Abt Associates (United States)

Few type-specific antibodies that recognize drifted epitopes are made during post-vaccination exposures to SARS-CoV-2 variants1-12, perhaps due to suppression by previous immunity. We compared type-specific B cell responses in unvaccinated and vaccinated individuals with Delta and Omicron BA.1 SARS-CoV-2 variant infections. For both Delta, which is antigenically similar to the vaccine strain, and the more distant BA.1 variant, neutralizing antibodies were greater in post-vaccination variant infections than in primary variant infections. Delta type-specific memory B cells were reduced in post-vaccination Delta infections relative to primary variant infections. Yet some drifted epitopes in the Delta variant elicited minimal responses even in primary infections. For BA.1 infections, type-specific antibodies and memory B cells were mostly undetectable, irrespective of previous immunity. Thus, poor intrinsic antigenicity of drifted epitopes in Delta and BA.1 infections superseded the impact of previous immunity. Enhancing the immunogenicity of vaccine antigens may promote type-specific responses.

2 Background: The Oncology Care Model (OCM) was a voluntary episode-based alternative payment model designed to improve the value of care for fee-for-service Medicare beneficiaries receiving systemic therapy for cancer. Participating practices received monthly payments to support care transformation and could earn performance-based payments (or be responsible for recoupments) dependent on meeting quality and spending goals during 6-month episodes. We examined OCM impacts on quality, including measures on which performance-based payments were based and other measures of timely and effective care. Methods: We evaluated OCM impacts on care quality during 6-month episodes before (July 2014-January 2016) and after (July 2016-June 2021) OCM began using a difference-in-differences design. Patient episodes were attributed to OCM-participating practices (n=202) or propensity score-matched comparison practices (n=534). We examined 3 of the 5 quality measures used to determine OCM performance-based payments in OCM - measures that we could assess for both OCM and comparison episodes - and nine additional measures of oncology care quality endorsed by the Centers for Medicare & Medicaid Services, the National Quality Forum, the American Society of Clinical Oncology, or national guidelines. Statistical significance was defined as p<0.10 to avoid missing program impacts. Results: We studied 1,502,665 OCM and 1,662,859 comparison episodes. There was no impact of OCM on quality measures for determining performance-based payments (Table). There was no or modest impact on other measures of oncology care quality (Table). Conclusions: Both OCM and comparison groups showed improvements across quality measures, but OCM practices did not improve significantly more than the comparison practices. [Table: see text]

Reduced complexity tools that provide a representation of both primarily emitted particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5), secondarily formed PM2.5, and ozone (O3) allow for a quick assessment of many iterations of pollution control scenarios. Here, a new reduced complexity tool, Pattern Constructed Air Pollution Surfaces (PCAPS), that estimates annual average PM2.5 and seasonal average maximum daily average 8 h (MDA8) O3 for any source location in the United States is described and evaluated. Typically, reduced complexity tools are not evaluated for skill in predicting change in air pollution by comparison with more sophisticated modeling systems. Here, PCAPS was compared against multiple types of emission control scenarios predicted with state-of-the-science photochemical grid models to provide confidence that the model is realistically capturing the change in air pollution due to changing emissions. PCAPS was also applied with all anthropogenic emissions sources for multiple retrospective years to predict PM2.5 chemical components for comparison against routine surface measurements. PCAPS predicted similar magnitudes and regional variations in spatial gradients of measured chemical components of PM2.5. Model performance for capturing ambient measurements was consistent with other reduced complexity tools. PCAPS also did well at capturing the magnitude and spatial features of changes predicted by photochemical transport models for multiple emissions scenarios for both O3 and PM2.5. PCAPS is a flexible tool that provides source-receptor relationships using patterns of air quality gradients from a training data set of generic modeled sources to create interpolated air pollution gradients for new locations not part of the training database. The flexibility provided for both sources and receptors makes this tool ideal for integration into larger frameworks that provide emissions changes and need estimates of air quality to inform downstream analytics, which often includes an estimate of monetized health effects.

