FOR PROFIT MEDICINE

HPV vaccine cost reimbursement could hinder vaccine access, study suggests

Peer-Reviewed Publication

MEDICAL UNIVERSITY OF SOUTH CAROLINA

 

IMAGE: DR. KALYANI SONAWANE INVESTIGATED DIFFERENCES IN REIMBURSEMENT RATES FOR THE HPV VACCINE. view more 

CREDIT: CLIF RHODES/MUSC HOLLINGS CANCER CENTER

Bare minimum reimbursement rates could be a factor in why some clinics may be struggling to offer HPV vaccination in the U.S.

MUSC Hollings Cancer Center researcher Kalyani Sonawane, Ph.D., and a team of researchers from South Carolina and Texas decided to quantify private insurance reimbursement rates for the HPV vaccine after several qualitative studies noted that health care providers were dissatisfied with HPV vaccine reimbursement by private insurance companies.

The results of their investigation were published July 24 in the Annals of Family Medicine.

They found that non-pediatric specialties were reimbursed at lower rates compared with pediatricians.

Although all specialties received at least the minimum payment recommended by the Centers for Disease Control and Prevention, that rate covers only the cost of the vaccine itself, Sonawane said.

Family medicine doctors received an average of 34 cents above the recommended rate, which would have to cover all of the indirect costs of vaccination, like storage, administration, insurance and record-keeping. In contrast, pediatricians received an average of $5.08 above the recommended rate.

“Family physicians – who are so critical and important, especially in rural areas where not all patients have access to pediatricians – are not receiving adequate reimbursement for the HPV vaccine, which is sort of a disincentive for them to offer this critical cancer-preventive vaccine,” Sonawane said.

“We did find that the number of doses administered by each specialty was slightly sensitive to the reimbursement level or the margin that they were receiving through the reimbursements, and family physicians were most sensitive to the change in reimbursement,” she added.

The HPV, or human papillomavirus, vaccine is recommended for adolescents at age 11 or 12, although it can be given starting at age 9 and up to age 45.

It protects men and women against HPV strains that can cause six types of cancer. The Healthy People 2030 goal is to have 80% of adolescents up to date on HPV vaccines by then. Right now, about 62% are up to date.

After lagging behind other states, South Carolina is now on par with national averages. Hollings has made a special effort to increase HPV vaccination rates, launching a statewide campaign in 2019 to improve them.

In 2021, Hollings launched the Community Health Van, which travels across the state offering HPV and other childhood vaccines as well as cancer education.

Sonawane suspects that the lower reimbursement rates for family physicians could contribute to geographic disparities in vaccination rates. Adolescents in rural areas are less likely to be up to date on vaccines than those in urban or suburban areas. Part of the issue is parental hesitancy about vaccines, she said. Lack of availability, though, if doctors in rural areas don’t stock the vaccine, could be another barrier.

“The key message here is that, yes, we are meeting the minimum threshold that the CDC has put out there, but that may not be enough to sustain vaccination programs, particularly in family medicine clinics,” she said.

About MUSC Hollings Cancer Center 

MUSC Hollings Cancer Center is South Carolina’s only National Cancer Institute-designated cancer center with the largest academic-based cancer research program in the state. The cancer center comprises more than 130 faculty cancer scientists and 20 academic departments. It has an annual research funding portfolio of more than $44 million and sponsors more than 200 clinical trials across the state. Dedicated to preventing and reducing the cancer burden statewide, the Hollings Office of Community Outreach and Engagement works with community organizations to bring cancer education and prevention information to affected populations. Hollings offers state-of-the-art cancer screening, diagnostic capabilities, therapies and surgical techniques within its multidisciplinary clinics. Hollings specialists include surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, psychologists and other clinical providers equipped to provide the full range of cancer care. For more information, visit hollingscancercenter.musc.edu. 

