Patient self-management of long-term oral anticoagulation in Switzerland

Indications for oral anticoagulation (OAC) have increased in recent years. OAC requires frequent monitoring of the prothrombin time to keep the intensity within the therapeutic range and to minimise the risk for complications. Patient self-management (PSM) has been found to improve the quality of OAC. The present study aimed to investigate the first 330 patients performing PSM in Switzerland. A questionnaire was sent to all patients who followed a teaching program for PSM of OAC between 1998 and 2003. Moreover, family physicians were contacted and/or discharge letters were obtained from the hospitals or the treating physicians. During the study period 13 patients died. Out of the 300 patients providing information 254 (85%) still perform PSM. At least one INR determination per two weeks was done by 74% of the patients and 25% performed at least one INR measurement every 15-30 days. The median time spent within the individual INR target range was 72%. No thromboembolic complications occurred, however, among the 13 patients who died, 1 had myocardial infarction and 6 died of heart failure. When counting these events as arterial thromboembolic complications the frequency was 0.6 (95% CI: 0.3-1.3) per 100 patient-years. The frequency of major bleeding was 0.6 (95% CI: 0.2-1.3) per 100 patient-years. We conclude from this study investigating a real-world patient collective that PSM is suitable and safe for the patients identified by their family physicians and successfully trained by our training centre.

Simulating Cortical Development as a Self Constructing Process: A Novel Multi-Scale Approach Combining Molecular and Physical Aspects

Current models of embryological development focus on intracellular processes such as gene expression and protein networks, rather than on the complex relationship between subcellular processes and the collective cellular organization these processes support. We have explored this collective behavior in the context of neocortical development, by modeling the expansion of a small number of progenitor cells into a laminated cortex with layer and cell type specific projections. The developmental process is steered by a formal language analogous to genomic instructions, and takes place in a physically realistic three-dimensional environment. A common genome inserted into individual cells control their individual behaviors, and thereby gives rise to collective developmental sequences in a biologically plausible manner. The simulation begins with a single progenitor cell containing the artificial genome. This progenitor then gives rise through a lineage of offspring to distinct populations of neuronal precursors that migrate to form the cortical laminae. The precursors differentiate by extending dendrites and axons, which reproduce the experimentally determined branching patterns of a number of different neuronal cell types observed in the cat visual cortex. This result is the first comprehensive demonstration of the principles of self-construction whereby the cortical architecture develops. In addition, our model makes several testable predictions concerning cell migration and branching mechanisms.

Collective Organization of Complex Networks: Emergent Scales, Vulnerability, and Targeting of Desired Dynamics

