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In keeping with the focus of this special edition of Humanities on the political child, this article builds on investigations into constructions of the child body in literature and society to examine how portrayals of the child body in Neil Gaiman’s The Graveyard Book repeatedly slip under the varying perspectives of the adults; that is, how adult politics are always at play in understandings of children and childhood both within and outside of the text. In taking this approach, this article focuses on two key texts in literary discussions of spectrality, bodies, and signification—Hamlet and ‘Fors’—to consider how the paradoxical child body in Gaiman’s The Graveyard Book is both constructed within the adult perspective and constantly slips from it, and how Gaiman approaches the issue at the heart of this analysis: that of who gets to decide who or what a child is, should be, or can be.

IntroductionEstimating Neonatal Abstinence Syndrome (NAS) and prenatal substance exposure rates in Medicaid can help target program efforts to improve access to services.MethodsThe data for this study was extracted from the 2016–2020 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) and included infants born between January 1, 2016 and December 31, 2020 with a either a NAS diagnosis or prenatal substance exposure.ResultsBetween 2016 and 2020, the estimated national rate of NAS experienced a 18% decline, while the estimated national rate of prenatal substance exposure experienced a 3.6% increase. At the state level in 2020, the NAS rate ranged from 3.2 per 1000 births (Hawaii) to 68.0 per 1000 births (West Virginia). Between 2016 and 2020, 28 states experienced a decline in NAS births and 20 states had an increase in NAS rates. In 2020, the lowest prenatal substance exposure rate was observed in New Jersey (9.9 per 1000 births) and the highest in West Virginia (88.1 per 1000 births). Between 2016 and 2020, 38 states experienced an increase in the rate of prenatal substance exposure and 10 states experienced a decline.DiscussionEstimated rate of NAS has declined nationally, but rate of prenatal substance exposure has increased, with considerable state-level variation. The reported increase in prenatal substance exposure in the majority of US states (38) suggest that substances other than opioids are influencing this trend. Medicaid-led initiatives can be used to identify women with substance use and connect them to services.SignificanceWhat is already known about the topic? Neonatal Abstinence Syndrome (NAS) and prenatal substance exposure are significant risk factors for poor neurodevelopmental and mental health outcomes in early childhood. NAS birth rates have been increasing in the US since 2000 and the majority of NAS births are covered by Medicaid.What this article adds? This article estimates national and state-level prenatal substance exposure and NAS rates among Medicaid-covered infants born between 2016-2020 using data from the Transformed Medicaid Statistical Information System. This is the first study using post-2017 data to estimate national NAS rates. The findings can inform future federal and state policy efforts to improve access to screening, diagnosis and treatment among pregnant women with substance use disorder and infants with NAS.

People with autism spectrum disorder (ASD) experience high rates of psychotropic medication utilization and barriers to psychosocial services, yet limited literature explores use of these services and the association between a mental health condition (MH) and use. Using national multipayer claims data, this study estimates a multinomial logistic regression model to discern psychotropic medication and psychosocial service use among transition age youth (TAY) with ASD (12-26 years; N = 52,083) compared to a matched cohort of those without ASD (12-26 years; N = 52,083). Approximately one-third of TAY with ASD and no MH condition receive only psychotropic medication and the likelihood of using both psychosocial services and medication is higher only when TAY with ASD have a co-occurring MH condition.

