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Developing An Ethics Curriculum For Humanitarian Research And Practice: A Special Project Mph Thesis
Full text linkDespite increasing ethical challenges in humanitarian crises, most Master of Public Health (MPH) programs offer limited, focused ethics training. Humanitarian emergencies, including armed conflict, mass displacement, pandemics, and climate-related disasters, challenge traditional ethical frameworks, exposing gaps in law, codes of conduct, and philosophical models. This thesis proposes a 13-week graduate course that integrates public health, international humanitarian law, field-based humanitarian practice, research methodology, and moral philosophy to equipe future public health leaders with ethical decision-making processes and skills to navigate complex dilemmas. Through critical engagement with scholarly literature, case studies (Ebola vaccine trials, refugee-camp research), simulations, and guest-speaker dialogues, students will learn about balancing impartiality, “do no harm,” and justice, even under duress. The curriculum promotes decolonial perspectives, interdisciplinary synthesis, innovative models and context-sensitive ethical reasoning. By doing so, it contributes to the advancement of humanitarian ethics as both a pedagogical priority and a dynamic framework for responsible research and practice
Cost-Effectiveness Of New Monoclonal Antibody And Maternal Immunization For The Prevention Of Respiratory Syncytial Virus (rsv) Disease In Infants: A Systematic Review
Full text linkAbstractIntroduction: Respiratory syncytial virus (RSV) remains a major cause of morbidity and mortality among infants and young children worldwide. Given the lack of specific therapeutic treatments for RSV that are suitable for universal use, the development of effective prevention strategies is of paramount importance. Previously, palivizumab was utilized for long-term prophylaxis of RSV infections; however, it was only recommended for specific populations due to its high cost and limited overall effectiveness. In 2023, the U.S. FDA approved RSVpreF maternal vaccine (Abrysvo™, Pfizer), and nirsevimab (Beyfortus™, Sanofi and AstraZeneca) for the prevention of RSV to newborns. Two newly developed interventions have demonstrated potential in reducing RSV burden in children aged 0-5 years and replaced existing interventions. However, their cost-effectiveness has not been systematically reviewed. This study aims to assess the cost-effectiveness of nirsevimab and RSVpreF in infants through a systematic review and provide some insights for policy making. Methods: Relevant studies were searched, screened and identified from PubMed, Scopus and Medline from 2020 to 2025. Studies were eligible if they met the multiple inclusion criteria based on Population, Intervention, Comparison, and Outcome (PICO) framework. The quality of included studies was assessed based on Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 statements. Risk of bias was assessed followed the advice from National Institute for Health and Clinical Excellence (NICE) in UK. For data analysis, extracted information from included studies and standardized all results to 2025 USD. Pooled incremental cost-effective ratios (ICERs )from high-income countries (HICs) and low- and middle-income countries (LMICs) and from different perspectives were estimated. Results: I identified 592 studies, of which 21 studies were included in the systematic review. Most studies indicated that nirsevimab and RSVpreF were cost-effective compared to no intervention and to the existing palivizumab (n=20). The pooled ICER for nirsevimab cost 541-58,589/QALY gained (427,836), compared with no interventions. In HICs, nirsevimab would cost 3,562-35,046/QALY (427,836). In LMICs, pooled ICER was 541-7,756/QALY (25,564) gained. The sensitivity analysis highlighted that intervention cost and real-world effectiveness were critical factors influencing cost-effectiveness outcomes. Conclusion: Both nirsevimab and RSVpreF are cost-effective in preventing RSV in infants. From the results of the subgroup analysis, nirsevimab may be more cost-effective than RSVpreF. And due to contexts of different product prices and disease burden, RSVpreventions are more cost-effective in LMICs compared to HICs. These findings support the inclusion of RSV prophylaxis in immunization programs, with careful consideration of country-specific healthcare policies and economic conditions. Further studies are needed to assess potential biases from industry sponsorship and explore additional economic measures such as net monetary benefit (NMB) to strengthen cost-effectiveness evaluations
Evaluating Saliva Based Glucose Testing For Accessible Diabetes Care In Tanzania
Full text linkBackground: In Tanzania, limited healthcare infrastructure and reliance on invasive diagnostic methods significantly hinder effective diabetes screening and management. Individuals with diabetes often go undetected and have lower immune systems that make them prone to further infectious complications. Thus, properly managing this chronic condition can prevent additional infectious diseases. Salivary glucose testing offers a non-invasive, innovative alternative with the potential to transform the early detection and management of diabetes, especially in resource-constrained settings.
