Minority preferences and disease types for non-emergent emergency department usage in a CHIP population

Background. Of the over five million annual pediatric visits to U.S. emergency departments, one-third to one-half are for non-emergent conditions. Minorities are more likely to utilize the emergency department (ED) for non-emergent conditions. Very little research has analyzed the role of illness type, perceived need, or family preferences in explaining this disparity. ^ Objectives. This study examined racial-ethnic differences in preferences for care among non-emergent users of the ED. ^ Research design. A random selection of pediatric non-emergent ED users within a single CHIP managed care plan were surveyed regarding attitudes and health care preferences. Preferences for ED utilization were analyzed by racial-ethnic category, controlling for illness type, child and guardian age, education level, language, and perceived need. ^ Results. A total of 250 families were surveyed. Most respondents reported having a regular doctor, satisfaction with their physician, and ready access to their physician. Fifteen percent of White, 39% of Hispanic, and 38% of Black families reported they preferred the emergency department for ill care. In multivariate analysis, Whites families were significantly less likely to prefer the emergency department for ill visits (odds ratio, 0.12; 95% confidence interval 0.03-0.55) compared to Blacks and Hispanics. ^ Conclusions. Racial-ethnic disparities in non-emergent ED utilization may be partially explained by different preferences for care. ^ Key words: children, emergency department, preferences for care, disparities ^

A comparative analysis of CHIP Perinatal policy in twelve states

The purpose of this comparative analysis of CHIP Perinatal policy (42 CFR § 457) was to provide a basis for understanding the variation in policy outputs across the twelve states that, as of June 2007, implemented the Unborn Child rule. This Department of Health and Human Services regulation expanded in 2002 the definition of “child” to include the period from conception to birth, allowing states to consider an unborn child a “targeted low-income child” and therefore eligible for SCHIP coverage. ^ Specific study aims were to (1) describe typologically the structural and contextual features of the twelve states that adopted a CHIP Perinatal policy; (2) describe and differentiate among the various designs of CHIP Perinatal policy implemented in the states; and (3) develop a conceptual model that links the structural and contextual features of the adopting states to differences in the forms the policy assumed, once it was implemented. ^ Secondary data were collected from publicly available information sources to describe characteristics of states’ political system, health system, economic system, sociodemographic context and implemented policy attributes. I posited that socio-demographic differences, political system differences and health system differences would directly account for the observed differences in policy output among the states. ^ Exploratory data analysis techniques, which included median polishing and multidimensional scaling, were employed to identify compelling patterns in the data. Scaled results across model components showed that economic system was most closely related to policy output, followed by health system. Political system and socio-demographic characteristics were shown to be weakly associated with policy output. Goodness-of-fit measures for MDS solutions implemented across states and model components, in one- and two-dimensions, were very good. ^ This comparative policy analysis of twelve states that adopted and implemented HHS Regulation 42 C.F.R. § 457 contributes to existing knowledge in three areas: CHIP Perinatal policy, public health policy and policy sciences. First, the framework allows for the identification of CHIP Perinatal program design possibilities and provides a basis for future studies that evaluate policy impact or performance. Second, studies of policy determinants are not well represented in the health policy literature. Thus, this study contributes to the development of the literature in public health policy. Finally, the conceptual framework for policy determinants developed in this study suggests new ways for policy makers and practitioners to frame policy arguments, encouraging policy change or reform. ^

Evaluation of CHIP perinatal program outcomes in Harris County, Texas

This study compared initial year trends in prenatal care and birth outcomes of women enrolled in the Texas Children's Health Insurance Program (CHIP) Perinatal program to trends in Medicaid program women. The study utilized claims data from Community Health Choice (CHC), a health plan in Harris County, Texas that provides coverage to both populations. Quarterly data was analyzed and compared for the first two years of the CHIP Perinatal program (2007-2008) to determine if outcome trends for the CHIP program improved over the outcome trends seen with those enrolled in Medicaid. Study findings indicate an increase in the quarterly prenatal care utilization for the CHIP Perinatal population from 2007 to 2008 and the associated birth weights of babies delivered also had marginal improvements during the same timeframe. Enrollees in Medicaid continued to have overall better outcomes than those enrolled within the CHIP Perinatal program. However, the study showed that the rate of improvement in both prenatal care utilization and birth outcomes were greater for the CHIP Perinatal enrollees than those enrolled in Medicaid. ^ The majority of these improvements were significant when comparing each coverage program and from year to year. Lastly, the study showed that there was a correlation between prenatal care utilization and birth outcomes. However, further analysis of the data could not conclusively indicate that access to prenatal care services provided by the CHIP Perinatal program contributed to the increases observed in utilization and birth outcomes for the study's sample population.^

Fabrication of sub-100 nm IDT SAW devices on insulating, semiconducting and conductive substrates

This work describes the electron-beam (e-beam) lithography process developed to manufacture nano interdigital transducers (IDTs) to be used in high frequency (GHz) surface acoustic wave (SAW) applications. The combination of electron-beam (e-beam) lithography and lift-off process is shown to be effective in fabricating well-defined IDT finger patterns with a line width below 100 nm with a good yield. Working with insulating piezoelectric substrates brings about e-beam deflection. It is also shown how a very thin organic anti-static layer works well in avoiding this charge accumulation during e-beam lithography on the resist layer. However, the use of this anti-static layer is not required with the insulating piezoelectric layer laying on a semiconducting substrate such as highly doped silicon. The effect of the e-beam dose on a number of different layers (of insulating, insulating on semiconducting, semiconducting, and conductive natures) is provided. Among other advantages, the use of reduced e-beam doses increases the manufacturing time. The principal aim of this work is to explain the interrelation among e-beam dose, substrate nature and IDT structure. An extensive study of the e-beam lithography of long IDT-fingers is provided, in a wide variety of electrode widths, electrode numbers and electrode pitches. It is worthy to highlight that this work shows the influence of the e-beam dose on five substrates of different conductive nature

Sputter optimization of AlN on diamond substrates for high frequency SAW resonators

The AlN/diamond structure is an attractive combination for SAW devices and its application at high frequencies. In this work, the synthesis of AlN thin films by reactive sputtering has been optimized on diamond substrates in order to process high frequency devices. Polished microcrystalline and as-grown nanocrystalline diamond substrates have been used to deposit AlN of different thickness under equal sputtering conditions. For the smoother substrates, the FWHM of the rocking curve of the (002) AlN peak varies from 3.8° to 2.7° with increasing power. SAW one port resonators have been fabricated on these films, whose electrical characterization (in terms of S11 parameters) is reported.

A Light-Weight On-Chip Monitoring Network for Dynamic Adaptation and Calibration

Current nanometer technologies suffer within-die parameter uncertainties, varying workload conditions, aging, and temperature effects that cause a serious reduction on yield and performance. In this scenario, monitoring, calibration, and dynamic adaptation become essential, demanding systems with a collection of multi purpose monitors and exposing the need for light-weight monitoring networks. This paper presents a new monitoring network paradigm able to perform an early prioritization of the information. This is achieved by the introduction of a new hierarchy level, the threshing level. Targeting it, we propose a time-domain signaling scheme over a single-wire that minimizes the network switching activity as well as the routing requirements. To validate our approach, we make a thorough analysis of the architectural trade-offs and expose two complete monitoring systems that suppose an area improvement of 40% and a power reduction of three orders of magnitude compared to previous works.