The Dependent Coverage Provision Is Good for Mothers, Good for Children, and Good for Taxpayers

Importance The effect of the Affordable Care Act (ACA) dependent coverage provision on pregnancy-related health care and health outcomes is unknown. Objective To determine whether the dependent coverage provision was associated with changes in payment for birth, prenatal care, and birth outcomes. Design, Setting, and Participants Retrospective cohort study, using a differences-in-differences analysis of individual-level birth certificate data comparing live births among US women aged 24 to 25 years (exposure group) and women aged 27 to 28 years (control group) before (2009) and after (2011-2013) enactment of the dependent coverage provision. Results were stratified by marital status. Main Exposures The dependent coverage provision of the ACA, which allowed young adults to stay on their parent’s health insurance until age 26 years. Main Outcomes and Measures Primary outcomes were payment source for birth, early prenatal care (first visit in first trimester), and adequate prenatal care (a first trimester visit and 80% of expected visits). Secondary outcomes were cesarean delivery, premature birth, low birth weight, and infant neonatal intensive care unit (NICU) admission. Results The study population included 1 379 005 births among women aged 24 to 25 years (exposure group; 299 024 in 2009; 1 079 981 in 2011-2013), and 1 551 192 births among women aged 27 to 28 years (control group; 325 564 in 2009; 1 225 628 in 2011-2013). From 2011-2013, compared with 2009, private insurance payment for births increased in the exposure group (36.9% to 35.9% [difference, −1.0%]) compared with the control group (52.4% to 51.1% [difference, −1.3%]), adjusted difference-in-differences, 1.9 percentage points (95% CI, 1.6 to 2.1). Medicaid payment decreased in the exposure group (51.6% to 53.6% [difference, 2.0%]) compared with the control group (37.4% to 39.4% [difference, 1.9%]), adjusted difference-in-differences, −1.4 percentage points (95% CI, −1.7 to −1.2). Self-payment for births decreased in the exposure group (5.2% to 4.3% [difference, −0.9%]) compared with the control group (4.9% to 4.3% [difference, −0.5%]), adjusted difference-in-differences, −0.3 percentage points (95% CI, −0.4 to −0.1). Early prenatal care increased from 70% to 71.6% (difference, 1.6%) in the exposure group and from 75.7% to 76.8% (difference, 0.6%) in the control group (adjusted difference-in-differences, 0.6 percentage points [95% CI, 0.3 to 0.8]). Adequate prenatal care increased from 73.5% to 74.8% (difference, 1.3%) in the exposure group and from 77.5% to 78.8% (difference, 1.3%) in the control group (adjusted difference-in-differences, 0.4 percentage points [95% CI, 0.2 to 0.6]). Preterm birth decreased from 9.4% to 9.1% in the exposure group (difference, −0.3%) and from 9.1% to 8.9% in the control group (difference, −0.2%) (adjusted difference-in-differences, −0.2 percentage points (95% CI, −0.3 to −0.03). Overall, there were no significant changes in low birth weight, NICU admission, or cesarean delivery. In stratified analyses, changes in payment for birth, prenatal care, and preterm birth were concentrated among unmarried women. Conclusions and Relevance In this study of nearly 3 million births among women aged 24 to 25 years vs those aged 27 to 28 years, the Affordable Care Act dependent coverage provision was associated with increased private insurance payment for birth, increased use of prenatal care, and modest reduction in preterm births, but was not associated with changes in cesarean delivery rates, low birth weight, or NICU admission

Model support roll balance and roll coupling

The design concepts of two specialized wind tunnel model support mechanisms are described. The forced oscillation roll balance mechanism was designed to meet the specific requirement to measure aerodynamic forces and moments to permit determination of the damping-in-roll parameters of winged configurations. A variable speed motor is used to oscillate the model by means of an offset crank. The oscillating motion is resisted by a torsion spring to provide a restoring torque and is attached to the section forward of the strain-gage balance. This spring action allows the model to be oscillated at a frequency for velocity resonance, whereby the mechanical spring and any aerodynamic spring balance. This spring action allows the model to be oscillated at a frequency for velocity resonance, whereby the mechanical spring and any aerodynamic spring balance out the model inertia. The only torque then required to oscillate the model at that particular frequency is equal to that due to aerodynamic damping. The second mechanism, a roll coupling for remotely rotating a model, was designed to invert or roll a model about its longitudinal axis when mounted for testing

Study of the impact of cruise speed on scheduling and productivity of commercial transport aircraft

A comparison is made between airplane productivity and utilization levels derived from commercial airline type schedules which were developed for two subsonic and four supersonic cruise speed aircraft. The cruise speed component is the only difference between the schedules which are based on 1995 passenger demand forecasts. Productivity-to-speed relationships were determined for the three discrete route systems: North Atlantic, Trans-Pacific, and North-South America. Selected combinations of these route systems were also studied. Other areas affecting the productivity-to-speed relationship such as aircraft design range and scheduled turn time were examined

Writing in your own voice: An intervention that reduces plagiarism and common writing problems in students' scientific writing.

