Utilization of Income Tax Credits by Low-Income Individuals

The Internal Revenue Service-a sub-agency that exists to collect revenue-has the task of administering and enforcing a wide array of social policy: from subsidies for college and child care expenses, to creating jobs in depressed areas, and assisting welfare recipients with employment. While these new or expanded credits represent a new paradigm in the delivery of social policy, little is known about who uses these programs and, equally important, who does not use these programs. Understanding utilization is a key to understanding how effective this means of transferring income is and whether we are reaching the targeted populations. This paper provides a framework for thinking about utilization of tax credits among low-income individuals, supported by existing research on credit utilization. With the existing data, it appears that utilization is by far the largest for the EITC, possibly because it is the oldest of these programs, the only refundable program, and the best targeted at low-income individuals. Utilization is low among low-income individuals in some tax credits because low-income individuals are not eligible. A redesign, including reducing complexity and administrative burdens or making these programs refundable, would result in the programs reaching those that they are ostensibly targeted towards. Conditional on being eligible, one common factor associated with increasing participation in many of these programs is a high benefit to cost ratio and sophistication with the tax system, whether that be through the use of a paid preparer, higher education levels, or experience with the tax system. Policymakers should think creatively about reducing filing burdens to increase participation, such as through wider use of electronic filing

How substance-based ontologies for gravity can be productive: A case study

Many science education researchers have argued that learners' commitment to a substance (matter-based) ontology impedes the learning of scientific concepts that scientists typically conceptualize as processes or interactions, such as such as force, electric current, and heat. By this account, students' tendency to classify these entities as substances or properties of substances leads to robust misconceptions, and instruction should steer novices away from substance-based reasoning. We argue that substance-based reasoning, when it supports learners' sense-making, can form the seeds for sophisticated understanding of these very same physics concepts. We present a case study of a group of elementary school science teachers in our professional development program. The teachers build a sophisticated explanation for why objects of different masses have the same acceleration due to gravity, starting from substance-based metaphors for gravity. We argue that, for conceptual, epistemological, and affective reasons, instructional interventions should focus on tapping these productive matter-based resources rather than attempting to replace them.Comment: Submitted to Physical Review Special Topics - Physics Education Researc

Time-Shifting vs. Appointment Viewing: The Role of Fear of Missing Out Within TV Consumption Behaviors

The current study employed a national sample in order to investigate the phenomenon of fear-of-missing-out (FoMO), the apprehension associated with the fear that other people are having a pleasurable experience that one is not a part of. The current study investigated the role that FoMO plays in TV viewing habits, particularly binge-watching and the consumption of one-time megaevents. Results indicated that FoMO predicts the pace at which people choose to watch TV, social media use as it relates to TV, and whether they are likely to watch some one-time TV programs—such as sporting events like the Super Bowl

Beyond deficit-based models of learners' cognition: Interpreting engineering students' difficulties with sense-making in terms of fine-grained epistemological and conceptual dynamics

Researchers have argued against deficit-based explanations of students' troubles with mathematical sense-making, pointing instead to factors such as epistemology: students' beliefs about knowledge and learning can hinder them from activating and integrating productive knowledge they have. In this case study of an engineering major solving problems (about content from his introductory physics course) during a clinical interview, we show that "Jim" has all the mathematical and conceptual knowledge he would need to solve a hydrostatic pressure problem that we posed to him. But he reaches and sticks with an incorrect answer that violates common sense. We argue that his lack of mathematical sense-making-specifically, translating and reconciling between mathematical and everyday/common-sense reasoning-stems in part from his epistemological views, i.e., his views about the nature of knowledge and learning. He regards mathematical equations as much more trustworthy than everyday reasoning, and he does not view mathematical equations as expressing meaning that tractably connects to common sense. For these reasons, he does not view reconciling between common sense and mathematical formalism as either necessary or plausible to accomplish. We, however, avoid a potential "deficit trap"-substituting an epistemological deficit for a concepts/skills deficit-by incorporating multiple, context-dependent epistemological stances into Jim's cognitive dynamics. We argue that Jim's epistemological stance contains productive seeds that instructors could build upon to support Jim's mathematical sense-making: He does see common-sense as connected to formalism (though not always tractably so) and in some circumstances this connection is both salient and valued.Comment: Submitted to the Journal of Engineering Educatio

