Intersection of political party control and health outcomes in Medicaid expansion

The Patient Protection and Affordable Care Act of 2010 (ACA) sought to reform the health care system of the United States in a number of key ways, including by expanding access to health insurance to low-income Americans. The legislation provided for the expansion of Medicaid, the jointly funded federal-state public health insurance program for low-income individuals and children. This work examines the health outcomes and health insurance status of three states which expanded their Medicaid programs under the ACA and three which did not, as well as the political landscape of those states in deciding to or to not expand.Key Words: Medicaid expansion, political landscape, health insurance, health outcome

Exact coherent structures in two-dimensional turbulence identified with convolutional autoencoders

Convolutional autoencoders are used to deconstruct the changing dynamics of two-dimensional Kolmogorov flow as $Re$ is increased from weakly chaotic flow at $Re=40$ to a chaotic state dominated by a domain-filling vortex pair at $Re=400$. The highly accurate embeddings allow us to visualise the evolving structure of state space and are interpretable using `latent Fourier analysis' (Page {\em et. al.}, \emph{Phys. Rev. Fluids} \textbf{6}, 2021). Individual latent Fourier modes decode into vortical structures with a streamwise lengthscale controlled by the latent wavenumber, $l$, with only a small number $l \lesssim 8$ required to accurately represent the flow. Latent Fourier projections reveal a detached class of bursting events at $Re=40$ which merge with the low-dissipation dynamics as $Re$ is increased to $100$. We use doubly- ($l=2$) or triply- ($l=3$) periodic latent Fourier modes to generate guesses for UPOs (unstable periodic orbits) associated with high-dissipation events. While the doubly-periodic UPOs are representative of the high-dissipation dynamics at $Re=40$, the same class of UPOs move away from the attractor at $Re=100$ -- where the associated bursting events typically involve larger-scale ($l=1$) structure too. At $Re=400$ an entirely different embedding structure is formed within the network in which no distinct representations of small-scale vortices are observed; instead the network embeds all snapshots based around a large-scale template for the condensate. We use latent Fourier projections to find an associated `large-scale' UPO which we believe to be a finite-$Re$ continuation of a solution to the Euler equations

Caffeine ingestion compromises thermoregulation and does not improve cycling time to exhaustion in the heat amongst males

Purpose Caffeine is a commonly used ergogenic aid for endurance events; however, its efficacy and safety have been questioned in hot environmental conditions. The aim of this study was to investigate the effects of acute caffeine supplementation on cycling time to exhaustion and thermoregulation in the heat. MethodsIn a double-blind, randomised, cross-over trial, 12 healthy caffeine-habituated and unacclimatised males cycled to exhaustion in the heat (35 °C, 40% RH) at an intensity associated with the thermoneutral gas exchange threshold, on two separate occasions, 60 min after ingesting caffeine (5 mg/kg) or placebo (5 mg/kg). ResultsThere was no effect of caffeine supplementation on cycling time to exhaustion (caffeine; 28.5 ± 8.3 min vs. placebo; 29.9 ± 8.8 min, P = 0.251). Caffeine increased pulmonary oxygen uptake by 7.4% (P = 0.003), heat production by 7.9% (P = 0.004), whole-body sweat rate by 21% (P = 0.008), evaporative heat transfer by 16.5% (P = 0.006) and decreased estimated skin blood flow by 14.1% (P 0.05). ConclusionThe greater heat production and storage, as indicated by a sustained increase in core temperature, corroborate previous research showing a thermogenic effect of caffeine ingestion. When exercising at the pre-determined gas exchange threshold in the heat, 5 mg/kg of caffeine did not provide a performance benefit and increased the thermal strain of participants

Factors contributing to the change in thermoneutral maximal oxygen consumption after iso-intensity heat acclimation programmes

