Variation In Coverage Research Articles

Utilization of influenza vaccination among chronically ill individuals in Germany: A nationwide claims-based analysis

BackgroundIndividuals with chronic diseases have a higher risk of serious complications or even death in case of influenza infection. The European Union (EU) set a goal to reach a vaccination coverage of 75% in seniors and chronically ill individuals. The aim of this study was to assess influenza vaccination uptake among individuals with a wide spectrum of chronic diseases and examine its regional variations and temporal trends over a period of the last ten years. MethodsWe used nationwide SHI-physician outpatient claims data from the years 2009 to 2018 covering 87% of the total German population to assess influenza vaccination uptake among individuals over 1 year of age with at least one of the following chronic diseases: pulmonary, cardiovascular, liver, kidney, metabolic, neurological and musculoskeletal diseases, as well as immune deficiency disorders, including HIV infection. ResultsInfluenza vaccination coverage varied across patient populations between 19% (multiple sclerosis) and 44% (chronic kidney disease) in the influenza season 2017/18. Vaccination coverage was slightly higher among females than males, except for HIV/AIDS patients. Among HIV-patients vaccination coverage was higher by 7 percent points among males (43%) than females (37%). The coverage was higher nearly for all patient groups in the eastern than western federal states. Over the observation period vaccination uptake showed decreasing trends in most of the target groups. Among patients with HIV/AIDS and immune deficiency disorders a stagnating trend was observed. ConclusionsVaccination uptake among chronically ill individuals is suboptimal and far from the EU-defined target of 75%. There were substantial variations in coverage by disease groups, individual factors and regions. The disease-specific evaluation of the current study allows identification of populations at higher risk with considerable vaccination gaps. Further efforts are needed to improve vaccination uptake in these vulnerable population groups.

The Effect of Health Insurance Coverage on Homeownership and Housing Prices: Evidence from the Medicaid Expansion

ObjectiveHomeownership as a way of wealth accumulation is important for low‐income people and the U.S. government has implemented policy to encourage homeownership among low‐income people. This article investigates the effects of health insurance coverage among low‐income people on homeownership and house prices.MethodsTo estimate the causal effects of health insurance coverage, we exploit the Medicaid expansion provisions of the Affordable Care Act as a source of exogenous variation in health insurance coverage and use it as an instrumental variable.ResultsUsing county‐level data from 2010 to 2018, this study finds that an increase in health insurance coverage among low‐income people results in an increase in homeownership rates and housing prices for bottom‐tier houses, and the results are robust.ConclusionOur study provides new evidence in supporting that higher shares of population with health insurance could increase both homeownership and house prices.

A Modified Roger's Distance Algorithm for Mixed Quantitative-Qualitative Phenotypes to Establish a Core Collection for Taiwanese Vegetable Soybeans.

Vegetable soybeans [Glycine max (L.) Merr.] have characteristics of larger seeds, less beany flavor, tender texture, and green-colored pods and seeds. Rich in nutrients, vegetable soybeans are conducive to preventing neurological disease. Due to the change of dietary habits and increasing health awareness, the demand for vegetable soybeans has increased. To conserve vegetable soybean germplasms in Taiwan, we built a core collection of vegetable soybeans, with minimum accessions, minimum redundancy, and maximum representation. Initially, a total of 213 vegetable soybean germplasms and 29 morphological traits were used to construct the core collection. After redundant accessions were removed, 200 accessions were retained as the entire collection, which was grouped into nine clusters. Here, we developed a modified Roger’s distance for mixed quantitative–qualitative phenotypes to select 30 accessions (denoted as the core collection) that had a maximum pairwise genetic distance. No significant differences were observed in all phenotypic traits (p-values > 0.05) between the entire and the core collections, except plant height. Compared to the entire collection, we found that most traits retained diversities, but seven traits were slightly lost (ranged from 2 to 9%) in the core collection. The core collection demonstrated a small percentage of significant mean difference (3.45%) and a large coincidence rate (97.70%), indicating representativeness of the entire collection. Furthermore, large values in variable rate (149.80%) and coverage (92.5%) were in line with high diversity retained in the core collection. The results suggested that phenotype-based core collection can retain diversity and genetic variability of vegetable soybeans, providing a basis for further research and breeding programs.

