The effect of immigration status on racial differences in health insurance coverage, access to care, and utilization in the United States

Background. Lack of coverage, lack of access, and failure to utilize health care services have all been linked to dismal health outcomes in the US. Such consequences have been a longstanding challenge that US minorities are faced with, in the context of a health care system believed to be lacking efficiency and equity. National population surveys in the US suggest that the number of uninsured approaches 50 millions, while some concerns and suspicions are raised by opponents to the growing number of foreign born US residents, many of whom are Hispanic. Research shows that race is a significant predictor of lack of coverage, access, and utilization, while age, gender, education, and income are also linked to these outcomes. We investigated the potential effect of immigration status or duration in the US on the association between coverage, access, use, and race. Methods. Using National Health Interview Survey (NHIS) data of 2006, we selected 22, 667 individuals of Non-Hispanic Black, Hispanic, and Non-Hispanic White descent, at least 18 years of age, US-born and foreign-born who reported their duration of residence in the US. Through complex sample survey logistic regression analysis, we computed odds ratios, beta coefficients, and 95% confidence intervals using models which excluded then included immigration status. Results. Although a significant predictor of the outcomes, immigration status did not change the relationship between each of the dependent variables (coverage, access, utilization), and the factor race, while adjusting for age, gender, education, and income. Our results show that Hispanics were least likely to have coverage (OR=.58; 95% CI[.49, .68]), access (OR=.62; 95% CI[.50, .76]), and to utilize services (OR=.60; 95% CI[.46, .79]) followed by Non-Hispanic Blacks, and Non-Hispanic Whites. These results were not changed by stratification, or the inclusion of interaction terms to eliminate the potential effect of relationships between independent variables. Recent immigrants (<5 years in US) were 0.12 times less likely to be insured, but also 0.26 times less likely to utilize services (p<0.001), and in addition they represented only 7.3% of the uninsured and 1.9% of the US population in 2006. Furthermore, 12% of the Non-Hispanic White population in the US was not covered, and 65% of the uninsured individuals were US-Born Citizens. Other predictors of lack of coverage, access and use were age below 45, male gender, education at high school or below, and income of less than $20,000. Conclusion. This investigation shows that the high percentage of uninsured was not directly caused by Hispanics, and immigration status alone could not explain racial differences in coverage, access, and utilization. An immigration reform may not be the solution to the healthcare crisis, and more specifically, will not stop the increase in the number of uninsured in the US, nor reduce the cost of health care. As a better alternative, universal health insu rance coverage should be considered, when aiming to eliminate racial disparities, and to solve the health care crisis. ^ Keywords. health insurance, coverage, access, utilization, race, immigration, disparities.^

Mechanisms by which nonsense codons downregulate T-cell receptor transcripts

Nonsense-mediated mRNA decay (NMD) is a quality control mechanism that degrades aberrant mRNAs harboring premature termination codons (PTCs). Two out of three T-cell receptor β (TCRβ) transcripts carry PTCs as a result of error-prone programmed rearrangements that occur at this locus during lymphocyte maturation. PTCs decrease TCRβ mRNA levels to a much greater extent than mRNAs transcribed from non-rearranging genes. This robust decrease in TCRβ mRNA levels is not a unique characteristic of the T-cell environment or the TCRβ promoter. The simplest explanation for this is that PTC-bearing TCRβ mRNAs elicit a stronger NMD response. An alternative explanation is NMD collaborates with another mechanism to dramatically decrease PTC-bearing TCRβ mRNA levels. ^ In my dissertation, I investigated the molecular mechanism behind the strong decrease in TCRβ mRNA levels triggered by PTCs. To determine the location of this response, I performed mRNA half-life analysis and found that PTCs elicited more rapid TCRβ mRNA decay in the nuclear fraction, not the cytoplasmic fraction. Although decay was restricted to the nuclear fraction, PTC-bearing TCRβ transcript levels were extremely low in the cytoplasm, a phenomenon that I named the nonsense-codon induced partitioning shift (NIPS). I established that NIPS shares several qualities with NMD, including its dependence on translation and NMD factors. Several lines of evidence suggested that NIPS results from PTCs eliciting retention of TCRβ transcripts in the nuclear fraction. This retention, as well as rapid TCRβ mRNA decay, most likely occurs in either the nucleoplasm or the outer nuclear membrane, based on analysis of nuclear and cytoplasmic markers in the highly purified nuclei I used for my studies. To further address the location of decay, I asked whether nuclear or cytoplasmic RNA decay factors mediated the destruction of PTC-bearing mRNAs. My results suggested that a nuclear component of the 3'-to-5' exosome, as well as an endonucleolytic activity, are involved in the destruction of PTC-containing TCRβ mRNAs. Individual endogenous NMD substrates had differential requirements for nuclear and cytoplasmic exonucleases. In summary, my results provide evidence that PTCs trigger multiple mechanisms involving multiple decay factors to remove and regulate mRNAs in mammalian cells. ^

