Supporting Health Equity and Affordable Health Coverage for Immigrant Populations: State-Funded Affordable Coverage Programs for Immigrants

This issue brief—the first in a series "Supporting Health Equity and Affordable Health Coverage for Immigrant Populations"—provides an overview of the national immigrant health coverage landscape and offers considerations for policymakers related to state-funded affordable coverage programs for low-income individuals who do not qualify for subsidized health insurance under the ACA or other public programs due to immigration status

Discerning Applicants\u27 Interests in Rural Medicine: A Textual Analysis of Admission Essays

BACKGROUND: Despite efforts to construct targeted medical school admission processes using applicant-level correlates of future practice location, accurately gauging applicants\u27 interests in rural medicine remains an imperfect science. This study explores the usefulness of textual analysis to identify rural-oriented themes and values underlying applicants\u27 open-ended responses to admission essays. METHODS: The study population consisted of 75 applicants to the Rural Physician Leadership Program (RPLP) at the University of Kentucky College of Medicine. Using WordStat, a proprietary text analysis program, applicants\u27 American Medical College Application Service personal statement and an admission essay written at the time of interview were searched for predefined keywords and phrases reflecting rural medical values. From these text searches, derived scores were then examined relative to interviewers\u27 subjective ratings of applicants\u27 overall acceptability for admission to the RPLP program and likelihood of practicing in a rural area. RESULTS: The two interviewer-assigned ratings of likelihood of rural practice and overall acceptability were significantly related. A statistically significant relationship was also found between the rural medical values scores and estimated likelihood of rural practice. However, there was no association between rural medical values scores and subjective ratings of applicant acceptability. CONCLUSIONS: That applicants\u27 rural values in admission essays were not related to interviewers\u27 overall acceptability ratings indicates that other factors played a role in the interviewers\u27 assessments of applicants\u27 acceptability for admission

Children’s comprehension of informational text: Reading, engaging, and learning

The Reading, Engaging, and Learning project (REAL) investigated whether a classroom intervention that enhanced young children's experience with informational books would increase reading achievement and engagement. Participants attended schools serving low income neighborhoods with 86% African American enrollment. The longitudinal study spanned second through fourth grades. Treatment conditions were: (1) Text Infusion/Reading for Learning Instruction -- students were given greater access to informational books in their classroom libraries and in reading instruction; (2) Text Infusion Alone -- the same books were provided but teachers were not asked to alter their instruction; (3) Traditional Instruction -- students experienced business as usual in the classroom. Children were assessed each year on measures of reading and reading engagement, and classroom instructional practices were observed. On most measures, the informational text infusion intervention did not yield differential growth over time. However, the results inform efforts to increase children’s facility with informational text in the early years in order to improve reading comprehension

The Human Connectome Project: A retrospective

The Human Connectome Project (HCP) was launched in 2010 as an ambitious effort to accelerate advances in human neuroimaging, particularly for measures of brain connectivity; apply these advances to study a large number of healthy young adults; and freely share the data and tools with the scientific community. NIH awarded grants to two consortia; this retrospective focuses on the “WU-Minn-Ox” HCP consortium centered at Washington University, the University of Minnesota, and University of Oxford. In just over 6 years, the WU-Minn-Ox consortium succeeded in its core objectives by: 1) improving MR scanner hardware, pulse sequence design, and image reconstruction methods, 2) acquiring and analyzing multimodal MRI and MEG data of unprecedented quality together with behavioral measures from more than 1100 HCP participants, and 3) freely sharing the data (via the ConnectomeDB database) and associated analysis and visualization tools. To date, more than 27 Petabytes of data have been shared, and 1538 papers acknowledging HCP data use have been published. The “HCP-style” neuroimaging paradigm has emerged as a set of best-practice strategies for optimizing data acquisition and analysis. This article reviews the history of the HCP, including comments on key events and decisions associated with major project components. We discuss several scientific advances using HCP data, including improved cortical parcellations, analyses of connectivity based on functional and diffusion MRI, and analyses of brain-behavior relationships. We also touch upon our efforts to develop and share a variety of associated data processing and analysis tools along with detailed documentation, tutorials, and an educational course to train the next generation of neuroimagers. We conclude with a look forward at opportunities and challenges facing the human neuroimaging field from the perspective of the HCP consortium

Demonstration and Dialogue : Mediation in Swedish Nuclear Waste Management

This report analyses mediation and mediators in Swedish nuclear waste management. Mediation is about establishing agreement and building common knowledge. It is argued that demonstrations and dialogue are the two prominent approaches to mediation in Swedish nuclear waste management. Mediation through demonstration is about showing, displaying, and pointing out a path to safe disposal for inspection. It implies a strict division between demonstrator and audience. Mediation through dialogue on the other hand, is about collective acknowledgements of uncertainty and suspensions of judgement creating room for broader discussion. In Sweden, it is the Swedish Nuclear Fuel and Waste Management Co. (SKB) that is tasked with finding a method and a site for the final disposal of the nation’s nuclear waste. Two different legislative frameworks cover this process. In accordance with the Act on Nuclear Activities, SKB is required to demonstrate the safety of its planned nuclear waste management system to the government, while in respect of the Swedish Environmental Code, they are obliged to organize consultations with the public. How SKB combines these requirements is the main question under investigation in this report in relation to materials deriving from three empirical settings: 1) SKB’s safety analyses, 2) SKB’s public consultation activities and 3) the ‘dialogue projects’, initiated by other actors than SKB broadening the public arena for discussion. In conclusion, an attempt is made to characterise the longterm interplay of demonstration and dialogue in Swedish nuclear waste management

