1,993 research outputs found

    What The Oregon Health Study Can Tell Us About Expanding Medicaid

    Get PDF
    The recently enacted Patient Protection and Affordable Care Act includes a major expansion of Medicaid to low-income adults in 2014. This paper describes the Oregon Health Study, a randomized controlled trial that will be able to shed some light on the likely effects of such expansions. In 2008, Oregon randomly drew names from a waiting list for its previously closed public insurance program. Our analysis of enrollment into this program found that people who signed up for the waiting list and enrolled in the Oregon Medicaid program were likely to have worse health than those who did not. However, actual enrollment was fairly low, partly because many applicants did not meet eligibility standards.United States. Dept. of Health and Human Services. Office of the Assistant Secretary for Planning and EvaluationCalifornia HealthCare FoundationJohn D. and Catherine T. MacArthur FoundationNational Institute on AgingRobert Wood Johnson FoundationAlfred P. Sloan FoundationUnited States. Social Security Administratio

    Transport Of Particles Across Continental Shelves

    Get PDF
    Transport of particulate material across continental shelves is well demonstrated by the distributions on the seabed and in the water column of geological, chemical, or biological components, whose sources are found farther landward or farther seaward. This paper addresses passive (incapable of swimming) particles and their transport across (not necessarily off) continental shelves during high stands of sea level. Among the general factors that influence across-shelf transport are shelf geometry, latitudinal constraints, and the timescale of interest. Research studies have investigated the physical mechanisms of transport and have made quantitative estimates of mass flux across continental shelves. Important mechanisms include wind-driven flows, internal waves, wave-orbital flows, infragravity phenomena, buoyant plumes, and surf zone processes. Most particulate transport occurs in the portion of the water column closet to the seabed. Therefore physical processes are effective where and when they influence the bottom boundary layer, causing shear stresses sufficient to erode and transport particulate material. Biological and geological processes at the seabed play important roles within the boundary layer. The coupling of hydrodynamic forces from currents and surface gravity waves has a particularly strong influence on across-shelf transport; during storm events, the combined effect can transport particles tens of kilometers seaward. Several important mechanisms can cause bidirectional (seaward and landward) transport, and estimates of the net flux are difficult to obtain. Also, measurements of across-shelf transport are made difficult by the dominance of along-shelf transport. Geological parameters are often the best indicators of net across-shelf transport integrated over time scales longer than a mouth. For example, fluvially discharged particles with distinct composition commonly accumulate in the midshelf region. Across-shelf transport of particulate material has important implications for basic and applied oceanographic research (e.g., dispersal of planktonic larvae and particle-reactive pollutants). Continued research is needed to understand the salient mechanisms and to monitor them over a range of timescales

    Sensitivity of bottom stress and bottom roughness estimates to density stratification, Eckernforde Bay, southern Baltic Sea

    Get PDF
    Thermohaline density stratification may significantly alter the classic near-bottom logarithmic velocity profile in many weak to moderately energetic, partially mixed estuaries. Results from Eckernforde Bay suggest fits to log profiles which neglect thermohaline stratification may lead to overestimates of bottom stress and roughness of the order of 130 % and 600 %, respectively. Measurements of velocity obtained at four heights within 1 m of the seabed are input to theoretical models for velocity shear derived via dimensional arguments for the \u27\u27overlap\u27\u27 layer. Previous investigators applying dimensional arguments to thermohaline stratification in estuaries have assumed buoyancy flux to be independent of height within the overlap layer. This may be a poor assumption since there is no significant source or sink of thermohaline buoyancy at the sediment-water interface. In this paper, dimensional arguments which do not assume constant buoyancy flux are used to reduce estimates of the drag coefficient and bottom roughness to below the unreasonably high values predicted by simple log profiles. Formulations assuming very weak and relatively strong stratification are applied, and estimates of buoyancy frequency derived from fits to velocity profiles are compared with independent estimates of stratification. Estimates of bottom stress and roughness derived from velocity profiles are also found to be sensitive to fluid acceleration, uncertainties in instrument settling, and limitations in current meter accuracy, but these latter effects appear secondary in Eckernforde Bay to the impacts of thermohaline stratification

    Are bisphosphonates effective in the treatment of osteoarthritis pain? A meta-analysis and systematic review.

