Healthcare delivery has advanced due to the implementation of point-of-care testing, which is often performed within minutes to hours in minimally equipped laboratories or at home. Technologic advances are leading to point-of-care kits that incorporate nucleic acid-based assays, including polymerase chain reaction, isothermal amplification, ligation, and hybridization reactions. As a limited number of single-nucleotide polymorphisms are associated with clinically significant human immunodeficiency virus (HIV) drug resistance, assays to detect these mutations have been developed. Early versions of these assays have been used in research. This review summarizes the principles underlying each assay and discusses strategic needs for their incorporation into the management of HIV infection.

Support from social network members may help to facilitate access to HIV medical care, especially in low resourced communities. As part of a randomized clinical trial of a community-level stigma and risk reduction intervention in Thai Nguyen, Vietnam for people living with HIV who inject drugs (PWID), 341 participants were administered a baseline social network inventory. Network predictors of antiretroviral therapy (ART) initiation at the 6-month follow-up were assessed. The social networks of PWID were sparse. Few participants who reported injectors in their networks also reported family members, whereas those who did not have injectors were more likely to report family members and network members providing emotional support and medical advice. In multivariate models, having at least one network member who provided medical advice predicted ART initiation at 6 months (OR 2.74, CI 1.20–6.28). These results suggest the importance of functional social support and network support mobilization for ART initiation among PWID. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

OBJECTIVES The aim of this study is to investigate racial differences in nursing home (NH) residents' quality of life (QOL) at the resident and facility levels. METHOD We used hierarchical linear modeling to identify significant resident- and facility-level predictors for racial differences in six resident-reported QOL domains. Data came from the following: (a) resident-reported QOL (n = 10,929), (b) the Minimum Data Set, and (c) facility-level characteristics from the Minnesota Department of Human Services (n = 376). RESULTS White residents reported higher QOL in five of six domains, but in full models, individual-level racial differences remained only for food enjoyment. On the facility level, higher percentage of White residents was associated with better scores in three domains, even after adjusting for all characteristics. DISCUSSION Racial differences in QOL exist on individual and aggregate levels. Individual differences are mainly explained by health status. The finding that facility racial composition predicts QOL more than individual race underscores the importance of examining NH structural characteristics and practices.

We examined whether and how lesbian, gay, and bisexual (LGB) adults between 40 and 65 years of age differ from heterosexual adults in long-term care (LTC) expectations. Our data were derived from the 2013 National Health Interview Survey. We used ordered logistic regression to compare the odds of expected future use of LTC among LGB (n=297) and heterosexual (n=13120) adults. We also used logistic regression models to assess the odds of expecting to use specific sources of care. All models controlled for key socioeconomic characteristics. Although LGB adults had greater expectations of needing LTC in the future than their heterosexual counterparts, that association was largely explained by sociodemographic and health differences. After control for these differentials, LGB adults were less likely to expect care from family and more likely to expect to use institutional care in old age. LGB adults may rely more heavily than heterosexual adults on formal systems of care. As the older population continues to diversify, nursing homes and assisted living facilities should work to ensure safety and culturally sensitive best practices for older LGB groups.

Most Americans know little about options for long-term services and supports and underestimate their likely future needs for such assistance. Using data from the 2012 National Health Interview Survey, we examined expectations about future use of long-term services and supports among adults ages 4065 and how these expectations varied by current living arrangement. We found differences by living arrangement in expectations about both future need for long-term services and supports and who would provide such care if needed. Respondents living with minor children were the least likely to expect to need long-term services and supports and to require paid care if the need arose. In contrast, respondents living alone were the most likely to expect that it was very likely that they would need long-term services and supports and to rely on paid care. Overall, we found a disconnect between expectations of use and likely future reality: 60 percent of respondents believed that they were unlikely to need long-term services and supports in the future, whereas the evidence suggests that nearly 70 percent of older adults will need them at some point. These findings both underscore the need for programs that encourage people to plan for long-term services and supports and indicate that information about living arrangements can be useful in developing and targeting such programs.

BACKGROUND: To identify best-fitting input sets using model calibration, individual calibration target fits are often combined into a single goodness-of-fit (GOF) measure using a set of weights. Decisions in the calibration process, such as which weights to use, influence which sets of model inputs are identified as best-fitting, potentially leading to different health economic conclusions. We present an alternative approach to identifying best-fitting input sets based on the concept of Pareto-optimality. A set of model inputs is on the Pareto frontier if no other input set simultaneously fits all calibration targets as well or better. METHODS: We demonstrate the Pareto frontier approach in the calibration of 2 models: a simple, illustrative Markov model and a previously published cost-effectiveness model of transcatheter aortic valve replacement (TAVR). For each model, we compare the input sets on the Pareto frontier to an equal number of best-fitting input sets according to 2 possible weighted-sum GOF scoring systems, and we compare the health economic conclusions arising from these different definitions of best-fitting. RESULTS: For the simple model, outcomes evaluated over the best-fitting input sets according to the 2 weighted-sum GOF schemes were virtually nonoverlapping on the cost-effectiveness plane and resulted in very different incremental cost-effectiveness ratios ($79,300 [95% CI 72,500-87,600] v. $139,700 [95% CI 79,900-182,800] per quality-adjusted life-year [QALY] gained). Input sets on the Pareto frontier spanned both regions ($79,000 [95% CI 64,900-156,200] per QALY gained). The TAVR model yielded similar results. CONCLUSIONS: Choices in generating a summary GOF score may result in different health economic conclusions. The Pareto frontier approach eliminates the need to make these choices by using an intuitive and transparent notion of optimality as the basis for identifying best-fitting input sets.

