ResearchPad - public-policy https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Retrospective observational cohort study on innovation in oncology and progress in survival: How far have we gotten in the two decades of treating patients with advanced non-small cell lung cancer as a single population?]]> https://www.researchpad.co/article/elastic_article_13816 We assessed the impact of new antineoplastic agents on the overall survival (OS) of advanced non-small cell lung cancer (aNSCLC) patients followed up until 2012. Multivariate regression models were run for OS (outcome) and four proxies for innovation (exposure): Index (InnovInd, for SEER-Research data 1973–2012) and three levels of aggregation of Mean Medication Vintage, i.e. Overall (MMVOverall), using data aggregated at the State Level (MMVState), and using patient-level data (MMVPatient) using data from the US captured in SEER-Medicare 1991–2012. We derived Hazard ratios (HR) from Royston-Parmar models and odds ratios (OR) from a logistic regression on 1-year OS. Including 164,704 patients (median age 72 years, 56.8% stage IV, 61.8% with no comorbidities, 37.8% with adenocarcinoma, 22.9% with squamous-cell, 6.1% were censored). One-year OS improved from 0.22 in 1973 to 0.39 in 2012, in correlation with InnovInd (r = 0.97). Ten new NSCLC drugs were approved and 28 more used off-label. Regression-models results indicate that therapeutic innovation only marginally reduced the risk of dying (HROverall = 0.98 [0.98–0.98], HRMMV-Patient = 0.98 [0.97–0.98], and HRMMV-State = 0.98 [0.98–0.98], and slightly improved 1-year survival (ORMMV-Overall = 1.05 95%CI [1.04–1.05]). These results were validated with data from the Swedish National Health Data registers. Until 2013, aNSCLC patients were treated undifferentiated and the introduction of innovative therapies had statistically significant, albeit modest, effects on survival. Most treatments used off-guidelines highlight the high unmet need; however new advancements in treatment may further improve survival.

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<![CDATA[Why pandemic response is unique: powerful experts and hands-off political leaders]]> https://www.researchpad.co/article/N777a5214-aec1-4675-9510-3b88967dc8c4

Purpose

The purpose of this paper is to show that 2009 H1N1 “swine” influenza pandemic vaccination policies deviated from predictions established in the theory of political survival, and to propose that pandemic response deviated because it was ruled by bureaucratized experts rather than by elected politicians.

Design/methodology/approach

Focussing on the 2009 H1N1 pandemic, the paper employs descriptive statistical analysis of vaccination policies in nine western democracies. To probe the plausibility of the novel explanation, it uses quantitative and qualitative content analyses of media attention and coverage in two deviant cases, the USA and Denmark.

Findings

Theories linking political survival to disaster responses find little empirical support in the substantial cross-country variations of vaccination responses during the 2009 H1N1 pandemic. Rather than following a political logic, the case studies of media coverage in the USA and Denmark demonstrate that the response was bureaucratized in the public health agencies (CDC and DMHA, respectively). Hence, while natural disaster responses appear to follow a political logic, the response to pandemics appears to be more strongly instituted in the hands of bureaucratic experts.

Research limitations/implications

There is an added value of encompassing bureaucratic dynamics in political theories of disaster response; bureaucratized expertise proved to constitute a strong plausible explanation of the 2009 pandemic vaccination response.

Practical implications

Pandemic preparedness and response depends critically on understanding the lessons of the 2009 H1N1 pandemic; a key lesson supported by this paper is that expert-based agencies rather than political leaders are the pivotal actors.

Originality/value

This paper is the first to pinpoint the limitations of political survival theories of disaster responses with respect to the 2009 pandemic. Further, it is among the few to analyze the causes of variations in cross-country pandemic vaccination policies during the 2009 H1N1 pandemic.

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<![CDATA[The “wicked problems” of governing UK health security disaster prevention]]> https://www.researchpad.co/article/Nb3e15b1a-82be-4f74-92da-aab246f1f583

Purpose

The purpose of this paper is to examine the governance and policy-making challenges in the context of “wicked problems” based on the case of pandemic influenza.

Design/methodology/approach

The case study research is based on an analysis of official documentation and interviews with policy elites at multiple levels of UK governance.

