Confronting ‘confounding by health system use’ in Medicare Part D: Comparative effectiveness of propensity score approaches to confounding adjustment

PubMed Central

Polinski, Jennifer M.; Schneeweiss, Sebastian; Glynn, Robert J.; Lii, Joyce; Rassen, Jeremy

2012-01-01

Purpose Under Medicare Part D, patient characteristics influence plan choice, which in turn influences Part D coverage gap entry. We compared pre-defined propensity score (PS) and high-dimensional propensity score (hdPS) approaches to address such ‘confounding by health system use’ in assessing whether coverage gap entry is associated with cardiovascular events or death. Methods We followed 243,079 Medicare patients aged 65+ with linked prescription, medical, and plan-specific data in 2005–2007. Patients reached the coverage gap and were followed until an event or year’s end. Exposed patients were responsible for drug costs in the gap; unexposed patients (patients with non-Part D drug insurance and Part D patients receiving a low-income subsidy (LIS)) received financial assistance. Exposed patients were 1:1 PS- or hdPS-matched to unexposed patients. The PS model included 52 predefined covariates; the hdPS model added 400 empirically identified covariates. Hazard ratios for death and any of five cardiovascular outcomes were compared. In sensitivity analyses, we explored residual confounding using only LIS patients in the unexposed group. Results In unadjusted analyses, exposed patients had no greater hazard of death (HR=1.00; 95% CI, 0.84–1.20) or other outcomes. PS- (HR=1.29;0.99–1.66) and hdPS- (HR=1.11;0.86–1.42) matched analyses showed elevated but non-significant hazards of death. In sensitivity analyses, the PS analysis showed a protective effect (HR=0.78;0.61–0.98), while the hdPS analysis (HR=1.06;0.82–1.37) confirmed the main hdPS findings. Conclusion Although the PS-matched analysis suggested elevated though non-significant hazards of death among patients with no financial assistance during the gap, the hdPS analysis produced lower estimates that were stable across sensitivity analyses. PMID:22552984

Closing the Gap Between Formal and Material Health Care Coverage in Colombia

PubMed Central

García, Johnattan

2016-01-01

Abstract This paper explores Colombia’s road toward universal health care coverage. Using a policy-based approach, we show how, in Colombia, the legal expansion of health coverage is not sufficient and requires the development of appropriate and effective institutions. We distinguish between formal and material health coverage in order to underscore that, despite the rapid legal expansion of health care coverage, a considerable number of Colombians—especially those living in poor regions of the country—still lack material access to health care services. As a result of this gap between formal and material coverage, an individual living in a rich region has a much better chance of accessing basic health care than an inhabitant of a poor region. This gap between formal and material health coverage has also resulted in hundreds of thousands of citizens filing lawsuits—tutelas—demanding access to medications and treatments that are covered by the health system, but that health insurance companies—also known as EPS— refuse to provide. We explore why part of the population that is formally insured is still unable to gain material access to health care and has to litigate in order to access mandatory health services. We conclude by discussing the current policy efforts to reform the health sector in order to achieve material, universal health care coverage. PMID:28559676

Saturn's Misbegotten Moonlets

NASA Astrophysics Data System (ADS)

Spitale, Joseph N.

2017-06-01

Saturn's rings are interspersed with numerous narrow (tens of km wide) gaps. Two of the largest of these gaps -- Encke and Keeler -- contain satellites -- Pan and Daphnis -- that maintain their respective gaps via the classical Goldreich/Tremaine-style shepherding mechanism wherein angular momentum is transferred across the essentially empty gap via torques acting between the satellites and the ring. Other prominent gaps are shepherded by resonances with external satellites or planetary modes: Mimas shepherds the outer edge of the B ring, clearing the inner part of the Cassini Division, Titan shepherds the Columbo ringlet / gap, and the Maxwell ringlet / gap is likely maintained by a resonance with a planetary mode. Prior to Cassini, it was expected that all of the gaps would be shepherded in a similar manner.However, many small gaps do not correspond with known resonances, and no satellites were spotted within those gaps during Cassini's prime and extended mission. To address this issue, a series of Cassini imaging observations were planned to examine 11 gaps in the C ring and Cassini division at a resolution and longitudinal coverage sufficient to either discover the shepherds or rule out their presence. The survey discovered no embedded satellites. Longitudinal coverage was incomplete, but within longitudes covered by the survey, satellites are ruled out to sizes in the 100-m range, far too small keep the observed gaps open. It is possible (about even odds) that there could be a larger satellite residing at a longitude not covered in the survey, but the probability that the survey was unfortunate enough to miss significant satellites in all 11 gaps is exceedingly small (~0.002%). Moreover, these gaps appear in earlier imaging sequences, with some high-resolution coverage, so the true probability is smaller yet. Therefore, a new theory is likely needed to explain the presence of the gaps.

Myopic and Forward Looking Behavior in Branded Oral Anti-Diabetic Medication Consumption: An Example from Medicare Part D.

PubMed

Sacks, Naomi C; Burgess, James F; Cabral, Howard J; Pizer, Steven D

2017-06-01

We evaluate consumption responses to the non-linear Medicare Part D prescription drug benefit. We compare propensity-matched older patients with diabetes and Part D Standard or low-income-subsidy (LIS) coverage. We evaluate monthly adherence to branded oral anti-diabetics, with high end-of-year donut hole prices (>$200) for Standard patients and consistent, low (≤$6) prices for LIS. As an additional control, we examine adherence to generic anti-diabetics, with relatively low, consistent prices for Standard patients. If Standard patients are forward looking, they will reduce branded adherence in January, and LIS-Standard differences will be constant through the year. Contrary to this expectation, branded adherence is lower for Standard patients in January and diverges from LIS as the coverage year progresses. Standard-LIS generic adherence differences are minimal. Our findings suggest that seniors with chronic conditions respond myopically to the nonlinear Part D benefit, reducing consumption in response to high deductible, initial coverage and gap prices. Thus, when the gap is fully phased out in 2020, cost-related nonadherence will likely remain in the face of higher spot prices for more costly branded medications. These results contribute to studies of Part D plan choice and medication adherence that suggest that seniors may not make optimal healthcare decisions. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Coverage gap in maternal and child health services in India: assessing trends and regional deprivation during 1992-2006.

PubMed

Kumar, Chandan; Singh, Prashant Kumar; Rai, Rajesh Kumar

2013-12-01

Increasing the coverage of key maternal, newborn and child health interventions is essential, if India has to attain Millennium Development Goals 4 and 5. This study assesses the coverage gap in maternal and child health services across states in India during 1992-2006 emphasizing the rural-urban disparities. Additionally, association between the coverage gap and under-5 mortality rate across states are illustrated. The three waves of National Family Health Survey (NFHS) conducted during 1992-1993 (NFHS-1), 1998-1999 (NFHS-2) and 2005-2006 (NFHS-3) were used to construct a composite index of coverage gap in four areas of health-care interventions: family planning, maternal and newborn care, immunization and treatment of sick children. The central, eastern and northeastern regions of India reported a higher coverage gap in maternal and child health care services during 1992-2006, while the rural-urban difference in the coverage gap has increased in Gujarat, Haryana, Rajasthan and Kerala over the period. The analysis also shows a significant positive relationship between the coverage gap index and under-five mortality rate across states. Region or area-specific focus in order to increase the coverage of maternal and child health care services in India should be the priority of the policy-makers and programme executors.

Towards universal health coverage: the role of within-country wealth-related inequality in 28 countries in sub-Saharan Africa.

PubMed

Hosseinpoor, Ahmad Reza; Victora, Cesar G; Bergen, Nicole; Barros, Aluisio J D; Boerma, Ties

2011-12-01

To measure within-country wealth-related inequality in the health service coverage gap of maternal and child health indicators in sub-Saharan Africa and quantify its contribution to the national health service coverage gap. Coverage data for child and maternal health services in 28 sub-Saharan African countries were obtained from the 2000-2008 Demographic Health Survey. For each country, the national coverage gap was determined for an overall health service coverage index and select individual health service indicators. The data were then additively broken down into the coverage gap in the wealthiest quintile (i.e. the proportion of the quintile lacking a required health service) and the population attributable risk (an absolute measure of within-country wealth-related inequality). In 26 countries, within-country wealth-related inequality accounted for more than one quarter of the national overall coverage gap. Reducing such inequality could lower this gap by 16% to 56%, depending on the country. Regarding select individual health service indicators, wealth-related inequality was more common in services such as skilled birth attendance and antenatal care, and less so in family planning, measles immunization, receipt of a third dose of vaccine against diphtheria, pertussis and tetanus and treatment of acute respiratory infections in children under 5 years of age. The contribution of wealth-related inequality to the child and maternal health service coverage gap differs by country and type of health service, warranting case-specific interventions. Targeted policies are most appropriate where high within-country wealth-related inequality exists, and whole-population approaches, where the health-service coverage gap is high in all quintiles.

Ongoing Coverage for Ongoing Care: Access, Utilization, and Out-of-Pocket Spending Among Uninsured Working-Aged Adults with Chronic Health Care Needs

PubMed Central

Rasch, Elizabeth K.; Chan, Leighton

2011-01-01

Objectives. We sought to determine how part-year and full-year gaps in health insurance coverage affected working-aged persons with chronic health care needs. Methods. We conducted multivariate analyses of the 2002–2004 Medical Expenditure Panel Survey to compare access, utilization, and out-of-pocket spending burden among key groups of persons with chronic conditions and disabilities. The results are generalizable to the US community-dwelling population aged 18 to 64 years. Results. Among 92 million adults with chronic conditions, 21% experienced at least 1 month uninsured during the average year (2002–2004). Among the 25 million persons reporting both chronic conditions and disabilities, 23% were uninsured during the average year. These gaps in coverage were associated with significantly higher levels of access problems, lower rates of ambulatory visits and prescription drug use, and higher levels of out-of-pocket spending. Conclusions. Implementation of health care reform must focus not only on the prevention of chronic conditions and the expansion of insurance coverage but also on the long-term stability of the coverage to be offered. PMID:21164090

Medicare prescription drug plan coverage of pharmacotherapies for opioid and alcohol dependence in WA.

