Stretching the Safety Net to Serve Undocumented Immigrants: Community Responses to Health Needs

Examines the ability of communities to provide health care for both legal and undocumented immigrant patients. Looks at community diversity, political climate, and advocacy groups. Based on site visits to twelve nationally representative communities

Safety Net hospital Emergency Departments: Creating Safety Valves for Non-urgent Care

Outlines how safety-net hospitals are addressing the rise in emergency department visits for non-urgent care, such as re-directing patients to outpatient clinics or community health centers and adding primary care capacity. Discusses policy implications

Public Health Workforce Shortages Imperil Nation's Health

Examines from a community-based perspective the scope of the shortages in the public health workforce; contributing factors such as inadequate funding, salaries, and benefits; and strategies for training, recruiting, and retaining public health workers

Pursuing Cost Containment in a Pluralistic Payer Environment: From the Aftermath of Clinton’s Failure at Health Care Reform to the Balanced Budget Act of 1997

Following a decade in which Medicare operated as the leading ‘change agent’ within the US health care system, the private sector rose to the fore in the mid 1990s. The failure of President Clinton’s attempt at comprehensive, public sector-led reform left managed care as the solution for cost control. And for a period it worked, largely because managed care organizations were able to both squeeze payments to selective networks of medical providers and significantly reduce inpatient hospital stays. There was a lot of ‘fat’ in the nation’s convoluted health care system that could be (and was) eliminated through competitive negotiations between medical providers and insurers, employers, or managed care organizations. One of our primary arguments in this article is that managed care operated partly as a systematic suppression of price discrimination or differential pricing (often referred to as ‘cost shifting’), as managed care organizations qua purchasing agents prevented hospitals and physicians from summarily raising prices to private payers to meet their financial requirements. Over time, however, managed care fell victim to inflated expectations, its own initial success, and larger fiscal forces. During this same period, Republicans and Democrats struggled to reach a consensus over the future direction of Medicare. Their disagreements contributed to the impasse over budget policy in 1995 and the infamous partial federal government shutdown. After President Clinton’s reelection in 1996, partisan disagreements over Medicare dissipated. And, in 1997, Congress and the president passed the Balanced Budget Act of 1997, which emerged as a massive piece of patchwork legislation that sought to balance the federal budget, rein in Medicare spending, and increase the number of the programme’s beneficiaries in private health plans

The Challenges of Capacity Building in the Aligning Forces for Quality Alliances

Summarizes the challenges and trade-offs in infrastructure and governance as well as stakeholder relations and participation, such as inclusive versus efficient decision making, in an alliance to coordinate regional healthcare improvement activities

The relationship between ciliary neurotrophic factor (CNTF) genotype and motor unit physiology: preliminary studies

BACKGROUND: Ciliary neurotrophic factor (CNTF) is important for neuronal and muscle development, and genetic variation in the CNTF gene has been associated with muscle strength. The effect of CNTF on nerve development suggests that CNTF genotype may be associated with force production via its influence on motor unit size and firing patterns. The purpose of this study is to examine whether CNTF genotype differentially affects motor unit activation in the vastus medialis with increasing isometric force during knee extension. RESULTS: Sixty-nine healthy subjects were genotyped for the presence of the G and A (null) alleles in the CNTF gene (n = 57 G/G, 12 G/A). They were tested using a dynamometer during submaximal isometric knee extension contractions that were from 10–50% of their maximal strength. During the contractions, the vastus medialis was studied using surface and intramuscular electromyography with spiked triggered averaging to assess surface-detected motor unit potential (SMUP) area and mean firing rates (mFR) from identified motor units. CNTF genotyping was performed using standard PCR techniques from DNA obtained from leucocytes of whole blood samples. The CNTF G/A genotype was associated with smaller SMUP area motor units and lower mFR at higher force levels, and fewer but larger units at lower force levels than G/G homozygotes. The two groups used motor units with different size and activation characteristics with increasing force generation. While G/G subjects tended to utilize larger motor units with increasing force, G/A subjects showed relatively less increase in size by using relatively larger units at lower force levels. At higher force levels, G/A subjects were able to generate more force per motor unit size suggesting more efficient motor unit function with increasing muscle force. CONCLUSION: Differential motor unit responses were observed between CNTF genotypes at force levels utilized in daily activities

