Disparities in Healthcare Coverage and Utilization after Expanded Dependent Coverage

Background. A goal of expanding insurance coverage is reducing racial disparities in healthcare utilization, however the effects of such expansions under the affordable care act (ACA) on disparities remain unclear. The 2010 dependent coverage expansion provided an opportunity to evaluate disparities following a major coverage expansion. Objectives. We sought to understand changes in emergency department (ED)utilization following a major insurance expansion, the 2010 dependent coverage expansion. Research Design. We present changes in coverage and utilization among young adults (19-25 years old) before and after the dependent coverage expansion, compared to a control group (26-31 years old) unaffected by the provision using administrative records from four states (California, Florida, Massachusetts and New York) using a difference in difference methodology. ResultsWe identified 9,089,116 adults aged 19-31 with at least one ED visit between 2008 and 2013. While rates of ED utilization continue to increase, we found dependent coverage expansion was associated with a reduced increase in adjusted ED utilization among Whites, Blacks, and Asians (p Conclusions. Expansion of dependent insurance coverage was associated with significantly different ED healthcare utilization patterns among Hispanics than among other young adults. This suggests that eligibility or accessibility of dependent coverage remains a barrier to care for young Hispanics

HRP's Healthcare Spin-Offs Through Computational Modeling and Simulation Practice Methodologies

Spaceflight missions expose astronauts to novel operational and environmental conditions that pose health risks that are currently not well understood, and perhaps unanticipated. Furthermore, given the limited number of humans that have flown in long duration missions and beyond low Earth-orbit, the amount of research and clinical data necessary to predict and mitigate these health and performance risks are limited. Consequently, NASA's Human Research Program (HRP) conducts research and develops advanced methods and tools to predict, assess, and mitigate potential hazards to the health of astronauts. In this light, NASA has explored the possibility of leveraging computational modeling since the 1970s as a means to elucidate the physiologic risks of spaceflight and develop countermeasures. Since that time, substantial progress has been realized in this arena through a number of HRP funded activates such as the Digital Astronaut Project (DAP) and the Integrated Medical Model (IMM). Much of this success can be attributed to HRP's endeavor to establish rigorous verification, validation, and credibility (VV&C) processes that ensure computational models and simulations (M&S) are sufficiently credible to address issues within their intended scope. This presentation summarizes HRP's activities in credibility of modeling and simulation, in particular through its outreach to the community of modeling and simulation practitioners. METHODS: The HRP requires all M&S that can have moderate to high impact on crew health or mission success must be vetted in accordance to NASA Standard for Models and Simulations, NASA-STD-7009 (7009) [5]. As this standard mostly focuses on engineering systems, the IMM and DAP have invested substantial efforts to adapt the processes established in this standard for their application to biological M&S, which is more prevalent in human health and performance (HHP) and space biomedical research and operations [6,7]. These methods have also generated substantial interest by the broader medical community though institutions like the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) to develop similar standards and guidelines applicable to the larger medical operations and research community. DISCUSSION: Similar to NASA, many leading government agencies, health institutions and medical product developers around the world are recognizing the potential of computational M&S to support clinical research and decision making. In this light, substantial investments are being made in computational medicine and notable discoveries are being realized [8]. However, there is a lack of broadly applicable practice guidance for the development and implementation of M&S in clinical care and research in a manner that instills confidence among medical practitioners and biological researchers [9,10]. In this presentation, we will give an overview on how HRP is working with the NIH's Interagency Modeling and Analysis Group (IMAG), the FDA and the American Society of Mechanical Engineers (ASME) to leverage NASA's biomedical VV&C processes to establish a new regulatory standard for Verification and Validation in Computational Modeling of Medical Devices, and Guidelines for Credible Practice of Computational Modeling and Simulation in Healthcare

SBC2009-204872 CIRCUMFERENTIAL CYCLIC STRAIN IN PATIENTS WITH DESCENDING THORACIC AORTIC ANEURYSMS: IMPLICATIONS FOR ENDOVASCULAR DEVICE DESIGN