PubMed

Kennedy, Jae; Dipzinski, Aaron; Roll, John; Coyne, Joseph; Blodgett, Elizabeth

2011-04-01

Pharmacotherapeutic treatments for drug addiction offer new options, but only if they are affordable for patients. The objective of this study is to assess the current availability and cost of five common antiaddiction medications in the largest federal medication insurance program in the US, Medicare Part D. In early 2010, we collected coverage and cost data from 41 Medicare Part D prescription drug plans (PDPs) and 45 Medicare Advantage Plans (MAPs) in Washington State. The great majority of Medicare plans (82-100%) covered common pharmacotherapeutic treatments for drug addiction. These Medicare plans typically placed patent protected medications on their highest formulary tiers, leading to relatively high patient co-payments during the initial Part D coverage period. For example, median monthly co-payments for buprenorphine (Suboxone®) were about $46 for PDPs, and about $56 for MAPs. While Medicare prescription plans usually cover pharmacotherapeutic treatments for drug addiction, high co-payments can limit access. For example, beneficiaries without supplemental coverage who use Vivitrol® would exceed their initial coverage cap in 7-8 months, reaching the "doughnut hole" in their Part D coverage and becoming responsible for the full cost of the medication (over $900 per month). The 2010 Patient Protection and Affordable Care Act will gradually eliminate this coverage gap, and loss of patent protection for other antiaddiction medications (Suboxone® and Campral®) should also drive down patient costs, improving access and compliance. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Transplant recipients are vulnerable to coverage denial under Medicare Part D.

PubMed

Potter, Lisa M; Maldonado, Angela Q; Lentine, Krista L; Schnitzler, Mark A; Zhang, Zidong; Hess, Gregory P; Garrity, Edward; Kasiske, Bertram L; Axelrod, David A

2018-02-15

Transplant immunosuppressants are often used off-label because of insufficient randomized prospective trial data to achieve organ-specific US Food and Drug Administration (FDA) approval. Transplant recipients who rely on Medicare Part D for immunosuppressant drug coverage are vulnerable to coverage denial for off-label prescriptions, unless use is supported by Centers for Medicare & Medicaid Services (CMS)-approved compendia. An integrated dataset including national transplant registry data and 3 years of dispensed pharmacy records was used to identify the prevalence of immunosuppression use that is both off-label and not supported by CMS-approved compendia. Numbers of potentially vulnerable transplant recipients were identified. Off-label and off-compendia immunosuppression regimens are frequently prescribed (3-year mean: lung 66.5%, intestine 34.2%, pancreas 33.4%, heart 21.8%, liver 16.5%, kidney 0%). The annual retail cost of these at-risk medications exceeds $30 million. This population-based study of transplant immunosuppressants vulnerable to claim denials under Medicare Part D coverage demonstrates a substantial gap between clinical practice, current FDA approval processes, and policy mandates for pharmaceutical coverage. This coverage barrier reduces access to life-saving medications for patients without alternative resources and may increase the risk of graft loss and death from medication nonadherence. © 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.

75 FR 29555 - Medicare Program; Medicare Coverage Gap Discount Program Model Manufacturer Agreement and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-26

... Center Hotel, 101 West Fayette Street, Baltimore, MD 21201. Registration and Special Accommodations... percent of the Part D negotiated price for covered Part D claims above the ICL until their TrOOP costs... of an amount equal to the negotiated price (as defined in section 1860D- 14A(g)(6) of the Act...

[Gaps in effective coverage by socioeconomic status and poverty condition].

PubMed

Gutiérrez, Juan Pablo

2013-01-01

To analyze, in the context of increased health protection in Mexico, the gaps by socioeconomic status and poverty condition on effective coverage of selected preventive interventions. Data from the National Health & Nutrition Survey 2012 and 2006, using previously defined indicators of effective coverage and stratifying them by socioeconomic (SE) status and multidimensional poverty condition. For vaccination interventions, immunological equity has been maintained in Mexico. For indicators related to preventive interventions provided at the clinical setting, effective coverage is lower among those in the lowest SE quintile and among people living in multidimensional poverty. Comparing 2006 and 2012, there is no evidence on gap reduction. While health protection has significantly increased in Mexico, thus reducing SE gaps, those gaps are still important in magnitude for effective coverage of preventive interventions.

Costs in the coverage gap

MedlinePlus

... D costs won’t enter the coverage gap. Brand-name prescription drugs Once you reach the coverage ... than 35% of the plan's cost for covered brand-name prescription drugs. You get these savings if ...

[Effects of forest gap size and light intensity on herbaceous plants in Pinus koraiensis-dominated broadleaved mixed forest].

PubMed

Duan, Wen-Biao; Wang, Li-Xia; Chen, Li-Xin; Du, Shan; Wei, Quan-Shuai; Zhao, Jian-Hui

2013-03-01

1 m x 1 m fixed quadrats were parallelly arranged with a space of 2 m in each of six forest gaps in Pinus koraiensis-dominated broadleaved mixed forest, taking the gap center as the starting point and along east-west and south-north directions. In each quadrat, the coverage and abundance of herbaceous plants at different height levels were investigated by estimation method in June and September 2011, and the matrix characteristics within the quadrats were recorded. Canopy analyzer was used to take fish-eye photos in the selected overcast days in each month from June to September, 2011, and the relative light intensity was calculated by using Gap Light Analyzer 2.0 software. The differences in the relative light intensity and herbaceous plants coverage and richness between different gaps as well as the correlations between the coverage of each species and the direct light, diffuse light, and matrix were analyzed. The results showed that in opening areas and under canopy, the relative light intensity in large gaps was higher than that in small gaps, and the variation ranges of diffuse light and direct light from gap center to gap edge were bigger in large gaps than in small gaps. The direct light reaching at the ground both in large gaps and in small gaps was higher in the north than in the south direction. In the Z1, Z2, Z3, and Z4 zones, both the coverage and the richness of herbaceous plants were larger in large gaps than in small gaps, and the differences of species richness between large and small gaps reached significant level. The coverage of the majority of the herbaceous plants had significant correlations with diffuse light and matrix, and only the coverage of a few herbaceous plants was correlated with direct light.

Three-Dimensional Analysis of Deep Space Network Antenna Coverage

NASA Technical Reports Server (NTRS)

Kegege, Obadiah; Fuentes, Michael; Meyer, Nicholas; Sil, Amy

2012-01-01

There is a need to understand NASA s Deep Space Network (DSN) coverage gaps and any limitations to provide redundant communication coverage for future deep space missions, especially for manned missions to Moon and Mars. The DSN antennas are required to provide continuous communication coverage for deep space flights, interplanetary missions, and deep space scientific observations. The DSN consists of ground antennas located at three sites: Goldstone in USA, Canberra in Australia, and Madrid in Spain. These locations are not separated by the exactly 120 degrees and some DSN antennas are located in the bowl-shaped mountainous terrain to shield against radiofrequency interference resulting in a coverage gap in the southern hemisphere for the current DSN architecture. To analyze the extent of this gap and other coverage limitations, simulations of the DSN architecture were performed. In addition to the physical properties of the DSN assets, the simulation incorporated communication forward link calculations and azimuth/elevation masks that constrain the effects of terrain for each DSN antenna. Analysis of the simulation data was performed to create coverage profiles with the receiver settings at a deep space altitudes ranging from 2 million to 10 million km and a spherical grid resolution of 0.25 degrees with respect to longitude and latitude. With the results of these simulations, two- and three-dimensional representations of the area without communication coverage and area with coverage were developed, showing the size and shape of the communication coverage gap projected in space. Also, the significance of this communication coverage gap is analyzed from the simulation data.

In-gap discounts in Medicare Part D and specialty drug use.

PubMed

Jung, Jeah; Xu, Wendy Yi; Cheong, Chelim

2017-09-01

Specialty drugs can bring significant benefits to patients, but they can be expensive. Medicare Part D plans charge relatively high cost-sharing costs for specialty drugs. A provision in the Affordable Care Act reduced cost sharing in the Part D coverage gap phase in an attempt to mitigate the financial burden of beneficiaries with high drug spending. We examined the early impact of the Part D in-gap discount on specialty cancer drug use and patients' out-of-pocket (OOP) spending. Natural experimental design. We compared changes in outcomes before and after the in-gap discount among beneficiaries with and without low-income subsidies (LIS). Beneficiaries with LIS, who were not affected by the in-gap discount, made up the control group. We studied a random sample of elderly standalone prescription drug plan enrollees with relatively uncommon cancers (eg, leukemia, skin, pancreas, kidney, sarcomas, and non-Hodgkin lymphoma) between 2009 and 2013. We constructed 4 outcome variables annually: 1) use of any specialty cancer drug, 2) the number of specialty cancer drug fills, 3) total specialty drug spending, and 4) OOP spending for specialty cancer drugs. The in-gap discount did not influence specialty cancer drug use, but reduced annual OOP spending for specialty cancer drugs among users without LIS by $1108. In-gap discounts in Part D decreased patients' financial burden to some extent, but resulted in no change in specialty drug use. As demand for specialty drugs increases, it will be important to ensure patients' access to needed drugs, while simultaneously reducing their financial burden.

Improving care for patients on antiretroviral therapy through a gap analysis framework.

PubMed

Massoud, M Rashad; Shakir, Fazila; Livesley, Nigel; Muhire, Martin; Nabwire, Juliana; Ottosson, Amanda; Jean-Baptiste, Rachel; Megere, Humphrey; Karamagi-Nkolo, Esther; Gaudreault, Suzanne; Marks, Pamela; Jennings, Larissa

2015-07-01

To improve quality of care through decreasing existing gaps in the areas of coverage, retention, and wellness of patients receiving HIV care and treatment. The antiretroviral therapy (ART) Framework utilizes improvement methods and the Chronic Care Model to address the coverage, retention, and wellness gaps in HIV care and treatment. This is a time-series study. The ART Framework was applied in five health centers in Buikwe District, Uganda. Quality improvement teams, consisting of healthcare workers and expert patients, were established in each of the five healthcare facilities. The intervention period was October 2010 to September 2012. It consisted of quality improvement teams analyzing their facility and systems of care from the perspective of the Chronic Care Model to identify areas of improvement. They implemented the ART Framework, collected data and assessed outcomes, focused on self-management support for patients, to improve coverage, retention, and wellness gaps in HIV care and treatment. Coverage was defined as every patient who needs ART in the catchment area, receives it. Retention was defined as every patient who receives ART stays on ART, and wellness defined as having a positive clinical, immunological, and/or virological response to treatment without intolerable or unmanageable side-effects. Results from Buikwe show the gaps in coverage, retention, and wellness greatly decreased a gap in coverage of 44-19%, gap in retention of 49-24%, and gap in wellness of 53-14% during a 2-year intervention period. The ART Framework is an innovative and practical tool for HIV program managers to improve HIV care and treatment.

Coordination of health coverage for Medicare enrollees: living with HIV/AIDS in California.

