Journal of Nutrition and Metabolism


Open to parents with children ages ! In Japan, a male predominance exists. There are four study rooms and a conference room that can be reserved. Dietary advice for patients with bloating, pain, and other IBS-like symptoms may include avoidance of spicy foods, fatty foods, gut irritants such as alcohol and caffeinated beverages , and individual foods that are poorly tolerated [ 19 ]. Epidemiological studies in Europe and North America have shown that people consuming Western-type diets are low in magnesium content, i. This section contains information about the general academic policies of the college.


It may also result in nausea and vomiting, although these are less frequent [ 69 ]. Ingestion of larger amounts of lactose, faster gastric emptying times, and faster intestinal transit times all contribute to more severe symptoms. Several factors determine the onset of symptoms of lactose intolerance, such as lactose content in the diet, gut transit time, fermentation capacity of the gut microbiome, visceral hypersensitivity [ 73 ], and possibly neuropsychological factors [ 74 ].

The diagnosis of lactose intolerance is based on self-reporting of symptoms after lactose ingestion [ 54 ]. Determining the dose of lactose that persons with lactose intolerance can tolerate is critical in determining its implications for health [ 68 ].

The presence of malabsorption of lactose is commonly not associated with symptoms. There are two key ways of treating lactose intolerance: Consideration should be given to reducing the intake of large quantities of lactose. There is an increasing demand for lactose-free products in some countries, resulting in the availability of lactose-free milk, yoghurt, cheese, cream and ice-cream. However, the need for products such as lactose-free cheese and cream is questionable, in view of their minimal lactose content [ 54 ].

Estimates of fructose consumption suggest that total fructose intake has increased in recent years, largely due to the increased use of high-fructose corn syrups. Fruit and fruit products were the main source of dietary fructose in — [ 81 ].

Early studies investigating the effect of excess fructose on gastrointestinal symptoms focused on fructose alone, or fructose in combination with sorbitol. However, these fructose-restricted diets were poorly described. Since excess fructose is often consumed together with other short-chain carbohydrates that have similar effects on the bowel i.

The grouping of these fermentable carbohydrates as part of the low FODMAP diet has been associated with symptom improvement in up to three-quarters of patients with functional gastrointestinal disorders [ 40 , 41 , 44 , 82 ].

Sucrase—isomaltase deficiency also known as sucrose intolerance usually manifests early in life and can result in carbohydrate malabsorption, causing symptoms of diarrhea, bloating, and abdominal pain, similar to the symptoms of diarrhea-predominant IBS.

The cause of sucrase—isomaltase deficiency is reduced small-intestinal activity of an enzyme known as glucosidase. The enzyme is normally involved in the digestion of starch and sugars.

With reduced glucosidase activity, carbohydrates—particularly sucrose—then behave as FODMAPs, with increased osmotic activity and fermentation in the bowel, potentially leading to symptoms of IBS [ 83 ].

A role for sucrase—isomaltase deficiency in later-onset IBS is poorly established. In congenital sucrase—isomaltase deficiency, mutations in the sucrase—isomaltase SI gene lead to severe symptoms.

This is a rare condition. However, recent studies have identified multiple variations of the SI gene with reduced function. However, it has yet to be shown whether it is pathogenetically involved with symptom induction in patients with functional gastrointestinal disorders.

Secondary or acquired sucrase—isomaltase deficiency can also theoretically occur, but it is usually transient. Animal studies have shown that villous atrophy, such as that occurring in untreated celiac disease, may result in sucrase—isomaltase deficiency. This should be reversible with healing of the villous atrophy [ 84 ]. A diagnosis of sucrase—isomaltase deficiency can be established using duodenal or jejunal biopsies in children, for assessment of sucrase, lactase, isomaltase, and maltase activity [ 84 ].

Other methods of diagnosis are available, such as sucrose breath testing, but performing hydrogen breath testing in young children is problematic [ 85 ].

More recently, genetic sequencing has become available to identify forms of congenital sucrase—isomaltase deficiency [ 84 ], although these results should be considered in combination with the clinical picture.

There are few data on the value of performing such tests in adults. Limited evidence is available for the treatment of sucrase—isomaltase deficiency. Treatment options include dietary restriction of sugars and starch, although this has been poorly studied.

Patients undertake an initial restrictive phase, followed by gradual reintroduction in order to determine tolerance. However, such dietary restrictions are difficult, and patients are often noncompliant [ 85 ]. An alternative to dietary modification is enzyme replacement with sacrosidase, which has shown good effect in studies with small sample sizes [ 85 , 86 ]. However, enzyme supplementation is costly and may not be available worldwide.

Although many IBS patients believe that they are intolerant of certain foods [ 87 ], this often cannot be reproduced on a blinded re-challenge with the offending foodstuff [ 88 , 89 ]. IBS patients often institute dietary changes themselves, in an attempt to alleviate symptoms [ 88 , 90 ]. Safe, reliable, and affordable tests for the diagnosis of food intolerance are lacking. Clinicians cannot therefore easily confirm the offending food component s in patients who report food-induced symptoms [ 91 ].

General principles are as follows:. Among other dietary approaches, few have good-quality evidence of efficacy, safety, and nutritional adequacy. The exception is the gluten-free diet GFD , which is widely initiated by IBS sufferers in the United States without any input from health-care professionals.

Several uncontrolled studies have shown that a proportion of patients who meet the criteria for IBS will respond to a GFD [ 95 — 98 ]. The controversy lies in whether the offending food components are gluten, nongluten wheat proteins, or fructans.

There is a cohort of patients with IBS or other functional gut symptoms, often with extraintestinal symptoms, who self-report that they are gluten-sensitive. However, gluten has yet to be implicated as the causative molecule in such patients.

A subgroup who have an increased density of intraepithelial lymphocytes and eosinophils in the small-bowel and often large-bowel mucosae have been shown to develop gastrointestinal symptoms after double-blind placebo-controlled challenges to wheat and other proteins [ 99 ]. Dietary restriction guided by the results of such challenges has led to long-term symptomatic benefits in these patients [ ].

Further research in other centers is required in order to assess the generalizability of these findings. In the majority of individuals who do not have the above-mentioned histopathological changes, GFD may be effective, but whether the patient needs to be gluten-free or whether gluten is a marker for other molecules contained in wheat, such as fructans, remains controversial.