Investigating the epidemic of heroin use in Dar es Salaam, Tanzania: Recognizing the issues of heroin smokers

Since heroin was introduced to East Africa during the 1980s, heroin use practices have changed rapidly in response to various internal and external pressures. The aim of this study was to identify and describe the population of heroin users and locations of heroin use in Dar es Salaam, Tanzania, in order to understand recent contexts of heroin use. The study took place between June 30 and August 19, 2011, in all three districts (Kinondoni, Ilala, and Temeke) of Dar es Salaam. We mapped sites using a Global Positioning System device, counted numbers of heroin users, and conducted informal interviews with heroin users. The mixed-methods analyses of the data included quantifying the basic demographic and aggregate information about the sites and heroin users, as well as qualitative analysis and coding of fieldnotes from observations and responses to interviews which was used to identify themes and characteristics of heroin users. ^ We identified a total of 150 sites and counted a total of 1046 male and 46 female non-injecting drug users and 78 male and 9 female injecting drug users (IDUs) of heroin. We found that social organization existed at some of the sites, with 31% (n=47) of sites reporting having a leader and 44% (n=66) of sites reporting mutual aid between users frequenting the site. We had difficulty locating IDUs and female drug users, and the majority of users we encountered were heroin smokers of kokteli, a mixture of heroin, cannabis, and/or tobacco which is smoked like a cigarette. ^ This research highlighted heroin smokers’ desire for access to drug treatment services. The current methadone-based medication assisted treatment (MAT) program is funded and operates as an HIV prevention program for IDUs to reduce HIV infection in this population and slow or stop the spread of a second wave of HIV infection in the general population. However, smokers perceived MAT to be primarily a drug use prevention or cessation program and felt unjustly neglected from the intervention, leading to a tense relationship with IDUs. From a public health standpoint, future interventions should include heroin smokers to prevent HIV transmission. ^

(Table 1) Sea level during storm surges at various sites along the german Baltic Sea coast

A seawall was constructed in 1897 along the steep coast of Streckelsberg, Usedom Island to stop the cliff retreat. It was destroyed several times by storm induced sea floods, reconstructed and gradually extended to a length of 450 m. After the severe storm event of 1/2.3.1949, no more repair work was implemented. The ruins were no longer capable of preventing further erosion of the Streckelsberg cliff. A new protective structure became a necessity against ongoing erosion, and to check the lowering of the abrasion platform. The construction of three breakwaters began in 1995. A severe storm occurred on 3/4.11.1995 before their completion. Coastal bottom sediment mapping using a sidescan-sonar carried out two days later showed that a channel system down to a depth of 1.5 m was cut into the sand layer covering the sea floor on both sides of the Koserow Bank. The bottom of these channels was paved with gravel and boulders. This layer was encountered in the whole surveyed area below a mobile sand layer. Discharged bodies of fine sand half a meter high and erosional cavities several m2 in diameter around boulders led to the conclusion that an intensive sediment movement down to a depth of 11 m had taken place during the storm. A storm related direction of sediment discharge could not be identified. The existing section of the breakwaters withstood the severe storm.

The European Hare (Lepus europaeus): A Picky Herbivore Searching for Plant Parts Rich in Fat

