Thirty-five years later: Long-term effects of the Matlab maternal and child health/family planning program on older women's well-being.

Family planning programs are believed to have substantial long-term benefits for women's health and well-being, yet few studies have established either extent or direction of long-term effects. The Matlab, Bangladesh, maternal and child health/family planning (MCH/FP) program afforded a 12-y period of well-documented differential access to services. We evaluate its impacts on women's lifetime fertility, adult health, and economic outcomes 35 y after program initiation. We followed 1,820 women who were of reproductive age during the differential access period (born 1938-1973) from 1978 to 2012 using prospectively collected data from the Matlab Health and Demographic Surveillance System and the 1996 and 2012 Matlab Health and Socioeconomic Surveys. We estimated intent-to-treat single-difference models comparing treatment and comparison area women. MCH/FP significantly increased contraceptive use, reduced completed fertility, lengthened birth intervals, and reduced age at last birth, but had no significant positive impacts on health or economic outcomes. Treatment area women had modestly poorer overall health (+0.07 SD) and respiratory health (+0.12 SD), and those born 1950-1961 had significantly higher body mass index (BMI) in 1996 (0.76 kg/m2) and 2012 (0.57 kg/m2); fewer were underweight in 1996, but more were overweight or obese in 2012. Overall, there was a +2.5 kg/m2 secular increase in BMI. We found substantial changes in lifetime contraceptive and fertility behavior but no long-term health or economic benefits of the program. We observed modest negative health impacts that likely result from an accelerated nutritional transition among treated women, a transition that would, in an earlier context, have been beneficial.

The effect of political control on financial performance, structure, and outcomes of US nursing homes.

OBJECTIVE: To evaluate the effect of partisan political control on financial performance, structure, and outcomes of for-profit and not-for-profit US nursing homes. DATA SOURCES/STUDY SETTING: Nineteen-year panel (1996-2014) of state election outcomes, financial performance data from nursing home cost reports, operational and aggregate resident characteristics from OSCAR of 13 737 nursing homes. STUDY DESIGN: A linear panel model was estimated to identify the effect of Democratic and Republican political control on next year's outcomes. Nursing home outcomes were defined as yearly facility revenues, expenses, and profits; the number of Medicaid, Medicare, and private-pay residents; staffing levels; and selected resident outcomes. PRINCIPAL FINDINGS: Democratic political control leads to an increase in financial flows to for-profit nursing homes, boosting profits without producing observable improvements in resident outcomes. Republican political control leads to lower revenues and profits of for-profit nursing homes. A shift from Medicaid to more profitable private-pay residents following Republican political control is observed for all nursing homes. Financial performance of not-for-profit nursing homes is not significantly affected by changes in political control. CONCLUSION: Political control of the two legislative chambers-but not of the governorship-shapes the structure of the nursing home industry as seen in provider behavior.

Staffing subsidies and the quality of care in nursing homes.

Concerns about the quality of state-financed nursing home care has led to the wide-scale adoption by states of pass-through subsidies, in which Medicaid reimbursement rates are directly tied to staffing expenditure. We examine the effects of Medicaid pass-through on nursing home staffing and quality of care by adapting a two-step FGLS method that addresses clustering and state-level temporal autocorrelation. We find that pass-through subsidies increases staffing by about 1% on average and 2.7% in nursing homes with a low share of Medicaid patients. Furthermore, pass-through subsidies reduce the incidences of pressure ulcer worsening by about 0.9%.

Methods for the creation of cyclic Peptide libraries for use in lead discovery.

The identification of initial hits is a crucial stage in the drug discovery process. Although many projects adopt high-throughput screening of small-molecule libraries at this stage, there is significant potential for screening libraries of macromolecules created using chemical biology approaches. Not only can the production of the library be directly interfaced with a cell-based assay, but these libraries also require significantly fewer resources to generate and maintain. In this context, cyclic peptides are increasingly viewed as ideal scaffolds and have proven capability against challenging targets such as protein-protein interactions. Here we discuss a range of methods used for the creation of cyclic peptide libraries and detail examples of their successful implementation.

Racial segregation and quality of care disparity in US nursing homes.

In this paper, we examine the contributions of travel distance and preferences for racial homogeneity as sources of nursing home segregation and racial disparities in nursing home quality. We first theoretically characterize the distinctive implications of these mechanisms for nursing home racial segregation. We then use this model to structure an empirical analysis of nursing home sorting. We find little evidence of differential willingness to pay for quality by race among first-time nursing home entrants, but do find significant distance and race-based preference effects. Simulation exercises suggest that both effects contribute importantly to racial disparities in nursing home quality.

Safe suture anchor insertion for anterior and posterior hip labral repair.