Cuando una colectividad de sistemas dinámicos acoplados mediante una estructura irregular de interacciones evoluciona, se observan dinámicas de gran complejidad y fenómenos emergentes imposibles de predecir a partir de las propiedades de los sistemas individuales. El objetivo principal de esta tesis es precisamente avanzar en nuestra comprensión de la relación existente entre la topología de interacciones y las dinámicas colectivas que una red compleja es capaz de mantener. Siendo este un tema amplio que se puede abordar desde distintos puntos de vista, en esta tesis se han estudiado tres problemas importantes dentro del mismo que están relacionados entre sí. Por un lado, en numerosos sistemas naturales y artificiales que se pueden describir mediante una red compleja la topología no es estática, sino que depende de la dinámica que se desarrolla en la red: un ejemplo son las redes de neuronas del cerebro. En estas redes adaptativas la propia topología emerge como consecuencia de una autoorganización del sistema. Para conocer mejor cómo pueden emerger espontáneamente las propiedades comúnmente observadas en redes reales, hemos estudiado el comportamiento de sistemas que evolucionan según reglas adaptativas locales con base empírica. Nuestros resultados numéricos y analíticos muestran que la autoorganización del sistema da lugar a dos de las propiedades más universales de las redes complejas: a escala mesoscópica, la aparición de una estructura de comunidades, y, a escala macroscópica, la existencia de una ley de potencias en la distribución de las interacciones en la red. El hecho de que estas propiedades aparecen en dos modelos con leyes de evolución cuantitativamente distintas que siguen unos mismos principios adaptativos sugiere que estamos ante un fenómeno que puede ser muy general, y estar en el origen de estas propiedades en sistemas reales. En segundo lugar, proponemos una medida que permite clasificar los elementos de una red compleja en función de su relevancia para el mantenimiento de dinámicas colectivas. En concreto, estudiamos la vulnerabilidad de los distintos elementos de una red frente a perturbaciones o grandes fluctuaciones, entendida como una medida del impacto que estos acontecimientos externos tienen en la interrupción de una dinámica colectiva. Los resultados que se obtienen indican que la vulnerabilidad dinámica es sobre todo dependiente de propiedades locales, por tanto nuestras conclusiones abarcan diferentes topologías, y muestran la existencia de una dependencia no trivial entre la vulnerabilidad y la conectividad de los elementos de una red. Finalmente, proponemos una estrategia de imposición de una dinámica objetivo genérica en una red dada e investigamos su validez en redes con diversas topologías que mantienen regímenes dinámicos turbulentos. Se obtiene como resultado que las redes heterogéneas (y la amplia mayora de las redes reales estudiadas lo son) son las más adecuadas para nuestra estrategia de targeting de dinámicas deseadas, siendo la estrategia muy efectiva incluso en caso de disponer de un conocimiento muy imperfecto de la topología de la red. Aparte de la relevancia teórica para la comprensión de fenómenos colectivos en sistemas complejos, los métodos y resultados propuestos podrán dar lugar a aplicaciones en sistemas experimentales y tecnológicos, como por ejemplo los sistemas neuronales in vitro, el sistema nervioso central (en el estudio de actividades síncronas de carácter patológico), las redes eléctricas o los sistemas de comunicaciones. ABSTRACT The time evolution of an ensemble of dynamical systems coupled through an irregular interaction scheme gives rise to dynamics of great of complexity and emergent phenomena that cannot be predicted from the properties of the individual systems. The main objective of this thesis is precisely to increase our understanding of the interplay between the interaction topology and the collective dynamics that a complex network can support. This is a very broad subject, so in this thesis we will limit ourselves to the study of three relevant problems that have strong connections among them. First, it is a well-known fact that in many natural and manmade systems that can be represented as complex networks the topology is not static; rather, it depends on the dynamics taking place on the network (as it happens, for instance, in the neuronal networks in the brain). In these adaptive networks the topology itself emerges from the self-organization in the system. To better understand how the properties that are commonly observed in real networks spontaneously emerge, we have studied the behavior of systems that evolve according to local adaptive rules that are empirically motivated. Our numerical and analytical results show that self-organization brings about two of the most universally found properties in complex networks: at the mesoscopic scale, the appearance of a community structure, and, at the macroscopic scale, the existence of a power law in the weight distribution of the network interactions. The fact that these properties show up in two models with quantitatively different mechanisms that follow the same general adaptive principles suggests that our results may be generalized to other systems as well, and they may be behind the origin of these properties in some real systems. We also propose a new measure that provides a ranking of the elements in a network in terms of their relevance for the maintenance of collective dynamics. Specifically, we study the vulnerability of the elements under perturbations or large fluctuations, interpreted as a measure of the impact these external events have on the disruption of collective motion. Our results suggest that the dynamic vulnerability measure depends largely on local properties (our conclusions thus being valid for different topologies) and they show a non-trivial dependence of the vulnerability on the connectivity of the network elements. Finally, we propose a strategy for the imposition of generic goal dynamics on a given network, and we explore its performance in networks with different topologies that support turbulent dynamical regimes. It turns out that heterogeneous networks (and most real networks that have been studied belong in this category) are the most suitable for our strategy for the targeting of desired dynamics, the strategy being very effective even when the knowledge on the network topology is far from accurate. Aside from their theoretical relevance for the understanding of collective phenomena in complex systems, the methods and results here discussed might lead to applications in experimental and technological systems, such as in vitro neuronal systems, the central nervous system (where pathological synchronous activity sometimes occurs), communication systems or power grids.

Policy processes and collective action in water reforms: the cases of Nicaragua and Suriname

