COSTS AND EFFECTS OF ARKANSAS' LONG-TERM CARE DEMONSTRATION PROJECT (MEDICAID, CHANELLING, COMMUNITY ASSESSMENT)

The purpose of this study was to assess the impact of the Arkansas Long-Term Care Demonstration Project upon Arkansas' Medicaid expenditures and upon the clients it serves. A Retrospective Medicaid expenditure study component used analyses of variance techniques to test for the Project's effects upon aggregated expenditures for 28 demonstration and control counties representing 25 percent of the State's population over four years, 1979-1982.^ A second approach to the study question utilized a 1982 prospective sample of 458 demonstration and control clients from the same 28 counties. The disability level or need for care of each patient was established a priori. The extent to which an individual's variation in Medicaid utilization and costs was explained by patient need, presence or absence of the channeling project's placement decision or some other patient characteristic was examined by multiple regression analysis. Long-term and acute care Medicaid, Medicare, third party, self-pay and the grand total of all Medicaid claims were analyzed for project effects and explanatory relationships.^ The main project effect was to increase personal care costs without reducing nursing home or acute care costs (Prospective Study). Expansion of clients appeared to occur in personal care (Prospective Study) and minimum care nursing home (Retrospective Study) for the project areas. Cost-shifting between Medicaid and Medicare in the project areas and two different patterns of utilization in the North and South projects tended to offset each other such that no differences in total costs between the project areas and demonstration areas occurred. The project was significant ((beta) = .22, p < .001) only for personal care costs. The explanatory power of this personal care regression model (R('2) = .36) was comparable to other reported health services utilization models. Other variables (Medicare buy-in, level of disability, Social Security Supplemental Income (SSI), net monthly income, North/South areas and age) explained more variation in the other twelve cost regression models. ^

Endemic tuberculosis, the homeless, and public transportation: A merging of geographical information systems surveillance and the Houston Tuberculosis Initiative Surveillance project

To reach the goals established by the Institute of Medicine (IOM) and the Centers for Disease Control's (CDC) STOP TB USA, measures must be taken to curtail a future peak in Tuberculosis (TB) incidence and speed the currently stagnant rate of TB elimination. Both efforts will require, at minimum, the consideration and understanding of the third dimension of TB transmission: the location-based spread of an airborne pathogen among persons known and unknown to each other. This consideration will require an elucidation of the areas within the U.S. that have endemic TB. The Houston Tuberculosis Initiative (HTI) was a population-based active surveillance of confirmed Houston/Harris County TB cases from 1995–2004. Strengths in this dataset include the molecular characterization of laboratory confirmed cases, the collection of geographic locations (including home addresses) frequented by cases, and the HTI time period that parallels a decline in TB incidence in the United States (U.S.). The HTI dataset was used in this secondary data analysis to implement a GIS analysis of TB cases, the locations frequented by cases, and their association with risk factors associated with TB transmission. ^ This study reports, for the first time, the incidence of TB among the homeless in Houston, Texas. The homeless are an at-risk population for TB disease, yet they are also a population whose TB incidence has been unknown and unreported due to their non-enumeration. The first section of this dissertation identifies local areas in Houston with endemic TB disease. Many Houston TB cases who reported living in these endemic areas also share the TB risk factor of current or recent homelessness. Merging the 2004–2005 Houston enumeration of the homeless with historical HTI surveillance data of TB cases in Houston enabled this first-time report of TB risk among the homeless in Houston. The homeless were more likely to be US-born, belong to a genotypic cluster, and belong to a cluster of a larger size. The calculated average incidence among homeless persons was 411/100,000, compared to 9.5/100,000 among housed. These alarming rates are not driven by a co-infection but by social determinants. The unsheltered persons were hospitalized more days and required more follow-up time by staff than those who reported a steady housing situation. The homeless are a specific example of the increased targeting of prevention dollars that could occur if TB rates were reported for specific areas with known health disparities rather than as a generalized rate normalized over a diverse population. ^ It has been estimated that 27% of Houstonians use public transportation. The city layout allows bus routes to run like veins connecting even the most diverse of populations within the metropolitan area. Secondary data analysis of frequent bus use (defined as riding a route weekly) among TB cases was assessed for its relationship with known TB risk factors. The spatial distribution of genotypic clusters associated with bus use was assessed, along with the reported routes and epidemiologic-links among cases belonging to the identified clusters. ^ TB cases who reported frequent bus use were more likely to have demographic and social risk factors associated with poverty, immune suppression and health disparities. An equal proportion of bus riders and non-bus riders were cultured for Mycobacterium tuberculosis, yet 75% of bus riders were genotypically clustered, indicating recent transmission, compared to 56% of non-bus riders (OR=2.4, 95%CI(2.0, 2.8), p<0.001). Bus riders had a mean cluster size of 50.14 vs. 28.9 (p<0.001). Second order spatial analysis of clustered fingerprint 2 (n=122), a Beijing family cluster, revealed geographic clustering among cases based on their report of bus use. Univariate and multivariate analysis of routes reported by cases belonging to these clusters found that 10 of the 14 clusters were associated with use. Individual Metro routes, including one route servicing the local hospitals, were found to be risk factors for belonging to a cluster shown to be endemic in Houston. The routes themselves geographically connect the census tracts previously identified as having endemic TB. 78% (15/23) of Houston Metro routes investigated had one or more print groups reporting frequent use for every HTI study year. We present data on three specific but clonally related print groups and show that bus-use is clustered in time by route and is the only known link between cases in one of the three prints: print 22. (Abstract shortened by UMI.)^

