Rewriting P Systems with Conditional Communication: Improved Hierarchies

We consider here a variant of rewriting P systems [1], where communication is controlled by the contents of the strings, not by the evolution rules used for obtaining these strings. Some new characterizations of recursively enumerable languages are obtained by means of P systems with a small number of membranes, which improves some of the known results from [1] and [4]

Toward a policy ecology of implementation of evidence-based practices in public mental health settings

BACKGROUND: Mental health policymaking to support the implementation of evidence-based practices (EBPs) largely has been directed toward clinicians. However, implementation is known to be dependent upon a broader ecology of service delivery. Hence, focusing exclusively on individual clinicians as targets of implementation is unlikely to result in sustainable and widespread implementation of EBPs. DISCUSSION: Policymaking that is informed by the implementation literature requires that policymakers deploy strategies across multiple levels of the ecology of implementation. At the organizational level, policies are needed to resource the added marginal costs of EBPs, and to assist organizational learning by re-engineering continuing education units. At the payor and regulatory levels, policies are needed to creatively utilize contractual mechanisms, develop disease management programs and similar comprehensive care management approaches, carefully utilize provider and organizational profiling, and develop outcomes assessment. At the political level, legislation is required to promote mental health parity, reduce discrimination, and support loan forgiveness programs. Regulations are also needed to enhance consumer and family engagement in an EBP agenda. And at the social level, approaches to combat stigma are needed to ensure that individuals with mental health need access services. SUMMARY: The implementation literature suggests that a single policy decision, such as mandating a specific EBP, is unlikely to result in sustainable implementation. Policymaking that addresses in an integrated way the ecology of implementation at the levels of provider organizations, governmental regulatory agencies, and their surrounding political and societal milieu is required to successfully and sustainably implement EBPs over the long term

Tropical and mid-latitude teleconnections interacting with the Indian summer monsoon rainfall: a theory-guided causal effect network approach

The alternation of active and break phases in Indian summer monsoon (ISM) rainfall at intraseasonal timescales characterizes each ISM season. Both tropical and mid-latitude drivers influence this intraseasonal ISM variability. The circumglobal teleconnection observed in boreal summer drives intraseasonal variability across the mid-latitudes, and a two-way interaction between the ISM and the circumglobal teleconnection pattern has been hypothesized. We use causal discovery algorithms to test the ISM circumglobal teleconnection hypothesis in a causal framework. A robust causal link from the circumglobal teleconnection pattern and the North Atlantic region to ISM rainfall is identified, and we estimate the normalized causal effect (CE) of this link to be about 0.2 (a 1 standard deviation shift in the circumglobal teleconnection causes a 0.2 standard deviation shift in the ISM rainfall 1 week later). The ISM rainfall feeds back on the circumglobal teleconnection pattern, however weakly. Moreover, we identify a negative feedback between strong updraft located over India and the Bay of Bengal and the ISM rainfall acting at a biweekly timescale, with enhanced ISM rainfall following strong updraft by 1 week. This mechanism is possibly related to the boreal summer intraseasonal oscillation. The updraft has the strongest CE of 0.5, while the Madden–Julian oscillation variability has a CE of 0.2–0.3. Our results show that most of the ISM variability on weekly timescales comes from these tropical drivers, though the mid-latitude teleconnection also exerts a substantial influence. Identifying these local and remote drivers paves the way for improved subseasonal forecasts

The Affordable Care Act and implications for health care services for American Indian and Alaska Native individuals

American Indian and Alaska Native (AI/AN) populations report poor physical and mental health outcomes while tribal health providers and the Indian Health Service (IHS) operate in a climate of significant under funding. Understanding how the Patient Protection and Affordable Care Act (ACA) affects Native American tribes and the IHS is critical to addressing the improvement of the overall access, quality, and cost of health care within AI/AN communities. This paper summarizes the ACA provisions that directly and/or indirectly affect the service delivery of health care provided by tribes and the IHS