A recent study in Norway provided evidence that fructans, but not gluten or wheat protein, were the culprits in patients with self-reported gluten sensitivity [ ]. Despite uncertainty regarding the role of gluten, specifically, in the genesis of symptoms in IBS, a trial of GFD is a reasonable intervention for people who feel that their symptoms become worse with gluten-containing foods.

World Gastroenterology Organisation global guidelines [Internet]. World Gastroenterology Organisation; [cited Jul 19]. Bai JC, Ciacci C. World Gastroenterology Organisation global guidelines: Health benefits of dietary fiber.

Position of the American Dietetic Association: J Am Diet Assoc. Kim Y, Je Y. Dietary fiber intake and total mortality: Dietary fibre intake and risk of cardiovascular disease: Association between dietary fiber and lower risk of all-cause mortality: Dietary fiber intake and risk of type 2 diabetes: American Association of Cereal Chemists. The definition of dietary fiber. Submitted January 10, Development of a publicly available, comprehensive database of fiber and health outcomes: The definition of dietary fiber — discussions at the Ninth Vahouny Fiber Symposium: Food Nutr Res [Internet].

Understanding the physics of functional fibers in the gastrointestinal tract: J Acad Nutr Diet. Fiber and functional gastrointestinal disorders.

Diet, gut microbiota and immune responses. Systematic review with meta-analysis: World Gastroenterology Organisation global guideline: Coping with common gastrointestinal symptoms in the community: Diagnosis and treatment of dyssynergic defecation.

British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults update. J Hum Nutr Diet. The role of fiber supplementation in the treatment of irritable bowel syndrome: Eur J Gastroenterol Hepatol. Fiber in the treatment and maintenance of inflammatory bowel disease: Reduction of dietary poorly absorbed short-chain carbohydrates FODMAPs improves abdominal symptoms in patients with inflammatory bowel disease-a pilot study.

Risk factors for diverticulosis, diverticulitis, diverticular perforation, and bleeding: Role of fiber in symptomatic uncomplicated diverticular disease: Dietary fibre for the prevention of colorectal adenomas and carcinomas.

Cochrane Database Syst Rev. Dietary fibre intake and risks of cancers of the colon and rectum in the European prospective investigation into cancer and nutrition EPIC. Dietary fibre for the prevention of recurrent colorectal adenomas and carcinomas. Low-residue and low-fiber diets in gastrointestinal disease management. The White Diet is preferred, better tolerated, and non-inferior to a clear-fluid diet for bowel preparation: A randomized controlled trial.

Global Nutrition and Policy Consortium. Dietary intake of major foods by region, [Internet]. United States Department of Agriculture. USDA food composition databases [Internet]. Why we eat what we eat: Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome.

Int J Clin Pract. Ehealth monitoring in irritable bowel syndrome patients treated with low fermentable oligo-, di-, mono-saccharides and polyols diet. Colon hypersensitivity to distension, rather than excessive gas production, produces carbohydrate-related symptoms in individuals with irritable bowel syndrome. Food components and irritable bowel syndrome. Fructan and free fructose content of common Australian vegetables and fruit.

J Agric Food Chem. Measurement of short-chain carbohydrates in common Australian vegetables and fruits by high-performance liquid chromatography HPLC. Quantification of fructans, galacto-oligosacharides and other short-chain carbohydrates in processed grains and cereals.

Dietary sorbitol and mannitol: Fermentable oligosaccharides, disaccharides, monosaccharides and polyols: Expert Rev Gastroenterol Hepatol. Tuck C, Barrett J. Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms. Gut microbial adaptation to dietary consumption of fructose, artificial sweeteners and sugar alcohols: Diet and effects of diet management on quality of life and symptoms in patients with irritable bowel syndrome.

A diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and a probiotic restores bifidobacterium species: Fermentable carbohydrate restriction low FODMAP diet in clinical practice improves functional gastrointestinal symptoms in patients with inflammatory bowel disease.

Endometriosis in patients with irritable bowel syndrome: Reducing the maternal dietary intake of indigestible and slowly absorbed short-chain carbohydrates is associated with improved infantile colic: A low fermentable oligo-di-mono saccharides and polyols FODMAP diet reduced pain and improved daily life in fibromyalgia patients. A worldwide correlation of lactase persistence phenotype and genotypes.

J Am Coll Nutr. Bloating and distention in irritable bowel syndrome: WGO handbook on diet and the gut. Physicochemical characteristics of commercial lactases relevant to their application in the alleviation of lactose intolerance. Effect of exogenous beta-galactosidase in patients with lactose malabsorption and intolerance: Eur J Clin Nutr.

Comparative effects of exogenous lactase beta-galactosidase preparations on in vivo lactose digestion. Enzyme replacement therapy for primary adult lactase deficiency. Effective reduction of lactose malabsorption and milk intolerance by direct addition of beta-galactosidase to milk at mealtime. Fructose and lactose testing. Poor reproducibility of breath hydrogen testing: Implications for its application in functional bowel disorders.

United Eur Gastroenterol J. National estimates of dietary fructose intake increased from to in the United States. Comparison of symptom response following advice for a diet low in fermentable carbohydrates FODMAPs versus standard dietary advice in patients with irritable bowel syndrome. Functional variants in the sucrase—isomaltase gene associate with increased risk of irritable bowel syndrome.

The clinical consequences of sucrase—isomaltase deficiency. Enzyme-substitution therapy with the yeast Saccharomyces cerevisiae in congenital sucrase—isomaltase deficiency.

N Engl J Med. Irritable bowel syndrome and diet. Perceived food and drug allergies in functional and organic gastrointestinal disorders. Perceived food intolerance in subjects with irritable bowel syndrome — etiology, prevalence and consequences.

The science, evidence, and practice of dietary interventions in irritable bowel syndrome. World Gastroenterology Organisation global guidelines. Non-celiac gluten sensitivity has narrowed the spectrum of irritable bowel syndrome: What role does wheat play in the symptoms of irritable bowel syndrome?

Long-term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhea-dominant and mixed-type irritable bowel syndrome. Int J Colorectal Dis. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity.

Molina-Infante J, Carroccio A. The effect of dietary intervention on irritable bowel syndrome: WHO guidelines on nutrition [Internet]. Diagnosis and management of adult coeliac disease: Diet, nutrition and obesity [Internet].

Diet and the Gut: Key recommendations and cascades 1. The following is a list of well-established beneficial physiological effects associated with the consumption of a high-fiber diet with whole foods in general [ 12 ]: Increasing fluid in the diet has long been considered a first-line treatment for constipation [ 3 , 17 , 18 ]; the evidence to support this is mixed. Fiber should be introduced gradually into the diet over weeks rather than days, to allow the body to adjust [ 18 , 19 ].

