South Carolina: Round 1 - State Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.South Carolina has its work cut out for it. As a state with one of the highest poverty rates and poorest health outcomes indicators, one thing stakeholders from all perspectives agree on is the need for improvement in the state's health status. Successful implementation of the ACA in South Carolina -- for those who believe that is the goal -- will require building greater public understanding of the ACA and enrolling all who are eligible in a state in which government distrust is high and public insurance program take-up rates have traditionally been low. It will also require a shift in position on the Medicaid expansion option. As long as the state's poorest uninsured remain without assistance, the aims of the ACA to promote widespread access to health care will never be realized

Emergency Department Use for Preventable Behavioral Health-related Disorders Among Ex-prisoners in Rhode Island

Background The population of ex-prisoners returning to their communities is large. Morbidity and mortality is increased during the period following release. Understanding utilization of emergency services by this population may inform interventions to reduce adverse outcomes. We examined Emergency Department utilization among a cohort of recently released prisoners. Methods We linked Rhode Island Department of Corrections records with electronic health record data from a large hospital system from 2007 to 2009 to analyze emergency department utilization for mental health disorders, substance use disorders and ambulatory care sensitive conditions by ex-prisoners in the year after release from prison in comparison to the general population, controlling for patient- and community-level factors. Results There were 333,369 total ED visits with 5,145 visits by a cohort of 1,434 ex-prisoners. In this group, 455 ex-prisoners had 3 or more visits within 1 year of release and 354 had a first ED visit within 1 month of release. ED visits by ex-prisoners were more likely to be made by men (85% vs. 48%, p \u3c 0.001) and by blacks (26% vs. 16%, p \u3c 0.001) compared to the Rhode Island general population. Ex-prisoners were more likely to have an ED visit for a mental health disorder (6% vs. 4%, p \u3c 0.001) or substance use disorder (16%vs. 4%, p \u3c 0.001). After controlling for patient- and community-level factors, ex-prisoner visits were significantly more likely to be for mental health disorders (OR 1.43; 95% CI 1.27-1.61), substance use disorders (OR 1.93; 95% CI 1.77-2.11) and ambulatory care sensitive conditions (OR 1.09; 95% CI 1.00-1.18). Conclusions ED visits by ex-prisoners were significantly more likely due to three conditions optimally managed in outpatient settings. Future work should determine whether greater access to outpatient services after release from prison reduces ex-prisoners’ utilization of emergency services

Client-Provider Relationship and Treatment Outcome: A Systematic Review of Substance Abuse, Child Welfare, and Mental Health Services Research

This systematic review reports on the association of the client-provider relationship with service outcomes across 3 service sectors: substance abuse, child welfare, and mental health. The review includes 60 research reports meeting inclusion criteria: 25 in substance abuse, 7 in child welfare, and 28 in mental health. For each social service sector, we analyze the association of the client-provider relationship to intermediate and ultimate outcomes. In addition, we examine potential moderating mechanisms of rater type (i.e., client, provider, and observer) and treatment setting (i.e., inpatient, outpatient, other). Social services research increasingly seeks to identify the active elements that affect outcomes common to all interventions. Results suggest the client-provider relationship is a consistent predictor of client retention in treatment and a somewhat less-consistent predictor of ultimate outcome across the 3 service sectors. These results contrast with recent findings from the psychotherapeutic literature in which the client-provider relationship demonstrated a weaker association with treatment retention (measured as drop out) than with other outcome measures. Findings indicate a clear need to refine the conceptualization and measurement of key service mechanisms and outcomes, particularly in the area of child welfare given that services research is less developed in that sector. The discussion includes recommendations for future research, including the use of selection criteria to enable researchers to conduct formal meta-analyses and expand the moderational framework with additional moderator variables relevant to social service delivery

