Effect of Medicaid Expansion on Health Service Utilization during the Postpartum Period among Low-income Women in Oregon

Background: Access to and effective utilization of healthcare services during the postpartum period is essential in preventing and managing health risks among women after childbirth, ensuring a smooth transition to motherhood, and promoting long-term health outcomes for women and their families. Low-income Medicaid women and those belonging to minority race/ethnicity or residing in rural areas bear a disproportionate burden of maternal mortalities and morbidities. Prioritizing reproductive and sexual health, and mental and behavioral health is critical to address the increasing rate of maternal morbidities and mortality in the US, particularly among vulnerable populations. This study examined the effect of Medicaid expansion on sexual and reproductive, and mental and behavioral healthcare services utilization during the postpartum period among low-income women in Oregon who were enrolled in Medicaid. Methods: Informed by the classic Aday and Anderson's (1974) framework for access to health care and using a retrospective pre-post quasi experimental design, I analyzed a linked data set that included Oregon Medicaid eligibility and claims, birth certificate, and hospital discharge data for women aged 18-44 with live births from 2011 through 2015. The outcome binary variables for healthcare utilization within 12 months after delivery included utilization of contraceptive counselling, effective contraceptive methods, STI testing services, mental health treatment services, tobacco cessation treatment services, and alcohol and other substance use treatment services. I hypothesized that Medicaid expansion was associated with increased utilization of healthcare services for women enrolled in Medicaid and across all racial/ethnic categories and rurality groups. I created one pre-Medicaid expansion (2011–2012) and two post-Medicaid expansion (2014–2015) cohorts (i.e., previously covered and newly covered). The post-Medicaid expansion cohorts were my independent variables. I utilized the linear probability regression model and implemented the single interrupted time series design. The post-Medicaid expansion cohorts served as the main independent variables. Results: Medicaid expansion in Oregon had mixed effects on the utilization of services by low-income women during the postpartum period, varying by type of services and post-Medicaid expansion cohort. Overall, both previously and newly enrolled women had similar gains, although in different types of services. Among the previously enrolled cohort, I found higher likelihood of utilization in the effective contraceptive methods (2.03 percentage points; <0.01), mental health services (7.88 percentage points; <0.001) and alcohol and substance use treatment services (4.81 percentage points; <0.001). Among the newly enrolled cohort, Medicaid expansion was associated with higher likelihood of utilization in contraceptive methods (2.68 percentage points; <0.01), mental health care utilization among all women (8.60 percentage points; <0.001) and among those with SMI (5.3 percentage points; <0.05). However, the utilization of contraceptive counselling services, STI screening methods, and tobacco cessation services did not change following Medicaid expansion in either post-Medicaid expansion cohort. I found that impact of Medicaid expansion was moderated by race/ethnicity, varying by types of services. Hispanic women experienced the largest gains in the utilization of contraceptive methods (previously enrolled cohort – 8.43 percentage points, <0.001; newly enrolled cohort – 5.81 percentage points; <0.01), and mental health care services (previously enrolled cohort – 13.65 percentage points, <0.001; newly enrolled cohort – 14.82 percentage points; <0.001), and STI services (newly enrolled cohort – 0.30 percentage points; <0.01). Asian women also experienced increased utilization of effective contraceptive methods (previously enrolled cohort – 10.69 percentage points, <0.001), mental healthcare (previously enrolled cohort – 11.56 percentage points; <0.001) and mental health care utilization among SMI subsample (newly enrolled cohort – 14.35 percentage points; <0.05). AIAN women experienced increased utilization only for alcohol and substance use treatment services (previously enrolled cohort – 14.60 percentage points; <0.001). White women also experienced increased utilization of services, specifically in mental health care services (previously enrolled cohort – 4.09 percentage points; <0.01), and alcohol and substance abuse services (previously enrolled cohort – 13.65 percentage points, <0.001; newly enrolled cohort – 14.82 percentage points; <0.001). The impact of Medicaid expansion was also moderated by rurality, varying by types of services. Urban women, and those in the previously enrolled cohorts made maximum gains in utilization of services following Medicaid expansion. Urban women had higher likelihood of utilization of contraceptive methods (previously enrolled - 1.94 percentage points; <0.01), mental health care services among all women (previously enrolled cohort – 7.44 percentage points, <0.001; newly enrolled cohort – 8.52 percentage points; <0.01) and among those with SMI (newly enrolled cohort – 4.57 percentage points; <0.01), and alcohol and substance use services (previously enrolled cohort – 4.06 percentage points; <0.05). Women from large rural areas experienced increased utilization only for mental health services (previously enrolled cohort – 10.92 percentage points, <0.001; newly enrolled cohort – 10.25 percentage points; <0.001). Lastly, women residing in the small rural areas experienced gains in contraceptive method utilization (previously enrolled cohort – 7.08 percentage points; <0.001), mental health care service utilization (previously enrolled cohort – 7.73 percentage points; <0.001), and utilization of alcohol and other substance use services (previously enrolled cohort – 21.21 percentage points; <0.001). Implications/Conclusion: The research findings indicated that when considering policy and practice implications, it is crucial to acknowledge that factors beyond increased insurance coverage influence healthcare utilization. A comprehensive healthcare system must recognize and address socio-cultural determinants of health and leverage policy measures to mitigate these disparities. This research highlighted the positive outcomes of Oregon's Medicaid expansion in enhancing healthcare utilization during the postpartum period. However, the findings also underscored the limitation of a policy primarily focused on expanding health insurance coverage to increase utilization. Including the multiple influences on healthcare utilization, such as socioeconomic factors and cultural determinants of health, are essential when designing polices, practices, and strategies to enhance healthcare utilization among new mothers and potentially reduce maternal morbidities and mortality