 

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JOURNAL

The Annals of Family Medicine

DOI

10.1370/afm.2990 

ARTICLE TITLE

Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties

ARTICLE PUBLICATION DATE

24-Jul-2023

COI STATEMENT

A.A.D. reported receiving a consulting fee from Merck on unrelated projects. K.S. has provided consultancy to Value Analytics Labs on unrelated projects. All other authors declare no competing interests.

Family medicine physicians receive lowest HPV vaccine cost reimbursements compared to pediatricians, internal medicine doctors, nurse practitioners and other specialists

Reimbursement for HPV vaccine cost in the private sector: a comparison across specialties

Peer-Reviewed Publication

AMERICAN ACADEMY OF FAMILY PHYSICIANS

Human papillomavirus (HPV) vaccination coverage has improved in the United States, but privately insured adolescents have lower initiation and completion rates compared to those under public insurance programs. One of the contributing factors to this disparity is the higher cost of the HPV vaccine compared to other routinely recommended adolescent vaccines. While private payers typically reimburse the cost of the HPV vaccine at or above the CDC list price (i.e., $210.99 in 2017-2018), it remains below the American Academy of Pediatrics' recommended price (i.e., $263.74). Adequate reimbursement for vaccine costs by third-party payers plays a critical role in enabling doctors and other medical staff to offer and continue providing vaccines.

Researchers investigated the reimbursement rates for HPV vaccine costs across various medical specialties, including pediatricians (as the comparison group), family physicians, internal medicine specialists, nurse practitioners, and other medical practitioners. Additionally, they examined whether the reimbursement amounts were associated with the number of HPV vaccine doses administered by these health care practitioners.

The study analyzed data from over 34,000 unique practitioners and found that family physicians had the lowest net returns per dose ($0.34), while pediatricians had the highest returns ($5.08). On average, during 2017-2018, pediatricians received higher reimbursement for HPV vaccine costs ($216.07) compared to family physicians ($211.33; p<0.0001), internists ($212.97;  p<0.0001), nurse practitioners ($212.91; p<0.0001), and 'other' practitioners ($213.29;  p<0.0001). The researchers also observed that a one-dollar increase in return was associated with a slight increase in HPV vaccine doses administered, particularly among family physicians (0.08% per dollar). Although reimbursement for HPV vaccine costs by private payers is considered adequate, according to the authors, the study highlights that non-pediatric specialties have a very marginal return on investment, which may be insufficient for covering indirect expenses for stocking vaccines (storage cost, personnel cost for monitoring inventory, insurance, waste, and lost opportunity costs). The authors argue that this makes them more sensitive to changes in cost reimbursement, emphasizing the need for an increase in reimbursement rates for these practitioners so that they can continue offering the cancer-preventing HPV vaccine.

What We Know: The human papillomavirus (HPV) vaccine is the most expensive of all routinely recommended pediatric vaccines. Adequate cost reimbursement by third-party payers is important for helping practitioners continue to offer the vaccine.

What This Study Adds: Researchers determined that net returns from HPV vaccine cost reimbursements are lowest for family physicians ($0.34/dose) and highest for pediatricians ($5.08/dose). Furthermore, a one dollar increment in return was associated with an increase in HPV vaccine doses administered (highest for family physicians; 0.08% per dollar). Although reimbursement for HPV vaccine costs by private payers is generally adequate, according to the authors, non-pediatric specialties face very marginal returns on investment. The authors argue that specialties with narrow returns are highly sensitive to changes in cost reimbursement, and therefore, are worthy of increased reimbursement.

Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties

Kalyani Sonawane, PhD, et al
Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
Permanent link

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JOURNAL

The Annals of Family Medicine

 

Study: An inverse model for food webs and ecosystem stability

In a new study published in the Proceedings of the National Academy of Sciences, authors Gabriel Gellner and Kevin McCann from the University of Guelph and SFI External Professor Alan Hastings (UC Davis) invert a classical approach to modeling food webs

Peer-Reviewed Publication

SANTA FE INSTITUTE

 

IMAGE: INTERACTION STRENGTH RELATIONSHIP WITH GENERALITY OF FEEDING. (IMAGE: GELLNER ET. AL./PNAS, FIG 4. IN PAPER) view more 

CREDIT: (IMAGE: GELLNER ET. AL./PNAS, FIG 4. IN PAPER)

In a new study published in the Proceedings of the National Academy of Sciences, authors Gabriel Gellner and Kevin McCann from the University of Guelph and SFI External Professor Alan Hastings (UC Davis) invert a classical approach to modeling food webs. Instead of trying to replicate stable, complex ecosystems using simplistic representations of species interactions, the authors’ novel inverse method assumes the ecosystems exist and works backward to characterize food webs that support that assumption. Their work represents a significant step toward addressing a fundamental ecological question of how biodiversity promotes ecosystem stability. The findings offer insights into how nature may respond to growing anthropogenic disturbances.

“Rather than start with what’s hard to measure — how species affect each other — we start with how many of each species there are and figure out how they interact in a way that explains their coexistence,” says Hastings.

Earth’s ecosystems display surprisingly stable dynamics, but attempts to understand that stability have flummoxed ecologists for generations. Lord Robert May, a past Chair of the SFI Science Board, drew from economic theory to introduce the community matrix, a mathematical tool to describe the relationships of species in an ecosystem. The matrix uses species interactions as a foundation to explain the role of diversity and complexity in ecosystem stability. The approach is useful because it considers all food web interactions; it comes up short because doing so requires overly simplistic assumptions about how organisms relate to each other. Many models based on this technique show stability decreasing as biodiversity increases, which contradicts observable stable ecosystems.

But understanding how large complex ecosystems persist is a vital question. If we fail to understand the mechanisms that stabilize ecosystems, we cannot preserve them in the face of ever-increasing chaos like severe weather events, rampaging wildfires, or rampant invasive species.

The inverse approach succeeds due to its inclusion of biological constraints in the model. A feasibility constraint dictates that only real interactions get represented in the model. Additionally, an energetic constraint stipulates that a meal cannot yield more energy than the hunt requires because, in a food chain, only 10-20% of a resource’s energy transfers to the consumer.

“We see lots of diverse ecosystems out in the world,” says Hastings. “We showed that if you put the proper biological information into the model, we can simulate large, diverse ecosystems and understand why they are stable.” 

The authors highlight that the inverse approach offers major theoretical advantages over May’s classical approach, introduced more than 40 years ago. “While Robert May’s approach operated with a statistical universe…, the inverse approach has the novel property that it allows us to only look at the collection of webs corresponding to realistic feasible solutions.”

May’s community matrix catalyzed ecological theory for nearly half a century. Just as May drew from economics to rethink diversity–stability relationships, Hastings and his coauthors draw on recent efforts in genomics for inspiration. The authors believe their inverse approach is, likewise, “rich in potential for theoretical advances.” 

Read the paper, "Stable diverse food webs become more common when interactions are more biologically constrained," in PNAS  (July 24, 2023). doi: 10.1073/pnas.2212061120

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JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2212061120 

ARTICLE TITLE

Stable diverse food webs become more common when interactions are more biologically constrained

ARTICLE PUBLICATION DATE

24-Jul-2023

SCI-FI-TEK

Department of Energy announces $4.6 million for research on public-private partnership awards to advance fusion energy

Projects span enabling technologies, materials science, modeling and simulation, and plasma diagnostics for fusion energy

Grant and Award Announcement

DOE/US DEPARTMENT OF ENERGY

WASHINGTON, D.C. - Today, the U.S. Department of Energy (DOE) announced $4.6 million in funding for 18 projects at national laboratories and U.S. universities. The awards are provided through the Innovation Network for Fusion Energy, or INFUSE, program, which was established in 2019. The program is sponsored by the Fusion Energy Sciences (FES) program office within DOE’s Office of Science and is focused on accelerating fusion energy development through public-private research partnerships.

