Urbanicity, Income, and Academic and Behavioral Functioning Across Childhood: Longitudinal Associations and Mediating Mechanisms

Economic disparities in academic and behavioral functioning are well documented in the U.S. Compared to more advantaged peers, low-income children begin kindergarten with fewer of the competencies that undergird school success. These disparities persist or grow as children age and ultimately relate to low educational attainment, worse psychological functioning, and intergenerational transmission of poverty in adulthood. In addressing income gaps in development, we must consider the changing geography of poverty. The last several decades have seen increases in the number of low-income families residing in suburbs and small towns, while poverty rates in urban centers and rural communities have remained high. Currently, low- income children are dispersed across communities spanning the urban-rural continuum. Urban, suburban, and rural areas represent unique contexts for development, which may alter relations between income and academic and behavioral functioning. In a series of studies using nationally representative data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998- 1999 (N≈16,000) and data from the Early Steps Multisite Study of 731 low-income families with children, this dissertation explores (1) whether links between family income and achievement and behavior problems at kindergarten entry differ by urbanicity; (2) whether links between income and growth/decline in achievement and behavior problems across elementary school differ by urbanicity; and (3) the processes that explain why economic disadvantage is differentially related to development across urbanicity. Results show that income gaps in kindergarten achievement are attenuated in rural areas and exacerbated in urban cities. Conversely, economic disparities in externalizing problems at kindergarten are largest in rural areas and small cities and relatively small in large urban cities and suburbs. Looking from kindergarten through fifth grade, income is more strongly linked to achievement growth and is more predictive of decreased risk of elevated behavior problems in rural areas and small cities compared to large cities and suburbs. Finally, within a sample of disadvantaged 5-year-olds, findings suggest that low-income rural children have better academic skills and fewer behavior problems than peers in urban areas, and this is partially explained by comparatively lower levels of pollution and neighborhood danger experienced by low-income rural children and families

Effects of community-level bed net coverage on malaria morbidity in Lilongwe, Malawi

Background The protective effect of insecticide-treated bed nets against individual-level malaria transmission is well known, however community-level effects are less understood. Protective effects from community-level bed net use against malaria transmission have been observed in clinical trials, however, the relationship is less clear outside of a controlled research setting. The objective of this research was to investigate the effect of community-level bed net use against malaria transmission outside of a bed net clinical trial setting in Lilongwe, Malawi following national efforts to scale-up ownership of long-lasting, insecticide-treated bed nets. Methods An annual, cross-sectional, household-randomized, malaria transmission intensity survey was conducted in Lilongwe, Malawi (2011–2013). Health, demographic, and geographic-location data were collected. Participant blood samples were tested for Plasmodium falciparum presence. The percentage of people sleeping under a bed net within 400-m and 1-km radii of all participants was measured. Mixed effects logistic regression models were used to measure the relationship between malaria prevalence and surrounding bed net coverage. Each year, 800 people were enrolled (400 <5 years; 200 5–19 years; 200 ≥20 years; total n = 2400). Results From 2011 to 2013, malaria prevalence declined from 12.9 to 5.6%, while bed net use increased from 53.8 to 78.6%. For every 1% increase in community bed net coverage, malaria prevalence decreased among children under 5 years old [adjusted odds ratio: 0.98 (0.96, 1.00)]. Similar effects were observed in participants 5–19 years [unadjusted odds ratio: 0.98 (0.97, 1.00)]; the effect was attenuated after adjusting for individual-level bed net use. Community coverage was not associated with malaria prevalence among adults ≥20 years. Supplemental analyses identified more pronounced indirect protective effects from community-level bed net use against malaria transmission among children under 5 years who were sleeping under a bed net [adjusted odds ratio: 0.97 (0.94, 0.99)], compared to children who were not sleeping under a bed net [adjusted odds ratio: 0.99 (0.97, 1.01)]. Conclusions Malawi’s efforts to scale up ownership of long-lasting, insecticide-treated bed nets are effective in increasing reported use. Increased community-level bed net coverage appears to provide additional protection against malaria transmission beyond individual use in a real-world context