Development of a Conceptual Model for a Stratigraphically and Structurally Compartmentalized Alluvial Aquifer in the Lower Umatilla Basin Using Forensic Hydrology: Data

Alluvial deposits are critical freshwater aquifers, requiring a detailed understanding of spatial heterogeneity for effective groundwater management. This study reassesses the permeability of the Lower Umatilla Basin Groundwater Management Area (GWMA), Oregon, using forensic hydrology and multiple working hypotheses. The research identified previously unrecognized Channeled Filled Belts (CFBs), composed of low-permeability fine-grained deposits, acting as serviceably impermeable barriers to groundwater flow. Geological cross-sections and steep hydraulic gradients suggest the aquifer is compartmentalized by CFBs, folds, and faults. A new hydrogeologic conceptual model (Conceptual Model 2) was developed, offering insights into groundwater flow dynamics. These findings support improved groundwater management and can be applied to other complex alluvial aquifers worldwide. This is the data used to conduct a hydrogeological study for compartmentalizing the Lower Umatilla Groundwater Management Area in northeast Oregon, USA

LPBF and Post Processing of H13 Tool Steel

Laser powder bed fusion (LPBF) is an innovative method where metal powder is fused together to generate complex geometries. LPBF is used as a technology to reduce material waste, and extensive labor that are often linked to conventional subtractive manufacturing. H13 tool steel is one of the widely used materials in several industries and has, therefore, gained interest in the additive manufacturing field due to its excellent mechanical properties. To produce H13 parts with optimal mechanical properties, printing parameters are optimized and a high relative density of 98% is obtained. Laser power of 203W, scanning speed of 700 mm/s, hatch spacing of 40μm and layer thickness of 25 μm are used to obtain the optimal results. Hot isostatic pressing is applied to cure the microcracks and has shown a 0.5% increase in the relative density, while it showed a significant decrease in other samples due to the excessive residual heat. Optical and scanning electron microscopy are used to observe the recrystallization of grains and grain growth resulted by tempering and rapid cooling. Tempering temperatures of 650˚C resulted in a greater reduction of microhardness than 550 ˚C. While high hot isostatic pressing temperature (1163 ˚C) shows a worsening effect on the microstructures

Northern spotted owl reproductive rates

These datasets were used in the prospective meta-analysis of northern spotted owl reproductive rates over 25 years across 11 study areas located throughout the range of the owl. A multi-state occupancy file was created by collapsing site-specific information on owl reproductive status into bimonthly (2 per month) survey occasions. These data were then analyzed to estimate annual reproductive rates, defined as: number of owls successfully reproducing/number of owl pairs, while accounting for variation in survey effort by accounting for imperfect detection of owls and potential misclassification of reproductive status. Covariates describing the probability of barred owl presence, habitat conditions, and climate were also included to explain variation in reproductive rates. These data were collected as part of the long-term demographic monitoring of northern spotted owls in association with the Effectiveness Monitoring Plan of the Northwest Forest Plan. Data included here were analyzed and interpreted in the following manuscript in review: Rockweit, J. T. et al. 2021. Sources of Variation in Reproductive Rates of Northern Spotted Owls Across Their Range: A Prospective Meta-Analysis.The datasets associated with this readme file include all relevant script files needed for the multi-state occupancy analysis of northern spotted owl reproduction. For specific file information see the readme files in this record. These data were collected as part of the long-term demographic monitoring of northern spotted owls in association with the Effectiveness Monitoring Plan of the Northwest Forest Plan

