What About Mom? The Forgotten Beneficiary of the Medicaid Expansions

This paper contributes to evidence regarding the effectiveness of the Medicaid expansions by focusing on a key beneficiary - the mother - who has previously been overlooked. Using the Natality Detail Files for 1989-96, we estimate the relationship between Medicaid eligibility and maternal health outcomes for several treatment groups and a control group. Potential biases caused by improved reporting are addressed by using a 'straw man' maternal complication not preventable with prenatal care. Our results suggest that increased Medicaid eligibility lead to fewer preventable maternal complications among women most likely to have benefited from the Medicaid expansions.Maternal health; Medicaid; Prenatal care

Phase behavior of hard spheres confined between parallel hard plates: Manipulation of colloidal crystal structures by confinement

We study the phase behavior of hard spheres confined between two parallel hard plates using extensive computer simulations. We determine the full equilibrium phase diagram for arbitrary densities and plate separations from one to five hard-sphere diameters using free energy calculations. We find a first-order fluid-solid transition, which corresponds to either capillary freezing or melting depending on the plate separation. The coexisting solid phase consists of crystalline layers with either triangular or square symmetry. Increasing the plate separation, we find a sequence of crystal structures from n triangular to (n+1) square to (n+1) triangular, where n is the number of crystal layers, in agreement with experiments on colloids. At high densities, the transition between square to triangular phases are intervened by intermediate structures, e.g., prism, buckled, and rhombic phases.Comment: 9 pages, 4 figures. Accepted for publication in J. Phys.: Condens. Matte

Humans, Robots, or Avatars? Which do children and young people prefer disclosing forensic information to?

Virtual characters (VCs), such as agents and avatars, are becoming increasingly common across professional fields including medicine and education. However, research into their application as child forensic interviewers is limited. VCs would allow disclosure recipients to become tailored to individual preferences. Such technologies may generate new interviewing tools that are attractive to children who are reluctant to disclose information. The aim of this survey was to gage children’s preferred disclosure recipient characteristics (i.e., age, gender, presentation mode) when revealing forensic information. This study was a Qualtrics online survey, recruiting children aged between 8 and 16. All participants read fictional witness and victim scenarios perpetrated by either a “stranger” or “family member”. For each scenario, participants stated their preferred disclosure recipients’ characteristics, and whether these recipients should appear as human or non-human VCs. Preliminary findings suggest children prefer disclosing forensic information to adult gender-matching humans. Males felt better about disclosing crimes than females, and participants under 12 felt best about disclosing crimes. Children preferred disclosing to adult humans congruent with their own gender more than VCs. However, in practice, gender-matched interviewers might not always be available. The benefits of gender-congruent VCs will be explored in future work

Content analysis of on-package formula labelling in Great Britain: use of marketing messages on first infant, follow-on, growing-up and specialist formula

OBJECTIVE: To explore on-package formula messaging with reference to legislation and government issued guidance in Great Britain (GB). DESIGN: Formula products were identified, pictures of all sides of packs collated, and on-package text and images were coded. Compliance with both GB legislation and guidance issued by the Department of Health and Social Care (DHSC) was assessed. SETTING: All formula packs available for sale over the counter in GB between April and October 2020. PARTICIPANTS: Formula packs (n71) including infant formula, follow-on formula, growing-up formula and specialist formula were identified, coded and analysed. RESULTS: In total, 41% of formula packs included nutrition claims and 18% included health claims that may be considered non-permitted according to DHSC guidance. Additionally, 72% of products showed images considered 'non-permitted'. BMS legislation states infant and follow-on formula packs should be clearly distinguishable but does not provide criteria to assess similarity. Based on DHSC guidance, 72% of infant and follow-on formula packs were categorised as showing a high degree of similarity. Marketing practices not covered by current legislation were widespread, such as 94% of infant formula packs including advertisements for follow-on formula or growing-up formula. CONCLUSIONS: Text and images considered non-permitted according to DHSC guidance for implementing Breast Milk Substitute (BMS) legislation were widespread on formula products available in GB. As terms such as 'similarity' are not defined in BMS legislation it was unclear if breaches had occurred. Findings support the WHO call for loopholes in domestic legislation to be closed as a matter of urgency