A Standardized Approach for Measuring Multi-Dimensional Equity in Vaccination Coverage, Cost-of-Illness, and Health Outcomes: Evidence from the Vaccine Economics Research for Sustainability & Equity (VERSE) Project

Background: Following a call from the World Health Organization in 2017 for a dashboard to monitor immunization coverage equity in line with the 2030 Agenda for Sustainable Development, this study proposes a new methodology and toolkit for measuring and tracking multi-dimensional equity in vaccine coverage, economic impact, and health outcomes. Methods: The Vaccine Economics Research for Sustainability & Equity (VERSE) composite vaccination equity assessment metric is derived from literature on the measurement of socioeconomic equity combined with measures of direct unfairness in healthcare access. The metric takes the form of a concentration index of vaccination coverage, where instead of ranking individuals by income, individuals are ranked by multi-dimensional unfairness in access. The direct unfairness ranking variable is the predicted vaccination coverage from a logistic model based upon multiple dimensions of fair and unfair sources of variation in vaccination coverage. Fair sources of variation in coverage may include whether the child is underage to receive the vaccine according to the national immunization schedule. Unfair sources of variation may include sex of the child, maternal education, or socioeconomic status. Regression decomposition is applied to determine the relative share each unfair dimension has on overall inequality in vaccination status. These methods are applied to the most recent National Family Health Survey (NFHS) from 2015-2016 in India to assess the equity in fully immunized for age vaccination coverage and zero-dose status. Equity results are computed by state and nationally and compared with coverage to produce an equity-coverage plane. Results: The multi-dimensional equity measure in is 0.105 (SE: 0.003) and 0.068 (SE: 0.005) for zero-dose status and fully immunized for age respectively. The most disadvantaged quintile is therefore 10.5% more likely to be zero-dose than the most advantaged quintile or 6.8% less likely to be fully immunized. The primary driver of unfair disadvantage in zero-dose status and fully immunized status, respectively, is maternal education accounting for 31.4% and 18.9% of observed inequality, followed by socioeconomic status contributing 15.9% and 14.9%, and health insurance coverage contributing 7.0% and 4.16%. Conclusions: Our work builds upon existing methods and toolkits by providing a standardized method for measuring equity across multiple dimensions. It also allows policymakers to determine the relative magnitude of drivers of overall equity in vaccine outcomes rather than only the drivers of socioeconomic or unidimensional equity. Additionally, the toolkit expands the available outcomes for inequity analysis from coverage to include financing and health outcomes. This framework could be adapted to track equitable progress toward Universal Health Coverage (UHC) beyond the vaccine space. Funding: The Vaccine Economics Research for Sustainability & Equity (VERSE) project is funded by the Bill & Melinda Gates Foundation under award INV-003813 Declaration of Interest: None to declare. Ethical Approval: The Vaccine Economics Research for Sustainaability & Equity (VERSE) project, under which this study falls, obtained IRB approval from the Johns Hopkins Bloomberg School of Public Health IRB (IRB00014999).

The Value of Choice in Mandatory Health Insurance

Giving consumers choice can improve welfare in principle. In this study, we explore choice optimality in a health insurance market that allows for variations in coverage but is standardized otherwise, theoretically implying optimal conditions for observing welfare improvements from choice. However, we find that as much as 49 percent of the adult population opts into non-welfare maximizing plans. In a laboratory experimental setting, we estimate treatment effects of increasing transparency through information provision and restricting choice on choice optimality. We find that decision quality cannot be improved meaningfully by our interventions and that non-optimal choice is economically relevant as it accounts for approximately 9.4 percent of total annual health costs. We suggest several policy changes in light of our findings.

