Cultural Context Index: A Geospatial Measure of Social Determinants of Health in the United States

Minority populations will continue to grow in the United States. Such pluralism necessitates iterative, geospatial measurements of cultural contexts. Our objective in this study was to create a measure of social determinants of health in geographic areas with varying ethnic, linguistic, and religious diversity in the United States. We extracted geographic information systems data based on community characteristics that have known associations with population health disparities from 2015 to 2019. We used principal component analysis to construct a Cultural Context Index (CCI). We created the CCI for 73,682 census tracts across 50 states and five inhabited territories. We identified hot and cold spots that are the highest and lowest CCI quintile, respectively. Hot spots census tracts were mostly located in metropolitan areas (84.8%), in the Southern census region (41.5%), and also had larger Black and Hispanic populations. The census tracts with the greatest need for culturally competent health care also had the sickest populations. Census tracts with a CCI rank of 5 (\u27greatest need\u27) had higher prevalences of self-reported poor physical health (17.2%) and poor mental health (17.4%), compared to either the general population (13.9% and 14.5%) or to CCI rank of 1 (\u27lowest need\u27) (11.9% and 10.8%). The CCI can pinpoint census tracts with a need for culturally competent health care and inform supply-side policy planning as healthcare and social service providers will inevitably come in contact with consumers from different backgrounds

Evoluția tuberculozei la pacienţii cu adicții

Background. The association of tuberculosis with addictions such as alcoholism and drug use contribute to severe evolution of the case. Objective of the study. Consisted in the identifying the evolution of tuberculosis in patients with chronic alcoholism and drug addiction. Material and Methods. It was performed a longitudinal, descriptive and retrospective study composed from 141 patients with chronic alcoholism, including 7 patients with a history of intravenous drug use registered during 2018 years. Results. A high rate of late-detected forms with chronic evolution - 20 (14%) diagnosed with fibrocavitary TB and insidious evolution 121 (86%) such as infiltrative TB was established. The high rate of cases undergoing repeated anti-TB treatment 62 (44%) and the rate of new cases -79 (56%) explained the low rate of treatment success rate - 42 (30%), death of 33 (23%) cases, lost to follow-up of 7 (5%) cases and those who evolved with therapeutic failure - 5 (3.5%) patients. In 54 (38%) cases no data about the therapeutic continuity were identified. Conclusion. Evolution of tuberculosis in patients with chronic alcoholism and drug addiction is insidious, which contributed to the detection of chronic previously treated forms and the high rate of death as well as patients lost to follow-up. Introducere. Asocierea tuberculozei cu adicțiile precum: consumul de alcool și droguri conferă o severitate deosebită a cazului. Scopul lucrării. A constatat în identificarea evoluției tuberculozei la pacienții cu alcoolism cronic și narcomanie. Material și Metode. S-a efectuat un studiu longitudinal, descriptiv şi retrospectiv format din 141 de pacienți cu alcoolism cronic, inclusiv 7 pacienți cu istoric de utilizare intravenoasă de droguri înregistrați în perioada anului 2018. Rezultate. S-a constatat o rată înaltă a formelor tardiv depistate cu evoluție cronică - 20 (14%) diagnosticați cu TB fibrocavitară și evoluție insidioasă 121 (86%), precum și TB infiltrativă. Rata înaltă a cazurilor supuse tratamentului anti-TB repetat 62 (44%) și rata cazurilor noi-79 (56%) a explicat rata scăzută a succesului terapeutic- 42 (30%), decesului la 33 (23%) cazuri, pierderii din supraveghere a 7 (5%) cazuri şi a celor care au evoluat cu eșec terapeutic - 5 (3, 5%) pacienți. În 54 (38%) cazuri nu au fost găsite date despre continuitatea terapeutică. Concluzii. Evoluția tuberculozei la pacienții cu alcoolism cronic și narcomanie este insidioasă, fapt care a contribuit atât la depistarea formelor cronice supuse tratamentului repetat și ratei înalte a decesului, cât și a pacienților pierduți din supraveghere

Effective and scalable software compatibility testing

Today’s software systems are typically composed of multiple components, each with different versions. Software compat-ibility testing is a quality assurance task aimed at ensuring that multi-component based systems build and/or execute correctly across all their versions ’ combinations, or config-urations. Because there are complex and changing interde-pendencies between components and their versions, and be-cause there are such a large number of configurations, it is generally infeasible to test all potential configurations. Con-sequently, in practice, compatibility testing examines only a handful of default or popular configurations to detect prob-lems; as a result costly errors can and do escape to the field. This paper presents a new approach to compatibility test-ing, called Rachet. We formally model the entire config-uration space for software systems and use the model to generate test plans to sample a portion of the space. In this paper, we test all direct dependencies between components and execute the test plan efficiently in parallel. We present empirical results obtained by applying our approach to two large-scale scientific middleware systems. The results show that for these systems Rachet scaled well and discovered in-compatibilities between components, and that testing only direct dependences did not compromise test quality