PURPOSE OF THE STUDY: Although there is substantial research on quality of care in nursing homes (NH), less is known about what contributes to quality of life (QOL) for NH residents. This study assesses multiple domains of QOL and examines facility- and resident-level correlates for different domains. DESIGN AND METHODS: Data come from (a) self-reported resident interviews using a multidimensional measure of QOL; (b) resident clinical data from the Minimum Data Set; and (c) facility-level characteristics from Minnesota Department of Human Services. We used factor analysis to confirm domains of QOL, and then employed cross-sectional hierarchical linear modeling to identify significant resident- and facility-level predictors of each domain. RESULTS: We examined six unique domains of QOL: environment, personal attention, food, engagement, negative mood, and positive mood. In multilevel models, resident-level characteristics were more reliable correlates of QOL than facility characteristics. Among resident characteristics, gender, age, marital status, activities of daily living, mood disorders, cognitive limitations, and length of stay consistently predicted QOL domains. Among facility characteristics, size, staff hours, quality of care, and percent of residents on Medicaid predicted multiple QOL domains. IMPLICATIONS: Examining separate domains rather than a single summary score makes associations with predictors more accurate. Resident characteristics account for the majority of variability in resident QOL. Helping residents maintain functional abilities, and providing an engaging social environment may be particularly important in improving QOL.

The Terra Populus project (TerraPop) addresses a variety of data management, curation, and preservation challenges with respect to spatiotemporal population and environmental data. In this article, we describe our approaches to these challenges, with a particular focus on geospatial data workflows and associated provenance metadata. The goal of TerraPop is to enable research, learning, and policy analysis by providing integrated spatiotemporal data describing people and their environment. To do so, TerraPop is assembling a globe-spanning and temporally extensive collection of high-quality population and environmental data, ensuring good documentation, and developing a Web-based data access system that enables users to assemble customized integrated data sets drawing on a variety of data sources and formats. We describe TerraPop's collection strategies, detail the geospatial workflows involved in preparing data for ingest into the project database and those used to transform data across formats for dissemination, and discuss the system used to capture and manage provenance metadata throughout the project. A key aspect of the project is the development of global current and historical administrative unit boundaries that can be linked to census data. These boundaries serve as the linchpin of TerraPop's data integration strategy, and constitute an important data set in their own right.

Improving quality of nursing homes (NHs) is a major social priority, yet few studies examine the role of facility characteristics for residents' quality of life (QOL). This study goes beyond cross-sectional analyses by examining the predictors of NH residents' QOL on the facility level over time. We used three data sources, namely resident interviews using a multidimensional measure of QOL collected in all Medicaid-certified NHs in Minnesota (N = 369), resident clinical data from the minimum data set, and facility-level characteristics. We examined change in six QOL domains from 2007 to 2010, using random coefficient models. Eighty-one facilities improved across most domains and 85 facilities declined. Size, staffing levels (especially activities staff), and resident case mix are some of the most salient predictors of QOL over time, but predictors differ by facility performance status. Understanding the predictors of facility QOL over time can help identify facility characteristics most appropriate for targeting with policy and programmatic interventions.

OBJECTIVES: This study examines the association of age and other sociodemographic variables with properties of personal networks; using samples of individuals residing in the rural western United States and the City of Los Angeles, we evaluate the degree to which these associations vary with geographical context. For both samples, we test the hypothesis that age is negatively associated with network size (i.e., degree) and positively associated with network multiplexity (the extent of overlap) on 6 different relations: core discussion members, social activity participants, emergency contacts, neighborhood safety contacts, job informants, and kin. We also examine the relationship between age and spatial proximity to alters. METHOD: Our data consist of a large-scale, spatially stratified egocentric network survey containing information about respondents and those to whom they are tied. We use Poisson regression to test our hypothesis regarding degree while adjusting for covariates, including education, gender, race, and self-reported sense of neighborhood belonging. We use multiple linear regression to test our hypotheses on multiplexity and distance to alters. RESULTS: For both rural and urban populations, we find a nonmonotone association between age and numbers of core discussants and emergency contacts, with rural populations also showing nonmonotone associations for social activity partners and kin. These nonmonotone relationships show a peak in expected degree at midlife, followed by an eventual decline. We find a decline in degree among the elderly for all relations in both populations. Age is positively associated with distance to nonhousehold alters for the rural population, although residential tenure is associated with shorter ego-alter distances in both rural and urban settings. Additionally, age is negatively associated with network multiplexity for both populations. DISCUSSION: Although personal network size ultimately declines with age, we find that increases for some relations extend well into late-midlife and most elders still maintain numerous contacts across diverse relations. The evidence we present suggests that older people tap into an wider variety of different network members for different types of relations than do younger people. This is true even for populations in rural settings, for whom immediate access to potential alters is more limited.

