Sangeetha Madhavan - US grants

[unreadable] DESCRIPTION (provided by applicant): This proposal addresses the effects of HIV/AIDS-related morbidity and mortality on household structure, composition, power dynamics and children's living arrangements. HIV/AIDS has attained epidemic proportions in sub-Saharan Africa over the past 10 years with particularly high prevalence rates in southern Africa.-While it is clear that the disease affects entire families and communities, few studies have explored the magnitude and patterns of these changes at the household level. To contribute to this needed body of research, we propose secondary analyses of data from rural South Africa, specifically from the Agincourt Health and Demographic Surveillance System (AHDSS) and an ethnographic study, Children's Weil-Being and Social Connection in Rural South Africa (CWSC), conducted in the AHDSS study area. The hypothesis driving this analysis is that HIV/AIDS related mortality affects household structure and composition and does so differently from other causes of death due to age and gender distribution of mortality. A secondary premise is that HIV/AIDS related morbidity engenders unique effects on household structure, composition and power relations due to duration of illness and gender and age of the ill. The AHDSS area is situated in Limpopo Province, which has a prevalence rate estimated at 13.5%, making it a medium-affected HIV/AIDS context (National Antenatal Survey 2000). The longitudinal AHDSS collected data annually since 1992 including: 1) household censuses, 2) update of vital events and 3) verbal autopsies, which are used to identify HIV/AIDS as probable cause of death. The 2002 CWSC focused on children's well being and social connections. Cross-sectional and longitudinal analyses of the AHDSS data will be used to examine the impact of HIV/AIDS related mortality on household level changes. The CWSC data will enable initial investigations into the effects of HIV/AIDS related morbidity on households through the use of case studies. Additionally, the proposed research includes a pilot qualitative study to examine the effects of HIV/AIDS morbidity and mortality on gender and generational power dynamics within the household. This research builds on ten years of collaborative research linked to the AHDSS. The proposed research will take advantage of 1) the existing wealth of data and 2) the research infrastructure to provide new insights into the effects of HIV/AIDS on families and households. [unreadable] [unreadable]

DESCRIPTION (provided by applicant): South Africa provides a unique context in which to examine aging because of the confluence of three factors: (1) a steady increase in the proportion of older persons in the population; (2) a decrease in life expectancy brought on by HIV/AIDS and (3) the existence of a state-funded non-contributory pension system for persons aged 60 and over. The proportion of South Africans in the 60+ age group was 7% in 2009 and is projected to double by 2050 (UN 2009). At the same time, life expectancy has dropped from a high of 61.5 in 1991 to 51.6 in 2009, much of it attributable to HIV/AIDS (World Bank 2009; Hontalez et al. 2011). The old age pension has become an invaluable household resource, particularly in rural areas, where it is equal to nearly 50% of mean household income, and benefits not just the recipient but entire households and their networks (Ardington et al., 2010; Case & Menendez, 2007; Schatz & Ogunmefun, 2007). All three factors are likely to be reflected in the living arrangements of older persons. The extant literature suggests that elders in African countries with higher HIV-prevalence are more likely to be living without caregivers (Kautz, Bendavid, Bhattacharya, & Miller, 2010) and providing care to orphaned grandchildren is resulting in increasing numbers of skipped generation households (Amaoteng et al. 2007; Cheng & Slankam 2009). However, emerging evidence shows that pensions may make elders attractive as household members, particularly in households with unemployed adults, thus resulting in multiple generation households (Schatz, Madhavan & Williams 2011). Most analysis of living arrangements of the elderly (Bongaarts and Zimmer 2002; Merli and Palloni 2004), however, use cross-sectional data, greatly limiting our ability to understand how the living arrangements of older persons are changing over time. Moreover, we know even less about how AIDS-related mortality and access to pensions influence older persons living arrangements. In this project, we address these gaps leveraging the power of a unique longitudinal dataset in rural South Africa. We propose to examine changes in the living arrangements of older persons aged 50+ over a ten year period (2000-2010) in a rural, Black community in Northeastern South Africa, a setting that has experienced an increase in the number of deaths attributable to AIDS and where the proportion of pension eligible persons in the population has also increased over a 10-year period. Using longitudinal data from the Agincourt Health and Demographic Surveillance System which covers approximately 14,000 households in the Agincourt sub-district of Mpumalanga province, we will undertake the following analyses: 1) examine the distribution of household types in which older persons reside at three time points (2000, 2005 and 2010); 2) calculate the probabilities of older persons' households transitioning from one type to another over two 5-year periods starting in 2000; and 3) analyze the roles of AIDS-related mortality and access to pension in driving changes in older persons' living arrangements. PUBLIC HEALTH RELEVANCE: The findings from this project will contribute to the small but growing research on the living arrangements of the elderly in Africa by focusing on 1) the change over time in living arrangements, 2) the extent of stability in household living arrangements over time and 3) the relationship between AIDS related mortality and access to pensions and living arrangements over a 10 year period (2000-2010) in rural South Africa. This time period is characterized by an increase in the deaths related to AIDS as well the number of people eligible for pension receipt (eligible age - 60). These results will inform intervention efforts and policy development for improving the health and wellbeing of older adults given that living arrangements are one important proximate determinant of physical and psycho-social health.