We sought to define bone thickness in relation to the chondral surface at various depths along the anterior and posterior acetabular rim and safe portals for anchor insertion in these regions. Six cadaveric pelvises were mounted on a custom jig. A custom guide was attached to simulate anterolateral (AL), mid-anterior (MA), distal anterolateral (DALA) and posterolateral (PL) arthroscopy portals. Anterior 3 o'clock and 4 o'clock positions were drilled using MA and DALA portals. Posterior 8 o'clock to 11 o'clock positions were drilled using a 1.4-mm drill bit from the PL portal. At depths of 5, 10 and 15 mm, the distance from the drill to the intra and extra-articular surfaces was measured using a custom caliper. Mean distance between drill hole and articular surface for anterior and posterior positions ranged from 1.61 to 2.75 mm at 5 mm. The smallest distance between the drill hole and articular surface and the largest width between drill hole and the extra-articular surface were at the 4 o'clock position. No difference between the MA and DALA portals were noted for the anterior positions. For the posterior rim positions, the distance on the articular side remained consistent throughout. For the posterior positions, only the PL portal was utilized. Both the MA or DALA portals can be utilized for safe drilling of the anterior rim positions. The posterior positions can all be safely drilled with a relatively good bone margin using the PL portal, but use of the MA or DALA portals resulted in extra-articular cortical perforation in all cases.

Effect of hospital-SNF referral linkages on rehospitalization.

OBJECTIVE: To determine whether the rate of rehospitalization is lower among patients discharged to skilled nursing facilities (SNFs) with which a hospital has a strong linkage. DATA SOURCES/COLLECTION: We used national Medicare enrollment, claims, and the Minimum Data Set to examine 2.8 million newly discharged patients to 15,063 SNFs from 2,477 general hospitals between 2004 and 2006. STUDY DESIGN: We examined the relationship between the proportion of discharges from a hospital and alternative SNFs on the rehospitalization of patients treated by that hospital-SNF pair using an instrumental variable approach. We used distances to alternative SNFs from residence of the patients of the originating hospital as the instrument. PRINCIPAL FINDINGS: Our estimates suggest that if the proportion of a hospital's discharges to an SNF was to increase by 10 percentage points, the likelihood of patients treated by that hospital-SNF pair to be rehospitalized within 30 days would decline by 1.2 percentage points, largely driven by fewer rehospitalizations within a week of hospital discharge. CONCLUSIONS: Stronger hospital-SNF linkages, independent of hospital ownership, were found to reduce rehospitalization rates. As hospitals are held accountable for patients' outcomes postdischarge under the Affordable Care Act, hospitals may steer their patients preferentially to fewer SNFs.

Creating Good Employment Opportunities for the Rural Sector.

This paper examines the potential for sector-specific productivity growth, human capital, credit markets, and infrastructure to contribute to the development of stable, well-paid employment in rural areas of low-income countries. Particular emphasis is placed on the way that different sectors of the rural economy interact with each other and with local and regional product markets. A simple theoretical framework and descriptive analysis of panel data from India suggests that more emphasis should be placed on increasing the production of goods that incorporate local agricultural products as inputs.

Satellite Remote Sensing for Developing Time and Space Resolved Estimates of Ambient Particulate in Cleveland, OH.

This article empirically demonstrates the use of fine resolution satellite-based aerosol optical depth (AOD) to develop time and space resolved estimates of ambient particulate matter (PM) ≤2.5 µm and ≤10 µm in aerodynamic diameters (PM(2.5) and PM(10), respectively). AOD was computed at three different spatial resolutions, i.e., 2 km (means 2 km × 2 km area at nadir), 5 km, and 10 km, by using the data from MODerate Resolution Imaging Spectroradiometer (MODIS), aboard the Terra and Aqua satellites. Multiresolution AOD from MODIS (AOD(MODIS)) was compared with the in situ measurements of AOD by NASA's AErosol RObotic NETwork (AERONET) sunphotometer (AOD(AERONET)) at Bondville, IL, to demonstrate the advantages of the fine resolution AOD(MODIS) over the 10-km AOD(MODIS), especially for air quality prediction. An instrumental regression that corrects AOD(MODIS) for meteorological conditions was used for developing a PM predictive model.The 2-km AOD(MODIS) aggregated within 0.025° and 15-min intervals shows the best association with the in situ measurements of AOD(AERONET). The 2-km AOD(MODIS) seems more promising to estimate time and space resolved estimates of ambient PM than the 10-km AOD(MODIS), because of better location precision and a significantly greater number of data points across geographic space and time. Utilizing the collocated AOD(MODIS) and PM data in Cleveland, OH, a regression model was developed for predicting PM for all AOD(MODIS) data points. Our analysis suggests that the slope of the 2-km AOD(MODIS) (instrumented on meteorological conditions) is close to unity with the PM monitored on the ground. These results should be interpreted with caution, because the slope of AOD(MODIS) ranges from 0.52 to 1.72 in the site-specific models. In the cross validation of the overall model, the root mean square error (RMSE) of PM(10) was smaller (2.04 µg/m(3) in overall model) than that of PM(2.5) (2.5 µg/m(3)). The predicted PM in the AOD(MODIS) data (∼2.34 million data points) was utilized to develop a systematic grid of daily PM at 5-km spatial resolution with the aid of spatiotemporal Kriging.

Air quality interventions and spatial dynamics of air pollution in Delhi and its surroundings.

The paper examines the spatial distribution of air pollution in response to recent air quality regulations in Delhi, India. Air pollution was monitored at 113 sites spread across Delhi and its surrounding areas from July-December 2003. From the analysis of these data three important findings emerge. First, air pollution levels in Delhi and its surroundings were significantly higher than that recommended by the World Health Organization (WHO). Second, air quality regulations in the city adversely affected the air quality of the areas surrounding Delhi. Third, industries and trucks were identified as the major contributors of both fine and coarse particles.