Maternal HIV-1 envelope-specific antibody responses and reduced risk of perinatal transmission.

Despite the wide availability of antiretroviral drugs, more than 250,000 infants are vertically infected with HIV-1 annually, emphasizing the need for additional interventions to eliminate pediatric HIV-1 infections. Here, we aimed to define humoral immune correlates of risk of mother-to-child transmission (MTCT) of HIV-1, including responses associated with protection in the RV144 vaccine trial. Eighty-three untreated, HIV-1-transmitting mothers and 165 propensity score-matched nontransmitting mothers were selected from the Women and Infants Transmission Study (WITS) of US nonbreastfeeding, HIV-1-infected mothers. In a multivariable logistic regression model, the magnitude of the maternal IgG responses specific for the third variable loop (V3) of the HIV-1 envelope was predictive of a reduced risk of MTCT. Neutralizing Ab responses against easy-to-neutralize (tier 1) HIV-1 strains also predicted a reduced risk of peripartum transmission in secondary analyses. Moreover, recombinant maternal V3-specific IgG mAbs mediated neutralization of autologous HIV-1 isolates. Thus, common V3-specific Ab responses in maternal plasma predicted a reduced risk of MTCT and mediated autologous virus neutralization, suggesting that boosting these maternal Ab responses may further reduce HIV-1 MTCT.

Impact of protected forests on rural household fuel tree planting and deforestation: Chiro District, Ethiopia

This study aims at exploring the potential impact of forest protection intervention on rural households’ private fuel tree planting in Chiro district of eastern Ethiopia. The study results revealed a robust and significant positive impact of the intervention on farmers’ decisions to produce private household energy by growing fuel trees on their farm. As participation in private fuel tree planting is not random, the study confronts a methodological issue in investigating the causal effect of forest protection intervention on rural farm households’ private fuel tree planting through non-parametric propensity score matching (PSM) method. The protection intervention on average has increased fuel tree planting by 503 (580.6%) compared to open access areas and indirectly contributed to slowing down the loss of biodiversity in the area. Land cover/use is a dynamic phenomenon that changes with time and space due to anthropogenic pressure and development. Forest cover and land use changes in Chiro District, Ethiopia over a period of 40 years was studied using remotely sensed data. Multi temporal satellite data of Landsat was used to map and monitor forest cover and land use changes occurred during three point of time of 1972,1986 and 2012. A pixel base supervised image classification was used to map land use land cover classes for maps of both time set. The result of change detection analysis revealed that the area has shown a remarkable land cover/land use changes in general and forest cover change in particular. Specifically, the dense forest cover land declined from 235 ha in 1972 to 51 ha in 1986. However, government interventions in forest protection in 1989 have slowed down the drastic change of dense forest cover loss around the protected area through reclaiming 1,300 hectares of deforested land through reforestation program up to 2012.

UPTAKE OF THE PERIODIC HEALTH EXAM AMONG ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES FROM 2003 TO 2015

Background: Over the past decade, annual heath exams have been de-emphasized for the general population but emphasized for adults with intellectual and developmental disabilities (IDD). The purpose of this project was to determine if there has been an increase in the uptake of the health exam among adults with IDD in Ontario, to what extent, and the effect on the quality of preventive care provided. Methods: Using administrative health data, the proportion of adults (18-64 years old) with IDD who received a health exam (long appointment, general assessment, and “true” health exam), a high value on the primary care quality composite score (PCQS), and a health exam or high PCQS each year was compared to the proportion in a propensity score matched sample of the general population. Negative binomial and segmented negative binomial regression controlling for age and sex were used to determine the relative risk of having a health exam/high PCQS/health exam or PCQS over time. Results: Pre joinpoint, the long appointment and general assessment health exam definitions saw a decrease and the “true” health exam saw an increase in the likelihood of adults having a health exam. Post joinpoint, all health exam definitions saw a decrease in the likelihood of adults having a health exam. Pre joinpoint, all PCQS measures (high PCQS, long appointment or high PCQS, “true” health exam or high PCQS) saw an increase in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Post joinpoint, all PCQS measures saw a decrease in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Achieving a high PCQS was strongly associated with having a health exam regardless of health exam definition or IDD status. Conclusions: Despite the publication of guidelines, only a small proportion of adults with IDD are receiving health exams. This indicates that the publication of guidelines alone was not sufficient to change practice. More targeted measures, such as the implementation of an IDD-specific health exam fee code, should be considered to increase the uptake of the health exam among adults with IDD.