The Equitable Distribution of Opportunity to Learn in Mathematics Textbooks

Low-income students and students of color are faced with pervasively lower levels of opportunity to learn compared with their peers, creating unequal opportunities for educational success. Textbooks, which serve as the backbone of the curriculum in most mathematics classrooms, present a potentially powerful tool to help mitigate unequal opportunity to learn across students. Using the Surveys of Enacted Curriculum framework, we investigate the content of commonly used eighth-grade math textbooks in California and the extent to which they align with the Common Core State Standards. We also explore the relationship between the variation in content coverage and alignment and student characteristics. We find poor alignment between the textbooks in our sample and the Common Core State Standards and low overall levels of cognitive demand, but only limited evidence of systematic differences in alignment or cognitive demand coverage associated with student characteristics at the school or district level.

A spatial and temporal analysis on NDVI in Urad grassland during 2010-2019 over remote sensing

The temporal-spatial dynamic variation of vegetation coverage from 2010 to 2019 in Urad Grassland, Inner Mongolia has been investigated by analysing on MODIS NDVI remote sensing products. This paper applies pixel dichotomy approach and linear regression trend analysis method to analyze the temporal and spatial evolution trend of vegetation coverage over the past 10 years. The average annual vegetation coverage showed a downward trend in general from 2010 to 2019. The vegetation distribution and change trend analysis provide a thorough and scientific reference for policymaking in environmental protection.

Vegetation variation trend and its influencing factors in Urad Grassland over remote sensing

In this work, the temporal-spatial dynamic variation of vegetation coverage from 2010 to 2019 in Urad Grassland has been explored by remote sensing technique. The change of precipitation and temperature has obvious effects on the vegetation, which affects the agriculture and the stability of the ecosystem. Pixel dichotomy approach and correlation analysis are introduced to analyse the temporal and spatial evolution trend of vegetation coverage and its response to climate change in the past 10 years. Specifically, the correlation between vegetation coverage and the critical climate impacting factors such as temperature and precipitation are fully investigated. The results show the vegetation coverage in the study area was influenced by effectors including climate, topography, human activities and government policies. The average annual vegetation coverage showed a downward trend in general from 2010 to 2019. Statistical correlation analysis indicates that the correlation between the vegetation coverage and the precipitation is positive in most parts of the area, while the correlation between the vegetation coverage and the precipitation shows negative with difference with various geographic features. As a result, precipitation was the major natural factor that affected dynamics of vegetation coverage in Urad grassland.