Stool frequency is thought to be improved by soluble fiber through an increase in stool bulk and weight, and by insoluble fiber through the acceleration of intestinal transit time; for both, however, and especially for insoluble fibers, high-quality evidence is lacking [ 14 ].

The best evidence for fiber supplementation is for psyllium in the management of chronic constipation [ 18 ]. Evidence for the efficacy of fiber is particularly lacking for individual constipation subtypes: In patients with obstructive diseases of the intestine, a high-fiber diet should be avoided. Delayed colon transit or dyssynergic defecation may be present when patients experience marked worsening of their constipation-related symptoms with fiber [ 17 , 20 , 21 ].

Soluble fiber supplements—including linseed, methylcellulose, partially hydrolyzed guar gum, and psyllium—have demonstrated therapeutic benefit in a number of clinical trials, particularly for patients with constipation-predominant IBS IBS-C [ 3 , 14 , 22 , 23 ].

Highly fermentable fibers, such as oligosaccharides, inulin, and wheat bran fiber by virtue of its oligosaccharide content may contribute to increased gas production, thus exacerbating symptoms of bloating, flatus, and gastrointestinal discomfort in IBS [ 14 , 22 , 23 ]. However, due to the potential anti-inflammatory and immune-modulating effects of fiber, this warrants further investigation [ 24 ]. Restriction of dietary fiber in IBD is unnecessary except in the case of significant intestinal stenosis [ 24 ].

Survey respondents were asked to report on their access to, and utilization of, health care resources. Respondents were asked to report if there was one person they consider to be their personal doctor or health care provider. Regular health screenings are recommended by CDC to diagnose and prevent health conditions. Respondents were asked to indicate the length of time since their last routine physical exam or checkup not an exam for a specific injury, illness, or condition ; responses of 12 months or fewer were used to calculate the annual checkup indicator.

Respondents were asked if they had received the flu vaccine in the past 12 months, including a shot in the arm or intradermal injection; and nasal spray, mist, or drop. Since , CDC has recommended that all adults be vaccinated for the flu, particularly those at risk of serious complications. Respondents were asked not to count tests that were part of a blood donation. To determine self-assessed perceived health, respondents were asked to rate their overall health as poor, fair, good, very good, or excellent.

Self-assessed health status can be a reliable estimate of population health and well-being. As a measure of health-related quality of life, the BRFSS survey also measures healthy days for physical and mental health. Though there are no standard cutpoints for mentally and physically unhealthy days, health problems at least seven days per month can be considered serious or severe.

Health-risk behaviors are those that contribute to negative health outcomes, such as illness or injury. BRFSS includes questions relating to use of tobacco and alcohol products, as well as seatbelt use.

Risk behaviors can be underreported due to social desirability bias in response to survey questions. Respondents were also asked if they had smoked at least cigarettes equivalent to five packs in their lifetime.

Current or former smoking status is associated with negative health outcomes. Consumption of alcoholic beverages was assessed by asking respondents how many drinks they consumed during the past 30 days. A drink is equivalent to a ounce beer, 5-ounce glass of wine, or single shot of liquor. The definitions of heavy drinking and binge drinking differ for males and females: To assess seatbelt use, respondents were asked to estimate how often they use seatbelts when driving or riding in a car: This database includes initial and refill prescriptions dispensed at retail pharmacies but does not include mail order prescriptions.

Prescriptions include those purchased through commercial insurance, Medicaid, Medicare, or cash or its equivalent. Opioid prescriptions include butrans buprenorphine , codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, and tramadol. Cough and cold formulations containing opioids and buprenorphine, an opioid partial agonist used for treatment of opioid use disorder as well as for pain, are not included.

In addition, methadone dispensed through methadone maintenance treatment programs is not included. Opioid prescription rates per persons are calculated using population estimates from the Population Estimates Program, U. Specifically, — Intercensal Estimates of the Resident Population for Counties and States were used for — rate calculations and — Postcensal Estimates of the Resident Population for Counties and National were used for — rate calculations.

After a steady increase in overall opioid prescribing rates from , total opioid prescriptions peaked in at million and a rate of The rate does not represent the percent of the population receiving opioid prescriptions. Since an individual may receive multiple prescriptions in a year, many counties have rates that are greater than prescriptions per persons. Counties displayed as having insufficient data may indicate counties with no retail pharmacies, counties where no retail pharmacies were sampled, or counties where the prescription volume was erroneously attributed to an adjacent, more populous county according to the sampling rules used.

This data differs from the data shown in the July issue of CDC Vital Signs, which featured different facets of opioid prescribing from to For more information visit https: The Centers for Disease Control CDC dataset provides the number of births, the number and percent of infants born with birth weight under 2, ounces low birthweight , the number and percent of infants born with birth weight under 1, ounces very low birthweight , the number and percent of births where prenatal care began during the first trimester and the number and percent of births where prenatal care was received in only the third trimester or not at all.

The CDC only reports numbers of births for counties with populations of , The CDC also provides numbers and rates for mothers under age Additionally, this dataset includes the number and percent of births to mothers under the age of 20, with break outs for mother under age 18 and mothers 18 and 19 for select years.

Data on prenatal care is only available for counties with populations of , or more. Beginning in , data are reported from the U. Flu activity indicators are a measure of the proportion of visits to healthcare providers for influenza-like illness ILI symptoms.

These data may disproportionately represent certain populations within a state; for instance, a severe flu outbreak in one city or region may cause the statewide activity level to be High, even if flu activity is low or minimal in other areas throughout the state. State health departments may have more geographically precise information available; contact information for these departments is available in FluView.

Geographic spread of influenza is reported directly to CDC by state epidemiologists. This is a measure of how much of each state is affected by flu, and is not a measure of the severity of influenza activity. Weekly data and state and local surveillance information are available at the CDC Influenza Surveillance website. ILI activity and geographic spread measures are provided weekly. To obtain seasonal values, PolicyMap calculated the average of the numerical activity levels for all weeks ending in a given season.

Flu season is defined as the period beginning in October and ending in March. Only states with at least 24 weeks of activity per season are included in these calculations. The data is available in 5-year intervals. Data are likely underreported, as is common with surveillance system data.

Not every case of Lyme disease is reported to the CDC, and some reported cases may be due to another cause. In highly endemic areas, under-reporting is more likely, and in non-endemic areas, over-reporting is likely.