“The latest round of INFUSE selections demonstrates the growing interest from private industry in partnering with national laboratories and U.S. universities,” said Jean Paul Allain, DOE Associate Director of Science for Fusion Energy Sciences. “INFUSE is attracting interest from both fusion developers and from companies seeking to serve as their suppliers or partners. We are seeing this program evolve and continue to encourage contributions to a vibrant fusion ecosystem in the U.S.”

“Six of these awards are to companies in the rising ‘fusion-adjacent industry.’ These companies won’t design fusion power plants on their own, but they will serve as domestic suppliers. By partnering with companies like those in the Milestone-Based Fusion Development Program, these suppliers enable technologies that advance fusion in the U.S.,” said Allain.

Projects include enabling technologies, materials science, modeling and simulation, as well as plasma diagnostics. The funded projects will provide companies with access to the leading expertise and capabilities available at DOE national laboratories and U.S. universities to address critical scientific and technological challenges in pursuing fusion energy systems. The program solicited proposals from the fusion industry and selected projects for one- or two-year awards between $100,000 and $750,000 each, with a 20% (or greater) cost share from industry partners.

The 18 projects for the 2023 INFUSE Request for Applications were selected via a competitive peer review process managed by the INFUSE leadership team at Oak Ridge National Laboratory and Princeton Plasma Physics Laboratory.

Total funding is $4.6 million for projects lasting up to two years in duration, with all the funding from Fiscal Year 2023 dollars. The full list of planned awards can be found under “Latest Topical Funding Opportunity Awards” on the FES website. Full abstracts for each project are available on the INFUSE website.

 

Selection for award negotiations is not a commitment by DOE to issue an award or provide funding. Before funding is issued, DOE and the applicants will undergo a negotiation process, and DOE may cancel negotiations and rescind the selection for any reason during that time.   

 

Study shows that the shape of objects could be perceived via vision and touch

The inferolateral occipitotemporal cortex selectively encodes object shape even in people who become blind from a very early age, suggesting that the brain is organized as operators that execute a given function regardless of input senses

Peer-Reviewed Publication

PLOS

 

IMAGE: STUDY SHOWS THAT THE SHAPE OF OBJECTS COULD BE PERCEIVED VIA VISION AND TOUCH. view more 

CREDIT: RON LACH, PEXELS (CC0, HTTPS://CREATIVECOMMONS.ORG/PUBLICDOMAIN/ZERO/1.0/)

Study shows that the shape of objects could be perceived via vision and touch; the inferolateral occipitotemporal cortex selectively encodes object shape even in people who become blind from a very early age, suggesting that the brain is organized as operators that execute a given function regardless of input senses.

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In your coverage, please use this URL to provide access to the freely available paper in PLOS Biology: http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3001930

Article Title: Similar object shape representation encoded in the inferolateral occipitotemporal cortex of sighted and early blind people

Author Countries: Italy, Switzerland, Belgium

Funding: see manuscript

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JOURNAL

PLoS Biology

DOI

10.1371/journal.pbio.3001930 

 

Understanding social media discussions about female genital mutilation

Peer-Reviewed Publication

PLOS

Conversations on social media about female genital mutilation (FGM) have not changed dramatically over the five years to 2020, according to an analysis of English Twitter data, though there was a shift from raising awareness to calling for an end to the practice. Earlier on, users discussing the topic were mainly from the USA and UK, but later the majority came from Nigeria and Kenya. The research, published in PLOS Global Public Health, may be useful in informing communication and designing culturally effective campaigns against FGM. 

At least 200 million women and girls living in 30 countries have undergone FGM despite it being illegal in almost all of the countries where it happens. FGM can lead to short- and long-term health consequences such as hemorrhage, shock, chronic infections, sexual health challenges and obstetric complications and poor mental health outcomes.

Gray Babbs and Sarah E. Weber of Boston University School of Public Health and colleagues analyzed social media discussion between 2015 and 2020 to assess sentiments, knowledge and attitudes about FGM over time. Surveys do not always elicit truthful answers, and the perceived anonymity of social media can bring private conversations into the public sphere.