European hares of both sexes rely on fat reserves, particularly during the reproduc-tive season. Therefore, hares should select dietary plants rich in fat and energy. However, hares also require essential polyunsaturated fatty acids (PUFA) such as linoleic acid (LA) and alpha-linolenic acid (ALA) to reproduce and survive. Although hares are able to absorb PUFA selectively in their gastrointestinal tract, it is unknown whether this mechanism is sufficient to guarantee PUFA supply. Thus, diet selection may involve a trade-off between a preference for energy versus a preference for crucial nutrients, namely PUFA. We compared plant and nutrient availability and use by hares in an arable landscape in Austria over three years. We found that European hares selected their diet for high energy content (crude fat and crude protein), and avoided crude fibre. There was no evidence of a preference for plants rich in LA and ALA. We conclude that fat is the limiting resource for this herbivorous mammal, whereas levels of LA and ALA in forage are sufficiently high to meet daily requirements, especially since their uptake is enhanced by physiological mechanisms. Animals selected several plant taxa all year round, and preferences did not simply correlate with crude fat content. Hence, European hares might not only select for plant taxa rich in fat, but also for high-fat parts of preferred plant taxa. As hares preferred weeds/grasses and various crop types while avoiding cereals, we suggest that promoting heterogeneous habitats with high crop diversity and set-asides may help stop the decline of European hares throughout Europe.

Analysis of the operator action and the single failure criteria in a SGTR sequence using best estimate assumptions with TRACE 5.0

Steam Generator Tube Rupture (SGTR) sequences in Pressurized Water Reactors are known to be one of the most demanding transients for the operating crew. SGTR are a special kind of transient as they could lead to radiological releases without core damage or containment failure, as they can constitute a direct path from the reactor coolant system to the environment. The first methodology used to perform the Deterministic Safety Analysis (DSA) of a SGTR did not credit the operator action for the first 30 min of the transient, assuming that the operating crew was able to stop the primary to secondary leakage within that period of time. However, the different real SGTR accident cases happened in the USA and over the world demonstrated that the operators usually take more than 30 min to stop the leakage in actual sequences. Some methodologies were raised to overcome that fact, considering operator actions from the beginning of the transient, as it is done in Probabilistic Safety Analysis. This paper presents the results of comparing different assumptions regarding the single failure criteria and the operator action taken from the most common methodologies included in the different Deterministic Safety Analysis. One single failure criteria that has not been analysed previously in the literature is proposed and analysed in this paper too. The comparison is done with a PWR Westinghouse three loop model in TRACE code (Almaraz NPP) with best estimate assumptions but including deterministic hypothesis such as single failure criteria or loss of offsite power. The behaviour of the reactor is quite diverse depending on the different assumptions made regarding the operator actions. On the other hand, although there are high conservatisms included in the hypothesis, as the single failure criteria, all the results are quite far from the regulatory limits. In addition, some improvements to the Emergency Operating Procedures to minimize the offsite release from the damaged SG in case of a SGTR are outlined taking into account the offsite dose sensitivity results.

Geomorphological analysis and evolution of an altered floodplain drainage system. The case of the Partido Stream (Spain)

The Partido Stream is a small torrential course that flows into the marsh of the Doñana National Park, an area that was declared a World Heritage Site in 1994. Before 1981, floods occurred, and the stream overflowed onto a floodplain. As an old alluvial fan, the floodplain has its singular orography and functionality. Fromthe floodplain, several drainage channels, locally called caño, discharged into themarsh. The Partido Streamhad themorphology of a caño and covered approximately 8 km from the old fan to the marsh. The stream was straightened and channelised in 1981 to cultivate the old fan. This resulted in floods that were concentrated between the banks in the following years, which caused the depth of water and the shear stress to increase, thus, scouring the river bed and river banks. In this case, the eroded materials were carried towards the marsh where a new alluvial fan evolved. Control measures on the old fan were implemented in 2006 to stop the development of the new alluvial fan downstream over the marsh. Thus, the stream would partially recover its original behaviour that it had before channelisation, moving forwards in a new, balanced state. The present study describes the geomorphological evolution that channelisation has caused since 1981 and the later slow process of recovery of the original hydraulic-sedimentation regime since 2006. Additionally, it deepens the understanding of the original hydraulic behaviour of the stream, combining field data and 2D simulations.

Requests to stop commons, 1775

Requests from Tutors John Wadsworth, Caleb Gannett, and Stephen Hall to the Steward, dated March 20, March 25, and April 4, 1775, to stop the commons of students. Reasons given include illness and absence from the College.

The EU’s Sanctions against Syria: Conflict Management by Other Means. Security Policy Brief No. 38

Since May 2011, the EU has launched one of its most far reaching and sophisticated sanctions operations in support of the protests against the current regime in Syria. The present brief examines the measures wielded by the EU, its expected impact and its implications for the EU’s relations with its global partners. While seriously undermined by the lack of support of Russia, the sanctions are having a noticeable economic impact. Yet, the choice of measures is ill-suited to stop the bloodshed. The sanctions have also served to (re)define partnerships with other powers, both in the Middle-East and globally.