Data are captured individually by states, which may vary in ability to capture and classify cases, both state-to-state and year-to-year. The case definition for reporting Lyme Disease changed in , so caution should be taken when comparing values before and after that time period. Data reported by county of residence, not county of exposure.

The Centers for Disease Control CDC dataset provides the number of infant deaths, and the rate of deaths to infants for every live births by maternal residents of the US. The CDC only reports numbers of births for counties with populations of , or more and number and rate of infant deaths for counties with populations of , or more. It suppresses the rate where there are fewer than 20 deaths reported.

The Compressed mortality file provides the number and rate of deaths, by age group and cause of death as reported through the tenth revision of the International Statistical Classification of Diseases and Related Health Problems ICD Data on PolicyMap represent deaths from cancer, coronary heart disease, stroke, and chronic lower respiratory disease among all age groups, from through ; and deaths from homicide, suicide, motor vehicle traffic, and accidental injury.

Underlying cause-of-death is indicated on the death certificate by the physician. The National Center for Health Statistics determines one cause of death when more than one cause or condition is entered by the physician. Adults ages 35 and older are used as a base category for deaths from disease because these age groups represent most of the deaths from the four leading causes. Rates are calculated per , population 35 and over in the source data using population estimates based on and U.

The CDC provides only ranges of rates rather than specific rates for each county. This method allows estimates to be generated for counties that have small populations. The CDC adds a disclaimer to this dataset that in certain states and years, for example New Jersey and West Virginia , , the rates may be lower than expected due to a large number of unresolved cases or misclassification of ICD codes.

Drug overdose deaths were classified using the Tenth Revision ICD of the International Classification of Disease underlying-cause-of-death codes for drug poisonings overdose: X unintentional , X suicide , X85 homicide , and Y10—Y14 undetermined intent.

The types of opioid involved in drug overdose deaths were classified following the ICD codes: The category for all opioid overdoses includes all these categories T Deaths involving multiple types of opioids are recorded in each applicable category, therefore the US totals may include overcounting.

Heroin is an illegally-made semi-synthetic opioid derived from morphine. Methadone is a prescribed synthetic opioid used to treat moderate to severe pain, and also withdrawal symptoms in those addicted to heroin or other narcotics. The CDC does not differentiate between deaths from pharmaceutical fentanyl and illegally-made fentanyl, and deaths from both forms are included in the data.

The types of narcotics involved in drug overdose deaths were classified following the ICD codes: The category for all narcotics overdoses includes T The methods used to classify deaths on death certificates may lead to a significant undercount of opioid-related deaths, which could inaccurately portray the severity of this public health problem.

Because of reporting discrepancies and nonspecific language, it is likely that national statistics underestimate by a substantial fraction the amount of opioid analgesic- and heroin-related deaths.

For more information undercounting opioid-related deaths visit https: To provide context for a given area, it is helpful to also look at how many overdose deaths are recorded with no additional drug information.

These were classified according to the ICD code of T For more information on the data visit https: These data are available for states and counties. These data represent the place of residence at earliest HIV diagnosis; duplicate records from different states are reconciled by the source. These data may not be limited to new infections i. Estimates are statistically-adjusted values based upon actual case counts reported to CDC by state and local health departments.

Data on the number of new cases of chlamydia, gonorrhea, and syphilis reported each year, and the rate of new STD cases reported for every , residents, by state and county are available from CDC.

Data are based on cases of STDs reported to state and local health departments. The CDC collects data from regional jurisdictions, and publishes the data in an annual report, which can be downloaded here: Syphilis is presented as a combined sum of cases classified in either primary or secondary stages of the disease.

Other categories of syphilis — not included in the data — are latent without symptoms , tertiary late stage , and congenital transferred from mother to child. Primary and secondary forms of the disease are the most infectious and therefore important when considering the risk of transfer and spread of disease. Some variability in the amount of in the amount of reporting may exist across the country.

Chlamydia, gonorrhea, and syphilis are considered Nationally Notifiable , which means that regional jurisdictions provide information to the CDC on a voluntary basis. A nationally notifiable disease is not necessarily reportable by law within a given state. Because of incomplete diagnosis and reporting, the number of STD cases reported is less than the actual number of cases occurring.

The level of consistency may vary between local jurisdictions, reporting agencies, and reporting years. In some areas, reporting from public sources is thought to be more complete than reporting from private sources. Incidence rates were calculated by the CDC using total population as the denominator. Census data as a base year. The data presents the estimated Annual Incidence Rate and Average Cases of cancer by type per year in state and county level geographies.

The data is available in the aggregate, but also divides into demographic characteristics, including: In some cases, data have been suppressed to ensure confidentiality and stability of rate estimates. Counts are suppressed if fewer than 16 cases were reported in a specific area-sex-race category. This data is collected from public health surveillance systems by using either their published reports or public use files.

This data may be more recent or in more detail than can be provided nationally. Only information for beneficiaries enrolled in both Part A and Part B is included; information for beneficiaries who have died during the study year is included.

Chronic health condition data is based on CMS administrative enrollment and claims data for Medicare fee-for-service beneficiaries. A Medicare beneficiary is considered to have a chronic condition if there is a CMS claim indicating that the beneficiary received a service or treatment for that specific condition. Beneficiaries may have more than one of the chronic conditions listed. All dollar amounts in this data set are standardized by CMS to adjust for factors that result in different payment rates for the same service, including local variations in wages and payments Medicare makes to hospitals to advance program goals including training doctors.

The standardized values represent what Medicare would have paid in the absence of those adjustments. Because the state of Maryland is exempt from reporting special payments to Medicare, costs in Maryland were standardized using different factors than the nationwide model. The dataset was created in collaboration with organizations representing consumers, doctors, hospitals, employers, accrediting organizations, and other federal agencies, as part of an overall effort to improve patient safety and care.

More details on data collection and computation methodology for each dataset can be found here. This dataset is available on PolicyMap as point data based on hospital location, and can be viewed upon clicking each respective point. HRSA hospital location data can be found here. For information about the NMTC, please see entry, below.

In , there was a one-year transition period for investments started under the ACS data; that data is also available. More information is available here: Please note that the data on PolicyMap do not take into account the following, due to unavailability of data: Because any of these data sources may have been updated since the production of these calculations, users should verify eligibility directly with the CDFI Fund.

CMF, established in and appropriated in , is a competitive grant program to attract private capital for affordable housing development.

