The Lack of a Structured Universal Healthcare System in the United States: How This Affects the Lives of Millions of Americans and What Can Be Done About It

The purpose of this research is to explore on a deeper level the healthcare system of the United States, its background, and other factors that could provide possible solutions to simplify the fragmented healthcare system. The ultimate goal is the formation of concise ideas that could make the system, which prevents millions of Americans from obtaining adequate medical attention, substantially better. The paper will offer a better insight into the four different models of healthcare insurance found around the world in other developed countries with the purpose of establishing a comparison with that of the United States. The changes implemented by the Patient Protection and Affordable Care Act of 2010 are also analyzed to arrive at the conclusion of whether it has helped more American citizens get access to medical attention. Quality Improvement tools and thorough analysis of different methods from a financial, managerial, legal, and administrative perspective are used to provide valuable information that could aid in the implementation of modifications to the healthcare system of the United States in the near future.

Proteomic Analysis of Wolbachia Symbiosis within the Drosophila

Wolbachia pipientis are bacterial endosymbionts of arthropods and in some filarial nematodes. Wolbachia are of particular interest because nematodeWolbachia have been shown to cause the diseases African river blindness and Lymphatic Filariasis. Doxycycline can be used to eliminate nematode Wolbachia, however, more efficient treatments are needed. Ideally, we would like to repurpose another FDA approved drug that helps to shorten treatment duration. Vitamins are one of the best classes of FDA approved compounds, generally recognized as safe. Interestingly, prior work by Serbus and colleagues found that dietary yeast, which is highly enriched in vitamins, dramatically reducesWolbachia titer in Drosophila melanogaster ovarian tissue. Imaging data indicated that the Wolbachia nucleoids were disrupted in response to yeast. This raised the possibility that yeast cells contain a bio-reactive, anti-Wolbachiacompound. Our close examination of yeast nutritional information identified which vitamins are most highly enriched in yeast. We then administered several of these to D. melanogaster, and saw that two of these led to reduced ovarianWolbachia titers, analogous to yeast-fed flies. This was especially interesting, as both vitamins are critical for functioning of the same biochemical pathway. We used retested effect of one of these vitamins in oogenesis by performing a dilution series, and achieved positive correlation from this dilution series. This opens up the avenue for clarifying the mechanism of how vitamins suppressWolbachia titer, and for testing enhancement of Doxycycline, to hopefully provide faster, more affordable treatment for millions of patients.

Proteomic Analysis of Wolbachia Symbiosis within the Drosophila

Wolbachia pipientis are bacterial endosymbionts of arthropods and in some filarial nematodes. Wolbachia are of particular interest because nematodeWolbachia have been shown to cause the diseases African river blindness and Lymphatic Filariasis. Doxycycline can be used to eliminate nematode Wolbachia, however, more efficient treatments are needed. Ideally, we would like to repurpose another FDA approved drug that helps to shorten treatment duration. Vitamins are one of the best classes of FDA approved compounds, generally recognized as safe. Interestingly, prior work by Serbus and colleagues found that dietary yeast, which is highly enriched in vitamins, dramatically reducesWolbachia titer in Drosophila melanogaster ovarian tissue. Imaging data indicated that the Wolbachia nucleoids were disrupted in response to yeast. This raised the possibility that yeast cells contain a bio-reactive, anti-Wolbachiacompound. Our close examination of yeast nutritional information identified which vitamins are most highly enriched in yeast. We then administered several of these to D. melanogaster, and saw that two of these led to reduced ovarianWolbachia titers, analogous to yeast-fed flies. This was especially interesting, as both vitamins are critical for functioning of the same biochemical pathway. We used retested effect of one of these vitamins in oogenesis by performing a dilution series, and achieved positive correlation from this dilution series. This opens up the avenue for clarifying the mechanism of how vitamins suppressWolbachia titer, and for testing enhancement of Doxycycline, to hopefully provide faster, more affordable treatment for millions of patients.