A geomorphological seabed classification for the Weddell Sea, Antarctica, with links to ArcGIS project files

Sea floor morphology plays an important role in many scientific disciplines such as ecology, hydrology and sedimentology since geomorphic features can act as physical controls for e.g. species distribution, oceanographically flow-path estimations or sedimentation processes. In this study, we provide a terrain analysis of the Weddell Sea based on the 500 m × 500 m resolution bathymetry data provided by the mapping project IBCSO. Seventeen seabed classes are recognized at the sea floor based on a fine and broad scale Benthic Positioning Index calculation highlighting the diversity of the glacially carved shelf. Beside the morphology, slope, aspect, terrain rugosity and hillshade were calculated. Applying zonal statistics to the geomorphic features identified unambiguously the shelf edge of the Weddell Sea with a width of 45-70 km and a mean depth of about 1200 m ranging from 270 m to 4300 m. A complex morphology of troughs, flat ridges, pinnacles, steep slopes, seamounts, outcrops, and narrow ridges, structures with approx. 5-7 km width, build an approx. 40-70 km long swath along the shelf edge. The study shows where scarps and depressions control the connection between shelf and abyssal and where high and low declination within the scarps e.g. occur. For evaluation purpose, 428 grain size samples were added to the seabed class map. The mean values of mud, sand and gravel of those samples falling into a single seabed class was calculated, respectively, and assigned to a sediment texture class according to a common sediment classification scheme.

Abundance of mesozooplankton in the western part of the Black Sea in summer 2005 during Phase 2: Leg1 from the GEF Project

The sampling area was extended to the Western-South area off the Black Sea coast from Kaliakra cape toward the Bosforous. Samples were collected along four transects. The whole dataset is composed of 17 samples (from 10 stations) with data of mesozooplankton species composition abundance and biomass. Sampling for zooplankton was performed from bottom up to the surface at depths depending on water column stratification and the thermocline depth. These data are organized in the "Control of eutrophication, hazardous substances and related measures for rehabilitating the Black Sea ecosystem: Phase 2: Leg I: PIMS 3065". Data Report is not published. Zooplankton samples were collected with vertical closing Juday net,diameter - 36cm, mesh size 150 µm. Tows were performed from surface down to bottom meters depths in discrete layers. Samples were preserved by a 4% formaldehyde sea water buffered solution. Sampling volume was estimated by multiplying the mouth area with the wire length. Mesozooplankton abundance: The collected material was analysed using the method of Domov (1959). Samples were brought to volume of 25-30 ml depending upon zooplankton density and mixed intensively until all organisms were distributed randomly in the sample volume. After that 5 ml of sample was taken and poured in the counting chamber which is a rectangle form for taxomomic identification and count. Large (> 1 mm body length) and not abundant species were calculated in whole sample. Counting and measuring of organisms were made in the Dimov chamber under the stereomicroscope to the lowest taxon possible. Taxonomic identification was done at the Institute of Oceanology by Kremena Stefanova using the relevant taxonomic literature (Mordukhay-Boltovskoy, F.D. (Ed.). 1968, 1969,1972). Taxon-specific abundance: The collected material was analysed using the method of Domov (1959). Samples were brought to volume of 25-30 ml depending upon zooplankton density and mixed intensively until all organisms were distributed randomly in the sample volume. After that 5 ml of sample was taken and poured in the counting chamber which is a rectangle form for taxomomic identification and count. Copepods and Cladoceras were identified and enumerated; the other mesozooplankters were identified and enumerated at higher taxonomic level (commonly named as mesozooplankton groups). Large (> 1 mm body length) and not abundant species were calculated in whole sample. Counting and measuring of organisms were made in the Dimov chamber under the stereomicroscope to the lowest taxon possible. Taxonomic identification was done at the Institute of Oceanology by Kremena Stefanova using the relevant taxonomic literature (Mordukhay-Boltovskoy, F.D. (Ed.). 1968, 1969,1972).

