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In 2010, Massachusetts had a population of 6.6 million, of whom 1.4 million, or 22%, are children ≤18 years old. 7 The percentage of children <5 years of age was 5.6%. 8 The study population included all cases of IPD in children ≤5 years old who had an IPD diagnosis in Massachusetts.

Full-scale distribution of PCV7 according to guidelines began in July 2000 in Massachusetts, where all recommended childhood vaccines are purchased and distributed by the Massachusetts Department of Public Health (MDPH) to both public and private health care providers. Immunization uptake of ≥3 of PCV7 among children aged 19 to 35 months in Massachusetts in 2011 was 98%. 9 In February 2010, PCV13 was approved for use in all children aged 6 weeks to 60 months, and up to 71 months of age in those with comorbidity, and replaced PCV7. All doses of PCV13 for both routine administration and supplemental doses are supplied universally by MDPH.

Increased statewide surveillance for IPD has been in place since October 2001. Each pediatric IPD case in Massachusetts is reportable, and clinical microbiology laboratories in Massachusetts are requested to provide all S. pneumoniae isolates recovered from sterile sites from children <18 years of age to MDPH. MDPH epidemiologists, in collaboration with local boards of health, collect a standardized set of data on age, gender, race, vaccination status, clinical presentation, and underlying medical conditions of the case and interview parents or guardians to document day care attendance and household information such as occupancy number.

Serotyping is performed on available isolates at the Maxwell Finland Laboratory for Infectious Diseases at Boston Medical Center, using the Quellung reaction with pneumococcal antisera (Statens Serum Institute, Copenhagen, Denmark). Antibiotic susceptibilities to penicillin, ceftriaxone, and azithromycin are determined by E-test, and minimum inhibitory concentration interpretations are based on current Clinical and Laboratory Standards Institute guidelines.

Statistical Methods

Patient characteristics were compared by using the Fisher’s exact test for categorical variables and the Wilcoxon or Kruskal–Wallis test for continuous variables. In analyzing length of hospitalization, we used the Wilcoxon test by ranking children who were not hospitalized as though they had the shortest stays and those who died during hospitalization as though they had the longest stays. We investigated the effect of VT on disease severity using logistic regression models, adjusting for gender, age group, and comorbidity as potential confounders. All data management was performed with Microsoft Excel 2011 version 14.3.6 (Microsoft Corporation, Redmond, WA), and statistical analyses were performed with SAS version 9.3 (SAS Institute, Inc, Cary, NC). The significant level for all tests was set at 5%. values were not adjusted, but because numerous values were calculated, all results were conservatively interpreted.

This study was approved by the institutional review boards of the University of Minnesota and the MDPH.

There were 168 cases of IPD from 2007 to 2009 and 85 cases of IPD from 2010 to 2012 in Massachusetts children ≤5 years of age ( Black Faux Suede Mini Skirt With Buckles 10 / BLACK I Saw It First Buy Cheap Exclusive ET6pCx
). This was equivalent to incidence rates of 46 per 100 000 pre-PCV13 and 23 per 100 000 post-PCV13, with an estimated change in IPD rate being 23 per 100 000 (95% confidence interval, 14–31; P < .00001). In terms of absolute numbers, children 2 to 23 months of age formed the largest group with IPD in both pre- and post-PCV13 phases, comprising 53.0% and 56.5% of patients, respectively ( Table 2 ). Caucasians were the predominant race, making up 47.0% of cases in the pre-PCV13 and 41.2% in the post-PCV13 phase ( Table 1 ). In the pre-PCV13 phase, 59.5% were up to date on their PCV immunization, compared with 58.8% in the post-PCV13 phase. Comparing VT and NVT, 56.9% of patients with VT-IPD were up to date with their PCV immunization, compared with 67.8% of patients who had NVT-IPD, although this difference was not statistically significant ( P = .145; Table 3 ).

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13 Mar, 2017, 12:34 pm

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Hearing loss may be the third most common medical condition in the US, but there is nothing common about how each person experiences it.

There are many different configurations of hearing loss – and one of them is the degree at which people experience it.

Approximately 70% of people who treat hearing loss with hearing aids, the degree of hearing loss falls between mild to moderate. This means that sounds between 25 and 60 decibels (dB) are difficult to hear.

Thirty-percent of people experience severe to profound degrees of hearing loss. For those who experience severe hearing loss, sounds below 60 dB are difficult. Most normal conversations fall in the 60 dB range. As such, people with severe hearing loss require more powerful amplification of speech. For those with profound hearing loss, sounds below 80dB are difficult to hear. To put this into context, the sound of a lawnmower registers at 90 dB. Speech recognition and most sounds of daily life are hindered.