Research Objective: To investigate: (1.) How the risk of delayed medical care varies by household composition and (2.) Whether the relationship between household composition and delayed care differs by disability status. Study Design: Data are from the Integrated Health Interview Series (IHIS). Disability was defined by the presence of an activity limitation. Household composition is was constructed as living: with a spouse, alone, or with others. Respondents were asked whether they delayed care in the past year for several reasons, including: cost, difficulty making a timely appointment, limited office hours, difficulty getting through by phone, lack of transportation, or too long of a wait in the office. We used logistic regression to assess the odds of each type of delayed care, with sub-group analyses by disability status, controlling for demographic characteristics. Population Studied: Non-institutionalized adults aged 65 and older who answered questions on reasons for delayed medical care (n=17,663). Principal Findings: Fifteen percent of those living alone and with others delayed care for any reason vs. 10% of those living with a spouse. Older adults with disabilities had higher rates of delayed care than those without disabilities (18% vs. 10%). In multivariate models, having a disability was associated with higher odds of each type of delayed care. In sub-group analyses, living alone and living with others were associated with higher odds of delayed care due to cost or lack of transportation, compared with older adults living with a spouse, regardless of disability status. However, older adults without disabilities living alone had lower odds of delayed care due to difficulty getting a timely appointment, limited office hours, or long waits in the doctor's office if they lived alone, compared with those living with a spouse. Conclusions: Risk of delayed care is associated with both household composition and disability status. In particular, the risk of delayed care due to cost or lack of transportation is higher for older adults living alone or with others, compared with those living with a spouse. These relationships differ by disability status, however, and older adults living alone without a disability actually face lower odds of several types of delayed care compared with their counterparts living with a spouse. Implications for Policy, Delivery or Practice: Patterns of living arrangements for older adults have changed in recent decades, with a decline in institutionalization and an increase in multigenerational households. Such arrangements are impacted by disability, with older adults acting as caregivers (e.g., for spouses or grandchildren) and receiving care themselves (e.g., from spouses and adult children). Despite evidence of these changing patterns and complex roles, there is limited research on how household composition affects health services use. Delayed medical care can lead to poor health outcomes and increased risk of hospitalization or nursing home use, especially for older adults with complex medical conditions. Identifying who is at greatest risk of delayed care by household composition and disability status can help to target interventions, including home and community-based care and medical transportation.

Every school district has authority to determine how it will assign public school students to its schools. The principal assignment mechanism used by most school districts is to draw lines that comprise attendance zones. These zones designate the public school in which children should enroll given where they live. Some districts create sprawling, truly irregular attendance zones that pull children from far-flung neighbourhoods; others create compact zones that resemble regular-looking squares. Still, no one knows if and how many irregularly-shaped zones exist and whether they integrate or segregate students by race. This research addresses educational gerrymandering in three ways. First, it describes measures of four attendance zone properties: (1) shape; (2) internal racial diversity; (3) the distribution of racial groups across small areas within them; (4) the degree to which they exclude members of nearby racial groups in order to isolate the members of other racial groups. Second, it documents the correlations among these measures. The third and last contribution is to classify attendance zones into categories with the aim of identifying zones that represent the typical cases of shape irregularity and racial balance. To meet these goals, over 13,169 attendance zones embedded in 307 of the largest school districts are analyzed. Results indicate that educational gerrymandering is infrequent and when zones are shaped irregularly, they are almost always racially balanced.

Close to two-thirds of all US nursing home residents have some type of cognitive impairment such as Alzheimer's disease, and the quality of care and quality of life of these people has long been called into question. In this overview we first clarify the ongoing importance of nursing home care for people with Alzheimer's, even as policy makers "rebalance" long-term supports and services with home and community-based programs. We next identify the components of optimal care for people with Alzheimer's in nursing homes, and we highlight care innovations already in use. Finally, we summarize policy-relevant challenges to implementing best practices and innovations and explore potential policy solutions. Federal and state policy makers have a critical role to play in ensuring that nursing home residents with Alzheimer's disease have access to the appropriate, high-quality care that they and their families expect.