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. ^

Utilization behavior of the elderly in an HMO: A causal analysis

Planning and providing health care services for the elderly represents a major challenge to the health care system. One part of that challenge is the identification of those factors which determine the utilization of services by this population. The purpose of this study is to explain the use of health care services by elderly subscribers in a prepaid group health plan, using the theoretical framework developed by Andersen and Aday. The impact of the predisposing, enabling and need factors on utilization was modelled through a structural equation approach using LISREL. The data were derived from Kaiser-Permanente's Medicare Prospective Payment Project, August 1980-December 1982. Need factors, in general, were the most significant determinants of utilization, with the predisposing and enabling factors found to be secondary but necessary links in the causal chain. The model was fitted to the data from the youngest age group (65-74 years) and then evaluated for goodness of fit in the two older groups (75-84 and 85+ years). Implications of the study's findings and suggestions for further modelling the utilization behavior of the elderly are discussed. ^

Design of long-term animal bioassay for low-dose extrapolation using a multistage model

Conventional designs of animal bioassays allocate the same number of animals into control and dose groups to explore the spontaneous and induced tumor incidence rates, respectively. The purpose of such bioassays are (a) to determine whether or not the substance exhibits carcinogenic properties, and (b) if so, to estimate the human response at relatively low doses. In this study, it has been found that the optimal allocation to the experimental groups which, in some sense, minimize the error of the estimated response for low dose extrapolation is associated with the dose level and tumor risk. The number of dose levels has been investigated at the affordable experimental cost. The pattern of the administered dose, 1 MTD, 1/2 MTD, 1/4 MTD,....., etc. plus control, gives the most reasonable arrangement for the low dose extrapolation purpose. The arrangement of five dose groups may make the highest dose trivial. A four-dose design can circumvent this problem and has also one degree of freedom for testing the goodness-of-fit of the response model.^ An example using the data on liver tumors induced in mice in a lifetime study of feeding dieldrin (Walker et al., 1973) is implemented with the methodology. The results are compared with conclusions drawn from other studies. ^

Diurnal and seasonal measurements of seawater chemistry, temperature and PAR in Hurricane Hole, U.S. Virgin Islands - 2010-2012

Risk analyses indicate that more than 90% of the world's reefs will be threatened by climate change and local anthropogenic impacts by the year 2030 under "business-as-usual" climate scenarios. Increasing temperatures and solar radiation cause coral bleaching that has resulted in extensive coral mortality. Increasing carbon dioxide reduces seawater pH, slows coral growth, and may cause loss of reef structure. Management strategies include establishment of marine protected areas with environmental conditions that promote reef resiliency. However, few resilient reefs have been identified, and resiliency factors are poorly defined. Here we characterize the first natural, non-reef coral refuge from thermal stress and ocean acidification and identify resiliency factors for mangrove-coral habitats. We measured diurnal and seasonal variations in temperature, salinity, photosynthetically active radiation (PAR), and seawater chemistry; characterized substrate parameters; and examined water circulation patterns in mangrove communities where scleractinian corals are growing attached to and under mangrove prop roots in Hurricane Hole, St. John, US Virgin Islands. Additionally, we inventoried the coral species and quantified incidences of coral bleaching, mortality, and recovery for two major reef-building corals, Colpophyllia natans and Diploria labyrinthiformis, growing in mangrove-shaded and exposed (unshaded) areas. Over 30 species of scleractinian corals were growing in association with mangroves. Corals were thriving in low-light (more than 70% attenuation of incident PAR) from mangrove shading and at higher temperatures than nearby reef tract corals. A higher percentage of C. natans colonies were living shaded by mangroves, and no shaded colonies were bleached. Fewer D. labyrinthiformis colonies were shaded by mangroves, however more unshaded colonies were bleached. A combination of substrate and habitat heterogeneity, proximity of different habitat types, hydrographic conditions, and biological influences on seawater chemistry generate chemical conditions that buffer against ocean acidification. This previously undocumented refuge for corals provides evidence for adaptation of coastal organisms and ecosystem transition due to recent climate change. Identifying and protecting other natural, non-reef coral refuges is critical for sustaining corals and other reef species into the future.

Amino acid geochronology of foraminifera test from north Queensland margin

In this study, we demonstrate the utility of amino acid geochronology based on single-foraminiferal tests in Quaternary sediment cores from the Queensland margin, Australia. The large planktonic foraminifer Pulleniatina obliquiloculata is ubiquitous in shelf, slope, and basin sediments of north Queensland as well as pantropical oceans. Fossil tests are resistant to dissolution, and retain substantial concentrations of amino acids (2-4 nmol/mg of shell) over hundreds of thousands of years. Amino acid D and L isomers of aspartic acid (Asp) and glutamic acid (Glu) were separated using reverse phase chromatography, which is sensitive enough to analyze individual foraminifera tests. In all, 462 Pulleniatina tests from 80 horizons in 11 cores exhibit a systematic increase in D/L ratios down core. D/L ratios were determined in 32 samples whose ages are known from AMS 14C analyses. In all cases, the Asp and Glu D/L ratios are concordant with 14C age. D/L ratios of equal-age samples are slightly lower for cores taken from deeper water sites, reflecting the sensitivity of the rate of racemization to bottom water temperature. Beyond the range of 14C dating, previously identified marine oxygen-isotope stage boundaries provide approximate ages of the sediments up to about 500,000 years. For this longer time frame, D/L ratios also vary systematically with isotope-correlated ages. The rate of racemization for Glu and Asp was modeled using power functions. These equations can be used to estimate ages of samples from the Queensland margin extending back at least 500,000 years. This analytical approach provides new opportunities for geochronological control necessary to understand fundamental sedimentary processes affecting a wide range of marine environments.

Grain-size distributions and bulk chemistry of sediment core MD00-2361

The terrigenous fraction of sediments from a deep-sea sediment core recovered from the northwestern Western Australian continental slope offshore North West Cape, SE Indian Ocean, reveals a history of Western Australian climate throughout the last 550 ka. End-member modelling of a data set of grain-size distributions (n = 438) of the terrigenous sediment fraction allows to interpret the record in terms of aeolian and fluvial sediment deposition, both related to palaeo-environmental conditions in the North West Cape area. The data set can be best described by two aeolian end members and one fluvial one. Changes in the ratio of the two aeolian end members over the fluvial one are interpreted as aridity variations in northwestern Western Australia. These grain-size data are compared with bulk geochemical data obtained by XRF scans of the core. Log-ratios of the elements Zr/Fe and Ti/Ca, which indicate a terrigenous origin, corroborate the grain-size data. We postulate that the mid- to late Quaternary near North West Cape climate was relatively arid during the glacial and relatively humid during the interglacial stages, owing to meridional shifts in the atmospheric circulation system. Opposite to published palaeo-environmental records from the same latitude (20°S) offshore Chile and offshore Namibia, the Australian aridity record does not show the typical southern hemisphere climate variability of humid glacials and dry interglacials, which we interpret to be the result of the relatively large land mass of the Australian continent, which emphasises a strong monsoonal climatic system.