Las reformas de agua en países en desarrollo suelen llevarse a cabo junto con cambios institucionales más profundos o, incluso, acompañadas de cambios constitucionales o de régimen político. Por lo tanto, los marcos institucionales adaptados a países gobernados sujetos al estado de derecho pueden no ser apropiados para contextos gobernados fundamentalmente, al menos en sus inicios, por instituciones informales o poco maduras. Esta tesis toma las reformas de agua como punto de partida y pretende contribuir a la literatura mediante una serie de análisis empíricos tanto del ámbito general como del plano individual o sujeto personal de la política del agua. En el ámbito general, el foco se pone en los factores que explican el fallo de la acción colectiva en dos contextos diferentes: 1) en la implementación de la nueva Ley de Aguas de Nicaragua y 2) en el mantenimiento y revitalización de las instituciones de riego en Surinam. En el plano del individuo, la investigación se centra en las decisiones de los usuarios de los recursos y analiza el papel crítico de las variables sociales para la gestión de los recursos comunes. Para ello, el método de investigación utilizado es mixto, combinando el análisis de entrevistas, encuestas y experimentos. En el ámbito general, los resultados muestran que las principales barreras para la implementación de la nueva Ley de Aguas de Nicaragua podrían tener su reflejo en el lenguaje de la Ley y, por tanto, en la forma en la que se definen y configuran las instituciones incluidas en dicha Ley. Así, la investigación demuestra que la implementación de políticas no puede ser estudiada o entendida sin tener en cuenta tanto el diseño de la propia política como el marco socio-ecológico en el que se enmarca. El contexto específico de Nicaragua remarca la importancia de considerar tanto las instituciones formales como informales en los procesos de transición política. A pesar de que las reformas de agua requieren plazos largos para su implementación, el hecho de que exista una diferencia entre las reglas tal cual se definen formalmente y las reglas que operan en la realidad merece una mayor consideración en el diseño de políticas basadas fundamentalmente en instituciones formales. En el ámbito de la conducta individual, el análisis de la acción colectiva ofrece una serie de observaciones empíricas interesantes. En el caso de Nicaragua, los resultados indican que la intensidad de las relaciones sociales, el tipo de agentes dispuestos a proporcionar apoyo social y el nivel de confianza en la comunidad son factores que explican de manera significativa la participación en la comunidad. Sin embargo, el hecho de que la gestión colectiva de riego se produzca, en la mayoría de casos, en torno a lazos familiares sugiere que las variables de capital social críticas se definen en gran medida en la esfera familiar, siendo difícil que se extiendan fuera de estos nexos. El análisis experimental de los resultados de un juego de uso de recurso común y contribución al bien público muestra que las preferencias pro-sociales de los individuos y la heterogeneidad del grupo en términos de composición por sexo son factores que explican significativamente los resultados y las decisiones de apropiación a lo largo del juego. En términos del diseño de las políticas, es fundamental tener en cuenta las dinámicas de participación y uso de los recursos comunes de manera que los niveles de cooperación puedan mantenerse en el largo plazo, lo cual, como se observa en el caso de Surinam, no es siempre posible. Finalmente, el caso de Surinam es un ejemplo ilustrativo de los procesos de acción colectiva en economías en transición. El análisis del fallo de la acción colectiva en Surinam muestra que los procesos políticos vinculados al período colonial y de independencia explican en gran medida la falta de claridad en las reglas operacionales y colectivas que gobiernan la gestión de los sistemas de riego y drenaje. Los resultados empíricos sugieren que a pesar de que la acción colectiva para la provisión de los servicios de riego y drenaje estaba bien establecida bajo el régimen colonial, la auto-organización no prosperó en un contexto dependiente del apoyo externo y regido fundamentalmente por reglas diseñadas al nivel competencial del gobierno central. El sistema socio-ecológico que se desarrolló durante la transición post-colonial favoreció, así, la emergencia de comportamientos oportunistas, y posteriormente la inoperancia de los Water Boards (WBs) creados en la época colonial. En este sentido, cualquier intento por revitalizar los WBs y fomentar el desarrollo de la auto-organización de los usuarios necesitará abordar los problemas relacionados con los patrones demográficos, incluyendo la distribución de la tierra, el diseño de instituciones y la falta de confianza en el gobierno, además de las inversiones típicas en infraestructura y sistemas de información hidrológicos. El liderazgo del gobierno, aportando empuje de arriba-abajo, es, además, otro elemento imprescindible en Surinam. ABSTRACT Water reforms in developing countries take place along deeper institutional and even constitutional. Therefore, institutional frameworks that might result in positive outcomes in countries governed by the rule of law might not fit in contexts governed mainly by informal or immature institutions. This thesis takes water reforms as the starting point and aims to contribute to the literature by presenting several conceptual and empirical analyses at both general and individual levels. At the general national level, the focus is on the factors explaining failure of collective action in two different settings: 1) in the implementation of the new Nicaraguan Water Law and 2) in sustaining and revitalizing irrigation institutions in Suriname. At the individual level, the research focuses on the actions of resource users and analyzes the critical role of social variables for common pool resources management. For this purpose, the research presented in this thesis makes use of a mixed-method approach, combining interviews, surveys and experimental methods. Overall, the results show that major barriers for the implementation of the new Nicaraguan Water Law have its reflection on the language of the Law and, therefore, on the way institutions are defined and configured. In this sense, our study shows that implementation cannot fruitfully be studied and understood without taking into account both the policy design and the social-ecological context in which it is framed. The specific setting of Nicaragua highlights the relevance of considering both formal and informal institutions when promoting policy transitions. Despite the unquestionable fact that water reforms implementation needs long periods of time, there is still a gap between the rules on paper and the rules on the ground that deserves further attention when proposing policy changes on the basis of formal institutions. At the level of the individual agent, the analysis of collective action provides a number of interesting empirical insights. In the case of Nicaragua, I found that the intensity of social networks, the type of agents willing to provide social support and the level of trust in the community are all significant factors in explaining collective action at community level. However, the fact that most collective irrigation relies on family ties suggests that critical social capital variables might be defined within the family sphere and making it difficult to go beyond it. Experimental research combining a common pool resource and a public good game in Nicaragua shows that individuals’ pro-social traits and group heterogeneity in terms of sex composition are significant variables in explaining efficiency outcomes and effort decisions along the game. Thus, with regard to policy design, it is fundamental to consider carefully the dynamics of agents' participation and use of common pool resources, for sustaining cooperation in the long term, which, as seen in the case and Surinam, is not always possible. The case of Suriname provides a rich setting for the analysis of collective action in transition economies. The analysis of decay of collective irrigation in Suriname shows that the lack of clear operational and collective choice rules appear to be rooted in deeper political processes that date back to the colonial period. The empirical findings suggest that despite collective action for the provision of irrigation and drainage services was well established during the colonial period, self-organization did not flourish in a context governed by colonial state-crafted rules and mostly dependent on external support. The social-ecological system developed during the post-colonial transition process favored the emergence of opportunistic behavior. In this respect, any attempt to revitalize WBs and support self-organization will need to tackle the problems derived from demographic patterns, including land allocation, institutions design and government distrust, in addition to the typical investments in both physical infrastructure and hydrological information systems. The leadership role of the government, acting as a top-down trigger, is another essential element in Suriname.