Information Core. Beginning in February 2011, in addition to its normal services, the Information Core provided document sharing and collaboration tools for researchers organizing the International Perspectives on Time Use Conference, which took place in June. The Core coordinator researched available project management and collaboration tools to support the process of developing the Center's R24 Renewal Proposal. A Sharepoint site hosted by the UMD Office of Information Technology was selected and this tool was augmented by task management organized using Microsoft Project. Core staff provided initial set-up and organization of the site,training for Center researchers and staff, regular updates ofthe content, and maintenance ofthe renewal task list. Core staff also developed the model and text for requesting, processing, and storing required biosketch and grant information from Faculty Associates. Post-renewal activities will focus on planned upgrades to the Center website.

PROJECT SUMMARY Achieving functional ambulation post stroke continues to be a challenge for stroke survivors, clinicians and researchers. The proposed study builds on our earlier R01 where we successfully examined the feasibility of a clinically implementable walking program which involves high intensity speed-based treadmill training (HIISTT) in combination with cortical priming to improve walking speed of individuals with stroke. Cortical priming has emerged as a promising adjuvant to enhance the outcomes of motor training. Our research team has pioneered and successfully developed neuromodulation techniques for the lower limb motor cortex using non-invasive transcranial direct current stimulation (tDCS) and ankle motor skill training. In this renewal application, our goal is to quantify the effectiveness of 36 sessions of cortical priming plus HIISTT intervention in comparison to sham priming plus HIISTT. Outcome measures will include gait variables, balance, aerobic capacity, quality of life, neurophysiological measures of descending and interhemispheric corticomotor excitability measured with transcranial magnetic stimulation (TMS), and changes in serum BDNF before, immediately after and 3-months post training. There has been a growing interest in understanding responsiveness to training to personalize stroke rehabilitation. We aim to understand variability in responsiveness to training using patient-specific parameters such as participant demographics, neurophysiological measures and the presence of genetic variations such as brain derived neurotrophic factor (BDNF) polymorphism. With our innovative mechanistic approach to enhance walking recovery, we seek to optimize gait rehabilitation post stroke and characterize relationships between neural mechanisms, motor function and genetic variations. Improved gait will enable stroke survivors to be more independent in the community and advance their quality of life, which is highly relevant to the mission of the NIH.