PubMed

Eichner, J; Kahn, J G

2001-08-01

Because Medicare does not cover a large part of the health care that its enrollees living with HIV/AIDS require, they need other coverage to supplement Medicare. Medicaid is a major source of that supplemental coverage. In California, Medicare enrollees with HIV/AIDS who were also enrolled in Medi-Cal (California's Medicaid program) had total payments from both programs of $177 million, or an average of $28,956 per person in the fee-for-service-system in 1998. Of that total, Medicare paid for 38 percent, mainly for inpatient visits and ambulatory care, while Medi-Cal paid 62 percent, mainly for prescription drugs. For these dual enrollees, many of Medicare's benefit gaps--including a large share of prescription drugs, nursing facility services and home care--are being filled by Medi-Cal. Data in this Medicare Brief indicate that the incremental cost to the federal government of filling gaps in the Medicare benefits package would be considerably less than the full cost of the additional benefits. Through Medicaid and other programs, the federal government is already paying a substantial part of public program expenditures for dual enrollees with HIV/AIDS. Other issues to consider are how the dual Medicare-Medicaid funding streams affect the programs' cost efficiency, and from the perspective of Medicare enrollees and providers, how well the dual programs coordinate to meet the needs of people with HIV/AIDS and other chronic conditions.

Assessment of DSN Communication Coverage for Space Missions to Potentially Hazardous Asteroids

NASA Technical Reports Server (NTRS)

Kegege, Obadiah; Bittner, David; Gati, Frank; Bhasin, Kul

2012-01-01

A communication coverage gap exists for Deep Space Network (DSN) antennas. This communication coverage gap is on the southern hemisphere, centered at approximate latitude of -47deg and longitude of -45deg. The area of this communication gap varies depending on the altitude from the Earth s surface. There are no current planetary space missions that fall within the DSN communication gap because planetary bodies in the Solar system lie near the ecliptic plane. However, some asteroids orbits are not confined to the ecliptic plane. In recent years, Potentially Hazardous Asteroids (PHAs) have passed within 100,000 km of the Earth. NASA s future space exploration goals include a manned mission to asteroids. It is important to ensure reliable and redundant communication coverage/capabilities for manned space missions to dangerous asteroids that make a sequence of close Earth encounters. In this paper, we will describe simulations performed to determine whether near-Earth objects (NEO) that have been classified as PHAs fall within the DSN communication coverage gap. In the study, we reviewed literature for a number of PHAs, generated binary ephemeris for selected PHAs using JPL s HORIZONS tool, and created their trajectories using Satellite Took Kit (STK). The results show that some of the PHAs fall within DSN communication coverage gap. This paper presents the simulation results and our analyses

Riding the rollercoaster: the ups and downs in out-of-pocket spending under the standard Medicare drug benefit.

PubMed

Stuart, Bruce; Briesacher, Becky A; Shea, Dennis G; Cooper, Barbara; Baysac, Fatima S; Limcangco, M Rhona

2005-01-01

This study projects how much Medicare beneficiaries who sign up for the standard Part D drug benefit in 2006 will pay in quarterly out-of-pocket payments through 2008. In the first year we estimate that about 38 percent of enrollees will hit the benefit's no-coverage zone, known as the "doughnut hole," and that 14 percent will exceed the catastrophic threshold. Because drug spending is highly persistent over time, beneficiaries who experience the biggest gaps in coverage are likely to do so year after year, with potentially serious financial consequences.

Gaps in health insurance: why so many Americans experience breaks in coverage and how the Affordable Care Act will help: findings from the Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults, 2011.

PubMed

Collins, Sara R; Robertson, Ruth; Garber, Tracy; Doty, Michelle M

2012-04-01

The Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults finds that one-quarter of adults ages 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. Losing or changing jobs was the primary reason people experienced a gap. Compared with adults who had continuous coverage, those who experienced gaps were less likely to have a regular doctor and less likely to be up to date with recommended preventive care tests, with rates declining as the length of the coverage gap increases. Early provisions of the Affordable Care Act are already helping bridge gaps in coverage among young adults and people with preexisting conditions. Beginning in 2014, new affordable health insurance options through Medicaid and state insurance exchanges will enable adults and their families to remain insured even in the face of job changes and other life disruptions.

To close the childhood immunization gap, we need a richer understanding of parents' decision-making.

PubMed

Corben, Paul; Leask, Julie

2016-12-01

Vaccination is widely acknowledged as one of the most successful public health interventions globally and in most high-income countries childhood vaccination coverage rates are moderately high. Yet in many instances, immunisation rates remain below aspirational targets and have shown only modest progress toward those targets in recent years, despite concerted efforts to improve uptake. In part, coverage rates reflect individual parents' vaccination attitudes and decisions and, because vaccination decision-making is complex and context-specific, it remains challenging at individual and community levels to assist parents to make positive decisions. Consequently, in the search for opportunities to improve immunisation coverage, there has been a renewed research focus on parents' decision-making. This review provides an overview of the literature surrounding parents' vaccination decision-making, offering suggestions for where efforts to increase vaccination coverage should be targeted and identifying areas for further research.

State Medicaid Coverage, ESRD Incidence, and Access to Care

PubMed Central

Goldstein, Benjamin A.; Hall, Yoshio N.; Mitani, Aya A.; Winkelmayer, Wolfgang C.

2014-01-01

The proportion of low-income nonelderly adults covered by Medicaid varies widely by state. We sought to determine whether broader state Medicaid coverage, defined as the proportion of each state’s low-income nonelderly adult population covered by Medicaid, associates with lower state-level incidence of ESRD and greater access to care. The main outcomes were incidence of ESRD and five indicators of access to care. We identified 408,535 adults aged 20–64 years, who developed ESRD between January 1, 2001, and December 31, 2008. Medicaid coverage among low-income nonelderly adults ranged from 12.2% to 66.0% (median 32.5%). For each additional 10% of the low-income nonelderly population covered by Medicaid, there was a 1.8% (95% confidence interval, 1.0% to 2.6%) decrease in ESRD incidence. Among nonelderly adults with ESRD, gaps in access to care between those with private insurance and those with Medicaid were narrower in states with broader coverage. For a 50-year-old white woman, the access gap to the kidney transplant waiting list between Medicaid and private insurance decreased by 7.7 percentage points in high (>45%) versus low (<25%) Medicaid coverage states. Similarly, the access gap to transplantation decreased by 4.0 percentage points and the access gap to peritoneal dialysis decreased by 3.8 percentage points in high Medicaid coverage states. In conclusion, states with broader Medicaid coverage had a lower incidence of ESRD and smaller insurance-related access gaps. PMID:24652791

Realizing Universal Health Coverage in East Africa: the relevance of human rights.

PubMed

Yamin, Alicia Ely; Maleche, Allan

2017-08-03

Applying a robust human rights framework would change thinking and decision-making in efforts to achieve Universal Health Coverage (UHC), and advance efforts to promote women's, children's, and adolescents' health in East Africa, which is a priority under the Sustainable Development Agenda. Nevertheless, there is a gap between global rhetoric of human rights and ongoing health reform efforts. This debate article seeks to fill part of that gap by setting out principles of human rights-based approaches (HRBAs), and then applying those principles to questions that countries undertaking efforts toward UHC and promoting women's, children's and adolescents' health, will need to face, focusing in particular on ensuring enabling legal and policy frameworks, establishing fair financing; priority-setting processes, and meaningful oversight and accountability mechanisms. In a region where democratic institutions are notoriously weak, we argue that the explicit application of a meaningful human rights framework could enhance equity, participation and accountability, and in turn the democratic legitimacy of health reform initiatives being undertaken in the region.

Closing the gap in Australian Aboriginal infant immunisation rates -- the development and review of a pre-call strategy.

PubMed

Cashman, Patrick M; Allan, Natalie A; Clark, Katrina K; Butler, Michelle T; Massey, Peter D; Durrheim, David N

2016-06-16

Improving timely immunisation is key to closing the inequitable gap in immunisation rates between Aboriginal children and non-Indigenous children. Aboriginal Immunisation Officers were employed in Hunter New England Local Health District (HNELHD), New South Wales (NSW), Australia, to telephone the families of all Aboriginal infants prior to the due date for their first scheduled vaccination. Aboriginal Immunisation Officers contacted the families of Aboriginal children born in the Hunter New England Local Health District (HNELHD) by telephone before their due immunisation date (pre-call) to provide the rationale for timely immunisation, and to facilitate contact with culturally safe local immunisation services if this was required. The impact of this strategy on immunisation coverage rates is reviewed. For the period March 2010 to September 2014 there was a significant increase in immunisation coverage rate for Aboriginal children at 12 months of age in HNELHD (p < 0.0001). The coverage in the rest of NSW Aboriginal children also increased but not significantly (p = 0.218). Over the full study period there was a significant decrease in the immunisation coverage gap between Aboriginal children and non-Indigenous children in HNELHD (p < 0.0001) and the rest of NSW (p = 0.004). The immunisation coverage gap between Aboriginal and non-Indigenous infants decreased at a significantly faster rate in HNELHD than the rest of NSW (p = 0.0001). By the end of the study period in 2014, immunisation coverage in HNELHD Aboriginal infants had surpassed that of non-Indigenous infants by 0.8 %. The employment of Aboriginal immunisation officers may be associated with closing of the gap between Aboriginal and non-Indigenous infants' immunisation coverage in HNELHD and NSW. The pre-call telephone strategy provided accelerated benefit in closing this gap in HNELHD.

Preliminary analysis of Dione Regio, Venus: The final Magellan regional imaging gap

NASA Technical Reports Server (NTRS)

Keddie, S. T.

1993-01-01

In Sep. 1992, the Magellan spacecraft filled the final large gap in its coverage of Venus when it imaged an area west of Alpha Regio. F-BIDR's and some test MIDR's of parts of this area were available as of late December. Dione Regio was imaged by the Arecibo observatory and a preliminary investigation of Magellan images supports the interpretations made based on these earlier images: Dione Regio is a regional highland on which is superposed three large, very distinct volcanic edifices. The superior resolution and different viewing geometry of the Magellan images also clarified some uncertainties and revealed fascinating details about this region.