Findings

Results of this study show that policy actors regard risk communication, the dynamics of international public policy and UK territorial governance as the main governance challenges in the management of influenza at a macro-level. The paper also serves to identify that although contingencies management for epidemiological issues require technical and scientific considerations to feature in governance arrangements, equally there are key “wicked problems” in the context public policy that pervade the health security sector.

Practical implications

The study indicates the need to build in resources at a national level to plan for policy coordination challenges in areas that might at first be seen as devoid of political machinations (such as technical areas of public policy that might be underpinned by epidemiological processes). The identification of the major governance challenges that emerge from the pandemic influenza case study is a springboard for a research agenda in relation to the analysis of the parallels and paradoxes of governance challenges for health security across EU member states.

Originality/value

This paper provides a novel interrogation of the pandemic influenza case study in the context of UK governance and public policy by providing a strategic policy lens from perspective of elites.

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<![CDATA[Long-term effect of the Brazilian Workers’ Food Program on the nutritional status of manufacturing workers: A population-based prospective cohort study]]> https://www.researchpad.co/article/N23375fc9-a89d-407e-9d06-75f348bd7d78

Background

The Brazilian Workers Food Program (WFP) is a public policy program of nutritional assistance to workers, with the main objective of improving nutritional conditions, which was implemented 40 years ago and serves over 21.4 million workers.

Objectives

To compare the long-term change in anthropometric indicators of the nutritional status and dietary intake between workers of manufacturing industries adherent to and non-adherent to the WFP.

Methods

A prospective cohort study, based on a combined stratified and multistage probability sampling, was carried out, with two waves with a 4-year interval. The change in body mass index (BMI), waist circumference (WC) and dietary intake at lunch by the 24-hour recall method were compared between groups with analysis of covariance.

Results

A total of 273 workers in 16 industries from an initial cohort of 1069 workers in 26 industries of the State of Rio Grande do Norte in Brazil were evaluated in the two waves. The mean age was 37±10 years and 53.1% were male, with no differences between groups in age and sex distribution. BMI increased in both groups (0.44 kg/m2 in non-WFP, p = 0.003, and 0.56 kg/m2 in WFP, p = 0.0006) and WC increased in the WFP group (1.50 cm, p = 0.0006). BMI change over time did not show statistical differences between groups (p = 0.54) but WC had a greater increase in the WFP group (difference 1.37 cm, p = 0.047). There were no differences between groups in the change over time of the dietary intake.

Conclusion

BMI and WC increased over time in manufacturing workers of industries both adherent and non-adherent to the WFP, but with a greater increase of WC in the WFP group. In order to achieve the objectives of the WFP, there will be a need for periodic evaluation and monitoring of nutritional indicators in these workers and implementation of monitoring and enforcement actions of the WFP.

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<![CDATA[Incidence of statin use in older adults with and without cardiovascular disease and diabetes mellitus, January 2008- March 2018]]> https://www.researchpad.co/article/N40ec07ea-30b4-4753-a09f-b8fe9ef6ec46

Background

Data from randomized controlled trials and observational studies on older adults who take statins for primary prevention of atherosclerotic cardiovascular disease are limited. To determine the incidence of statin use in older adults with and without cardiovascular disease (CVD) and/or diabetes (DM), we conducted a descriptive observational study.

Methods

The cohort consisted of health plan members in the NIH Collaboratory Distributed Research Network aged >75 years who had continuous drug and medical benefits for ≥183 days during the study period, January 1, 2008- March 31, 2018. We defined DM and CVD using diagnosis codes, and identified statins using dispensing data. Statin use was considered incident if a member had no evidence of statin exposure in the claims during the previous 183 days, and the use was considered long-term if statins were supplied for ≥180 days. Incidence rates were reported among members with and without CVD and/or diabetes, and stratified by year, sex, and age group.

Results

Among 757,569 eligible members, 109,306 older adults initiated statins and 54,624 became long-term users. Health plan members with CVD had the highest incidence of statin use (143.9 initiators per 1,000 member-years for CVD & DM; 114.5 initiators per 1,000 member-years for CVD & No DM). Among health plan members without CVD, those with DM had rates of statin use that were over two times higher than members without DM (76.1 versus 34.5 initiators per 1,000 member-years, respectively). Statin initiation remained steady throughout 2008–2016, was slightly higher in males, and declined with increasing age.

Conclusion

Incidence of statin use varied by CVD and DM comorbidity, and was lowest among those without CVD. These results highlight the potential clinical equipoise to conduct large pragmatic clinical trials to generate evidence that could be used to inform future blood cholesterol guidelines.