Design: This cross-sectional study, conducted at Muhimbili National Hospital\u27s Diabetes Clinic in Dar es Salaam, evaluates the feasibility of salivary glucose testing using a colorimetric glucose-oxidase-peroxidase point-of-care method. The primary goal is to assess its potential as an alternative tool for type 2 diabetes mellitus (T2DM) screening and to evaluate its capacity for equitable use based on its acceptability and user satisfaction. Over five weeks, data were collected from 201 patients to address three key objectives: 1) analyze current diabetes care through surveys, 2) evaluate the acceptability and satisfaction of salivary glucose testing among individuals with diabetes, and 3) compare the diagnostic sensitivity of salivary glucose testing with traditional blood-based methods.
Methods: Adult patients with T2DM were recruited from the Department of Endocrinology. All patients completed demographic and diabetes management surveys before performing supervised self-collection of saliva samples using a colorimetric glucose test strip. The test employed a glucose oxidase-horseradish peroxidase reaction, producing color changes corresponding to four glucose concentration categories: ‘low’, ‘normal’, ‘high’ and ‘extremely high’. Concurrent finger-prick blood glucose measurements were obtained for comparison. Post-test surveys evaluated user experience and preferences. The analysis included descriptive statistics, Fisher\u27s exact tests, ANOVA with Tukey\u27s post-hoc tests, Markov Chain Monte Carlo (MCMC) modelling to refine cutoffs, and geospatial mapping of healthcare accessibility.
Results: Among 201 patients (53% female, 47% male, predominantly aged 50-64), 94.5% reported positive experiences with salivary testing, and 93% preferred this method over blood-based alternatives. Salivary glucose measurements demonstrated significant differentiation between glycemic ranges, with median finger-prick values of 131.4, 166.3, 217.8, and 310.5 mg/dL across the four colorimetric categories (p\u3c0.05). MCMC modelling established data driven refined cutoff points: \u3c141.8 mg/dL (borderline diabetes), 141.8-288.3 mg/dL (moderately high), 288.3-480.5 mg/dL (very high), \u3e480.5 mg/dL (extremely high). Geospatial analysis revealed a 60% preference for salivary testing among patients from high-elevation regions with limited healthcare access, identifying potential implementation opportunities in underserved areas.
Conclusion: Salivary glucose testing demonstrated high patient satisfaction and moderate clinical alignment with blood glucose readings. Its non-invasive nature, ease of self-administration, and broad acceptability suggest that it may offer a practical and equitable strategy to improve diabetes screening and care in underserved Tanzanian communities. Further validation and technical refinement are needed to optimize implementation
Environmental Gentrification And Health: An Exploratory Analysis Of New York City
No full textBackground: Environmental gentrification is an emerging field seeking to understand the integrated effects of environmental improvements and gentrification. To date, we have a limited understanding of how to analyze environmental gentrification with intersecting health impacts. Our exploratory study investigates this relationship in New York City, where environmental improvement policies coincided with gentrification between 2000-2016. Methods: Using a census tract-level index of gentrification and corresponding environmental exposure data on air quality and vegetation, we conducted a clustering analysis to group and label census tracts according to environmental gentrification patterns. We then performed covariate-adjusted multivariable regression analyses to evaluate the association between cluster grouping and changes in prevalence for poor physical health, physical inactivity, poor mental health, current asthma, and routine health checkups from the Centers for Disease Control and Prevention PLACES datasets for 2016 and 2023 (modeled from Behavioral Risk Factor Surveillance System data). We used a multiple imputation framework to propagate uncertainty in our health datasets, employing Rubin’s rules to pool regression results. Results: From our generalized additive models, we found that the “environmental gentrification” cluster was associated with a 0.51 percentage point decrease (95% CI: -1.01, -0.013) in physical inactivity and a 0.29 percentage point decrease (95% CI: -0.43, -0.15) in routine health checkups compared to the “no environmental gentrification” cluster. However, sensitivity analyses propagating uncertainty found null associations across pooled results. Conclusion: These findings provide important conceptual and methodological insights for this topic. The overall null associations may be due to the health of subgroups being differentially affected in opposite directions. Further research should expand our ecological analysis to investigate questions on subgroup characteristics and individual-level health equity, all of which have significant implications for environmental and housing policies
Assessing The Cross-Species Vaccine Potential Of Pfripr Using Transgenic Chimeric Plasmodium Knowlesi Models
Full text linkMalaria remains a major global health burden, with an estimated 263 million cases and597,000 deaths reported in 83 countries in 2023 (1). While P. falciparum is responsible for the most severe cases, non-falciparum species such as P. vivax, P. ovale curtisi, P. ovale wallikeri, P. malariae, and P. knowlesi also pose significant public health risks, particularly in co-endemic regions. Current malaria vaccine efforts mainly focus on P. falciparum which is reasonable because over 90% of the global malaria-related morbidity and mortality are caused by P. falciparum (2). However, laying emphasis on targeting P. falciparum leaves a critical gap in cross- species protection, because the non-falciparum species are also prevalent in many endemic regions and contribute significantly to the global malaria burden through mechanisms such as relapse, chronic infection, and asymptomatic infection (3). Therefore, it is important to develop strategies that address both P. falciparum and non-falciparum species if we want to achieve comprehensive and sustainable malaria elimination. Identifying conserved antigens with potential for broad- spectrum malaria immunity is essential for advancing malaria vaccine development.