Accelerating clinical development of a live attenuated vaccine against Salmonella Paratyphi A (VASP): study protocol for an observer-participant-blind randomised control trial of a novel oral vaccine using a human challenge model of Salmonella Paratyphi A infection in healthy adult volunteers

Introduction: This is the first efficacy study of an oral live attenuated vaccine against Salmonella Paratyphi A using a human challenge model of paratyphoid infection. S. Paratyphi A is responsible for 3.3 million cases of enteric fever every year, with over 19 000 deaths. Although improvements to sanitation and access to clean water are vital to reduce the burden of this condition, vaccination offers a cost-effective, medium-term solution. Efficacy trials of potential S. Paratyphi vaccine candidates in the field are unlikely to be feasible given the large number of participants required. Human challenge models therefore offer a unique, cost-effective solution to test efficacy of such vaccines. Methods and analysis: This is an observer-blind, randomised, placebo-controlled trial phase I/II of the oral live-attenuated vaccine against S. Paratyphi A, CVD 1902. Volunteers will be randomised 1:1 to receive two doses of CVD 1902 or placebo, 14 days apart. One month following second vaccination all volunteers will ingest S. Paratyphi A bacteria with a bicarbonate buffer solution. They will be reviewed daily in the following 14 days and diagnosed with paratyphoid infection if the predefined microbiological or clinical diagnostic criteria are met. All participants will be treated with antibiotics on diagnosis, or at day 14 postchallenge if not diagnosed. The vaccine efficacy will be determined by comparing the relative attack rate, that is, the proportion of those diagnosed with paratyphoid infection, in the vaccine and placebo groups. Ethics and dissemination: Ethical approval for this study has been obtained from the Berkshire Medical Research Ethics Committee (REC ref 21/SC/0330). The results will be disseminated via publication in a peer-reviewed journal and presentation at international conferences. Trial registration number: ISRCTN15485902

Paediatric meningitis in the conjugate vaccine era and a novel clinical decision model to predict bacterial aetiology

Objectives The aims of this study were to assess aetiology and clinical characteristics in childhood meningitis, and develop clinical decision rules to distinguish bacterial meningitis from other similar clinical syndromes. Methods Children aged <16 years hospitalised with suspected meningitis/encephalitis were included, and prospectively recruited at 31 UK hospitals. Meningitis was defined as identification of bacteria/viruses from cerebrospinal fluid (CSF) and/or a raised CSF white blood cell count. New clinical decision rules were developed to distinguish bacterial from viral meningitis and those of alternative aetiology. Results The cohort included 3002 children (median age 2·4 months); 1101/3002 (36·7%) had meningitis, including 180 bacterial, 423 viral and 280 with no pathogen identified. Enterovirus was the most common pathogen in those aged <6 months and 10–16 years, with Neisseria meningitidis and/or Streptococcus pneumoniae commonest at age 6 months to 9 years. The Bacterial Meningitis Score had a negative predictive value of 95·3%. We developed two clinical decision rules, that could be used either before (sensitivity 82%, specificity 71%) or after lumbar puncture (sensitivity 84%, specificity 93%), to determine risk of bacterial meningitis. Conclusions Bacterial meningitis comprised 6% of children with suspected meningitis/encephalitis. Our clinical decision rules provide potential novel approaches to assist with identifying children with bacterial meningitis. Funding This study was funded by the Meningitis Research Foundation, Pfizer and the NIHR Programme Grants for Applied Research

Effects of Clove Oil (Eugenol) on Proprioceptive Neurons, Heart Rate, and Behavior in Model Crustaceans

