Medi-Cal Versus Employer-Based Coverage: Comparing Access to Care

This report takes a close look at access to care under Medi-Cal for nonelderly adults and children on the eve of Affordable Care Act (ACA) implementation. Using data from the 2012 and 2013 California Health Interview Surveys (CHIS), the research examines a total of 49 measures (45 on realized and potential access and 4 on health status and health behaviors) for nonelderly adults and 31 measures (28 on realized and potential access and 3 on health status and behaviors) for children.For adults, access under Medi-Cal is compared to access under employer-sponsored insurance (ESI) overall; among Medi-Cal enrollees, access is compared across subgroups defined by region, race/ethnicity, language, and other dimensions. For children, access under Medi-Cal and Healthy Families together (referred hereafter simply as "Medi-Cal") is compared against access under ESI. To account for differences in health status and socioeconomic status between those with Medi-Cal and those with ESI, for each measure, three sets of analyses are presented: unadjusted percentages, predicted percentages adjusted for health care need, and predicted percentages adjusted for both health care need and socioeconomic status. The same approach is used in the analysis of regional and subgroup differences within the Medi-Cal population

Metabolomes and lipidomes of the infective stages of the gastrointestinal nematodes, Nippostrongylus brasiliensis and Trichuris muris

Soil-transmitted helminths, including hookworms and whipworms, infect billions of people worldwide. Their capacity to penetrate and migrate through their hosts’ tissues is influenced by the suite of molecules produced by the infective developmental stages. To facilitate a better understanding of the immunobiology and pathogenicity of human hookworms and whipworms, we investigated the metabolomes of the infective stage of Nippostrongylus brasiliensis third-stage larvae (L3) which penetrate the skin and Trichuris muris eggs which are orally ingested, using untargeted liquid chromatography–mass spectrometry (LC-MS). We identified 55 polar metabolites through Metabolomics Standard Initiative level-1 (MSI-I) identification from N. brasiliensis and T. muris infective stages, out of which seven were unique to excretory/secretory products (ESPs) of N. brasiliensis L3. Amino acids were a principal constituent (33 amino acids). Additionally, we identified 350 putative lipids, out of which 28 (all known lipids) were unique to N. brasiliensis L3 somatic extract and four to T. muris embryonated egg somatic extract. Glycerophospholipids and glycerolipids were the major lipid groups. The catalogue of metabolites identified in this study shed light on the biology, and possible therapeutic and diagnostic targets for the treatment of these critical infectious pathogens. Moreover, with the growing body of literature on the therapeutic utility of helminth ESPs for treating inflammatory diseases, a role for metabolites is likely but has received little attention thus far

The problem of scale in the prediction and management of pathogen spillover

Disease emergence events, epidemics and pandemics all underscore the need to predict zoonotic pathogen spillover. Because cross-species transmission is inherently hierarchical, involving processes that occur at varying levels of biological organization, such predictive efforts can be complicated by the many scales and vastness of data potentially required for forecasting. A wide range of approaches are currently used to forecast spillover risk (e.g. macroecology, pathogen discovery, surveillance of human populations, among others), each of which is bound within particular phylogenetic, spatial and temporal scales of prediction. Here, we contextualize these diverse approaches within their forecasting goals and resulting scales of prediction to illustrate critical areas of conceptual and pragmatic overlap. Specifically, we focus on an ecological perspective to envision a research pipeline that connects these different scales of data and predictions from the aims of discovery to intervention. Pathogen discovery and predictions focused at the phylogenetic scale can first provide coarse and pattern-based guidance for which reservoirs, vectors and pathogens are likely to be involved in spillover, thereby narrowing surveillance targets and where such efforts should be conducted. Next, these predictions can be followed with ecologically driven spatio-temporal studies of reservoirs and vectors to quantify spatio-temporal fluctuations in infection and to mechanistically understand how pathogens circulate and are transmitted to humans. This approach can also help identify general regions and periods for which spillover is most likely. We illustrate this point by highlighting several case studies where long-term, ecologically focused studies (e.g. Lyme disease in the northeast USA, Hendra virus in eastern Australia, Plasmodium knowlesi in Southeast Asia) have facilitated predicting spillover in space and time and facilitated the design of possible intervention strategies. Such studies can in turn help narrow human surveillance efforts and help refine and improve future large-scale, phylogenetic predictions. We conclude by discussing how greater integration and exchange between data and predictions generated across these varying scales could ultimately help generate more actionable forecasts and interventions