In FY , CMF awardees used the funds to finance 8, affordable rental units and homeowner-occupied homes. CMF dollars may be used for the following purposes: CMF grants must be matched at least Rental housing projects have more specific requirements; please see the CDFI Fund website for more information. Areas of Economic Distress and Underserved Rural Areas are among the selection criteria used to determine eligibility.

Additionally, Areas of High Housing Need were among the selection criteria used to determine eligibility and are also available on PolicyMap. CDFIs are financial institutions that provide products and services in economically distressed target markets. Not all CDFIs are certified, but certification is a requirement for some federal program funding. Median and aggregate investment amounts are calculated by type of CDFI and for select transaction characteristics.

For CDFI transactions that span multiple census tracts or counties, medians are calculated using the total project cost while aggregations are calculated by dividing the total transaction cost by the number of census tracts or counties involved. Transaction or project counts at smaller geographies may not match larger geography counts given the double counting of split transactions and projects across census tracts and counties.

This dataset is an aggregated collection of these projects, totaling the number, project type, and dollar value of investments reported from through Calculations were conducted by PolicyMap to create summary values based on geography and by project type.

Total values were aggregated to state and zip code based on the address provided for the transaction. Dollar values for transactions in multiple tracts were averaged across all tracts associated with the project. The total number of transactions for census tracts in an area may not be equivalent to totals by state and zip code.

The legislation defines a persistent poverty county as any county that has had 20 percent or more of its population living in poverty for the past 30 years as measured by the U.

Based on this criteria, the CDFI Fund used data from the and decennial censuses, and the American Community Survey to determine qualifying counties. The score is tabulated using various distress indicators, which are also mapped on PolicyMap. Once designated, Qualified Opportunity Zones QOZ can receive substantial tax breaks for long term investments to low-income neighborhoods.

State governors can nominate up to twenty five percent or twenty five total, whichever is larger, low-income community LIC census tracts for QOZ designation. Updates by the CDFI Fund on February 27th, , expanded the LIC eligibility definition to also include select qualified high migration tracts, low-population tracts within Empowerment Zones, and territorial census tracts that meet the LIC qualifications.

These updates resulted in an additional LIC eligible census tracts, and are included here. This data includes technical corrections to the contiguity analysis that were released by the CDFI Fund on February 27th, These corrections accounted for an increase in 1, additional eligible non-LIC contiguous census tracts and the removal of 72 previously eligible non-LIC contiguous tracts. The data is based on school district responses to a biennial survey conducted by the Office of Civil Rights in the Department of Education.

More information can be found on the CRDC website. Most indicators are broken out by student race and sex, but have been aggregated together on PolicyMap.

Percent indicators have all been derived by PolicyMap. The rate of students who have taken the ACT or SAT exams per seniors is not the percent of seniors who have taken the exams. School locations, names, district names, level, type, and charter school status are all from the NCES CCD for the school year.

The next version of this data will be for the school year, and will be released in The Escrow Requirements under the Truth in Lending Act rule known as the Escrows Rule requires that certain creditors create escrow accounts for a minimum of five years for higher-priced mortgage loans HPMLs , except HPMLs made by certain small creditors that operate predominantly in rural or underserved counties.

The Community Reinvestment Act CRA , which was enacted by Congress in , is intended to encourage depository institutions to help meet the credit needs of the communities in which they operate, including low- and moderate-income neighborhoods, consistent with safe and sound banking operations.

These examinations are conducted by federal agencies: In order to gauge CRA performance, the evaluation looks for bank activity in low- and moderate-income neighborhoods, nonmetropolitan distressed and underserved areas, and federally designated disaster areas.

These areas are identified by calculating tract income level. For additional information on data and calculations see: The tract income level is defined as follows: Tracts are CRA eligible if they are low- or moderate-income, or if they are nonmetropolitan middle income tracts designated by FFIEC as distressed or underserved.

Distressed middle income tracts are those with: Lists of these tracts are released annually and available on the CRA website at: Revitalization or stabilization activities undertaken during the lag period will receive consideration as community development activities if they would have been considered to have a primary purpose of community development if the census tract in which they were located were still designated as distressed or underserved.

Disaster areas are not mapped in PolicyMap because they are subject to frequent changes. Data obtained from the Convenient Care Association on March 31, Includes only members of the Convenient Care Association. HRRs represent regional health care markets, and were determined based on the locations of referrals for major cardiovascular surgeries and neurosurgery procedures.

HSAs represent smaller, local health care markets, based on Medicare hospitalizations. Hospital Service Area boundaries are available only for the contiguous United States. Hospital Referral Region boundaries include Alaska and Hawaii. If the volume of immigrants receiving green cards in any year was more than 15, people, the country was included. Energy Mapping System provides the locations and capacity of operable electric generating plants which includes all plants that are operating, on standby, or short- or long-term out of service with a combined nameplate capacity of 1 MW or more.

Geographic coordinates are assigned to the plant locations in the source data. Thematic indicators of electricity generation capacity were determined based on a spatial join performed by PolicyMap of geocoded plant locations and standard Census geographic boundaries. Generator-level megawatt output capacity was aggregated for county and state boundaries. This is consistent with how the EIA classifies renewable energy sources as outlined on their renewable sources webpage. The median AQI is based on the value for which half of daily AQI values during the year were less than or equal to the median value, and half equaled or exceeded it.

Air quality is defined by the EPA as follows: The points in PolicyMap are as of December of Brownfields designated by states or local entities, sites that may qualify for but have not received EPA assessment funding, and underground storage tanks are not included on the map.

Each point represents a transfer of funds related to a known brownfield site. Multiple points for the same brownfield location indicate multiple actions over a period of time; the entity receiving funds may differ. To construct a layer of forestland data, the following raster fields were selected from the NLCD, and converted to a shapefile:.

Deciduous Forest — Areas dominated by trees where 75 percent or more of the tree species shed foliage simultaneously in response to seasonal change. Evergreen Forest — Areas dominated by trees where 75 percent or more of the tree species maintain their leaves all year. Canopy is never without green foliage. Mixed Forest — Areas dominated by trees where neither deciduous nor evergreen species represent more than 75 percent of the cover present.

This program is a voluntary assistance program focused on capturing methane from landfills. Using EPA guidelines, PolicyMap categorizes each violation as a health violation or a monitoring and reporting violation. The source data comes at the agency-level; PolicyMap determines what county the water system is in and provides county-level data. Only water systems that serve 10, people or more are included. In counties where multiple water systems were included, the average number of violations was calculated weighted by the population size served by each system.

