged 4-7 years, ‘numeracy apprehension’ is suggested in this body of work, as the foundation phase of negative emotions and experiences, in which mathematics anxiety can develop. Building on this research, the first piece of research utilized 2 interviews and 5 focus groups to obtain insight from parents (n=7), teachers (n=9) and mathematics experts (n=2), to explore how children experience numeracy and their observations of children’s attitudes and responses. Thematic and content analysis uncovered a range of factors that characterised children’s numeracy experiences. These included: stigma and peer comparisons; the difficulty of numeracy and persistent failure; a low sense of ability; feelings of inadequacy; peer evaluation; transference of teacher anxieties; the right or wrong nature of numeracy; parental influences; dependence on peers; avoidance and children being aware of a hierarchy based on numeracy performance. Key themes reflected the focus group findings of children aged 4-7 years. This contributed to an item pool for study 2, to produce a first iteration of the Numeracy Apprehension Scale (NAS) that described day-to-day numeracy lesson situations. This 44-item measure was implemented with 307 children aged 4-7 years, across 4 schools in the U.K. Exploratory factor analysis led to a 26-item iteration of the NAS, with a 2-factor structure of Prospective Numeracy Task Apprehension and On-line Number Apprehension, which related to, for example, observation and evaluation anxiety, worry and teacher anxiety. The results suggested that mathematics anxiety may stem from the initial development of numeracy apprehension and is based on consistent negative experiences throughout an educational career. The 26-item iteration of the NAS was further validated in study 3 with 163 children aged 4-7 years, across 2 schools in the U.K. The construct validity of the scale was tested by comparing scale scores against numeracy performance on a numeracy task to determine whether a relationship between scale and numeracy task scores was evident. Exploratory factor analysis was again conducted and resulted in the current 19-item iteration of the NAS that related to a single factor of On-line Number Apprehension. This related to the experience of an entire numeracy lesson, from first walking in to completing a task and was associated with, for example, explaining an answer to the teacher, making mistakes and getting work wrong. A significant negative correlation was observed between the NAS and numeracy performance scores, suggesting that apprehensive children demonstrate a performance deficit early in education and that the NAS has the potential to be a reliable assessment of children’s numeracy apprehension. This empirical reinforces that the early years of education are the origins of mathematics anxiety, in the form of numeracy apprehension.

Abstract This book describes and compares three co-creation projects that were conducted in two European cities as part of a larger EU-funded innovation project called Mobile Age. This chapter introduces Mobile Age and presents the project’s framework and methodology for co-creating digital public services. Part of the framework are seven streams of activity that need to be considered. These streams of activity are not sequential but run in parallel and inform each other: (1) governing and managing a co-creation process; (2) continuous recruitment and engagement of stakeholders; (3) co-creating a service concept; (4) working with (open) (government) data; (5) co-creating software; (6) evaluating the co-creation process and its results; and (7) exploiting and disseminating the co-created service. All three co-creation projects featured in this book are described along those streams of activity. In addition, for each project its specific problem focus, target audiences, value propositions and resources are provided.

Abstract This chapter examines new directions in garden tourism by selecting seven major research, product development, and marketing innovations that have characterized gardens in the preceding seven years. They are: (1) gardens and wildlife; (2) art and gardens; (3) gardens and music; (4) Levy walk analysis and gardens; (5) plant societies and gardens; (6) sensory experiences at gardens; and (7) garden branding.

Abstract This chapter examines new directions in garden tourism by selecting seven major research, product development, and marketing innovations that have characterized gardens in the preceding seven years. They are: (1) gardens and wildlife; (2) art and gardens; (3) gardens and music; (4) Levy walk analysis and gardens; (5) plant societies and gardens; (6) sensory experiences at gardens; and (7) garden branding.

The aim of the opening speech is to present the most discussed issues in relation to inequality in personal distribution of income and wealth. In particular, it first examines the current trends in economic inequality (§ 1-4). Overall, some certainty has been achieved on these trends over the last century. In a second part of this opening speech (§ 5-7), some knowledge we have about pre-modern inequalities is summarized. In this regard, uncertainties are much more numerous than certainties.

AbstractThis chapter addresses the problematics for the conceptualization of multiplication in school mathematics and fundamental difficulties, which include semantics for defining multiplication meaningfully, syntax in relation to languages, and difficulties that originate from historical transitions. The chapter discusses the contradictions or inconsistencies in the various meanings of multiplication in school mathematics situations. Many of these problems of multiplication are originated from European languages. This discussion of these problematics provides some answers to the questions posed in Chap. 2 and provides bases for the necessity to consider the Japanese approach described in Chaps. 4, 5, 6, and 7 of this book. The terminology of multiplication discussed here is related to mathematical usages of multiplication in relation to situations and models. Educational terminology used for multiplication to explain the curriculum and task sequences for designing lessons are discussed in Chap. 4 of this book.