Síntese e caracterização de pigmentos nanométricos encapsulados pelos métodos dos precursores poliméricos, hidrotermal de microondas e co-precipitação associado à química sol-gel convencional

The demand for materials with high consistency obtained at relatively low temperatures has been leveraging the search for chemical processes substituents of the conventional ceramic method. This paper aims to obtain nanosized pigments encapsulated (core-shell) the basis of TiO2 doped with transition metals (Fe, Co, Ni, Al) through three (3) methods of synthesis: polymeric precursors (Pechini); hydrothermal microwave, and co-precipitation associated with the sol-gel chemistry. The study was motivated by the simplicity, speed and low power consumption characteristic of these methods. Systems costs are affordable because they allow achieving good control of microstructure, combined with high purity, controlled stoichiometric phases and allowing to obtain particles of nanometer size. The physical, chemical, morphological, structural and optical properties of the materials obtained were analyzed using different techniques for materials characterization. The powder pigments were tested in discoloration and degradation using a photoreactor through the solution of Remazol yellow dye gold (NNI), such as filtration, resulting in a separation of solution and the filter pigments available for further UV-Vis measurements . Different calcination temperatures taken after obtaining the post, the different methods were: 400 º C and 1000 º C. Using a fixed concentration of 10% (Fe, Al, Ni, Co) mass relative to the mass of titanium technologically and economically enabling the study. By transmission electron microscopy (TEM) technique was possible to analyze and confirm the structural formation nanosized particles of encapsulated pigment, TiO2 having the diameter of 20 nm to 100 nm, and thickness of coated layer of Fe, Ni and Co between 2 nm and 10 nm. The method of synthesis more efficient has been studied in the work co-precipitation associated with sol-gel chemistry, in which the best results were achieved without the need for the obtainment of powders the calcination process

An evaluation of an online peer support forum for university students with depressive symptoms

Background: Depression is the most common mental health problem among young people, particularly university students, with prevalence rates as high as 48% reported. This population however, is reluctant to seek professional help. Online interventions may be particularly appealing to students, with evidence suggesting that they use the Internet for mental health support. While there are many mental health resources on the Internet few focus specifically on the needs of young people and few have been evaluated. This research aimed to develop and pilot test an online peer support intervention for students experiencing depressive symptoms. Methods: A depression support Web site (www.losetheblues.ie) was designed specifically for 18-24. year old students. The study used a mixed method, involving quantitative descriptive, pre- and post-test and qualitative descriptive designs. Data were collected using the Centre for Epidemiological Studies Depression Scale (CES-D), a background questionnaire and online forum posts. Results: The sample consisted of 117 university students with self-reported depressive symptoms. Results from participants in the pre- and post-test element of the study, showed no statistical significance. The forum posts revealed that the participants' main difficulties were loneliness and perceived lack of socialization skills. The Web site provided a place for sharing, offering and receiving emotional and informational support. Conclusion: Developing health care interventions in an online environment presents unique challenges to the research process, however they have the potential to provide mental health care that is accessible and affordable.

Electronic health records: essential tools in integrating substance abuse treatment with primary care.

While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted.

Essays on the Role of Government Incentives in the Private Provision of Social Goods

The economic rationale for public intervention into private markets through price mechanisms is twofold: to correct market failures and to redistribute resources. Financial incentives are one such price mechanism. In this dissertation, I specifically address the role of financial incentives in providing social goods in two separate contexts: a redistributive policy that enables low income working families to access affordable childcare in the US and an experimental pay-for-performance intervention to improve population health outcomes in rural India. In the first two papers, I investigate the effects of government incentives for providing grandchild care on grandmothers’ short- and long-term outcomes. In the third paper, coauthored with Manoj Mohanan, Grant Miller, Katherine Donato, and Marcos Vera-Hernandez, we use an experimental framework to consider the the effects of financial incentives in improving maternal and child health outcomes in the Indian state of Karnataka.