They saw increases in conversation related to five news stories in the study period: when stricter laws were set in Eritrea, when the practice was outlawed in Egypt and banned in The Gambia and Sudan, and when a doctor was charged in the USA with performing FGM. Although it is not associated with any one religious group, Islam was associated with FGM in all years studied, with some individuals using FGM to justify Islamophobia and connecting it to other practices like honor killings and acid attacks.

There was a shift over time from awareness raising to explicit calls to end FGM. This aligned with movement-based language in the later period, tying FGM to feminism and human rights struggles. Using Twitter data in this way allows public health workers to listen to public discourse, understand perceptions, and develop appropriate communications and effective interventions.     

The authors add: “We observed a 17-fold increase in daily FGM conversations on International Day of Zero Tolerance. This suggests there might be opportunity for using social media to educate the public about the FGM practice on or around International Day of Zero Tolerance.”

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In your coverage please use this URL to provide access to the freely available article in PLOS Global Public Health: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000878        

Citation: Babbs G, Weber SE, Abdalla SM, Cesare N, Nsoesie EO (2023) Use of machine learning methods to understand discussions of female genital mutilation/cutting on social media. PLOS Glob Public Health 3(7): e0000878. https://doi.org/10.1371/journal.pgph.0000878

Author Countries: US

Funding: The authors received no specific funding for this work.

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JOURNAL

PLOS Global Public Health

DOI

10.1371/journal.pgph.0000878 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Use of machine learning methods to understand discussions of female genital mutilation/cutting on social media

ARTICLE PUBLICATION DATE

25-Jul-2023

 

Shedding light on a dark problem

ASU research delivers UV-C in a novel way to defeat bacteria in tight spaces

Peer-Reviewed Publication

ARIZONA STATE UNIVERSITY

 

IMAGE: TESTING UV LIGHT THROUGH SIDE-EMITTING OPTICAL FIBERS (SEOFS): (A) WESTERHOFF AND HIS TEAM CREATED AN EXPERIMENTAL SETUP FOR GROWING BIOFILM ON AN INCONEL PLATE COUPON WITH IRRADIATION FROM SEOFS DELIVERING UV-A, -B, OR -C FROM AN LED OR A CONTROL REACTOR WITH SEOFS NOT CONNECTED TO A UV-LED. (B) EXPERIMENTAL IRRADIANCE WAS MEASURED AT DIFFERENT DISTANCES AWAY FROM AND ALONG THE LENGTH OF THE SEOF. (C) INTEGRATED SPATIAL LIGHT IRRADIANCE WAS MEASURED FROM ALL THREE PARALLEL SEOFS IN THE REACTOR. GRAPHIC COURTESY OF PAUL WESTERHOFF/ASU view more 

CREDIT: PAUL WESTERHOFF / ARIZONA STATE UNIVERSITY

Bacterial biofilms are clusters of microorganisms that form on wetted surfaces virtually everywhere. They harbor pathogens that compromise water quality, and they can disrupt the operation of many different engineered systems through the corrosion, fouling and clogging of tanks, pipes and valves.

In some settings, they could even be deadly. Space suits that enable crew operations outside of the International Space Station use recirculating water to regulate body temperatures in the orbital extremes of full sun (250 F) and full shade (-250 F). But biofilms blooming in those water lines have nearly compromised astronaut safety during spacewalks.

Ultraviolet, or UV, light offers an effective, chemical-free means of controlling this problem by damaging the DNA and enzyme repair systems of microbes—which leads to their demise. But the UV lamps commonly used for disinfecting water bring the risk of hazardous material leaks because they are mercury-based. Additionally, their designs are not practical for narrow-diameter tubing and other tight spaces where biofilms are likely to grow.

Seeking a practical solution, Arizona State University researchers collaborated with the start-up company H2Optic Insights to develop a novel method of using UV light, specifically shorter-wavelength UV-C, to inhibit biofilm growth in almost any space. The results of their work are published in the July issue of the journal Nature Water.

