The Precarious State of Family Balance Sheets

This report seeks to develop a clear picture of the current state of household financial security. It begins by exploring three components of family balance sheets -- income, expenditures, and wealth -- and how they have changed over the past several decades, and concludes with an examination of how these pieces interrelate and why understanding family finances requires that they be examined holistically. The data tell a powerful story about the state of household economic security and opportunity: Despite the national recovery, most families feel vulnerable and stressed, and could not withstand a serious financial emergency. This reality must begin to change if the American Dream is to remain alive and well for future generations

Neighborhood Poverty and Household Financial Security

In a previous study, The Pew Charitable Trusts examined the effects of neighborhood context on American families' economic mobility. That analysis found that neighborhood poverty is associated with downward mobility, reinforcing other research that has shown a link between high-poverty neighborhoods and unemployment, poorer performing schools, and increased violence, all of which pose risks to residents' economic security.This chartbook draws on data from the Survey of American Family Finances, commissioned by Pew in November 2014, to illustrate the health of family balance sheets in high- and low-poverty communities across the United States and to examine how neighborhood context influences people's attitudes toward the economy

The Complex Story of American Debt

This report explores a key element of wealth: household debt. Debt is sometimes acquired for mobility-enhancing purposes, such as to pay for college or purchase a home. But debt can also serve as a stopgap for families to cover regular expenses or deal with financial emergencies, especially if their savings are not sufficient. The type and amount of debt that households carry contribute to their wealth and their overall financial health

Shipping blood to a central laboratory in multicenter clinical trials: effect of ambient temperature on specimen temperature, and effects of temperature on mononuclear cell yield, viability and immunologic function

<p>Abstract</p> <p>Background</p> <p>Clinical trials of immunologic therapies provide opportunities to study the cellular and molecular effects of those therapies and may permit identification of biomarkers of response. When the trials are performed at multiple centers, transport and storage of clinical specimens become important variables that may affect lymphocyte viability and function in blood and tissue specimens. The effect of temperature during storage and shipment of peripheral blood on subsequent processing, recovery, and function of lymphocytes is understudied and represents the focus of this study.</p> <p>Methods</p> <p>Peripheral blood samples (n = 285) from patients enrolled in 2 clinical trials of a melanoma vaccine were shipped from clinical centers 250 or 1100 miles to a central laboratory at the sponsoring institution. The yield of peripheral blood mononuclear cells (PBMC) collected before and after cryostorage was correlated with temperatures encountered during shipment. Also, to simulate shipping of whole blood, heparinized blood from healthy donors was collected and stored at 15°C, 22°C, 30°C, or 40°C, for varied intervals before isolation of PBMC. Specimen integrity was assessed by measures of yield, recovery, viability, and function of isolated lymphocytes. Several packaging systems were also evaluated during simulated shipping for the ability to maintain the internal temperature in adverse temperatures over time.</p> <p>Results</p> <p>Blood specimen containers experienced temperatures during shipment ranging from -1 to 35°C. Exposure to temperatures above room temperature (22°C) resulted in greater yields of PBMC. Reduced cell recovery following cryo-preservation as well as decreased viability and immune function were observed in specimens exposed to 15°C or 40°C for greater than 8 hours when compared to storage at 22°C. There was a trend toward improved preservation of blood specimen integrity stored at 30°C prior to processing for all time points tested. Internal temperatures of blood shipping containers were maintained longer in an acceptable range when warm packs were included.</p> <p>Conclusions</p> <p>Blood packages shipped overnight by commercial carrier may encounter extreme seasonal temperatures. Therefore, considerations in the design of shipping containers should include protecting against extreme ambient temperature deviations and maintaining specimen temperature above 22°C or preferably near 30°C.</p

Pursuing the American Dream: Economic Mobility Across Generations

Pursuing the American Dream uses the most current data to measure mobility by family income, wealth, and personal earnings to reveal how closely tied a person’s place on the economic ladder is to that of his or her parents’. While a majority of Americans exceed their parents’ family income and wealth, the extent of their absolute mobility gains are not always enough to move them to a different rung of the economic ladder. Measuring both absolute and relative mobility, some of the highlights of the research include: Eighty-four percent of Americans have higher family incomes than their parents did. However, those born at the top and bottom of the income ladder are likely to stay there as adults. Over 40 percent of Americans raised in the bottom quintile of the family income ladder remain stuck there adults, and 70 percent remain below the middle. African Americans are still less likely to exceed their parents’ income than are whites and they are more likely to be stuck at the bottom of the economic ladder across a generation. A four-year college degree promotes upward mobility from the bottom and prevents downward mobility from the middle and the top.https://www.pewtrusts.org/en/research-and-analysis/reports/2012/07/10/pursuing-the-american-dream-economic-mobility-across-generation