GapFiller: a de novo assembly approach to fill the gap within paired reads

PubMed Central

2012-01-01

Background Next Generation Sequencing technologies are able to provide high genome coverages at a relatively low cost. However, due to limited reads' length (from 30 bp up to 200 bp), specific bioinformatics problems have become even more difficult to solve. De novo assembly with short reads, for example, is more complicated at least for two reasons: first, the overall amount of "noisy" data to cope with increased and, second, as the reads' length decreases the number of unsolvable repeats grows. Our work's aim is to go at the root of the problem by providing a pre-processing tool capable to produce (in-silico) longer and highly accurate sequences from a collection of Next Generation Sequencing reads. Results In this paper a seed-and-extend local assembler is presented. The kernel algorithm is a loop that, starting from a read used as seed, keeps extending it using heuristics whose main goal is to produce a collection of error-free and longer sequences. In particular, GapFiller carefully detects reliable overlaps and operates clustering similar reads in order to reconstruct the missing part between the two ends of the same insert. Our tool's output has been validated on 24 experiments using both simulated and real paired reads datasets. The output sequences are declared correct when the seed-mate is found. In the experiments performed, GapFiller was able to extend high percentages of the processed seeds and find their mates, with a false positives rate that turned out to be nearly negligible. Conclusions GapFiller, starting from a sufficiently high short reads coverage, is able to produce high coverages of accurate longer sequences (from 300 bp up to 3500 bp). The procedure to perform safe extensions, together with the mate-found check, turned out to be a powerful criterion to guarantee contigs' correctness. GapFiller has further potential, as it could be applied in a number of different scenarios, including the post-processing validation of insertions/deletions detection pipelines, pre-processing routines on datasets for de novo assembly pipelines, or in any hierarchical approach designed to assemble, analyse or validate pools of sequences. PMID:23095524

Computer Techniques for Studying Coverage, Overlaps, and Gaps in Collections.

ERIC Educational Resources Information Center

White, Howard D.

1987-01-01

Describes techniques for using the Statistical Package for the Social Sciences (SSPS) to create tables for cooperative collection development across a number of libraries. Specific commands are given to generate holdings profiles focusing on collection coverage, overlaps, gaps, or other areas of interest, from a master bibliographic list. (CLB)

Monitoring intervention coverage in the context of universal health coverage.

PubMed

Boerma, Ties; AbouZahr, Carla; Evans, David; Evans, Tim

2014-09-01

Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of reliable, comprehensive, and timely health facility data. Please see later in the article for the Editors' Summary.

Monitoring Intervention Coverage in the Context of Universal Health Coverage

PubMed Central

Boerma, Ties; AbouZahr, Carla; Evans, David; Evans, Tim

2014-01-01

Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups—promotion/prevention, and treatment/care—as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of reliable, comprehensive, and timely health facility data. Please see later in the article for the Editors' Summary PMID:25243586

Pension coverage among the baby boomers: initial findings from a 1993 survey.

PubMed

Woods, J R

1994-01-01

Using data from a series of supplements to the Current Population Survey, this article presents findings on workers' coverage under employer-sponsored retirement plans in 1993, and recent trends in coverage. The analysis focuses on workers 25-54, a group that includes the baby boom generation. Among all wage and salary workers in this age range (including government employees and part-time workers), 55 percent reported participating in a retirement plan on their current primary jobs, and an additional 3 percent were covered from other jobs. After a modest decline in the early 1980's, the coverage rate has remained essentially unchanged over the past 10 years, and limited data suggest that the baby boomers are doing about as well on pension coverage as older workers at similar points in their careers. Beneath this relative stability in overall coverage, however, at least two important changes have occurred: a significant narrowing of the gender gap in coverage and a shift in types of retirement plans. Increasing numbers of workers are being covered solely by 401(k)-type plans, a development that raises new uncertainties about the form and amount of future benefits. On the other hand, limited data in this study suggest that 401(k) plans may be serving their intended purpose for the majority of workers who have them.

Modernizing Medicare's Benefit Design and Low-Income Subsidies to Ensure Access and Affordability.

PubMed

Schoen, Cathy; Davis, Karen; Buttorff, Christine; Andersen, Martin

2015-07-01

Insurance coverage through the traditional Medicare program is complex, fragmented, and incomplete. Beneficiaries must purchase supplemental private insurance to fill in the gaps. While impoverished beneficiaries may receive supplemental coverage through Medicaid and subsidies for prescription drugs, help is limited for people with incomes above the poverty level. This patchwork quilt leads to confusion for beneficiaries and high administrative costs, while also undermining coverage and care coordination. Most important, Medicare's benefits fail to limit out-of-pocket costs or ensure adequate financial protection, especially for beneficiaries with low incomes and serious health problems. This brief, part of a series about Medicare's past, present, and future, presents options for an integrated benefit for enrollees in traditional Medicare. The new benefit would not only reduce cost burdens but also could potentially strengthen the Medicare program and enhance its role in stimulating and supporting innovations throughout the health care delivery system.

Gaps in universal health coverage in Malawi: A qualitative study in rural communities

PubMed Central

2014-01-01

Background In sub-Saharan Africa, universal health coverage (UHC) reforms have often adopted a technocratic top-down approach, with little attention being paid to the rural communities’ perspective in identifying context specific gaps to inform the design of such reforms. This approach might shape reforms that are not sufficiently responsive to local needs. Our study explored how rural communities experience and define gaps in universal health coverage in Malawi, a country which endorses free access to an Essential Health Package (EHP) as a means towards universal health coverage. Methods We conducted a qualitative cross-sectional study in six rural communities in Malawi. Data was collected from 12 Focus Group Discussions with community residents and triangulated with 8 key informant interviews with health care providers. All respondents were selected through stratified purposive sampling. The material was tape-recorded, fully transcribed, and coded by three independent researchers. Results The results showed that the EHP has created a universal sense of entitlements to free health care at the point of use. However, respondents reported uneven distribution of health facilities and poor implementation of public-private service level agreements, which have led to geographical inequities in population coverage and financial protection. Most respondents reported affordability of medical costs at private facilities and transport costs as the main barriers to universal financial protection. From the perspective of rural Malawians, gaps in financial protection are mainly triggered by supply-side access-related barriers in the public health sector such as: shortages of medicines, emergency services, shortage of health personnel and facilities, poor health workers’ attitudes, distance and transportation difficulties, and perceived poor quality of health services. Conclusions Moving towards UHC in Malawi, therefore, implies the introduction of appropriate interventions to fill the financial protection gaps in the private sector and the access-related gaps in the public sector and/or an effective public-private partnership that completely integrates both sectors. Current universal health coverage reforms need to address context specific gaps and be carefully crafted to avoid creating a sense of universal entitlements in principle, which may not be effectively received by beneficiaries due to contextual and operational bottlenecks. PMID:24884788

Analysis and simulation of wireless signal propagation applying geostatistical interpolation techniques

NASA Astrophysics Data System (ADS)

Kolyaie, S.; Yaghooti, M.; Majidi, G.

2011-12-01

This paper is a part of an ongoing research to examine the capability of geostatistical analysis for mobile networks coverage prediction, simulation and tuning. Mobile network coverage predictions are used to find network coverage gaps and areas with poor serviceability. They are essential data for engineering and management in order to make better decision regarding rollout, planning and optimisation of mobile networks.The objective of this research is to evaluate different interpolation techniques in coverage prediction. In method presented here, raw data collected from drive testing a sample of roads in study area is analysed and various continuous surfaces are created using different interpolation methods. Two general interpolation methods are used in this paper with different variables; first, Inverse Distance Weighting (IDW) with various powers and number of neighbours and second, ordinary kriging with Gaussian, spherical, circular and exponential semivariogram models with different number of neighbours. For the result comparison, we have used check points coming from the same drive test data. Prediction values for check points are extracted from each surface and the differences with actual value are computed. The output of this research helps finding an optimised and accurate model for coverage prediction.

Specialty Tier-Level Cost Sharing and Biologic Agent Use in the Medicare Part D Initial Coverage Period Among Beneficiaries With Rheumatoid Arthritis.

PubMed

Doshi, Jalpa A; Hu, Tianyan; Li, Pengxiang; Pettit, Amy R; Yu, Xinyan; Blum, Marissa

2016-11-01

To examine associations between specialty tier-level cost sharing and use of biologic agents for rheumatoid arthritis (RA) during Medicare Part D's initial coverage period (ICP). This was a retrospective study using 2007-2010 5% sample Medicare files to examine RA patients with use of a Part D RA biologic agent in the prior year. Patients without low-income subsidies (non-LIS group), who faced specialty tier-level cost sharing, were compared to a control group of low-income subsidy patients (LIS group), who faced nominal out-of-pocket costs in the ICP. Outcomes included use of a Part D or Part B RA biologic agent during the ICP and presence of a ≥30-day continuous gap in treatment among Part D biologic agent users in the ICP. Risk-adjusted outcomes were estimated using logistic regressions, controlling for patient demographic, clinical, and Part D plan characteristics. On average, a 30-day Part D biologic agent supply cost the non-LIS group $484 out of pocket (29.9% cost sharing) versus $5 (0.3% cost sharing) for the LIS group. The non-LIS group was less likely to fill Part D biologic agents (61.2% versus 72.7%, odds ratio [OR] 0.58 [95% confidence interval (95% CI) 0.46-0.72]; P < 0.001), more than twice as likely to receive Part B biologic agents (9.9% versus 4.4%, OR 2.41 [95% CI 1.61-3.60]; P < 0.001), and less likely to use any biologic agent (70.1% versus 76.9%, OR 0.69 [95% CI 0.55-0.88]; P = 0.002). The non-LIS subgroup filling Part D biologic agents had approximately twice the odds of a gap in both Part D biologic agent and any biologic agent availability. Specialty tier-level cost sharing was associated with interruptions in RA biologic agent treatment among Medicare patients. © 2016, American College of Rheumatology.

Changes in health insurance for US children and their parents: comparing 2003 to 2008.

PubMed

Angier, Heather; DeVoe, Jennifer E; Tillotson, Carrie; Wallace, Lorraine

2013-01-01

Recent policy changes have affected access to health insurance for families in the United States. Private health insurance premiums have increased, and state Medicaid programs have cut back coverage for adults. Concurrently, the Children's Health Insurance Program has made public insurance available to more children. We aimed to better understand how child and parent health insurance coverage patterns may have changed as a result of these policies. We analyzed data from the nationally representative Medical Expenditure Panel Survey, comparing cohorts from 2003 and 2008. We assessed cross-sectional and full-year coverage patterns for child/parent pairs, stratified by income. We conducted chi-square tests to assess significant differences in coverage over time. Middle-income child/parent pairs had the most significant changes in their coverage patterns. For example, those with full-year health insurance coverage significantly decreased from 85.4% in 2003 to 80.6% in 2008. There was also an increase in uninsured middle-income child/parent pairs for the full year (5.6% in 2003 to 8.3% in 2008) and an increase in pairs who had a gap in coverage (9.7% in 2003 to 13.0% in 2008). The percentage of middle-income child/parent pairs who were lacking insurance, for part or all of the year, has risen, suggesting that these families may be caught between affording private coverage and being eligible for public coverage. Unless private coverage becomes more affordable, insurance instability among middle-income families may persist despite the passage of the Patient Protection and Affordable Care Act.