Understanding Geographic Variations in Bmi in India

Comparison of Body Mass Index is a useful marker for energy imbalance and associated variations across populations. High BMI is associated with cardiovascular and metabolic diseases, whereas low BMI is associated with increased mortality. BMI comparisons across geographical locations may give us indication as to which direction the public health policies should head and what could be the corrective approach towards a more balanced and healthier energy level. The current study uses Indian National Family Health Survey (NFHS-3) data for women from 2005-06 to develop state-specific models of BMI and do inter-state comparisons. We also examined the individual versus contextual predictors of these variations. of the total sample (N = 118,734), 29% had a BMI lower than 18.5, and were classified as underweight, with Uttar Pradesh having the highest number of underweight women, followed by Maharashtra, West Bengal and Karnataka. North-eastern states of Arunachal Pradesh, Nagaland, Manipur, and Mizoram, collectively had lowest percentage of underweight residents. Female respondents who had higher levels of education, were married, and were employed, had a lower prevalence of being underweight (p\u3c0.000). Women who smoked and consumed alcohol were also more likely to be underweight. But addition of such individual level variables like income and wealth variables, educational and demographic variables, and health behaviors alter the odds of having a low BMI in some states (such as Punjab, Kerala, Goa & Delhi), but not in others (such as Bihar, Jharkhand, Arunachal Pradesh, Nagaland, Madhya Pradesh & Manipur). In former types of states where individual level variables change the odds of having low BMI, continued investments in education, health education targeted toward health-adverse behaviors, and access to public health resources may show improvement in levels of BMI. On the other hand, states where individual level variables did not influence the odds of having low BMI in our analysis might have different genotypical characteristics of the female respondents. It is also possible that these states might need intervention not only at individual level, but also at the level of macroeconomic and developmental factors such as food security, or to health-related factors such as the availability, accessibility, and quality of health care services, particularly those directed toward women. The current study shows the need for two-pronged policy interventions to alter the BMI imbalance in India

“Can we walk?” Environmental supports for physical activity in India

India is currently facing a non-communicable disease epidemic. Physical activity (PA) is a preventative factor for non-communicable diseases. Understanding the role of the built environment (BE) to facilitate or constrain PA is essential for public health interventions to increase population PA. The objective of this study was to understand BEs associations with PA occurring in two major life domains or life areas—travel and leisure—in urban India. Between December 2014 and April 2015, in-person surveys were conducted with participants (N = 370; female = 47.2%) in Chennai, India. Perceived BE characteristics regarding residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure for walking and bicycling, aesthetics, traffic safety, and safety from crime were measured using the adapted Neighborhood Environment Walkability Scale-India (NEWS-India). Self-reported PA was measured the International Physical Activity Questionnaire. High residential density was associated with greater odds of travel PA (aOR = 1.9, 95% CI = 1.2, 3.2). Land use mix-diversity was positively related to travel PA (aOR = 2.1, 95%CI = 1.2, 3.6), but not associated with leisure or total PA. The aggregate NEWS-India score predicted a two-fold increase in odds of travel PA (aOR = 1.9, 95% CI = 1.1, 3.1) and a 40% decrease in odds of leisure PA (aOR = 0.6, 95% CI = 0.4, 1.0). However, the association of the aggregated score with leisure PA was not significant. Results suggest that relationships between BE and PA in low-and-middle income countries may be context-specific, and may differ markedly from higher income countries. Findings have public health implications for India suggesting that caution should be taken when translating evidence across countries

Sub-synoptic circulation variability in the Himalayan extreme precipitation event during June 2013

This study investigates the sub-synoptic scale circulation aspects associated with the extreme rainfall event occurred over the North Indian state of Uttarakhand located in the western Himalayas (WH) during the 15–18 June 2013 period. A diagnosis based on hourly ERA5 reanalyzed circulation products archived on finer grids reveals that sustenance of heavy rains during the event period is supported by a propensity of cyclonic vorticity sources channeled toward the WH region through a narrow quasi-steady conduit in the lower troposphere from the ISM circulation. The equatorward segregating mesoscale potential vorticity (PV) structures from the quasi-stationary upper level PV anomaly (trough) during the event administered two pathways for vorticity sources. The first pathway is from the base of the trough culminating into longer horizontal conduit path from the western Arabian Sea, lending perpetual cyclonic vorticity support to the ISM environment. The second pathway is from the right flank of the trough, which promotes sustained environment of deeper mesoscale convergence zone, potentially unstable atmosphere and strong ascent over the Uttarakhand region. The convergence zone is potentially viewed as a region for strong monsoon and extratropical circulation interactions to occur on finer horizontal scales of motion, where significant vertical synchronization of positive PV advection is realized during the 16–17 June 2013 period. In addition to orographic precipitation enhancements, deeper advective synchronization noticed at sub-synoptic time periods is accredited to the nearly doubling 24-h rainfall amounts in the foothill region of Uttarakhand during the event period. The ERA5 diagnosed diabatic heating additionally indicates that precipitating systems at higher (foothill) elevations contribute to upper (lower) tropospheric heat sources

Racial Disparities in Student Debt: Evidence From the Refund to Savings Initiative

This brief provides evidence that low- and moderate-income (LMI) Black households accumulate significantly more debt in pursuit of a higher education than do LMI White students, even after using rigorous methods to account for race- and debt-related confounders. Using data from the Refund to Savings experiment, the authors find that LMI Black households accrued $7,721 more in student loan debt than their White counterparts did. This finding is crucial in light of the financial vulnerability of this population both before and after college. That vulnerability potentially contributes to diminished returns and exacerbates racial disparities in educational outcomes and wealth accumulation. The brief discusses policy remedies that can continue to enhance access to college for low-income minorities while ensuring equitable outcomes during and after college