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<![CDATA[Exploring the use of machine learning for risk adjustment: A comparison of standard and penalized linear regression models in predicting health care costs in older adults]]> https://www.researchpad.co/article/5c89772fd5eed0c4847d264d

Background

Payers and providers still primarily use ordinary least squares (OLS) to estimate expected economic and clinical outcomes for risk adjustment purposes. Penalized linear regression represents a practical and incremental step forward that provides transparency and interpretability within the familiar regression framework. This study conducted an in-depth comparison of prediction performance of standard and penalized linear regression in predicting future health care costs in older adults.

Methods and findings

This retrospective cohort study included 81,106 Medicare Advantage patients with 5 years of continuous medical and pharmacy insurance from 2009 to 2013. Total health care costs in 2013 were predicted with comorbidity indicators from 2009 to 2012. Using 2012 predictors only, OLS performed poorly (e.g., R2 = 16.3%) compared to penalized linear regression models (R2 ranging from 16.8 to 16.9%); using 2009–2012 predictors, the gap in prediction performance increased (R2:15.0% versus 18.0–18.2%). OLS with a reduced set of predictors selected by lasso showed improved performance (R2 = 16.6% with 2012 predictors, 17.4% with 2009–2012 predictors) relative to OLS without variable selection but still lagged behind the prediction performance of penalized regression. Lasso regression consistently generated prediction ratios closer to 1 across different levels of predicted risk compared to other models.

Conclusions

This study demonstrated the advantages of using transparent and easy-to-interpret penalized linear regression for predicting future health care costs in older adults relative to standard linear regression. Penalized regression showed better performance than OLS in predicting health care costs. Applying penalized regression to longitudinal data increased prediction accuracy. Lasso regression in particular showed superior prediction ratios across low and high levels of predicted risk. Health care insurers, providers and policy makers may benefit from adopting penalized regression such as lasso regression for cost prediction to improve risk adjustment and population health management and thus better address the underlying needs and risk of the populations they serve.

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<![CDATA[Public finances and tobacco taxation with product variety: Theory and application to Senegal and Nigeria]]> https://www.researchpad.co/article/5c6f14b2d5eed0c48467a641

This study endeavors to answer two questions: which category of excise taxes is more appropriate for Senegal and Nigeria and which consequences an increase of the tobacco taxes would have on the price, the demand and the tax revenues in each one of the two countries? To answer these questions, we adopt a double approach: first, a theoretical model of taxation with variety; and second, a simulation model to answer the second question. The results of the theoretical model indicate that, in the context of excise taxation, the number of products variety—or that of cigarette brands—directly affects both the degree of market concentration and the marginal effects of specific and ad valorem excise taxes on the price of tobacco. In addition, the comparison of the marginal effects of ad valorem and specific excise taxes depends on the marginal costs of production of different varieties weighted by the tax rates and the number of varieties. Our empirical results first show that the specific excise taxes are more adapted to Senegal while ad valorem excise taxes fit best Nigeria. This result crucially matters for the excise taxes are exclusively of an ad valorem nature in both Senegal and Nigeria. It is perfectly possible to envisage a situation where the two main forms of excise taxes could co-exist. It also appears from our results that tax development does not have the same implications for the two countries. Increasing tobacco taxes in Senegal strongly reduces the demand, but also induces a decrease in the tax revenues, while this will imply a lesser decline in demand in Nigeria accompanied however by a sharp increase of the country’s tax revenues. This difference stems from the fact that the price-elasticity of tobacco demand is very high in Senegal, contrary to Nigeria. Finally, it is important to mention that there is a specific threshold beyond which the tax increases cease to have a positive effect on tax revenues in Nigeria.

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<![CDATA[Alternative method to measure the VAT gap in the EU: Stochastic tax frontier model approach]]> https://www.researchpad.co/article/5c58d615d5eed0c4840315a6

In this paper, we pursue an alternative method to measure the Value Added Tax gap in the European Union using the stochastic tax frontier model. We use the Value Added Tax total tax liability as the input to estimate the optimal frontier of the Value Added Tax, as well as to predict technical inefficiency. Using the latest innovations of the stochastic frontier approach, we aim to obtain the accurate size of the Value Added Tax gap in the EU-26 countries and contrast them with extant estimates. The obtained estimates of the Value Added Tax gap using the stochastic tax frontier model are different from the estimates produced by the top-down method to calculate the Value Added Tax gap in the EU. Moreover, the stochastic tax frontier approach allows us to disentangle the Value Added Tax gap, which is time dependent, from the persistent Value Added Tax gap, which is country specific. The stochastic tax frontier model allows us to test the effect of exogenous factors on the technical inefficiency of the Value Added Tax and propose appropriate policy recommendations.