黄河三角洲刺槐群落土壤优先流及养分分布特征

黄河三角洲湿地面临严重的水资源短缺、湿地退化、土壤盐碱化等问题，湿地土壤干旱缺水，土壤收缩产生裂隙等优先流路径，在小尺度上改变湿地内部以及湿地板块之间水文连通性，小尺度水文效应往往制约大尺度水文连通性，基于当前社会对湿地修复的迫切需求，从小尺度对水文连通研究有必要加以重视。然而，目前的研究多集中在大尺度水文连通的阐述，为进一步明确黄河三角洲湿地小尺度水文连通和养分随优先流路径运移分布情况，以此区域典型刺槐群落为研究对象，基于室外染色示踪实验和室内图像处理技术，分析土壤优先流形态和分布特征，并探究优先流和土壤养分含量之间的关系。结果表明：（1）刺槐群落染色面积比随土壤深度变化主要包括2个阶段，第一阶段：优先流和基质流相互影响作用显著，第二阶段：优先流和基质流相互作用不显著，优先流强度逐渐增强，明显存在指流现象，极少部分管流现象。（2）刺槐群落染色面积比、基质流深度和百分之五十染色深度的数值较大，优先流区染色面积比较小，基质流深度发生在土壤深10-15 cm区间，该类型植被群落水流均匀入渗深度较大，优先流和基质流相互作用程度大，水文连通性较高。（3）优先流区土壤有机碳、有机质、全氮、全磷和有效磷含量值均高于基质流区；（4）土壤优先流区染色面积比与5种养分指标均呈负相关关系，有机碳、有机质和有效磷含量受优先流路径影响显著。（5）土壤中有机碳、有机质和有效磷含量在一定程度上可以衡量土壤优先流发育水平。研究结果可为黄河三角洲湿地生态系统保护和管理提供参考。;More serious environmental problems including water shortage, wetland degradation, and soil salinization are gradually recognized in the Yellow River Delta wetland. Due to water deficiency of wetland soils, preferential pathways including soil cracks occur as soil shrinkage which changes the hydrological connectivity of inside wetlands or between wetlands at small scale, and small scale hydrological processes tend to affect the large scale hydrological cycle, depending on our urgent needs to restore wetlands, it is necessary to pay attentions to the study of hydrological connectivity research from microcosmic perspectives to promote the understanding of connotation of hydrological connectivity. However, most of the current studies focused on the hydrological connectivity from macroscopical perspectives. In order to clarify the small-scale hydrological connectivity in the Yellow River Delta, the morphology and distribution characteristics of preferential flow in soil were analyzed based on outdoor dyeing tracer experiment and indoor image processing technology. The relationship between preferential flow and soil nutrient content was explored. The results show that:(1) There are two stages in the variation of the dry coverage of Robinia pseudoacacia Linn community with soil depth. The first stage:the interaction between preferential flow and matrix flow is significant; the second stage:the interaction between preferential flow and matrix flow is not significant, and the intensity of preferential flow is gradually increasing, finger flow phenomenon and a small part of pipe flow phenomenon is observed. (2) Vertical soil-profile indexes (dry coverage, dry coverage of preferential pathway, depth of diffusion area, and depth of 50% dry coverage) reveal a strong interaction between preferential flow and matrix flow, and depth of diffusion area occurs in the range of 10-15cm in the soil, which indicates that this type of vegetation community has large depth of water infiltration flow uniformly and the hydrological connectivity is high; (3) The contents of soil organic carbon, organic matter, total nitrogen, total phosphorus and available phosphorus in preferential flow area were higher than those in matrix flow area; (4) The dye coverage ratio of preferential flow area was negatively correlated with the five nutrient indexes, and the contents of organic carbon, organic matter and available phosphorus were significantly affected by preferential pathway. (5) The content of organic carbon, organic matter and available phosphorus in soil can measure the development level of preferential flow to a certain extent. These results can provide references for wetland ecosystem protection and management in the Yellow River Delta.

Variation in access to hemophilia A treatments in the United States

Background: US commercial health plans have been found to vary in how they cover specialty drugs indicated for a range of diseases. In this study, we examined patients’ access to hemophilia A (HemA) treatments across a set of large commercial health plans. Objective: To examine variation in health plans’ coverage policies for HemA treatments. Methods: We reviewed HemA treatment coverage policies (current as of August 2019) issued by 17 commercial health plans primarily using the Tufts Medical Center Specialty Drug Evidence and Coverage Database. We categorized policies as: covered without conditions (coverage consistent with the FDA label); covered with conditions (conditions on coverage beyond the FDA label); broader coverage (coverage for a broader patient population than the FDA label); and mixed (conditions on coverage beyond the FDA label in one way, but coverage was broader than the FDA label in another). Results: We identified 296 coverage policies for 26 HemA treatments, including 15 short half-life factor VIII (FVIII) products, five extended half-life FVIII products, three bypassing agents, two desmopressin products and emicizumab. We classified 36% of policies as coverage without conditions, 50% as covered with conditions, 7% as broader coverage, and 7% as mixed. Plans applied conditions on coverage with different frequencies: two did not apply conditions in any policies; ten applied conditions in ≥50%; four applied conditions in <40%. One plan did not publish coverage policies for any HemA products. Conditions on coverage most often related to bleeding frequency (36%), although specific requirements varied. Plans applied step therapy protocols in 17% of policies. Conclusions: How health plans covered HemA treatments varied. Plans added conditions on coverage beyond the FDA label roughly half the time. Conditions most often related to bleeding frequency. Variable coverage affects patients’ access to treatment, and potentially has clinical implications on disease management and disease progression.