“Ultraviolet light has been extensively studied for its ability to deactivate bacteria and microorganisms in water,” said Paul Westerhoff, the corresponding author of the paper and a professor of civil and environmental engineering in ASU’s Ira A. Fulton Schools of Engineering. “But there is limited research on its effectiveness against bacteria in established biofilms, and a key challenge in biofilm research using UV-C light is delivering light effectively to surfaces in pressurized water systems.”

Westerhoff and his team overcame this challenge by using LEDs connected to thin, side-emitting optical fibers, or SEOFs, placed directly on surfaces where biofilms can develop. The team successfully inhibited biofilm growth by delivering UV-C light through SEOFs at wavelengths of 265 or 275 nanometers and at low irradiance levels, just above a threshold of 9 µW/cm2.

The study also considered the impact of different UV wavelengths on biofilm inhibition, revealing that UV-A and UV-B had negligible effects at low irradiance levels where UV-C was effective. Westerhoff and his team further demonstrated that intermittent cycling of UV-C—with 10 minutes of irradiation followed by 50 minutes of dark time—achieved results comparable to continuous light exposure. That meant reducing energy use by more than 80%.

“From a design perspective, SEOFs offer a flexible solution for effectively illuminating extensive surface areas within narrow pipes or irregularly shaped surfaces,” said Westerhoff, who also is deputy director of the National Science Foundation Nanosystems Engineering Research Center on Nanotechnology-Enabled Water Treatment, or NEWT. “This can be achieved using either a single SEOF or multiple SEOFs integrated into mesh designs.”

He said SEOFs also have the potential to revolutionize the design of apparatus for biofilm control since they can deliver UV at any wavelengths to surfaces where biofilms can develop and without the need to account for complications like light absorption or scattering through water, which would be a concern when using a point source LED to illuminate a surface.

“Using UV-C LEDs with SEOFs shows real promise in combating biofilms in water systems, particularly in enclosed and flowing water systems where traditional light delivery methods are limited,” said Westerhoff.  “So, these findings contribute to improving the safety, performance and energy efficiency of water treatment systems, including in challenging environments like the International Space Station.”

Westerhoff said further research is required to explore how biofilms at various stages of development respond to UV light of different wavelengths. There also is a need to optimize the UV-SEOF method for different applications, such as biomedical devices and energy systems.

Other authors of the Nature Water paper are Zhe Zhao, Nora Shapiro, François Perreault and Bruce Rittmann—all from ASU—as well as Hojung Rho from the Korea Institute of Civil Engineering and Building Technology and Li Ling from the Advanced Interdisciplinary Institute of Environment and Ecology at Beijing Normal University.

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JOURNAL

Nature Water

DOI

10.1038/s44221-023-00111-7 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Cells

ARTICLE TITLE

Biofilm inhibition on surfaces by ultraviolet light side-emitted from optical fibres

ARTICLE PUBLICATION DATE

10-Jul-2023

COI STATEMENT

P.W., Z.Z. and N.S. are authors on a patent application for side-emitting optical fibers; P.W. is co-owner of a company (H2Optic Insights LLC) aiming to commercialize the side-emitting optical fiber technology. The other authors declare no competing interests.

 

Scientists develop tool to predict dam removal costs by analyzing 55 years of past removals

Peer-Reviewed Publication

OREGON STATE UNIVERSITY

 

IMAGE: GLINES CANYON DAM REMOVAL ON SEPT. 3, 2014. view more 

CREDIT: JEFF DUDA, USGS.

CORVALLIS, Ore. – Scientists analyzed more than 650 dam removal projects over 55 years in the United States totaling $1.52 billion inflation-adjusted dollars to develop a tool to better estimate the cost of future dam removals.

The analysis arrives at a time of increasing awareness of the disruptive impact dams can have on ecosystems, while thousands of dams are increasingly being removed because they are aging, unsafe, no longer serving their original purpose or in need of costly repairs and maintenance.

