The rhetoric of the uninsured : claimsmaking in public policy research

The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file.Title from title screen of research.pdf file (viewed on September 3, 2008)Thesis (M.A.) University of Missouri-Columbia 2008.Public policy research is often seen as another arena applicable to the objective lens of science, as policy makers "the best evidence," or scientific facts, about a social problem to determine which solutions are most warranted. Hundreds of millions of dollars are spent annually to determine the prevalence and extent of social problems, such as drug abuse, teen pregnancy and uninsured, to name a few. Yet, much of this data is ignored or even discredited by policy makers despite the rigorous and rational efforts of knowledge creation employed by scientists, leading many researchers to feel exasperated or frustrated at the public policy formation process. What many often fail to realize is that public policy research and the public policy formation process are socially constructed by those involved. There are no facts, only claims made by stakeholders with varying interests and values. Claims are not measured on their own merit but rather by how effectively they appeal to the policy formation audience. Claimsmaking theory, therefore, provides a robust theoretical framework for examining the process of how claims are made, received, denied through counter claims, and reshaped. It also illustrates how claims and those who make them interact to formulate public policy this research explores claimsmaking in public policy formation within a public policy research grant focused on reducing the social problem of the uninsured. Claims were examined across a four year period to understand how grounds, warrants, and conclusions were negotiated through discourse to derive a single policy recommendation.Includes bibliographical reference

A comparison of structured and unstructured navigation through a CBT package

The advent of hypertext has opened up new possibilities in computer-based training. The design of courseware without any predetermined structure could make the designer's task easier, and allow greater flexibility for the trainee to structure the learning environment to suit their own learning style, This investigation was concerned with the exploration of performance differences in structured and unstructured training environments. In the structured condition, subjects encountered presequenced training and practice modules. For the unstructured condition, subjects determined their own sequence of modules. It was proposed that performance may be better in the unstructured condition. The findings indicate that this depends upon individual differences in cognitive style, some styles seemingly better at exploiting the unstructured learning environment than others

Missouri Medicaid Program: A Graphical Profile

Audience: Governor's Medicaid Reform Commission August, 2005.This report provides a graphical summary of the Missouri Medicaid program. It is intended to provide background information of the policy issues being considered by the Missouri Medicaid Reform Commission. Medicaid at the national level is summarized first, and then the report describes Missouri Medicaid. The types of health care services, expenditure levels, and categories of participants are presented. Health care service types are summarized with a focus on overall expenditure levels. Participants are summarized into general enrollment groups: Children, Adults, Blind and Disabled, Elderly, and Other. The interrelationships among services, expenditures and participants are explored using current data and historical trends. County level maps display these patterns for the state. Estimates of the effect of recent changes to the Missouri Medicaid Program are provided. (58 slides

Incorporation of peptides targeting EGFR and FGFR1 into the adenoviral fibre knob domain, and their evaluation as targeted cancer therapies

Oncolytic virotherapies based on Adenovirus 5 (Ad5) hold promise as adjunctive cancer therapies; however their efficacy when delivered systemically is hampered by poor target cell specificity and pre-existing anti-Ad5 immunity. Ovarian cancer represents a promising target for virotherapy, since the virus can be delivered locally into the peritoneal cavity. Both Epidermal Growth Factor Receptor (EGFR) and Fibroblast Growth Factor Receptor 1 (FGFR1) are over-expressed in the majority of human tumours, including ovarian cancer. To generate adenoviral vectors with improved tumour specificity, we generated a panel of Ad5 vectors with altered tropism for EGFR and FGFR, rather than the natural Ad5 receptor, hCAR. We have included mutations within AB loop the viral fibre knob (KO1 mutation) to preclude interaction with, hCAR, combined with insertions in the HI loop to incorporate peptides that bind either EGFR (peptide YHWYGYTPQNVI, GE11) or FGFR1 (peptides MQLPLAT, M* and LSPPRYP, LS). Viruses were produced to high titres, and the integrity of the fibre protein was validated by Western blotting. The KO1 mutation efficiently ablated hCAR interactions, and significantly increased transduction was observed in hCARlow/EGFRhigh cell lines using Ad5.GE11, whilst transduction levels using Ad5.M* or Ad5.LS were not increased. In the presence of physiological concentrations of human blood clotting factor X (hFX), significantly increased levels of transduction via the hFX-mediated pathway were observed in cell lines, but not in primary tumour cells derived from epithelial ovarian cancer (EOC) ascites samples. Ad5 mediated transduction of EOC cells were completely abolished by the presence of 2.5% serum from patients, whilst surprisingly, incorporation of the GE11 peptide resulted in significant evasion of neutralisation in the same samples. We thus speculate that incorporation of the YHWYGYTPQNVI dodecapeptide within the fibre knob domain may provide a novel means of circumventing pre-existing Ad5 immunity that warrants further investigation

Lymphocyte subsets and the role of Th1/Th2 balance in stressed chronic pain patients

Background: The complex regional pain syndrome (CRPS) and fibromyalgia (FM) are chronic pain syndromes occurring in highly stressed individuals. Despite the known connection between the nervous system and immune cells, information on distribution of lymphocyte subsets under stress and pain conditions is limited. Methods: We performed a comparative study in 15 patients with CRPS type I, 22 patients with FM and 37 age- and sex-matched healthy controls and investigated the influence of pain and stress on lymphocyte number, subpopulations and the Th1/Th2 cytokine ratio in T lymphocytes. Results: Lymphocyte numbers did not differ between groups. Quantitative analyses of lymphocyte subpopulations showed a significant reduction of cytotoxic CD8+ lymphocytes in both CRPS (p < 0.01) and FM (p < 0.05) patients as compared with healthy controls. Additionally, CRPS patients were characterized by a lower percentage of IL-2-producing T cell subpopulations reflecting a diminished Th1 response in contrast to no changes in the Th2 cytokine profile. Conclusions: Future studies are warranted to answer whether such immunological changes play a pathogenetic role in CRPS and FM or merely reflect the consequences of a pain-induced neurohumoral stress response, and whether they contribute to immunosuppression in stressed chronic pain patients. Copyright (c) 2008 S. Karger AG, Basel