The Significant Impact of Different Insurance Enrollment Criteria on the HEDIS Chlamydia Screening Measure for Young Women Enrolled in Medicaid and Commercial Insurance Plans.

PubMed

Patel, Chirag G; Tao, Guoyu

2015-10-01

The impact of length of enrollment in a health plan on eligibility of women under the Healthcare Effectiveness Data and Information Set (HEDIS) chlamydia screening measure is not fully understood. We assessed the representativeness of the measure among the proportion of women aged 15 to 24 years with a gap in coverage for Medicaid and commercial health insurance. Truven Health Marketscan Medicaid and commercial health insurance data from 2006 to 2012 were used to make comparisons between proportions of women with a gap in coverage to those enrolled in insurance plans for different numbers of months. Approximately 48% of Medicaid-insured women and 31% of commercially insured women had an at least 2-month gap that disqualified them from eligibility for inclusion in the HEDIS chlamydia screening measure. Extending eligibility to women with at least 6 months of coverage, regardless of gap, would increase the proportion of insured women included in the HEDIS measure to 76% (from 52%) for Medicaid and 83% (from 69%) for commercial insurance, without much effect on chlamydia testing rate. This would make the measure more representative of all insured women. The large proportion of young women who had a 2-month or greater gap in coverage in Medicaid had a significant impact on the overall representativeness of the current HEDIS chlamydia screening measure.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed

Desmond, Katherine A; Rice, Thomas H; Leibowitz, Arleen A

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary's current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed Central

Desmond, Katherine A.; Rice, Thomas H.; Leibowitz, Arleen A.

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary’s current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits. PMID:28990452

Incorporating shrub and snag specific LiDAR data into GAP wildlife models

Treesearch

Teresa J Lorenz; Kerri T Vierling; Jody Vogeler; Jeffrey Lonneker; Jocelyn Aycrigg

2015-01-01

The U.S. Geological Survey’s Gap Analysis Program (hereafter, GAP) is a nationally based program that uses land cover, vertebrate distributions, and land ownership to identify locations where gaps in conservation coverage exist, and GAP products are commonly used by government agencies, nongovernmental organizations, and private citizens. The GAP land-cover...

Fighting Hepatitis B in North Korea: Feasibility of a Bi-modal Prevention Strategy

PubMed Central

Stich, August

2015-01-01

In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Part 1: Hepatitis B vaccination catch-up campaign. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. By vaccinating 7 million children between 2010 and 2012, the hepatitis B vaccination gap was closed. Coverage of 99.23% was reached. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. The bi-modal preventive strategy was implemented successfully. Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea. PMID:26539001

Fighting Hepatitis B in North Korea: Feasibility of a Bi-modal Prevention Strategy.

PubMed

Unnewehr, Markus; Stich, August

2015-11-01

In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Part 1: Hepatitis B vaccination catch-up campaign. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. By vaccinating 7 million children between 2010 and 2012, the hepatitis B vaccination gap was closed. Coverage of 99.23% was reached. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. The bi-modal preventive strategy was implemented successfully. Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea.

Vaccine exemptions and the kindergarten vaccination coverage gap.

PubMed

Smith, Philip J; Shaw, Jana; Seither, Ranee; Lopez, Adriana; Hill, Holly A; Underwood, Mike; Knighton, Cynthia; Zhao, Zhen; Ravanam, Megha Shah; Greby, Stacie; Orenstein, Walter A

2017-09-25

Vaccination requirements for kindergarten entry vary by state, but all states require 2 doses of measles containing vaccine (MCV) at kindergarten entry. To assess (i) national MCV vaccination coverage for children who had attended kindergarten; (ii) the extent to which undervaccination after kindergarten entry is attributable to parents' requests for an exemption; (iii) the extent to which undervaccinated children had missed opportunities to be administered missing vaccine doses among children whose parent did not request an exemption; and (iv) the vaccination coverage gap between the "highest achievable" MCV coverage and actual MCV coverage among children who had attended kindergarten. A national survey of 1465 parents of 5-7year-old children was conducted during October 2013 through March 2014. Vaccination coverage estimates are based provider-reported vaccination histories. Children have a "missed opportunity" for MCV if they were not up-to-date and if there were dates on which other vaccines were administered but not MCV. The "highest achievable" MCV vaccination coverage rate is 100% minus the sum of the percentages of (i) undervaccinated children with parents who requested an exemption; and (ii) undervaccinated children with parents who did not request an exemption and whose vaccination statuses were assessed during a kindergarten grace period or period when they were provisionally enrolled in kindergarten. Among all children undervaccinated for MCV, 2.7% were attributable to having a parent who requested an exemption. Among children who were undervaccinated for MCV and whose parent did not request an exemption, 41.6% had a missed opportunity for MCV. The highest achievable MCV coverage was 98.6%, actual MCV coverage was 90.9%, and the kindergarten vaccination gap was 7.7%. Vaccination coverage may be increased by schools fully implementing state kindergarten vaccination laws, and by providers assessing children's vaccination status at every clinic visit, and administering missed vaccine doses. Published by Elsevier Ltd.

Obesity coverage gap: Consumers perceive low coverage for obesity treatments even when workplace wellness programs target BMI.

PubMed

Wilson, Elizabeth Ruth; Kyle, Theodore K; Nadglowski, Joseph F; Stanford, Fatima Cody

2017-02-01

Evidence-based obesity treatments, such as bariatric surgery, are not considered essential health benefits under the Affordable Care Act. Employer-sponsored wellness programs with incentives based on biometric outcomes are allowed and often used despite mixed evidence regarding their effectiveness. This study examines consumers' perceptions of their coverage for obesity treatments and exposure to workplace wellness programs. A total of 7,378 participants completed an online survey during 2015-2016. Respondents answered questions regarding their health coverage for seven medical services and exposure to employer wellness programs that target weight or body mass index (BMI). Using χ 2 tests, associations between perceptions of exposure to employer wellness programs and coverage for medical services were examined. Differences between survey years were also assessed. Most respondents reported they did not have health coverage for obesity treatments, but more of the respondents with employer wellness programs reported having coverage. Neither the perception of coverage for obesity treatments nor exposure to wellness programs increased between 2015 and 2016. Even when consumers have exposure to employer wellness programs that target BMI, their health insurance often excludes obesity treatments. Given the clinical and cost-effectiveness of such treatments, reducing that coverage gap may mitigate obesity's individual- and population-level effects. © 2017 The Obesity Society.

Spatial Aspects of Multi-Sensor Data Fusion: Aerosol Optical Thickness

NASA Technical Reports Server (NTRS)

Leptoukh, Gregory; Zubko, V.; Gopalan, A.

2007-01-01

The Goddard Earth Sciences Data and Information Services Center (GES DISC) investigated the applicability and limitations of combining multi-sensor data through data fusion, to increase the usefulness of the multitude of NASA remote sensing data sets, and as part of a larger effort to integrate this capability in the GES-DISC Interactive Online Visualization and Analysis Infrastructure (Giovanni). This initial study focused on merging daily mean Aerosol Optical Thickness (AOT), as measured by the Moderate Resolution Imaging Spectroradiometer (MODIS) onboard the Terra and Aqua satellites, to increase spatial coverage and produce complete fields to facilitate comparison with models and station data. The fusion algorithm used the maximum likelihood technique to merge the pixel values where available. The algorithm was applied to two regional AOT subsets (with mostly regular and irregular gaps, respectively) and a set of AOT fields that differed only in the size and location of artificially created gaps. The Cumulative Semivariogram (CSV) was found to be sensitive to the spatial distribution of gap areas and, thus, useful for assessing the sensitivity of the fused data to spatial gaps.

Discontinuity of Medicaid Coverage: Impact on Cost and Utilization Among Adult Medicaid Beneficiaries With Major Depression.

PubMed

Ji, Xu; Wilk, Adam S; Druss, Benjamin G; Lally, Cathy; Cummings, Janet R

2017-08-01

Gaps in Medicaid coverage may disrupt access to and continuity of care. This can be detrimental for beneficiaries with chronic conditions, such as major depression, for whom disruptions in access to outpatient care may lead to increased use of acute care. However, little is known about how Medicaid coverage discontinuities impact acute care utilization among adults with depression. Examine the relationship between Medicaid discontinuities and service utilization among adults with major depression. A total of 139,164 adults (18-64) with major depression was identified using the 2003-2004 Medicaid Analytic eXtract Files. We used generalized linear and two-part models to examine the effect of Medicaid discontinuity on service utilization. To establish causality in this relationship, we used instrumental variables analysis, relying on exogenous variation in a state-level policy for identification. Emergency department (ED) visits, inpatient episodes, inpatient days, and Medicaid-reimbursed costs. Approximately 29.4% of beneficiaries experienced coverage disruptions. In instrumental variables models, those with coverage disruptions incurred an increase of $650 in acute care costs per-person per Medicaid-covered month compared with those with continuous coverage, evidenced by an increase in ED use (0.1 more ED visits per-person-month) and inpatient days (0.6 more days per-person-month). The increase in acute costs contributed to an overall increase in all-cause costs by $310 per-person-month (all P-values<0.001). Among depressed adults, those experiencing coverage disruptions have, on average, significantly greater use of costly ED/inpatient services than those with continuous coverage. Maintenance of continuous Medicaid coverage may help prevent acute episodes requiring high-cost interventions.

Dental Care And Medicare Beneficiaries: Access Gaps, Cost Burdens, And Policy Options.

PubMed

Willink, Amber; Schoen, Cathy; Davis, Karen

2016-12-01

Despite the wealth of evidence that oral health is related to physical health, Medicare explicitly excludes dental care from coverage, leaving beneficiaries at risk for tooth decay and periodontal disease and exposed to high out-of-pocket spending. To profile these risks, we examined access to dental care across income groups and types of insurance coverage in 2012. High-income beneficiaries were almost three times as likely to have received dental care in the previous twelve months, compared to low-income beneficiaries-74 percent of whom received no dental care. We also describe two illustrative policies that would expand access, in part by providing income-related subsidies. One would offer a voluntary, premium-financed benefit similar to those offered by Part D prescription drug plans, with an estimated premium of $29 per month. The other would cover basic dental care in core Medicare Part B benefits, financed in part by premiums ($7 or $15 per month, depending on whether premiums covered 25 percent or 50 percent of the cost) and in part by general revenues. The fact that beneficiaries are forgoing dental care and are exposed to significant costs if they seek care underscores the need for action. The policies offer pathways for improving health and financial independence for older adults. Project HOPE—The People-to-People Health Foundation, Inc.

Disparity in maternal, newborn and child health services in high focus states in India: a district-level cross-sectional analysis.