INTRODUCTION Endovascular graft (EVG) therapy has emerged as a promising alternative to open surgical repair of thoracic aortic aneurysms. However, the long-term durability of thoracic endovascular repair (TEVAR) remains uncertain due to complications such as incomplete aneurysm exclusion (endoleaks), migration, and stent fracture and collapse. These complications could likely be reduced if the biomechanical environment of the thoracic aorta was better understood. Currently, there are three FDA approved EVGs for treatment of descending thoracic aortic aneurysms (DTAA), but the range of bench-top testing mechanisms for these devices are limited. Despite many advances in medical imaging and analysis techniques, relatively little is known about the wall dynamics of the thoracic aorta, particularly in patients with aneurysms. While one recent study reports diameter change before and after endovascular therap

Multi trace element profiling in pathogenic and non-pathogenic fungi

Acknowledgements SW and EM were funded by an MRC NIRG to AB (G0900211/90671). AP was funded by a British Mycological Society Summer Studentship. AB was funded by a Royal Society URF (UF080611) and a Senior Wellcome Research Fellowship (206412/A/17/Z), which also funded TB. DW was funded by a Senior Wellcome Research Fellowship (214317/A/18/Z). The work was carried out in the MRC Centre for Medical Mycology (MR/N006364/2). This article is part of the Fungal Adaptation to Hostile Challenges special issue for the third International Symposium on Fungal Stress (ISFUS), which is supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo grant 2018/20571-6 and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior grant 88881.289327/2018-01.Peer reviewedproofPublisher PD

Drinking in style? Literature review of luxury wine consumption

Purpose – This paper aims to review and map the landscape of luxury wine consumption in the multidisciplinary literature. It highlights the key themes of analysis, consumer markets, and common behaviours of luxury wine consumption. Design/methodology/approach – The paper analyses 85 articles on luxury wine consumption using Leximancer and content analysis. Findings – Six main topics in the extant literature are identified as follows: product perception, wine price, wine information, consumption behaviour, group, and the China market. Our study revealed the shift in luxury consumption towards affordability, availability, middle-class, younger consumers, and predominately Asian markets. Research limitations/implications – As a follow-up to this research, empirical research on luxury wine consumption is needed to establish more precise definitions of terms. Social implications – Wine as a product is susceptible to societal changes and preferences, positioning it between old and common luxury. Originality/value – This research offers theoretical insights into research on luxury wine, including how the literature reflects recent societal changes. It also provides a roadmap for future research in this field

Advancing Regulatory Science With Computational Modeling for Medical Devices at the FDA's Office of Science and Engineering Laboratories

Protecting and promoting public health is the mission of the U.S. Food and Drug Administration (FDA). FDA's Center for Devices and Radiological Health (CDRH), which regulates medical devices marketed in the U.S., envisions itself as the world's leader in medical device innovation and regulatory science–the development of new methods, standards, and approaches to assess the safety, efficacy, quality, and performance of medical devices. Traditionally, bench testing, animal studies, and clinical trials have been the main sources of evidence for getting medical devices on the market in the U.S. In recent years, however, computational modeling has become an increasingly powerful tool for evaluating medical devices, complementing bench, animal and clinical methods. Moreover, computational modeling methods are increasingly being used within software platforms, serving as clinical decision support tools, and are being embedded in medical devices. Because of its reach and huge potential, computational modeling has been identified as a priority by CDRH, and indeed by FDA's leadership. Therefore, the Office of Science and Engineering Laboratories (OSEL)—the research arm of CDRH—has committed significant resources to transforming computational modeling from a valuable scientific tool to a valuable regulatory tool, and developing mechanisms to rely more on digital evidence in place of other evidence. This article introduces the role of computational modeling for medical devices, describes OSEL's ongoing research, and overviews how evidence from computational modeling (i.e., digital evidence) has been used in regulatory submissions by industry to CDRH in recent years. It concludes by discussing the potential future role for computational modeling and digital evidence in medical devices

Report on UNESCO End of Decade Conference on Education for Sustainable Development

Education for Sustainable Development (ESD), now often referenced to Education for Global Citizenship has a new platform for implementation through the Global Action Plan and the Aichi Nagoya Declaration. The Global Action Plan provides a structure for States and Organizations to make commitments for ESD¹. The Aichi Nagoya Declaration expresses responsibility for the transformative task of ESD²

