Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations

Outlines how policy makers can build on Medicaid to expand health coverage for low-income, high-need people by basing eligibility on income, boosting provider participation, increasing federal funding, and containing costs as a step toward broader reform

Herd-level bovine tuberculosis risk factors:assessing the role of low-level badger population disturbance

Bovine TB (bTB) is endemic in Irish cattle and has eluded eradication despite considerable expenditure, amid debate over the relative roles of badgers and cattle in disease transmission. Using a comprehensive dataset from Northern Ireland (>10,000 km2; 29,513 cattle herds), we investigated interactions between host populations in one of the first large-scale risk factor analyses for new herd breakdowns to combine data on both species. Cattle risk factors (movements, international imports, bTB history, neighbours with bTB) were more strongly associated with herd risk than area-level measures of badger social group density, habitat suitability or persecution (sett disturbance). Highest risks were in areas of high badger social group density and high rates of persecution, potentially representing both responsive persecution of badgers in high cattle risk areas and effects of persecution on cattle bTB risk through badger social group disruption. Average badger persecution was associated with reduced cattle bTB risk (compared with high persecution areas), so persecution may contribute towards sustaining bTB hotspots; findings with important implications for existing and planned disease control programmes

A new phylodynamic model of Mycobacterium bovis transmission in a multi-host system uncovers the role of the unobserved reservoir

Multi-host pathogens are particularly difficult to control, especially when at least one of the hosts acts as a hidden reservoir. Deep sequencing of densely sampled pathogens has the potential to transform this understanding, but requires analytical approaches that jointly consider epidemiological and genetic data to best address this problem. While there has been considerable success in analyses of single species systems, the hidden reservoir problem is relatively under-studied. A well-known exemplar of this problem is bovine Tuberculosis, a disease found in British and Irish cattle caused by Mycobacterium bovis, where the Eurasian badger has long been believed to act as a reservoir but remains of poorly quantified importance except in very specific locations. As a result, the effort that should be directed at controlling disease in badgers is unclear. Here, we analyse densely collected epidemiological and genetic data from a cattle population but do not explicitly consider any data from badgers. We use a simulation modelling approach to show that, in our system, a model that exploits available cattle demographic and herd-to-herd movement data, but only considers the ability of a hidden reservoir to generate pathogen diversity, can be used to choose between different epidemiological scenarios. In our analysis, a model where the reservoir does not generate any diversity but contributes to new infections at a local farm scale are significantly preferred over models which generate diversity and/or spread disease at broader spatial scales. While we cannot directly attribute the role of the reservoir to badgers based on this analysis alone, the result supports the hypothesis that under current cattle control regimes, infected cattle alone cannot sustain M. bovis circulation. Given the observed close phylogenetic relationship for the bacteria taken from cattle and badgers sampled near to each other, the most parsimonious hypothesis is that the reservoir is the infected badger population. More broadly, our approach demonstrates that carefully constructed bespoke models can exploit the combination of genetic and epidemiological data to overcome issues of extreme data bias, and uncover important general characteristics of transmission in multi-host pathogen systems

Pan Africa Bean Research Alliance Model

The Pan Africa Bean Research Alliance is a consortium of African-owned regional bean networks consisting of National Agricultural Research Systems (NARS) from 28 countries in sub- Saharan Africa, the International Center for Tropical Agriculture (CIAT) and a number of donor organizations. PABRA’s focus is to improve bean productivity, utilization and commercialization for the benefit of the urban and rural poor. The ultimate goal is to enhance food security, income generation and health of poor communities in a gender equitable manner. The regional bean networks are Eastern and Central Africa Bean Research Network (ECABREN) covering 9 countries, Southern Africa Bean Research Network (SABRN), covering 11 countries and the West and Central Africa Bean Research Network (WECABREN), covering 10 countries. ECABREN, SABRN and WECABREN are semi-autonomous and respond to priorities defined by corresponding sub-regional organizations, which are ASARECA, SADC/FANR and CORAF/WECARD, respectively. All networks implement the same log-frame under PABRA. Activities in the PABRA workplan are developed using a bottom-up approach, and build on the outcome of national program planning followed by planning at the regional network level. PABRA facilitates collaborative research within, among and beyond the regional networks. It also provides a forum for building and maintaining linkages to multiple partners. These collaborative linkages are maintained and strengthened through joint priority-setting, planning, agreed division of responsibilities, joint implementation of activities, and joint reporting. Collaboration is based on national members’ interest and on comparative advantage. In this way, research technologies are shared among countries and significantly contribute to scaling up and wider distribution efforts. Through this partnership, PABRA facilitated seed access to 7.5 million farmers between 2003-2008 and about 7 million between 2009-2011