BeanCAP snap bean diversity panel SNP data

Genotype data consisting of 10,546 single nucleotide polymorphisms on the Illumina Infinium Genechip BARCBEAN6K_3 platform for 149 snap bean accessions.The accessions used to create the Snap Bean Diversity Panel were 149 snap bean accessions selected from North American and European germplasm. This panel was developed with support from the Common Bean Coordinated Agriculture Project (USDA-NIFA grant no. 2009-85606-05964). A modified CTAB procedure was used to extract genomic DNA and the resulting DNA samples were analyzed on an Illumina Infinium Genechip BARCBEAN6K_3 platform. The single nucleotide polymorphism (SNP) array utilized was composed of 10,546 allele-specific probes. The raw data was initially processed on GenomeStudio (v2.0.4) software (Illumina, San Diego, CA, USA). Two marker SNP positions contained greater than 20% missing data and were removed from the study. All missing data for the remaining SNPs was imputed using fastPHASE software (v1.4), including heterozygous SNPs which were treated as missing data. SNPs not assigned to a genomic position in Phytozome12 (Phaseolus vulgaris, version 2.1) were removed from the study resulting in 10,073 remaining SNPs

Assessing the feasibility of a sea otter reintroduction to Oregon through a coupled natural-human lens

Sea otters fulfill a keystone role in several Northeastern Pacific nearshore ecosystems. However, their influence has been absent in Oregon coastal waters since their extirpation in the 19th and early 20th century. Interest has been growing for a translocation attempt to reintroduce sea otters to Oregon from one or more source populations of the southern sea otter and northern sea otter subspecies. Numerous unanswered questions require inquiry before a productive discussion can take place on the advisability of such an effort. A successful reintroduction would alter the existing coupled natural-human system dynamics between Oregon coastal communities, Oregon residents as a whole, and the nearshore environment. The appropriate source of reintroduction stock bears discussion, as do the optimal sites on the Oregon coast for a translocation effort and stakeholders’ attitudes towards such a proposal. This paper considers select issues related to the genetics, ecology, and human dimensions of a potential Oregon sea otter reintroduction, integrating insights from each discipline to provide a preliminary interdisciplinary examination

Deer-mediated ecosystem service vs. disservice depends on forest management intensity - Dataset

This dataset consists of planted crop-tree growth metrics (Pseudotsuga menziesii), non-crop tree vegetation metrics, and foraging data for black-tailed deer (Odocoileus hemionus columbianus) and Roosevelt elk (Cervus canadensis rooseveli) collected from the Intensive Forest Management experiment, Oregon Coast Range, USA, 2011-2016. The objective of the experiment was to quantify the effects of silvicultural herbicide treatments on biodiversity and ecosystem functions.MANUSCRIPT ABSTRACT As global terrestrial biodiversity declines via land-use intensification, society has placed increasing value on non-commercialspecies as providers of ecosystem services. Yet, many deer species and non-crop plants are perceived negatively when they decrease crop productivity, leading to reduced economic gains and human-wildlife conflict. We hypothesized that deer provide an ecosystem service in forest plantations by controlling competition and promoting crop-tree growth, although the effects of herbivory may depend on forest management intensity. If management negatively affects foraging habitat at local and landscape scales, then we expected browsing to shift to less-palatable crop trees. To test these hypotheses, we established a 5-year experiment that manipulated early forest management intensity via herbicide treatments and access of two deer species to vegetation via exclosures. Contrary to our hypothesis, deer provided an ecosystem service at high management intensities and a disservice occurred with low-intensity management. Crop-tree growth and survival was greatest when herbivory and herbicides suppressed broadleaf regeneration. In contrast, crop-tree growth was lowest when broadleaf vegetation was retained and crop-trees were subject to both browse damage and competition. We found a positive, yet variable, association between deer detections and stand- and landscape-scale broadleaf habitat, and despite initial reductions in forage, herbivory pressure was similar among management intensities. When broadleaf vegetation was suppressed by herbicides and herbivory, selection of herbaceous forage by deer intensified, likely aiding in the service. Overall, our findings indicate that the effects of vegetation management for promoting timber production are highly dependent on the presence of large herbivores. Synthesis and applications: Although deer are thought to reduce crop productivity in many systems, we found that herbivory switched from reducing crop tree growth where non-crop vegetation was retained, to promoting crop tree growth when both herbivory and herbicides suppressed competing vegetation. However, the provision of this ecosystem service is likely contingent on the amount of forage available in the landscape and subsequent foraging pressure. We conclude that nature’s capacity to provide ecosystem services depends on the intensity of management at local and landscape scales.Keywords: Elk (Cervus canadensis roosevelti); Deer (Odocoileus hemionus columbianus); Douglas-fir (Pseudotsuga menziesii

Bean CAP Snap Bean Diversity Panel Passport Data

The accessions used to create the Snap Bean Diversity Panel were 150 snap bean (Phaseolus vulgaris) cultivars and breeding lines selected from North American and European germplasm to create a population that is representative of the snap bean market class from a historical and geographical viewpoint. This panel was developed with support from the Common Bean Coordinated Agriculture Project (USDA-NIFA grant no. 2009-85606-05964). The passport data provides information on when and where these cultivars were developed. This panel has been genotyped using the Illumina Infinium Genechip BARCBEAN6K_3 platform. This SNP data has also been deposited in OSU ScholarsArchive and can be accessed using the link https://ir.library.oregonstate.edu/concern/datasets/m900p1589

Is the laboratory growth of Pacific oyster spat, Crassostrea gigas, exposed to varying salinities, predictive of their growth in the estuary?