DESCRIPTION (provided by applicant): The objective of this study is to pilot and assess the feasibility of a new survey instrument to collect data on kinship support for young children of single mothers living in the slums of Nairobi, Kenya. These children are disadvantaged by their precarious environment, characterised by lack of sanitation, limited health care facilities, congested and low-quality housing, and wide-spread unemployment and poverty. Children born in the slums of Nairobi are significantly more likely to die than children in the rest of Kenya. Moreover, high rates of premarital childbirth, union dissolution, and adult mortality result in a large proportion of children who are raised by single mothers. As in most African contexts, however, these single mothers are assumed to receive considerable economic support and childcare assistance from their residential and non-residential extended kin. However, kinship support is potentially declining due to three processes under way in many African contexts: 1) increased distance between children and extended kin due to high rates of female migration, particularly to informal settlements in urban locations; 2) pervasive poverty which limits the ability of kin to provide support; and 3) transformation of views on marriage, women's roles, and family norms, with a greater reliance on conjugal bonds than kinship ties. As a result, we hypothesize that there might be enormous variation in the type and amount of kinship support that children of poor, urban, single mothers receive which, in turn, could put their health and well-being at risk. This hypothesis and the mechanisms underlying it have not been tested because of inadequate data collection instruments. Thus, we have three primary objectives in this project. First is to pilot a new survey instrument - the kinship support tree (KST) - to collet data on kinship networks and support in three domain: emotional closeness, childcare provision and economic support and record multiple indicators of geographic proximity to non-residential kin on approximately 500 children under the age of five at two points in time. Second is to assess feasibility of administering this instrument at multiple time points in a highly mobile population. Key markers for assessing feasibility of administering this instrument include: 1) time investment; 2) financial cost; 3) ease of administration; and 4) attrition. Third, is to assess reliability of the data collected and conduct exploratory analysis of the data. Multiple and repeated measures of both kinship support and geo-spatial data will be collected to assess reliability. Exploratory analysis will correlate our three indicators of support with selected geo-spatial measures and examine how support varies over time. By developing a new method of data collection, we will not only significantly advance our understanding of the amount and type of kinship support available to single mothers living in disadvantaged contexts in sub-Saharan Africa, but also make innovative contributions to the broader field of family demography and child well-being.

PROJECT SUMMARY The Development Core has, as its primary mission, the development and promotion of population research at the university in line with our four PRAs: Gender, Family and Social Change, Health in Social Context, Social and Economic Inequality, and Migrant and Immigrant Processes. The Core's mission is accomplished through: 1) promoting inter-disciplinary engagement in population research through seminars, workshops and other collaborative opportunities including with the Federal statistics agencies and larger Washington DC community; 2) supporting our faculty, in particular junior and URM faculty, to develop and expand their research agenda in the population sciences through Seed Grants; 3) hosting resident and visiting population scientists in order to support and expand collaborative opportunities for MPRC faculty associates; 4) fostering the careers of underrepresented scholars in population research in order to foster balanced and broadened perspectives in setting population research priorities; and 5) co-sponsoring symposia and workshops on a range of population related issues in order to increase our visibility at UMD and strengthen our interdisciplinary mission. The seminar series and workshops offer an invaluable opportunity for the UMD community to engage with population researchers at other universities in the US and beyond. The Seed Grant program is critical to supporting the development of proposals for submission to NIH/PDB, other federal agencies and foundations. The resident and visiting researcher programs are critical to increasing the visibility of MPRC nationally, internationally and to the greater Washington DC community. The DC?s programs to support URM scholars addresses the call by NICHD/PDB and other federal funding agencies to increase the visibility of URM researchers in population research. Co-sponsoring symposia is a highly effective and cost efficient way to interact with other entities at UMD to elevate the role of MPRC in promoting population research at UMD.

