Access to Primary and Preventive Health Care Across States Prior to the Coverage Expansions of the Affordable Care Act

One goal of health insurance is ensuring people have timely access to primary and preventive care. This issue brief finds wide differences in primary and preventive care access among adults under age 65—across states and within states by income—before the Affordable Care Act's major insurance expansions took effect. When comparing experiences of adults with insurance, the analysis finds that state and income differences narrow markedly. When insured, middle- and lower-income adults across states are far more likely to have a regular source of care, receive preventive care, and be able to afford care when needed. The findings highlight the potential of expanding health insurance to reduce the steep geographic and income divide in primary and preventive care that existed across the country before 2014. Success will depend on the participation of all states. This brief offers baseline data for states and the nation to track and assess change

Diversity, Trends, Opportunities and Challenges in Australian Grasslands–Meeting the Sustainability and Productivity Imperatives of the Future?

Grassland production systems contribute 40% to Australia’s gross agricultural production value and utilise over 50% of its land area. Across this area a broad diversity of systems exist, but these can be broadly classified into four main production systems: 1. Pastoral grazing of mainly cattle at low intensity (i.e. \u3c 0.4 DSE/ha) on relatively unimproved native rangelands in the arid and semi-arid regions of northern and central Australia; 2. Crop-livestock systems in the semi-arid zone where livestock graze a mixture of pastures and crops which are often integrated; 3. High rainfall permanent pasture zone in the coastal hinterland and highlands and; 4. Dairy systems covering a broad range of environments and production intensities. A notable trend across these systems has been the replacement of wool sheep with beef cattle or meat sheep breeds, which has been driven by low wool prices. Although there is evidence that most of these systems have lifted production efficiencies over the past 30 years, total factor productivity growth has failed to match the decline in terms of trade. This has renewed attention on how research and development can help increase productivity. In addition, these industries are facing increasing scrutiny to improve their environmental performance and develop sustainable production practices. We propose several areas in which grasslands research and development might help provide gains in system productivity and sustainability. In particular, pasture productivity might be improved by filling gaps in the array of pastures available either through exploring new species or improving the adaptation and agronomic characteristics of species currently sown. Meanwhile there is a need to maintain efforts to overcome persistent and emerging constraints to pasture productivity. Improving livestock forage feed systems and more precise and lower cost management of grasslands would translate into improved utilisation and conversion of forage produced into livestock products. There is significant scope to capture value from the ecological services grasslands provide and mitigate greenhouse gas emissions from livestock production. Multi-purpose grasslands provide not only grazing for livestock but produce other food products such as grain which may also have potential to integrate livestock with cropping. However, reduced human research capacity in pasture science will challenge our ability to realise these potential opportunities unless efforts are made to attract and support a new generation of pasture scientists

Aiming Higher: Results from a State Scorecard on Health System Performance, 2014

The Commonwealth Fund's Scorecard on State Health System Performance, 2014, assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007–2012 period, which includes the Great Recession and precedes the major coverage expansions of the Affordable Care Act. Changes in health system performance were mixed overall, with states making progress on some indicators while losing ground on others. In a few areas that were the focus of national and state attention—childhood immunizations, hospital readmissions, safe prescribing, and cancer deaths— there were widespread gains. But more often than not, states exhibited little or no improvement. Access to care deteriorated for adults, while costs increased. Persistent disparities in performance across and within states and evidence of poor care coordination highlight the importance of insurance expansions, health care delivery reforms, and payment changes in promoting a more equitable, highquality health system

America's Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions

The Affordable Care Act insurance reforms seek to expand coverage and to improve the affordability of care and premiums. Before the implementation of the major reforms, data from U.S. census surveys indicated nearly 32 million insured people under age 65 were in households spending a high share of their income on medical care. Adding these "underinsured" people to the estimated 47.3 million uninsured, the state share of the population at risk for not being able to afford care ranged from 14 percent in Massachusetts to 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas. Nationally, more than half of people with low incomes and 20 percent of those with middle incomes were either underinsured or uninsured in 2012. The report provides state baselines to assess changes in coverage and affordability and compare states as insurance expansions and market reforms are implemented.