PubMed

Awasthi, Ashish; Pandey, C M; Chauhan, Rajesh K; Singh, Uttam

2016-08-05

To examine the level and trend in the coverage gap of a set of interventions of maternal and child health services using a summary index and to assess the disparity in usage of maternal and child health services in the districts of high focus states of India. Data for the present study are taken from the Annual Health Survey (AHS), 2010-2013 and Census of India, 2011. This study used secondary data from states having higher mortality and fertility rates, termed as high focus states in India. District-level information regarding children aged 12-23 months and ever married women aged 15-49 years has been extracted from the AHS (2010-2013), and household amenities, female literacy and main workforce information has been obtained from the Census of India 2011. 2 summary indexes were calculated first for maternal and child health services and another for socioeconomic and development status, using data from AHS and Census. Cronbach's α was used to assess the internal consistency of the items used in the index. The result shows that the coverage gap is highest in Uttar Pradesh (37%) and lowest in Madhya Pradesh (21%). Converge gap and socioeconomic development are negatively correlated (r=-0.49, p=0.01). The average coverage gap was highest in the lowest quintile of socioeconomic development. There was an absolute change of 1.5% per year in coverage gap during 2009-2013. In regression analysis, the coefficient of determination was 0.24, β=-30.05, p=0.01 for a negative relationship between socioeconomic development and coverage gap. There is a significant disparity in the usage of maternal and child healthcare services in the districts of India. Resource-rich people (urban residents and richest quintile) are way ahead of marginalised people (rural residents and poorest quintile) in the usage of healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Adherence to hormonal contraception among women veterans: differences by race/ethnicity and contraceptive supply.

PubMed

Borrero, Sonya; Zhao, Xinhua; Mor, Maria K; Schwarz, Eleanor B; Good, Chester B; Gellad, Walid F

2013-08-01

The objective of the study was to assess the adherence to hormonal contraception (pill, patch, ring, or injectable) among women veterans and examine the relationships between race/ethnicity and the months of contraceptive supply dispensed with contraceptive adherence. We conducted a retrospective analysis of the Department of Veterans Affairs (VA) national databases to examine the adherence to hormonal contraception over 12 months among women aged 18-45 years who had hormonal contraceptive coverage during the first week of fiscal year 2008. We examined several adherence indicators including gaps between refills and months of contraceptive coverage. Descriptive statistics and multivariable models were used to examine the associations between race/ethnicity and contraceptive supply dispensed with adherence. Our cohort included 6946 women: 47% were white, 6% were Hispanic, 22% were black, and 25% were other race or had missing race information. Most women (83%) received a 3 month supply of contraception at each fill. More than 64% of women had at least 1 gap in coverage of 7 days or longer. Only 22% of women received a full 12 months of contraception without any gaps (perfect adherence). Compared with whites, Hispanics were significantly more likely to experience gaps (64% vs 70%; P = .02), and Hispanics and blacks received fewer months of contraceptive coverage (9.3 vs 8.9 and 9.0, P < .001). Compared with women receiving 3 month supplies, those receiving 1 month supplies had a higher likelihood of a gap (63% vs 72%, P < .001), fewer months of coverage (9.3 vs 6.9, P < .001), and a lower likelihood of perfect adherence (22% vs 11%, P < .001). Adherence to hormonal contraception among women veterans is poor. Efforts to improve contraceptive adherence and lower risk of unintended pregnancy are needed; dispensing more months of supply for hormonal contraception may be a promising strategy. Copyright © 2013 Mosby, Inc. All rights reserved.

Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care.

PubMed

Weaver, Meaghann S; Wichman, Brittany; Bace, Sue; Schroeder, Denice; Vail, Catherine; Wichman, Chris; Macfadyen, Andrew

2018-06-01

The national nursing shortage translates into a gap in home nursing care available to children with complex, chronic medical conditions and their family caregivers receiving palliative care consultations. A total of 38 home health nursing surveys were completed by families receiving pediatric palliative care consultation services at a freestanding children's hospital in the Midwest. The gap in the average number of nursing hours allotted versus received was 40 h/wk per family, primarily during evening hours. Parents missed an average of 23 hours of employment per week to provide hands-on nursing care at home, ranking stress regarding personal employment due to nursing shortage at 6.2/10. Families invested an average of 10 h/mo searching for additional nursing coverage and often resorted to utilizing more than 6 different home nurse coverage personnel per month. Families reported multiple delays to hospital discharges (mean, 15 days per delay) due to inability to find home nursing coverage. Respiratory technology and lack of Medicaid coverage ( P < .02) correlated with the gap in home nursing access. This study examines how the pediatric home nursing shortage translates into a lived experience for families with children with complex medical conditions receiving palliative care.

First-principles study of electronic structure modulations in graphene on Ru(0001) by Au intercalation

NASA Astrophysics Data System (ADS)

Nishidate, Kazume; Tanibayashi, Satoru; Yoshimoto, Noriyuki; Hasegawa, Masayuki

2018-03-01

First-principles calculations based on density functional theory are used to explore the electronic-structure modulations in graphene on Ru(0001) by Au intercalation. We first use a lattice-matched model to demonstrate that a substantial band gap is induced in graphene by sufficiently strong A-B sublattice symmetry breaking. This band gap opening occurs even in the absence of hybridization between graphene π states and Au states, and a strong sublattice asymmetry is established for a small separation (d ) between the graphene and Au layer, typically, d <3.0 Å , which can actually be achieved for a low Au coverage. In realistic situations, which are mimicked using lattice-mismatched models, graphene π states near the Dirac point easily hybridize with nearby (in energy) Au states even for a van der Waals distance, d ˜3.4 Å , and this hybridization usually dictates a band gap opening in graphene. In that case, the top parts of the intact Dirac cones survive the hybridization and are isolated to form midgap states within the hybridization gap, denying that the band gap is induced by sublattice symmetry breaking. This feature of a band gap opening is similar to that found for the so-called "first" graphene layer on silicon carbide (SiC) and the predicted band gap and doping level are in good agreement with the experiments for graphene/Au/Ru(0001).

Coverage of, and compliance with, mass drug administration under the programme to eliminate lymphatic filariasis in India: a systematic review.

PubMed

Babu, Bontha V; Babu, Gopalan R

2014-09-01

India's mass drug administration (MDA) programme to eliminate lymphatic filariasis (PELF) covers all 250 endemic districts, but compliance with treatment is not adequate for the programme to succeed in eradicating this neglected tropical disease. The objective of our study was to systematically review published studies on the coverage of and compliance with MDA under the PELF in India. We searched several databases-PubMed/Medline, Google Scholar, CINAHL/EBSCO, Web of Knowledge (including Web of Science) and OVID-and by applying selection criteria identified a total of 36 papers to include in the review. Overall MDA coverage rates varied between 48.8% and 98.8%, while compliance rates ranged from 20.8% to 93.7%. The coverage-compliance gap is large in many MDA programmes. The effective level of compliance, ≥65%, was reported in only 10 of a total of 31 MDAs (5 of 20 MDAs in rural areas and 2 of 12 MDAs in urban areas). The review has identified a gap between coverage and compliance, and potentially correctable causes of this gap. These causes need to be addressed if the Indian programme is to advance towards elimination of lymphatic filariasis. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Improving coverage measurement for reproductive, maternal, neonatal and child health: gaps and opportunities.

PubMed

Munos, Melinda K; Stanton, Cynthia K; Bryce, Jennifer

2017-06-01

Regular monitoring of coverage for reproductive, maternal, neonatal, and child health (RMNCH) is central to assessing progress toward health goals. The objectives of this review were to describe the current state of coverage measurement for RMNCH, assess the extent to which current approaches to coverage measurement cover the spectrum of RMNCH interventions, and prioritize interventions for a novel approach to coverage measurement linking household surveys with provider assessments. We included 58 interventions along the RMNCH continuum of care for which there is evidence of effectiveness against cause-specific mortality and stillbirth. We reviewed household surveys and provider assessments used in low- and middle-income countries (LMICs) to determine whether these tools generate measures of intervention coverage, readiness, or quality. For facility-based interventions, we assessed the feasibility of linking provider assessments to household surveys to provide estimates of intervention coverage. Fewer than half (24 of 58) of included RMNCH interventions are measured in standard household surveys. The periconceptional, antenatal, and intrapartum periods were poorly represented. All but one of the interventions not measured in household surveys are facility-based, and 13 of these would be highly feasible to measure by linking provider assessments to household surveys. We found important gaps in coverage measurement for proven RMNCH interventions, particularly around the time of birth. Based on our findings, we propose three sets of actions to improve coverage measurement for RMNCH, focused on validation of coverage measures and development of new measurement approaches feasible for use at scale in LMICs.

Integrating environmental gap analysis with spatial conservation prioritization: a case study from Victoria, Australia.

PubMed

Sharafi, Seyedeh Mahdieh; Moilanen, Atte; White, Matt; Burgman, Mark

2012-12-15

Gap analysis is used to analyse reserve networks and their coverage of biodiversity, thus identifying gaps in biodiversity representation that may be filled by additional conservation measures. Gap analysis has been used to identify priorities for species and habitat types. When it is applied to identify gaps in the coverage of environmental variables, it embodies the assumption that combinations of environmental variables are effective surrogates for biodiversity attributes. The question remains of how to fill gaps in conservation systems efficiently. Conservation prioritization software can identify those areas outside existing conservation areas that contribute to the efficient covering of gaps in biodiversity features. We show how environmental gap analysis can be implemented using high-resolution information about environmental variables and ecosystem condition with the publicly available conservation prioritization software, Zonation. Our method is based on the conversion of combinations of environmental variables into biodiversity features. We also replicated the analysis by using Species Distribution Models (SDMs) as biodiversity features to evaluate the robustness and utility of our environment-based analysis. We apply the technique to a planning case study of the state of Victoria, Australia. Copyright © 2012 Elsevier Ltd. All rights reserved.

Specialist availability in emergencies: contributions of response times and the use of ad hoc coverage in New York State.