The Superfund program is an evaluation program for active and inactive hazardous waste sites. Human exposure and groundwater migration information are environmental indicators based on metrics set by the EPA. These indicators are used to measure progress made through site cleanup activities. The UCR Program is voluntary, and includes data for only counties and cities with population over 10, As a result, coverage is not universal.

The UCR Program collects data on known offenses and persons arrested by law enforcement agencies. The UCR Program does not record the findings of a court, coroner, jury, or the decision of a prosecutor. Data was reported to the FBI for selected places and counties by local law enforcement agencies. County counts reflect the sum of all reported offenses from agencies within the county that submitted data to the FBI.

The county count may not include all offenses if agencies within the county did not report or if reported figures did not comply with FBI reporting standards. Values for places were obtained by matching each agency with the place it is in based on the Crosswalk. Where multiple agencies reported data in one place, the values were aggregated by PolicyMap. The FBI cautions against using UCR data to rank municipalities, as many factors contribute to the number of crimes that occur and are reported.

More information can be found here: PolicyMap divides the total number of aggravated assaults that were reported in a county or place by the population count provided by the FBI and multiplied that ratio by , The population count used for places in this calculation is from the FBI.

The county population count is an estimate of the number of people served by the agencies within the county that report offenses. In , Vermont data may not be complete due to technical issues at agencies in the state. According to the FBI, underreporting of data is highly likely. Hate crime data is captured by including the element of bias in offenses already being reported to the UCR Program.

State hate crime counts reflect the sum of all reported offenses from agencies within the state that submitted data to the FBI. The state population count used in the rate calculations is an estimate of the number of people served by the agencies within the state that report offenses. In , a total of 14, law enforcement agencies participated in the Hate Crime Statistics Program, and, of those, a total of 1, agencies reported hate crime occurring within their jurisdiction.

Due to variation in reporting and hate crime definitions changing over time, FBI hate crime statistics should not be compared across states, and should not be compared from one year to another. An agency can report up to four bias motivation types per offense. While hate crime counts are available on PolicyMap for , hate crime rates are only available as of All facilities-based broadband internet providers are required to file Form with the FCC twice a year with information on where they offer internet access at speeds of kbps or more in at least one direction.

The wired and wireless data is accurate as of December 31, Data are provided at the Census block level. The data shown on PolicyMap indicates service available anywhere in the block, not necessarily for the entire block. For indicators showing number of providers, this is the number of providers throughout the block, even if they are not in the same part of the block, so it is not necessarily a measure of competition.

Wireless data are also provided at the block level. However, because wireless signals often do not conform to these boundaries, the source data indicates how much of the block is covered by a particular provider. Because these two technologies provide a similar level of service, they are shown as a single indicator on PolicyMap. The area covered by 4G service represents whichever one of the two technologies covers the most area, not necessarily the total area covered by the two technologies.

Similarly, the area covered by all wireless broadband service represents whichever one of 3G, 4G, and 4G LTE covers the most area. The Federal Deposit Insurance Corporation releases data on failures and assistance transactions of financial institutions in the United States and its territories. This data draws on information from two FDIC databases: PolicyMap is updated on a quarterly basis.

The data includes banks that have failed since October 1, The fields in the data for the assets and deposits of the acquiring bank are from the most recent quarterly report by the FDIC at the time of the most recent data update this may be different than the acquiring bank information at the time of the initial bank closing.

Data is updated by the FDIC annually. This survey is conducted by the U. The first survey was conducted in January and results were released in December The FDIC undertook this effort to address a gap in the availability of comprehensive data on the number of unbanked and underbanked households in the United States.

The housing price index HPI is a broad measure of the movement of single-family house prices based on transactions involving conforming, conventional mortgages purchased or securitized by Fannie Mae or Freddie Mac. The HPI is a weighted, repeat-sales index, meaning that it measures average price changes in repeat sales or refinancings on the same properties. The annual indices for smaller geographies should be considered developmental. Indexes are calibrated using appraisal values and sales prices for mortgages bought or guaranteed by Fannie Mae and Freddie Mac.

An index is not reported in cases where sample sizes on mortgage transactions are too small for a given geographic area. Local House Price Dynamics: New Indices and Stylized Facts. The working paper may be accessed at http: Feeding America first published the Map the Meal Gap project in , using food insecurity data, to look at hunger on the state and local level.

The data has since been collected annually. The project includes overall and child food insecurity, along with the percentages of food insecure individuals eligible for National Nutrition Assistance and other nutrition programs, their average cost per meal, and annual food-budget shortfalls. The poverty thresholds that determine SNAP and other nutrition program eligibility vary by state. Changes in state eligibility requirements limit year to year comparisons. More detail on how Feeding America obtained the data can be found in the technical brief located here: The map divides areas into three primary risk classifications: The maps processed by PolicyMap show areas of high risk, moderate risk, minimal risk, and undetermined risk.

Moderate risk includes X shaded. Low risk includes X unshaded. Not all counties are included in the NFHL. Counties which show data available on the FEMA coverage map do not necessarily have complete coverage.

After a governor seeks a presidential disaster declaration, FEMA conducts a preliminary damage assessment before recommending a decision to the president. Factors influencing the declaration of a federal disaster include the amount and type of damage, impact on infrastructure or critical facilities, imminent threats to health and public safety, impacts to essential government services and functions, unique capability of the Federal government to provide resources and available assistance from other sources, dispersion or concentration of damage, level of local insurance coverage, state and local resource commitments from previous events, and the frequency of recent disaster events.

FEMA provides disaster funding though four programs: Each declaration area is assigned a sequential disaster number. Disaster numbers are unique to states. Disasters indicate both the dates the incident itself began and ended, as well as the date of the disaster declaration and the date all financial transactions for all programs are completed the closeout date.

Federal disaster declarations are only displayed on PolicyMap for the previous five calendar years, and do not include disasters declared before January 1, or after August 10, CRA examinations are conducted by the federal agencies that are responsible for supervising depository institutions: PolicyMap aggregated the number of loans by amount of loan and by borrower revenue. PolicyMap also aggregated the number, average amount and percent of loans by top small business lenders and by top small farm lenders in order to construct categories that would be useful to policymakers and descriptive of neighborhoods and markets.