Abstract A multiple choice question has a stem (the 'question'), a key (the 'answer') and a number of distracters (wrong answers intended to distract the student from the key). This part of the book contains the key to each question along with a brief explanation of why this is correct and, in some cases, what the distracters mean. The questions are grouped into 10 major topic areas: (1) The history and foundations of ecology, (2) Abiotic factors and environmental monitoring, (3) Taxonomy and biodiversity, (4) Energy flow and production ecology, (5) Nutrient and material cycles, (6) Ecophysiology, (7) Population ecology, (8) Community ecology and species interactions, (9) Ecological genetics and evolution, (10) Ecological methods and statistics.

AbstractCancer stem cells (CSCs), also known as tumorinitiating cells (TICs), are a group of cells found within cancer cells. Like normal stem cells, CSCs can proliferate, engage in self-renewal, and are often implicated in the recurrence of tumors after therapy [1, 2]. The existence of CSCs in various types of cancer has been proven, such as in acute myeloid leukemia (AML) [3], breast [4], pancreatic [5], and lung cancers [6], to name a few. There are two theories regarding the origin of CSCs. First, CSCs may have arisen from normal stem/progenitor cells that experienced changes in their environment or genetic mutations. On the other hand, CSCs may also have originated from differentiated cells that underwent genetic and/or heterotypic modifications [7]. Either way, CSCs reprogram their metabolism in order to support tumorigenesis.

Qualitative research is focused on the influence of COVID-19 pandemic and restriction measures on sexual and reproductive health in Latvia. Results of the anonymous online survey (I-SHARE) of 1173 people living in Latvia age 18 and over were used as a background in finalization the interview and the focus group discussion protocols ensuring better understanding of the influencing factors. Protocols included 9 parts (0.Introduction. 1. COVID-19 general influence, 2. SRH, 3. Communication with health professionals, 4.Access to SRH services, 5.Communication with population incl. three target groups 5.1. Pregnant women, 5.2. People with suspected STIs, 5.3.Women, who require abortion, 6. HIV/COVID-19, 7. External support, 8. Conclusions and recommendations. Data include audiorecords in Latvian of: 1) 11 semi-structures interviews with policy makers including representatives from governmental and non-governmental organizations involved in sexual and reproductive health, information and health service provision. 2) 12 focus group discussions with pregnant women (1), women in postpartum period (3) and their partners (3), people living with HIV (1), health care providers involved in maternal health care and emergency health care for women (4) (2021-02-18) Subject: Medicine, Health and Life Sciences Keywords: Sexual and reproductive health, COVID-19, access to services, Latvia

Two major components of insensitive munition formulations, nitroguanidine (NQ) and 3-nitro-1,2,4-triazol-5-one (NTO), are highly water soluble and therefore likely to photo-transform while in solution in the environment. The ecotoxicities of NQ and NTO solutions are known to increase with UV exposure, but a detailed accounting of aqueous degradation rates, products, and pathways under different exposure wavelengths is currently lacking. We irradiated aqueous solutions of NQ and NTO over a 32-h period at three ultraviolet wavelengths and analyzed their degradation rates and transformation products. NQ was completely degraded by 30 min at 254 nm and by 4 h at 300 nm, but it was only 10% degraded after 32 h at 350 nm. Mass recoveries of NQ and its transformation products were >80% for all three wavelengths. NTO degradation was greatest at 300 nm with 3% remaining after 32 h, followed by 254 nm (7% remaining) and 350 nm (20% remaining). Mass recoveries of NTO and its transformation products were high for the first 8 h but decreased to 22–48% by 32 h. Environmental half-lives of NQ and NTO in pure water were estimated as 4 and 6 days, respectively. We propose photo-degradation pathways for NQ and NTO supported by observed and quantified degradation products and changes in solution pH.