Miocene strontium isotope record of DSDP Hole 30-289

A composite strontium isotopic seawater curve was constructed for the Miocene between 24 and 6 Ma by combining 87Sr/86Sr measurements of planktonic foraminifera from Deep Sea Drilling Project sites 289 and 588. Site 289, with its virtually continuous sedimentary record and high sedimentation rates (26 m/m.y.), was used for constructing the Oligocene to mid-Miocene part of the record, which included the calibration of 63 biostratigraphic datums to the Sr seawater curve using the timescale of Cande and Kent (1992 doi:10.1029/92JB01202). Across the Oligocene/Miocene boundary, a brief plateau occurred in the Sr seawater curve (87Sr/86Sr values averaged 0.70824) which is coincident with a carbon isotopic maximum (CM-O/M) from 24.3 to 22.6 Ma. During the early Miocene, the strontium isotopic curve was marked by a steep rise in 87Sr/86Sr that included a break in slope near 19 Ma. The rate of growth was about 60 ppm/m.y. between 22.5 and 19.0 Ma and increased to over 80 ppm/m.y. between 19.0 and 16 Ma. Beginning at ~16 Ma (between carbon isotopic maxima CM3 and CM4 of Woodruff and Savin (1991 doi:10.1029/91PA02561)), the rate of 87Sr/86Sr growth slowed and 87Sr/86Sr values were near constant from 15 to 13 Ma. After 13 Ma, growth in 87Sr/86Sr resumed and continued until ~9 Ma, when the rate of 87Sr/86Sr growth decreased to zero once again. The entire Miocene seawater curve can be described by a high-order function, and the first derivative (d87Sr/86Sr/dt) of this function reveals two periods of increased slope. The greatest rate of 87Sr/86Sr change occurred during the early Miocene between ~20 and 16 Ma, and a smaller, but distinct, period of increased slope also occurred during the late Miocene between ~12 and 9 Ma. These periods of steepened slope coincide with major phases of uplift and denudation of the Himalayan-Tibetan Plateau region, supporting previous interpretations that the primary control on seawater 87Sr/86Sr during the Miocene was related to the collision of India and Asia. The rapid increase in 87Sr/86Sr values during the early Miocene from 20 to 16 Ma imply high rates of chemical weathering and dissolved riverine fluxes to the oceans. In the absence of another source of CO2, these high rates of chemical weathering should have quickly resulted in a drawdown of atmospheric CO2 and climatic cooling through a reversed greenhouse effect. The paleoclimatic record, however, indicates a warming trend during the early Miocene, culminating in a climatic optimum between 17 and 14.5 Ma. We suggest that the high rates of chemical erosion and warm temperatures during the climatic optimum were caused by an increase in the contribution of volcanic CO2 from the eruption of the Columbia River Flood Basalts (CRFB) between 17 and 15 Ma. The decrease in the rate of CRFB eruptions at 15 Ma and the removal of atmospheric carbon dioxide by increased organic carbon burial in Monterey deposits eventually led to cooling and increased glaciation between ~14.5 and 13 Ma. The CRFB hypothesis helps to explain the significant time lag between the onset of increased rates of organic carbon burial in the Monterey at 17.5 Ma (as marked by increased delta13C values) and the climatic cooling and glaciation during the middle Miocene (as marked by the increase in delta18O values), which did not begin until ~14.5 Ma.

