Impact of Healthcare Delivery and Policies on Children\u27s Outcomes after the Affordable Care Act of 2010

The Patient Protection and Affordable Care Act (ACA) of 2010 introduced programs to promote integrated pediatric healthcare delivery and to expand public health insurance (Medicaid) eligibility for adults from low-income families in the United States. This dissertation examined whether progress was made towards integration of healthcare delivery for children with developmental disabilities after the implementation of ACA, and also whether expansion of Medicaid for adults impacted the preventive care utilization and school absenteeism of children from low-income families. A cross-sectional study design was used to examine whether integration of pediatric healthcare delivery was accomplished and a quasi-experimental difference-in-differences approach was used to establish the causal impact of Medicaid expansion on children’s outcomes. From the findings of this study, it was concluded that much work still needed to be done to accomplish high-quality integration of pediatric healthcare delivery and that expansion of Medicaid eligibility for adults had positive impacts on children’s preventive care utilization and school absenteeism

Investigation of behavioral and cellular changes in the Maternal Immune Activation model of autism spectrum disorders

Maternal infection during pregnancy, which leads to maternal immune activation (MIA), is an environmental risk factor for autism spectrum disorders (ASD). MIA can be induced in mice and their offspring exhibit behaviors that model the core symptoms of ASD. One of the core behavioral symptoms in ASD patients is presence of increased repetitive behavior, which is modeled by an increase in marble burying in MIA mice. It has been shown that the deficits seen in MIA mice are associated with the dysregulation of cytokine levels in the developing brain, specifically an increase in pro-inflammatory cytokines. In this thesis, I tested whether a reversal of this inflammatory state in the brains of MIA mice by administration of an anti-inflammatory drug, Ibudilast, can ameliorate the behavioral deficit. The results indicated that MIA mice exhibit increased marble burying which is normalized by prenatal administration of Ibudilast without significant effects on control mice. I also tried to establish an additional paradigm of repetitive behavior in the MIA mice, using the rotarod and found that MIA mice have a trend towards increased stereotyped motor routine as measured by an accelerating rotarod test. Altered behaviors in MIA mice are thought to be mediated by impaired synaptic connectivity. Our lab recently showed structural and functional alterations in synapses in the MIA offspring. An important component of the synapse are astrocytes, a type of glial cell, that regulate synapse formation and function. Whether astrocytic development and function are impaired in MIA offspring is not known. Because cytokines have been shown to modulate the release of transmitters from astrocytes it is possible that increase in inflammatory state in MIA offspring can affect the signaling in astrocytes. Based on these observations, I hypothesized that astrocytic calcium activity is altered in the brains of MIA offspring and proposed to study the same using in-vivo astrocytic calcium imaging

Lysophosphatidic Acid Promotes Epithelial to Mesenchymal Transition in Ovarian Cancer Cells by Repressing SIRT1

Epithelial-to-mesenchymal transition (EMT) plays an essential role in the transition from early to invasive phenotype, however the underlying mechanisms still remain elusive. Herein, we propose a mechanism through which the class-III deacetylase SIRT1 regulates EMT in ovarian cancer (OC) cells. Methods: Expression analysis was performed using Q-PCR, western blot, immunofluorescence and fluorescence-IHC study. Matrigel invasion assay was used for the invasion study. Morphological alterations were observed by phalloidin-staining. Co-immunoprecipitation study was performed to analyze protein-protein interaction. Results: Overexpression of SIRT1-WT as well as Resveratrol-mediated SIRT1 activation antagonized the invasion of OC cells by suppressing EMT. SIRT1 deacetylates HIF1α, to inactivate its transcriptional activity. To further validate HIF1α inactivation, its target gene, i.e. ZEB1, an EMTinducing factor was found to attenuate upon SIRT1 activation. To uncover the regulatory factor governing SIRT1 expression, lysophosphatidic acid (LPA), a highly enriched oncolipid in ascites/ serum of OC patients, was found to down-regulate SIRT1 expression. Importantly, LPA was found to induce the mesenchymal switch in OC cells through suppression of SIRT1. Decreased level of SIRT1 was further validated in ovarian tissue samples of OC patients. Conclusion: We have identified a mechanism that relates SIRT1 down-regulation to LPA-induced EMT in OC cells and may open new arenas on developing novel anti-cancer therapeutics

Sectoral approach : what is in it for the Chinese economy?

