Motivated by the extremely low level of the CBOE VIX accompanied by the high level of US economic policy uncertainty in the period of late 2016 to the end of 2017, we examine the factors affecting the relationship between market volatility and economic policy uncertainty in the United States and the United Kingdom. Our analysis shows that low-quality political signals, higher opinion divergence among investors, and exceptional equity market performance consistently weaken the positive relationship between implied market volatility and policy uncertainty. Our findings help to explain the divergence between the market volatility index and economic policy uncertainty post the 2016 US presidential election and the UK Brexit referendum.
Background Community health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs). However, in countries with decentralized health systems like the Philippines, the quality and effectiveness of CHW programs may differ across settings due to variations in resource allocation and local politics. In the context of health system decentralization and the push toward UHC in the Philippines, the objective of this study was to explore how the experiences of CHWs across different settings were shaped by the governance and administration of CHW programs. Methods We conducted 85 semi-structured interviews with CHWs (n = 74) and CHW administrators (n = 11) in six cities across two provinces (Negros Occidental and Negros Oriental) in the Philippines. Thematic analysis was used to analyze the qualitative data with specific attention to how the experiences of participants differed within and across geographic settings. Results Health system decentralization contributed to a number of variations across settings including differences in the quality of human resources and the amount of financial resources allocated to CHW programs. In addition, the quality and provider of CHW training differed across settings, with implications for the capacity of CHWs to address specific health needs in their community. Local politics influenced the governance of CHW programs, with CHWs often feeling pressure to align themselves politically with local leaders in order to maintain their employment. Conclusions The functioning of CHW programs can be challenged by health system decentralization through the uneven operationalization of national health priorities at the local level. Building capacity within local governments to adequately resource CHWs and CHW programs will enhance the potential of these programs to act as a bridge between the local health needs of communities and the public health system.
Traditional geospatial information platforms are built, managed and maintained by the geoinformation agencies. They integrate various geospatial data (such as DLG, DOM, DEM, gazetteers, and thematic data) to provide data analysis services for supporting government decision making. In the era of big data, it is challenging to address the data- and computing- intensive issues by traditional platforms. In this research, we propose to build a spatiotemporal cloud platform, which uses HDFS for managing image data, and MapReduce-based computing service and workflow for high performance geospatial analysis, as well as optimizing auto-scaling algorithms for Web client users' quick access and visualization. Finally, we demonstrate the feasibility by several GIS application cases.
Traditional geospatial information platforms are built, managed and maintained by the geoinformation agencies. They integrate various geospatial data (such as DLG, DOM, DEM, gazetteers, and thematic data) to provide data analysis services for supporting government decision making. In the era of big data, it is challenging to address the data- and computing- intensive issues by traditional platforms. In this research, we propose to build a spatiotemporal cloud platform, which uses HDFS for managing image data, and MapReduce-based computing service and workflow for high performance geospatial analysis, as well as optimizing auto-scaling algorithms for Web client users' quick access and visualization. Finally, we demonstrate the feasibility by several GIS application cases.
Purpose of the studyThe primary Week 48 analysis of this ongoing, randomized, double‐blind, double‐dummy, active‐controlled Phase 3 international trial of elvitegravir/cobicistat/emtricitabine/tenofovir DF (Quad) in treatment‐naïve patients demonstrated that Quad was non‐inferior to atazanavir boosted by ritonavir (ATV/r) + FTC/TDF with a differentiated safety profile. We report the Week 96 interim data.MethodsKey eligibility criteria included HIV‐1 RNA≥5,000 c/mL and eGFR≥70 mL/min. Virologic success (HIV‐1 RNA <50 c/mL) at Week 96 was assessed per snapshot algorithm. Adverse events and laboratory data were collected prospectively. Bone mineral density (BMD) was assessed by DEXA scan in a subgroup of patients.Results708 patients (90% male, 74% white, 41% with HIV‐1 