Commitments or prohibition? The EU antitrust dilemma. Bruegel Policy Brief 2014/01, 31 January 2014

The issue: Excluding cartels, most investigations into suspected infringements of European Union competition law are resolved with ‘commitment decisions’. The European Commission drops the case in exchange for a commitment from the company under investigation to implement measures to stop the presumed anti-competitive behaviour. Commitment decisions are considered speedier than formal sanctions (prohibition decisions) in restoring normal competitive market conditions. They have a cost, however: commitments are voluntary and are unlikely to be subject to judicial review. This reduces the European Commission’s incentive to build a robust case. Because commitment decisions do not establish any legal precedent, they provide for little guidance on the interpretation of the law. Policy challenge: The European Commission relies increasingly on commitment decisions. More transparency on the substance of allegations, and the establishment of a higher number of legal precedents, are however necessary. This applies in particular to cases that tackle antitrust issues in new areas, such as markets for digital goods, in which companies might find it difficult to assess if a certain behaviour constitutes a violation of competition rules. To ensure greater transparency and mitigate some of the drawbacks of commitment decisions, while retaining their main benefits, the full detail of the objections addressed by the European Commission to defendants should be published.

Kosowo - przed ostatecznym rozwiazaniem. Proces uregulowania statusu miedzynarodowego = uwarunkowania polityczne i historyczne perspektywy rozwoju sytuacji. Prace OSW 2008. Kosovo before the final decision. Regulation Kosovo's international status - historical and political conditions and prospects for future developments. OSW Study 27/2008

The question of Kosovo's status is currently one of the most important issues in international politics. Since 1999, Kosovo has been an international protectorate which was created in the aftermath of the NATO intervention to stop the brutal pacification of the Albanian insurgency by Serb forces. The province has since de facto become independent of Serbia. Resolution 1244 of the UN Security Council, which established the protectorate, does not preclude any possible outcome as regards its status. Aware that after the crimes of 1999, any attempt to re-integrate Kosovo into Serbia would lead to a massive Albanian uprising, the West has decided that the best solution would be to award Kosovo internationally supervised independence, while at the same time granting very wide autonomy to the Kosovo Serbs. Serbia and Russia rejected the solution proposed by the West, and so Kosovo became an arena of international rivalry for influence in the Western Balkans as well as another element of rivalry, transcending the regional dimension, between Russia and the West. Russia has been using the Kosovo case to build a new model of its relations with the United States and the EU. Since there is a group of countries sceptical about, or even opposed to, Kosovo's independence within the EU, the Kosovo settlement will be a test of the EU's ability to speak with one voice with regard to its external policy.

The 2005 Reform of the Stability and Growth Pact: Too Little, Too Late? Bruges European Economic Research (BEER) Papers 6/November 2006

This paper analyses the main critiques addressed by the literature and the policymakers to the 1997 Stability and Growth Pact. It further indicates to what extent the 2005 reform of the Pact meets those critics. It finally argues that the 2005 reform may be too little and arrive too late to restore the Pact credibility, ensure its enforceability and correctly set the derogations to the excessive deficit procedure on the nature of the shocks which cause the output gap rather than its size: a 3% of GDP limit on deficit spending may be a too binding constraint in front of a strongly negative demand shock, while it is irrationally large in front of a supply shock. Some empirical evidence is provided to identify in the last years strongly negative demand shocks from other shocks in the 25 EU Member States. Had this identifying method been adopted in November 2003, the European Commission and the Council would have both agreed to stop the excessive deficit procedure against Germany, but they would have both proceeded against France which apparently was not at the time hit by a strongly negative demand shock.