Unaltered neurocardiovascular reactions to mental stress after renal sympathetic denervation

Background: The impact of renal denervation (RDN) on muscle sympathetic nerve activity (MSNA) at rest remains controversial. Mental stress (MS) induces transient changes in sympathetic nerve activity, heart rate (HR) and blood pressure (BP). It is not known whether RDN modifies these changes. Purpose: The main objective was to assess the effect of RDN on MSNA and BP alterations during MS. Methods: In 14 patients (11 included in analysis) with resistant hypertension multi-unit MSNA, BP (Finometer ®) and HR were assessed at rest and during forced arithmetics at baseline and 6 months after RDN. Results: Systolic office BP decreased significantly 6 months after RDN (185 ± 29 vs.175 ± 33 mmHG; p = 0.04). No significant changes in MSNA at rest (68 ± 5 vs 73 ± 5 bursts/100hb; p = 0.43) were noted and no significant stress-induced change in group averaged sympathetic activity was found pre- (101 ± 24%; p = 0.9) or post-intervention (108 ± 26%; p = 0.37). Stress was associated with significant increases in mean arterial BP (p < 0.01) and HR (p < 0.01) at baseline, reactions which remained unaltered after intervention. We did not note any correlation between sympathetic nerve activity and BP changes after RDN. Conclusion: Thus, in our group of resistant hypertensives we find no support for the hypothesis that the BP-lowering effect of RDN depends on altered neurovascular responses to stress

Robust machine learning in critical care - Software engineering and medical perspectives

Using machine learning in clinical practice poses hard requirements on explainability, reliability, replicability and robustness of these systems. Therefore, developing reliable software for monitoring critically ill patients requires close collaboration between physicians and software engineers. However, these two different disciplines need to find own research perspectives in order to contribute to both the medical and the software engineering domain. In this paper, we address the problem of how to establish a collaboration where software engineering and medicine meets to design robust machine learning systems to be used in patient care. We describe how we designed software systems for monitoring patients under carotid endarterectomy, in particular focusing on the process of knowledge building in the research team. Our results show what to consider when setting up such a collaboration, how it develops over time and what kind of systems can be constructed based on it. We conclude that the main challenge is to find a good research team, where different competences are committed to a common goal

Discerning applicants’ interests in rural medicine: a textual analysis of admission essays

Background: Despite efforts to construct targeted medical school admission processes using applicant-level correlates of future practice location, accurately gauging applicants’ interests in rural medicine remains an imperfect science. This study explores the usefulness of textual analysis to identify rural-oriented themes and values underlying applicants’ open-ended responses to admission essays. Methods: The study population consisted of 75 applicants to the Rural Physician Leadership Program (RPLP) at the University of Kentucky College of Medicine. Using WordStat, a proprietary text analysis program, applicants’ American Medical College Application Service personal statement and an admission essay written at the time of interview were searched for predefined keywords and phrases reflecting rural medical values. From these text searches, derived scores were then examined relative to interviewers’ subjective ratings of applicants’ overall acceptability for admission to the RPLP program and likelihood of practicing in a rural area. Results: The two interviewer-assigned ratings of likelihood of rural practice and overall acceptability were significantly related. A statistically significant relationship was also found between the rural medical values scores and estimated likelihood of rural practice. However, there was no association between rural medical values scores and subjective ratings of applicant acceptability. Conclusions: That applicants’ rural values in admission essays were not related to interviewers’ overall acceptability ratings indicates that other factors played a role in the interviewers’ assessments of applicants’ acceptability for admission

Medical School Performance, Alumni Membership, and Giving: How Do Scholarship Recipients and Non-Recipients Differ?

recipients and non-recipients differ

Brain structural and functional correlates to defense-related inhibition of muscle sympathetic nerve activity in man

An individual’s blood pressure (BP) reactivity to stress is linked to increased risk of hypertension and cardiovascular disease. However, inter- and intra-individual BP variability makes understanding the coupling between stress, BP reactivity, and long-term outcomes challenging. Previous microneurographic studies of sympathetic signaling to muscle vasculature (i.e. muscle sympathetic nerve activity, MSNA) have established a neural predictor for an individual’s BP reactivity during short-lasting stress. Unfortunately, this method is invasive, technically demanding, and time-consuming and thus not optimal for widespread use. Potential central nervous system correlates have not been investigated. We used MagnetoEncephaloGraphy and Magnetic Resonance Imaging to search for neural correlates to sympathetic response profiles within the central autonomic network and sensorimotor (Rolandic) regions in 20 healthy young males. The main correlates include (a) Rolandic beta rebound and an anterior cingulate cortex (ACC) response elicited by sudden stimulation and (b) cortical thickness in the ACC. Our findings highlight the involvement of the ACC in reactions to stress entailing peripheral sympathetic responses to environmental stimuli. The Rolandic response furthermore indicates a surprisingly strong link between somatosensory and autonomic processes. Our results thus demonstrate the potential in using non-invasive neuroimaging-based measures of stress-related MSNA reactions, previously assessed only using invasive microneurography