A high proportion of low-income people insured by the Medicaid program smoke. Earlier research concerning a comprehensive tobacco cessation program implemented by the state of Massachusetts indicated that it was successful in reducing smoking prevalence and those who received tobacco cessation benefits had lower rates of in-patient admissions for cardiovascular conditions, including acute myocardial infarction, coronary atherosclerosis and non-specific chest pain. This study estimates the costs of the tobacco cessation benefit and the short-term Medicaid savings attributable to the aversion of inpatient hospitalization for cardiovascular conditions. A cost-benefit analysis approach was used to estimate the program's return on investment. Administrative data were used to compute annual cost per participant. Data from the 2002-2008 Medical Expenditure Panel Survey and from the Behavioral Risk Factor Surveillance Surveys were used to estimate the costs of hospital inpatient admissions by Medicaid smokers. These were combined with earlier estimates of the rate of reduction in cardiovascular hospital admissions attributable to the tobacco cessation program to calculate the return on investment. Administrative data indicated that program costs including pharmacotherapy, counseling and outreach costs about $183 per program participant (2010 $). We estimated inpatient savings per participant of $571 (range $549 to $583). Every $1 in program costs was associated with $3.12 (range $3.00 to $3.25) in medical savings, for a $2.12 (range $2.00 to $2.25) return on investment to the Medicaid program for every dollar spent. These results suggest that an investment in comprehensive tobacco cessation services may result in substantial savings for Medicaid programs. Further federal and state policy actions to promote and cover comprehensive tobacco cessation services in Medicaid may be a cost-effective approach to improve health outcomes for low-income populations.

In keeping with the focus of this special edition of Humanities on the political child, this article builds on investigations into constructions of the child body in literature and society to examine how portrayals of the child body in Neil Gaiman’s The Graveyard Book repeatedly slip under the varying perspectives of the adults; that is, how adult politics are always at play in understandings of children and childhood both within and outside of the text. In taking this approach, this article focuses on two key texts in literary discussions of spectrality, bodies, and signification—Hamlet and ‘Fors’—to consider how the paradoxical child body in Gaiman’s The Graveyard Book is both constructed within the adult perspective and constantly slips from it, and how Gaiman approaches the issue at the heart of this analysis: that of who gets to decide who or what a child is, should be, or can be.

Cell migration is a stepwise process that coordinates multiple molecular machineries. Using in vitro angiogenesis screens with short interfering RNA and chemical inhibitors, we define here a MAP4K4–moesin–talin–β1-integrin molecular pathway that promotes efficient plasma membrane retraction during endothelial cell migration. Loss of MAP4K4 decreased membrane dynamics, slowed endothelial cell migration, and impaired angiogenesis in vitro and in vivo . In migrating endothelial cells, MAP4K4 phosphorylates moesin in retracting membranes at sites of focal adhesion disassembly. Epistasis analyses indicated that moesin functions downstream of MAP4K4 to inactivate integrin by competing with talin for binding to β1-integrin intracellular domain. Consequently, loss of moesin (encoded by the MSN gene) or MAP4K4 reduced adhesion disassembly rate in endothelial cells. Additionally, α5β1-integrin blockade reversed the membrane retraction defects associated with loss of Map4k4 in vitro and in vivo . Our study uncovers a novel aspect of endothelial cell migration. Finally, loss of MAP4K4 function suppressed pathological angiogenesis in disease models, identifying MAP4K4 as a potential therapeutic target. A new MAP4K4–moesin–talin–β1-integrin pathway regulating endothelial cell motility was discovered through chemical and siRNA screens; loss of Map4k4 or inhibition of MAP4K4 kinase activity altered the sprout morphology of endothelial cells during angiogenesis by blocking moesin phosphorylation, which regulates the disassembly of focal adhesions, demonstrating that this pathway is involved in both normal and pathological angiogenesis. MAP4K4 regulation of angiogenesis Cell migration is crucial in important biological processes such as embryogenesis, inflammation and angiogenesis, but many aspects of the cell motility machinery remain to be defined at the molecular level. Here Weilan Ye and colleagues identify a previously unknown pathway regulating endothelial cell motility. Using chemical and RNA screens, they found that a selective inhibitor of MAP4K4 altered the sprout morphology of endothelial cells during angiogenesis. The inhibitor caused endothelial cells to accumulate long, thin subcellular protrusions, suggesting a failure to retract these protrusions. The authors show that MAP4K4 phosphorylates moesin, which regulates the disassembly of focal adhesions by inactivating β1-integrin, and they demonstrate that this MAP4K4–moesin–talin–β1-integrin pathway plays a role in both normal and pathological angiogenesis.