Geochemistry of oceanic flood basalts from the Caribbean plate

The thick oceanic crust of the Caribbean plate appears to be the tectonized remnant of an eastern Pacific oceanic plateau that has been inserted between North and South America. The emplacement of the plateau into its present position has resulted in the obduction and exposure of its margins, providing an opportunity to study the age relations, internal structure and compositional features of the plateau. We present the results of 40Ar-39Ar radiometric dating, major-, trace-element, and isotopic compositions of basalts from some of the exposed sections as well as drill core basalt samples from Leg 15 of the Deep Sea Drilling Project. Five widely spaced, margin sections yielded ages ranging from 91 to 88 Ma. Less well-constrained radiometric ages from the drill cores, combined with the biostratigraphic age of surrounding sediments indicate a minimum crystallization age of ~90 Ma in the Venezuelan Basin. The synchroneity of ages across the region is consistent with a flood basalt origin for the bulk of the Caribbean plateau i.e., large volume, rapidly erupted, regionally extensive volcanism.. The ages and compositions are also consistent with plate reconstructions that place the Caribbean plateau in the vicinity of the Galápagos hotspot at its inception. The trace-element and isotopic compositions of the ~90 Ma rocks indicate a depleted mantle and an enriched, plume-like mantle were involved in melting to varying degrees across the plateau. Within the same region, a volumetrically secondary, but widespread magmatic event occurred at 76 Ma, as is evident in Curacao, western Colombia, Haiti, and at DSDP Site 152/ODP Site 1001 near the Hess Escarpment. Limited trace-element data indicate that this phase of magmatism was generally more depleted than the first. We speculate that magmatism may have resulted from upwelling of mantle, still hot from the 90 Ma event, during lithospheric extension attending gravitational collapse of the plateau, andror tectonic emplacement of the plateau between North and South America. Still younger volcanics are found in the Dominican Republic (69 Ma) and the Quepos Peninsula of Costa Rica (63 Ma). The latter occurrence conceivably formed over the Galápagos hotspot and subsequently accreted to the western edge of the plateau during subduction of the Farallon plate.

Inorganic major, minor, and trace element geochemistry and clay mineralogy of sediments from the Deep Sea Drilling Project Leg 96, Gulf of Mexico

Sediment samples collected at DSDP Leg 96 Mississippi Fan Sites 615, 616, 620, 621, and 623, Orca Basin Site 618, and Pigmy Basin Site 619 were analyzed for 22 major, minor, and trace elements. This study was undertaken to document the downhole variability in inorganic geochemistry between sites. The mineralogy of the clays, including those from Sites 614, 617, and 622 on the fan, was determined by X-ray diffraction to define the principal clay minerals present at the sites, examine any downhole trends in clay mineralogy, and aid in the interpretation of the geochemical signature of the sediments. Clay mineral composition at all the sites is smectite:illite:chlorite:kaolinite in the approximate percentage ratio 50:20:20:10. Geochemical results indicate only slight variation between and within the sites, with the exception of a discrete unit of carbonates that occurs near the bottom of Site 615. Variation in the major, minor, and trace element composition can be explained by a change in the relative abundance of quartz, clay minerals, and carbonates.

Control of ambient pH on growth and stable isotopes in phytoplanktonic calcifying algae

The present work examines the relationship between pH-induced changes in growth and stable isotopic composition of coccolith calcite in two coccolithophore species with a geological perspective. These cells (Gephyrocapsa oceanica and Coccolithus pelagicus) with differing physiologies and vital effects possess a growth optimum corresponding to average pH of surface seawater in the geological period during their first known occurrence. Diminished growth rates outside of their optimum pH range are explained by the challenge of proton translocation into the extracellular environment at low pH, and enhanced aqueous CO2 limitation at high pH. These diminished growth rates correspond to a lower degree of oxygen isotopic disequilibrium in G. oceanica. In contrast, the slower growing and ancient species C. pelagicus, which typically precipitates near-equilibrium calcite, does not show any modulation of oxygen isotope signals with changing pH. In CO2-utilizing unicellular algae, carbon and oxygen isotope compositions are best explained by the degree of utilization of the internal dissolved inorganic carbon (DIC) pool and the dynamics of isotopic re-equilibration inside the cell. Thus, the "carbonate ion effect" may not apply to coccolithophores. This difference with foraminifera can be traced to different modes of DIC incorporation into these two distinct biomineralizing organisms. From a geological perspective, these findings have implications for refining the use of oxygen isotopes to infer more reliable sea surface temperatures (SSTs) from fossil carbonates, and contribute to a better understanding of how climate-relevant parameters are recorded in the sedimentary archive.