Grandmothers provide a significant amount of childcare in the US, but little is known about how this informal, and often uncompensated, time transfer impacts their economic and health outcomes. The first two chapters of this dissertation address the impact of federally funded, state-level means-tested programs that compensate grandparent-provided childcare on the retirement security of older women, an economically vulnerable group of considerable policy interest. I use the variation in the availability and generosity of childcare subsidies to model the effect of government payments for grandchild care on grandmothers’ time use, income, earnings, interfamily transfers, and health outcomes. After establishing that more generous government payments induce grandmothers to provide more hours of childcare, I find that grandmothers adjust their behavior by reducing their formal labor supply and earnings. Grandmothers make up for lost earnings by claiming Social Security earlier, increasing their reliance on Supplemental Security Income (SSI) and reducing financial transfers to their children. While the policy does not appear to negatively impact grandmothers’ immediate economic well-being, there are significant costs to the state, in terms of both up-front costs for care payments and long-term costs as a result of grandmothers’ increased reliance on social insurance.

The final paper, The Role of Non-Cognitive Traits in Response to Financial Incentives: Evidence from a Randomized Control Trial of Obstetrics Care Providers in India, is coauthored with Manoj Mohanan, Grant Miller, Katherine Donato and Marcos Vera-Hernandez. We report the results from “Improving Maternal and Child Health in India: Evaluating Demand and Supply Side Strategies” (IMACHINE), a randomized controlled experiment designed to test the effectiveness of supply-side incentives for private obstetrics care providers in rural Karnataka, India. In particular, the experimental design compares two different types of incentives: (1) those based on the quality of inputs providers offer their patients (inputs contracts) and (2) those based on the reduction of incidence of four adverse maternal and neonatal health outcomes (outcomes contracts). Along with studying the relative effectiveness of the different financial incentives, we also investigate the role of provider characteristics, preferences, expectations and non-cognitive traits in mitigating the effects of incentive contracts.

We find that both contract types input incentive contracts reduce rates of post-partum hemorrhage, the leading cause of maternal mortality in India by about 20%. We also find some evidence of multitasking as output incentive contract providers reduce the level of postnatal newborn care received by their patients. We find that patient health improvements in response to both contract types are concentrated among higher trained providers. We find improvements in patient care to be concentrated among the lower trained providers. Contrary to our expectations, we also find improvements in patient health to be concentrated among the most risk averse providers, while more patient providers respond relatively little to the incentives, and these difference are most evident in the outputs contract arm. The results are opposite for patient care outcomes; risk averse providers have significantly lower rates of patient care and more patient providers provide higher quality care in response to the outputs contract. We find evidence that overconfidence among providers about their expectations about possible improvements reduces the effectiveness of both types of incentive contracts for improving both patient outcomes and patient care. Finally, we find no heterogeneous response based on non-cognitive traits.

A Qualitative Study of Contextual Factors’ Impact on the Adaptation of a Caregiver-mediated Early Autism Intervention in South Africa

Background: Autism Spectrum Disorder (ASD) is a major global health challenge as the majority of individuals with ASD live in low- and middle-income countries (LMICs) and receive little to no services or support from health or social care systems. Despite this global crisis, the development and validation of ASD interventions has almost exclusively occurred in high-income countries, leaving many unanswered questions regarding what contextual factors would need to be considered to ensure the effectiveness of interventions in LMICs. This study sought to conduct explorative research on the contextual adaptation of a caregiver-mediated early ASD intervention for use in a low-resource setting in South Africa.

Methods: Participants included 22 caregivers of children with autism, including mothers (n=16), fathers (n=4), and grandmothers (n=2). Four focus groups discussions were conducted in Cape Town, South Africa with caregivers and lasted between 1.5-3.5 hours in length. Data was recorded, translated, and transcribed by research personnel. Data was then coded for emerging themes and analyzed using the NVivo qualitative data analysis software package.

Results: Nine contextual factors were reported to be important for the adaptation process including culture, language, location of treatment, cost of treatment, type of service provider, familial needs, length of treatment, support, and parenting practices. One contextual factor, evidence-based treatment, was reported to be both important and not important for adaptation by caregivers. The contextual factor of stigma was identified as an emerging theme and a specifically relevant challenge when developing an ASD intervention for use in a South African context.