Working with PAHO/WHO to prioritize childhood cancer in the context of systems strengthening is central to St. Jude Children's Research Hospital (SJCRH)'s role as WHO Collaborating Centre for Childhood Cancer. This manuscript focuses on how SJCRH and PAHO/WHO have partnered to apply C5 (Country Collaboration for Childhood Cancer Control) to define and implement priority actions regionally, strengthening Ministry programs for childhood cancer, while implementing the Global Initiative for Childhood Cancer since 2018. Using C5, a tool developed by SJCRH, PAHO/WHO and SJCRH co-hosted regional/national workshops engaging authorities, clinicians and other stakeholders across 10 countries to map health systems needs and prioritize strategic activities (spanning Central America, Dominican Republic, Haiti, Brazil and Uruguay). SJCRH provided English/Spanish/Portuguese C5 versions/templates for analysis/prioritization exercises, and worked with PAHO/WHO and country teams to implement C5, analyze findings, and develop outputs. In an eight-country regional workshop, countries defined priorities within national/regional initiatives and ranked their value and political will, incorporating country-specific surveys and stakeholder dialogues. Each country prioritized one strategic activity for 2022-2023, exchanged insights via storytelling, and disseminated and applied results to inform country-specific and regional action plans. National workshops analyses have been incorporated into cancer control planning activities and collaborative work regionally. Implementation success factors include engaging actors beyond the clinic, enabling flexibility, and focusing on co-design with stakeholders. Joint implementation of C5 catalyzed prioritization and accelerated strategic activities to improve policies, capacity, and quality of care for children in the Americas, supporting Ministries to integrate childhood cancer interventions as part of systems strengthening.

In 2016, the Centers for Medicare & Medicaid Services (CMS) implemented the Service Intensity Add-on (SIA) payment for the Medicare Hospice Benefit. The SIA incentivizes direct patient care by registered nurses and medical social workers during the last seven days of life through additional payments to hospices. We examined 100% of Fee-for-Service Medicare hospice claims in Fiscal Year 2020 to determine whether SIA utilization varies by patient and hospice characteristics. Using hospice level fixed-effects regression, we examine the associations between SIA utilization and various beneficiary and hospice characteristics. Relative to beneficiaries with cancer as a principal diagnosis, we find that other diagnoses are associated with only a slight reduction in SIA utilization (a reduction between 0.6 and 1.1 percentage points - where the average SIA utilization overall is equal to 85.3%). Those identifying as black had a reduction in SIA of 1.3 percentage points compared to those identifying as white. Compared to a patient dying on a Sunday, a patient’s death on Tuesday through Friday was associated with a higher likelihood of SIA (between 9.7 and 11.6 percentage points more likely) and more SIA minutes (between 29.9 minutes and 36 minutes). All reported results were statistically significant at the 0.1% level. Based on these results, we find that SIA utilization varied by certain characteristics. As a result, CMS should continue to monitor rates of SIA utilization to better understand whether any patient groups appear to be underserved at the end of life.

Abstract The multispectral imaging of the sample from BAV, Vat. gr. 73 in 2016 resulted in the discovery of important texts by Dexippus and Polybius. Imaging with a then state-of-technology integrated multispectral imaging system helped reveal texts in the manuscript that were no longer visible to the unaided eye due to interventions by earlier librarians. The resulting images were processed with several techniques that produced remarkable results for researchers. Collaboration between the scientific team, the BAV staff and other investigators provided new information and large amounts of data for further research.

Trends in estimates of US pediatric SARS-CoV-2 infection-induced seroprevalence from commercial laboratory specimens may overrepresent children with frequent health care needs. We examined seroprevalence trends and compared seroprevalence estimates by testing type and diagnostic coding. Cross-sectional convenience samples of residual sera September 2021-February 2022 from 52 US jurisdictions were assayed for infection-induced SARS-CoV-2 antibodies; monthly seroprevalence estimates were calculated by age group. Multivariate logistic analyses compared seroprevalence estimates for specimens associated with International Classification of Diseases-Tenth Revision (ICD-10) codes and laboratory orders indicating well-child care with estimates for other pediatric specimens. Infection-induced SARS-CoV-2 seroprevalence increased in each age group, from 30 to 68 (14 years), 38 to 77 (511 years), and 40 to 74 (1217 years). On multivariate analysis, patients with well-child ICD-10 codes were seropositive more often than other patients aged 117 years (adjusted prevalence ratio [aPR] 1.04; 95 confidence interval [CI], 1.021.07); children aged 911 years receiving standard lipid screening were seropositive more often than those receiving other laboratory tests (aPR, 1.05; 95 CI, 1.021.08). Infection-induced seroprevalence more than doubled among children younger than 12 years between September 2021 and February 2022, and increased 85 in adolescents. Differences in seroprevalence by care type did not substantially impact US pediatric seroprevalence estimates.