The factors explaining variance in thermoneutral maximal oxygen uptake (V ̇O2max) adaptation to heat acclimation (HA) were evaluated, with consideration of HA programme parameters, biophysical variables and thermo-physiological responses. Seventy-one participants consented to perform iso-intensity training (range: 45%-55% V ̇O2max) in the heat (range: 30°C-38°C; 20%-60% relative humidity) on consecutive days (range: 5-days-14-days) for between 50-min and-90 min. The participants were evaluated for their thermoneutral V ̇O2max change pre-to-post HA. Participants’ whole-body sweat rate, heart rate, core temperature, perceived exertion and thermal sensation and plasma volume were measured, and changes in these responses across the programme determined. Partial least squares regression was used to explain variance in the change in V ̇O2max across the programme using 24 variables. Sixty-three percent of the participants increased V ̇O2max more than the test error, with a mean±SD improvement of 2.6 ± 7.9%. A two-component model minimised the root mean squared error and explained the greatest variance (R2; 65%) in V ̇O2max change. Eight variables positively contributed (P < 0.05) to the model: exercise intensity (%V ̇O2max), ambient temperature, HA training days, total exposure time, baseline body mass, thermal sensation, whole-body mass losses and the number of days between the final day of HA and the post-testing day. Within the ranges evaluated, iso-intensity HA improved V ̇O2max 63% of the time, with intensity- and volume-based parameters, alongside sufficient delays in post-testing being important considerations for V ̇O2max maximisation. Monitoring of thermal sensation and body mass losses during the programme offers an accessible way to gauge the degree of potential adaptation

Validating written feedback in clinical formative assessment

Formative assessment is widely accepted as being crucial to promoting student learning and, since 2010, the UK General Medical Council has mandated its use in workplace-based clinical training for all new doctors. As a result, the Royal College of Radiologists (RCR) instituted a range of formative workplace-based assessments including the Radiology Direct Observation of Procedural Skills (Rad-DOPS), in which supervisors appraise trainees’ performance in carrying out clinical procedures. This paper reports on the quality of the written feedback in 2,500 Rad-DOPS online feedback forms in addressing the aims of the new assessment approach. Random samples of 500 were selected from the first three years of the new assessment implementation, 2010–13, and from 2016 to 17. Using an appropriate coding frame, the feedback was analysed across the samples against key trainee attributes including stage of training and level of adjudged competence. Criteria for identifying high quality feedback were derived from the literature and a simplified form of qualitative comparative analysis was used to identify the conditions associated with high quality feedback. An average of 97% of the assessments contained written feedback but the number of instances of high quality feedback was found to be exceedingly small at around 5%. The paper offers suggestions for making the feedback process more purposeful in achieving the aims of formative assessment

Superboom Caustic Analysis and Measurement Program (SCAMP) Final Report

The objectives of the Superboom Caustic Analysis and Measurement (SCAMP) Program were to develop and validate, via flight-test measurements, analytical models for sonic boom signatures in and around focal zones as they are expected to occur during commercial aircraft transition from subsonic to supersonic flight, and to apply these models to focus boom prediction of low-boom aircraft designs. The SCAMP program has successfully investigated sonic boom focusing both analytically and experimentally, while gathering a comprehensive empirical flight test and acoustic dataset, and developing a suite of focused sonic boom prediction tools. An experimental flight and acoustic measurement test was designed during the initial year of the SCAMP program, with execution of the SCAMP flight test occurring in May 2011. The current SCAMP team, led by Wyle, includes partners from the Boeing Company, Pennsylvania State University, Gulfstream Aerospace, Eagle Aeronautics, and Central Washington University. Numerous collaborators have also participated by supporting the experiment with human and equipment resources at their own expense. The experiment involved precision flight of a McDonnell Douglas (now Boeing) F-18B executing different maneuvers that created focused sonic booms. The maneuvers were designed to center on the flight regime expected for commercial supersonic aircraft transonic transition, and also span a range of caustic curvatures in order to provide a variety of conditions for code validations. The SCAMP experiment was designed to capture concurrent F-18B on-board flight instrumentation data, high-fidelity ground-based and airborne acoustic data, and surface and upper air meteorological data. Close coordination with NASA Dryden resulted in the development of new experimental instrumentation and techniques to facilitate the SCAMP flight-test execution, including the development of an F-18B Mach rate cockpit display, TG-14 powered glider in-flight sonic boom measurement instrumentation and "Where's the Focus?" (WTF) software for near-real time way-point computation accounting for local atmospherics. In May 2011, 13 F-18B flights were conducted during 5 flying days over a 2 week period. A densely populated 10,000 ft-long ground acoustic array with 125-ft microphone spacing was designed to capture pre-, focus, and post-focus regions. The ground-based acoustic array was placed in a nominally east-west orientation in the remote Cuddeback lakebed region, north of Edwards AFB. This area was carefully selected to avoid placing focused booms on populated areas or solar power facilities. For the SCAMP measurement campaign, approvals were obtained to temporarily extend the Black Mountain supersonic corridor northward by three miles. The SCAMP flight tests successfully captured 70 boom events, with 61 focus passes, and 9 calibration passes. Seventeen of the focus passes and three of the calibration passes were laterally offset; with the others being centerline flights. Airborne incoming sonic boom wave measurements were measured by the TG-14 for 10 of the F-18B flight passes including one maximum focus signature, several N-u combinations, several overlapped N-u signatures, and several evanescent waves. During the 27-month program, the SCAMP team developed a suite of integrated computer codes with sonic boom focusing predictive capabilities: PCBoom, Lossy Nonlinear Tricomi Equation Method (LNTE) and the Nonlinear Progressive wave Equation (NPE) method. PCBoom propagates the rays through the atmosphere and, in addition to legacy focus signature prediction based on the Gill-Seebass method, provides input source characteristics and propagation parameters to LNTE and NPE. LNTE, a Tricomi solver that incorporates atmospheric losses, computes the focus signature at the focus, and computes the focus signature in the vicinity of the focal zone, including the evanescent and post-focus zones. LNTE signature auralization from low-boom vehicle designs has been demonstrated in the NASA Langley Interior Effects Room (IER). The NPE has also been validated for use in prediction of focused ground boom signatures in sonic boom focal zones. The NPE formulation has the capability to incorporate atmospheric turbulence in the predictions. This has been applied to sonic boom propagation in the past. Prediction of turbulence effects on focal zone signatures was not, however, explored during the SCAMP program