Response to Orr and Siegler - collective intentionality and procreative desires: the permissible view on consent to posthumous conception

Orr and Siegler have recently defended a restrictive view concerning posthumous sperm retrieval and conception, which would limit insemination to those cases where the deceased man has provided explicit consent for such a procedure. The restrictive view dominates current law and practice. A permissible view, in contrast, would allow insemination and conception in all but those cases where the posthumous procedure has been explicitly refused, or where there is no reasonable evidence that the deceased person desired children. I describe a phenomenology of procreative desires which supports the permissible view, and which is compatible with requirements concerning the interests of the decedent, concepts of medical infertility, and the welfare of the future child. The account illustrates how our current obsession with individual rights and autonomy can be self-defeating and repressive.

Leadership, self, and identity: A review and research agenda

This article reviews empirical research on the role of follower self-conception in leader-ship effectiveness. and specifies an agenda for future research in this area. The review shows that several aspects of follower self-conception (i.e., self-construal, self-efficacy, self-esteem, and self-consistency) may be affected by leadership. and may mediate the effects of leadership on follower behavior. There also is consistent evidence that follower self-construal moderates the impact of leadership on follower attitudes and behavior. Two key themes for future research are defined. First, future research should focus on the development of theory about the role of relational self-construal in the leadership process. Second, it seems particularly valuable to develop theory about the interplay of different aspects of follower self-conception in leadership effectiveness. including the interactive effects of these aspects of self Working backwards from these theoretical models of follower self-conception, specific leader behavior relevant to these aspects of self should then be identified. (C) 2004 Elsevier Inc. All rights reserved.

Speaking for others: The pros and cons of group advocates using collective language

We examined how rhetorical style affects evaluations of group advocates, and how these evaluations are moderated by group identification. University students were given a letter to the editor defending student welfare. The argument was either constructed using personal language ('I believe') or collective language ('we believe'). Furthermore, the letter was either attributed to an official advocate (president of the student union) or an unofficial advocate (a rank-and-file member of the student body). Consistent with the social identity perspective, participants who showed strong identification as a university student thought that the group would feel better represented by official advocates using collective rather than personal language. Low identifiers, however, did not rate the rhetorical styles differently on representativeness. Furthermore, low identifiers (but not high identifiers) rated official advocates as more likable and more effective when they used personal rather than collective language. The discussion focuses on the conflict low identifiers might feel between (a) needing to homogenize with other group members in order to maximize the influence and political effectiveness of their message at the collective level, and (b) protecting themselves against categorization threat.