The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland:a natural experiment

Background: Financial incentives are often used to influence professional practice, yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood. In keeping with clinical guidelines, Childsmile (Scotland’s oral health improvement programme) advocates twice yearly fluoride varnish application (FVA) for children in dental practice. To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2–5-year-olds’ teeth through a pilot. In October 2011 payment was extended to all dental practitioners. This paper compares FVA pre- and post-roll-out and explores the financial incentive’s behavioural mechanisms. Methods: A natural experimental approach using a longitudinal cohort of dental practitioners (n = 1090) compared FVA pre- (time 1) and post- (time 2) financial incentive. Responses from practitioners who did not work in a Childsmile pilot practice when considering their 2–5-year-old patients (novel incentive group) were compared with all other responses (continuous incentive group). The Theoretical Domains Framework (TDF) was used to measure change in behavioural mechanisms associated with the incentive. Analysis of covariance was used to investigate FVA rates and associated behavioural mechanisms in the two groups. Results: At time 2, 709 74%, of eligible responders, were followed up. In general, FVA rates increased over time for both groups; however, the novel incentive group experienced a greater increase (β [95% CI] = 0.82 [0.72 to 0.92]) than the continuous incentive group. Despite this, only 33% of practitioners reported ‘always’ varnishing increased risk 2–5-year-olds’ teeth following introduction of the financial incentive, 19% for standard risk children. Domain scores at time 2 (adjusting for time 1) increased more for the novel incentive group (compared to the continuous incentive group) for five domains: knowledge, social/professional role and identity, beliefs about consequences, social influences and emotion. Conclusions: In this large, prospective, population-wide study, a financial incentive moderately increased FVA in dental practice. Novel longitudinal use of a validated theoretical framework to understand behavioural mechanisms suggested that financial incentives operate through complex inter-linked belief systems. While financial incentives are useful in narrowing the gap between clinical guidelines and FVA, multiple intervention approaches are required

Perceived influence of commercial milk formula labelling on mothers’ feeding choices in Great Britain: a qualitative study

OBJECTIVE: To understand how mothers use commercial milk formula (CMF) labels to inform their feeding choices and explore mothers' understanding of differences between CMF products. DESIGN: Qualitative study with recruitment via social media. Online semistructured interviews, including a product mapping exercise and thematic analysis. PARTICIPANTS: Mothers (n=25) using CMF for children <3 years living in Great Britain (GB). RESULTS: Mothers were drawn to brands they recognised from years of exposure to CMF advertising. CMF products were assumed to vary according to brand and stage, but participants found on-pack information did not explain how. This added to anxiety about choosing 'the best one' and mothers would have liked guidance from healthcare professionals (HCPs). Wide availability of CMF for older infants and children, and on-pack messaging suggesting progression from one product to the next, led many to believe these products were necessary. There was confusion over the appropriate use of specialist products. While mothers rarely mentioned on-pack health and nutrition claims, they were attracted to the overall appearance of packs and messaging relating to science, research and nature. References to breast milk and a logo perceived to represent a breastfeeding mother were taken as indicators of closer similarity to breast milk. CONCLUSIONS: CMF legislation in GB should be updated to restrict brand advertising and the use of on-pack text and images that mothers perceive as indicating products have a closer similarity to breast milk. Greater input from HCPs was desired by new mothers and would support them to make more informed choices about CMF

Intraring allostery controls the function and assembly of a hetero‐oligomeric class II chaperonin