Clove oil contains eugenol as an active ingredient and is used as a topical anesthetic in mammals to remedy pain and to anesthetize fish and other seafood for short periods; however, the exact mechanism of action of eugenol is not fully understood. We examined use of eugenol as a reversible anesthetic in crustaceans by examining its effect on sensory and motor neurons in the Red Swamp crayfish (Procambarus clarkii), Blue crab (Callinectes sapidus) and Whiteleg shrimp (Litopenaeus vannamei) with electrophysiological recordings. The neurogenic heart rate in the three species was also monitored along with behaviors and responsiveness to sensory stimuli. The activity of the primary proprioceptive neurons was reduced at 200 ppm and ceased at 400 ppm for both crayfish (i.e., muscle receptor organ) and crab (i.e., leg PD organ) preparations when exposed to saline containing eugenol. Flushing out eugenol resulted in recovery in the majority of the preparations within five to ten minutes. Administering eugenol to crayfish and crabs both systemically and through environmental exposure resulted in the animals becoming lethargic. Direct injection into the hemolymph was quicker to decrease reflexes and sensory perception, but heart rate was still maintained. Eugenol at a circulating level of 400 ppm decreased electromyogram activity in the claw muscle of crabs. Surprisingly, this study found no change in heart rate despite administering eugenol into the hemolymph to reach 400 ppm in crabs or crayfish but heart rate in shrimp preparations decreased. Our results demonstrate the feasibility of eugenol as a short-term anesthetic for crustaceans to decrease stress during handling or transportation, considering its effectiveness at decreasing sensory input and the quick recovery of upon removal of eugenol. A neurophysiology course took this project on as an authentic course-based undergraduate research experience (ACURE)

Healthcare costs in women with metastatic breast cancer receiving chemotherapy as their principal treatment modality

<p>Abstract</p> <p>Background</p> <p>The economic costs of treating patients with metastatic breast cancer have been examined in several studies, but available estimates of economic burden are at least a decade old. In this study, we characterize healthcare utilization and costs in the US among women with metastatic breast cancer receiving chemotherapy as their principal treatment modality.</p> <p>Methods</p> <p>Using a large private health insurance claims database (2000-2006), we identified all women initiating chemotherapy for metastatic breast cancer with no evidence of receipt of concomitant or subsequent hormonal therapy, or receipt of trastuzumab at anytime. Healthcare utilization and costs (inpatient, outpatient, medication) were estimated on a cumulative basis from date of chemotherapy initiation ("index date") to date of disenrollment from the health plan or the end of the study period, whichever occurred first. Study measures were cumulated over time using the Kaplan-Meier Sample Average (KMSA) method; 95% CIs were generated using nonparametric bootstrapping. Findings also were examined among the subgroup of patients with uncensored data.</p> <p>Results</p> <p>The study population consisted of 1444 women; mean (SD) age was 59.1 (12.1) years. Over a mean follow-up of 532 days (range: 3 to 2412), study subjects averaged 1.7 hospital admissions, 10.7 inpatient days, and 83.6 physician office and hospital outpatient visits. Mean (95% CI) cumulative total healthcare costs were $128,556 ($118,409, $137,644) per patient. Outpatient services accounted for 29% of total costs, followed by medication other than chemotherapy (26%), chemotherapy (25%), and inpatient care (20%).</p> <p>Conclusions</p> <p>Healthcare costs-especially in the outpatient setting--are substantial among women with metastatic breast cancer for whom treatment options other than chemotherapy are limited.</p

Intracranial Efficacy and Survival With Tucatinib Plus Trastuzumab and Capecitabine for Previously Treated HER2-Positive Breast Cancer With Brain Metastases in the HER2CLIMB Trial

PURPOSE: In the HER2CLIMB study, patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer with brain metastases (BMs) showed statistically significant improvement in progression-free survival (PFS) with tucatinib. We describe exploratory analyses of intracranial efficacy and survival in participants with BMs. PATIENTS AND METHODS: Patients were randomly assigned 2:1 to tucatinib or placebo, in combination with trastuzumab and capecitabine. All patients underwent baseline brain magnetic resonance imaging; those with BMs were classified as active or stable. Efficacy analyses were performed by applying RECIST 1.1 criteria to CNS target lesions by investigator assessment. CNS-PFS (intracranial progression or death) and overall survival (OS) were evaluated in all patients with BMs. Confirmed intracranial objective response rate (ORR-IC) was evaluated in patients with measurable intracranial disease. RESULTS: There were 291 patients with BMs: 198 (48%) in the tucatinib arm and 93 (46%) in the control arm. The risk of intracranial progression or death was reduced by 68% in the tucatinib arm (hazard ratio [HR], 0.32; 95% CI, 0.22 to 0.48; CONCLUSION: In patients with HER2-positive breast cancer with BMs, the addition of tucatinib to trastuzumab and capecitabine doubled ORR-IC, reduced risk of intracranial progression or death by two thirds, and reduced risk of death by nearly half. To our knowledge, this is the first regimen to demonstrate improved antitumor activity against BMs in patients with HER2-positive breast cancer in a randomized, controlled trial