Challenges and Solutions in Constructing a Microsimulation Model of the Use and Costs of Medical Services in Australia

This paper describes the development of a microsimulation model =HealthMod‘ which simulates the use and costs of medical and related services by Australian families. Australia has a universal social insurance scheme known as =Medicare‘ which provides all Australians with access to free or low-cost essential medical services. These services are provided primarily by general practitioners as well as specialist doctors but also include diagnostic and imaging services. Individuals may pay a direct out-of pocket contribution if fees charged for services are higher than the reimbursement schedule set by government. HealthMod is based on the Australian 2001 National Health Survey. This survey had a number of deficiencies in terms of modelling the national medical benefits scheme. The article outlines three major methodological steps that had to be taken in the model construction: the imputation of synthetic families, the imputation of short-term health conditions, and the annualisation of doctor visits and costs. Some preliminary results on the use of doctor services subsidised through Australia‘s Medicare are presented.Economic microsimulation modelling, medical services, use and costs, Australia

ERISA and State Health Care Reform: Roadblock or Scapegoat?

Think back on any number of stories of health insurance atrocities: the Texas man whose employer was allowed to slash his AIDS coverage as he was dying of the disease; the retiree whose lifetime insurance was suddenly canceled; the woman with advanced breast cancer unfairly denied coverage for the only treatment that might save her life. All these cases have one unexpected thing in common: the monumentally boring, complex, far-reaching law called ERISA

The Role of the Cytoskeleton in the Modulation of the Connexin36 Nexus in N2a Cells

We tested the hypothesis that the interaction of Cx36 with the cytoskeleton is necessary to achieve synaptic plasticity in neurons. In living cells, BioID and FRAP technology was used to demonstrate binding of Cx36 to actin and tubulin. Wild-type and mutant proteins, together with pharmacological blockers or TAT peptides were used to characterize the interaction. Major results of this study are that rCx36 interacts primarily with the neuronal βIII-tubulin isoform to regulate the trafficking and aggregation of connexons at the GJP. Amino acid Lys279 in the CTB domain is critical for this interaction. A potential actin-binding site in the CLB domain of rCx36 was identified, with actin mainly serving as an anchor to stabilize connexons. During a simulation of plasticity in vitro, GJPs became more stable; we attribute this to interactions with the cytoskeleton and associating proteins. We conclude that cytoskeletal-dependent interaction is required to modulate the strength of Cx36 synapses

Investigating Determinants of Employer\u27s Perspectives to Hire and Willingness to Accommodate Individuals in Addiction Recovery: A Mixed Method Approach

The purpose of this study was to examine the nature and extent of factors affecting employer\u27s perspectives when hiring individuals in recovery, and their willingness to provide reasonable accommodations. The study investigated (a) employer perspectives based on specific demographic characteristics, (b) employer perspectives differences based on industry types, (c) the relationship between personal and business related characteristics, and employer perspectives, (d) employer willingness to provide reasonable accommodations, (e) the relationship between personal and business related characteristics, and employer willingness to provide accommodations, (f) the relationship between employer perspectives and willingness to accommodate, and (g) employer views regarding personal experience, collegiality, and hiring individuals in recovery. Past investigation of employer attitudes focused on stigmatized groups including persons with disabilities (PWD), individuals with HIV/AIDS, and ex-offenders, but none address attitudes towards individuals in recovery. The dependent variables were scales used to investigate employers\u27 level of concern and willingness to accommodate, Modified Employer Attitudes Questionnaire (M-EAQ) and the Willingness to Accommodate Scale (WAS). Both scales utilized a 5-point likert scale. Independent variables consisted of demographic data, personal and business characteristics related to recovery, and a measurement of compassion measured by the Santa Clara Brief Compassion Scale. The study participants were 436 employers from the local Chambers of Commerce recruited to participate in the survey. A mixed methods design, concurrent triangulation, was used to collect quantitative and qualitative data components simultaneously, then analyze the data separately, and compare or combine the results of each. Descriptive and inferential statistical methods were utilized for quantitative data analysis. Qualitative data analysis using thematic analysis was employed to analyze two open-ended questions. The overall results demonstrated employer perspectives vary but majority of participants have relatively favorable perspectives toward individuals in recovery. Employers reported a high level of likelihood to provide accommodations. However, many believe there are challenges and hindrances such as a lack of knowledge, resources, and training when working with individuals in recovery. Based on the findings, implications will be offered for educators, practitioners, employers, and policy makers. Limitations of the study, future research and suggestions are also discussed

Oyster reef restoration in the northern Gulf of Mexico: effect of substrate and age on ecosystem services

Oyster reefs provide estuaries with ecosystem services including carbon sequestration, shoreline stabilization, refugia for invertebrate biodiversity, and fisheries enhancement, but have been disappearing over the past century due to increasing overharvesting, disease, and eutrophication. The northern Gulf of Mexico has over 400 artificial oyster reefs constructed of various materials created through efforts to restore ecosystem services lost with declining oyster populations. The purpose of this study was to determine how two common artificial reef construction materials (rock vs. oyster shell) at various ages affect ecosystem services, specifically blue crab abundance, the commensal community, and oyster recruitment, as well as to determine the refuge value of oyster reefs. To determine whether the provision of ecosystem services varied over time, rock (n = 7) and oyster shell (n = 6) reefs of varying ages (new \u3c 5 years since construction; old \u3e 5 years since construction) were compared to natural oyster reefs (n = 7) and were sampled twice in the summer of 2011. Sampling devices included baited crab traps, spat settlement plates and commensal collectors. Results indicate no difference between reef category (reef by age) and blue crab abundances, most likely due to their mobility. Diversity, abundance and richness of the commensal community are lowest on old shell reefs. Old rock reefs were most similar to natural reefs in regards to commensal community assemblages, even surpassing them in commensal abundance seasonally. Spat densities and size varied across reef categories, and were more closely correlated with salinity than reef category. To determine refuge value of oyster structure, a mesocosm with a depth gradient and different oyster reef complexities in the deepest end was used. When high complexity shell areas were provided, juvenile crabs were more likely to use these deep water reef refugia when a predator was introduced to the tank; when no shell areas were available, juvenile crabs selected shallow water refuge. The refuge value of oyster reefs, based both on the field survey and laboratory experiment, seems to be the driver of higher commensal abundances, richness, and diversity on older rock reefs, which last longer than old shell reefs which seem to disperse over time in sediments

Candida auris: a decade of understanding of an enigmatic pathogenic yeast

Candida auris is an enigmatic yeast that continues to stimulate interest within the mycology community due its rapid and simultaneous emergence of distinct clades. In the last decade, almost 400 manuscripts have contributed to our understanding of this pathogenic yeast. With dynamic epidemiology, elevated resistance levels and an indication of conserved and unique pathogenic traits, it is unsurprising that it continues to cause clinical concern. This mini-review aims to summarise some of the key attributes of his remarkable pathogenic yeast

The Oneida County 4-H Conservation Field Days Conflict

In its 30-year history, New York\u27s Oneida County 4-H Conservation Education Field Days program generated no known controversy. That trend changed radically when a citizens group shot undercover video footage portraying the event as children being brainwashed into thinking guns, hunting and trapping are okay. The video aired statewide and resulted in a national controversy. Oneida County 4-H responded by trying to build consensus among the organizations involved, but discovered that this was not possible. This article relates the events that precipitated this conflict, and examines the various perspectives on the conflict held by the three major organizations involved