Can a market-assisted land redistribution program improve the lives of the poor ? evidence from Malawi

This paper uses a rural household survey dataset collected in 2006 and 2008 to investigate the impact of a market-based land resettlement project in southern Malawi. The program provided a conditional cash and land transfer to poor families to relocate to larger plots of farm land. The average treatment effect of the program is estimated using a difference-in-difference matching technique based on propensity score matching; qualitative information complement the analysis to ensure unobservable characteristics do not bias the findings. As expected, the results show a significant effect on landholdings and agricultural production, with land size increasing and maize production increasing by more than 100 kilograms relative to the control. However, the impacts on food security and asset holdings were mixed. Households that relocated great distances had systematically lower impacts than those households that stayed within their district of origin because they had to adapt to unfamiliar agro-ecological, cultural, and market environments. Impacts also varied across gender of the household head; female-headed beneficiary households increased their productive and consumption assets significantly, while male-headed households increased their asset holdings less so.Environmental Economics&Policies,Rural Development Knowledge&Information Systems,Economic Theory&Research,Debt Markets,Rural Poverty Reduction

A Flicker Change Detection Task Reveals Object-in-Scene Memory Across Species

Tests of recognition memory in macaques typically assay memory for objects or isolated images, over time spans of seconds to hours from stimulus presentation, and/or require extensive training. Here, we propose a new application of the flicker change detection task that could measure object-in-scene memory days after single-trial exposures. In three experiments, participants searched for a changing object – or “target” – embedded within a scene as their eye movements were tracked. For new targets-in-scenes, the change is difficult to detect and requires extensive search. Once the target is found, however, the change becomes obvious. We reasoned that the decreased times required to find a target in a repeated scene would indicate memory for the target. In humans, targets were found faster when the targets-and-scenes were explicitly remembered than when they were forgotten, or had never been seen before. This led to faster repeated-trial compared to novel-trial search times. Based solely on repeated-trial search times, we were able to select distributions comprised of predominantly remembered or predominantly forgotten trials. Macaques exhibited the same repetition effects as humans, suggesting that remembered trials could be dissociated from novel or forgotten trials using the same procedures we established in humans. Finally, an anterograde amnesic patient with damage that included the medial temporal lobe (MTL) showed no search time differences, suggesting that memory revealed through search times on this task requires MTL integrity. Together, these findings indicate that the time required to locate a changing object reveals object-in-scene memory over long retention intervals in humans and macaques

Weekly paclitaxel, gemcitabine, and external irradiation followed by randomized farnesyl transferase inhibitor R115777 for locally advanced pancreatic cancer.

PURPOSE: The Radiation Therapy Oncology Group (RTOG) multi-institutional Phase II study 98-12, evaluating paclitaxel and concurrent radiation (RT) for locally advanced pancreatic cancer, demonstrated a median survival of 11.3 months and a 1-year survival of 43%. The purpose of the randomized Phase II study by RTOG 0020 was to evaluate the addition of weekly low- dose gemcitabine with concurrent paclitaxel/RT and to evaluate the efficacy and safety of the farnesyl transferase inhibitor R115777 following chemoradiation. PATIENTS AND METHODS: Patients with unresectable, nonmetastatic adenocarcinoma of the pancreas were eligible. Patients in Arm 1 received gemcitabine, 75 mg/m(2)/week, and paclitaxel, 40 mg/m(2)/week, for 6 weeks, with 50.4 Gy radiation (CXRT). Patients in Arm 2 received an identical chemoradiation regimen but then received maintenance R115777, 300 mg twice a day for 21 days every 28 days (CXRT+R115777), until disease progression or unacceptable toxicity. RESULTS: One hundred ninety-five patients were entered into this study, and 184 were analyzable. Grade 4 nonhematologic toxicities occurred in less than 5% of CXRT patients. The most common grade 3/4 toxicity from R115777 was myelosuppression; however, grade 3/4 hepatic, metabolic, musculoskeletal, and neurologic toxicities were also reported. The median survival time was 11.5 months and 8.9 months for the CXRT and CXRT+R115777 arms, respectively. CONCLUSIONS: The CXRT arm achieved a median survival of almost 1-year, supporting chemoradiation as an important therapeutic modality for locally advanced pancreatic cancer. Maintenance R115777 is not effective and is associated with a broad range of toxicities. These findings provide clinical evidence that inhibition of farnesylation affects many metabolic pathways, underscoring the challenge of developing an effective K-ras inhibitor

The HIV Care Continuum among Female Sex Workers: A Key Population in Lilongwe, Malawi

ObjectiveThe HIV care continuum among female sex workers (FSW), a key population, has not been well characterized, especially within the generalized epidemics of sub-Saharan Africa. This was the first study to characterize the HIV care continuum among FSW in Lilongwe, Malawi.MethodsFrom July through September 2014, we used venue-based sampling to enroll 200 adult FSW in Lilongwe, Malawi into a cross-sectional evaluation assessing HIV care continuum outcomes. Seropositive FSW, identified using HIV rapid testing, received rapid CD4 counts in addition to viral loads using dried blood spots. We calculated proportions of HIV-infected FSW who had history of care, were on ART, and had suppressed viral load and we used Poisson regression to estimate the associations of demographic characteristics and transmission risk behaviors with each outcome.ResultsHIV seroprevalence was 69% (n = 138). Among all FSW the median age was 24 years (IQR: 22–28). Among the 20% who were newly diagnosed and reported previously testing negative, the median time since last HIV test was 11 months (interquartile range: 3–17). The majority (69%) of HIV-infected FSW had a history of HIV care, 52% reported current ART use, and 45% were virally suppressed. Of the FSW who reported current ART use, 86% were virally suppressed. Transmission risk behaviors were not associated with continuum outcomes.ConclusionsFSW in Lilongwe were predominately young and have a high HIV prevalence. Only half of HIV-infected FSW reported current ART use, but the majority of those on ART were virally suppressed. To reduce ongoing transmission and improve health outcomes, increased HIV testing, care engagement, and ART coverage is urgently needed among FSW. Universal testing and treatment strategies for all FSW in Malawi must be strongly considered

Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi

HIV diagnosis, the first step in HIV care and treatment engagement, may be inhibited by substance use among female sex workers (FSW). We assessed the relationship between alcohol and marijuana use and lack of HIV infection awareness among HIV-infected FSW in Lilongwe, Malawi

Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study

Background: Alcohol use is pervasive among female sex workers (FSW) placing them at increased risk of violence and sexual risk behaviors. FSW often live and work where alcohol is highly normative. Objective: To understand the socioecological influences on hazardous alcohol use among FSW in Malawi. Methods: In 2014, 200 FSW identified through venue-based sampling in Lilongwe, Malawi, completed a quantitative behavioral survey, with a sub-sample participating in qualitative interviews. Multivariable log-binomial regression was used to identify associations between hazardous alcohol use (AUDIT score ≥ 7) and time in sex work, clients per week, unprotected sex, alcohol use with clients, and living environment. Qualitative interviews enhanced findings from quantitative data and identify emergent themes around socioecological influences on alcohol use. Results: Over 50% reported hazardous alcohol use and lived in an alcohol-serving venue. Hazardous alcohol use was associated with sex work duration of ≥2 years (aPR: 1.30; 95%CI: 1.02,1.65) and alcohol use at last sex with a client (aPR: 1.29; 95%CI: 1.06,1.57). FSW perceived alcohol as a facilitator for sex work by reducing inhibitions and attracting clients, but acknowledged alcohol leads to violence and/or unprotected sex. Despite these risks and a motivation to reduce use, FSW feared that refusing to drink would be tantamount to turning away clients. Conclusions: Although FSW recognized alcohol-related risks, the norms and power dynamics of sex work perpetuated hazardous alcohol use. Multilevel interventions are needed to collectively change norms around drinking and sex work that will enable FSW to reduce alcohol consumption when engaging in their work

Implementation of a Curriculum to Optimize Hygiene Behaviors Among Refugees and Migrants Being Resettled

Health knowledge and behaviors can impact well-being and promote community integration post-arrival for refugees and migrants being resettled. Health and hygiene curricula are efficient and accessible mechanisms to mitigate the risk of chronic and infectious diseases in populations being resettled. This report summarizes a successful interagency/interdisciplinary Uganda-based collaboration between the International Organization for Migration, U.S. Centers for Disease Control and Prevention, and the University of Minnesota. The project's objective was to co-create and align a health curriculum and education messages across the resettlement continuum. Due to timing, the curriculum expanded to include COVID-19 prevention education, thus broadening the initiative's impact. Since the initial implementation, thousands of US-bound applicants have had exposure to the curriculum modules. The curriculum is now the primary tool for health education during pre-departure procedures in Kampala, Uganda, with implementations planned in other countries. The modular format and standardized non-technical language facilitated uptake by medical and non-medical personnel. Incorporating end users in curriculum development supports the early adoption and sustainability of the project. The interagency/interdisciplinary partnership strengthens systems and supports resource sharing to optimize the health and well-being of persons resettling in the United States

The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi

Female sex workers (FSW) have a high prevalence of substance use and HIV, but the impact of substance use on HIV treatment engagement is not well established. We evaluated the association between alcohol and marijuana use and sub-optimal HIV treatment engagement outcomes among HIV-infected FSW in Lilongwe, Malawi. We enroled FSW using venue-based recruitment into a cross-sectional evaluation assessing substance use and HIV treatment engagement. Seropositive FSW, identified through HIV rapid testing, received rapid CD4 count and viral load testing. We used Poisson regression with robust variance estimates to ascertain associations of alcohol and marijuana use with sub-optimal HIV treatment outcomes: (1) lack of ART use among previously diagnosed, ART-eligible FSW and (2) viral nonsuppression among FSW on ART. Of previously diagnosed, ART-eligible FSW (n = 96), 29% were not using ART. Patterns of hazardous drinking were identified in 30%, harmful drinking in 10%, and alcohol dependence in 12%. ART-eligible FSW with harmful drinking or alcohol dependency were 1.9 (95% CI: 1.0, 3.8) times as likely to not use ART compared to FSW without harmful or dependent drinking. Among those on ART, 14% were virally nonsuppressed. The prevalence ratio for viral nonsuppression was 2.0 (95% CI: 0.6, 6.5) for harmful drinkers and alcohol-dependent FSW. Over 30% of ART-eligible FSW reported using marijuana. Marijuana-using FSW were 1.9 (95% CI: 0.8, 4.6) times as likely to not use ART compared to FSW who were not using marijuana. Given the high prevalence of alcohol use and its association with lack of ART use, ART uptake and alcohol reduction strategies should be tailored for alcohol-using FSW in Malawi