Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya.

BACKGROUND:Cervical cancer is the most frequent neoplasm among Kenyan women, with 4800 diagnoses and 2400 deaths per year. One reason is an extremely low rate of screening through pap smears, at 13.8% in 2014. Knowing the costs of screening will help planners and policymakers design, implement, and scale programs. METHODS:We conducted HPV-based cervical cancer screening via self-collection in 12 communities in rural Migori County, Kenya. Six communities were randomized to community health campaigns (CHCs), and six to screening at government clinics. All HPV-positive women were referred for cryotherapy at Migori County Hospital. We prospectively estimated direct costs from the health system perspective, using micro-costing methods. Cost data were extracted from expenditure records, staff interviews, and time and motion logs. Total costs per woman screening included three activities: outreach, HPV-based screening, and notification. Types of inputs include personnel, recurrent goods, capital goods, and services. We costed potential changes to implementation for scaling. RESULTS:From January to September 2016, 2899 women were screened in CHCs and 2042 in clinics. Each CHC lasted for 30 working days, 10 days each for outreach, screening, and notification. The mean cost per woman screened was $25.00 for CHCs [median:$25.09; Range: $22.06-30.21] and$29.56 for clinics [$28.90;$25.27-37.08]. Clinics had higher costs than CHCs for personnel ($14.27 vs.$11.26) and capital ($5.55 vs.$2.80). Screening costs were higher for clinics at $21.84, compared to$17.48 for CHCs. In contrast, CHCs had higher outreach costs ($3.34 vs.$0.17). After modeling a reduction in staffing, clinic per-screening costs ($25.69) were approximately equivalent to CHCs. CONCLUSIONS:HPV-based cervical cancer screening through community health campaigns achieved lower costs per woman screened, compared to screening at clinics. Periodic high-volume CHCs appear to be a viable low-cost strategy for implementing cervical cancer screening

Small Cues Change Savings Choices

In randomized field experiments, we embedded one- to two-sentence anchoring, goal-setting, or savings threshold cues in emails to employees about their 401(k) savings plan. We find that anchors increase or decrease 401(k) contribution rates by up to 1.9% of income. A high savings goal example raises contribution rates by up to 2.2% of income. Highlighting a higher savings threshold in the match incentive structure raises contributions by up to 1.5% of income relative to highlighting the lower threshold. Highlighting the maximum possible contribution rate raises contribution rates by up to 2.9% of income among low savers.

Dominance of the proximal coordinate frame in determining the locations of hippocampal place cell activity during navigation.

The place-specific activity of hippocampal cells provides downstream structures with information regarding an animal\u27s position within an environment and, perhaps, the location of goals within that environment. In rodents, recent research has suggested that distal cues primarily set the orientation of the spatial representation, whereas the boundaries of the behavioral apparatus determine the locations of place activity. The current study was designed to address possible biases in some previous research that may have minimized the likelihood of observing place activity bound to distal cues. Hippocampal single-unit activity was recorded from six freely moving rats as they were trained to perform a tone-initiated place-preference task on an open-field platform. To investigate whether place activity was bound to the room- or platform-based coordinate frame (or both), the platform was translated within the room at an early and at a late phase of task acquisition (Shift 1 and Shift 2). At both time points, CA1 and CA3 place cells demonstrated room-associated and/or platform-associated activity, or remapped in response to the platform shift. Shift 1 revealed place activity that reflected an interaction between a dominant platform-based (proximal) coordinate frame and a weaker room-based (distal) frame because many CA1 and CA3 place fields shifted to a location intermediate to the two reference frames. Shift 2 resulted in place activity that became more strongly bound to either the platform- or room-based coordinate frame, suggesting the emergence of two independent spatial frames of reference (with many more cells participating in platform-based than in room-based representations)

Decoupling B-Trees From Reinforcement Learning in Virtual Machines

Many end-users would agree that, had it not been for consistent hashing, the improvement of the Ethernet might never have occurred. Given the trends in relational modalities, biologists compellingly note the typical unification of checksums and checksums, demonstrates the theoretical importance of theory. In this work we describe an analysis of the Internet (SphinxTye), demonstrating that the partition table and super-pages can collude to realize this ambition

Elevated pCO2 enhances bacterioplankton removal of organic carbon.