Early detection of dry bubble disease in Agaricus bisporus using volatile compounds

Lecanicillium fungicola is a pathogen of the commercial white button mushroom (Agaricus bisporus) and is the causal agent of dry bubble disease, which can cause severe economic losses to mushroom growers. Volatile compounds were measured by GC/MS techniques over pure cultures of mycelia on agars, over microcosms of growing mushrooms, and over harvested mushrooms to identify compounds that might give an early warning of the disease. The mushroom strain tested was Agaricus bisporus, strain Sylvan A15; either deliberately infected with L. fungicola or water as a control. Over microcosms, the appearance of β-copaene, β-cubebene, and α-cedrene coincided with, but did not precede, the earliest visual signs of the disease. Mushrooms with dry bubble symptoms also had high levels of β barbatene and an unknown diterpene (UK 1821). Over some harvested mushroom sets, high levels of cis-α-bisabolene developed as a defence reaction to infection

Responding to the U.S. Research Community\u27s Liquid Helium Crisis

An Action Plan to Preserve U.S. Innovation. This report lays out the issues facing researchers who use liquid helium and the negative impact on U.S. innovation. The report then proposes five key steps that will have a transformative effect on the ability to maintain the ready availability of helium and ensure the vibrancy of the U.S. low-temperature research capability. These recommendations focus on: conservation of helium use; a mechanism to pay for the capital investment required for helium recycling; a mechanism to ensure an appropriate price is paid by researchers for helium; and a methodology which allows researchers to best explore the options available to them. A SCIENCE POLICY REPORT ISSUED BY: American Physical Society, Materials Research Society, American Chemical Society Representing more than 200,000 scientists, engineers, and innovator worldwide. This report was overseen by the APS Panel on Public Affairs (POPA). POPA routinely produces reports on timely topics being debated in government so as to inform the debate with the perspectives of physicists working in the relevant issue areas

An Examination of Concepts of School Readiness Among Parents and Educators in Ireland

The Department of Children and Youth Affairs commissioned research through the Irish Research Council (IRC) to examine concepts of school readiness as they are understood by early years educators and managers, primary school principals, junior infant teachers and parents of children participating in the first Free Preschool Year in Ireland. A mixed-methods approach was adopted, involving interviews, an online survey and “draw and tell” sessions with children. Representative samples of FPSY settings and primary schools were selected and an online survey based on the findings of the qualitative phase was sent to 500 pre-primary settings and 500 primary schools. In this study, the concept of school readiness as understood by parents of children availing of the FPSY, and early years educators and managers, emerged as a multi-faceted and complex concept, influenced by and entwined with a range of interrelated factors at macro (policy), meso (interrelationships) and micro (pre-primary and primary) levels. These factors included children’s social and emotional skills, dispositions, language development, self-help skills, appropriate classroom behaviour and pre-academic skills. School readiness was clearly located along a maturationist-environmentalist continuum where readiness was associated with a child’s age as well as external evidence of the acquisition of specific skills. Interview and survey participants articulated a range of school readiness indicators, with significant differences in some instances between the importance allocated to these indicators by individual participant groups

Cognitive bias modification of interpretation in children with social anxiety disorder

Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of social anxiety disorder completed CBM-I training, adapted from materials designed for socially anxious children in the community, or no training. Effects on interpretation bias and social anxiety were assessed. The adapted CBM-I training was not associated with significant changes in benign or negative interpretation. Unsurprisingly given the lack of successful interpretation training, there were no significant changes in child or parent reported social anxiety symptoms, clinician-rated severity or diagnoses and change in interpretation was not significantly associated with change in social anxiety. These findings contrast with some studies with community populations although it is possible that more intensive CBM-I training is required to fully test this hypothesis among clinical groups

Endocrine therapy initiation among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors

Hormone receptor positive (HR+) cancers account for most breast cancer diagnoses and deaths. Among survivors with HR+ breast cancers, endocrine therapy (ET) reduces 5-year risk of recurrence by up to 40%. Observational studies in Medicare and privately-insured survivors suggest under-utilization of ET. We sought to characterize ET use in a low-income Medicaid-insured population in North Carolina

Parental responsibility beliefs: associations with parental anxiety and behaviours in the context of childhood anxiety disorders

Background: High levels of parental anxiety are associated with poor treatment outcomes for children with anxiety disorders. Associated parental cognitions and behaviours have been implicated as impediments to successful treatment. We examined the association between parental responsibility beliefs, maternal anxiety and parenting behaviours in the context of childhood anxiety disorders. Methods: Anxious and non-anxious mothers of 7-12 year old children with a current anxiety disorder reported their parental responsibility beliefs using a questionnaire measure. Parental behaviours towards their child during a stressor task were measured. Results: Parents with a current anxiety disorder reported a greater sense of responsibility for their child’s actions and wellbeing than parents who scored within the normal range for anxiety. Furthermore, higher parental responsibility was associated with more intrusive and less warm behaviours in parent-child interactions and there was an indirect effect between maternal anxiety and maternal intrusive behaviours via parental responsibility beliefs. Limitations: The sample was limited to a treatment-seeking, relatively high socio-economic population and only mothers were included so replication with more diverse groups is needed. The use of a range of stressor tasks may have allowed for a more comprehensive assessment of parental behaviours. Conclusions: The findings suggest that parental anxiety disorder is associated with an elevated sense of parental responsibility and may promote parental behaviours likely to inhibit optimum child treatment outcomes. Parental responsibility beliefs may therefore be important to target in child anxiety treatments in the context of parental anxiety disorders