Transformações do uso e cobertura da terra na estação metroviária de Campo Limpo – SP

As estações ferroviárias exercem grande influência no ambiente urbano. A magnitude do seu impacto, no entanto, pode ser considerada variável. O trabalho analisa as mudanças no uso e cobertura da terra no entorno da estação do Metrô Campo Limpo, inaugurada em 2002 em São Paulo. A classificação da imagem de satélite de 2002 e da ortofoto de 2010, os dados do censo demográfico e dos lançamentos imobiliários foram utilizados para analisar a cobertura e variação populacional. Constatou-se pequena variação das classes na área mais próxima ao Metrô (até 600m), mas significativa variação entre 600 e 1000m. As maiores transformações foram: vegetação arbórea (+4,89%), telhado de concreto (+4,54%), sombra (-7,42%) e solo exposto (-5,77%). A elevação do número de lançamentos imobiliários, principalmente em 2001, foi observada, mas com redução da área útil e do preço do metro quadrado dos imóveis.

Greenhouse application of light-drone imaging technology for assessing weeds severity occurring on baby-leaf red lettuce beds approaching fresh-cutting

Aim of study: For baby-leaf lettuces greenhouse cultivations the absence of weeds is a mandatory quality requirement. One of the most promising and innovative technologies in weed research, is the use of Unmanned Aerial Vehicles (or drones) equipped with acquisition systems. The aim of this study was to provide an estimation of the exact weed amount on baby-sized red lettuce beds using a light drone equipped with an RGB microcamera.Area of study: Trials were performed at specialized organic farm site in Eboli (Salerno, Italy), under polyethylene multi-tunnel greenhouse.Material and methods: The RGB images acquired were processed with specific algorithms distinguishing weeds from crop yields, estimating the weeds covered surface and the severity of weed contamination in terms of biomass. A regression between the percentage of the surface covered by weed (with respect to the image total surface) and the weight of weed (with respect to the total harvested biomass) was calculated.Main results: The regression between the total cover values of the 25 calibration images and the total weight measured report a significant linear correlation. Digital monitoring was able to capture with accuracy the highly variable weed coverage that, among the different grids positioned under real cultivation conditions, was in the range 0-16.4% of the total cultivated one.Research highlights: In a precision weed management context, with the aim of improving management and decreasing the use of pesticides, this study provided an estimation of the exact weed amount on baby-sized red lettuce beds using a light drone.

Meningococcal disease epidemiology in Brazil (2005–2018) and impact of MenC vaccination

BackgroundMeningococcal disease (MD) presents a substantial public health problem in Brazil. Meningococcal C conjugate (MenC) vaccination was introduced into the routine infant immunization program in 2010, followed by adolescent vaccination in 2017. We evaluated changes in national and regional MD incidence and mortality between 2005 and 2018, serogroup distribution and vaccine coverage. MethodsData were obtained from national surveillance systems from 2005 to 2018. Age-stratified incidence and mortality rates were calculated and a descriptive time-series analysis was performed comparing rates in the pre-(2005–2009) and post-vaccination (2011–2018) periods; MD due to specific meningococcal serogroups were analyzed in the pre-(2007–2009) and post-vaccination (2011–2018) periods. ResultsFrom 2005 to 2018, 31,108 MD cases were reported with 6496 deaths; 35% of cases and deaths occurred in children < 5 years. Incidence and mortality rates declined steadily since 2012 in all age-strata, with significantly lower incidence and mortality in the post-vaccine introduction period in children aged < 1-year, 1–4 years, 5–9 years and 10–14 years. A significant decline in MenC disease in children < 5 years was observed following MenC vaccine introduction; infants < 1 year, from 3.30/100,000 (2007–2009) to 1.08/100,000 (2011–2018) and from 1.44/100,000 to 0.42/100,000 in 1–4-year-olds for these periods. Reductions in MenB disease was also observed. MenW remains an important cause of MD with 748 cases reported across 2005–2018. While initial infant vaccination coverage was high (>95% nationwide), this has since declined (to 83% in 2018); adolescent uptake was < 20% in 2017/18). Regional variations in outcomes and vaccine coverage were observed. ConclusionA substantial decline in incidence and mortality rates due to MD was seen following MenC vaccine introduction in Brazil, especially among children < 5 years chiefly driven by reductions in MenC serogroup. While these benefits are considerable, the prevalence of MD due to other serogroups such as MenW and MenB remains a concern. A video summary linked to this article can be found on Figshare: https://doi.org/10.6084/m9.figshare.13379612.v1