Self-explanation in adaptive systems based on runtime goal-based models

The behaviour of self adaptive systems can be emergent, which means that the system’s behaviour may be seen as unexpected by its customers and its developers. Therefore, a self-adaptive system needs to garner confidence in its customers and it also needs to resolve any surprise on the part of the developer during testing and maintenance. We believe that these two functions can only be achieved if a self-adaptive system is also capable of self-explanation. We argue a self-adaptive system’s behaviour needs to be explained in terms of satisfaction of its requirements. Since self-adaptive system requirements may themselves be emergent, we propose the use of goal-based requirements models at runtime to offer self-explanation of how a system is meeting its requirements. We demonstrate the analysis of run-time requirements models to yield a self-explanation codified in a domain specific language, and discuss possible future work.

It's good to be different:diversity, heterogeneity, and dynamics in collective systems

We identify two different forms of diversity present in engineered collective systems, namely heterogeneity (genotypic/phenotypic diversity) and dynamics (temporal diversity). Three qualitatively different case studies are analysed, and it is shown that both forms of diversity can be beneficial in very different problem and application domains. Behavioural diversity is shown to be motivated by input diversity and this observation is used to present recommendations for designers of collective systems.

The power of the powerless:neighbourhood based self-help networks of the poor in Istanbul

Recent poverty research focuses on the household responses to poverty through structure vs. agency perspectives. The human agency perspective, however, provides us important insights for looking beyond these simplistic tendencies which assume poor people as inherently passive, or envision them as helpless victims. In Turkey, politicians view poverty as a temporary and manageable problem which can be dealt with the provision of more charity or community support. Migrant networks, informal sector work and social assistance are considered to be important mechanisms that would provide resources for the poor. This paper argues that for some of the poor households none of these mechanisms provide sufficient resources. Instead, neighbourhood-based small-group solidarities and self-help networks enable those poor to develop collective capabilities and make ends meet. The paper also reveals that in Turkey, the implementation of social policies for poverty reduction could bring about relationships of patronage and in some cases contribute to existing inequalities.

Intra -organizational turnover in a self -selective team environment

Four-hundred twenty-seven firefighter/paramedics and firefighter/emergency medical technicians completed questionnaires regarding past and current turnover decisions. The employees, who work in teams of either three or four, have a collective bargaining benefit that allows them to "bid for" (request) new positions/teams every six months; positions are awarded on the basis of seniority. Because employees are leaving neither the organization nor their job, the "bid" process creates intra-organizational turnover on a regular basis. It was hypothesized that those individuals higher in teamwork/social cohesion expectations, higher in interpersonal orientation, and lower in conflict tolerance would report placing greater importance on interpersonal reasons (teamwork/social cohesion) in past bid/assignment decisions. Creation of a conflict tolerance scale was the goal of a preliminary study. It was further hypothesized that current bid/assignment satisfaction would predict the current turnover decision (during the cycle in which the study was conducted), and that past individual turnover frequency would also predict current turnover. All hypotheses were supported. ^

Collective excitability, synchronization, and array-enhanced coherence resonance in a population of lasers with a saturable absorber

In this article we present a numerical study of the collective dynamics in a population of coupled semiconductor lasers with a saturable absorber, operating in the excitable regime under the action of additive noise. We demonstrate that temporal and intensity synchronization takes place in a broad region of the parameter space and for various array sizes. The synchronization is robust and occurs even for a set of nonidentical coupled lasers. The cooperative nature of the system results in a self-organization process which enhances the coherence of the single element of the population too and can have broad impact for detection purposes, for building all-optical simulators of neural networks and in the field of photonics-based computation.