Malaria pathogenesis is closely tied to the blood-stage of the parasite’s life cycle, wheremerozoites invade human erythrocytes, multiply, and cause the clinical manifestations of disease. This process of erythrocyte invasion is not only central to symptom development and disease severity but also represents a key target for vaccine and drug interventions. A major advance in our understanding of this invasion mechanism came with the identification of the PCRCR complex. This complex is a conserved five-protein assembly composed of PTRAMP, CSS, Ripr, CyRPA, and RH5 which facilitates merozoite entry into red blood cells in Plasmodium falciparum by binding the receptor Basigin (4). Notably, while RH5 is unique to P. falciparum, another component of the complex, called Ripr, is conserved across multiple Plasmodium species (4, 5). In P. knowlesi, which lacks RH5, Ripr instead interacts with distinct invasion ligands, highlighting the functional plasticity and evolutionary significance of this complex (4). These findings indicate the importance of Ripr as a central, conserved component of the invasion machinery, making it a promising candidate for cross-species malaria vaccine development (Figure 2 and 3).
PfRipr is a key component of the PCRCR complex in P. falciparum, where it plays anessential role in stabilizing the interactions between the merozoite and the host erythrocyte during invasion (4). Given its conservation across multiple Plasmodium species, PfRipr has emerged as a promising candidate for cross-species malaria vaccine development (5). However, functional evaluation of PfRipr orthologs from non-falciparum species remains challenging, as most of these parasites cannot be continuously cultured in vitro (6). To overcome this limitation, alternative model systems such as P. knowlesi, which is genetically tractable and capable of in vitro culture, offer a valuable platform to assess the functional conservation and vaccine potential of PfRipr across species.
This study focuses on generating a transgenic chimeric P. knowlesi model to assess thepotential of Ripr protein as a cross-species vaccine candidate. Since most non-falciparum Plasmodium species cannot be continuously cultured in vitro, assays relying on isolated parasites are limited in scope, short-lived, and often highly variable. In contrast, a transgenic approach using P. knowlesi enables stable genetic replacement of endogenous genes with orthologs from other species in a tractable, human-compatible culture system. This provides a controlled and reproducible platform for functional analysis of conserved antigens such as Ripr and allows for deeper investigation of their role in erythrocyte invasion and potential as universal vaccine targets. The research follows a structured approach, beginning with in silico design of CRISPR guides for Ripr chimeras using Geneious. This is followed by cloning experiments using designed guides, transformation into E. coli, and subsequent plasmid extraction. Plasmids are then sent for sequencing, and alignment verification is performed to identify successfully edited constructs. Donor templates, incorporating 500 bp upstream and downstream homologous regions, are designed for recombination and submitted for synthesis to facilitate further transgenic modifications in P. knowlesi (Figure 1). While this project does not include antibody testing or invasion assays, it establishes a foundational transgenic platform for future functional studies on the Ripr protein. These transgenic lines can be used in downstream assays to assess cross-species functional conservation and immune recognition. For example, monoclonal antibodies described in studies such as Healer et al. and the recent Seager preprint could be employed to evaluate the inhibitory effects on invasion, providing critical insight into the potential of Ripr as a broadly protective vaccine target (5, 7). The successful generation of transgenic P. knowlesi expressing PfRipr orthologs will provide an essential tool for evaluating its role in erythrocyte invasion and its potential as a vaccine target in future experiments. This research contributes to advancing the application of genetic tools for malaria vaccine development and lays the groundwork for future investigations into cross-species malaria immunity
Universal School Meal Programs At The State-Level: Assessing The Next Iteration Of Child Nutrition Policy For A New Generation Of Students
Full text linkBackgroundEight states have passed legislation to codify universal school meal programs (USMPs) for public and nonprofit schools. These programs provide free school breakfasts and lunches to all students with no exclusions. A strong link exists between health, education, and social outcomes and the presence of subsidized school meal programs, and these outcomes are often used to advocate for such programs. This study assesses the prevalence of other state policies passed to address health, education and social outcomes (Medicaid expansion, universal pre-k, and state child tax credits) among states which have also passed USMP policies. We hypothesized that USMP passage would be most strongly correlated with the passage of the education outcomes-oriented policy, universal pre-k.