“We are transitioning from a period of building dams to one that includes removing dams,” said Jeffrey Duda, a research ecologist with U.S. Geological Survey’s Western Fisheries Research Center. “But estimating costs of removing dams is a challenge, which makes it difficult to weigh when dam removal may be a viable alternative.”

Duda and scientists from the USGS, Oregon State University, the Bureau of Reclamation, U.S. Army Corps of Engineers, and the University of Georgia, begin to unravel those challenges in a paper just published in Frontiers in Ecology and Evolution.

“The results help us get beyond the common perception of ‘every dam removal is different,’” said Desiree Tullos, a water resources engineer at Oregon State. “That’s still true, but these databases give us a sense of the common and divergent features of dam removals across the U.S.

“When working through detailed costs with practitioners, we found that height isn’t always the best predictor of cost. Other factors like site restoration, mitigation of potential negative impacts of dam removal and sediment management can be major cost drivers, and those are often dependent on the preferences of local regulators and interested parties.”

The number of dams removed in the United State has increased significantly the past 50 years. For four 10-year periods beginning in 1976 and ending in 2015, the number of dams removed jumped from 45 to 139 to 313 to 637, according to past research by Duda, Tullos and others.

Now, as part of the 2022 Bipartisan Infrastructure Law, the federal government is awarding $733 million for dam safety projects, including dam removals. A recent estimate predicted that by 2050 between 4,000 and 32,000 more dams will be removed in the United States.

For the new paper, the researchers compiled reported costs for 668 dams removed from 1965 to 2020 in the United States. When adjusted for inflation into 2020 dollars, the projects totaled $1.52 billion dollars.

They divided the dams removed into three height categories: less than 5 meters, between 5 and 10 meters and greater than 10 meters. The median cost respectively for the three categories was $157,000, $823,000 and $6.2 million.

They also analyzed geographic differences in dam removals. The northeast accounted for the most dam removals with 277, followed by the Midwest (222), Southwest (78), Northwest (50) and Southeast (41). More than 80% of the dams were five meters or less.

The Northwest accounted for the highest cost, totaling $775.8 million, more than triple the second-place Midwest. The cost in the Northwest is influenced by several recent large-scale projects on the Elwha and Clark Fork rivers in Washington and Montana.

The researchers also estimated the main cost drivers of dam removal. Dam height was the strongest predictor, followed by average river discharge and project complexity, which accounts for costs associated with construction and sediment management, mitigation for dam removal effects and post-removal outcomes like replanting vegetation in former reservoir surfaces. Regional differences and dam material were also significant but less important factors.

In the coming years, the researchers plan to incorporate additional data as new projects and reported costs become available, with a goal of further refining the predictive accuracy of a machine-learning model.

“The model is going to get better and better and further help decision-makers as they grapple with how to manage the large number of dams approaching obsolescence,” Duda said.

Other co-authors of the paper are Suman Jumani, Daniel Wieferich, S. Kyle McKay, Timothy Randle, Alvin Jansen, Susan Bailey, Benjamin L. Jensen, Rachelle Johnson, Ella Wagner, Kyla Richards, Seth Wenger, Eric Walther and Jennifer Bountry.

Tullos is affiliated with Oregon State’s colleges of engineering and agricultural sciences.

Regional cost estimates of dam removal by dam height category in the United States from 1965 to 2020.

CREDIT

Jeff Duda

JOURNAL

Frontiers in Ecology and Evolution

 

Menstrual cups can help prevent infection, improve vaginal health

Peer-Reviewed Publication

UNIVERSITY OF ILLINOIS CHICAGO

Many girls in low- and middle-income countries struggle to buy products to manage their periods, which can cause them to skip school. So, ensuring they have access to menstrual products is critical. 

A new Kenya-based study from University of Illinois Chicago researchers shows that the benefits of one kind of menstrual product — a menstrual cup — extend well beyond educational access. Teenage girls who were given menstrual cups were less likely to acquire certain kinds of vaginal infections and were more likely to have a healthy vaginal microbiome, the study found. The findings are published in PLOS Medicine. 