“Trait EI in the relationship between needs fulfilment and symptoms and attitudes associated with EDs”

Eating disorders (EDs) are a set of pathologies, which have been increasing in prevalence in the recent years, suggesting the importance of studying symptoms and attitudes associated with EDs in depth. Several studies have showed that both psychological basic needs and trait emotion intelligence (trait EI) are relevant aspects of EDs, however these two aspects were never tested concurrently. Previous studies have shown that self-determined motivation could be a plausible antecedent that may account for individual variation in trait EI, and for this reason, it seems to be extremely relevant to integrate trait EI in a Self-Determination Theory (SDT) framework. The aim of this study is to test a mediation model of trait EI in the relationship between need fulfilment and eating disorders. In a sample of 159 females aged between 16 and 22 years old (M = 18.71; SD = 1.98) instruments were administered to measure the basic psychological needs, trait EI, and eating disorders. Results of this study showed that need fulfilment was negatively related to eating disorders and positively related to trait EI, whereas trait EI was negatively related to eating disorders. Furthermore, trait EI has shown a mediation role in the relation between basic psychological needs and eating disorders

“Trait EI in the relationship between needs fulfilment and symptoms and attitudes associated with EDs”

Eating disorders (EDs) are a set of pathologies, which have been increasing in prevalence in the recent years, suggesting the importance of studying symptoms and attitudes associated with EDs in depth. Several studies have showed that both psychological basic needs and trait emotion intelligence (trait EI) are relevant aspects of EDs, however these two aspects were never tested concurrently. Previous studies have shown that self-determined motivation could be a plausible antecedent that may account for individual variation in trait EI, and for this reason, it seems to be extremely relevant to integrate trait EI in a Self-Determination Theory (SDT) framework. The aim of this study is to test a mediation model of trait EI in the relationship between need fulfilment and eating disorders. In a sample of 159 females aged between 16 and 22 years old (M = 18.71; SD = 1.98) instruments were administered to measure the basic psychological needs, trait EI, and eating disorders. Results of this study showed that need fulfilment was negatively related to eating disorders and positively related to trait EI, whereas trait EI was negatively related to eating disorders. Furthermore, trait EI has shown a mediation role in the relation between basic psychological needs and eating disorders

Determinants of Health-Related Quality of Life (HRQoL) in the Multiethnic Singapore Population - A National Cohort Study

Background: HRQoL is an important outcome to guide and promote healthcare. Clinical and socioeconomic factors may influence HRQoL according to ethnicity. Methodology: A multiethnic cross-sectional national cohort (N = 7198) of the Singapore general population consisting of Chinese (N = 4873), Malay (N = 1167) and Indian (N = 1158) adults were evaluated using measures of HRQoL (SF-36 version 2), family functioning, health behaviours and clinical/laboratory assessments. Multiple regression analyses were performed to identify determinants of physical and mental HRQoL in the overall population and their potential differential effects by ethnicity. No a priori hypotheses were formulated so all interaction effects were explored. Principal Findings: HRQoL levels differed between ethnic groups. Chinese respondents had higher physical HRQoL (PCS) than Indian and Malay participants (p<0.001) whereas mental HRQoL (MCS) was higher in Malay relative to Chinese participants (p<0.001). Regressions models explained 17.1% and 14.6% of variance in PCS and MCS respectively with comorbid burden, income and employment being associated with lower HRQoL. Age and family were associated only with MCS. The effects of gender, stroke and musculoskeletal conditions on PCS varied by ethnicity, suggesting non-uniform patterns of association for Chinese, Malay and Indian individuals. Conclusions: Differences in HRQoL levels and determinants of HRQoL among ethnic groups underscore the need to better or differentially target population segments to promote well-being. More work is needed to explore HRQoL and wellness in relation to ethnicity

Physical mixing effects on iron biogeochemical cycling: FeCycle experiment

The effects of physical processes on the distribution, speciation, and sources/sinks for Fe in a high-nutrient low-chlorophyll (HNLC) region were assessed during FeCycle, a mesoscale SF6 tracer release during February 2003 (austral summer) to the SE of New Zealand. Physical mixing processes were prevalent during FeCycle with rapid patch growth (strain rate γ = 0.17–0.20 d−1) from a circular shape (50 km2) into a long filament of ∼400 km2 by day 10. Slippage between layers saw the patch-head overlying noninfused waters while the tail was capped by adjacent surface waters resulting in a SF6 maximum at depth. As the patch developed it entrained adjacent waters containing higher chlorophyll concentrations, but similar dissolved iron (DFe) levels, than the initial infused patch. DFe was low ∼60 pmol L−1 in surface waters during FeCycle and was dominated by organic complexation. Nighttime measurements of Fe(II) ∼20 pmol L−1 suggest the presence of Fe(II) organic complexes in the absence of an identifiable fast Fe(III) reduction process. Combining residence times and phytoplankton uptake fluxes for DFe it is cycled through the biota 140–280 times before leaving the winter mixed layer (WML). This strong Fe demand throughout the euphotic zone coupled with the low Fe:NO3 − (11.9 μmol:mol) below the ferricline suggests that vertical diffusion of Fe is insufficient to relieve chronic iron limitation, indicating the importance of atmospheric inputs of Fe to this region