Correlates of Suicide Ideation and Attempt among Youth Living in the Slums of Kampala

While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14–24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23–4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16–3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09–3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20–4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12–6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53–4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11–3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30–7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25–3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed

Dietary Factors May Be Associated With Measures of Ultrasound-derived Skeletal Muscle Echo Intensity

Skeletal muscle echo intensity (EI) is affected by ageing and physical activity; however, the effects of nutrition are less understood. The aim of this study was to explore whether habitual nutrient intake may be associated with ultrasound-derived EI. Partial least squares regression (PLSR) models were trained on an initial sample (n=100, M=45; F=55; 38±15 years) to predict EI of two quadriceps muscles from 19 variables, using the ‘jack-knife’ function within the ‘pls’ package (RStudio), which was then tested in an additional dataset (n= 30, M=13; F=17; 38±16 years). EI was determined using B-mode ultrasonography of the rectus femoris (RF) and vastus lateralis (VL) and nutritional intake determined via three-day weighed food diaries. Mean daily intake of specific nutrients were included as predictor variables with age, sex and self-reported physical activity. PLSR training model 1 explained ~52% and model 2 ~46% of the variance in RF and VL EI, respectively. Model 1 also explained ~35% and model 2 ~30% of the variance in RF and VL EI in the additional testing dataset. Age and biological sex were associated with EI in both models (P<0.025). Dietary protein (RF: β=-7.617,VL: β=-7.480), and selenium (RF: β=-7.144,VL: β=-4.775) were associated with EI in both muscles (P<0.05), whereas fibre intake (RF: β=-5.215) was associated with RF EI only and omega-3 fatty acids (n-3/ω-3 FAs, RF: β=3.145) with VL EI only (P<0.05). Therefore, absolute protein, selenium, fibre and n-3 FAs may be associated with skeletal muscle EI, although further mechanistic work is required before claiming causal inference

The Atacama Cosmology Telescope: Two-Season ACTPol Spectra and Parameters

We present the temperature and polarization angular power spectra measured by the Atacama Cosmology Telescope Polarimeter (ACTPol). We analyze night-time data collected during 2013-14 using two detector arrays at 149 GHz, from 548 deg$^2$ of sky on the celestial equator. We use these spectra, and the spectra measured with the MBAC camera on ACT from 2008-10, in combination with Planck and WMAP data to estimate cosmological parameters from the temperature, polarization, and temperature-polarization cross-correlations. We find the new ACTPol data to be consistent with the LCDM model. The ACTPol temperature-polarization cross-spectrum now provides stronger constraints on multiple parameters than the ACTPol temperature spectrum, including the baryon density, the acoustic peak angular scale, and the derived Hubble constant. Adding the new data to planck temperature data tightens the limits on damping tail parameters, for example reducing the joint uncertainty on the number of neutrino species and the primordial helium fraction by 20%.Comment: 23 pages, 25 figure