Project Summary Despite significant progress in improving child survival, sub-Saharan Africa continues to have some of the worst outcomes for children?s physical growth and early childhood development. This is driven in large part by elevated risks for children living in low-income urban communities. Whereas research has focused on environmental factors, socioeconomic status and access to services, much less effort have gone into understanding how rapid social transformation in marriage and the role of kin impacts children?s well-being in these communities. In this project, we build on the success of an NICHD R21 project to develop and test the Kinship Support Tree (KST) to assess quantity and quality of support from kin to single mothers and their children in a slum context in Nairobi, Kenya. The proposed mixed methods, the longitudinal study develops a new measure of union formalization to examine the relationships among kinship support, union formalization and infant/child development outcomes. The union formalization measure will capture the process of recognizing unions socially and/or legally. The study will be carried out in the same site as the KST project. The site hosts a Health and Demographic Surveillance System (HDSS) which facilitates initial sample selection and provides strong infrastructure. We will conduct rigorous cognitive testing to finalize the questions on union formalization, validate existing relationship quality scales and pretest all instruments in the first year to inform the survey development. We will then start with 1250 children ages 0 ? 24 months with mothers aged 18-29 and collect data on the children, mothers and selected kin two times per year over 3 years. Data on kin include geospatial indicators of residence and distance and multiple domains of kinship support. This will be supplemented with qualitative follow up once a year on a subsample of mothers, biological fathers, and current partners. Our analysis will focus on the direct effects of union formalization and kinship support on child outcomes as well as on a set of intermediate outcomes known to be associated with child development. We will use cross-lagged structural equation and growth models to examine the effects of union formalization and kinship support on children?s physical growth and early child development (ECD) over time. We will also assess the extent to which union formalization moderates the effect of kinship support on physical growth and ECD outcomes and kinship support mediates the effect of union formalization on physical growth and ECD outcomes. We will use moderated mediation models to accomplish this. The ultimate goal of the study is to identify models of family support that offer optimum protection for vulnerable mothers and young children.

PROJECT SUMMARY ALS affects as many as 30,000 individuals in the United States, with 5,600 new cases diagnosed each year. Riluzole and edaravone, the only drugs approved by the U.S. FDA for ALS, slow ALS progression; however, they do not demonstrate marked improvement in ALS symptoms and increase survival time only by a few months. Hence, most of the care is centered on patient support and symptom management, making rehabilitation an integral aspect for slowing disease progression, prolonging life span and increasing quality of life. Our long-term goal is to develop neuromodulation therapies for easy clinical management of ALS. Transcranial direct current stimulation (tDCS) has been increasingly explored as a promising neuromodulatory tool to prime motor function in several neurological disorders. Despite the emerging importance of cortical dysfunction as a pathophysiological biomarker in disease progression, the study of tDCS in ALS is limited. Here we propose a novel mechanism using remotely supervised tDCS (RS-tDCS) to target hypoexcitable neural pathways to preserve motor function in individuals with ALS. Due to its low risk, ease of use, and portability, tDCS is a candidate neuromodality to be administered in a home-based environment with remote supervision from qualified personnel. Remote supervision would ensure that the stimulation is delivered optimally in the comfort of a patient?s home, reducing burden on patients and caregivers to travel to the clinic or research facility and encourage protocol adherence. We aim to investigate the effectiveness and feasibility of long-term RS-tDCS in individuals with ALS. In a delayed-start design, 38 participants with ALS will be randomized into remotely supervised tDCS or delayed-start control group. The intervention group will receive 24 weeks of anodal tDCS (3 times/week; 72 sessions). The delayed-start group will first receive sham tDCS for 12 weeks followed by a switch to anodal tDCS for 12 weeks. Aim 1 will investigate the safety and feasibility of long-term treatment with anodal RS-tDCS in ALS. Aim 2 will determine the effects of 24-weeks of RS-tDCS on disease progression in individuals with ALS, using the ALS Functional Rating Scale (ALSFRS-R) and other clinical outcomes. As a secondary aim, we will explore the effectiveness of RS-tDCS on upper and lower motor neuron mechanisms in individuals with ALS, quantified using transcranial magnetic stimulation and peripheral nerve stimulation. Successful completion of this project will trigger future studies that will test the clinical translation of tDCS as a home-based neuromodulatory adjuvant to slow disease progression in ALS and create a paradigm shift in the clinical management of ALS.