Managers are challenged with the impact of problematic plants, including exotic, invasive, and pest plant species. Information on the cover and frequency of these plants is essential for developing risk-based approaches to managing these species. Based on surveys conducted in 2008, 2011, 2015, and 2019, Heartland Network staff and contractors identified a cumulative total of 51 potentially problematic plant species in Hopewell Culture National Historical Park. Of the 37 species found in 2019, we characterized 7 as very low frequency, 9 as low frequency, 17 as medium frequency, and 4 as high frequency. Of these, midpoint cover estimates of 2 medium frequency and 2 high frequency species exceeded the 10-acre threshold. Because of the number, extent, and cover of problematic plants in the park and the small park size, control efforts should focus on treating high priority species across the entire park. High priority species may include plant species capable of rapid spread, species at low population levels, and species which can effectively be controlled.

Managers are challenged with the impact of problematic plants, including exotic, invasive, and pest plant species. Information on the cover, distribution, and location of these plants is essential for developing risk-based approaches to managing these species. Based on surveys conducted in 2006, 2011, 2015, and 2019, Heartland Network staff and contractors identified a cumulative total of 45 potentially problematic plant taxa in Lincoln Boyhood National Memorial. Of the 34 species found in 2019, we characterized 4 as very low frequency, 14 as low frequency, 9 as medium frequency, and 7 as high frequency. A single species exceeded a 10-acre threshold based on a mid-point estimate. Because of the number of problematic plant taxa, as well as the extent and cover of problematic plants in the park and the small park size, control efforts should focus on treating high priority species across the entire park. High priority species may include plant species capable of rapid spread, species at low population levels, and species which can effectively be controlled.

The Everglades National Park and Big Cypress National Preserve vegetation mapping project is part of the Comprehensive Everglades Restoration Plan (CERP). It is a cooperative effort between the South Florida Water Management District (SFWMD), the United States Army Corps of Engineers (USACE), and the National Park Service’s (NPS) Vegetation Mapping Inventory Program (VMI). The goal of this project is to produce a spatially and thematically accurate vegetation map of Everglades National Park and Big Cypress National Preserve prior to the completion of restoration efforts associated with CERP. This spatial product will serve as a record of baseline vegetation conditions for the purpose of: (1) documenting changes to the spatial extent, pattern, and proportion of plant communities within these two federally-managed units as they respond to hydrologic modifications resulting from the implementation of the CERP; and (2) providing vegetation and land-cover information to NPS park managers and scientists for use in park management, resource management, research, and monitoring. This mapping project covers an area of approximately 7,400 square kilometers (1.84 million acres [ac]) and consists of seven mapping regions: four regions in Everglades National Park, Regions 1–4, and three in Big Cypress National Preserve, Regions 5–7. The report focuses on the mapping effort associated with the Northwest Coastal Everglades (NWCE), Region 4 , in Everglades National Park. The NWCE encompasses a total area of 1,278 square kilometers (493.7 square miles [sq mi], or 315,955 ac) and is geographically located to the south of Big Cypress National Preserve, west of Shark River Slough (Region 1), and north of the Southwest Coastal Everglades (Region 3). Photo-interpretation was performed by superimposing a 50 × 50-meter (164 × 164-feet [ft] or 0.25 hectare [0.61 ac]) grid cell vector matrix over stereoscopic, 30 centimeters (11.8 inches) spatial resolution, color-infrared aerial imagery on a digital photogrammetric workstation. Photo-interpreters identified the dominant community in each cell by applying majority-rule algorithms, recognizing community-specific spectral signatures, and referencing an extensive ground-truth database. The dominant vegetation community within each grid cell was classified using a hierarchical classification system developed specifically for this project. Additionally, photo-interpreters categorized the absolute cover of cattail (Typha sp.) and any invasive species detected as either: Sparse (10–49%), Dominant (50–89%), or Monotypic (90–100%). A total of 178 thematic classes were used to map the NWCE. The most common vegetation classes are Mixed Mangrove Forest-Mixed and Transitional Bayhead Shrubland. These two communities accounted for about 10%, each, of the mapping area. Other notable classes include Short Sawgrass Marsh-Dense (8.1% of the map area), Mixed Graminoid Freshwater Marsh (4.7% of the map area), and Black Mangrove Forest (4.5% of the map area). The NWCE vegetation map has a thematic class accuracy of 88.4% with a lower 90th Percentile Confidence Interval of 84.5%.

