Massachusetts Health Reform in 2008: Who Are the Remaining Uninsured Adults?

Profiles residents still uninsured after the individual mandate was implemented: young, single, urban, male racial/ethnic minorities and non-citizens with limited English proficiency. Outlines lessons on outreach to those eligible for public coverage

Variation in Insurance Coverage Across Congressional Districts: New Estimates From 2008

Examines trends in rates of private health insurance coverage, public coverage, and uninsurance by congressional district and poverty rate. Identifies districts that have the most to gain from health reforms designed to increase coverage

Quantifying the effect of extreme and seasonal floods on waterborne infectious disease in the United States

The severity of flood events is predicted to increase as a consequence of climate change and may lead to a higher burden of waterborne infectious diseases in the United States. Contaminated floodwater transports bacterial, protozoal, and viral pathogens that typically cause moderate intestinal or respiratory disease, but can also lead to more serious disseminated infections among immunocompromised, young, and older people. Hydroclimatology and drinking water infrastructure influence the transmission of disease, but their roles are not well-understood and may vary by pathogen-type or geographic region. Specific outbreaks of waterborne disease have been attributed to major floods and cases have been positively associated with some meteorological variables, but the association between infections and flooding has not been systematically examined. In this dissertation, we examine the association between seasonal and extreme floods and parasitic and bacterial infections using multiple flood-indicator variables and exposure definitions. In Chapter 2, we use multimodel inference and generalized linear mixed models to determine the effect of seasonal meteorology on hospitalizations across the US. We found that hospitalization rates were generally higher in rural areas and in places that relied on groundwater for drinking water sources. Soil moisture, precipitation, and runoff were associated with significant increases in hospitalizations for Legionnaires' disease, Cryptosporidiosis, and Campylobacteriosis, respectively. In Chapter 3, we use 23 years of weekly case data to examine the effect of cyclonic storms on six waterborne infections in a conditional quasi-Poisson statistical model. Storm exposure was defined separately for distinct storm hazards, namely wind speed and cumulative rainfall, and effects were examined over 3 weeks post-storm. We found that exposure to storm-related rainfall was associated with immediate and lagged increases in cases. In Chapter 4, we use a nonparametric bootstrap to examine the effect of anomalous meteorological conditions, i.e. extremes unrelated to cyclonic storms, on Legionnaires' disease hospitalizations. We also assess the effect of exposure to specific cyclonic storms in a GLMM framework and compare these approaches. Extreme precipitation and months with cyclonic storms were positively associated with Legionnaires' disease hospitalizations. Determining the effect of flooding on Legionnaires' disease is particularly important as it causes severe illness and has steadily increased in incidence for 20 years. An objective of this dissertation was to develop a framework for examining flood-disease dynamics in the context of hydrometeorological and infrastructure-related factors that may influence transmission. We demonstrated that drinking water source, rurality, and geography may play an important role in these dynamics; the analyses also underscored, however, the urgent need for more extensive epidemiological surveillance and water quality data. Climate change will likely place a considerable strain on aging water infrastructure in the US. A nuanced understanding of flood-disease dynamics is central to mitigating these effects

State and Local Coverage Changes under Full Implementation of the Affordable Care Act

The Affordable Care Act (ACA) of 2010 includes a number of new policies intended to substantially reduce the number of people without health insurance. Key provisions to be implemented in 2014 include new health insurance exchanges, subsidies for coverage in those exchanges, health insurance market reforms, and an individual mandate. The ACA also includes an expansion of Medicaid coverage to individuals with incomes up to 138 percent of the Federal Poverty Level ($15,856 for an individual or$26,951 for family of three in 2013). The Medicaid expansion under the ACA became a state option following the Supreme Court ruling in June of 2012. At this point, it is not clear how many states will elect to expand Medicaid coverage. If all states were to do so, enrollment in Medicaid is projected to increase nationwide by about 18.1 million and the uninsured would decline by 23.1 million. This brief provides highlights from new state and sub-state estimates of how the number and composition of individuals enrolled in Medicaid/CHIP would change with full implementation of the ACA, including the Medicaid expansion (see kff.org/zooming-in-ACA). These estimates provide more detail on the projected coverage changes under the ACA at the state level than in prior research. They also provide new information on the expected coverage changes resulting from the ACA at the local level in all states. This analysis demonstrates that there is substantial variation across and within states in the magnitude and composition of the population that is projected to gain Medicaid coverage under the ACA. These estimates also provide guidance on the areas that are likely to experience the largest declines in the uninsured and where the residual uninsured are likely to be concentrated

Green Bank Telescope and Swift X-ray Telescope Observations of the Galactic Center Radio Magnetar SGR J1745-2900