Highly sensitive detection of [formula omitted] adsorbed on Si(111)7 [formula omitted] 7 and Si(100)2 [formula omitted] 1 surfaces by means of slow highly charged Xe ions

The proton yields from Si(111)7 × 7 and Si(100)2 × 1 reconstructed surfaces irradiated with slow (v<0.25vBohr) highly charged Xe ions are obtained. H2O molecules adsorbed over time on the surfaces at room temperature, under ultra-high vacuum can be detected as an increase of the proton yield. For the Si(100)2 × 1 surface, the proton yield with HCI-irradiation time is discussed based on temporal variation of the H2O coverage. The proton desorption efficiency with Xe50+ is more than about ten times and twice as compared with Xe29+ and Xe44+, respectively. For the Si(111)7 × 7 and Si(100)2 × 1 surfaces, the proton yield in each time increases with the charge states q to the power of 6 and 4, respectively, and is changed with time with the power laws held on.

Infertility insurance: What coverage exists for physician trainees?

We aimed to describe infertility insurance coverage provided to male and female fellows working at institutions that offer advanced infertility training. Faculty and fellows working within U.S. and Canadian andrology or reproductive endocrinology and infertility (REI) programs were contacted and asked for a copy of their institutional health insurance summary of benefits. Documents were assessed for coverage of diagnosis and treatment, shared costs, and maximum lifetime coverage for infertility care. Insurance policies from 24 institutions were reviewed; 16 of 24 (66%) institutions covered costs related to the diagnosis of infertility. Six institutions (25%) offered coverage for diagnosis but not treatment. There were 15 (62.5%) institutions that offered some amount of coverage for the treatment of infertility, and the average lifetime maximum was $16 100. Only six of 24 (25%) plans explicitly described a covered male-specific treatment, which included sperm extraction (12.5%), varicocele repair (4.2%), and sperm cryopreservation (8.3%). For physician trainees, infertility insurance coverage is not universal, policies are not transparent, and treatment for male factor infertility is often omitted. With high costs of infertility treatment, variable insurance coverage, and debt and time constraints, residents and fellows are a particularly vulnerable population that may experience significant financial toxicity when faced with infertility.

Enhance Ocean Carbon Observations: Successful Implementation of a Novel Autonomous Total Alkalinity Analyzer on a Ship of Opportunity

Over recent decades, observations based on merchant vessels (Ships of Opportunity—SOOP) equipped with sensors measuring the CO2 partial pressure (pCO2) in the surface seawater formed the backbone of the global ocean carbon observation system. However, the restriction to pCO2 measurements alone is one severe shortcoming of the current SOOP observatory. Full insight into the marine inorganic carbon system requires the measurement of at least two of the four measurable variables which are pCO2, total alkalinity (TA), dissolved inorganic carbon (DIC), and pH. One workaround is to estimate TA values based on established temperature-salinity parameterizations, but this leads to higher uncertainties and the possibility of regional and/or seasonal biases. Therefore, autonomous SOOP-based TA measurements are of great interest. Our study describes the implementation of a novel autonomous analyzer for seawater TA, the CONTROS HydroFIAⓇ TA system (-4H-JENA engineering GmbH, Germany) for unattended routine TA measurements on a SOOP line operating in the North Atlantic. We present the installation in detail and address major issues encountered with autonomous measurements using this analyzer, e.g., automated cleaning and stabilization routines, and waste handling. Another issue during long-term deployments is the provision of reference seawater in large-volume containers for quality assurance measurements and drift correction. Hence, a stable large-volume seawater storage had to be found. We tested several container types with respect to their suitability to store seawater over a time period of 30 days without significant changes in TA. Only one gas sampling bag made of polyvinylidene fluoride (PVDF) satisfied the high stability requirement. In order to prove the performance of the entire setup, we compared the autonomous TA measurements with TA from discrete samples taken during the first two trans-Atlantic crossings. Although the measurement accuracy in unattended mode (about ± 5 μmol kg^-1) slightly deteriorated compared to our previous system characterization, its overall uncertainty fulfilled requirements for autonomous TA measurements on SOOP lines. A comparison with predicted TA values based on an established and often used parameterization pointed at regional and seasonal limitations of such TA predictions. Consequently, TA observations with better coverage of spatiotemporal variability are needed, which is now possible with the method described here.