Objectives. To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient setting (vs. inpatient, vs. other outpatient intervention) and of fetal surveillance when a prostaglandin is used for cervical ripening. Data sources. Electronic databases (Ovid® MEDLINE®, Embase®, CINAHL®, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) to July 2020; reference lists; and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) and cohort studies of cervical ripening comparing prostaglandins and mechanical methods in outpatient versus inpatient settings; one outpatient method versus another (including placebo or expectant management); and different methods/protocols for fetal surveillance in cervical ripening using prostaglandins. When data from similar study designs, populations, and outcomes were available, random effects using profile likelihood meta-analyses were conducted. Inconsistency (using I2) and small sample size bias (publication bias, if ≥10 studies) were assessed. Strength of evidence (SOE) was assessed. All review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center methods guidance. Results. We included 30 RCTs and 10 cohort studies (73% fair quality) involving 9,618 women. The evidence is most applicable to women aged 25 to 30 years with singleton, vertex presentation and low-risk pregnancies. No studies on fetal surveillance were found. The frequency of cesarean delivery (2 RCTs, 4 cohort studies) or suspected neonatal sepsis (2 RCTs) was not significantly different using outpatient versus inpatient dinoprostone for cervical ripening (SOE: low). In comparisons of outpatient versus inpatient single-balloon catheters (3 RCTs, 2 cohort studies), differences between groups on cesarean delivery, birth trauma (e.g., cephalohematoma), and uterine infection were small and not statistically significant (SOE: low), and while shoulder dystocia occurred less frequently in the outpatient group (1 RCT; 3% vs. 11%), the difference was not statistically significant (SOE: low). In comparing outpatient catheters and inpatient dinoprostone (1 double-balloon and 1 single-balloon RCT), the difference between groups for both cesarean delivery and postpartum hemorrhage was small and not statistically significant (SOE: low). Evidence on other outcomes in these comparisons and for misoprostol, double-balloon catheters, and hygroscopic dilators was insufficient to draw conclusions. In head to head comparisons in the outpatient setting, the frequency of cesarean delivery was not significantly different between 2.5 mg and 5 mg dinoprostone gel, or latex and silicone single-balloon catheters (1 RCT each, SOE: low). Differences between prostaglandins and placebo for cervical ripening were small and not significantly different for cesarean delivery (12 RCTs), shoulder dystocia (3 RCTs), or uterine infection (7 RCTs) (SOE: low). These findings did not change according to the specific prostaglandin, route of administration, study quality, or gestational age. Small, nonsignificant differences in the frequency of cesarean delivery (6 RCTs) and uterine infection (3 RCTs) were also found between dinoprostone and either membrane sweeping or expectant management (SOE: low). These findings did not change according to the specific prostaglandin or study quality. Evidence on other comparisons (e.g., single-balloon catheter vs. dinoprostone) or other outcomes was insufficient. For all comparisons, there was insufficient evidence on other important outcomes such as perinatal mortality and time from admission to vaginal birth. Limitations of the evidence include the quantity, quality, and sample sizes of trials for specific interventions, particularly rare harm outcomes. Conclusions. In women with low-risk pregnancies, the risk of cesarean delivery and fetal, neonatal, or maternal harms using either dinoprostone or single-balloon catheters was not significantly different for cervical ripening in the outpatient versus inpatient setting, and similar when compared with placebo, expectant management, or membrane sweeping in the outpatient setting. This evidence is low strength, and future studies are needed to confirm these findings.

Eminent Domain is the power of the government or quasi-government entities to take private or public property interests through condemnation. Eminent Domain has been a significant issue since 1879 when, in the case of Boom Company v. Patterson, the Supreme Court first acknowledged that the power of eminent domain may be delegated by state legislatures to agencies and non-governmental entities. Thus, the era of legal takings began. Though an important legal dispute then, more recently eminent domain has blossomed into an enduring contentious social and political problem throughout the United States. The Fifth Amendment to the United States Constitution states, “nor shall private property be taken for public use, without just compensation.” Thus, in the wake of the now infamous decision in Kelo v. City of New London, where the Court upheld the taking of private property for purely economic benefit as a “public use,” the requirement of “just compensation” stands as the primary defender of constitutionally protected liberty under the federal constitution. In response to Kelo, many state legislatures passed a variety of eminent domain reforms specifically tailoring what qualifies as a public use and how just compensation should be calculated. Texas landowners recognize that the state’s population is growing at a rapid pace. There is an increasing need for more land and resources such as energy and transportation. But, private property rights are equally important, especially in Texas, and must be protected as well. Eminent domain and the condemnation process is not a willing buyer and willing seller transition; it is a legally forced sale. Therefore, it is necessary to consider further improvements to the laws that govern the use of eminent domain so Texas landowners can have more assurance that this process is fair and respectful of their private property rights when they are forced to relinquish their land. This report compiles statutes and information from the other forty-nine states to illustrate how they address key eminent domain issues. Further, this report endeavors to provide a neutral third voice in Texas to strike a more appropriate balance between individual’s property rights and the need for increased economic development. This report breaks down eminent domain into seven major topics that, in addition to Texas, seemed to be similar in many of the other states. These categories are: (1) Awarding of Attorneys’ Fee; (2) Compensation and Valuation; (3) Procedure Prior to Suit; (4) Condemnation Procedure; (5) What Cannot be Condemned; (6) Public Use & Authority to Condemn; and (7) Abandonment. In analyzing these seven categories, this report does not seek to advance a particular interest but only to provide information on how Texas law differs from other states. This report lays out trends seen across other states that are either similar or dissimilar to Texas, and additionally, discusses interesting and unique laws employed by other states that may be of interest to Texas policy makers. Our research found three dominant categories which tend to be major issues across the country: (1) the awarding of attorneys’ fees; (2) the valuation and measurement of just compensation; and (3) procedure prior to suit.