MethodsThis analysis uses Medicaid expansion as a proxy for states ‘political will to address health outcomes, universal pre-k policy as a proxy for states’ political will to address education outcomes, and state child tax credits as a proxy for states’ political will to address socioeconomic outcomes. This study utilizes data from public resources to identify the eight states that have passed legislation to codify USMPs, the 40 states which have passed Medicaid expansion, the 14 states which have passed universal pre-k, the 16 states which have passed state child tax credits. This analysis assesses the overlap of these three policies with the passage of USMPs. It also compares the passage of these three policies among the USMP states to the passage of these three policies across the United States as a whole to garner national context.
ResultsThrough this analysis we found that the health outcomes-oriented policy (Medicaid expansion) is the most strongly correlated policy to USMP passage of the three policies considered. Additionally, Democratic partisanship in state-level government is highly correlated with USMP passage.
ConclusionsThis study suggests that policymakers in other states across America may successfully pass universal school meal legislation by leaning into the health benefits that such policies generate when advocating for their enactment. This thesis also suggests that states without universal school meal programs that have passed the prevention-focused policies of interest (Medicaid expansion, universal pre-k, and state child tax credits) should be considered as the primary candidates for further advancing USMP policy
Cross Section Curve Autoregression: the Unit Root case
No full textThis paper is part of a joint study of parametric autoregression with cross section curve time series, focussing on unit root (UR) nonstationary curve data autoregression. The Hilbert space setting extends scalar UR and local UR models to accommodate high dimensional cross section dependent data under very general conditions. New limit theory is introduced that involves two parameter Gaussian processes that generalize the standard UR and local UR asymptotics. Bias expansions provide extensions of the well-known results in scalar autoregression and fixed effect dynamic panels to functional dynamic regressions. Semiparametric and ADF-type UR tests are developed with corresponding limit theory that enables time series inference with high dimensional curve cross section data, allowing also for functional fixed effects and deterministic trends. The asymptotics reveal the effects of general forms of cross section dependence in wide nonstationary panel data modeling and show dynamic panel regression limit theory as a special limiting case of curve time series asymptotics. Simulations provide evidence of the impact of curve cross section data on estimation and test performance and the adequacy of the asymptotics. An empirical illustration of the methodology is provided to assess the presence of time series nonstationarity in household Engel curves among ageing seniors in Singapore using the Singapore life panel dataset
Order Statistics as Finite Mixtures
No full textWe propose a new way to obtain identification results using order statistics as finite mixtures with two key properties: i) the weights are known integer numbers; and ii) the elements of the mixture are the distributions of the maximum over a subset of the original random variables. We leverage Exponentiated Distributions (ED), which extend extreme value theory results. ED are max-stable, and we show that finite mixtures of ED are linearly independent. This enables us to derive non-parametric identification results and extend commonly known results using Gumbel and Fréchet distributions, both examples of ED. The results have broad applications in auctions, discrete-choice, and other settings where maximum or minimum choices play a central role. We illustrate the usefulness of our results by proposing new estimators for auctions with bidder-level heterogeneity
Large-Scale Curve Time Series with Common Stochastic Trends
No full textThis paper studies high-dimensional curve time series with common stochastic trends. A dual functional factor model structure is adopted with a high-dimensional factor model for the observed curve time series and a low-dimensional factor model for the latent curves with common trends. A functional PCA technique is applied to estimate the common stochastic trends and functional factor loadings. Under some regularity conditions we derive the mean square convergence and limit distribution theory for the developed estimates, allowing the dimension and sample size to jointly diverge to infinity. We propose an easy-to-implement criterion to consistently select the number of common stochastic trends and further discuss model estimation when the nonstationary factors are cointegrated. Extensive Monte-Carlo simulations and two empirical applications to large-scale temperature curves in Australia and log-price curves of S&P 500 stocks are conducted, showing finite-sample performance and providing practical implementations of the new methodology
Edgeworth Expansions in Curved Cross Section Autoregression
No full textEdgeworth expansions are developed for the finite sample distribution of the least squares estimator in a time series parametric first order autoregression with Hilbert space curves of cross section data. The main result extends to this functional data environment the Edgeworth expansion in the corresponding scalar time series AR(1). In doing so, the results show how function-valued cross section data, and hence general forms of cross section dependence, affect the finite sample distribution of the serial correlation coefficient. Autoregressions with functional fixed effect intercepts are included and the results therefore relate to dynamic panel autoregression with individual effects. The primary impact of the use of high-dimensional curved cross section data is to reduce the variation in scalar regression estimation and provide some improvement in the accuracy of the usual asymptotic approximation to the finite sample distribution. Limit results for the expansions under full cross section dependence matching the scalar time series case and independence matching the dynamic panel case are given as special cases. The findings are supported by numerical computations of the exact distributions and the approximations