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<![CDATA[Readmission risk and costs of firearm injuries in the United States, 2010-2015]]> https://www.researchpad.co/article/5c536c37d5eed0c484a49bcc

Background

In 2015 there were 36,252 firearm-related deaths and 84,997 nonfatal injuries in the United States. The longitudinal burden of these injuries through readmissions is currently underestimated. We aimed to determine the 6-month readmission risk and hospital costs for patients injured by firearms.

Methods

We used the Nationwide Readmission Database 2010–2015 to assess the frequency of readmissions at 6 months, and hospital costs associated with readmissions for patients with firearm-related injuries. We produced nationally representative estimates of readmission risks and costs.

Results

Of patients discharged following a firearm injury, 15.6% were readmitted within 6 months. The average annual cost of inpatient hospitalizations for firearm injury was over $911 million, 9.5% of which was due to readmissions. Medicare and Medicaid covered 45.2% of total costs for the 5 years, and uninsured patients were responsible for 20.1%.

Conclusions

From 2010–2015, the average total cost of hospitalization for firearm injuries per patient was $32,700, almost 10% of which was due to readmissions within 6 months. Government insurance programs and the uninsured shouldered most of this.

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<![CDATA[Cryptanalysis and improvement of an elliptic curve based signcryption scheme for firewalls]]> https://www.researchpad.co/article/5c1c0af5d5eed0c484426fcd

In network security, firewall is a security system that observes and controls the network traffic based on some predefined rules. A firewall sets up a barrier between internal network and another outside unsecured network, such as the Internet. A number of signcryption schemes for firewall are proposed over the years, many of them are proved to have security flaws. In this paper, an elliptic curve based signcryption scheme for firewalls is analyzed. It is observed that the scheme is not secure and has many security flaws. Anyone who knows the public parameters, can modify the message without the knowledge of sender and receiver. The claimed security attributes of non-repudiation, unforgeability, integrity and authentication are compromised. After successful cryptanalysis of this scheme, we proposed a modified version of the scheme.

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<![CDATA[Menopausal hormone therapy and the incidence of carpal tunnel syndrome in postmenopausal women: Findings from the Women’s Health Initiative]]> https://www.researchpad.co/article/5c102901d5eed0c484248c7e

Importance

Carpal tunnel syndrome (CTS) is a common and debilitating condition that commonly affects postmenopausal women.

Objective

To determine the effect of menopausal hormone therapy (HT) in healthy postmenopausal women on CTS risk.

Design

We conducted a secondary analysis of the Women’s Health Initiative’s (WHI) HT trials linked to Medicare claims data. Separate intention-to-treat analyses were performed for the two trials; the conjugated equine estrogens alone (CEE alone) and the trial of CEE plus medroxyprogesterone acetate (MPA) trial. (ClinicalTrials.gov, NCT number): NCT00000611.

Setting

Two randomized, double-blind, placebo-controlled trials conducted at 40 US clinical centers.

Participants

The sample size included in the analysis was 16,053 community-dwelling women aged ≥65 years at study entry or those who later aged into Medicare eligibility, and who were enrolled in Medicare (including Part A and/or Part B coverage).

Intervention

Women with hysterectomy were randomized to 0.625 mg/d of conjugated equine estrogens (CEE) or placebo (n = 8376). Women without hysterectomy were randomized to estrogen plus progestin (E+P), given as CEE plus 2.5 mg/d of medroxyprogesterone acetate (n = 14203).

Main outcome(s)

The primary outcome was incident CTS and the secondary outcome was therapeutic CTS procedure occurring during the intervention phases of the trials.

Results

A total of 16,053 women were randomized in both trials. During mean follow up of 4.5 ± 2.8 years in the CEE trial (n = 6,833), there were 203 incident CTS cases in the intervention and 262 incident CTS cases in the placebo group (HR, 0.78; 95% CI, 0.65–0.94; P = 0.009). The CEE+MPA trial (n = 9,220) followed participants for a mean of 3.7 ± 2.3 years. There were 173 incident CTS cases in the intervention compared to 203 cases in the placebo group (HR, 0.80, 95% CI, 0.65–0.97; P = 0.027).