“Art Will Not Disappear Into Nothing; It Will Disappear Into Everything“: The Black Audio Film Collective and Latin America

The development of Latin American cinema in the 1960s was underwritten by a number of key texts that outlined the aesthetic and political direction of individual filmmakers and collectives (Solanas and Getino, 1969; Rocha, 1965; Espinosa, 1969). Although asserting the specificity of Latin American culture, the theoretical foundations of its New Wave influenced oppositional filmmaking way beyond its own regional boundaries. This chapter looks at how movements in British art cinema, especially the Black Audio Film Collective, were inspired and propelled by the theories behind New Latin American cinema. Facilitated by English translations in journals such as Jump Cut in the early ‘80s, Cuban and Argentine cinematic manifestoes provided a radical alternative to the traditional language of film theory available to filmmakers in Europe and works such as Signs of Empire (1983-4); Handsworth Songs (1986) and Seven Songs for Malcolm X (1993) grew out of this trans-continental exchange. The Black Audio Film Collective represented a merging of politics, popular culture, and art that was, at once, oppositional and melodic. Fusing postcolonial discourse with pop music, the avant-garde and re-imaginings of subalternity, the work of ‘The Collective’ provides us with a useful example of how British art cinema has drawn from theoretical foundations formed outside of Europe and the West. As this chapter will argue however, the Black Audio Film Collective’s work can also be read as a reaction to the specificity of British socio-politics of the ‘80s and ‘90s. Its engagement with the aesthetico-political strategies of Latin American cinema, then, undercut what was a solidly British project, rooted in (post)colonial history and emerging ideas of disaporic identity. If the propulsive thrust of The Black Audio Film Collective’s art was shaped by Third Cinema, its images and concerns were self-consciously British.

L’inclusion scolaire dans l’enseignement primaire: L’évaluative formative comme source de progression collective?

Ce travail s’inscrit dans le champ des recherches concernant les pratiques inclusives en milieu scolaire ordinaire dans l’enseignement primaire. En France, le système éducatif propose de scolariser les élèves à besoins éducatifs particuliers soit en classe ordinaire, soit en classe spécialisée, bien que les gouvernements valorisent l’accueil en milieu ordinaire depuis la loi de 2005. Or, ceci questionne les pratiques des acteurs de l’école sur la prise en charge de ces élèves. Partant des travaux montrant que les enseignants utilisant l’évaluation formative gèrent mieux la diversité des élèves, nous étudions ici dans quelle mesure cette fonction de l’évaluation aiderait les élèves présentant des besoins éducatifs particuliers à acquérir des connaissances grâce aux feedbacks émis lors d’évaluations orales et de corrections collectives. L’analyse des données recueillies à l’aide d’entretiensavec des enseignants et d’observations d’élèves fait ressortir les attitudes des acteurs, les interactions et les régulations. (DIPF/Orig.)

THE HEALTH OF YOUNG ADULTS WITH DISABILITIES IN THE UNITED STATES: THE COLLECTIVE ROLES OF RISK FACTORS IN SOCIAL ECOLOGIC FRAMEWORK

Background: Over the last few decades, the prevalence of young adults with disabilities (YAD) has steadily risen as a result of advances in medicine, clinical treatment, and biomedical technologythat enhanced their survival into adulthood. Despite investments in services, family supports, and insurance, they experience poor health status and barriers to successful transition into adulthood. Objectives: We investigated the collective roles of multi-faceted factors at intrapersonal, interpersonal and community levels within the social ecological framework on health related outcome including self-rated health (SRH) of YAD. The three specific aims are: 1) to examine sociodemographic differences and health insurance coverage in adolescence; 2) to investigate the role of social skills in relationships with family and peers developed in adolescence; and 3) to collectively explore the association of sociodemographic characteristics, social skills, and community participation in adolescence on SRH. Methods: Using longitudinal data (N=5,020) from the National Longitudinal Transition Study (NLTS2), we conducted multivariate logistic regression analyses to understand the association between insurance status as well as social skills in adolescence and YAD’s health related outcomes. Structural equation modeling (SEM) assessed the confluence of multi-faceted factors from the social ecological model that link to health in early adulthood. Results: Compared with YAD who had private insurance, YAD who had public health insurance in adolescence are at higher odds of experiencing poorer health related outcomes in self-rated health [adjusted odds ratio (aOR=2.89, 95% confidence interval (CI): 1.16, 7.23), problems with health (aOR=2.60, 95%CI: 1.26, 5.35), and missing social activities due to health problems (aOR=2.86, 95%CI: 1.39, 5.85). At the interpersonal level, overall social skills developed through relationship with family and peers in adolescence do not appear to have association with health related outcomes in early adulthood. Finally, at the community level, community participation in adolescence does not have an association with SRH in early adulthood. Conclusions: Having public health insurance coverage does not equate to good health. YAD need additional supports to achieve positive health outcomes. The findings in social skills and community participation suggest other potential factors may be at play for health related outcomes for YAD and the need for further investigation.