Low leakage-current InAsSb nanowire photodetectors on silicon

Axially doped p–i–n InAs0.93Sb0.07 nanowire arrays have been grown on Si substrates and fabricated into photodetectors for shortwave infrared detection. The devices exhibit a leakage current density around 2 mA/cm2 and a 20% cutoff of 2.3 μm at 300 K. This record low leakage current density for InAsSb based devices demonstrates the suitability of nanowires for the integration of III–V semiconductors with silicon technology

Efficacy of antiviral therapy and host–virus interactions visualised using serial liver sampling with fine-needle aspirates

Background &amp; Aims: Novel therapies for chronic hepatitis B (CHB), such as RNA interference, target all viral RNAs for degradation, whereas nucleoside analogues are thought to block reverse transcription with minimal impact on viral transcripts. However, limitations in technology and sampling frequency have been obstacles to measuring actual changes in HBV transcription in the liver of patients starting therapy. Methods: We used elective liver sampling with fine-needle aspirates (FNAs) to investigate the impact of treatment on viral replication in patients with CHB. Liver FNAs were collected from patients with CHB at baseline and 12 and 24 weeks after starting tenofovir alafenamide treatment. Liver FNAs were subjected to single-cell RNA sequencing and analysed using the Viral-Track method. Results: HBV was the only viral genome detected and was enriched within hepatocytes. The 5′ sequencing technology identified protein-specific HBV transcripts and showed that tenofovir alafenamide therapy specifically reduced pre-genomic RNA transcripts with little impact on HBsAg or HBx transcripts. Infected hepatocytes displayed unique gene signatures associated with an immunological response to viral infection. Conclusions: Longitudinal liver sampling, combined with single-cell RNA sequencing, captured the dynamic impact of antiviral therapy on the replication status of HBV and revealed host–pathogen interactions at the transcriptional level in infected hepatocytes. This sequencing-based approach is applicable to early-stage clinical studies, enabling mechanistic studies of immunopathology and the effect of novel therapeutic interventions. Impact and Implications: Infection-dependent transcriptional changes and the impact of antiviral therapy on viral replication can be measured in longitudinal human liver biopsies using single-cell RNA sequencing data.</p

The Great Mortgaging: Housing Finance, Crises, and Business Cycles

This paper unveils a new resource for macroeconomic research: a long-run dataset covering disaggregated bank credit for 17 advanced economies since 1870. The new data show that the share of mortgages on banks' balance sheets doubled in the course of the 20th century, driven by a sharp rise of mortgage lending to households. Household debt to asset ratios have risen substantially in many countries. Financial stability risks have been increasingly linked to real estate lending booms which are typically followed by deeper recessions and slower recoveries. Housing finance has come to play a central role in the modern macroeconomy

Mortgage design in an equilibrium model of the housing market

How can mortgages be redesigned to reduce macrovolatility and default? We address this question using a quantitative equilibrium life‐cycle model. Designs with countercyclical payments outperform fixed payments. Among those, designs that front‐load payment reductions in recessions outperform those that spread relief over the full term. Front‐loading alleviates liquidity constraints when they bind most, reducing default and stimulating housing demand. To illustrate, a fixed‐rate mortgage (FRM) with an option to convert to adjustable‐rate mortgage, which front‐loads payment reductions relative to an FRM with an option to refinance underwater, reduces price and consumption declines six times as much and default three times as much.Funding Provided by NSF under grant "Mortgage Design in an Equilibrium Model of the Housing Market" (1623801 - National Science Foundation)Accepted manuscrip

The Production Impact of 'Cash-for-Clunkers': Implications for Stabilization Policy

Stabilization policies frequently aim to boost spending as a means to increase GDP. Spending does not necessarily translate into production, however, especially when inventories are involved. We look at the cash-for-clunkers program that helped finance the purchase of nearly 700,000 vehicles in 2009. An analysis of auto sales and production movements reveals that the program did prompt a large spike in sales. But the program had only a modest and fleeting impact on production, as inventories buffered the movements in sales. These findings suggest caution in judging the efficacy of such policies by their impact on spending alone