In many of our courses, particularly laboratory courses, students are expected to engage in scientific writing. Despite various efforts by other courses and library resources, as instructors we are often faced with the frustration of student plagiarism and related writing problems. Here, we describe a simple Writing in Your Own Voice intervention designed to help students become more aware of different types of plagiarism and writing problems, avoid those problems, and practice writing in their own voice. In this article, we will introduce the types of plagiarism and writing problems commonly encountered in our molecular biology laboratory course, the intervention, and the results of our study. From the evaluation of 365 student reports, we found the intervention resulted in nearly 50% fewer instances of plagiarism and common writing problems. We also observed significantly fewer instances of severe plagiarism (e.g. several sentences copied from an external source). In addition, we find that the effects last for several weeks after the students complete the intervention assignment. This assignment is particularly easy to implement and can be a very useful tool for teaching students how to write in their own voices. © 2019 International Union of Biochemistry and Molecular Biology, 47(5):589-598, 2019

Glucocorticoid therapy for adrenal insufficiency: nonadherence, concerns and dissatisfaction with information

Objective: Appropriate self‐management of glucocorticoid therapy (GC) is crucial for patients with adrenal insufficiency (AI). We aimed to describe patients’ self‐reported nonadherence to GC, evaluate perceived doubts about need for GC, concerns about adverse effects, and dissatisfaction with information received about GC. Design: Cross‐sectional survey. Patients: Patients prescribed GC for AI (n = 81) from five European countries. Measurements: Online survey including the Medication Adherence Report Scale (MARS), Beliefs about Medicines Questionnaire© (BMQ Specific, adapted for AI) and Satisfaction with Information about Medicines Scale© (Prof Rob Horne; SIMS). Results: Most patients (85·2%) reported a degree of nonadherence to GC. The most frequent types of nonadherence concerned changing the timing of GC doses, for example taking a dose later in the day than advised (37·0%). Few patients doubted their personal need for daily GC, but most reported high concerns about GC including potential weight gain (50·6%), osteoporosis (53·6%) and the continuing risk of adrenal crisis (50·6%). Dissatisfaction with information about GC was frequent, with participants particularly dissatisfied with the amount of information they had received about potential problems with GC. People who expressed dissatisfaction with information about GC, and concerns about its adverse effects were also more likely to report nonadherence (P < 0·05). Conclusions: Nonadherence to treatment, concerns about potential adverse effects and dissatisfaction with the information provided about treatment were frequently reported by this European sample of AI patients. Many AI patients may need additional information about their GC and support to address concerns about GC and facilitate adherence

Buoyant Venus station mission feasibility study for 1972 and 1973 launch opportunities. Volume 3 - Configuration definition. Part 1 - Configuration Final report

Configuration definitions for buoyant Venus station missions for 1972 - 1973 launch perio

Rippled Cosmological Dark Matter from Damped Oscillating Newton Constant

Let the reciprocal Newton 'constant' be an apparently non-dynamical Brans-Dicke scalar field damped oscillating towards its General Relativistic VEV. We show, without introducing additional matter fields or dust, that the corresponding cosmological evolution averagely resembles, in the Jordan frame, the familiar dark radiation -> dark matter -> dark energy domination sequence. The fingerprints of our theory are fine ripples, hopefully testable, in the FRW scale factor; they die away at the General Relativity limit. The possibility that the Brans-Dicke scalar also serves as the inflaton is favorably examined.Comment: RevTex4, 12 pages, 5 figures; Minor revision, References adde

A cross-sectional study of predatory publishing emails received by career development grant awardees

OBJECTIVE: To investigate the scope of academic spam emails (ASEs) among career development grant awardees and the factors associated with the amount of time spent addressing them. DESIGN: A cross-sectional survey of career development grant investigators via an anonymous online survey was conducted. In addition to demographic and professional information, we asked investigators to report the number of ASEs received each day, how they determined whether these emails were spam and time they spent per day addressing them. We used bivariate analysis to assess factors associated with the amount of time spent on ASEs. SETTING: An online survey sent via email on three separate occasions between November and December 2016. PARTICIPANTS: All National Institutes of Health career development awardees funded in the 2015 fiscal year. MAIN OUTCOME MEASURES: Factors associated with the amount of time spent addressing ASEs. RESULTS: A total of 3492 surveys were emailed, of which 206 (5.9%) were returned as undeliverable and 96 (2.7%) reported an out-of-office message; our overall response rate was 22.3% (n=733). All respondents reported receiving ASEs, with the majority (54.4%) receiving between 1 and 10 per day and spending between 1 and 10 min each day evaluating them. The amount of time respondents reported spending on ASEs was associated with the number of peer-reviewed journal articles authored (p<0.001), a history of publishing in open access format (p<0.01), the total number of ASEs received (p<0.001) and a feeling of having missed opportunities due to ignoring these emails (p=0.04). CONCLUSIONS: ASEs are a common distraction for career development grantees that may impact faculty productivity. There is an urgent need to mitigate this growing problem