PubMed

Rabin, Elaine; Patrick, Lisa

2016-04-01

Nationwide, hospitals struggle to maintain specialist on-call coverage for emergencies. We seek to further understand the issue by examining reliability of scheduled coverage and the role of ad hoc coverage when none is scheduled. An anonymous electronic survey of all emergency department (ED) directors of a large state. Overall and for 10 specialties, respondents were asked to estimate on-call coverage extent and "reliability" (frequency of emergency response in a clinically useful time frame: 2 hours), and use and effect of ad hoc emergency coverage to fill gaps. Descriptive statistics were performed using Fisher exact and Wilcoxon sign rank tests for significance. Contact information was obtained for 125 of 167 ED directors. Sixty responded (48%), representing 36% of EDs. Forty-six percent reported full on-call coverage scheduled for all specialties. Forty-six percent reported consistent reliability. Coverage and reliability were strongly related (P<.01; 33% reported both), and larger ED volume correlated with both (P<.01). Ninety percent of hospitals that had gaps in either employed ad hoc coverage, significantly improving coverage for 8 of 10 specialties. For all but 1 specialty, more than 20% of hospitals reported that specialists are "Never", "Rarely" or "Sometimes" reliable (more than 50% for cardiovascular surgery, hand surgery and ophthalmology). Significant holes in scheduled on-call specialist coverage are compounded by frequent unreliability of on-call specialists, but partially ameliorated by ad hoc specialist coverage. Regionalization may help because a 2-tiered system may exist: larger hospitals have more complete, reliable coverage. Better understanding of specialists' willingness to treat emergencies ad hoc without taking formal call will suggest additional remedies. Copyright © 2015 Elsevier Inc. All rights reserved.

Drug Coverage (Part D)

MedlinePlus

... insurance Find health & drug plans Drug coverage (Part D) How to get drug coverage Choose from 2 ... drug coverage. You can choose a Medicare Part D plan. Or, you can choose a Medicare Advantage ...

A Case Study into Microbial Genome Assembly Gap Sequences and Finishing Strategies.

PubMed

Utturkar, Sagar M; Klingeman, Dawn M; Hurt, Richard A; Brown, Steven D

2017-01-01

This study characterized regions of DNA which remained unassembled by either PacBio and Illumina sequencing technologies for seven bacterial genomes. Two genomes were manually finished using bioinformatics and PCR/Sanger sequencing approaches and regions not assembled by automated software were analyzed. Gaps present within Illumina assemblies mostly correspond to repetitive DNA regions such as multiple rRNA operon sequences. PacBio gap sequences were evaluated for several properties such as GC content, read coverage, gap length, ability to form strong secondary structures, and corresponding annotations. Our hypothesis that strong secondary DNA structures blocked DNA polymerases and contributed to gap sequences was not accepted. PacBio assemblies had few limitations overall and gaps were explained as cumulative effect of lower than average sequence coverage and repetitive sequences at contig termini. An important aspect of the present study is the compilation of biological features that interfered with assembly and included active transposons, multiple plasmid sequences, phage DNA integration, and large sequence duplication. Our targeted genome finishing approach and systematic evaluation of the unassembled DNA will be useful for others looking to close, finish, and polish microbial genome sequences.

Immigrants and Employer-Sponsored Health Insurance

PubMed Central

Buchmueller, Thomas C; Lo Sasso, Anthony T; Lurie, Ithai; Dolfin, Sarah

2007-01-01

Objective To investigate the factors underlying the lower rate of employer-sponsored health insurance coverage for foreign-born workers. Data Sources 2001 Survey of Income and Program Participation. Study Design We estimate probit regressions to determine the effect of immigrant status on employer-sponsored health insurance coverage, including the probabilities of working for a firm that offers coverage, being eligible for coverage, and taking up coverage. Data Extraction Methods We identified native born citizens, naturalized citizens, and noncitizen residents between the ages of 18 and 65, in the year 2002. Principal Findings First, we find that the large difference in coverage rates for immigrants and native-born Americans is driven by the very low rates of coverage for noncitizen immigrants. Differences between native-born and naturalized citizens are quite small and for some outcomes are statistically insignificant when we control for observable characteristics. Second, our results indicate that the gap between natives and noncitizens is explained mainly by differences in the probability of working for a firm that offers insurance. Conditional on working for such a firm, noncitizens are only slightly less likely to be eligible for coverage and, when eligible, are only slightly less likely to take up coverage. Third, roughly two-thirds of the native/noncitizen gap in coverage overall and in the probability of working for an insurance-providing employer is explained by characteristics of the individual and differences in the types of jobs they hold. Conclusions The substantially higher rate of uninsurance among immigrants is driven by the lower rate of health insurance offers by the employers of immigrants. PMID:17355593

Universal coverage with insecticide-treated nets - applying the revised indicators for ownership and use to the Nigeria 2010 malaria indicator survey data.

PubMed

Kilian, Albert; Koenker, Hannah; Baba, Ebenezer; Onyefunafoa, Emmanuel O; Selby, Richmond A; Lokko, Kojo; Lynch, Matthew

2013-09-10

Until recently only two indicators were used to evaluate malaria prevention with insecticide-treated nets (ITN): "proportion of households with any ITN" and "proportion of the population using an ITN last night". This study explores the potential of the expanded set of indicators recommended by the Roll Back Malaria Monitoring and Evaluation Reference Group (MERG) for comprehensive analysis of universal coverage with ITN by applying them to the Nigeria 2010 Malaria Indicator Survey data. The two additional indicators of "proportion of households with at least one ITN for every two people" and "proportion of population with access to an ITN within the household" were calculated as recommended by MERG. Based on the estimates for each of the four ITN indicators three gaps were calculated: i) households with no ITN, ii) households with any but not enough ITN, iii) population with access to ITN not using it. In addition, coverage with at least one ITN at community level was explored by applying Lot Quality Assurance Sampling (LQAS) decision rules to the cluster level of the data. All outcomes were analysed by household background characteristics and whether an ITN campaign had recently been done. While the proportion of households with any ITN was only 42% overall, it was 75% in areas with a recent mass campaign and in these areas 66% of communities had coverage of 80% or better. However, the campaigns left a considerable intra-household ownership gap with 66% of households with any ITN not having enough for every family member. In contrast, the analysis comparing actual against potential use showed that ITN utilization was good overall with only 19% of people with access not using the ITN, but with a significant difference between the North, where use was excellent (use gap 11%), and the South (use gap 36%) indicating the need for enhanced behaviour change communication. The expanded ITN indicators to assess universal coverage provide strong tools for a comprehensive system effectiveness analysis that produces clear, actionable evidence of progress as well as the need for specific additional interventions clearly differentiating between gaps in ownership and use.

Improving travel information products via robust estimation techniques : final report, March 2009.

DOT National Transportation Integrated Search

2009-03-01

Traffic-monitoring systems, such as those using loop detectors, are prone to coverage gaps, arising from sensor noise, processing errors and : transmission problems. Such gaps adversely affect the accuracy of Advanced Traveler Information Systems. Th...

AN APPROACH FOR DETERMINING REGIONAL LAND COVER AND SPECIES HABITAT DISTRIBUTIONS IN THE AMERICAN SOUTHWEST: THE SOUTHWEST REGIONAL GAP ANALYSIS PROJECT

EPA Science Inventory

The Southwest Regional Gap Analysis Project (SWReGAP) is developing seamless digital coverages for land cover, vertebrate animal habitat, and land management status for the 5-state region of Nevada, Arizona, Utah, New Mexico, and Colorado. The project is a second generation effor...

A vorticity transport model to restore spatial gaps in velocity data

NASA Astrophysics Data System (ADS)

Ameli, Siavash; Shadden, Shawn

2017-11-01

Often measurements of velocity data do not have full spatial coverage in the probed domain or near boundaries. These gaps can be due to missing measurements or masked regions of corrupted data. These gaps confound interpretation, and are problematic when the data is used to compute Lagrangian or trajectory-based analyses. Various techniques have been proposed to overcome coverage limitations in velocity data such as unweighted least square fitting, empirical orthogonal function analysis, variational interpolation as well as boundary modal analysis. In this talk, we present a vorticity transport PDE to reconstruct regions of missing velocity vectors. The transport model involves both nonlinear anisotropic diffusion and advection. This approach is shown to preserve the main features of the flow even in cases of large gaps, and the reconstructed regions are continuous up to second order. We illustrate results for high-frequency radar (HFR) measurements of the ocean surface currents as this is a common application of limited coverage. We demonstrate that the error of the method is on the same order of the error of the original velocity data. In addition, we have developed a web-based gateway for data restoration, and we will demonstrate a practical application using available data. This work is supported by the NSF Grant No. 1520825.

Electronic theoretical study of the influences of O adsorption on the electronic structure and optical properties of graphene

NASA Astrophysics Data System (ADS)

Shuang, Zhou; Guili, Liu; Dazhi, Fan

2017-02-01

The electronic structure and optical properties of adsorbing O atoms on graphene with different O coverage are researched using the density functional theory based upon the first-principle study to obtain further insight into properties of graphene. The adsorption energies, band structures, the density of states, light absorption coefficient and reflectivity of each system are calculated theoretically after optimizing structures of each system with different O coverage. Our calculations show that adsorption of O atoms on graphene increases the bond length of C-C which adjacent to the O atoms. When the O coverage is 9.4%, the adsorption energy (3.91 eV) is the maximum, which only increases about 1.6% higher than that of 3.1% O coverage. We find that adsorbed O atoms on pristine graphene opens up indirect gap of about 0.493-0.952 eV. Adsorbing O atoms make pristine graphene from metal into a semiconductor. When the O coverage is 9.4%, the band gap (0.952 eV) is the maximum. Comparing with pristine graphene, we find the density of states at Fermi level of O atoms adsorbing on graphene with different coverage are significantly increased. We also find that light absorption coefficient and reflectivity peaks are significantly reduced, and the larger the coverage, the smaller the absorption coefficient and reflectivity peaks are. And the blue shift phenomenon appears.

Design and methodology of the Geo-social Analysis of Physicians' settlement (GAP-Study) in Germany.

PubMed

Groneberg, David A; Boll, Michael; Bauer, Jan

2016-01-01

Unequally distributed disease burdens within populations are well-known and occur worldwide. They are depending on residents' social status and/or ethnic background. Country-specific health care systems - especially the coverage and distribution of health care providers - are both a potential cause as well as an important solution for health inequalities. Registers are built of all accredited physicians and psychotherapists within the outpatient care system in German metropolises by utilizing the database of the Associations of Statutory Health Insurance Physicians. The physicians' practice neighborhood will be analyzed under socioeconomic and demographic perspectives. Therefore, official city districts' statistics will be assigned to the physicians and psychotherapists according to their practice location. Averages of neighborhood indicators will be calculated for each specialty. Moreover, advanced studies will inspect differences by physicians' gender or practice type. Geo-spatial analyses of the intra-city practices distribution will complete the settlement characteristics of physicians and psychotherapists within the outpatient care system in German metropolises. The project "Geo-social Analysis of Physicians' settlement" (GAP) is designed to elucidate gaps of physician coverage within the outpatient care system, dependent on neighborhood residents' social status or ethnics in German metropolises. The methodology of the GAP-Study enables the standardized investigation of physicians' settlement behavior in German metropolises and their inter-city comparisons. The identification of potential gaps within the physicians' coverage should facilitate the delineation of approaches for solving health care inequality problems.