Agricultural microcredit and technical efficiency: The case of smallholder rice farmers in Northern Ghana

In the current study, we compared technical efficiency of smallholder rice farmers with and without credit in northern Ghana using data from a farm household survey. We fitted a stochastic frontier production function to input and output data to measure technical efficiency. We addressed self-selection into credit participation using propensity score matching and found that the mean efficiency did not differ between credit users and non-users. Credit-participating households had an efficiency of 63.0 percent compared to 61.7 percent for non-participants. The results indicate significant inefficiencies in production and thus a high scope for improving farmers’ technical efficiency through better use of available resources at the current level of technology. Apart from labour and capital, all the conventional farm inputs had a significant effect on rice production. The determinants of efficiency included the respondent’s age, sex, educational status, distance to the nearest market, herd ownership, access to irrigation and specialisation in rice production. From a policy perspective, we recommend that the credit should be channelled to farmers who demonstrate the need for it and show the commitment to improve their production through external financing. Such a screening mechanism will ensure that the credit goes to the right farmers who need it to improve their technical efficiency.

CAUSAL INFERENCE WITH A CONTINUOUS TREATMENT AND OUTCOME: ALTERNATIVE ESTIMATORS FOR PARAMETRIC DOSE-RESPONSE FUNCTIONS WITH APPLICATIONS.

Causal inference with a continuous treatment is a relatively under-explored problem. In this dissertation, we adopt the potential outcomes framework. Potential outcomes are responses that would be seen for a unit under all possible treatments. In an observational study where the treatment is continuous, the potential outcomes are an uncountably infinite set indexed by treatment dose. We parameterize this unobservable set as a linear combination of a finite number of basis functions whose coefficients vary across units. This leads to new techniques for estimating the population average dose-response function (ADRF). Some techniques require a model for the treatment assignment given covariates, some require a model for predicting the potential outcomes from covariates, and some require both. We develop these techniques using a framework of estimating functions, compare them to existing methods for continuous treatments, and simulate their performance in a population where the ADRF is linear and the models for the treatment and/or outcomes may be misspecified. We also extend the comparisons to a data set of lottery winners in Massachusetts. Next, we describe the methods and functions in the R package causaldrf using data from the National Medical Expenditure Survey (NMES) and Infant Health and Development Program (IHDP) as examples. Additionally, we analyze the National Growth and Health Study (NGHS) data set and deal with the issue of missing data. Lastly, we discuss future research goals and possible extensions.

The Effect of Private Management of Public Schools on Student Achievement in Bogotá, Colombia

During the last 15 years, the public school system in Bogotá, Colombia has maintained a concession system in which 25 schools are managed privately with exemptions to many of the rules required in the traditional schools -- This study uses the propensity score matching technique to examine whether students in the privately-managed schools have better scores on the Saber 11° examinations taken upon completion of secondary school -- The results for 251 schools indicates that students with comparable socioeconomic characteristics score considerably better on these tests in the privately-managed schools than in the traditional public schools -- Thus, there is evidence that the privately-managed public schools are a cost-effective alternative to the traditional public school

Três ensaios sobre avaliação de políticas públicas para o estado de Goiás

Tese (doutorado)—Universidade de Brasília, Departamento de Economia, Brasília, 2016.

L’évaluation des déterminants des paramètres hémodynamiques centraux à l’aide de la cohorte populationnelle CARTaGENE.

Les maladies cardiovasculaires ont un impact considérable sur la vie des Canadiens, et de nombreux efforts ont permis d’identifier différents facteurs de risque associés à cette condition. L’hypertension artérielle représente un de ces facteurs modifiables les plus importants. Quoique l’hypertension est définie à l’aide de mesures de pression artérielle en périphérie, il devient de plus en plus apparent que la mesure de pression centrale et de ses composantes auraient des avantages au niveau de la prédiction de la survenue d’événements cardiovasculaires. Le présent mémoire vise à mieux caractériser deux déterminants de cette pression centrale, le traitement antihypertenseur à base de bêtabloqueurs et l’insuffisance rénale chronique précoce. En utilisant les données recueillies dans la banque de données populationnelle CARTaGENE, il a été possible à l’aide d’analyses statistiques par appariement basé sur le coefficient de propension de démontrer que l’utilisation d’agents antihypertensifs de type bêtabloqueurs était associée à un profil hémodynamique central défavorable. Ainsi, les individus recevant ces agents avaient une pression centrale et une amplification artérielle plus élevées que des individus du groupe contrôle apparié et ce, malgré une pression périphérique identique. Cet effet semblait être incomplètement expliqué par la réduction du rythme cardiaque associé à l’utilisation de bêtabloqueurs. Aussi, il a été démontré que l’insuffisance rénale chronique de stade 3 (débit de filtration glomérulaire estimé entre 30 et 60 mL/min/1.73m2) n’était pas associée à une élévation des paramètres hémodynamiques centraux, contrairement à ce qui avait déjà été décrit chez des individus avec insuffisance rénale chronique plus avancée. De plus, le niveau d’albuminurie ne serait également pas associé à un changement du profil central dans un sous-groupe de la cohorte CARTaGENE.

