Pennsylvania: Base Line Report - State Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.Although the ACA will no doubt have real financial consequences for insurers, hospitals, and health care providers, at this early stage in implementation, it is difficult to calculate precise gains and losses. For example, the Hospital Association of Pennsylvania supported the ACA, believing, in part, that reform was necessary to reduce current levels of uncompensated care and to reduce reliance on emergency care for patients who put off treatment for as long as possible to avoid out-of-pocket costs. The association agreed to significant cuts in Medicare and Medicaid to support the bill's passage. However, because cost savings from universal coverage have not yet been realized, hospitals reported cutting staff in April 2014 to offset the loss of Medicaid and Medicare funding. Safety net hospitals, which are required to serve all populations, seem especially affected, as many of their patients who fall into the Medicaid coverage gap are still showing up in emergency rooms without insurance

Social Justice as an Organizational Identity: An Inductive Case Study Examining the Role of Diversity and Inclusivity Initiatives in Corporate Climate and Productivity

Although research has begun to establish the benefits of implementing disability inclusion initiatives within companies, there is relatively limited research examining the impact of applied diversity management practices in the employment of PWDs. This study explores the disability initiatives of an exemplar midwestern company through an in-depth case study. An inductive, qualitative design was utilized to identify themes from interviews with multiple employees. Interviews were examined to understand how the company’s social mission and corporate identity impacted productivity and perceptions. Results suggest that employees are drawn to the company by their social justice mission in hiring and creating meaningful employment for persons with disabilities. Moreover, the fact that the company sees this mission as a central part of its organizational identity rather than as an ancillary initiative motivates employees. Findings indicate that centering a commitment to hire and support persons with disabilities within the organizational identity, forming partnerships within the community, and connecting employees with a sense of meaning in their work generates greater productivity, engagement, and commitment from employees

World Art History: Shiva Nataraja and the Concept of Agency

The purpose of this thesis is to demonstrate how a new method of art historical analysis that focuses on the agency of art works could be explored as a fundamental basis of world art history. I propose that the power of images is a common characteristic of art across the globe that’s unhindered by time. It could be used as a tool to create a world art history that deals equally well with both Western and non-Western art objects. I will use the Museum of Fine Arts Houston’s thirteenth century, Shiva Nataraja sculpture to explore core issues in world art history. More importantly, I will use this sculpture to demonstrate how traditional analyses are beneficial to understanding certain aspects of non-Western art. While exploring the application of traditional art historical strategies, I will also discuss how those analytical strategies do not adequately address how the art object functioned in its original context. New methods of analyses need to be developed to create a world art history.Art, School o

Ancient Maya Regional Settlement and Inter-Site Analysis: The 2013 West-Central Belize LiDAR Survey

During April and May 2013, a total of 1057 km2 of LiDAR was flown by NCALM for a consortium of archaeologists working in West-central Belize, making this the largest surveyed area within the Mayan lowlands. Encompassing the Belize Valley and the Vaca Plateau, West-central Belize is one of the most actively researched parts of the Maya lowlands; however, until this effort, no comprehensive survey connecting all settlement had been conducted. Archaeological projects have investigated at least 18 different sites within this region. Thus, a large body of archaeological research provides both the temporal and spatial parameters for the varied ancient Maya centers that once occupied this area; importantly, these data can be used to help interpret the collected LiDAR data. The goal of the 2013 LiDAR campaign was to gain information on the distribution of ancient Maya settlement and sites on the landscape and, particularly, to determine how the landscape was used between known centers. The data that were acquired through the 2013 LiDAR campaign have significance for interpreting both the composition and limits of ancient Maya political units. This paper presents the initial results of these new data and suggests a developmental model for ancient Maya polities

Safe and Efficient Silencing with a Pol II, but not a Pol lII, Promoter Expressing an Artificial miRNA Targeting Human Huntingtin

Huntington\u27s disease is a devastating, incurable neurodegenerative disease affecting up to 12 per 100,000 patients worldwide. The disease is caused by a mutation in the Huntingtin (Htt) gene. There is interest in reducing mutant Huntingtin by targeting it at the mRNA level, but the maximum tolerable dose and long-term effects of such a treatment are unknown. Using a self-complementary AAV9 vector, we delivered a mir-155-based artificial miRNA under the control of the chicken β-actin or human U6 promoter. In mouse brain, the artificial miRNA reduced the human huntingtin mRNA by 50%. The U6, but not the CβA promoter, produced the artificial miRNA at supraphysiologic levels. Embedding the antisense strand in a U6-mir-30 scaffold reduced expression of the antisense strand but increased the sense strand. In mice treated with scAAV9-U6-mir-155-HTT or scAAV9-CβA-mir-155-HTT, activated microglia were present around the injection site 1 month post-injection. Six months post-injection, mice treated with scAAV9-CβA-mir-155-HTT were indistinguishable from controls. Those that received scAAV9-U6-mir-155-HTT showed behavioral abnormalities and striatal damage. In conclusion, miRNA backbone and promoter can be used together to modulate expression levels and strand selection of artificial miRNAs, and in brain, the CβA promoter can provide an effective and safe dose of a human huntingtin miRNA