Conclusions

These findings suggest a protective effect of menopausal HT on the incidence of CTS among postmenopausal women. A potential therapeutic role for other forms of estrogen therapy in the management of CTS warrants future research.

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<![CDATA[Screening, diagnosis, and long-term health outcomes in developing countries—The case of hypertension]]> https://www.researchpad.co/article/5c117b37d5eed0c4846984a5

Hypertension is a rapidly growing problem in developing countries. At the same time, due to its asymptomatic nature, the afflicted population is largely unaware of being hypertensive. Due to a lack of resources, routine medical exams are very rare in developing countries and many sick individuals remain undiagnosed. Using a large sample of hypertensive individuals from Indonesia, we show the importance of being diagnosed. Diagnosed individuals exhibit lower systolic and diastolic blood pressure, and overall lower probability of remaining hypertensive than undiagnosed individuals. We also show the main channels through which this is achieved: taking medication, routinely monitoring one’s blood pressure, and engaging in moderate physical activities. We also point to channels through which additional benefits could be realized, but that are currently ineffective: dietary changes and maintaining a healthy body weight. Combined, these results point to the importance of directing public policy towards addressing the under-diagnosis problem and educating the public of the benefits of adopting a healthy life-style.

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<![CDATA[The palatability of sugar-sweetened beverage taxation: A content analysis of newspaper coverage of the UK sugar debate]]> https://www.researchpad.co/article/5c117b64d5eed0c484698fe3

Background

Excess sugar consumption, including sugar-sweetened beverages (SSBs), contributes to a variety of negative health outcomes, particularly for young people. The mass media play a powerful role in influencing public and policy-makers’ perceptions of public health issues and their solutions. We analysed how sugar and SSB policy debates were presented in UK newspapers at a time of heightened awareness and following the announcement of the UK Government’s soft drinks industry levy (SDIL), to inform future public health advocacy.

Methods & findings

We carried out quantitative content analysis of articles discussing the issues of sugar and SSB consumption published in 11 national newspapers from April 2015 to November 2016. 684 newspaper articles were analysed using a structured coding frame. Coverage peaked in line with evidence publication, campaigner activities and policy events. Articles predominantly supportive of SSB taxation (23.5%) outnumbered those that were predominantly oppositional (14.2%). However, oppositional articles outnumbered supportive ones in the month of the announcement of the SDIL. Sugar and SSB consumption were presented as health risks, particularly affecting young people, with the actions of industry often identified as the cause of the public health problem. Responsibility for addressing sugar overconsumption was primarily assigned to government intervention.

Conclusion

Our results suggest that the policy landscape favouring fiscal solutions to curb sugar and SSB consumption has benefited from media coverage characterising the issue as an industry-driven problem. Media coverage may drive greater public acceptance of the SDIL and any future taxation of products containing sugar. However, future advocacy efforts should note the surge in opposition coinciding with the announcement of the SDIL, which echoes similar patterns of opposition observed in tobacco control debates.

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<![CDATA[The zone of parental discretion and the complexity of paediatrics: A response to Alderson]]> https://www.researchpad.co/article/5c217f08d5eed0c4844cc509

Alderson critiques our recent book on the basis that it overlooks children’s own views about their medical treatment. In this response, we discuss the complexity of the paediatric clinical context and the value of diverse approaches to investigating paediatric ethics. Our book focuses on a specific problem: entrenched disagreements between doctors and parents about a child’s medical treatment in the context of a paediatric hospital. As clinical ethicists, our research question arose from clinicians’ concerns in practice: What should a clinician do when he or she thinks that parents are choosing a treatment pathway that does not serve the child’s best interests? Alderson’s work, in contrast, focuses on the much broader issue of children’s role in decision-making about treatment and research. We argue that these different types of work are zooming in on different aspects of paediatric ethics, with its complex mix of agents, issues and relationships. Paediatric ethics overall needs a rich mix of approaches, investigating a range of different focal problems in order to further understanding. The zone of parental discretion is not incompatible with valuing children’s rights and views; its focus is a different element of a complex whole.

