Low-Income Subsidies for the Medicare Prescription Drug Benefit: The Impact of the Asset Test

Assesses the impact of the requirement that low-income individuals with Medicare meet an asset test in order to receive additional help paying premiums and cost sharing under the new Medicare drug benefit. Raises questions about the equity of the test

The Burden of Out-of-Pocket Health Spending Among Older Versus Younger Adults: Analysis from the Consumer Expenditure Survey, 1998-2003

Analyzes the extent to which health care spending as a share of income has differed among younger adults versus people ages 65 and older, both at a single point in time (2003) and over the six-year period from 1998 to 2003

Investigating interventions to increase uptake of HIV testing and linkage into care or prevention for male partners of pregnant women in antenatal clinics in Blantyre, Malawi: study protocol for a cluster randomised trial.

BACKGROUND: Despite large-scale efforts to diagnose people living with HIV, 54% remain undiagnosed in sub-Saharan Africa. The gap in knowledge of HIV status and uptake of follow-on services remains wide with much lower rates of HIV testing among men compared to women. Here, we design a study to investigate the effect on uptake of HIV testing and linkage into care or prevention of partner-delivered HIV self-testing alone or with an additional intervention among male partners of pregnant women. METHODS: A phase II, adaptive, multi-arm, multi-stage cluster randomised trial, randomising antenatal clinic (ANC) days to six different trial arms. Pregnant women accessing ANC in urban Malawi for the first time will be recruited into either the standard of care (SOC) arm (invitation letter to the male partner offering HIV testing) or one of five intervention arms offering oral HIV self-test kits. Three of the five intervention arms will additionally offer the male partner a financial incentive (fixed or lottery amount) conditional on linkage after self-testing with one arm testing phone call reminders. Assuming that 25% of male partners link to care or prevention in the SOC arm, six clinic days, with a harmonic mean of 21 eligible participants, per arm will provide 80% power to detect a 0.15 absolute difference in the primary outcome. Cluster proportions will be analysed by a cluster summaries approach with adjustment for clustering and multiplicity. DISCUSSION: This trial applies adaptive methods which are novel and efficient designs. The methodology and lessons learned here will be important as proof of concept of how to design and conduct similar studies in the future. Although small, this trial will potentially present good evidence on the type of effective interventions for improving linkage into ART or prevention. The trial results will also have important policy implications on how to implement HIVST targeting male partners of pregnant women who are accessing ANC for the first time while paying particular attention to safety concerns. Contamination may occur if women in the intervention arms share their self-test kits with women in the SOC arm. TRIAL REGISTRATION: ISRCTN, ID: 18421340 . Registered on 31 March 2016

Detecting microRNA activity from gene expression data

<p>Abstract</p> <p>Background</p> <p>MicroRNAs (miRNAs) are non-coding RNAs that regulate gene expression by binding to the messenger RNA (mRNA) of protein coding genes. They control gene expression by either inhibiting translation or inducing mRNA degradation. A number of computational techniques have been developed to identify the targets of miRNAs. In this study we used predicted miRNA-gene interactions to analyse mRNA gene expression microarray data to predict miRNAs associated with particular diseases or conditions.</p> <p>Results</p> <p>Here we combine correspondence analysis, between group analysis and co-inertia analysis (CIA) to determine which miRNAs are associated with differences in gene expression levels in microarray data sets. Using a database of miRNA target predictions from TargetScan, TargetScanS, PicTar4way PicTar5way, and miRanda and combining these data with gene expression levels from sets of microarrays, this method produces a ranked list of miRNAs associated with a specified split in samples. We applied this to three different microarray datasets, a papillary thyroid carcinoma dataset, an in-house dataset of lipopolysaccharide treated mouse macrophages, and a multi-tissue dataset. In each case we were able to identified miRNAs of biological importance.</p> <p>Conclusions</p> <p>We describe a technique to integrate gene expression data and miRNA target predictions from multiple sources.</p

The Analysis of a Bay

This problem, The Analysis of a Bay, is a preparatory exercise directly related to the major architectural design project for this semester, and its particular focus on design development. The following statement by Professor Val Warke (The Cornell Journal of Architecture 3) clearly outlines the rationale and pedagogical objectives for such an exercise

Acceptability of woman-delivered HIV self-testing to the male partner, and additional interventions: a qualitative study of antenatal care participants in Malawi