The research, which was funded by the National Institutes of Health, followed 436 Kenyan secondary school girls, half of whom were given menstrual cups. They were tested every six months for bacterial vaginosis, a common type of infection, and at 12 months and 30 months for sexually transmitted infections. The researchers also tested participants’ vaginal microbiome to determine the relative prevalence of beneficial and harmful bacteria. 

At the end of the study, the girls with menstrual cups were 26% less likely to have bacterial vaginosis and were 37% more likely to have an optimal vaginal microbiome than the girls who didn’t receive a cup. Overall, the menstrual cups did not appear to lower the risk of sexually transmitted infections, but when the researchers controlled for confounding factors, such as age and whether the girls were sexually active, they did see a decrease in STIs among those using a menstrual cup. 

“The results showed that menstrual cups could be a game-changer in helping keep girls healthy,” said Supriya Mehta, an adjunct professor of epidemiology and biostatistics in the School of Public Health at UIC and principal investigator on the study.  

The study grew out of a conversation that Mehta had at a conference in Kenya in 2016 with Penelope Phillips-Howard, a professor at the Liverpool School of Tropical Medicine in the United Kingdom. At the time, Phillips-Howard had conducted an initial randomized trial looking at whether menstrual cups were effective at keeping girls in Kenya in school. As part of the study, the team tested for bacterial vaginosis and sexually transmitted infections, and she mentioned to Mehta that their results thus far suggested that menstrual cups were reducing infections. 

Mehta believed she knew why — because menstrual cups help maintain a healthy microbiome during menses. “If your vagina is healthy, then it’s more resilient to STI pathogens,” she explained.  

With this hypothesis, Mehta and her coauthors were able to create a sub-study looking at the biological impact of menstrual cups that was nested within a larger study of 4,000 girls that Phillips-Howard was embarking upon.  

There are a few reasons that menstrual cups are more beneficial to vaginal health than other menstrual products, Mehta explains. The cup, which is bell-shaped and made from medical-grade silicone, is inserted into the vagina, where it collects blood. Tampons, on the other hand, don’t take the blood out of the vaginal vault, and this iron-rich setting can be welcoming to the bacteria that cause bacterial vaginosis. The cups are also better than tampons at maintaining an acidic environment, which is a deterrent to infections. As for sanitary pads or reusable cloths that are worn too long or not cleaned properly, they can end up transferring bacteria into the vagina. 

“These are all challenges that menstrual cups address,” Mehta said. 

The study was conducted in Kenya because of the link between menstrual products and staying in school, and because of an additional potential benefit given that 10% of 15-year-olds there reported having exchanged sex for sanitary pads. Yet, Mehta sees the results as relevant in higher-income countries, too. She hopes the study is repeated elsewhere to assess these benefits. Beyond the health benefits for women in countries like the U.S., she also thinks menstrual cups would be particularly helpful for groups such as homeless women. 

The researchers have received $2.6 million in additional NIH funding to continue this study for another year. Mehta is also launching a second study focused on sex workers in Kenya, which is a particularly vulnerable group. Because they can’t stop working when they are menstruating, they often engage in risky behaviors to manage their periods, have to charge less or don’t get paid at all. Mehta received a $3 million NIH grant to study the impact of giving sex workers menstrual cups, one style of which can be worn unobtrusively during sex. 

Other researchers on the study include Stefan Green, formerly of UIC, and Runa Bhaumik, research assistant professor in the College of Medicine at UIC, who is co-investigator of the sex worker study. 

Written by Emily Stone

 

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JOURNAL

PLoS Medicine

DOI

10.1371/journal.pmed.1004258 

ARTICLE TITLE

Analysis of bacterial vaginosis, the vaginal microbiome, and sexually transmitted infections following the provision of menstrual cups in Kenyan schools: Results of a nested study within a cluster randomized controlled trial

ARTICLE PUBLICATION DATE

25-Jul-2023