When performing aggregations and calculations on the CRA data, averages were not calculated and percents were not computed where the denominator of the calculation was less than five. These places are identified on the map as having Insufficient Data. The data is at the Census boundaries and the data is at the boundaries. For percent changes, PolicyMap created a bridge table between and geographies in order to calculate previous years of data at Census boundaries.

These previous years of data calculations are used for comparison to the current year of data. The Home Mortgage Disclosure Act HMDA , which was enacted by Congress in , requires most mortgage lenders located in metropolitan areas to collect data about their housing-related lending activity, report the data annually to the government, and make the data publicly available.

PolicyMap aggregated originated purchase and refinance loans for owner-occupied, one-to-four family dwellings, in order to construct categories that would be useful to policymakers and descriptive of neighborhoods and markets, such as Prime Refinance Loans, or Purchase Loans to African Americans. All high-cost those with a reported rate spread and prime loans for reflect the reporting rule changes implemented in Q4, discussed below. In order to accurately display the data according to these rule adjustments, PolicyMap divided the data into QQ3 and Q4.

The reason for this is that in the fourth quarter of , HMDA changed its rules for reporting rate spreads in an effort to more accurately capture the current high-cost lending activity.

For more information and analysis of the HMDA data, see the published article in the Federal Reserve Bulletin, available at https: When performing aggregations and calculations on the HMDA data, medians were not calculated and percents were not computed where the count of loan events of that type or the denominator of the calculation was less than five.

PolicyMap classifies loans as high cost if they had a reported rate spread. In , HMDA changed its rules for reporting rate spreads for the fourth quarter of the year in an effort to more accurately capture the current high-cost lending activity. Rate spreads were only reported by financial institutions if the APR was 3 or more percentage points higher for a first lien loan, or 5 or more percentage points higher for a second lien loan.

A rate spread of 3 or more suggested that a loan was of notably higher price than a typical loan, indicating that it could be classified as high cost. The new rules introduced in the fourth quarter of indicate that the rate spread on a loan is the difference between the Annual Percentage Rate APR on the loan and the estimated average prime offer rate APOR. With the rule change, rate spreads are only reported by financial institutions if the APR is more than 1.

A rate spread of 1. Likewise, all loans without reported rate spreads are considered to be prime, as the APR is within reasonable range of the treasury security yield or, in the case of Q4 and through , within reasonable range of the estimated average prime offer rate.

HOEPA loans are a subset of the high-cost loan category. PolicyMap contains layer data on the number of loans originated for the purpose of a home purchase that had multiple mortgages.

The second loan finances that part of the purchase price not being financed by the first loan. Studies suggest that these transactions have a higher risk of default and foreclosure as the homebuyers have little or no equity at risk. HMDA data does not explicitly identify or piggyback loans. PolicyMap created an algorithm for estimating transactions involving multiple loans to purchase a property. First- and second-position loans in the same census tract, from the same lender, and to applicants with the same race, ethnicity, gender, and income were flagged as multiple loans for the same property.

These loans were then combined into one record, the loan amounts summed, thus reflecting the total loan for the property transaction. These loans were originated for the purchase of an owner-occupied, one-to-four family dwelling, as reported by HMDA. Prime loans are defined as loans with no reported rate spread. For that time period, rate spreads were only reported by financial institutions if the APR was 3 or more percentage points higher for a first lien loan, or 5 or more percentage points higher for a second lien loan, the rate spread for Q4 and through is the difference between the Annual Percentage Rate APR on the loan and the estimated average prime offer rate APOR.

A tract was considered part of a Place if it was completely contained by the Place. In the event a tract was divided in two or more sections, the tract was considered to belong to the Place that the largest section of the tract was located.

The federal government has several entities through which it insures or guarantees consumer home loans. Although often referred to as government insurance, a government guarantee on a loan does not take the place of private mortgage insurance PMI. Rather, the government guarantees the value of the property to the bank that originates the loans. In the case of default on the loan or foreclosure on the property, the government entity that guaranteed the loan repays the debt to the bank in full and takes over ownership of the property.

The programs that the federal government uses to guarantee loans have varied target populations, but generally are committed to expanding the opportunities for home ownership to buyers who might not otherwise qualify for a loan with favorable terms. Government-guaranteed loans generally also require banks to commitment to negotiation with the homeowner in the event of loan default, beyond what is required of banks for non-government-insured home loans. There are several FHA programs with missions that include helping moderate income first-time homebuyers, buyers of properties that need significant rehabilitation, and the elderly.

For more on FHA-insured lending, see http: The Department of Veterans Affairs VA is one entity through which the government guarantees consumer loans. The purpose of the VA home loan program is to help veterans finance the purchase of homes with favorable loans terms and interest rates. For more on VA-insured lending, see http: FSA loans are intended for farmers who cannot qualify for conventional loans due to insufficient financial resources and farmers who have suffered financial setbacks due to natural disasters.

RHS guarantees mostly apply to loans for essential community facilities in rural areas. For more on FSA-insured lending, see http: Sanchagrin and Richard H. Taylor supervised the collection.

The data excludes most of the historically African-American denominations and some other major groups. In an effort to correct for this, in the ASARB released an adjusted rate of adherence to all denominations per 1, people. The adjusted rate is included on PolicyMap; because of this correction some counties will have rates in excess of For more on the corrections see Roger Finke and Christopher P.

In contrast to the study, researchers obtained mailing lists for the eight largest historically African-American denominations. In addition to including membership information gathered from this list, online church locators were identified and used to identify additional congregation locations. For each congregation located in this way, a membership of was assigned. However, it is important to note that, while the figures for African-American denominations are more accurate than those imputed for the U.

Religion Census, the figures are still significantly lower than those reported by the denominations in the Yearbook of American and Canadian Churches, In total, the groups reported , congregations with ,, adherents, comprising The data reported on Jews and Muslims are estimates rather than counts. For more information on how these estimates were calculated, including changes in the estimation methodologies from the to surveys, see: GreatSchools is a national, independent nonprofit organization providing elementary, middle and high school information for public, private, and charter schools nationwide.

GreatSchools Summary Ratings are based on test scores, student or academic progress, college readiness, equity, advanced courses, and discipline and attendance disparities.

In states where not all information is available, a rating based on test scores is given. GreatSchools ratings are designed to be a starting point to help parents compare schools, and should not be the only factor used in school selection. More information about GreatSchools Ratings can be found here. The SBA is a standards-based test, which means it measures specific skills defined for each grade by the state of Alaska.