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<![CDATA[Commentary on “The number of undocumented immigrants in the United States: Estimates based on demographic modeling with data from 1990-2016”]]> https://www.researchpad.co/article/5bae98d740307c0c23a1c146

“The number of undocumented immigrants in the United States: Estimates based on demographic modeling with data from 1990–2016” by Fazel-Zarandi, Feinstein and Kaplan presents strikingly higher estimates of the unauthorized immigrant population than established estimates using the residual method. Fazel-Zarandi et. al.’s estimates range from a low or “conservative” number of 16.7 million unauthorized immigrants, to an “average” of 22.1 million, and to a high of 27.5 million. The Pew Hispanic Center estimated the population at 11.3 million in 2016, and the Department of Homeland Security (DHS) estimated it at 12.3 million. The new method shows much more rapid growth in unauthorized immigration during the 1990s and a substantially higher population in 2000 (13.3 million according to their “conservative” model) than Pew (8.6 million) and DHS (8.5 million). In this commentary, we explain that such an estimate for 2000 is implausible, as it suggests that the 2000 Census undercounted the unauthorized immigrant population by at least 42% in the 2000 Census, and it is misaligned with other demographic data. Fazel-Zarandi, Feinstein and Kaplan’s model produces estimates that have a 10 million-person range in 2016, far too wide to be useful for public policy purposes; their estimates are not benchmarked against any external data sources; and their model appears to be driven by assumptions about return migration of unauthorized immigrants during the 1990s. Using emigration rates from the binational Mexican Migration Project survey for the illegal border-crosser portion of the unauthorized population, we generate a 2000 unauthorized population estimate of 8.2 million—slightly below Pew and DHS’s estimates—without changing other assumptions in the model. We conclude that this new model’s estimates are highly sensitive to assumptions about emigration, and moreover, that the knowledge base about emigration in the unauthorized population during the 1990s is not well enough developed to support the model underlying their estimates.

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<![CDATA[<i>PLoS Medicine</i> Issue Image | Vol. 15(11) November 2018]]> https://www.researchpad.co/article/5c0ae483d5eed0c484589dd7

Advancing the beneficial use of machine learning in health care and medicine: Toward a community understanding

Modern statistical modeling techniques—often called machine learning—are posited as a transformative force for human health. This month we present our Special Issue, Guest Edited by Atul Butte, Suchi Saria, and Aziz Sheikh, on machine learning-based advances in clinical care, health systems, and pathophysiology.

The Special Issue provides a broad perspective on what machine learning can currently achieve in health and biomedicine, and presents expert commentary on future benefits and constraints of bringing machine learning into clinical care, population health, and public policy.

In our accompanying Editorial, the PLOS Medicine Editors parlay the lessons we've learned during the development of the Special Issue into guidance for generating machine learning-based models that are demonstrably valid and fit-for-purpose.

Image Credit: StockSnap, Pixabay

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<![CDATA[Defining Catastrophic Costs and Comparing Their Importance for Adverse Tuberculosis Outcome with Multi-Drug Resistance: A Prospective Cohort Study, Peru]]> https://www.researchpad.co/article/5989da4fab0ee8fa60b8d9f0

Tom Wingfield and colleagues investigate the relationship between catastrophic costs and tuberculosis outcomes for patients receiving free tuberculosis care in Peru.

Please see later in the article for the Editors' Summary

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<![CDATA["Willing to Pay?" Tax Compliance in Britain and Italy: An Experimental Analysis]]> https://www.researchpad.co/article/5989da22ab0ee8fa60b7f663

As shown by the recent crisis, tax evasion poses a significant problem for countries such as Greece, Spain and Italy. While these societies certainly possess weaker fiscal institutions as compared to other EU members, might broader cultural differences between northern and southern Europe also help to explain citizens’ (un)willingness to pay their taxes? To address this question, we conduct laboratory experiments in the UK and Italy, two countries which straddle this North-South divide. Our design allows us to examine citizens’ willingness to contribute to public goods via taxes while holding institutions constant. We report a surprising result: when faced with identical tax institutions, redistribution rules and audit probabilities, Italian participants are significantly more likely to comply than Britons. Overall, our findings cast doubt upon “culturalist” arguments that would attribute cross-country differences in tax compliance to the lack of morality amongst southern European taxpayers.