PurposeThe purpose of this study is quantify the fast growing and dynamic population of workers known as digital nomads, workers who live a location agnostic, technology enabled lifestyle, traveling while living and working away from their home for extended periods of time. Since the pandemic, companies that embrace remote work policies are winning accolades. But along with the work-from-home crowd, there is another distinct group of employees that companies need to address: digital nomads – a rising new class of traditional job holders that have taken to the road. As human resources (HR) departments rewrite their policies for the remote workforce, it is critical that you put in place a digital nomad policy. Having a digital nomad policy will not only allow your company to attract and retain top talent but will also protect you from regulatory and legal risks.Design/methodology/approachThe Digital Nomad data cited in this paper comes from the 2021 MBO Partners State of Independence in America study, which was fielded in July of 2021. This is the 11th consecutive year this study has been conducted. For the 2021 study, Emergent Research and Rockbridge Associates surveyed 6,240 residents of the USA (aged 18 and older). The survey results were weighted to reflect the demographics of the USA.FindingsToday, the USA alone boasts 15.5 million digital nomads – a massive 112% increase from 2019 and 42% increase from 2020. With workers untethered from the office, the pandemic drove an increase in digital nomadism; however, the trend is here to stay. Corporations and HR teams need to take note and develop forward-thinking policies that will attract and retain talent.Originality/valueOver the past three years, MBO Partners, in partnership with Emergent Research, have collaborated on an extensive digital nomad study that has attracted the interest of Harvard Business Review. The company’s larger State of Independence report is also the longest-running longitudinal study on the independent workforce. Despite the large and growing number of digital nomads, few organizations have formal policies and programs for them. MBO is the first to develop policies and programs to help HR teams embrace this new era of talent who want the freedom to roam.

Almost half of under-five deaths occur during the neonatal period. Delivery with a skilled attendant, adherence to essential newborn care (ENC) and postnatal care (PNC) standards, and immediate treatment of infections are essential to improve neonatal survival. This article uses Demographic and Health Survey data from 45 low- and middle-income countries to assess 1) levels of ENC and PNC that mothers and newborns receive and how this differs by place of delivery and 2) levels of and sources for care-seeking for neonates sick with fever. For five of the ten ENC and PNC indicators assessed, less than two-thirds of mothers and newborns received care in alignment with global standards. Adherence is higher in private facilities than public facilities for all indicators other than immediate breastfeeding and skin-to-skin contact. Except for immediate breastfeeding, adherence is lowest for newborns born at home with a skilled birth attendant (SBA). Socioeconomic disparities exist in access to skilled delivery and adherence to ENC and PNC, with the largest disparities among newborns delivered at home with a SBA. Private provider adherence to ENC and PNC standards was relatively high for newborns from the wealthiest families, indicating that meeting recommended guidelines is achievable. On average across the 45 countries, half of caregivers for neonates with fever sought care outside the home and 45 percent of those sought care from the private sector. There were substantial socioeconomic disparities in care-seeking for fever, but illness prevalence and sources of care seeking were consistent across wealth quintiles. Closing inequities in neonatal care and care seeking and ensuring that all families, including the poorest, can access high quality maternal and newborn care is crucial to ensure equity and accelerate reductions in neonatal and child mortality.

To determine whether the Comprehensive Care for Joint Replacement (CJR) model, a mandatory episode-based payment program for knee and hip replacement surgery, affected patient-reported measures of quality. Surveys of Medicare fee-for-service beneficiaries who had hip or knee replacement surgery, collected between July 2018 and March 2019, secondary Medicare administrative data, the Provider of Services file, CJR and Bundled Payments for Care Improvement participant lists from the Centers for Medicare & Medicaid Services, and the Area Health Resource Files. In 2018, participation in the CJR model was mandatory for nearly all hospitals in 34 randomly selected, metropolitan statistical areas (MSAs) that had high historical Medicare payments for lower-extremity joint replacements surgery. The control group included 47 high-payment MSAs randomly assigned as controls. We estimated risk-adjusted differences in self-reported measures of functional status and pain, satisfaction with care, and caregiver help between respondents in CJR hospitals and respondents in hospitals located in the control group. We selected a census of CJR patients and an equal number of control patients to survey. We fielded two waves of surveys using a mail and phone protocol, yielding 8433 CJR and 9014 control respondents. CJR respondents were slightly more likely to depend on caregivers for certain activities of daily living when they got home (either directly from the hospital or after an institutional post-acute care stay). On a 100-point scale, differences ranged from -2.6 points (p< 0.01) for help needed bathing to -1.7 points (p< 0.05) for help needed using the toilet. However, differences in eight measures of self-reported functional status approximately 90-120 days after hospital discharge were not statistically significant, ranging from -1.1% (p= 0.087) to 0.7% (p= 0.437). CJR did not harm patient health or affect patient satisfaction on average but did increase reliance on caregivers during recovery.