Tobacco Use and Health Insurance Literacy Among Vulnerable Populations: Implications for Health Reform

Background: Under the Affordable Care Act (ACA), millions of Americans have been enrolling in the health insurance marketplaces. Nearly 20% of them are tobacco users. As part of the ACA, tobacco users may face up to 50% higher premiums that are not eligible for tax credits. Tobacco users, along with the uninsured and racial/ethnic minorities targeted by ACA coverage expansions, are among those most likely to suffer from low health literacy – a key ingredient in the ability to understand, compare, choose, and use coverage, referred to as health insurance literacy. Whether tobacco users choose enough coverage in the marketplaces given their expected health care needs and are able to access health care services effectively is fundamentally related to understanding health insurance. However, no studies to date have examined this important relationship.Methods: Data were collected from 631 lower-income, minority, rural residents of Virginia. Health insurance literacy was assessed by asking four factual questions about the coverage options presented to them. Adjusted associations between tobacco use and health insurance literacy were tested using multivariate linear regression, controlling for numeracy, risk-taking, discount rates, health status, experiences with the health care system, and demographics.Results: Nearly one third (31%) of participants were current tobacco users, 80% were African American and 27% were uninsured. Average health insurance literacy across all participants was 2.0 (SD 1.1) out of a total possible score of 4. Current tobacco users had significantly lower HIL compared to non-users (−0.22, p \u3c 0.05) after adjustment. Participants who were less educated, African American, and less numerate reported more difficulty understanding health insurance (p \u3c 0.05 each.)Conclusions: Tobacco users face higher premiums for health coverage than non-users in the individual insurance marketplace. Our results suggest they may be less equipped to shop for plans that provide them with adequate out-of-pocket risk protection, thus placing greater financial burdens on them and potentially limiting access to tobacco cessation and treatment programs and other needed health services

Causal convergence conditions through variable timelike Ricci curvature bounds

We describe a nonsmooth notion of globally hyperbolic, regular length metric spacetimes $(\mathrm{M},l)$. It is based on ideas of Kunzinger-S\"amann, but does not require Lipschitz continuity of causal curves. We study geodesics on $\mathrm{M}$ and the space of probability measures over $\mathrm{M}$ in detail. Furthermore, for such a spacetime endowed with a reference measure $\mathfrak{m}$, a lower semicontinuous function $k\colon \mathrm{M} \to \textbf{R}$, and constants $0<p<1$ and $N\geq 1$, we introduce and study the entropic timelike curvature dimension condition $\smash{\mathrm{TCD}_p^e(k,N)}$ with variable Ricci curvature bound $k$. This provides a unified synthetic approach to general relativistic energy conditions, including $\bullet$ the Hawking-Penrose strong energy condition $\mathrm{Ric}\geq 0$, or more generally $\mathrm{Ric}\geq K$ for constant $K\in\textbf{R}$, in all timelike directions, $\bullet$ the weak energy condition $\mathrm{Ric} \geq \mathrm{scal} - \Lambda$ in all timelike directions, and $\bullet$ the null energy condition $\smash{\mathrm{Ric} \geq 0}$ in all null directions. Our approach also allows for the synthetic quantification of asymptotic conditions or integral controls on the timelike Ricci curvature. For example, we give a nonsmooth generalization of a timelike diameter estimate of Frankel-Galloway (and Schneider), and of a Hawking-type singularity theorem which requires only that the negative Ricci curvature have small enough integral relative to the maximal mean curvature of an achronal slice. As further applications, we discuss the stability of our notion and provide timelike geometric inequalities. To obtain sharp constants in the latter, we develop the localization paradigm in the variable $k$ framework.Comment: 109 pages. Comments welcom

Flow Instabilities in Feather Seals due to Upstream Harmonic Pressure Fluctuations

Feather seals (also called slot seals) typically found in turbine stators limit leakage from the platform into the core cavities and from the shroud to the case. They are of various geometric shapes, yet all are contoured to fit the aerodynamic shape of the stator and placed as close as thermomechanically reasonable the powerstream flow passage. Oscillations engendered in the compressor or combustor alter the steady leakage characteristics of these sealing elements and in some instances generate flow instabilities downstream of the seal interface. In this study, a generic feather seal geometry was studied numerically by imposing an upstream harmonic pressure disturbance on the simulated stator-blade gap. The flow and thermal characteristics were determined; it was found that for high pressure drops, large fluctuations in flows in the downstream blade-stator gap can occur. These leakages and pulsations in themselves are not all that significant, yet if coupled with cavity parameters, they could set up resonance events. Computationally generated time-dependent flow fields are captured in sequence video streaming