RNA >100,000 c/mL) were randomized and treated. At Week 48, Quad was non‐inferior to ATV/r+FTC/TDF (90% vs 87%, difference 3.0%, 95% CI −1.9% to 7.8%). High rates of virologic success were maintained at Week 96 (83% vs 82%, difference 1.1%, 95% CI −4.5% to 6.7%). Subgroup analysis revealed similar rates of virologic success in patients with baseline HIV‐1 RNA >100,000 c/mL (82% vs 80%). Mean CD4 cell increases (cells/mm3) were 256 vs 261 at Week 96. Emergent resistance was infrequent (2% vs<1%). Rates of study drug discontinuation due to adverse events (AEs) were low and comparable (4% vs 6%). Rates of study drug discontinuation due to renal reasons remained low and similar through Week 96 (3 [0.8%] vs 2 [0.6%]); since Week 48, 1 patient in each group discontinued study drug due to serum creatinine (Cr) increase without features of proximal renal tubulopathy. Median increases from baseline in serum Cr (µmol/L [mg/dL]) in Quad vs ATV/r+FTC/TDF at Week 96 (10.6 vs 7.1 [0.12 vs 0.08]) were similar to those at Week 48 (10.6 vs 7.1 [0.12 vs 0.08]). Quad continued to have smaller increases (mmol/L [mg/dL]) in triglycerides (0.06 vs 0.18 [5 vs 16], P=0.012); Quad had greater increases in total cholesterol (0.36 vs 0.21 [14 vs 8], P=0.046) at Week 96 only; changes in LDL and HDL cholesterol were similar. Quad had smaller mean decreases (%) in BMD (hip: −3.16 vs ‐4.19, P=0.069, spine: −1.96 vs −3.54, P=0.049).ConclusionsAt Week 96, Quad demonstrated high rates of virologic suppression with low rates of resistance and a differentiated safety and tolerability profile relative to ATV/r+FTC/TDF. These results support the durable efficacy and long‐term safety of Quad in HIV‐1 infected patients.
Background The healthcare system of mainland China is undergoing drastic reform and the optimal models for healthcare financing for provision of primary care will need to be identified. This study compared the performance indicators of the community health centres (CHCs) under different healthcare financing systems in the six cities of the Pearl River Delta region. Methods Approximately 300 hypertensive patients were randomly recruited from the computerized chronic disease management records provided by one CHC in each of the six cities in 2011 using a multi-stage cluster random sampling method. The major outcome measures included the treatment rate of hypertension, defined as prescription of ≥ one antihypertensive agent; and the control rate of hypertension, defined as systolic blood pressure levels <140 mmHg and diastolic blood pressure levels <90 mmHg in patients without diabetes mellitus, or <130/80 mmHg among patients with concomitant diabetes. Binary logistic regression analyses were conducted with these two measures as outcome variables, respectively, controlling for patients' socio-demographic variables. The financing system (Hospital- vs. Government- vs. private-funded) was the independent variable tested for association with the outcomes. Results From 1,830 patients with an average age of 65.9 years (SD 12.8), the overall treatment and control rates were 75.4% and 20.2%, respectively. When compared with hospital-funded CHCs, patients seen in the Government-funded (adjusted odds ratio [AOR] 0.462, 95% C.I. 0.325–0.656) and private-funded CHCs (AOR 0.031, 95% C.I. 0.019–0.052) were significantly less likely to be prescribed antihypertensive medication. However, the Government-funded CHC was more likely to have optimal BP control (AOR 1.628, 95% C.I. 1.157–2.291) whilst the privately-funded CHC was less likely to achieve BP control (AOR 0.146, 95% C.I. 0.069–0.310), irrespective of whether antihypertensive drugs were prescribed. Conclusions Privately-funded CHCs had the lowest rates of BP treatment and control due to a variety of potential factors as discussed.
AbstractBackgroundYouth with intellectual disabilities experience disparities in physical activity and diet quality. Physical and food literacy are hypothesised to support adoption of healthy lifestyles; however, few such interventions have been developed for this population.MethodParticipants with intellectual disabilities ages 12–16 years were recruited for a 12‐week online sports skills and nutrition education intervention. Feasibility, acceptability, and preliminary efficacy were assessed by attendance, satisfaction, and pre‐post measures of motor skills, perceived competence and motivation for physical activity, classifying foods, making healthy choices, and food consumption.ResultsSix teens participated in the program and attended 87.5% of the sessions. Satisfaction data suggested that the program was well‐received by both teens and parents. Trends toward improvements on physical activity and nutrition outcome measures were observed.ConclusionsPreliminary data from this pilot study suggest that physical and food literacy in youth with intellectual disabilities can be improved, which in turn may contribute to the adoption of healthy lifestyles.