Conclusions: Eleven contextual factors were discussed in detail by caregivers and examples were given regarding the challenges, sources, and preferences related to the contextual adaptation of a parent-mediated early ASD intervention in South Africa. Caregivers reported a preference for an affordable, in-home, individualized early ASD intervention, where they have an active voice in shaping treatment goals. Distrust of community-based nurses and health workers to deliver an early ASD intervention and challenges associated with ASD-based stigma were two unanticipated findings from this data set. Implications for practice and further research are discussed.

Can the Quilombo Model of Collective Land Titling Work in Rio’s Favelas?

Due to their informality, the favelas of Rio de Janeiro are in a precarious position. Though the informal neighborhoods have long served as sites of affordable housing for Rio’s poorest residents, changes within in the city related to public security, mega-events, real estate speculation, and urban revitalization jeopardize their permanence. As one possible solution, this study, conducted for the client Catalytic Communities, investigated collective titling in favelas modeled after quilombos, territories recognized and titled by Brazilian federal law as patrimonies of black cultural traditions.

Prostate cancer screening

Universal screening for prostate cancer (Pca) using prostate-specific antigen-based testing is not recommended, as the potential harms of screening (overdiagnosis and overtreatment) outweigh potential benefits. The case for Pca screening requires a paradigm shift, which emphasizes the risks of screening over the risks of undetected cancer. Physicians are encouraged to use shared decision making with patients who express an interest in Pca screening, taking into account both the patient's screening preferences and individual risk profile. New models of care informed by the Patient Protection and Affordable Care Act are intended to assist clinicians in providing recommended preventive services. © 2014 Elsevier Inc.

Revisiting the Land Issue

This paper seeks to review the critical role of land in delivering sustainable development, focusing on the supply of affordable homes. It first presents a historical overview of debates on land reform, including nationalisation of development land and betterment, before reviewing the impact of land costs on housing delivery, using London as a case study. It then considers alternative policy approaches to ensuring the most effective use of land resources and development capacity, and sets out a programme embracing planning reform, public land acquisition, disposal and taxation.

Housing and Planning in London under the Conservative Government: Spatial impacts, social polarisation, sustainable development and social justice

This paper will be based on my continuing research on planning and housing development in London. It will focus on the proposals in the Government’s Housing and Planning Bill, which are likely to be enacted in Spring 2016. It will review the evidence of potential spatial impacts in terms of the supply of existing affordable homes and the location and affordability of new supply. This will be related to a review of the alternative development options for London’s growth in the context of the Mayor of London’s draft 2050 Infrastructure Plan. The paper will analyse the potential impact of new Government policy and legislation on whether London’s housing requirements can be delivered in accordance with the objectives of sustainable planning and social justice, and will also consider the constraints on the ability of the new Mayor of London, to be elected in May 2016 to achieve manifesto commitments.

Clear hero and dark hero in the cinematographic narration

The role of the hero is changing, slightly irregular, but it’s purpose is constant. The line that separates good from evil is frequently so thin that sometimes the main hero can act in a negative way, casting doubts about his own nature in the pursuit of good. This paper aims to inquire into the character’s heroic condition showing two variations of this archetype in the context of postmodern cinema: the “clear hero”, and the “dark hero”. The former keeps the most traditional values of the hero, while the latter provides a dimension which distinguishes it from the previous one: his experience executing evil as a part of his process to heroici­ty. Postmodernity implies an ambivalence in the character’s identity which can be comparable to the hero’s role, and to his way of making good. The “clear hero” does not imply negative features in the active nature of the hero, whilst the “dark hero” does include them. Through the protagonists of Gladiator (Scott, 2000) and Batman Begins (Nolan, 2005) are offered both heroic perspectives based on a selection of their principal ac­tions which have been subjected to analysis according to some parameters: behavior, implication, and cause. The decisive action will also be signalized, according to the narration’s teleonomy in reason of the favorable or unfavorable sense for the hero. Finally, each character will be observed from its archetype. By analyzing their actions from these perspectives, we observe the clear hero and the dark hero as affordable categories for the heroic role.

