A Decade of Coverage Losses: Implications for the Affordable Care Act

Examines 2000-10 trends in employer-sponsored health insurance and Medicaid/CHIP coverage by income group; contributing factors, including a growing low-income population; and projected coverage among low-income adults under the 2010 healthcare reform

Temperature-Dependent Sex Determination under Rapid Anthropogenic Environmental Change: Evolution at a Turtle’s Pace?

Organisms become adapted to their environment by evolving through natural selection, a process that generally transpires over many generations. Currently, anthropogenically driven environmental changes are occurring orders of magnitude faster than they did prior to human influence, which could potentially outpace the ability of some organisms to adapt. Here, we focus on traits associated with temperature-dependent sex determination (TSD), a classic polyphenism, in a model turtle species to address the evolutionary potential of species with TSD to respond to rapid climate change. We show, first, that sex-ratio outcomes in species with TSD are sensitive to climatic variation. We then identify the evolutionary potential, in terms of heritability, of TSD and quantify the evolutionary potential of 3 key traits involved in TSD: pivotal temperature, maternal nest-site choice, and nesting phenology. We find that these traits display different patterns of adaptive potential: pivotal temperature exhibits moderate heritable variation, whereas nest-site choice and nesting phenology, with considerable phenotypic plasticity, have only modest evolutionary potential to alter sex ratios. Therefore, the most likely response of species with TSD to anthropogenically induced climate change may be a combination of microevolution in thermal sensitivity of the sex-determining pathway and of plasticity in maternal nesting behavior

Nest-site philopatry and the evolution of temperature-dependent sex determination

Despite intensive research, there is no clear empirical evidence to explain the evolution and persistence of temperature-dependent sex determination in reptiles. A recent hypothesis presented by Reinhold proposes that natal homing could lead directly to the evolution of temperature-dependent sex determination. According to his hypothesis, daughters are produced in rare high-quality sites (associated with higher survival rates) to which they return and use to nest, thus deriving higher fitness than sons for whom the quality of the natal patch does not affect their reproductive output if they survive to maturity. We performed an initial empirical evaluation of several assumptions and predictions of this hypothesis as applied to painted turtles (Chrysemys picta), using data from five consecutive nesting seasons, on a major nesting beach. Females were somewhat philopatric to microgeographic sites and to vegetation cover types within the nesting beach, consistent with one of the assumptions of Reinhold’s hypothesis. The variables we examined that influence hatchling fitness (predation, hatching success and sex ratio) were not stable at microgeographic nesting sites or at vegetation cover types. Predation was repeatable within females, whereas hatching success and sex ratio were not. Contrary to Reinhold’s hypothesis, females did not nest more frequently in open sites (which tend to produce more females) than in patches with more vegetation (which tend to produce more males). Furthermore, preferred nest sites (as measured by nest density) did not produce predominantly females. However, nests with higher hatching success tended to produce slightly more females (although the magnitude of this effect was very small). Therefore, Reinhold’s hypothesis is not applicable to C. picta at the level studied – that is, within a nesting beach over a 5 year period – because most of the essential conditions were not met by our data

Evaluation of "Life with Diabetes" Patient Education Booklets

Evaluation of written patient education materials is a necessary part of pro viding education to pa tients with diabetes. Evaluation, however, is useful only if the needs of both those who use the materials (patients) and those who recommend and distribute the materials (health care professionals) are considered. Eight booklets in the "Life with Diabetes" patient educa tion series (developed by the Michigan Diabetes Research and Training Center) were evaluated by both health professionals and patients. Twenty-eight to 37 health professionals including nurses, dieti tians, and physicians evaluated each booklet. Their comments were used to revise and im prove the booklets before publication (formative or process evaluation).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69005/2/10.1177_014572178601200113.pd