Factors that affect the removal of organic carbon by heterotrophic bacterioplankton can impact the rate and magnitude of organic carbon loss in the ocean through the conversion of a portion of consumed organic carbon to CO2. Through enhanced rates of consumption, surface bacterioplankton communities can also reduce the amount of dissolved organic carbon (DOC) available for export from the surface ocean. The present study investigated the direct effects of elevated pCO2 on bacterioplankton removal of several forms of DOC ranging from glucose to complex phytoplankton exudate and lysate, and naturally occurring DOC. Elevated pCO2 (1000-1500 ppm) enhanced both the rate and magnitude of organic carbon removal by bacterioplankton communities compared to low (pre-industrial and ambient) pCO2 (250 -~400 ppm). The increased removal was largely due to enhanced respiration, rather than enhanced production of bacterioplankton biomass. The results suggest that elevated pCO2 can increase DOC consumption and decrease bacterioplankton growth efficiency, ultimately decreasing the amount of DOC available for vertical export and increasing the production of CO2 in the surface ocean

Consumer Purchases of Biotech Sweet Corn: Results from a Market Experiment

In the increasingly consumer-driven food system, consumer preferences toward agricultural biotechnology have the potential to influence decisions about development and adoption of biotech crop varieties. Current knowledge about consumer attitudes toward biotech foods is largely based on a number of consumer surveys and a growing body of experimental auctions. This paper reports results of a market experiment designed to isolate the effect of the use of biotechnology on consumer choices between two otherwise identical products. Two related varieties of fresh-market sweet corn were grown, labeled, and sold side-by-side in nine participating grocery stores in the Philadelphia area. Sales data indicate a market share of biotech corn of about 45 percent, with store-specific shares varying between 10 and 80 percent. Over 700 surveys were collected in stores. Surprisingly, only 65 percent of respondents noticed that there were two types of corn for sale despite the labeling and merchandising, and 87 percent of the sample spent one minute or less choosing their corn. About half of the respondents had heard of biotechnology before, and 16 percent volunteered the biotechnology trait as an influence on their purchase decision. Approximately 40 percent of the sample purchased some of the biotech variety, with several respondents purchasing some of each.Institutional and Behavioral Economics,

Europium, Samarium, and Neodymium Isotopic Fractions in Metal-Poor Stars

We have derived isotopic fractions of europium, samarium, and neodymium in two metal-poor giants with differing neutron-capture nucleosynthetic histories. These isotopic fractions were measured from new high resolution (R ~ 120,000), high signal-to-noise (S/N ~ 160-1000) spectra obtained with the 2dCoude spectrograph of McDonald Observatory's 2.7m Smith telescope. Synthetic spectra were generated using recent high-precision laboratory measurements of hyperfine and isotopic subcomponents of several transitions of these elements and matched quantitatively to the observed spectra. We interpret our isotopic fractions by the nucleosynthesis predictions of the stellar model, which reproduces s-process nucleosynthesis from the physical conditions expected in low-mass, thermally-pulsing stars on the AGB, and the classical method, which approximates s-process nucleosynthesis by a steady neutron flux impinging upon Fe-peak seed nuclei. Our Eu isotopic fraction in HD 175305 is consistent with an r-process origin by the classical method and is consistent with either an r- or an s-process origin by the stellar model. Our Sm isotopic fraction in HD 175305 suggests a predominantly r-process origin, and our Sm isotopic fraction in HD 196944 is consistent with an s-process origin. The Nd isotopic fractions, while consistent with either r-process or s-process origins, have very little ability to distinguish between any physical values for the isotopic fraction in either star. This study for the first time extends the n-capture origin of multiple rare earths in metal-poor stars from elemental abundances to the isotopic level, strengthening the r-process interpretation for HD 175305 and the s-process interpretation for HD196944.Comment: 40 pages, 16 figures. Accepted for publication in ApJ. Full versions of tables 4 and 5 are available from the first author upon reques