Dashed Hopes; Broken Promises; More Despair: How the Lack of State Participation in the Medicaid Expansion Will Punish Americans with Mental Illness

This comprehensive study shows that 6.7 million uninsured people with a mental illness are currently eligible for coverage under the Medicaid Expansion that went into effect on Jan. 1, 2014. But the majority of these individuals with mental health conditions will be left out in the coverage cold due to their state's antagonism toward the Medicaid Expansion health insurance initiative

Beyond the Tunnel Problem, Addressing Cross-Cutting Issues that Impact Vulnerable Youth

Across the country, mayors, commissioners, superintendents, governors, and state policymakers are innovating to address the needs of vulnerable youth. These efforts take many forms: restructuring high schools to improve graduation rates, creating developmentally appropriate interventions to reduce juvenile delinquency, and revamping child welfare practices to keep more youth safely in their homes are just a few of these strategies. Many initiatives, however, are plagued by "crosscutting problems" -- issues that cut across the different agencies that serve youth. Unless crosscutting issues are addressed proactively, they may undermine systemic reforms. This short paper is the first in a series of briefing papers designed to inform officials, practitioners, funders, advocates, scholars and the general public about crosscutting problems and possible solutions to these problems. This paper focuses primarily on the authors' experiences in New York City, though many of the crosscutting problems discussed are known to occur in many jurisdictions large and small. The series starts by presenting a typology of crosscutting issues. The next paper in this series will elaborate on a specific area -- namely, juvenile justice and education. Additional briefing papers will focus on local initiatives that tackle specific problems and more systemic attempts to solve crosscutting issues

Saturation Effects and the Concurrency Hypothesis: Insights from an Analytic Model

Sexual partnerships that overlap in time (concurrent relationships) may play a significant role in the HIV epidemic, but the precise effect is unclear. We derive edge-based compartmental models of disease spread in idealized dynamic populations with and without concurrency to allow for an investigation of its effects. Our models assume that partnerships change in time and individuals enter and leave the at-risk population. Infected individuals transmit at a constant per-partnership rate to their susceptible partners. In our idealized populations we find regions of parameter space where the existence of concurrent partnerships leads to substantially faster growth and higher equilibrium levels, but also regions in which the existence of concurrent partnerships has very little impact on the growth or the equilibrium. Additionally we find mixed regimes in which concurrency significantly increases the early growth, but has little effect on the ultimate equilibrium level. Guided by model predictions, we discuss general conditions under which concurrent relationships would be expected to have large or small effects in real-world settings. Our observation that the impact of concurrency saturates suggests that concurrency-reducing interventions may be most effective in populations with low to moderate concurrency

An Early Holiday Surprise: Cholecystitis Wrapped in Takotsubo Cardiomyopathy

This is a novel case report of a 44-year-old woman who presented to the emergency department with epigastric pain wrapping around to her back. She had no risk factors for cardiac disease, but her initial electrocardiogram (ECG) showed a Wellens syndrome pattern and she was taken urgently to the catheterization lab. After a negative catheterization, she underwent cardiac magnetic resonance imaging, which was positive for Takotsubo cardiomyopathy (TC). Ultimately, abdominal computed tomography revealed that she had cholecystitis, which likely was the cause of her TC and ECG changes