Households with unimproved water sources in Ethiopia: spatial variation and point-of-use treatment based on 2016 Demographic and Health Survey

BackgroundImproved water sources are not equally available in all geographical regions. Populations dependent on unsafe water sources are recommended to treat their water at point-of-use using adequate methods to reduce associated health problems. In Ethiopia, the spatial distribution of households using unimproved water sources have been incomplete or ignored in most of the studies. Moreover, evidence on the point-of-use water treatment practice of households dependent on such water sources is scarce. Therefore, the current study is intended to analyze the spatial distribution of unimproved water sources by wealth quintiles at country level and point-of-use treatment (POU) practices using nationally representative data.MethodThe data of 2016 Ethiopian Demographic and Health Survey (EDHS) conducted on 16650 households from 643 clusters were used for the analysis. For spatial analysis, the raw and spatially smoothed coverage data was joined to the geographic coordinates based on EDHS cluster identification code. Global spatial autocorrelation was performed to analyze whether the pattern of unimproved water coverage is clustered, dispersed, or random across the study areas. Once a positive global autocorrelation was confirmed, a local spatial autocorrelation analysis was applied to detect local clusters. The POU water treatment is analyzed based on reported use of either boiling, chlorine (bleach), filtration, or solar disinfection (SODIS).ResultsThere were 5005 households using unimproved water sources for drinking purposes. Spatial variation of unimproved water coverage was observed with high coverage observed at Amhara, Afar, Southern Nations Nationalities and People and Somalia regions. Disparity in unimproved water coverage between wealth quintiles was also observed. The reported point-of-use water treatment practice among these households is only 6.24%. The odds of POU water treatment among household heads with higher education status is 2.5 times higher (95% CI = 1.43-4.36) compared to those who did not attend education.ConclusionAn apparent clustering trend with high unimproved water coverage was observed between regions and among wealth quintiles hence indicates priority areas for future resource allocation and the need for regional and national policies to address the issue. Promoting households to treat water prior to drinking is essential to reduce health problems.

Estimated impact of RTS,S/AS01 malaria vaccine allocation strategies in sub-Saharan Africa: A modelling study.