In any international negotiation on climate change close link among science, economics and politics can hardly be ignored. The argument for mitigation in case of long lived stock pollutants can never be rationally based on current growth level. It is a complex situation and any over simplifies approach will further complicate rather than lead to any positive solution. Competitiveness argument, border adjustment, trade barriers on emission intensive goods and services of Annex I countries can hardly be justified even at the current market share in trade, production, consumption. The best way to approach the problem can be to combine domestic and international actions judiciously. Need for transition to globally low carbon economy by the end of the century is least contested today. Common responsibility of attaining decarbonised growth path for global human welfare is uncontested but much contested is the differentiated responsibility design mechanism. Differentiated responsibility is a dynamic notion. So who should do how much and when, in dynamic context, is still an unresolved research question. But what is understood well is a fully functional global carbon market with global carbon price can provide a least cost solution with desired level of autonomy chosen by each country. Past attempts through CDM provide a small short term step towards that for flow of finance in niche investments and new technology, Sectoral Approach (SA) can provide a second level of stepping stone towards fully functional carbon market through financial flow into non niche market such as energy efficiency type of investment. China today is the leader among Non-Annex I countries in CDM and with first layer of capacity building it can be the natural leaders in SA

Strategies for Low Carbon Growth In India: Industry and Non Residential Sectors

This report analyzed the potential for increasing energy efficiency and reducing greenhouse gas emissions (GHGs) in the non-residential building and the industrial sectors in India. The first two sections describe the research and analysis supporting the establishment of baseline energy consumption using a bottom up approach for the non residential sector and for the industry sector respectively. The third section covers the explanation of a modeling framework where GHG emissions are projected according to a baseline scenario and alternative scenarios that account for the implementation of cleaner technology

Barriers of Colorectal Cancer Screening in Rural USA: A Systematic Review

INTRODUCTION: Colorectal cancer (CRC) screening rates are lower in rural areas in the USA. To guide the design of interventions to improve CRC screening, a systematic review was conducted to identify CRC screening barriers for rural populations. METHODS: A search was conducted in four literature databases - Medline, CINAHL, Embase, and Scopus - for articles from 1998 to 2017 that examine CRC screening barriers in rural areas. This review included a total of 27 articles reporting perceived CRC screening barriers by rural residents or providers or examining factors associated with CRC screening of rural populations in the USA. RESULTS: The most frequently reported barriers were high screening cost and lack of insurance coverage, embarrassment or discomfort undergoing screening, lack of knowledge or perceived need on CRC screening, and lack of physician recommendation. These barriers were confirmed in quantitative studies examining their association with CRC screening status. Age, marital status, and race/ethnicity were the most frequently reported factors associated with CRC screening in rural areas. Lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities were reported as rural-specific barriers for CRC screening. CONCLUSIONS: Main barriers for CRC screening at both the individual and healthcare system level are identified in rural areas and they are in line with those found in urban areas in general. In particular, lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities disproportionately hamper CRC screening for rural Americans

Effects of ultraviolet radiation on pigmentation and malondialdehyde content of three aquatic macrophytes

A study has been done in order to evaluate the ill effects of UV-A,UV-B and UV-C on pigmentation and malondialdehyde content of floating macrophytes (Lemna sp., Pistia sp. and Eichhornia sp.) in one, three, and five days interval. Study results revealed that all types of ultraviolet light (UV-A, UV-B, and UV-C) did not produce same extent of ill effects on the studied macrophytes. Pistia sp. and Eichhornia sp. showed similar reduction pattern of chl a/chl b ratio with respect to control. Results also suggest that among the three types of radiation only UV-B showed higher level of changes in both the pigment and malondialdehyde content. Moreover, among the three tested macrophytes only Lemna sp. showed some protective role against UV radiation compared to other to macrophytes