Background. Automated-entry consumer devices that collect and transmit patient-generated health data (PGHD) are being evaluated as potential tools to aid in the management of chronic diseases. The need exists to evaluate the evidence regarding consumer PGHD technologies, particularly for devices that have not gone through Food and Drug Administration evaluation. Purpose. To summarize the research related to automated-entry consumer health technologies that provide PGHD for the prevention or management of 11 chronic diseases. Methods. The project scope was determined through discussions with Key Informants. We searched MEDLINE and EMBASE (via EMBASE.com), In-Process MEDLINE and PubMed unique content (via PubMed.gov), and the Cochrane Database of Systematic Reviews for systematic reviews or controlled trials. We also searched ClinicalTrials.gov for ongoing studies. We assessed risk of bias and extracted data on health outcomes, surrogate outcomes, usability, sustainability, cost-effectiveness outcomes (quantifying the tradeoffs between health effects and cost), process outcomes, and other characteristics related to PGHD technologies. For isolated effects on health outcomes, we classified the results in one of four categories: (1) likely no effect, (2) unclear, (3) possible positive effect, or (4) likely positive effect. When we categorized the data as “unclear” based solely on health outcomes, we then examined and classified surrogate outcomes for that particular clinical condition. Findings. We identified 114 unique studies that met inclusion criteria. The largest number of studies addressed patients with hypertension (51 studies) and obesity (43 studies). Eighty-four trials used a single PGHD device, 23 used 2 PGHD devices, and the other 7 used 3 or more PGHD devices. Pedometers, blood pressure (BP) monitors, and scales were commonly used in the same studies. Overall, we found a “possible positive effect” of PGHD interventions on health outcomes for coronary artery disease, heart failure, and asthma. For obesity, we rated the health outcomes as unclear, and the surrogate outcomes (body mass index/weight) as likely no effect. For hypertension, we rated the health outcomes as unclear, and the surrogate outcomes (systolic BP/diastolic BP) as possible positive effect. For cardiac arrhythmias or conduction abnormalities we rated the health outcomes as unclear and the surrogate outcome (time to arrhythmia detection) as likely positive effect. The findings were “unclear” regarding PGHD interventions for diabetes prevention, sleep apnea, stroke, Parkinson’s disease, and chronic obstructive pulmonary disease. Most studies did not report harms related to PGHD interventions; the relatively few harms reported were minor and transient, with event rates usually comparable to harms in the control groups. Few studies reported cost-effectiveness analyses, and only for PGHD interventions for hypertension, coronary artery disease, and chronic obstructive pulmonary disease; the findings were variable across different chronic conditions and devices. Patient adherence to PGHD interventions was highly variable across studies, but patient acceptance/satisfaction and usability was generally fair to good. However, device engineers independently evaluated consumer wearable and handheld BP monitors and considered the user experience to be poor, while their assessment of smartphone-based electrocardiogram monitors found the user experience to be good. Student volunteers involved in device usability testing of the Weight Watchers Online app found it well-designed and relatively easy to use. Implications. Multiple randomized controlled trials (RCTs) have evaluated some PGHD technologies (e.g., pedometers, scales, BP monitors), particularly for obesity and hypertension, but health outcomes were generally underreported. We found evidence suggesting a possible positive effect of PGHD interventions on health outcomes for four chronic conditions. Lack of reporting of health outcomes and insufficient statistical power to assess these outcomes were the main reasons for “unclear” ratings. The majority of studies on PGHD technologies still focus on non-health-related outcomes. Future RCTs should focus on measurement of health outcomes. Furthermore, future RCTs should be designed to isolate the effect of the PGHD intervention from other components in a multicomponent intervention.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.