Pursuing the American Dream: Economic Mobility Across Generations

Pursuing the American Dream uses the most current data to measure mobility by family income, wealth, and personal earnings to reveal how closely tied a person’s place on the economic ladder is to that of his or her parents’. While a majority of Americans exceed their parents’ family income and wealth, the extent of their absolute mobility gains are not always enough to move them to a different rung of the economic ladder. Measuring both absolute and relative mobility, some of the highlights of the research include: Eighty-four percent of Americans have higher family incomes than their parents did. However, those born at the top and bottom of the income ladder are likely to stay there as adults. Over 40 percent of Americans raised in the bottom quintile of the family income ladder remain stuck there adults, and 70 percent remain below the middle. African Americans are still less likely to exceed their parents’ income than are whites and they are more likely to be stuck at the bottom of the economic ladder across a generation. A four-year college degree promotes upward mobility from the bottom and prevents downward mobility from the middle and the top

Biomarkers From Late Pregnancy to 6 Weeks Postpartum in HIV-Infected Women Who Continue Versus Discontinue Antiretroviral Therapy After Delivery

BackgroundWomen who use antiretroviral therapy (ART) solely for the prevention of mother-to-child transmission of HIV discontinue postpartum. We hypothesized that women discontinuing ART by 6 weeks postpartum ("discontinuers") would have elevated postpartum inflammatory biomarker levels relative to women remaining on ART postpartum ("continuers").MethodsData from HIV-infected pregnant women enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1025 with CD4 counts &gt;350 cells per cubic millimeter before initiating ART or first pregnancy CD4 counts &gt;400 cells per cubic millimeter after starting ART and with available stored plasma samples at &gt;20 weeks of gestation, delivery, and 6 weeks postpartum were analyzed. Plasma samples were tested for highly sensitive C-reactive protein, D-dimer, and interleukin-6. We used longitudinal linear spline regression to model biomarkers over time.ResultsData from 128 women (65 continuers and 63 discontinuers) were analyzed. All biomarkers increased from late pregnancy to delivery, then decreased postpartum (slopes different from 0, P &lt; 0.001). Continuers had a steeper decrease in log D-dimer between delivery and 6 weeks postpartum than discontinuers (P = 0.002).ConclusionsIn contrast to results from treatment interruption studies in adults, both ART continuers and ART discontinuers had significant decreases in the levels of D-dimer, highly sensitive C-reactive protein, or interleukin-6 postpartum. Continuation was associated with a more rapid decline in D-dimer levels compared with discontinuation

Methods for scaling up an outreach intervention to increase colorectal cancer screening rates in rural areas

Abstract Background Mailed fecal immunochemical test (FIT) outreach and patient navigation are evidence-based practices shown to improve rates of colorectal cancer (CRC) and follow-up in various settings, yet these programs have not been broadly adopted by health systems and organizations that serve diverse populations. Reasons for low adoption rates are multifactorial, and little research explores approaches for scaling up a complex, multi-level CRC screening outreach intervention to advance equity in rural settings. Methods SMARTER CRC, a National Cancer Institute Cancer Moonshot project, is a cluster-randomized controlled trial of a mailed FIT and patient navigation program involving 3 Medicaid health plans and 28 rural primary care practices in Oregon and Idaho followed by a national scale-up trial. The SMARTER CRC intervention combines mailed FIT outreach supported by clinics, health plans, and vendors and patient navigation for colonoscopy following an abnormal FIT result. We applied the framework from Perez and colleagues to identify the intervention’s components (including functions and forms) and scale-up dissemination strategies and worked with a national advisory board to support scale-up to additional organizations. The team is recruiting health plans, primary care clinics, and regional and national organizations in the USA that serve a rural population. To teach organizations about the intervention, activities include Extension for Community Healthcare Outcomes (ECHO) tele-mentoring learning collaboratives, a facilitation guide and other materials, a patient navigation workshop, webinars, and individualized technical assistance. Our primary outcome is program adoption (by component), measured 6 months after participation in an ECHO learning collaborative. We also assess engagement and adaptations (implemented and desired) to learn how the multicomponent intervention might be modified to best support broad scale-up. Discussion Findings may inform approaches for adapting and scaling evidence-based approaches to promote CRC screening participation in underserved populations and settings. Trial registration Registered at ClinicalTrials.gov (NCT04890054) and at the NCI’s Clinical Trials Reporting Program (CTRP no.: NCI-2021–01032) on May 11, 2021