A Report on the Status of Standards for Tenure and Promotion in Debate

In what follows, we first provide an overview of debate in order to explain the importance of the activity and then review the status of tenure and evaluation standards among directors/coaches in various types of programs across the country. A mass email was used to ask directors/coaches to submit information about the nature of their current appointment (tenure track, term appointment, and so forth) and the standards through which their performance is evaluated. In addition to seeking information about appointment and evaluation standards for current coaches, we reviewed material from previous developmental conferences and the Quail Roost document, as well as information about how faculty in theater and academic professionals in positions similar to that of a debate director/ coach are evaluated. Following the review of current appointment and evaluation practices, we develop a case for the proposed two tracks for evaluating the performance of debate coaches. We conclude with draft standards

Dynamics of Western Juniper Woodland Expansion into Sagebrush Communities in Central Oregon

Western juniper (Juniperus occidentalis) woodlands in Oregon have expanded four-fold from 600,000 ha in 1930 to \u3e 2.6 million ha, often resulting in the reduction and fragmentation of sagebrush (Artemisia spp.) communities. We documented dynamics of western juniper across the John Day Ecological Province in central Oregon by recording size class and growth form at 178 sites. We used stratified random sampling, with strata based on vegetation association (sagebrush, juniper, other) and distance from juniper stands. Only 26 percent of sites contained pre-settlement trees (in other words, \u3e 140 years old), and \u3c 5 percent of the 2,254 junipers tallied were pre-settlement trees. Mean densities of pre-settlement trees by stratum ranged from 0 to 18 trees/ha, suggesting that historically, juniper was widely scattered across the landscape. Current densities of post-settlement trees ranged from 75 to 211 trees/ha in non-woodland strata to 457 trees/ha in the juniper stratum. Juniper in non-woodland strata was most abundant in sites adjacent to juniper stands and in sagebrush communities. Mean densities of post-settlement trees were greatest in the \u3e 2.0-m tall size class (82 trees/ha), followed by the 0.3 to 1-m tall size class (52 trees/ha). These densities pose substantial risk to sagebrush communities in central Oregon. Questions remain about the extent of western juniper woodlands across the species’ range that have replaced or are expanding into sagebrush communities versus sites that historically supported woodlands. However, our findings suggest that within sagebrush communities of the John Day province, intensive management through removal of western juniper may be prudent, while retaining pre-settlement trees

Anthropometric indices of Gambian children after one or three annual rounds of mass drug administration with azithromycin for trachoma control.

BACKGROUND: Mass drug administration (MDA) with azithromycin, carried out for the control of blinding trachoma, has been linked to reduced mortality in children. While the mechanism behind this reduction is unclear, it may be due, in part, to improved nutritional status via a potential reduction in the community burden of infectious disease. To determine whether MDA with azithromycin improves anthropometric indices at the community level, we measured the heights and weights of children aged 1 to 4 years in communities where one (single MDA arm) or three annual rounds (annual MDA arm) of azithromycin had been distributed. METHODS: Data collection took place three years after treatment in the single MDA arm and one year after the final round of treatment in the annual MDA arm. Mean height-for-age, weight-for-age and weight-for-height z scores were compared between treatment arms. RESULTS: No significant differences in mean height-for-age, weight-for-age or weight-for-height z scores were found between the annual MDA and single MDA arms, nor was there a significant reduction in prevalence of stunting, wasting or underweight between arms. CONCLUSIONS: Our data do not provide evidence that community MDA with azithromycin improved anthropometric outcomes of children in The Gambia. This may suggest reductions in mortality associated with azithromycin MDA are due to a mechanism other than improved nutritional status