The RTS,S/AS01 vaccine against Plasmodium falciparum malaria infection completed phase III trials in 2014 and demonstrated efficacy against clinical malaria of approximately 36% over 4 years for a 4-dose schedule in children aged 5-17 months. Pilot vaccine implementation has recently begun in 3 African countries. If the pilots demonstrate both a positive health impact and resolve remaining safety concerns, wider roll-out could be recommended from 2021 onwards. Vaccine demand may, however, outstrip initial supply. We sought to identify where vaccine introduction should be prioritised to maximise public health impact under a range of supply constraints using mathematical modelling. Using a mathematical model of P. falciparum malaria transmission and RTS,S vaccine impact, we estimated the clinical cases and deaths averted in children aged 0-5 years in sub-Saharan Africa under 2 scenarios for vaccine coverage (100% and realistic) and 2 scenarios for other interventions (current coverage and World Health Organization [WHO] Global Technical Strategy targets). We used a prioritisation algorithm to identify potential allocative efficiency gains from prioritising vaccine allocation among countries or administrative units to maximise cases or deaths averted. If malaria burden at introduction is similar to current levels-assuming realistic vaccine coverage and country-level prioritisation in areas with parasite prevalence >10%-we estimate that 4.3 million malaria cases (95% credible interval [CrI] 2.8-6.8 million) and 22,000 deaths (95% CrI 11,000-35,000) in children younger than 5 years could be averted annually at a dose constraint of 30 million. This decreases to 3.0 million cases (95% CrI 2.0-4.7 million) and 14,000 deaths (95% CrI 7,000-23,000) at a dose constraint of 20 million, and increases to 6.6 million cases (95% CrI 4.2-10.8 million) and 38,000 deaths (95% CrI 18,000-61,000) at a dose constraint of 60 million. At 100% vaccine coverage, these impact estimates increase to 5.2 million cases (95% CrI 3.5-8.2 million) and 27,000 deaths (95% CrI 14,000-43,000), 3.9 million cases (95% CrI 2.7-6.0 million) and 19,000 deaths (95% CrI 10,000-30,000), and 10.0 million cases (95% CrI 6.7-15.7 million) and 51,000 deaths (95% CrI 25,000-82,000), respectively. Under realistic vaccine coverage, if the vaccine is prioritised sub-nationally, 5.3 million cases (95% CrI 3.5-8.2 million) and 24,000 deaths (95% CrI 12,000-38,000) could be averted at a dose constraint of 30 million. Furthermore, sub-national prioritisation would allow introduction in almost double the number of countries compared to national prioritisation (21 versus 11). If vaccine introduction is prioritised in the 3 pilot countries (Ghana, Kenya, and Malawi), health impact would be reduced, but this effect becomes less substantial (change of <5%) if 50 million or more doses are available. We did not account for within-country variation in vaccine coverage, and the optimisation was based on a single outcome measure, therefore this study should be used to understand overall trends rather than guide country-specific allocation. These results suggest that the impact of constraints in vaccine supply on the public health impact of the RTS,S malaria vaccine could be reduced by introducing the vaccine at the sub-national level and prioritising countries with the highest malaria incidence.

Soft Information in the Financial Press and Analyst Revisions

Both sell-side analysts and the media are information intermediaries in capital markets. This study investigates the association between sell-side analyst research and information in firm-specific news coverage. More frequent recent news coverage is associated with stronger market reactions to analysts’ research revisions, and primarily explained by soft information in news coverage. The primary result is robust to using both an instrumental variable and a quasi-natural experimental setting to generate exogenous variation in media coverage, alleviating concerns about endogeneity. In addition, using textual analysis, we document that explicit media references in analyst research reports are significantly associated with more frequent analyst revisions and stronger market reactions to revisions. Our study provides empirical evidence of analysts’ assimilation of information from the financial press and their role in the efficiency of capital markets.

Influence of plant coverage and environmental variables on pollen productivities: evidence from northern China

Pollen productivity is a critical parameter in the interpretation of pollen-vegetation relationships, and in the quantitative reconstructions of past vegetation from fossil pollen records. One-year monitoring records were collected for 143 pollen traps in various parts of northern China, together with modern vegetation data. Absolute Pollen Productivity Estimates (APPE) were calculated for 11 taxa using the ratio of pollen influx to plant coverage at each applicable sampling site, in which the plants of the target taxon were present. Relative Pollen Productivity Estimates (RPPE) were calculated for the 11 taxa (taking Poaceae as the reference taxon) at those sites in which each taxon occurred together with Poaceae. Artemisia and Chenopodiaceae were found to have the highest RPPEs and the largest RPPEs ranges, while Pinus and Quercus also had higher RPPEs than Poaceae; Abies, Betula, Larix, Picea and Cyperaceae had relatively low RPPEs. Variations in RPPE between different areas may be explained by variations in climatic conditions, plant coverage and land use practices which might influence plant growing situation. Marked effect that variations in pollen productivity can have on vegetation reconstructions was demonstrated by applying these distinct RPPEs to reconstructions of Holocene vegetation in the Lake Daihai area (northern China), such as a large range of RPPE produces a large range of plant coverage. Variations in RPPEs within a single taxon, related to vegetation coverage and climatic conditions, therefore need to be considered in future vegetation reconstructions.