Young People, Biographical Narratives and the Life Grid: Young People's Accounts of Parental Substance Use

Research into potentially sensitive issues with young people presents numerous methodological and ethical challenges. While recent studies have highlighted the advantages of task-based activities in research with young people, the literature on life history research provides few suggestions as to effective and appropriate research tools for encouraging young people to tell their stories. This paper explores the contribution that may be made to such research by the life grid, a visual tool for mapping important life events against the passage of time and prompting wide-ranging discussion. Critical advantages of the life grid in qualitative research include: its visual element which can help to engage interviewer and interviewee in a process of constructing and reflecting on a concrete life history record; its role in creating a more relaxed research encounter supportive of the respondent’s ‘voice’; and facilitating the discussion of sensitive issues. In addition, the way in which use of the grid anchors such narratives in accounts of everyday life, often revealing interesting tensions, is explored. These points are discussed with reference to an exploratory study of young people’s experience of parental substance use

Environmental drivers of variation in bleaching severity of Acropora species during an extreme thermal anomaly

High sea surface temperatures caused global coral bleaching during 2015–2016. During this thermal stress event, we quantified within- and among-species variability in bleaching severity for critical habitat-forming Acropora corals. The objective of this study was to understand the drivers of spatial and species-specific variation in the bleaching susceptibility of these corals, and to evaluate whether bleaching susceptibility under extreme thermal stress was consistent with that observed during less severe bleaching events. We surveyed and mapped Acropora corals at 10 sites (N = 596) around the Lizard Island group on the northern Great Barrier Reef. For each colony, bleaching severity was quantified using a new image analysis technique, and we assessed whether small-scale environmental variables (depth, microhabitat, competition intensity) and species traits (colony morphology, colony size, known symbiont clade association) explained variation in bleaching. Results showed that during severe thermal stress, bleaching of branching corals was linked to microhabitat features, and was more severe at reef edge compared with lagoonal sites. Bleaching severity worsened over a very short time-frame (∼1 week), but did not differ systematically with water depth, competition intensity, or colony size. At our study location, within- and among-species variation in bleaching severity was relatively low compared to the level of variation reported in the literature. More broadly, our results indicate that variability in bleaching susceptibility during extreme thermal stress is not consistent with that observed during previous bleaching events that have ranged in severity among globally dispersed sites, with fewer species escaping bleaching during severe thermal stress. In addition, shaded microhabitats can provide a refuge from bleaching which provides further evidence of the importance of topographic complexity for maintaining the biodiversity and ecosystem functioning of coral reefs

Projected health and economic effects of the increase in childhood obesity during the COVID-19 pandemic in England : the potential cost of inaction

BackgroundThe prevalence of overweight and obesity in young children rose sharply during the COVID-19 pandemic. Here we estimate the potential future health and economic effects of these trends in England.MethodsUsing publicly available annual Body Mass Index (BMI) data from 2006-2022, we calculated the increase in overweight/obesity prevalence (BMI ≥85th reference percentile) during the COVID-19 pandemic among children aged 4-5 and 10-11, and variation by deprivation and ethnicity. We projected the impact of child BMI trends on adult health measures to estimate added lifelong medical and social costs.ResultsDuring 2020-2021 there were steep increases in overweight and obesity prevalence in children. By 2022, overweight and obesity prevalence in children aged 4-5 returned to expected levels based on pre-pandemic trends. However, overweight and obesity prevalence in children aged 10-11 persisted and was 4 percentage points (pDiscussionThe return of overweight and obesity prevalence to pre-pandemic trends in children aged 4-5 provides a clear policy target for effective intervention to tackle this growing and serious population health concern

Exosome-mediated Delivery of Hydrophobically Modified siRNA for Huntingtin mRNA Silencing

Delivery represents a significant barrier to the clinical advancement of oligonucleotide therapeutics for the treatment of neurological disorders, such as Huntington\u27s disease. Small, endogenous vesicles known as exosomes have the potential to act as oligonucleotide delivery vehicles, but robust and scalable methods for loading RNA therapeutic cargo into exosomes are lacking. Here, we show that hydrophobically modified small interfering RNAs (hsiRNAs) efficiently load into exosomes upon co-incubation, without altering vesicle size distribution or integrity. Exosomes loaded with hsiRNAs targeting Huntingtin mRNA were efficiently internalized by mouse primary cortical neurons and promoted dose-dependent silencing of Huntingtin mRNA and protein. Unilateral infusion of hsiRNA-loaded exosomes, but not hsiRNAs alone, into mouse striatum resulted in bilateral oligonucleotide distribution and statistically significant bilateral silencing of up to 35% of Huntingtin mRNA. The broad distribution and efficacy of hsiRNA-loaded exosomes delivered to brain is expected to advance the development of therapies for the treatment of Huntington\u27s disease and other neurodegenerative disorders