Evaluation of an alternative spectroscopic approach for aflatoxin analysis: Comparative analysis of food and feed samples with UPLC-MS/MS

Increasing research has highlighted the effects of changing climates on the occurrence and prevalence of toxigenic Aspergillus species producing aflatoxins. There is concern of the toxicological effects to human health and animal productivity following acute and chronic exposure that may affect the future ability to provide safe and sufficient food globally. Considerable research has focused on the detection of these toxins, based on the physicochemical and biochemical properties of the aflatoxin compounds, in agricultural products for human and animal consumption. As improvements in food security continue more regulations for acceptable levels of aflatoxins have arisen globally; the most stringent in Europe. These regulations are important for developing countries as aflatoxin occurrence is high significantly effecting international trade and the economy. In developed countries analytical approaches have become highly sophisticated, capable of attaining results with high precision and accuracy, suitable for regulatory laboratories. Regrettably, many countries that are affected by aflatoxin contamination do not have resources for high tech HPLC and MS instrumentation and require more affordable, yet robust equally accurate alternatives that may be used by producers, processors and traders in emerging economies. It is especially important that those companies wishing to exploit the opportunities offered by lucrative but highly regulated markets in the developed world, have access to analytical methods that will ensure that their exports meet their customers quality and safety requirements.

This work evaluates the ToxiMet system as an alternative approach to UPLC–MS/MS for the detection and determination of aflatoxins relative to current European regulatory standards. Four commodities: rice grain, maize cracked and flour, peanut paste and dried distillers grains were analysed for natural aflatoxin contamination. For B1 and total aflatoxins determination the qualitative correlation, above or below the regulatory limit, was good for all commodities with the exception of the dried distillers grain samples for B1 for which no calibration existed. For B1 the quantitative R² correlations were 0.92, 0.92, 0.88 (<250 μg/kg) and 0.7 for rice, maize, peanuts and dried distillers grain samples respectively whereas for total aflatoxins the quantitative correlation was 0.92, 0.94, 0.88 and 0.91. The ToxiMet system could be used as an alternative for aflatoxin analysis for current legislation but some consideration should be given to aflatoxin M1 regulatory levels for these commodities considering the high levels detected in this study especially for maize and peanuts

Finding the idea of home

La notion de chez-soi est porteuse d’un imaginaire foisonnant et génère un grand intérêt dans notre culture et société. Bien qu’elle soit une considération importante pour la plupart d’entre nous, l’architecte occupe une position privilégiée qui lui permette d’agir sur le chez-soi de manière significative et tangible. La présente recherche explore le concept du chez-soi tel qu’étudié par les architectes et non-architectes de manière à comprendre son impact sur la création du lieu et sur la construction des environnements domestiques en Amérique du nord. Un regard porté sur les connotations entre espace et lieu, à travers la temporalité, les comportements et les perspectives sociales, supporte l’épistémologie du chez-soi comme un élément important des théories et pratiques de design contemporain. Le démantèlement hypothétique d’un espace en ses composantes suppose que les dispositifs architecturaux peuvent être modelés de manière à ce qu’ils opèrent un transfert depuis la maison, en tant qu’élément physique, vers le domaine psychologique du chez-soi. Afin d’élargir la maniabilité des éléments constitutifs du bâtiment et de son environnement, six thèmes sont appliqués à trois champs de données. Les six thèmes, qui incluent l’entre-deux, la limite, la voie, le nœud, le détail et la représentation, illustrent des moments architecturaux déterminants, potentiellement présents à l’intérieur et à l’extérieur du projet domestique et qui transforment les comportements physiques et psychiques. Depuis la pratique normalisée du logement social et abordable au Canada, une analyse de photographies de maisons abordables existantes, du discours critique sur cette typologie et de projets de recherche-création conduits par des étudiants en architecture, révèle le caractère opérationnel de la notion de chez-soi et consolide les valeurs de communauté et de frontière. L’objectif premier de la recherche est d’avancer la production de connaissances en architecture par l’exploration de la notion de chez­soi dans l’enseignement, la recherche et le design. L’approche fonctionnaliste vis-à-vis le < penser > en design, place l’usager au centre de l’environnement domestique, soutient la proposition que le chez­soi donne sens et utilité au logement, et renforce la responsabilité éthique de l’architecte à faire de cette notion une partie intégrante de la réalité quotidienne.