In 2010 the Patient Protection and Affordable Care Act boosted the expansion of community health centers (CHCs) with $11 billion in mandatory funding from 2011 to 2015. This study used data from the Medical Expenditure Panel Survey (MEPS) and the North Carolina Behavioral Risk Factor Surveillance System (BRFSS) to assess the cost savings associated with the use of community health centers compared to other primary care providers. After controlling for various demographic, socioeconomic characteristics and health conditions, we found savings at an average of $3,437 in total expenditures and $1,211 in ambulatory care expenditures. These results suggest that continuing investment in health centers are important during times of budget cuts in order to improve access to care and to generate cost savings to the healthcare system.

Child maltreatment is a universal problem with severe life-long effects. One thousand six hundred sixty children were placed into foster care from January 2021 to December 2021 in Riverside County (California Child Welfare Indicators Project, n.d.). Child maltreatment prevention efforts have moved beyond a public awareness tactic to highlight the essential responsibility of the community, early intervention, and parenting education to help keep children safe from maltreatment. Literature has shown that home visiting interventions aim to improve protective factors for parents by having a lay or nurse home visitor provide support and education to parents in areas such as child health and development, attachment, and parenting education (MacLeod & Nelson, 2000). While child maltreatment continues to be a public health concern, innovative approaches to preventive programs are necessary to better serve the at-risk families and children against child maltreatment. This project utilized the community engagement and social innovation (CESI) model as the framework for engaging with the community in a comprehensive and collaborative approach to creating an innovative approach to home visiting. Following the observation and identification stages, integration, engagement, and assessment came from a formal relationship with a study conducted with stakeholders. Results of the study provided implications for home visiting programs, including the importance of understanding the program regardless of role and a clear strategy of how the program challenges child maltreatment occurrence. An innovative home visiting model was created to incorporate intergenerational relationships in a home visiting program to reduce child maltreatment. The home visiting model was founded on a theoretical framework with the theory of change, the theory of human motivation, the social-ecological model of health theory, social learning theory, and intergenerational practice. It Takes a Village services follows a general framework of a home visiting program with added mentorship and advisory board components. Successful intervention implementation is intended to enhance Child Welfare outcomes related to child safety and child and family well-being. To evaluate the innovation, three types of evaluations will occur in the pilot of the model. The first evaluation will answer the research question: Is there an association between supportive relationships and the manifestation of child maltreatment? The second evaluation will answer the research question: What are the perspectives and experiences of at-risk families who engaged and established a relationship with an older volunteer? The third form of evaluation will be based on program performance. The innovative approach of intergenerational relationships in home visiting offers implications for future research on the effectiveness of the relationships associated with child maltreatment. Other areas of interest for future research include specific components of intergenerational relationships and their effect on parent engagement and retention rates. The examples and relationships older volunteers can provide for families can help tackle the social problem of child maltreatment with the decrease of child abuse and neglect in the communities.

Cell migration is a stepwise process that coordinates multiple molecular machineries. Using in vitro angiogenesis screens with short interfering RNA and chemical inhibitors, we define here a MAP4K4-moesin-talin-β1-integrin molecular pathway that promotes efficient plasma membrane retraction during endothelial cell migration. Loss of MAP4K4 decreased membrane dynamics, slowed endothelial cell migration, and impaired angiogenesis in vitro and in vivo. In migrating endothelial cells, MAP4K4 phosphorylates moesin in retracting membranes at sites of focal adhesion disassembly. Epistasis analyses indicated that moesin functions downstream of MAP4K4 to inactivate integrin by competing with talin for binding to β1-integrin intracellular domain. Consequently, loss of moesin (encoded by the MSN gene) or MAP4K4 reduced adhesion disassembly rate in endothelial cells. Additionally, α5β1-integrin blockade reversed the membrane retraction defects associated with loss of Map4k4 in vitro and in vivo. Our study uncovers a novel aspect of endothelial cell migration. Finally, loss of MAP4K4 function suppressed pathological angiogenesis in disease models, identifying MAP4K4 as a potential therapeutic target.