A teoria da escolha pública e as reformas do Estado: uma crítica habermasiana

Neste artigo é apresentada uma análise crítica da teoria da Escolha Pública sob a ótica da teoria social de Jürgen Habermas. Essa análise se justifica pelos pontos de convergência entre as duas teorias, ainda que a partir de perspectivas opostas. Enquanto a teoria da Escolha Pública concebe a política como uma relação de troca entre Estado e eleitores, a teoria crítica habermasiana considera que é justamente esse aspecto da polí- tica de massas que deve ser superado pela ação comunicativa de cidadãos participantes. Procura-se demonstrar ao longo do texto que o impasse teórico da Escolha Pública – de um lado, como postula o “Teorema da Possibilidade Geral” de Kenneth Arrow, a impossibilidade de uma função-utilidade coletiva e de outro, a ambição normativa de fornecer parâmetros de eficiência para o fornecimento de bens públicos – reside, fundamentalmente, no pressuposto do individualismo metodológic

Study on Miniaturization of Antenna Using Metamaterials

Metamaterials (MTMs) are artificially built materials intended to give its properties from the internal structure, rather than the chemical composition found in natural materials. Electric permittivity (ε) and magnetic permeability (μ) are the two basic parameters which describe the electromagnetic property of a material or medium. Permittivity describes how a material is affected when it is placed in electric field. And permeability describes how a material is affected in presence of magnetic field. Metamaterials may have either negative permittivity or permeability or both may be negative simultaneously. The concept of metamaterials has additionally been utilized to design different kinds of patches with upgraded performance, such as improved gain and enhanced efficiency. Also, it has been utilized for the scaling down of patches. Two parameters are utilized in the collected works for antennas using metamaterials. We can adjust the refractive index of the metamaterial to positive, near-zero or negative values. Utilization of epsilon negative, MNG (μ - Mu negative) or DNG (double negative) are called metamaterial- based antennas and the use of metamaterial unit cell for example complementary split ring resonator, split ring resonator and so on are alluded as metamaterial inspired antennas. The design of complementary split ring resonator and its equivalent circuit will be discussed in this work. CSRR (complementary split ring resonator) provides both isolation enhancement and miniaturization for MIMO antenna

Evaluating the potential risks and benefits of infant rotavirus vaccination in England.

Rotarix(®), a vaccine for the prevention of gastroenteritis in young children, was introduced in England in July 2013. At around this time, an elevated risk of intussusception (a cause of bowel obstruction) was reported among infants vaccinated in Australia and the USA. A risk-benefit analysis compared potential vaccine-related risks (additional intussusception admissions and deaths) with estimated vaccine benefits (prevented rotavirus general practitioner visits, emergency visits, admissions and deaths) in the 2012 birth cohort. Detailed data from England included the incidence of intussusception events aged <2 years by week of age, the coverage of vaccination aged <2 years by week of age, and the incidence of rotavirus gastroenteritis (RVGE) events aged <5 years by week of age. Recent estimates of vaccine-related risk from Australia were applied during the 1-21 day period after the first and second dose of vaccination. Rotarix(®) is estimated to cause one additional intussusception admission in every 18,551 vaccinated English infants (5th and 95th percentiles, 6728-93,952), equivalent to 35 (7-98) additional intussusception admissions each year. The vaccine is estimated to prevent three rotavirus deaths, 13,000 rotavirus admissions, 27,000 rotavirus emergency visits and 74,000 rotavirus GP consultations in children aged <5 years, and lead to annual savings of over £11 million, each year. We estimate 375 (136-1900) fewer RVGE admissions for every additional intussusception admission, and 88 (18-852) fewer RVGE deaths for every additional intussusception death. The estimated benefits of Rotarix(®) vaccination would greatly exceed the potential risk in England

The exocyst is required for trypanosome invasion and the repair of mechanical plasma membrane wounds

