Restructuring Medicare's Benefit Design: Implications for Beneficiaries and Spending

Estimates the effects of options for restructuring Medicare's fee-for-service benefit design, including a $550 deductible for Parts A and B, a 20 percent coinsurance on nearly all services, and a$5,500 limit on cost sharing for Medicare-covered services

Less government intervention in biodiversity management: risks and opportunities

n a changing global environment, with increasing pressure on ecosystem goods and services, biodiversity conservation is likely to become increasingly important. However, with the current global financial crisis, governments are increasingly trying to stabilise economies through spending cuts aiming to reduce national deficits. Within such an economic climate, the devolution of governance through public participation is an intrinsically appealing concept. We outline a number of challenges that explain why increased participation in biodiversity management has been and may continue to be problematic. Using as a case study the local stakeholder-driven Moray Firth Seal Management Plan in Scotland, we identify four key conditions that were crucial to the successful participatory management of a biodiversity conflict: a local champion, the emergence of a crisis point, the involvement of decision-makers, and long-term financial and institutional support. Three of the four conditions point to the role of direct government involvement, highlighting the risk of devolving responsibility for biodiversity conflict management to local communities. We argue that without an informed debate, the move towards a more participatory approach could pose a danger to hard-won policy gains in relation to public participation, biodiversity conservation and conflict management

Emerging themes and provisional ideas for how the toolkits developed during the MAX project can help local authorities maximise the use of data in adult social care

The third in a series of three blogs produced by the MAX project team which summarises the preliminary findings from an online survey conducted with local authority staff associated with the Adult Social Care Survey (ASCS) and Personal Social Services Survey of Adult Carers in England (PSS SACE or Carers’ Survey)

The factors that affect local authority use of adult social care and carers survey data

The second in a series of three blogs produced by the MAX project team which summarises the preliminary findings from an online survey conducted with local authority staff associated with the Adult Social Care Survey (ASCS) and Personal Social Services Survey of Adult Carers in England (PSS SACE or Carers’ Survey)

Local authority views and use of the adult social care and carers survey

The first in a series of three blogs produced by the MAX project team which summarises the preliminary findings from an online survey conducted with local authority staff associated with the Adult Social Care Survey (ASCS) and Personal Social Services Survey of Adult Carers in England (PSS SACE or Carers’ Survey

Prevalence and Associated Risk Factors of Hepatitis B Virus Infections Among HIV-1 Infected Patients Attending the Comprehensive Care Clinic in Malindi Sub-County Hospital in Kenya

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infections are common all over the world. Infection with HIV increases rates of HBV chronicity, prolong the time the HBV stays in circulation and increase liver-related morbidity. Factors such as intravenous drug use, multiple blood transfusions, presence of tattoos, unsafe sexual practices and being health workers have been implicated as drivers of infection & transmission of HBV & HIV. This study aimed to determine the prevalence and genotypes of HBV associated risk factors among HIV infected patients in a descriptive cross-sectional study. Malindi was chosen as a suitable study site because of the high numbers of residents involved in sex tourism as well as intravenous drug use. A structured questionnaire was used to capture social demographic data such as age, gender, employment status, occupation, the level of education and marital status, clinical history information such as duration since diagnosis with HIV, ART drug history, duration taking ARVs and baseline CD4 count and risk factors associated with HBV infections such as intravenous drug use, history of blood transfusion, tattooing/scarification, and the sexual history from 446 consenting randomly selected HIV infected participants. Five millilitres of whole blood was obtained from each participant, 50µl of which was used for CD4 cell counts using a flow cytometer. HBsAg serology was done using Diaspot® rapid diagnostic test and confirmed by Hepanostika® HBsAg Ultra ELISA kit (BioMérieux SA) and HBV DNA was extracted from all HBsAg positive samples. Nested polymerise chain (PCR) reaction and sequencing of the Pre S1 region was done. Sample sequences were compared with published HBV genotypes sequences from GenBank and Phylogenetic trees were constructed using the NJ Plot software using a PHB file created through DNA Database of Japan (DDBJ) to determine the HBV genotypes. Out of the 446 HIV positive participants, 126 (28.3%) were males and 320 (71.7%) females. Only 19/446 (4.26%) participants were positive for HBV based on rapid strip test while 22/446 (4.93%) participants had HBV based on ELISA. Twelve of the 22 ELISA positive samples were successfully amplified by PCR. Out of the 12 PCR positive samples 10 were successfully sequenced. Phylogenetic analysis revealed that 9/10 (90%) samples belonged to genotype A while 1/10 (10%) belonged to genotype E. Males (p=0.028) and intravenous drug use (p= 0.08) were significantly associated HBV infections. The high prevalence (4.9%) of HBV among HIV patients attending Malindi Sub-county hospital is most likely highly driven by intravenous drug use and multiple sexual partners among the male gender and is predominantly genotypes A and E which is similar to the general population. Keywords: Hepatitis B virus, HIV, Co-infection, HBsAg, genotypes, intravenous drug us