We present results from eight months of Green Bank Telescope 8.7-GHz observations and nearly 18 months Swift X-ray telescope observations of the radio magnetar SGR J1745-2900, which is located 2.4" from Sgr A*. We tracked the magnetar's radio flux density, polarization properties, pulse profile evolution, rotation, and single-pulse behavior. We identified two main periods of activity in SGR J1745-2900. The first is characterized by approximately 5.5 months of relatively stable evolution in radio flux density, rotation, and profile shape, while in the second these properties varied substantially. Specifically, a third profile component emerged and the radio flux increased on average, but also became more variable. Bright single pulses are visible and are well described by a log-normal energy distribution at low to moderate energies, but with an excess at high energies. The 2-10 keV flux has decayed steadily since the initial X-ray outburst, in contrast with the radio flux. Our timing analysis includes Green Bank Telescope, Swift, and NuSTAR data. When we include the X-ray data in our analyses, we find that SGR J1745-2900 exhibited a level of timing noise unprecedented in a radio magnetar, though an analysis of only the radio data indicates timing noise at a level similar to that observed in other radio magnetars. We conclude that, while SGR J1745-2900 is similar to other radio magnetars in many regards, it differs by having experienced a period of relative stability in the radio band that now appears to have ended, while the X-ray properties have evolved independently.Comment: Submitted to ApJ; 10 pages (emulateapj style), 6 figures, 1 tabl

Peripheral blood gene expression reveals an inflammatory transcriptomic signature in Friedreich's ataxia patients.

Transcriptional changes in Friedreich's ataxia (FRDA), a rare and debilitating recessive Mendelian neurodegenerative disorder, have been studied in affected but inaccessible tissues-such as dorsal root ganglia, sensory neurons and cerebellum-in animal models or small patient series. However, transcriptional changes induced by FRDA in peripheral blood, a readily accessible tissue, have not been characterized in a large sample. We used differential expression, association with disability stage, network analysis and enrichment analysis to characterize the peripheral blood transcriptome and identify genes that were differentially expressed in FRDA patients (n = 418) compared with both heterozygous expansion carriers (n = 228) and controls (n = 93 739 individuals in total), or were associated with disease progression, resulting in a disease signature for FRDA. We identified a transcriptional signature strongly enriched for an inflammatory innate immune response. Future studies should seek to further characterize the role of peripheral inflammation in FRDA pathology and determine its relevance to overall disease progression

Coverage Gains for Children: Increased Participation in Medicaid and CHIP in 2009

Updates analyses of patterns in Medicaid and Children's Health Insurance Program enrollment by state, including increases due to eligibility expansion and those due to income declines. Offers insights into Medicaid expansion under healthcare reform

Recruiting for Epigenetic Research: Facilitating the Informed Consent Process

Because the effects of epigenetic (gene-environment interaction) changes have been associated with numerous adverse health states, the study of epigenetic measures provides exciting research opportunities for biobehavioral scientists. However, recruitment for studies focusing on any aspect of genetics poses challenges. Multiple factors, including lack of knowledge regarding a research study, have been identified as barriers to recruitment. Strengthening the informed consent process through extended discussion has been found to be effective in recruiting for research studies in general, yet there is a paucity of information that focused on such a recruitment strategy for epigenetic studies. In this paper, we share our experiences with strategies to strengthen the informed consent process as well as provide samples of materials developed to heighten potential participants’ understanding of epigenetics, in 4 epigenetic research studies with women from diverse backgrounds experiencing a range of health issues. The combined enrollment success rate for epigenetic studies using the process was 89% with participants representing a diverse population. We posit that carefully developed recruitment scripts provided a foundation for improving potential participants’ understanding of the research project. Easy to understand illustrations of the epigenetic process provided a basis for active engagement and encouraged individual questions

“POOL: A Social History of Segregation Exhibition” Exploring Social Justice Through the Lens of Water Safety Awareness and Art-based Education

Art exhibitions, with a focus on water safety and drowning prevention, are rarely seen as a medium to address social justice and public health, or water safety awareness and drowning prevention efforts in communities. Globally, data have shown drowning is considered a “neglected public health threat” (World Health Organization, 2021, CDC, 2023). Additionally, reports have shown that across the globe there are demographic groups of people impacted by drowning, historical traumas, and social determinants, also impacting some communities that are at greater risk (WHO 2021, CDC, 2023). Although there are national and international efforts to address the importance of water safety, drowning prevention, and its disproportionate impact on historically marginalized, Black, Indigenous People of Color (BIPOC), and culturally and linguistically diverse (CLD) groups, alternative mediums, such as exhibitions of art, which can portray narratives of groups of people and their relationships with water, should be explored to counter stigma, and correct the narratives of BIPOC’s communal relationships to water, in an effort combat drowning disparities. As readers, you are encouraged to participate in this ongoing research and enter the “POOL” http://poolphl.com/, and explore “A Social History of Segregation” and Learn http://poolphl.com/learn.html (POOL-ongoing, 2021)