A ship run aground Deepening problems in the Ukrainian economy. OSW Commentary Number 173, 16 June 2015

The drop in Ukraine’s GDP by nearly 18% in the first three months of 2015 (versus the corresponding period in 2014) has confirmed the decline of the country’s economy. Over the last 14 months, the Ukrainian currency was subject to an almost threefold devaluation against the US dollar, and in April 2015 the inflation rate was 61% (year-on-year), which exacerbated the impoverishment of the general public and weakened domestic demand. The main reason behind the crisis has been the destruction of heavy industry and infrastructure in the war-torn Donbas region, over which Kyiv no longer has control, as well as a sharp decline in foreign trade (by 24% in 2014 and by 34% in the first quarter of 2015), recorded primarily in trading volume with Ukraine’s major trade partner, i.e. Russia (a drop of 43%). The conflict has also had a negative impact on the production figures for the two key sectors of the Ukrainian economy: agriculture and metallurgy, which account for approximately 50% of Ukrainian exports. The government’s response to the crisis has primarily been a reduction in the costs of financing the Donbas and an increase in the financial burden placed on the citizens and companies of Ukraine. No radical reforms which would encompass the entire system, including anti-corruption reforms, have been carried out to stop the embezzlement of state funds and to facilitate business activity. The reasons for not initiating reforms have included the lack of will to launch them, Ukraine’s traditionally slow pace of bureaucratic action and growing dissonance among the parties making up the parliamentary coalition. The few positive changes, including marketisation of energy prices and sustaining budgetary discipline (in the first quarter of 2015, budgetary revenues grew by 25%, though partly as a result of currency devaluation), are being carried out under pressure from the International Monetary Fund, which is making the payment of further loan instalments to the tune of US$ 17.5 billion conditional upon reforms. Despite assistance granted by Western institutional donors and by individual states, the risk of Ukraine going bankrupt remains real. The issue of restructuring foreign debt worth US$ 15 billion has not been resolved, as foreign creditors who hold Ukrainian bonds have not consented to any partial cancellation of the debt. Whether Ukraine’s public finances can be stabilised will depend mainly on the situation in the east of the country and on the possible renewal of military action. It seems that the only way to rescue Ukraine’s public finances from deteriorating further is to continue to ‘freeze’ the conflict, to gradually implement wide-ranging reforms and to reach a consensus in negotiations with lenders.

Forced retroevolution of an RNA bacteriophage

The operator hairpin ahead of the replicase gene in RNA bacteriophage MS2 contains overlapping signals for binding the coat protein and ribosomes. Coat protein binding inhibits further translation of the gene and forms the first step in capsid formation. The hairpin sequence was partially randomized to assess the importance of this structure element for the bacteriophage and to monitor alternative solutions that would evolve on the passaging of mutant phages. The evolutionary reconstruction of the operator failed in the majority of mutants. Instead, a poor imitation developed containing only some of the recognition signals for the coat protein. Three mutants were of particular interest in that they contained double nonsense codons in the lysis reading frame that runs through the operator hairpin. The simultaneous reversion of two stop codons into sense codons has a very low probability of occurring. Therefore the phage solved the problem by deleting the nonsense signals and, in fact, the complete operator, except for the initiation codon of the replicase gene. Several revertants were isolated with activities ranging from 1% to 20% of wild type. The operator, long thought to be a critical regulator, now appears to be a dispensable element. In addition, the results indicate how RNA viruses can be forced to step back to an attenuated form.

The effects of using rap music on the fluency skills of 2nd grade African American students

A concern for both educators and policy makers is how to increase the reading achievement of African American students. Studies have shown that rap music, which has its roots in the African American community, can be used as a tool to facilitate this increase, specifically how using rap songs in reading lessons can improve a child's reading motivation, information recall, and vocabulary development. There are also studies on how repeated reading of a text can help improve a child's reading fluency. Yet, there are no studies that combine rap music and repeated reading of a text. This study describes the effects of using a culturally responsive reading strategy on the fluency, decoding, and comprehension skills of African American students. ^ The sample consisted of 105 African American students within eight, second grade classrooms at two different elementary schools. The classes were randomly selected and assigned to the rap group or the control group. Students received eight half-hour sessions using either a rap text or a traditional text in a repeated reading lesson. All of the students were pre-tested and post-tested on the Oral Reading Fluency and the Nonsense Word Fluency portions of the Dynamic Indicators of Basic Literacy Skills Test. Additionally, a researcher constructed comprehension quiz was given to the students at the beginning, middle, and end of the study. Research questions were analyzed using ANOVAs and t tests. ^ The hypotheses were not supported but there was some evidence that rap music in a reading lesson helped improve the fluency skills of African American students at one of the schools. The results also revealed that rap music used in a reading lesson initially improved the comprehension skills of African American students. The rap treatment may not have worked best overall because of the lack of intensity of the treatment. ^ The study has shown some evidence to support using culturally appropriate materials such as rap with students. There needs to be more research on the interaction between teaching methods, materials, and students. ^