L’évaluation des déterminants des paramètres hémodynamiques centraux à l’aide de la cohorte populationnelle CARTaGENE

Les maladies cardiovasculaires ont un impact considérable sur la vie des Canadiens, et de nombreux efforts ont permis d’identifier différents facteurs de risque associés à cette condition. L’hypertension artérielle représente un de ces facteurs modifiables les plus importants. Quoique l’hypertension est définie à l’aide de mesures de pression artérielle en périphérie, il devient de plus en plus apparent que la mesure de pression centrale et de ses composantes auraient des avantages au niveau de la prédiction de la survenue d’événements cardiovasculaires. Le présent mémoire vise à mieux caractériser deux déterminants de cette pression centrale, le traitement antihypertenseur à base de bêtabloqueurs et l’insuffisance rénale chronique précoce. En utilisant les données recueillies dans la banque de données populationnelle CARTaGENE, il a été possible à l’aide d’analyses statistiques par appariement basé sur le coefficient de propension de démontrer que l’utilisation d’agents antihypertensifs de type bêtabloqueurs était associée à un profil hémodynamique central défavorable. Ainsi, les individus recevant ces agents avaient une pression centrale et une amplification artérielle plus élevées que des individus du groupe contrôle apparié et ce, malgré une pression périphérique identique. Cet effet semblait être incomplètement expliqué par la réduction du rythme cardiaque associé à l’utilisation de bêtabloqueurs. Aussi, il a été démontré que l’insuffisance rénale chronique de stade 3 (débit de filtration glomérulaire estimé entre 30 et 60 mL/min/1.73m2) n’était pas associée à une élévation des paramètres hémodynamiques centraux, contrairement à ce qui avait déjà été décrit chez des individus avec insuffisance rénale chronique plus avancée. De plus, le niveau d’albuminurie ne serait également pas associé à un changement du profil central dans un sous-groupe de la cohorte CARTaGENE.

Impacto del Programa de Alimentación Escolar en el Trabajo Infantil: Una aproximación desde la toma de decisiones familiares

Esta investigación analiza el impacto del Programa de Alimentación Escolar en el trabajo infantil en Colombia a través de varias técnicas de evaluación de impacto que incluyen emparejamiento simple, emparejamiento genético y emparejamiento con reducción de sesgo. En particular, se encuentra que este programa disminuye la probabilidad de que los escolares trabajen alrededor de un 4%. Además, se explora que el trabajo infantil se reduce gracias a que el programa aumenta la seguridad alimentaria, lo que consecuentemente cambia las decisiones de los hogares y anula la carga laboral en los infantes. Son numerosos los avances en primera infancia llevados a cabo por el Estado, sin embargo, estos resultados sirven de base para construir un marco conceptual en el que se deben rescatar y promover las políticas públicas alimentarias en toda la edad escolar.

Diferencias regionales en las estructuras de ingresos laborales en Colombia

Dada la persistencia de las diferencias en ingresos laborales por regiones en Colombia, el presente artículo propone cuantificar la magnitud de este diferencial que es atribuida a la diferencia en estructuras de mercado laboral, entendiendo esta última como la diferencia en los retornos a las características de la fuerza laboral. Para ello se propone el uso de un método de descomposición del tipo Oaxaca- Blinder y se compara a Bogotá –la ciudad con mayores ingresos laborales- con otras ciudades principales. Los resultados obtenidos al conducir el ejercicio de descomposición muestran que las diferencias en estructura están a favor de Bogotá y que estas explican más de la mitad de la diferencia total, indicando que si se quieren reducir las disparidades de ingresos laborales entre ciudades no es suficiente con calificar la fuerza laboral y que es necesario indagar por las causas que hacen que los retornos a las características difieran entre ciudades.

Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study

Background and ObjectivesHypokalemia has been consistently associated with high mortality rate in peritoneal dialysis. However, studies investigating if hypokalemia is acting as a surrogate marker of comorbidities or has a direct effect in the risk for mortality have not been studied. Thus, the aim of this study was to analyze the effect of hypokalemia on overall and cause-specific mortality.Design, Setting, Participants and MeasurementsThis is an analysis of BRAZPD II, a nationwide prospective cohort study. All patients on PD for longer than 90 days with measured serum potassium levels were used to verify the association of hypokalemia with overall and cause-specific mortality using a propensity match score to reduce selection bias. In addition, competing risks were also taken into account for the analysis of cause-specific mortality.ResultsThere was a U-shaped relationship between time-averaged serum potassium and all-cause mortality of PD patients. Cardiovascular disease was the main cause of death in the normokalemic group with 133 events (41.8%) followed by PD-non related infections, n=105 (33.0%). Hypokalemia was associated with a 49% increased risk for CV mortality after adjustments for covariates and the presence of competing risks (SHR 1.49; CI95% 1.01-2.21). In contrast, in the group of patients with K < 3.5mEq/L, PD-non related infections were the main cause of death with 43 events (44.3%) followed by cardiovascular disease (n=36; 37.1%). For PD-non related infections the SHR was 2.19 (CI95% 1.52-3.14) while for peritonitis was SHR 1.09 (CI95% 0.47-2.49).ConclusionsHypokalemia had a significant impact on overall, cardiovascular and infectious mortality even after adjustments for competing risks. The causative nature of this association suggested by our study raises the need for intervention studies looking at the effect of potassium supplementation on clinical outcomes of PD patients.