Rapa Nui (Easter Island) monument (ahu) locations explained by freshwater sources

Explaining the processes underlying the emergence of monument construction is a major theme in contemporary anthropological archaeology, and recent studies have employed spatially-explicit modeling to explain these patterns. Rapa Nui (Easter Island, Chile) is famous for its elaborate ritual architecture, particularly numerous monumental platforms (ahu) and statuary (moai). To date, however, we lack explicit modeling to explain spatial and temporal aspects of monument construction. Here, we use spatially-explicit point-process modeling to explore the potential relations between ahu construction locations and subsis- tence resources, namely, rock mulch agricultural gardens, marine resources, and freshwa- ter sources—the three most critical resources on Rapa Nui. Through these analyses, we demonstrate the central importance of coastal freshwater seeps for precontact populations. Our results suggest that ahu locations are most parsimoniously explained by distance from freshwater sources, in particular coastal seeps, with important implications for community formation and inter-community competition in precontact times

Berkeley UXO Discriminator (BUD)

The Berkeley UXO Discriminator (BUD) is an optimally designed active electromagnetic system that not only detects but also characterizes UXO. The system incorporates three orthogonal transmitters and eight pairs of differenced receivers. it has two modes of operation: (1) search mode, in which BUD moves along a profile and exclusively detects targets in its vicinity, providing target depth and horizontal location, and (2) discrimination mode, in which BUD, stationary above a target, from a single position, determines three discriminating polarizability responses together with the object location and orientation. The performance of the system is governed by a target size-depth curve. Maximum detection depth is 1.5 m. While UXO objects have a single major polarizability coincident with the long axis of the object and two equal transverse polarizabilities, scrap metal has three different principal polarizabilities. The results clearly show that there are very clear distinctions between symmetric intact UXO and irregular scrap metal, and that BUD can resolve the intrinsic polarizabilities of the target. The field survey at the Yuma Proving Ground in Arizona showed excellent results within the predicted size-depth range

Dynamic and integrative approaches to understanding pathogen spillover

No abstract available

Different partial volume correction methods lead to different conclusions: An 18F-FDG-PET study of aging.

A cross-sectional group study of the effects of aging on brain metabolism as measured with 18F-FDG-PET was performed using several different partial volume correction (PVC) methods: no correction (NoPVC), Meltzer (MZ), Müller-Gärtner (MG), and the symmetric geometric transfer matrix (SGTM) using 99 subjects aged 65-87years from the Harvard Aging Brain study. Sensitivity to parameter selection was tested for MZ and MG. The various methods and parameter settings resulted in an extremely wide range of conclusions as to the effects of age on metabolism, from almost no changes to virtually all of cortical regions showing a decrease with age. Simulations showed that NoPVC had significant bias that made the age effect on metabolism appear to be much larger and more significant than it is. MZ was found to be the same as NoPVC for liberal brain masks; for conservative brain masks, MZ showed few areas correlated with age. MG and SGTM were found to be similar; however, MG was sensitive to a thresholding parameter that can result in data loss. CSF uptake was surprisingly high at about 15% of that in gray matter. The exclusion of CSF from SGTM and MG models, which is almost universally done, caused a substantial loss in the power to detect age-related changes. This diversity of results reflects the literature on the metabolism of aging and suggests that extreme care should be taken when applying PVC or interpreting results that have been corrected for partial volume effects. Using the SGTM, significant age-related changes of about 7% per decade were found in frontal and cingulate cortices as well as primary visual and insular cortices