In the era of ambitious HIV targets, novel HIV testing models are required for hard-to-reach groups such as men, who remain underserved by existing services. Pregnancy presents a unique opportunity for partners to test for HIV, as many pregnant women will attend antenatal care (ANC). We describe the views of pregnant women and their male partners on HIV self-test kits that are woman-delivered, alone or with an additional intervention. A formative qualitative study to inform the design of a multi-arm multi-stage cluster-randomized trial, comprised of six focus group discussions and 20 in-depth interviews, was conducted. ANC attendees were purposively sampled on the day of initial clinic visit, while men were recruited after obtaining their contact information from their female partners. Data were analysed using content analysis, and our interpretation is hypothetical as participants were not offered self-test kits. Providing HIV self-test kits to pregnant women to deliver to their male partners was highly acceptable to both women and men. Men preferred this approach compared with standard facility-based testing, as self-testing fits into their lifestyles which were characterized by extreme day-to-day economic pressures, including the need to raise money for food for their household daily. Men and women emphasized the need for careful communication before and after collection of the self-test kits in order to minimize the potential for intimate partner violence although physical violence was perceived as less likely to occur. Most men stated a preference to first self-test alone, followed by testing as a couple. Regarding interventions for optimizing linkage following self-testing, both men and women felt that a fixed financial incentive of approximately USD$2 would increase linkage. However, there were concerns that financial incentives of greater value may lead to multiple pregnancies and lack of child spacing. In this low-income setting, a lottery incentive was considered overly disappointing for those who receive nothing. Phone call reminders were preferred to short messaging service. Woman-delivered HIV self-testing through ANC was acceptable to pregnant women and their male partners. Feedback on additional linkage enablers will be used to alter pre-planned trial arms

A randomized controlled trial of home visits by neighborhood mentor mothers to improve children's nutrition in South Africa

Malnourished children and babies with birth weights under 2500 g are at high risk for negative outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve nutritional outcomes for young children in South Africa. One “mentor mother” was recruited from each of 37 neighborhoods in Cape Town, South Africa. Mentor mothers were trained to conduct home visits to weigh children under six years old and to support mothers to problem-solve life challenges, especially around nutrition. Households with underweight children were assigned randomly on a 2:1 ratio to the Philani program (n = 500) or to a standard care condition (n = 179); selection effects occurred and children in the intervention households weighed less at recruitment. Children were evaluated over a one-year period (n = 679 at recruitment and n = 638 with at least one follow-up; 94%). Longitudinal random effects models indicated that, over 12 months, the children in the intervention condition gained significantly more weight than children in the control condition. Mentor mothers who are positive peer deviants may be a viable strategy that is efficacious and can build community, and the use of mentor mothers for other problems in South Africa is discussed

Kitchen Area Air Quality Measurements in Northern Ghana: Evaluating the Performance of a Low-Cost Particulate Sensor within a Household Energy Study

Household air pollution from the combustion of solid fuels is a leading global health and human rights concern, affecting billions every day. Instrumentation to assess potential solutions to this problem faces challenges-especially related to cost. A low-cost ($159) particulate matter tool called the Household Air Pollution Exposure (HAPEx) Nano was evaluated in the field as part of the Prices, Peers, and Perceptions cookstove study in northern Ghana. Measurements of temperature, relative humidity, absolute humidity, and carbon dioxide and carbon monoxide concentrations made at 1-min temporal resolution were integrated with 1-min particulate matter less than 2.5 microns in diameter (PM2.5) measurements from the HAPEx, within 62 kitchens, across urban and rural households and four seasons totaling 71 48-h deployments. Gravimetric filter sampling was undertaken to ground-truth and evaluate the low-cost measurements. HAPEx baseline drift and relative humidity corrections were investigated and evaluated using signals from paired HAPEx, finding significant improvements. Resulting particle coefficients and integrated gravimetric PM2.5 concentrations were modeled to explore drivers of variability; urban/rural, season, kitchen characteristics, and dust (a major PM2.5 mass constituent) were significant predictors. The high correlation (R2 = 0.79) between 48-h mean HAPEx readings and gravimetric PM2.5 mass (including other covariates) indicates that the HAPEx can be a useful tool in household energy studies.</p

A glimpse into real-world kitchens: Improving our understanding of cookstove usage through in-field photo-observations and improved cooking event detection (CookED) analytics

The combustion of solid fuels in residential cookstoves is a global health and climate issue, and expanded use ofimproved cookstoves could have significant benefits locally and globally. Evaluating impacts of improved cookstove programs requires more accurately measuring stove use patterns. This work builds on and improves existing stove use monitoring methods. First, we introduce and describe a novel, in-field photo-observation sampling method designed to capture near-continuous, real-world, ground-truth stove usage information. These measurements are used to validate predictions made by electronic stove use monitors (SUMs). Second, we present Cooking Event Detector (CookED), a SUM algorithm that translates stove-temperature measurements into classifications of cooking or not-cooking. The predictive performance of the new algorithm is evaluated using results from the photo-observations and compared to existing algorithms. CookED demonstrates considerable improvement over some methods for all five types of improved and traditional stoves monitored in the study. Overall minute-level predictive accuracy of CookED ranges from 95.6% to 98.4%, depending on the stove type, while Matthews correlation coefficients range from 72.8% to 88.3%. Comparisons between predicted and observed average cooking event durations show high correlation (Pearson&rsquo;s r = 0.85). These methods can be applied in a wide variety of applications, including research studies linking behavior, technology, exposure, and human and environmental health, as well as operational programs that aim to scale up improved cookstove adoption and quantify benefits.</p