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. ^

The assumptions and effects of conservative procedures in low -dose risk assessment for setting safety standards

Conservative procedures in low-dose risk assessment are used to set safety standards for known or suspected carcinogens. However, the assumptions upon which the methods are based and the effects of these methods are not well understood.^ To minimize the number of false-negatives and to reduce the cost of bioassays, animals are given very high doses of potential carcinogens. Results must then be extrapolated to much smaller doses to set safety standards for risks such as one per million. There are a number of competing methods that add a conservative safety factor into these calculations.^ A method of quantifying the conservatism of these methods was described and tested on eight procedures used in setting low-dose safety standards. The results using these procedures were compared by computer simulation and by the use of data from a large scale animal study.^ The method consisted of determining a "true safe dose" (tsd) according to an assumed underlying model. If one assumed that Y = the probability of cancer = P(d), a known mathematical function of the dose, then by setting Y to some predetermined acceptable risk, one can solve for d, the model's "true safe dose".^ Simulations were generated, assuming a binomial distribution, for an artificial bioassay. The eight procedures were then used to determine a "virtual safe dose" (vsd) that estimates the tsd, assuming a risk of one per million. A ratio R = ((tsd-vsd)/vsd) was calculated for each "experiment" (simulation). The mean R of 500 simulations and the probability R $<$ 0 was used to measure the over and under conservatism of each procedure.^ The eight procedures included Weil's method, Hoel's method, the Mantel-Byran method, the improved Mantel-Byran, Gross's method, fitting a one-hit model, Crump's procedure, and applying Rai and Van Ryzin's method to a Weibull model.^ None of the procedures performed uniformly well for all types of dose-response curves. When the data were linear, the one-hit model, Hoel's method, or the Gross-Mantel method worked reasonably well. However, when the data were non-linear, these same methods were overly conservative. Crump's procedure and the Weibull model performed better in these situations. ^

Physicochemical properties and 3D geostatistical simulations of the Herten and the Descalvado aquifer analogs

This data set presents a comprehensive characterisation of the sedimentary structures from important groundwater hosting formations in Germany (Herten aquifer analog) and Brazil (Descalvado aquifer analog). Multiple 2-D outcrop faces are described in terms of hydraulic, thermal and chemical properties and interpolated in 3D using stochastic techniques. For each aquifer analog, multiple 3D realisations of the facies heterogeneity are provided using different stochastic simulations settings. These are unique analogue data sets that can be used by the wider community to implement approaches for characterising aquifer formations.

Physical properties and neutron texture measuerments of deep-sea carbonates of DSDP Holes 62-463 and 62-465A

In weakly indurated, nannofossil-rich, deep-sea carbonates compressional wave velocity is up to twice as fast parallel to bedding than normal to it. It has been suggested that this anisotropy is due to alignment of calcite c-axes perpendicular to the shields of coccoliths and shield deposition parallel to bedding. This hypothesis was tested by measuring the preferred orientation (fabric) of calcite c-axes in acoustic anisotropic, calcareous DSDP sediment samples by X-ray goniometry, and it was found that the maximum c-axis concentrations are by far too low to explain the anisotropies. The X-ray method is subject to a number of uncertainties due to preparatory and technical shortcomings in weakly indurated rocks. The most serious weaknesses are: sample preparation, volume of measured sample (fraction of a mm3), beam defocusing and background intensity corrections, combination of incomplete pole figures, and necessity of recalculation of the c-axis orientations from other crystallographic directions. Goniometry using thermal neutrons overcomes most of these difficulties, but it is time consuming. We test the interferences made about velocity anisotropy by X-ray studies about the concentration of c-axes in deep-sea carbonates by employing neutron texture goniometry to eight DSDP samples comprising mostly nannofossil material. Fabric and sonic velocity were determined directly on the core specimens, thus from the same rock volume and requiring no preparation. The c-axis orientation is obtained directly from the [0006] calcite diffraction peak without corrections. The fabrics are clearly defined, but weak (1.1 to 1.86 times uniform) with the maximum about normal to bedding. They have crudely orthorhombic symmetry, but are not axisymmetric around the bedding normal. The observed c-axis intensities, although higher than determined by the X-ray method on other samples, are by far too low to explain the observed acoustic anisotropies.

Physical properties and accumulation rates in Dronning Maud Land, Antarctica

The European Programme for Ice Coring in Antarctica includes a comprehensive pre-site survey on the inland ice plateau of Dronning Maud Land, Antarctica. The German glaciological programme during the 1997/98 field season was carried out along a 1200 km traverse on Amundsenisen and involved sampling the snow cover in pits and by shallow firn cores. This paper focuses on the accumulation studies. The cores were dated by dielectric-profiling and continuous-flow analysis. Distinct volcanogenic peaks and seasonal signals in the profiles served to establish a depth time-scale. The eruptions of Krakatoa, Tambora, an unknown volcano, Kuwae and El Chichon are well-documented in the ice. Variations of the accumulation rates over different times were inferred from the depth time-scales. A composite record of accumulation rates for the last 200 years was produced by stacking 12 annually resolved records. According to this, accumulation rates decreased in the 19th century and increased in the 20th century. The recent values are by no means extraordinary, as they do not exceed the values at the beginning of the 19th century. Variations in accumulation rates are most probably linked to temperature variations indicated in d18O records from Amundsenisen.