Évaluation de la performance du score de propension à hautes dimensions dans le cadre d’études observationnelles québécoises

Les scores de propension (PS) sont fréquemment utilisés dans l’ajustement pour des facteurs confondants liés au biais d’indication. Cependant, ils sont limités par le fait qu’ils permettent uniquement l’ajustement pour des facteurs confondants connus et mesurés. Les scores de propension à hautes dimensions (hdPS), une variante des PS, utilisent un algorithme standardisé afin de sélectionner les covariables pour lesquelles ils vont ajuster. L’utilisation de cet algorithme pourrait permettre l’ajustement de tous les types de facteurs confondants. Cette thèse a pour but d’évaluer la performance de l’hdPS vis-à-vis le biais d’indication dans le contexte d’une étude observationnelle examinant l’effet diabétogénique potentiel des statines. Dans un premier temps, nous avons examiné si l’exposition aux statines était associée au risque de diabète. Les résultats de ce premier article suggèrent que l’exposition aux statines est associée avec une augmentation du risque de diabète et que cette relation est dose-dépendante et réversible dans le temps. Suite à l’identification de cette association, nous avons examiné dans un deuxième article si l’hdPS permettait un meilleur ajustement pour le biais d’indication que le PS; cette évaluation fut entreprise grâce à deux approches: 1) en fonction des mesures d’association ajustées et 2) en fonction de la capacité du PS et de l’hdPS à sélectionner des sous-cohortes appariées de patients présentant des caractéristiques similaires vis-à-vis 19 caractéristiques lorsqu’ils sont utilisés comme critère d’appariement. Selon les résultats présentés dans le cadre du deuxième article, nous avons démontré que l’évaluation de la performance en fonction de la première approche était non concluante, mais que l’évaluation en fonction de la deuxième approche favorisait l’hdPS dans son ajustement pour le biais d’indication. Le dernier article de cette thèse a cherché à examiner la performance de l’hdPS lorsque des facteurs confondants connus et mesurés sont masqués à l’algorithme de sélection. Les résultats de ce dernier article indiquent que l’hdPS pourrait, au moins partiellement, ajuster pour des facteurs confondants masqués et qu’il pourrait donc potentiellement ajuster pour des facteurs confondants non mesurés. Ensemble ces résultats indiquent que l’hdPS serait supérieur au PS dans l’ajustement pour le biais d’indication et supportent son utilisation lors de futures études observationnelles basées sur des données médico-administratives.

Risk -taking propensity of faculty, administrators, and academic department heads at a large, urban, multi -campus community college

This research was undertaken to explore dimensions of the risk construct, identify factors related to risk-taking in education, and study risk propensity among employees at a community college. Risk-taking propensity (RTP) was measured by the 12-item BCDQ, which consisted of personal and professional risk-related situations balanced for the money, reputation, and satisfaction dimensions of the risk construct. Scoring ranged from 1.00 (most cautious) to 6.00 (most risky).^ Surveys including the BCDQ and seven demographic questions relating to age, gender, professional status, length of service, academic discipline, highest degree, and campus location were sent to faculty, administrators, and academic department heads. A total of 325 surveys were returned, resulting in a 66.7% response rate. Subjects were relatively homogeneous for age, length of service, and highest degree.^ Subjects were also homogeneous for risk-taking propensity: no substantive differences in RTP scores were noted within and among demographic groups, with the possible exception of academic discipline. The mean RTP score for all subjects was 3.77, for faculty was 3.76, for administrators was 3.83, and for department heads was 3.64.^ The relationship between propensity to take personal risks and propensity to take professional risks was tested by computing Pearson r correlation coefficients. The relationships for the total sample, faculty, and administrator groups were statistically significant, but of limited practical significance. Subjects were placed into risk categories by dividing the response scale into thirds. A 3 x 3 factorial ANOVA revealed no interaction effects between professional status and risk category with regard to RTP score. A discriminant analysis showed that a seven-factor model was not effective in predicting risk category.^ The homogeneity of the study sample and the effect of a risk-encouraging environment were discussed in the context of the community college. Since very little data on risk-taking in education is available, risk propensity data from this study could serve as a basis for comparison to future research. Results could be used by institutions to plan professional development activities, designed to increase risk-taking and encourage active acceptance of change. ^