Results of this study suggest that laboratory growth of full-sib families of five month old Pacific oyster spat can be predictive of growth to market size at different grow-out sites. Seven to ten millimeter spat were selected from each of fifteen full-sib families and commercially available polyploids. Each family was split into two groups and exposed to either variable salinity (V.S., 3-30 ppt) or constant salinity (C.S., 30 ppt) laboratory conditions for five months, then planted at either an upriver or downriver subtidal site in the Yaquina estuary, Oregon. After six months of growth in the estuary, the rankings of the families based on average individual weights, specific growth rates (SGR), survival and yields were compared between laboratory and estuary sites. There was a significant effect of family, laboratory treatment and site upon final individual live weights of oysters in the estuary (P=0.0001). The rankings of families based on average individual laboratory weights were correlated with average individual estuary weights at the downriver site (C.S. oysters, P=0.010, V.S. oysters, P=0.005). Tetraploid oysters grew to heavier final estuary weights than either triploids or diploids, with individual C.S. tetraploids averaging 79.4 g live weight by fifteen months of age. Laboratory family rankings based on SGRs were negatively correlated with estuary rankings of family SGRs for all treatments (P<0.0001, Rho=-0.668). Rankings of families based on laboratory yields on day 60 were correlated with standardized estuary yield rankings for all treatments, except V.S. oysters planted downriver. Laboratory yields of families were also found to be predictive of estuary yields at an intertidally planted site in Sequim Bay, Washington, indicating the potential for predicting yields across a wide range of sites and culture methods (subtidal vs. intertidal). Oyster breeding programs may realize more efficient progress from the results of this study. If family yields at grow-out sites can be predicted from spat yields in the laboratory, poor and average families could be identified early at the spat stage, eliminating the need to expend resources to plant them out at test sites

Gene expression in the peripartum canine placenta

This research investigated gene expression in the canine placenta during the peripartum period. Previous studies have recognized molecular changes that occur in the placenta around the time of placental release in other species, but no study has looked at gene expression in the late gestation canine placenta. Of particular significance for this thesis work is the groundwork laid for future studies modeling placental abnormalities in dogs (e.g. subinvolution of placental sites) and humans (e.g. preeclampsia, placenta accreta). Despite years of research in multiple species, the exact mechanisms and processes regulating trophoblast invasion and placental release remain unclear. Therefore, the specific objective of this research was to characterize gene expression changes that occur during the peripartum period in the dog using microarray and real-time RT-PCR. Following total RNA isolation, the microarray analysis was performed by hybridizing total RNA to the Canine 2.0 Array (Affymetrix, Santa Clara, CA). Microarray analysis was carried out using the limma and affy packages through the Bioconductor software in the R statistical environment. Differential expression was defined as p ≤ 0.05, FDR p ≤ 0.10 and a log fold change of ≤ 1.2. Following cDNA synthesis, real-time RT-PCR was performed using TaqMan primer and probes that were pre-made and pre-optimized for canine tissues (Applied Biosystems, Carlsbad, CA). Microarray analysis showed differential expression in 18 genes between pre-term and pre-labor sample groups, 38 genes that were differentially expressed between pre-term and parturient samples and no genes that were differentially expressed between pre-labor and parturient samples. Microarray analysis led to the identification of several candidate genes for closer investigation using real-time RT-PCR. These genes included MMP-1, MMP-2, MMP-9, TIMP-2, VEGF-A, Flt-1, CD44, DAG-1, IL-6 and CXCL10. All of these genes have been linked to trophoblast invasion or regression or placental release in a number of species including humans, cattle and rodents. Using real-time RT-PCR, there was a significant difference in MMP-9 mRNA expression in pre-term samples compared to pre- labor and parturient samples (p<0.05). However, there was no significant difference in mRNA expression of MMP-2, TIMP-2, VEGF-A, Flt-1 CD44, DAG-1, IL-6 or CXCL10. Future studies may focus on additional candidate genes identified by microarray that play a role in tissue remodeling at the end of canine gestation such as IL-8, EPHX2, PI3 and SERPINE1