Challenge Funds in International Development

The use of challenge funds to promote economic and social development continues to grow, buthas been the subject of relatively little research. This paper develops a definition of what challengefunds are and how they differ from other development funding mechanisms, taking into accounttheir purpose, financial terms, agency relationships, screening processes, selection mechanisms,implementation and risk sharing characteristics. A challenge fund provides grants or subsidies withan explicit public purpose between independent agencies with grant recipients selectedcompetitively on the basis of advertised rules and processes who retain significant discretion overformulation and execution of their proposals and share risks with the grant provider. This paperdraws on a review of fifty challenge funds being operated by international agencies in order toexplore variation in their characteristics. A distinction is drawn between business oriented‘enterprise’ challenge funds and civil society or social development challenge funds, and betweenrelatively ‘light touch’ and ‘hands-on’ approaches to their management. The paper concludes withsuggestions for further research

XLIM-MS Towards the Development of a Novel approach to Cross-linking Mass Spectrometry

In the cellular environment proteins form diverse and complex networks of interactions that control a variety of vital functions. Understanding the structure of these multi-subunit assemblies is key to understanding their function. To date the majority of structural information has been obtained through crystallographic studies, electron microscopy and NMR. However, the size and dynamics of these macro-molecular machines often precludes their analysis by such traditional methods. Cross-linking mass spectrometry offers a complementary structural technique. The distance restraints provided by the technique are formed in solution and offer more native structural information. Mapping of these restraints allows determination of the relative positions of amino acid residues in wider three dimensional structures. To date the analysis of cross-linked peptides has almost exclusively been conducted with Orbitrap analysers. As a result most of the software applications designed to identified cross- link:spectrum matches have been developed with data from this type of analyser. Here we present an optimised protocol for the analysis of cross-linked samples using a Quadrupole Time-of-Flight mass spectrometer (QToF). We show that existing software can be configured to analyse QToF data with minimal adaptations. We evaluate the usefulness of the xQuest linear discriminant score in determining genuine cross-link:spectrum assignments. The increased size and charge of crosslinked peptides compared to their un-crosslinked counterparts makes them ideal candidates for separation by ion mobility mass spectrometry. We take advantage of the unique geometry of the Triwave Stacked Ring Ion Guide to explore the effects of ion mobility separation on both precursors and fragment ions from cross-linked samples. To evaluate the sequence coverage and signal to noise ratio of identified cross-link:spectrum matches we present two computational solutions: ValidateXL and AnnotateXL

The ebb and flow of adaptive co-management: a longitudinal evaluation of a conservation conflict

Adaptive co-management (ACM) is an emerging approach to the governance of social-ecological systems, but there are few long-term assessments of its efficacy. This is especially true in conservation conflicts, where ACM can mitigate disputes between polarised stakeholders. We evaluated ACM that emerged in 2005 to address conflict between seal conservation and fisheries interests in the Moray Firth, Scotland. We interviewed 20 stakeholders in 2015, repeating a survey carried out in 2011 which applied an indicator framework to measure outcomes and pre-conditions for ACM to continue. In 2015, all but one of the 12 outcome indicators were positive, the exception being the conservation status of salmon. However, pre-conditions for ACM’s continuation had weakened, with declines between 2005, 2011 and 2015. These were most marked for three indicators: leaders prepared to champion the process, presence of a bridging organisation or individual, and participation of all impacted stakeholders. The results show that ACM in this conservation conflict is dynamic. Perceived declines in salmon abundance and increases in seal numbers have renewed tensions amongst stakeholders, triggering a ‘revival’ phase of ACM initiated by fishery interests. Our study provides empirical evidence of ACM’s fluid nature, and how resource crises can reignite ACM. We suggest that participatory evaluation is a potentially important early-warning mechanism that can identify remedial action and galvanise stakeholders to respond to the re-emergence of conflict