Thermomechanical Design Criteria for Ceramic-Coated Surfaces

Some early history of ceramic applications is presented. Finite element modeling of components to determine service and fabrication loads found inelastic behavior and residual stresses to be significant to component life. Inelastic behavior mitigates peak strains but enhances residual strains. Results of furnace, Mach 0.3 burner, and engine tests are discussed and categorized into design criteria (loading, geometry, fabrication, materials, analysis, and testing). These design rules and finite element analyses are brought to bear on two test cases: turboshaft engine seals, and rocket thrust chambers

Brief mindfulness training enhances cognitive control in socioemotional contexts: Behavioral and neural evidence.

In social contexts, the dynamic nature of others' emotions places unique demands on attention and emotion regulation. Mindfulness, characterized by heightened and receptive moment-to-moment attending, may be well-suited to meet these demands. In particular, mindfulness may support more effective cognitive control in social situations via efficient deployment of top-down attention. To test this, a randomized controlled study examined effects of mindfulness training (MT) on behavioral and neural (event-related potentials [ERPs]) responses during an emotional go/no-go task that tested cognitive control in the context of emotional facial expressions that tend to elicit approach or avoidance behavior. Participants (N = 66) were randomly assigned to four brief (20 min) MT sessions or to structurally equivalent book learning control sessions. Relative to the control group, MT led to improved discrimination of facial expressions, as indexed by d-prime, as well as more efficient cognitive control, as indexed by response time and accuracy, and particularly for those evidencing poorer discrimination and cognitive control at baseline. MT also produced better conflict monitoring of behavioral goal-prepotent response tendencies, as indexed by larger No-Go N200 ERP amplitudes, and particularly so for those with smaller No-Go amplitude at baseline. Overall, findings are consistent with MT's potential to enhance deployment of early top-down attention to better meet the unique cognitive and emotional demands of socioemotional contexts, particularly for those with greater opportunity for change. Findings also suggest that early top-down attention deployment could be a cognitive mechanism correspondent to the present-oriented attention commonly used to explain regulatory benefits of mindfulness more broadly

The X-ray Iron Emission from Tycho's Supernova Remnant

We present the results of broadband fits to the X-ray spectrum of Tycho's supernova remnant obtained by the Solid-State Imaging Spectrometers on the ASCA Observatory. We use single-temperature, single-ionization-age, nonequilibrium ionization models to characterize the ejecta and the blast-shocked interstellar medium. Based on the Fe K emission at 6.5 keV, previous spectral studies have suggested that the Fe ejecta in this Type Ia remnant are stratified interior to the other ejecta. The ASCA data provide important constraints from the Fe L emission near 1 keV as well as the Fe K emission. We find that the simplest models, with emission from the ejecta and blast wave each at a single temperature and ionization age, severely underestimate the Fe K flux. We show that there is little Fe emission associated with the Si and S ejecta shell. The blast-shocked interstellar medium has abundances roughly 0.3 times the solar value, while the ejecta, with the exception of Fe, have relative abundances that are typical of Type Ia supernovae. The addition of another component of Fe emission, which we associate with ejecta, at a temperature at least two times higher and an ionization age $\sim$ 100 times lower than the Si ejecta, does provide a good fit to the spectrum. This model is consistent with X-ray imaging results. Although fluorescent emission from dust in the remnant may contribute to the Fe K flux, we conclude that it is unlikely to dominate.Comment: 23 pages, LaTex; 4 postscript figures, 2 postscript tables. To appear in ApJ, vol 49

Mars Pathfinder Status at Launch

The Mars Pathfinder Flight System is in final test, assembly and launch preparations at the Kennedy Space Center in Florida. Launch is scheduled for 2 Dec. 1996. The Flight System development, in particular the Entry, Descent, and Landing (EDL) system, was a major team effort involving JPL, other NASA centers and industry. This paper provides a summary Mars Pathfinder description and status at launch. In addition, a section by NASA's Langley Research Center, a key EDL contributor, is provided on their support to Mars Pathfinder. This section is included as an example of the work performed by Pathfinder team members outside JPL