Physical properties and minerals of Leg 65 Holes basalts

Velocities and densities of submarine basalts obtained during Leg 65 are distinguished by their relatively high values (about 6.3 km/s and 2.9 g/cm/**3, respectively). This is consistent with their low degree of alteration. The range of velocities covered by these samples correlates well with porosity, and a comparison with in situ velocities from refraction data suggests maximum porosities ih the upper 100 meters of the crust of about 10%.

Consolidation properties and strength characteristics of ODP Site 204-1244 sediments

Eight whole-core samples from Ocean Drilling Program Site 1244, Hydrate Ridge, Cascadia continental margin, were provided to Massachusetts Institute of Technology (Cambridge, Massachusetts, USA) for geotechnical characterization. The samples were collected from depths ranging from 5 to 136 meters below seafloor (mbsf). Seven of the eight whole-core samples were located within the gas hydrate stability zone, whereas the eighth sample was located in the free gas zone. Atterberg limits testing showed that the average liquid limit of the soil is 81% and the average plastic limit is 38%, giving an average plasticity index of 43%. The liquid limit is sensitive to oven drying, shown by a drop in liquid limit to 64% when tests were performed on an oven-dried sample. Loss on ignition averages 5.45 wt%. Constant rate of strain consolidation (CRSC) tests were performed to obtain the compression characteristics of the soil, as well as to determine the stress history of the site. CRSC tests also provided hydraulic conductivity and coefficient of consolidation characteristics for these sediments. The compression ratio (Cc) ranges from 0.340 to 0.704 (average = 0.568). Cc is fairly constant to a depth of 79 mbsf, after which Cc decreases downhole. The recompression ratio (Cr) ranges from 0.035 to 0.064 (average = 0.052). Cr is constant throughout the depth range. In situ hydraulic conductivity varies between 1.5 x 10**-7 and 3 x 10**-8 cm/s and shows no trend with depth. Ko-consolidated undrained compression/extension (CKoUC/E) tests were also performed to determine the peak undrained shear strength, stress-strain curve, and friction angle. The normalized undrained strength ranges from 0.29 to 0.35. The friction angle ranges from 27 to 37. Because of the limited amount of soil, CRSC and CKoUC/E tests were also conducted on resedimented specimens.

Magnetic susceptibility, XRF and color reflectance data of DSDP Hole 72-516F, cores 113 and 114

Deep marine successions of early Campanian age from DSDP site 516F drilled at low paleolatitudes in the South Atlantic reveal distinct sub-Milankovitch variability in addition to precession and eccentricity related variations. Elemental abundance ratios point to a similar 5 climatic origin for these variations and exclude a quadripartite structure - as observed in the Mediterranean Neogene - of the precession related cycles as an explanation for the inferred semi-precession cyclicity in MS. However, the semi-precession cycle itself is likely an artifact, reflecting the first harmonic of the precession signal. The sub-Milankovitch variability is best approximated by a ~ 7 kyr cycle as shown by 10 spectral analysis and bandpass filtering. The presence of sub-Milankovitch cycles with a period similar to that of Heinrich events of the last glacial cycle is consistent with linking the latter to low-latitude climate change caused by a non-linear response to precession induced variations in insolation between the tropics.

Physical properties and elastic constants of ODP Holes 137-504B and 140-504B upper crustal rocks

Seismic velocities have been measured at confining pressures of 100 MPa and 600 MPa for sheeted dike samples recovered during Ocean Drilling Program Legs 137 and 140. The compressional- and shear-wave velocities show an increase with depth at Hole 504B, which is in sharp contrast to the atmospheric pressure velocity measurements performed as part of the shipboard analyses. Rocks exposed to different types of alteration and fracture patterns show distinct changes in their physical properties. The seismic reflectors observed on the vertical seismic profile (VSP) experiment performed during Leg 111 may have been caused by low velocity zones resulting from alteration. The amount of fracturing and hydrothermal alteration in several zones also may have contributed to the acoustic impedance contrast necessary to produce the E5 reflector. Poisson's ratios calculated from laboratory velocity measurements show several low values at depths ranging from 1600 mbsf to 2000 mbsf, which tends to follow similar trends obtained from previous oceanic refraction experiments. A comparison of physical properties between samples recovered from Hole 504B and ophiolite studies in the Bay of Islands and Oman shows a good correlation with the Bay of Islands but significant differences from the measurements performed in the Oman complex.

Mechanical properties and comparisons of dynamic and static Young's moduli at DSDP Holes 69-504B, 70-504B and 83-504B

From laboratory tests under simulated downhole conditions we tentatively conclude that the higher the triaxial-compressive strength, the lower the drilling rate of basalts from DSDP Hole 504B. Because strength is roughly proportional to Young's modulus of elasticity, which is related in turn to seismic-wave velocities, one may be able to estimate drilling rates from routine shipboard measurements. However, further research is needed to verify that P-wave velocity is a generally useful predictor of relative drilling rate.