    Get PDF
    Osteoarthritis (OA) is the most common form of arthritis worldwide. Pain and reduced function are the main symptoms in this prevalent disease. There are currently no treatments for OA that modify disease progression; therefore analgesic drugs and joint replacement for larger joints are the standard of care. In light of several recent studies reporting the use of bisphosphonates for OA treatment, our work aimed to evaluate published literature to assess the effectiveness of bisphosphonates in OA treatment

    Gene expression drives the evolution of dominance.

    Get PDF
    Dominance is a fundamental concept in molecular genetics and has implications for understanding patterns of genetic variation, evolution, and complex traits. However, despite its importance, the degree of dominance in natural populations is poorly quantified. Here, we leverage multiple mating systems in natural populations of Arabidopsis to co-estimate the distribution of fitness effects and dominance coefficients of new amino acid changing mutations. We find that more deleterious mutations are more likely to be recessive than less deleterious mutations. Further, this pattern holds across gene categories, but varies with the connectivity and expression patterns of genes. Our work argues that dominance arises as a consequence of the functional importance of genes and their optimal expression levels

    Destabilization of the thermohaline circulation by transient perturbations to the hydrological cycle

    Full text link
    We reconsider the problem of the stability of the thermohaline circulation as described by a two-dimensional Boussinesq model with mixed boundary conditions. We determine how the stability properties of the system depend on the intensity of the hydrological cycle. We define a two-dimensional parameters' space descriptive of the hydrology of the system and determine, by considering suitable quasi-static perturbations, a bounded region where multiple equilibria of the system are realized. We then focus on how the response of the system to finite-amplitude surface freshwater forcings depends on their rate of increase. We show that it is possible to define a robust separation between slow and fast regimes of forcing. Such separation is obtained by singling out an estimate of the critical growth rate for the anomalous forcing, which can be related to the characteristic advective time scale of the system.Comment: 37 pages, 8 figures, submitted to Clim. Dy

    International Veterinary Epilepsy Task Force consensus proposal: Medical treatment of canine epilepsy in Europe

    Get PDF
    In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature, 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors’ experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible

    Using latent class analysis to develop a model of the relationship between socioeconomic position and ethnicity: cross-sectional analyses from a multi-ethnic birth cohort study

    Get PDF
    Background: Almost all studies in health research control or investigate socioeconomic position (SEP) as exposure or confounder. Different measures of SEP capture different aspects of the underlying construct, so efficient methodologies to combine them are needed. SEP and ethnicity are strongly associated, however not all measures of SEP may be appropriate for all ethnic groups. Methods: We used latent class analysis (LCA) to define subgroups of women with similar SEP profiles using 19 measures of SEP. Data from 11,326 women were used, from eight different ethnic groups but with the majority from White British (40%) or Pakistani (45%) backgrounds, who were recruited during pregnancy to the Born in Bradford birth cohort study. Results: Five distinct SEP subclasses were identified in the LCA: (i) "Least socioeconomically deprived and most educated" (20%); (ii) "Employed and not materially deprived" (19%); (iii) "Employed and no access to money" (16%); (iv) "Benefits and not materially deprived" (29%) and (v) "Most economically deprived" (16%). Based on the magnitude of the point estimates, the strongest associations were that compared to White British women, Pakistani and Bangladeshi women were more likely to belong to groups: (iv) "benefits and not materially deprived" (relative risk ratio (95% CI): 5.24 (4.44, 6.19) and 3.44 (2.37, 5.00), respectively) or (v) most deprived group (2.36 (1.96, 2.84) and 3.35 (2.21, 5.06) respectively) compared to the least deprived class. White Other women were more than twice as likely to be in the (iv) "benefits and not materially deprived group" compared to White British women and all ethnic groups, other than the Mixed group, were less likely to be in the (iii) "employed and not materially deprived" group than White British women. Conclusions: LCA allows different aspects of an individual’s SEP to be considered in one multidimensional indicator, which can then be integrated in epidemiological analyses. Ethnicity is strongly associated with these identified subgroups. Findings from this study suggest a careful use of SEP measures in health research, especially when looking at different ethnic groups. Further replication of these findings is needed in other populations
    corecore