The goal is for all students to score at or above the proficient level. In some cases students may repeat the test during grades 11 or The HSGQE is a standards-based test, which means that it measures how well students are mastering specific skills defined by the state of Alaska.

Because the two assessments measure very different standards, under no circumstances should the results be compared between these two assessments. The AHSGE is a standards-based test, which means it measures specific skills defined for each grade by the state of Alabama. The goal is for all students to pass the test. The ARMT is a standards-based test, which means it measures specific skills defined for each grade by the state of Alabama.

The goal is for all students to score at or above the state standard. The ASA is a standards-based test, which means it measures specific skills defined for each grade by the state of Alabama. The goal is for all students to score at or above proficiency level 3.

The ACT Aspire is a standards-based assessment system that gauges student progression from grades 3 through 10 in english, math, and science. ACT Plan contains four curriculum-based assessment-English, mathematics, reading, and science. Students in grade 10 receive scores on each subject test as well as a predictor composite score for the ACT. Score reports provide information to help students identify skills and knowledge required for college success as well as areas where extra help or additional high school courses were needed.

In Arkansas used the Benchmark Exam to test students in grades 5 and 7 in science. The Benchmark Exam is a standards-based test, which means it measures specific skills defined for each grade by the state of Arkansas.

The results for End of Course Exams administered in the spring of each school year are displayed on GreatSchools profiles. The End of Course Exam is a standards-based test, which means it measures specific skills defined by the state of Arkansas.

The knowledge and skills students need to demonstrate at each of the performance levels were based on recommendations of educator panels representing each of the participating states in the Consortium.

Arkansas teachers were strong participants on these panels. All states in the Consortium have adopted these same performance standards. AIMS is a standards-based test, which means that it measures how well students have mastered Arizona learning standards.

The goal is for all students to meet or exceed state standards on the test. In , students in Arizona took the AZMerit. The CSTs are standards-based tests, which means they measure how well students are mastering specific skills defined for each grade by the state of California. The goal is for all students to score at or above proficient on the tests. These are comprehensive, end-of-year assessments of grade-level learning that measure progress toward college and career readiness.

The tests capitalize on the strengths of computer adaptive testing-efficient and precise measurement across the full range of achievement and timely turnaround of results. The TCAP is a standards-based test, which means it measures how well students are mastering specific skills defined for each grade by the state of Colorado.

The goal is for all students to score at or above proficient on the test. In , students in Connecticut took the CMT assessment for science in grades 5 and 8. Students were tested in ELA and Math. In Washington, D. Currently GreatSchools is displaying results for reading and math only. The DC-CAS is a standards-based testing program, which means it measures specific skills defined for each grade by the District of Columbia.

The DCAS is a standards-based test, which means it measures specific skills defined for each grade by the state of Delaware. The administration of the Smarter assessments in grades , and 11 occurred during spring From , the FCAT 2. In spring , it was replaced by the Florida Standards Assessments FSA in English language arts and mathematics to measure student achievement of the Florida Standards.

The CRCT is a standards-based assessment, which means it measures how well students are mastering specific skills defined for each grade by the state of Georgia. In Georgia administered End-of-Course Tests EOCT in 9th grade math level 2, geometry, analytic geometry, coordinated algebra, biology, United States history, physical science, American literature, and economics.

The EOCT is a standards-based assessment, which means it measures how well students are mastering specific skills defined by the state of Georgia. The GHSWT is a standards-based assessment, which means it measures how well students are mastering specific skills defined by the state of Georgia. This assessment was retired in March and will no longer be administered in Georgia. In , students in Georgia took the George Milestones Assessment. The Georgia Milestones Assessment System Georgia Milestones is a comprehensive summative assessment program spanning grades 3 through high school.

Georgia Milestones measures how well students have learned the knowledge and skills outlined in the state-adopted content standards in language arts, mathematics, science, and social studies. Students in grades 3 through 8 will take an end-of-grade assessment in each content area, while high school students will take an end-of-course assessment for each of the eight courses designated by the State Board of Education.

In Hawaii used the Hawaii State Assessment HSA to test students in grades 3 through 8 and 10 in reading and math, and grade 10 in biology. The HSA is a standards-based test that measures how well students are mastering specific skills defined for each grade by the state of Hawaii. The goal is for all students to score at or above the proficient level on the test.

These are mandatory assessments given to students in grades and In Iowa used the Iowa Assessments to test students in grades 3 through 8 and 11 in reading and math. The scores reflect the performance of students enrolled for the full academic year. The Iowa Assessments are standards-based tests, which measure specific skills defined for each grade by the state of Iowa.

In , students in grades 5 and 7, students took the ISAT science assessment. In , students in grades and once in high school take the SBAC to determine whether they have achieved the standards for their grade level and subject area.

The ISAT is a standards-based test, which means it measures how well students are mastering specific skills defined for each grade by the state of Illinois. These expectations have been adjusted to better align with the Common Core State Standards, a multi-state initiative that established year-by-year guidelines outlining the grade-specific skills and content students need to stay on the path to college and career readiness. The higher expectations of the new standards will result in a downward shift of where students rank in meeting or exceeding standards.

The PSAE is a standards-based test, which means it measures how well students are mastering specific skills defined for each grade by the state of Illinois.

PARCC is the state assessment and accountability measure for Illinois students enrolled in a public school district. The goal is for all students to score at the passing level on the test. In , Kansas used the Kansas State Assessments KSA to test students in grades 3 though 8, and 10 in reading and math; in grades 4, 7, and 11 in science.

The tests are standards-based, which means they measure how well students are mastering specific skills defined for each grade by the state of Kansas. In , Kentucky used the Kentucky Performance Rating for Educational Progress K-PREP tests to assess students in grades 3 through 8 in reading and mathematics, 4 and 7 in science, 5 and 8 in social studies, 5, 6, 8, 10, and 11 in writing, and 4, 6, and 10 in language mechanics.

The K-PREP is a standards-based test, which means it measures how well students are mastering specific skills defined for each grade by the state of Kentucky. EOCs are tests given to public high school students when they complete a course to assess their knowledge of important course concepts.

They are similar to a final exam, except that they are created and scored by an outside testing company, ensuring that the tests are both rigorous and aligned with state and national college readiness standards. These assessments are aligned to the Louisiana Standards which were developed with significant input from Louisiana educators.

In Louisiana used the integrated Louisiana Educational Assessment Program iLEAP to assess students in grades 3, 5, 6, and 7 in math, English language arts, science, and social studies.