The process of host cell invasion by Trypanosoma cruzi shares mechanistic elements with plasma membrane injury and repair. Both processes require Ca2+-triggered exocytosis of lysosomes, exocytosis of acid sphingomyelinase and formation of ceramide-enriched endocytic compartments. T. cruzi invades at peripheral sites, suggesting a need for spatial regulation of membrane traffic. Here, we show that Exo70 and Sec8 (also known as EXOC7 and EXOC4, respectively), components of the exocyst complex, accumulate in nascent T. cruzi vacuoles and at sites of mechanical wounding. Exo70 or Sec8 depletion inhibits T. cruzi invasion and Ca2+-dependent resealing of mechanical wounds, but does not affect the repair of smaller lesions caused by pore-forming toxins. Thus, T. cruzi invasion and mechanical lesion repair share a unique requirement for the exocyst, consistent with a dependence on targetedmembrane delivery.The process of host cell invasion by Trypanosoma cruzi shares mechanistic elements with plasma membrane injury and repair. Both processes require Ca2+-triggered exocytosis of lysosomes, exocytosis of acid sphingomyelinase and formation of ceramide-enriche12812732sem informaçãosem informaçãoWe thank Dr D. Toomre (Yale University) for the VSVG construct, Dr W. Guo (University of Pennsylvania) for antibodies and A. Beaven and K. Class (University of Maryland) for assistance with confocal microscopy and flow cytometry, respectivel

Palliative care services in families of males with muscular dystrophy: Data from MD STARnet

Introduction: Information on use of palliative care services among individuals with Duchenne and Becker muscular dystrophy is scant despite the clearly documented need. Methods: We examined associations between uptake of palliative care services by 233 males with Duchenne and Becker muscular dystrophy aged 12 and older for both caregiver and affected male characteristics using the Muscular Dystrophy Surveillance Tracking and Research Network baseline interview. Results: Ninety-one percent of caregivers (213/233) used at least one palliative care service. Case management had the highest frequency of use (59%). Use of palliative care was more frequently associated with the characteristics of affected males, as were some individual palliative care services. Utilization of six individual services differed among Muscular Dystrophy Surveillance Tracking and Research Network sites. While research suggests that pain is a frequent problem in Duchenne and Becker muscular dystrophy, only 12.5% reported use of pain management services. Discussion: Although palliative care use among families of males with Duchenne and Becker muscular dystrophy is high overall, there is much variability in use of individual services. Use of palliative care is driven by disease experience in the affected male. Many of the care recommendations for these individuals highlight the importance for early involvement of palliative care professionals.Centers for Disease Control and Prevention [DD000187, DD000189, DD000190, DD000191]Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Repair of injured plasma membrane by rapid Ca2+-dependent endocytosis

Ca2+ influx through plasma membrane lesions triggers a rapid repair process that was previously shown to require the exocytosis of lysosomal organelles (Reddy, A., E. Caler, and N. Andrews. 2001. Cell. 106:157–169). However, how exocytosis leads to membrane resealing has remained obscure, particularly for stable lesions caused by pore-forming proteins. In this study, we show that Ca2+-dependent resealing after permeabilization with the bacterial toxin streptolysin O (SLO) requires endocytosis via a novel pathway that removes SLO-containing pores from the plasma membrane. We also find that endocytosis is similarly required to repair lesions formed in mechanically wounded cells. Inhibition of lesion endocytosis (by sterol depletion) inhibits repair, whereas enhancement of endocytosis through disruption of the actin cytoskeleton facilitates resealing. Thus, endocytosis promotes wound resealing by removing lesions from the plasma membrane. These findings provide an important new insight into how cells protect themselves not only from mechanical injury but also from microbial toxins and pore-forming proteins produced by the immune system

Exocytosis of acid sphingomyelinase by wounded cells promotes endocytosis and plasma membrane repair

Lysosomal enzyme acid sphingomyelinase is released extracellularly when cells are wounded, converting sphingomyelin to ceramide and inducing endosome formation to internalize membrane lesions