Deconstructing the PCAOB: Using organizational economics to assess the state of a regulator

Using the principles of organizational economics in this study we assess the quality of the organizational architecture of the Public Companies Accounting Oversight Board (PCAOB). In particular, we use the Four Pillar Framework developed in Brickley et al. (2000) to understand why—according to the SEC’s Chairman Gensler and other stakeholders—the PCAOB may not have entirely realized its mission of investor protection. Our analysis is enabled by the transcripts of the 2019 criminal trial U.S. vs. Middendorf and Wada (i.e., PCAOB-KPMG “steal the inspection data” scandal), which for the first time exposed the inner workings of the PCAOB. Our analysis of the transcripts is augmented by other publicly available documents. Our primary conclusion is that the functioning of the PCAOB has been significantly hampered by misalignment of its tasks (in particular in relation to the SEC), sub-optimally designed performance measurement and employee compensation, and weaknesses in the PCAOB’s organizational culture. These misalignments created an environment susceptible to PCAOB employee criminal misconduct which enabled the PCAOB-KPMG “steal the inspection data” scandal and other Board governance and leadership challenges

Risk factors associated with the severity of pneumonia in a cohort of hospitalized children in a rural setting

Objectives: Pneumonia remains a leading cause of death in South African children under 5 years of age. Known risk factors for pneumonia have been the focus of public health strategies to mitigate disease. This study aimed to determine whether adverse household environmental factors were associated with severe compared to non-severe pneumonia in children admitted to Worcester Provincial Hospital (WPH), South Africa. Materials and Methods: We conducted a case–control study at WPH from January 1st to December 31st, 2019, including children aged 0–59 months admitted with pneumonia. Using the WHO definition, children were categorized as having severe or non-severe pneumonia. Structured interviews with consenting primary caregivers were conducted in both groups on weekdays throughout the year to collect demographic, social, maternal, infant, and household factors. We compared the odds of adverse household environmental factors including tobacco smoke exposure, indoor smoke exposure, and overcrowding in children with severe compared to non-severe pneumonia. Results: A total of 305 children were included, 134 (43.9%) cases with severe pneumonia and 171 (56.1%) controls with non-severe pneumonia. Baseline characteristics of children, including age (median 6.9 months; IQR 2.5–17.5), appropriate nutritional status (81.6%; n = 249), and HIV unexposed and uninfected status (81.3%; n = 248), were similar between groups. Caregiver characteristics, including age (median 28 years; IQR 23–33), secondary schooling (71.2%, n = 217), and HIV negative status (81%, n = 247), were also comparable between groups. There was no association in univariable or multivariable analysis between severe pneumonia and adverse household environmental factors including tobacco smoke exposure (aOR 0.73; 95% CI 0.44–1.21), overcrowding (aOR 0.65, 95% CI 0.39–1.08), and indoor smoke exposure (aOR 2.85; 95% CI 0.89–9.09). However, children with severe pneumonia had at least 5 times greater odds (aOR 5.42; 95% CI 1.10–26.65) of living in a household with a pit latrine toilet compared to any other toilet than children with non-severe pneumonia. Conclusion: Few factors were found to be associated with pneumonia severity, except for living in a household with a pit latrine toilet. This may represent socioeconomic vulnerability and the risk associated with developing severe pneumonia

Mississippi State Axion Search: A Light Shining though a Wall ALP Search

The elegant solutions to the strong CP problem predict the existence of a particle called axion. Thus, the search for axion like particles (ALP) has been an ongoing endeavor. The possibility that these axion like particles couple to photons in presence of magnetic field gives rise to a technique of detecting these particles known as light shining through a wall (LSW). Mississippi State Axion Search (MASS) is an experiment employing the LSW technique in search for axion like particles. The apparatus consists of two radio frequency (RF) cavities, both under the influence of strong magnetic field and separated by a lead wall. While one of the cavities houses a strong RF generator, the other cavity houses the detector systems. The MASS apparatus looks for excesses in RF photons that tunnel through the wall as a signature of candidate axion-like particles. The concept behind the experiment as well as the projected sensitivities are presented here.Comment: Xth Patras Workshop on Axions, WIMPs and WISPs; 4 Pages, 5 figure

Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan

Background Improving access to parasitological diagnosis of malaria is a central strategy for control and elimination of the disease. Malaria rapid diagnostic tests (RDTs) are relatively easy to perform and could be used in primary level clinics to increase coverage of diagnostics and improve treatment of malaria.<p></p> Methods A cost-effectiveness analysis was undertaken of RDT-based diagnosis in public health sector facilities in Afghanistan comparing the societal and health sector costs of RDTs versus microscopy and RDTs versus clinical diagnosis in low and moderate transmission areas. The effect measure was ‘appropriate treatment for malaria’ defined using a reference diagnosis. Effects were obtained from a recent trial of RDTs in 22 public health centres with cost data collected directly from health centres and from patients enrolled in the trial. Decision models were used to compare the cost of RDT diagnosis versus the current diagnostic method in use at the clinic per appropriately treated case (incremental cost-effectiveness ratio, ICER).<p></p> Results RDT diagnosis of Plasmodium vivax and Plasmodium falciparum malaria in patients with uncomplicated febrile illness had higher effectiveness and lower cost compared to microscopy and was cost-effective across the moderate and low transmission settings. RDTs remained cost-effective when microscopy was used for other clinical purposes. In the low transmission setting, RDTs were much more effective than clinical diagnosis (65.2% (212/325) vs 12.5% (40/321)) but at an additional cost (ICER) of US$4.5 per appropriately treated patient including a health sector cost (ICER) of US$2.5 and household cost of US$2.0. Sensitivity analysis, which varied drug costs, indicated that RDTs would remain cost-effective if artemisinin combination therapy was used for treating both P. vivax and P. falciparum. Cost-effectiveness of microscopy relative to RDT is further reduced if the former is used exclusively for malaria diagnosis. In the health service setting of Afghanistan, RDTs are a cost-effective intervention compared to microscopy.<p></p> Conclusions RDTs remain cost-effective across a range of drug costs and if microscopy is used for a range of diagnostic services. RDTs have significant advantages over clinical diagnosis with minor increases in the cost of service provision.<p></p&gt

Malaria "diagnosis" and diagnostics in Afghanistan.

In many malaria-endemic areas, including Afghanistan, overdiagnosis of malaria is common. Even when using parasite-based diagnostic tests prior to treatment, clinicians commonly prescribe antimalarial treatment following negative test results. This practice neglects alternative causes of fever, uses drugs unnecessarily, and might contribute to antimalarial drug resistance. We undertook a qualitative study among health workers using different malaria diagnostic methods in Afghanistan to explore perceptions of malaria diagnosis. Health workers valued diagnostic tests for their ability to confirm clinical suspicions of malaria via a positive result, but a negative result was commonly interpreted as an absence of diagnosis, legitimizing clinical diagnosis of malaria and prescription of antimalarial drugs. Prescribing decisions reflected uncertainty around tests and diagnosis, and were influenced by social- and health-system factors. Study findings emphasize the need for nuanced and context-specific guidance to change prescriber behavior and improve treatment of malarial and nonmalarial febrile illnesses

Characteristics and sexual health service use of MSM engaging in chemsex: results from a large online survey in England.

BACKGROUND: Chemsex, the use of select psychoactive drugs to enhance sexual experience, typically among men who have sex with men (MSM), is associated with sexual behaviours with higher STI risk. Understanding patterns of chemsex among MSM as well as the characteristics and sexual health service engagement of chemsex participants is important for developing interventions. METHODS: Between 5/2016 to 5/2017, 3933 MSM completed an online survey, recruited in sexual health clinics (SHCs) in England (n=421) and via four social networking/dating apps (n=3512). We described patterns of chemsex in the past year and used multivariable logistic regression to investigate differences in demographics and sexual behaviours by chemsex history. We described history of SHC attendance and STI test in the past year among app-recruited chemsex participants. RESULTS: Chemsex in the past year was reported by 10% of respondents; 19% of SHC-recruited and 9% of app-recruited. Among chemsex participants, 74% had used ≥2 chemsex drugs. In the multivariable model, MSM engaging in chemsex had a raised odds of being HIV-positive (adjusted OR (aOR): 3.6; 95% CI 2.1 to 6.1), aged 30-44 (aOR 1.5 vs <30 years; 95% CI 1.0 to 2.1), being born outside the UK and having engaged in higher risk sexual behaviours in the past 3 months. Chemsex participants also had higher odds of condomless anal sex with partners of different or unknown HIV status, but only among HIV-negative/untested. In the past year, 66% of app-recruited chemsex participants had attended a SHC and 81% had had an STI test. CONCLUSION: One in 10 MSM recruited through community and clinical settings across England had engaged in chemsex in the past year. Those that did appear to be at greater STI risk but engaged more actively with sexual health services. This highlights the need and opportunity for chemsex-related services in SHCs and robust referral pathways to drug treatment services

Core Competencies for Integrative Medicine Fellowship Training Programs

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140347/1/acm.2014.5258.abstract.pd