Prioritising Healthy Placemaking after Covid-19 Workshop Outcomes & Practitioner Insights

This on-line event is organised in association with the South West Local Health District, Western Sydney Health Alliance, and Healthy Urban Environments Collaboratory. What have we have learnt from living through COVID19 and how do we build back better? How do we deliver placemaking that incorporates the explicit recognition of the need for social, environmental and economic sustainability and puts healthy placemaking at the top of everyone’s priorities

Credible practice of modeling and simulation in healthcare: ten rules from a multidisciplinary perspective

The complexities of modern biomedicine are rapidly increasing. Thus, modeling and simulation have become increasingly important as a strategy to understand and predict the trajectory of pathophysiology, disease genesis, and disease spread in support of clinical and policy decisions. In such cases, inappropriate or ill-placed trust in the model and simulation outcomes may result in negative outcomes, and hence illustrate the need to formalize the execution and communication of modeling and simulation practices. Although verification and validation have been generally accepted as significant components of a model\u27s credibility, they cannot be assumed to equate to a holistic credible practice, which includes activities that can impact comprehension and in-depth examination inherent in the development and reuse of the models. For the past several years, the Committee on Credible Practice of Modeling and Simulation in Healthcare, an interdisciplinary group seeded from a U.S. interagency initiative, has worked to codify best practices. Here, we provide Ten Rules for credible practice of modeling and simulation in healthcare developed from a comparative analysis by the Committee\u27s multidisciplinary membership, followed by a large stakeholder community survey. These rules establish a unified conceptual framework for modeling and simulation design, implementation, evaluation, dissemination and usage across the modeling and simulation life-cycle. While biomedical science and clinical care domains have somewhat different requirements and expectations for credible practice, our study converged on rules that would be useful across a broad swath of model types. In brief, the rules are: (1) Define context clearly. (2) Use contextually appropriate data. (3) Evaluate within context. (4) List limitations explicitly. (5) Use version control. (6) Document appropriately. (7) Disseminate broadly. (8) Get independent reviews. (9) Test competing implementations. (10) Conform to standards. Although some of these are common sense guidelines, we have found that many are often missed or misconstrued, even by seasoned practitioners. Computational models are already widely used in basic science to generate new biomedical knowledge. As they penetrate clinical care and healthcare policy, contributing to personalized and precision medicine, clinical safety will require established guidelines for the credible practice of modeling and simulation in healthcare

Emerging alphaviruses are sensitive to cellular states induced by a novel small-molecule agonist of the STING pathway

The type I interferon (IFN) system represents an essential innate immune response that renders cells resistant to virus growth via the molecular actions of IFNinduced effector proteins. IFN-mediated cellular states inhibit growth of numerous and diverse virus types, including those of known pathogenicity as well as potentially emerging agents. As such, targeted pharmacologic activation of the IFN response may represent a novel therapeutic strategy to prevent infection or spread of clinically impactful viruses. In light of this, we employed a high-throughput screen to identify small molecules capable of permeating the cell and of activating IFN-dependent signaling processes. Here we report the identification and characterization of N-(methylcarbamoyl)-2-([5-(4- methylphenyl)-1,3,4-oxadiazol-2-yl]sulfanyl)-2-phenylacetamide (referred to as C11), a novel compound capable of inducing IFN secretion from human cells. Using reverse geneticsbased loss-of-function assays, we show that C11 activates the type I IFN response in a manner that requires the adaptor protein STING but not the alternative adaptors MAVS and TRIF. Importantly, treatment of cells with C11 generated a cellular state that potently blocked replication of multiple emerging alphavirus types, including chikungunya, Ross River, Venezuelan equine encephalitis, Mayaro, and O'nyong-nyong viruses. The antiviral effects of C11 were subsequently abrogated in cells lacking STING or the type I IFN receptor, indicating that they are mediated, at least predominantly, by way of STING-mediated IFN secretion and subsequent autocrine/paracrine signaling. This work also allowed characterization of differential antiviral roles of innate immune signaling adaptors and IFN-mediated responses and identified MAVS as being crucial to cellular resistance to alphavirus infection