Statistical properties of SGR 1900+14 bursts

We study the statistics of soft gamma repeater (SGR) bursts, using a data base of 187 events detected with BATSE and 837 events detected with RXTE PCA, all from SGR 1900+14 during its 1998-1999 active phase. We find that the fluence or energy distribution of bursts is consistent with a power law of index 1.66, over 4 orders of magnitude. This scale-free distribution resembles the Gutenberg-Richter Law for earthquakes, and gives evidence for self-organized criticality in SGRs. The distribution of time intervals between successive bursts from SGR 1900+14 is consistent with a log-normal distribution. There is no correlation between burst intensity and the waiting times till the next burst, but there is some evidence for a correlation between burst intensity and the time elapsed since the previous burst. We also find a correlation between the duration and the energy of the bursts, but with significant scatter. In all these statistical properties, SGR bursts resemble earthquakes and solar flares more closely than they resemble any known accretion-powered or nuclear-powered phenomena. Thus our analysis lends support to the hypothesis that the energy source for SGR bursts is internal to the neutron star, and plausibly magnetic.Comment: 11 pages, 4 figures, accepted for publication in ApJ

A Search for Early Optical Emission from Short and Long Duration Gamma-ray Bursts

Gamma-ray bursts of short duration may harbor vital clues to the range of phenomena producing bursts. However, recent progress from the observation of optical counterparts has not benefitted the study of short bursts. We have searched for early optical emission from six gamma-ray bursts using the ROTSE-I telephoto array. Three of these events were of short duration, including GRB 980527 which is among the brightest short bursts yet observed. The data consist of unfiltered CCD optical images taken in response to BATSE triggers delivered via the GCN. For the first time, we have analyzed the entire 16 degree by 16 degree field covered for five of these bursts. In addition, we discuss a search for the optical counterpart to GRB 000201, a well-localized long burst. Single image sensitivities range from 13th to 14th magnitude around 10 s after the initial burst detection, and 14 - 15.8 one hour later. No new optical counterparts were discovered in this analysis suggesting short burst optical and gamma-ray fluxes are uncorrelated.Comment: 8 pages, 2 figures, subm. to ApJ Let

Center for Research on the Education of Students Placed at Risk: Report #51

The Center for Research on the Education of Students Placed at Risk (CRESPAR) was established in 1994 and continued until 2004. It was a collaboration between Johns Hopkins University and Howard University. CRESPAR’s mission was to conduct research, development, evaluation, and dissemination of replicable strategies designed to transform schooling for students who were placed at risk due to inadequate institutional responses to such factors as poverty, ethnic minority status, and non-English-speaking home background.This report presents analyses of data from the Texas Assessment of Academic Skills (TAAS) reading measures. It sought to evaluate the program’s outcomes in all of the 111 Texas schools that began the program from 1994-1997.Grant (No. R-117-40005) from the Office of Educational Research and Improvement (OERI), U.S. Department of Educatio

Prompt Optical Observations of Gamma-ray Bursts

The Robotic Optical Transient Search Experiment (ROTSE) seeks to measure simultaneous and early afterglow optical emission from gamma-ray bursts (GRBs). A search for optical counterparts to six GRBs with localization errors of 1 square degree or better produced no detections. The earliest limiting sensitivity is m(ROTSE) > 13.1 at 10.85 seconds (5 second exposure) after the gamma-ray rise, and the best limit is m(ROTSE) > 16.0 at 62 minutes (897 second exposure). These are the most stringent limits obtained for GRB optical counterpart brightness in the first hour after the burst. Consideration of the gamma-ray fluence and peak flux for these bursts and for GRB990123 indicates that there is not a strong positive correlation between optical flux and gamma-ray emission.Comment: 4 pages, 3 figures, submitted to ApJ Letter