A common complaint of people with severe to profound hearing loss is that they may hear sounds, but they do not understand them. Luckily, there are a number of hearing aids available to address .

Severe to profound hearing loss is most commonly treated with high-powered hearing aids. These hearing aids are designed with many of the same features of hearing aids to treat other levels of hearing loss – with extra amplification and more powerful speech recognition features.

Hearing aids to treat severe to profound hearing loss are often worn behind-the-ear (BTE), as these hearing aids are more flexible and offer more customization and access to sounds based on the placement of the microphone.


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Phonak addresses severe to profound hearing loss with their model Naida V, which connects to the Roger wireless microphone for extra amplification. Naida V hearing aids are compatible with DECT phone, which allows wearers to transmit phone calls directly to their hearing aids. Naida V has been scientifically proven to enhance understanding of speech and sound against challenging background noise (when coupled with the Roger microphone, this increases to 62%). Naida V’s flexibility also allows wearers to focus on conversations with multiple speakers and capture sounds of high frequency that people with severe to profound hearing loss tend to miss.


The ENZO2 is ReSound ’s power hearing aid to address severe to profound hearing loss. This “Super Power” hearing aid gives wearers enhanced amplification and feedback elimination (buzzing which occurs due to higher levels of amplification). With the same wireless technology that won the LiNX2 much praise, the ENZO2 allows wearers to connect to personal electronic devices for an added level of accessibility and intelligibility. The Spatial Sense feature gives hearing aid wearers the ability to locate themselves in their environment. ENZO 2 is available in two power levels: High Power and Super Power, and is a discreet behind-the-ear hearing aid perfect for active lifestyles.


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Political failure through a business lens

Campaign ’16: How coverage rerouted

National World Affairs

National World Affairs

A report by HBS Professor Michael E. Porter and co-author Katherine Gehl looks at the dysfunction of the U.S. political system through a business lens to find practical, effective ways to improve how politics serves average voters.

Rose Lincoln/Harvard Staff Photographer

Lack of competition, accountability are crippling America’s ability to thrive, report says

By Christina Pazzanese Harvard Staff Writer



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There’s a general consensus that Washington is “broken.” But the reason politics doesn’t seem to deliver for citizens anymore may not involve who’s in the White House, which party controls Congress, or even any inherent flaws in the political system.

In fact, over the last few decades, the system may have worked better than ever for the constituencies that it was built to serve best: primary voters, donors, and lobbyists for special interests, including businesses. Unfortunately for the American public, most ordinary voters are not among those leading beneficiaries.

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, Washington’s proverbial “swamp” isn’t a set of disjointed public institutions. Rather, it’s a self-regulating industrial complex that limits healthy competition in order to promote its continued growth and caters to the power and profit-driven demands of its best customers instead of the broader public interest.

During the 2016 election cycle, the report estimates that federal political spending reached at least $16 billion, and nearly 20,000 jobs could be attributed to campaign staffing, consulting, and lobbying. The political media also benefitted, with most major news outlets posting record advertising revenues last year as a result of expanded interest in politics.

While competition between the two parties looks fiercer than ever, in reality, the study suggests, both Democrats and Republicans benefit from having the other as a foil to raise funds against, from having opposing policy positions to rally around, and from, in effect, roping off the playing field from outside challengers who might outshine them.

To understand how and why politics has become so disconnected from serving the people and producing positive results, Porter and Gehl studied the business of politics as they would study any company or sector, looking at structural components such as competitors, customers, channels to reach customers, suppliers, and the threat of new entrants into the market using the “five-forces framework.”

They wanted to know how a country that personified the success of modern democracy after World War II could have fallen into a state of failure and inertia, with no end in sight.

“How do you have this system that’s not meeting the customers’ needs, the citizens’ needs, not solving the problems that are in the public interest, and yet we’re not holding them accountable?” Gehl said she and Porter wondered. “What’s going on?”

Porter, who studies economic development and competitiveness, said the idea to examine politics through the lens of business stemmed from his experience overseeing the U.S. Competitiveness Project at HBS. Since 2011, the project has surveyed HBS alumni and other business leaders to assess perceptions about which aspects of the country, such as the economy or education, they see as thriving and which as lacking.