Class II chaperonins are essential multisubunit complexes that aid the folding of nonnative proteins in the cytosol of archaea and eukarya. They use energy derived from ATP to drive a series of structural rearrangements that enable polypeptides to fold within their central cavity. These events are regulated by an elaborate allosteric mechanism in need of elucidation. We employed mutagenesis and experimental analysis in concert with in silico molecular dynamics simulations and interface-binding energy calculations to investigate the class II chaperonin from Thermoplasma acidophilum. Here we describe the effects on the asymmetric allosteric mechanism and on hetero-oligomeric complex formation in a panel of mutants in the ATP-binding pocket of the α and β subunits. Our observations reveal a potential model for a nonconcerted folding mechanism optimized for protecting and refolding a range of nonnative substrates under different environmental conditions, starting to unravel the role of subunit heterogeneity in this folding machine and establishing important links with the behavior of the most complex eukaryotic chaperonins.—Shoemark, D. K., Sessions, R. B., Brancaccio, A., Bigotti, M. G. Intraring allostery controls the function and assembly of a hetero-oligomeric class II chaperonin

Determination of the exponent gamma for SAWs on the two-dimensional Manhattan lattice

We present a high-statistics Monte Carlo determination of the exponent gamma for self-avoiding walks on a Manhattan lattice in two dimensions. A conservative estimate is \gamma \gtapprox 1.3425(3), in agreement with the universal value 43/32 on regular lattices, but in conflict with predictions from conformal field theory and with a recent estimate from exact enumerations. We find strong corrections to scaling that seem to indicate the presence of a non-analytic exponent Delta < 1. If we assume Delta = 11/16 we find gamma = 1.3436(3), where the error is purely statistical.Comment: 24 pages, LaTeX2e, 4 figure

Obesity and dental caries in childhood : trends in prevalence and socioeconomic inequalities - a multicohort population-wide data linkage study

Objectives To quantify levels of coexisting obesity and caries experience in children in Scotland, and any associated socioeconomic inequalities over the years 2011/2012–2017/2018. Design A multicohort population-wide data linkage study. Setting Local authority primary schools in Scotland. Patients 335 361 primary 1 (approximately 5 years old) schoolchildren in Scotland between 2011/2012 and 2017/2018. Main outcome measures Prevalence and inequalities in coexisting caries and obesity. Results The prevalence of coexisting obesity and caries experience was 3.4% (n=11 494 of 335 361) and did not change over the 7 years. Children living in the 20% most deprived areas had more than sixfold greater odds of coexisting obesity and caries experience than children from the 20% least deprived areas (adjusted OR=6.63 (95% CI=6.16 to 7.14; p<0.001)). There was a large persistent socioeconomic gradient across the Scottish Index of Multiple Deprivation groups, with the Slope and Relative Indices of Inequality remaining unchanged over the 7 cohort years. Conclusions Despite improvements in oral health in children in Scotland, the prevalence of coexisting obesity and caries experience has remained static, with large persistent inequalities. These conditions are likely to signal increased risk of chronic conditions including multimorbidity in adulthood and therefore early identification of children most at risk and timely intervention tackling common risk factors should be developed and evaluated

Obesity and dental caries in childhood: trends in prevalence and socio-economic inequalities: a multi-cohort population-wide data linkage study

Objectives: To quantify levels of coexisting obesity and caries experience in children in Scotland, and any associated socioeconomic inequalities over the years 2011/2012–2017/2018. Design: A multicohort population-wide data linkage study. Setting: Local authority primary schools in Scotland. Patients: 335 361 primary 1 (approximately 5 years old) schoolchildren in Scotland between 2011/2012 and 2017/2018. Main outcome measures: Prevalence and inequalities in coexisting caries and obesity. Results: The prevalence of coexisting obesity and caries experience was 3.4% (n=11 494 of 335 361) and did not change over the 7 years. Children living in the 20% most deprived areas had more than sixfold greater odds of coexisting obesity and caries experience than children from the 20% least deprived areas (adjusted OR=6.63 (95% CI=6.16 to 7.14; p&lt;0.001)). There was a large persistent socioeconomic gradient across the Scottish Index of Multiple Deprivation groups, with the Slope and Relative Indices of Inequality remaining unchanged over the 7 cohort years. Conclusions: Despite improvements in oral health in children in Scotland, the prevalence of coexisting obesity and caries experience has remained static, with large persistent inequalities. These conditions are likely to signal increased risk of chronic conditions including multimorbidity in adulthood and therefore early identification of children most at risk and timely intervention tackling common risk factors should be developed and evaluated