Prevalence, Awareness, Treatment, and Control of Hypertension in United States Counties, 2001–2009

Hypertension is an important and modifiable risk factor for cardiovascular disease and mortality. Over the last decade, national-levels of controlled hypertension have increased, but little information on hypertension prevalence and trends in hypertension treatment and control exists at the county-level. We estimate trends in prevalence, awareness, treatment, and control of hypertension in US counties using data from the National Health and Nutrition Examination Survey (NHANES) in five two-year waves from 1999–2008 including 26,349 adults aged 30 years and older and from the Behavioral Risk Factor Surveillance System (BRFSS) from 1997–2009 including 1,283,722 adults aged 30 years and older. Hypertension was defined as systolic blood pressure (BP) of at least 140 mm Hg, self-reported use of antihypertensive treatment, or both. Hypertension control was defined as systolic BP less than 140 mm Hg. The median prevalence of total hypertension in 2009 was estimated at 37.6% (range: 26.5 to 54.4%) in men and 40.1% (range: 28.5 to 57.9%) in women. Within-state differences in the county prevalence of uncontrolled hypertension were as high as 7.8 percentage points in 2009. Awareness, treatment, and control was highest in the southeastern US, and increased between 2001 and 2009 on average. The median county-level control in men was 57.7% (range: 43.4 to 65.9%) and in women was 57.1% (range: 43.0 to 65.46%) in 2009, with highest rates in white men and black women. While control of hypertension is on the rise, prevalence of total hypertension continues to increase in the US. Concurrent increases in treatment and control of hypertension are promising, but efforts to decrease the prevalence of hypertension are needed

Campaign Spending with Impressionable Voters

We consider a model of two-candidate elections with a one-dimensional policy space. Spending on campaign advertisements can directly influence voters' preferences, and contributors give the money for campaign spending in exchange for promised services if the candidate wins. we find that the winner of the election depends crucially on the contributors' beliefs about who is likely to win, and the contribution market tends towards nonsymmetric equilibria in which one of the two candidates has no chance of winning. If the voters are only weakly influenced by advertising or if permissible campaign spending is small, then the candidates choose policies close to the median voter's ideal point, but the contributors still determine the winner. Uncertainty about the Condorcet-winning point (or its nonexistence) can change these results and generate equilibria in which both candidates have substantial probabilities of winning.

Systematic MicroRNA Analysis Identifies ATP6V0C as an Essential Host Factor for Human Cytomegalovirus Replication

Recent advances in microRNA target identification have greatly increased the number of putative targets of viral microRNAs. However, it is still unclear whether all targets identified are biologically relevant. Here, we use a combined approach of RISC immunoprecipitation and focused siRNA screening to identify targets of HCMV encoded human cytomegalovirus that play an important role in the biology of the virus. Using both a laboratory and clinical strain of human cytomegalovirus, we identify over 200 putative targets of human cytomegalovirus microRNAs following infection of fibroblast cells. By comparing RISC-IP profiles of miRNA knockout viruses, we have resolved specific interactions between human cytomegalovirus miRNAs and the top candidate target transcripts and validated regulation by western blot analysis and luciferase assay. Crucially we demonstrate that miRNA target genes play important roles in the biology of human cytomegalovirus as siRNA knockdown results in marked effects on virus replication. The most striking phenotype followed knockdown of the top target ATP6V0C, which is required for endosomal acidification. siRNA knockdown of ATP6V0C resulted in almost complete loss of infectious virus production, suggesting that an HCMV microRNA targets a crucial cellular factor required for virus replication. This study greatly increases the number of identified targets of human cytomegalovirus microRNAs and demonstrates the effective use of combined miRNA target identification and focused siRNA screening for identifying novel host virus interactions

What Design Research Does ... : 62 Cards Highlighting the Power and Impact of UK-based Design Research in Addressing a Range of Complex Social, Economic, Cultural and Environmental Issues

Design research makes a significant contribution to the UK economy and society as a whole. Ever since the establishment of the Government Schools of Design in the nineteenth century, the UK has been widely acknowledged as an international leader in design research. Following this lead, the What Design Research Does… cards highlight the wide range of social, economic, cultural and environmental impacts that design research, funded and based in the UK, makes all over the world. The 62 cards illustrate unambiguously the positive changes that contemporary UK-based design researchers are making in many complex issues. Each What Design Research Does… card lists the challenges and issues faced by the design researchers, who they collaborated with, the research methods and approaches taken, the outcomes of the design research, what the main results and findings have been, and what impact the design research has had. In short, the What Design Research Does… cards clearly articulate the breadth of social, economic, cultural and environmental impacts that UK-based design researchers are achieving today

Essays on Behavioral Responses to Health Policy

The three essays of my dissertation examine how behavioral responses to health policy can shape, and sometimes undermine, the intended impact of policies. The first essay, "Chasing the Missing Patients: Exploring the Unintended Consequences of Free Health Screenings," examines two possible unintended consequences of removing cost sharing for health screening for people at high risk for chronic conditions, as is done in the Affordable Care Act. First, free screenings could attract patients with lower uptake of medical treatment, reducing the impact of the policy on treatment and changing the composition of diagnosed patients. Second, expanding screening could increase adverse selection and reduce the stability of health insurance markets. Using data from three biomarker studies reflecting different populations affected by the Affordable Care Act, we find evidence for the former prediction but not the latter. This essay is joint work with Lisandro Colantonio, Monika Safford, and David Meltzer. The second essay, "Does Identification of Previously Undiagnosed Conditions Change Patient Care Seeking Behavior?", shows that screening leads to doctor visits for previously undiagnosed conditions for many but not all patients, with marginally lower effects among patients lacking a usual healthcare provider. To identify the effects of screening, we exploit the REasons for Geographic And Racial Differences in Stroke (REGARDS) epidemiological study as a natural experiment. This essay is joint work with Lisandro Colantonio, Monika Safford, and Elbert Huang. The third essay, "Policy Analysis with Endogenous Migration Decisions: The Case of Left-Behind Migrant Children in China," models parental decisions as responses to local policy to show that migration effects could undermine the benefits of place-specific government services for children. Addressing a puzzle in the empirical literature on children who are left-behind by migrant parents, I use a theoretical model to sign the effect of being left-behind on child well-being for a policy-relevant subset of children: children who become left-behind as a result of a policy change. For these children, becoming left-behind reduces their well-being. To show that these theoretically derived effects could be empirically important, I use panel data on Chinese families before and after a health policy change

Decisiveness of contributors’ perceptions in elections

Abstract. We consider a model of two-candidate elections with a one-dimensional policy space. Spending on campaign advertisements can directly influence voters ' preferences, and contributors give the money for campaign spending in exchange for promised services if the candidate wins. We find that the winner of the election depends crucially on the contributors' beliefs about who is likely to win, and the contribution market tends towards nonsymmetric equilibria in which one of the two candidates has no chance of winning. If the voters are only weakly influenced by advertising or if permissible campaign spending is small, then the candidates choose policies close to the median voter's ideal point, but the contributors still determine the winner. Uncertainty about the Condorcet-winning point (or its nonexistence) can change these results and generate equilibria in which both candidates have substantial probabilities of winning. Acknowledgements. The authors are indebted to Charles Cameron and the participants o