The survey results consistently showed that Washington’s persistent failure to pass legislation in recent years has been a major obstacle to moving the country forward on nearly every front that makes a healthy business environment, from tax reform and restoring economic growth to improving public education and health care and rebuilding the nation’s infrastructure.

Gehl, a former CEO who spent years in politics supporting candidates, said she eventually became disillusioned because while the names and faces changed, the partisan-driven gridlock in Washington and politicians’ focus on primary voters, special interests, and donors did not.

“I was always looking for ‘who’s the right candidate?’” she said. But “because the system was so dysfunctional, no matter who you send into that system, the system, the structure, and the incentives that are built into that system are larger and stronger than any individual’s desire to make a difference.”

Despite the present dire political straits, however, the pair say they see plenty of reasons to be optimistic.

“There are things that can be done”

“By changing the design, by changing the rules of the game, we can change the results that the system’s incented to deliver,” said Gehl. “We don’t just have to be frustrated about it, there are things that can be done.”

One troublesome aspect of our current political system, the report finds, is that it offers the key actors no incentive to change their behavior. After all, why would they when it’s working great for their interests?

Worst of all, the authors said, there’s no accountability.

Unlike other industries, which are subject to federal oversight or face threats from competition if they don’t serve customer needs, there’s no higher authority lording over the political system. Though the Federal Election Commission is nominally tasked with ensuring that election and financing rules are followed, the panel is stocked with political appointees and under constant pressure to operate with a very light touch.

Theoretically, voters are supposed to be the ultimate check: If the public doesn’t like what’s going on, the party or elected officials get voted out. Yet even with some leadership churn, candidates from outside the two parties rarely get elected, so the system continues to serve the needs of its preferred customers: the small number of hardcore primary voters, big-pocketed donors, and special-interest groups, the study says.

That closed loop is no accident, the authors believe. Democrats and Republicans control the political system through mutually beneficial rule-making done behind the scenes, Gehl and Porter assert. The parties have enacted rules that protect their dominance by controlling the primary process, access to voter data, fundraising limits, how Congress is governed, and what issues are debated. The system even coopts media attention and access, which creates a major barrier to entry.

Though no industry rolls out the red carpet to new competition, the Democratic and Republican parties have been particularly skillful in keeping challengers outside the two-party system from getting a toehold, the authors believe. Without a competitive threat, the parties have little worry that failing to serve the needs of average voters will have hurt them.

“It’s one of the most striking cases I’ve ever seen” of antitrust-style behavior, said Porter. “It’s impossible” to succeed from outside the parties.

What can be done to revamp the system

Though they concede that the situation is complex, Porter and Gehl identify four key areas of the political system that could be revamped to improve how politics can deliver for everyday voters.

Among their recommendations:

One major objective of the report, the pair say, is to get the business community to understand the structural source of Washington’s dysfunction and help begin to fix it. They acknowledge that won’t be easy. In the current environment, some business leaders want nothing to do with politics, while others have gotten into the game and done quite well for themselves with the help of lobbyists, who typically deliver a healthy return on investment. But while lobbying may produce short-term wins for an individual company or a specific business sector, it is at the expense of the country’s long-term well-being.

Some businesses have become special-interest advocates, and thus contributors to the larger political dysfunction, the authors say. While most businesses are unhappy with the current state of affairs, they often disconnect their own lobbying efforts from the dissatisfaction they feel, said Porter, adding, “We’ve got to bring those things together.”

“So we are determined, in whatever way we can, to try to get businesses to understand the kind of corrosive effects that is having on our entire economy, on everything they need to happen in our economy,” he said.

“Today’s CEOs also need to redefine corporate purpose in ways that align strategy and business competition with the needs of society, which will mean a different relationship with government,” the paper concludes.

Bringing the message to the business community

In the coming weeks, Porter and Gehl will bring their message to the business community and Harvard alumni across the country and plan to work with HBS students eager to change the way Washington works. The authors also hope to convene a major event at HBS with top business leaders to begin tackling the issues.

“We’re going to try to make the business community very uncomfortable with the status quo that they sort of fell into without necessarily understanding the consequences,” said Porter.

If the political system is to work for everyone, ordinary citizens also must take responsibility for action and demand changes in the rules of the game.

“That’s part of why we’ve written this, because we want to be explicit about what’s gone wrong, and we want to invite people who have heretofore engaged in the political system by supporting a candidate or a party to know that there’s another way they must engage,” said Gehl.

“You have to engage in caring about the way the system itself is structured. You cannot just show up and vote for the candidate or support the candidate. You’re going to have to care about the rules of the game overall.”

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