Predictors for mortality and loss to follow-up among children receiving anti-retroviral therapy in Lilongwe, Malawi

To determine predictors of mortality in children on anti-retroviral therapy (ART) who attended the Paediatric HIV Clinic at Kamuzu Central Hospital in Lilongwe, Malawi

Effects of community-level bed net coverage on malaria morbidity in Lilongwe, Malawi

Abstract Background The protective effect of insecticide-treated bed nets against individual-level malaria transmission is well known, however community-level effects are less understood. Protective effects from community-level bed net use against malaria transmission have been observed in clinical trials, however, the relationship is less clear outside of a controlled research setting. The objective of this research was to investigate the effect of community-level bed net use against malaria transmission outside of a bed net clinical trial setting in Lilongwe, Malawi following national efforts to scale-up ownership of long-lasting, insecticide-treated bed nets. Methods An annual, cross-sectional, household-randomized, malaria transmission intensity survey was conducted in Lilongwe, Malawi (2011–2013). Health, demographic, and geographic-location data were collected. Participant blood samples were tested for Plasmodium falciparum presence. The percentage of people sleeping under a bed net within 400-m and 1-km radii of all participants was measured. Mixed effects logistic regression models were used to measure the relationship between malaria prevalence and surrounding bed net coverage. Each year, 800 people were enrolled (400 <5 years; 200 5–19 years; 200 ≥20 years; total n = 2400). Results From 2011 to 2013, malaria prevalence declined from 12.9 to 5.6%, while bed net use increased from 53.8 to 78.6%. For every 1% increase in community bed net coverage, malaria prevalence decreased among children under 5 years old [adjusted odds ratio: 0.98 (0.96, 1.00)]. Similar effects were observed in participants 5–19 years [unadjusted odds ratio: 0.98 (0.97, 1.00)]; the effect was attenuated after adjusting for individual-level bed net use. Community coverage was not associated with malaria prevalence among adults ≥20 years. Supplemental analyses identified more pronounced indirect protective effects from community-level bed net use against malaria transmission among children under 5 years who were sleeping under a bed net [adjusted odds ratio: 0.97 (0.94, 0.99)], compared to children who were not sleeping under a bed net [adjusted odds ratio: 0.99 (0.97, 1.01)]. Conclusions Malawi’s efforts to scale up ownership of long-lasting, insecticide-treated bed nets are effective in increasing reported use. Increased community-level bed net coverage appears to provide additional protection against malaria transmission beyond individual use in a real-world context

Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Estimate association between postpartum antiretroviral adherence and breastmilk HIV-1 transmissio

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Poverty and Academic Achievement Across the Urban to Rural Landscape: Associations with Community Resources and Stressors

Poor children begin school with fewer academic skills than their nonpoor peers, and these disparities translate into lower achievement, educational attainment, and economic stability in adulthood. Child poverty research traditionally focuses on urban or rural poor, but a shifting spatial orientation of poverty necessitates a richer examination of how urbanicity intersects with economic disadvantage. Combining geospatial administrative data with longitudinal survey data on poor children from kindergarten through second grade (N ≈ 2,950), this project explored how differences in community-level resources and stressors across urbanicity explain variation in achievement. Resources and stressors increased in more urbanized communities and were associated with academic achievement. Both mediated differences in poor children’s achievement. Mediation was both direct and indirect, operating through cognitive stimulation and parental warmth

Leadership brand: deliver on your promise

Everyone has a reputation. Whether good or bad, your reputation precedes you, and can inhibit or enhance your professional goals. However, how do you actively nurture, develop, and manage how others see you? In this book, we'll discuss how crafting a brand can give you control of how you're perceived at work. From proven strategies from CCL experts, to practical advice you can implement immediately, Leadership Brand: Deliver on Your Promise can help you figure out the leader you want to be, and how to build the brand that can get you there