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<![CDATA[Measuring Nepotism through Shared Last Names: Are We Really Moving from Opinions to Facts?]]> https://www.researchpad.co/article/5989db12ab0ee8fa60bcc65f

Nepotistic practices are detrimental for academia. An analysis of shared last names among academics was recently proposed to measure the diffusion of nepotism, the results of which have had a huge resonance. This method was thus proposed to orient the decisions of policy makers concerning cuts and funding. Because of the social relevance of this issue, the validity of this method must be assessed. Thus, we compared results from an analysis of Italian and United Kingdom academic last names, and of Italian last and given names. The results strongly suggest that the analysis of shared last names is not a measure of nepotism, as it is largely affected by social capital, professional networking and demographic effects, whose contribution is difficult to assess. Thus, the analysis of shared last names is not useful for guiding research policy.

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<![CDATA[Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study]]> https://www.researchpad.co/article/5989db5aab0ee8fa60bdf254

Background

Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake.

Methods and findings

Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015–29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents.

Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented the tax in 2015; (2) sales of taxed beverages would decline, and sales of untaxed beverages would rise, in Berkeley stores more than in comparison non-Berkeley stores; (3) consumer spending per transaction (checkout episode) would not increase in Berkeley stores; and (4) self-reported consumption of taxed beverages would decline.

Main outcomes and measures included changes in inflation-adjusted prices (cents/ounce), beverage sales (ounces), consumers’ spending measured as store revenue (inflation-adjusted dollars per transaction) in two large chains, and usual beverage intake (grams/day and kilocalories/day).

Tax pass-through (changes in the price after imposition of the tax) for SSBs varied in degree and timing by store type and beverage type. Pass-through was complete in large chain supermarkets (+1.07¢/oz, p = 0.001) and small chain supermarkets and chain gas stations (1.31¢/oz, p = 0.004), partial in pharmacies (+0.45¢/oz, p = 0.03), and negative in independent corner stores and independent gas stations (−0.64¢/oz, p = 0.004). Sales-unweighted mean price change from scanner data was +0.67¢/oz (p = 0.00) (sales-weighted, +0.65¢/oz, p = 0.003), with +1.09¢/oz (p < 0.001) for sodas and energy drinks, but a lower change in other categories. Post-tax year 1 scanner data SSB sales (ounces/transaction) in Berkeley stores declined 9.6% (p < 0.001) compared to estimates if the tax were not in place, but rose 6.9% (p < 0.001) for non-Berkeley stores. Sales of untaxed beverages in Berkeley stores rose by 3.5% versus 0.5% (both p < 0.001) for non-Berkeley stores. Overall beverage sales also rose across stores. In Berkeley, sales of water rose by 15.6% (p < 0.001) (exceeding the decline in SSB sales in ounces); untaxed fruit, vegetable, and tea drinks, by 4.37% (p < 0.001); and plain milk, by 0.63% (p = 0.01). Scanner data mean store revenue/consumer spending (dollars per transaction) fell 18¢ less in Berkeley (−$0.36, p < 0.001) than in comparison stores (−$0.54, p < 0.001). Baseline and post-tax Berkeley SSB sales and usual dietary intake were markedly low compared to national levels (at baseline, National Health and Nutrition Examination Survey SSB intake nationally was 131 kcal/d and in Berkeley was 45 kcal/d). Reductions in self-reported mean daily SSB intake in grams (−19.8%, p = 0.49) and in mean per capita SSB caloric intake (−13.3%, p = 0.56) from baseline to post-tax were not statistically significant.

Limitations of the study include inability to establish causal links due to observational design, and the absence of health outcomes. Analysis of consumption was limited by the small effect size in relation to high standard error and Berkeley’s low baseline consumption.

Conclusions

One year following implementation of the nation’s first large SSB tax, prices of SSBs increased in many, but not all, settings, SSB sales declined, and sales of untaxed beverages (especially water) and overall study beverages rose in Berkeley; overall consumer spending per transaction in the stores studied did not rise. Price increases for SSBs in two distinct data sources, their timing, and the patterns of change in taxed and untaxed beverage sales suggest that the observed changes may be attributable to the tax. Post-tax self-reported SSB intake did not change significantly compared to baseline. Significant declines in SSB sales, even in this relatively affluent community, accompanied by revenue used for prevention suggest promise for this policy. Evaluation of taxation in jurisdictions with more typical SSB consumption, with controls, is needed to assess broader dietary and potential health impacts.

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