Understanding the Influence of Socioeconomic Environment on Paediatric Antiretroviral Treatment Coverage: Towards Closing Treatment Gaps in Sub-Saharan Africa.

PubMed

Adeyinka, Daniel A; Evans, Meirion R; Ozigbu, Chamberline E; van Woerden, Hugo; Adeyinka, Esther F; Oladimeji, Olanrewaju; Aimakhu, Chris; Odoh, Deborah; Chamla, Dick

2017-03-01

Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets. Ecological analyses of paediatric ART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage. Factors associated with paediatric ART coverage included adult literacy (r=0.6, p=0.004), effective governance (r=0.6, p=0.003), virology testing by 2 months of age (r=0.9, p=0.001), density of healthcare workers per 10,000 population (r=0.6, p=0.007), and government expenditure on health (r=0.5, p=0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, p<0.001) and gender inequality index (r=-0.6, p=0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices. Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals. Copyright© by the National Institute of Public Health, Prague 2017

A Case Study into Microbial Genome Assembly Gap Sequences and Finishing Strategies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Utturkar, Sagar M.; Klingeman, Dawn M.; Hurt, Jr., Richard A.

This study characterized regions of DNA which remained unassembled by either PacBio and Illumina sequencing technologies for seven bacterial genomes. Two genomes were manually finished using bioinformatics and PCR/Sanger sequencing approaches and regions not assembled by automated software were analyzed. Gaps present within Illumina assemblies mostly correspond to repetitive DNA regions such as multiple rRNA operon sequences. PacBio gap sequences were evaluated for several properties such as GC content, read coverage, gap length, ability to form strong secondary structures, and corresponding annotations. Our hypothesis that strong secondary DNA structures blocked DNA polymerases and contributed to gap sequences was not accepted.more » PacBio assemblies had few limitations overall and gaps were explained as cumulative effect of lower than average sequence coverage and repetitive sequences at contig termini. An important aspect of the present study is the compilation of biological features that interfered with assembly and included active transposons, multiple plasmid sequences, phage DNA integration, and large sequence duplication. Furthermore, our targeted genome finishing approach and systematic evaluation of the unassembled DNA will be useful for others looking to close, finish, and polish microbial genome sequences.« less

A Case Study into Microbial Genome Assembly Gap Sequences and Finishing Strategies

DOE PAGES

Utturkar, Sagar M.; Klingeman, Dawn M.; Hurt, Jr., Richard A.; ...

2017-07-18

This study characterized regions of DNA which remained unassembled by either PacBio and Illumina sequencing technologies for seven bacterial genomes. Two genomes were manually finished using bioinformatics and PCR/Sanger sequencing approaches and regions not assembled by automated software were analyzed. Gaps present within Illumina assemblies mostly correspond to repetitive DNA regions such as multiple rRNA operon sequences. PacBio gap sequences were evaluated for several properties such as GC content, read coverage, gap length, ability to form strong secondary structures, and corresponding annotations. Our hypothesis that strong secondary DNA structures blocked DNA polymerases and contributed to gap sequences was not accepted.more » PacBio assemblies had few limitations overall and gaps were explained as cumulative effect of lower than average sequence coverage and repetitive sequences at contig termini. An important aspect of the present study is the compilation of biological features that interfered with assembly and included active transposons, multiple plasmid sequences, phage DNA integration, and large sequence duplication. Furthermore, our targeted genome finishing approach and systematic evaluation of the unassembled DNA will be useful for others looking to close, finish, and polish microbial genome sequences.« less

A Case Study into Microbial Genome Assembly Gap Sequences and Finishing Strategies

PubMed Central

Utturkar, Sagar M.; Klingeman, Dawn M.; Hurt, Richard A.; Brown, Steven D.

2017-01-01

This study characterized regions of DNA which remained unassembled by either PacBio and Illumina sequencing technologies for seven bacterial genomes. Two genomes were manually finished using bioinformatics and PCR/Sanger sequencing approaches and regions not assembled by automated software were analyzed. Gaps present within Illumina assemblies mostly correspond to repetitive DNA regions such as multiple rRNA operon sequences. PacBio gap sequences were evaluated for several properties such as GC content, read coverage, gap length, ability to form strong secondary structures, and corresponding annotations. Our hypothesis that strong secondary DNA structures blocked DNA polymerases and contributed to gap sequences was not accepted. PacBio assemblies had few limitations overall and gaps were explained as cumulative effect of lower than average sequence coverage and repetitive sequences at contig termini. An important aspect of the present study is the compilation of biological features that interfered with assembly and included active transposons, multiple plasmid sequences, phage DNA integration, and large sequence duplication. Our targeted genome finishing approach and systematic evaluation of the unassembled DNA will be useful for others looking to close, finish, and polish microbial genome sequences. PMID:28769883

Equal Opportunity Laws: Topic Paper A.

ERIC Educational Resources Information Center

National Council on the Handicapped, Washington, DC.

This paper examines the status of U.S. disability-related equal opportunity laws and identifies gaps in coverage, shortcomings and inconsistencies in interpretation and application, and deficiencies in enforcement. Problems with the scope of coverage result from: (1) laws that are not enforceable in federal courts against states, not co-extensive…

Human resources for treating HIV/AIDS: needs, capacities, and gaps.

PubMed

Bärnighausen, Till; Bloom, David E; Humair, Salal

2007-11-01

Despite recent international efforts to scale-up antiretroviral treatment (ART), more than 5 million people needing ART in low- and middle-income countries (LMIC) do not receive it. Limited human resources to treat HIV/AIDS (HRHA) are one of the main constraints to achieving universal ART coverage. We model the gap between needed and available HRHA to quantify the challenge of achieving and sustaining universal ART coverage by 2017. We estimate the HRHA gap in LMIC using recently published estimates of ART coverage, HIV incidence, health-worker emigration rates, mortality rates of people needing ART, and numbers of HRHA needed to treat 1000 ART patients (based on review studies, 2006). We project the HRHA gap in 10 years (2017) using a simple discrete-time model with a health worker pool replenished through education and depleted through emigration/death; a population needing ART replenished with a given HIV incidence rate; and higher survival rates for treated populations. We analyze the effects of varying assumptions about HRHA inflows and outflows and the evolution of the HIV pandemic in three different regional base cases (sub-Saharan Africa, non-sub-Saharan African LMIC, and South Africa). Current ART coverage for LMIC is around 28%-32% and, other things equal, will drop to 16%-19% by 2017 with constant current HRHA production rates. A naive model, ignoring the increased survival probability resulting from ART, suggests that approximately the current number of HRHA in ART services needs to be added every year for the next ten years to achieve universal coverage by 2017. In a model accounting for increased survival of treated patients, outcomes vary by region; sub-Saharan Africa requires two times, non-sub-Saharan African LMIC require 1.5 times and South Africa requires more than three times their respective current HRHA population to be added every year for the next 10 years to achieve universal coverage by 2017. Even if achieved by 2017, sustaining universal coverage requires further HRHA increases until the system reaches steady state. ART coverage is sensitive to HRHA inflow and emigration. Our model quantifies the challenge of closing the HRHA gap in LMIC. It shows that strategies to achieve universal ART coverage must account for feedback due to higher survival probabilities of people receiving ART. It suggests that universal ART coverage is unlikely to be achieved and sustained with increased HRHA inflows alone, but will require decreased HRHA outflows, substantially reduced HIV incidence, or changes in the nature or organization of care. Means to decrease HRHA emigration outflows include scholarships for healthcare education that are conditional on the recipient delivering ART in a country with high ART need for a number of years, training health workers who are not internationally mobile, or changing recruitment policies in countries receiving health workers from the developing world. Effective organizational changes include those that reduce the number of HRHA required to treat a fixed number of patients. Given the large number of health workers that even optimistic assumptions suggest will be needed in ART services in the coming decades, policymakers must ensure that the flow of workers into ART programs does not jeopardize the provision of other important health services.

Monitoring progress towards universal health coverage at country and global levels.

PubMed

Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie-Paule; Wagstaff, Adam

2014-09-01

Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries.

Monitoring Progress towards Universal Health Coverage at Country and Global Levels

PubMed Central

Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie-Paule; Wagstaff, Adam

2014-01-01

Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries. PMID:25243899

Countdown to 2015 and beyond: fulfilling the health agenda for women and children.

PubMed

Requejo, Jennifer Harris; Bryce, Jennifer; Barros, Aluisio J D; Berman, Peter; Bhutta, Zulfiqar; Chopra, Mickey; Daelmans, Bernadette; de Francisco, Andres; Lawn, Joy; Maliqi, Blerta; Mason, Elizabeth; Newby, Holly; Presern, Carole; Starrs, Ann; Victora, Cesar G

2015-01-31

The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort. Copyright © 2015 Elsevier Ltd. All rights reserved.

Vectorial capacity and vector control: reconsidering sensitivity to parameters for malaria elimination

PubMed Central

Brady, Oliver J.; Godfray, H. Charles J.; Tatem, Andrew J.; Gething, Peter W.; Cohen, Justin M.; McKenzie, F. Ellis; Perkins, T. Alex; Reiner, Robert C.; Tusting, Lucy S.; Sinka, Marianne E.; Moyes, Catherine L.; Eckhoff, Philip A.; Scott, Thomas W.; Lindsay, Steven W.; Hay, Simon I.; Smith, David L.

2016-01-01

Background Major gains have been made in reducing malaria transmission in many parts of the world, principally by scaling-up coverage with long-lasting insecticidal nets and indoor residual spraying. Historically, choice of vector control intervention has been largely guided by a parameter sensitivity analysis of George Macdonald's theory of vectorial capacity that suggested prioritizing methods that kill adult mosquitoes. While this advice has been highly successful for transmission suppression, there is a need to revisit these arguments as policymakers in certain areas consider which combinations of interventions are required to eliminate malaria. Methods and Results Using analytical solutions to updated equations for vectorial capacity we build on previous work to show that, while adult killing methods can be highly effective under many circumstances, other vector control methods are frequently required to fill effective coverage gaps. These can arise due to pre-existing or developing mosquito physiological and behavioral refractoriness but also due to additive changes in the relative importance of different vector species for transmission. Furthermore, the optimal combination of interventions will depend on the operational constraints and costs associated with reaching high coverage levels with each intervention. Conclusions Reaching specific policy goals, such as elimination, in defined contexts requires increasingly non-generic advice from modelling. Our results emphasize the importance of measuring baseline epidemiology, intervention coverage, vector ecology and program operational constraints in predicting expected outcomes with different combinations of interventions. PMID:26822603

Can history improve big bang health reform? Commentary.

PubMed

Marchildon, Gregory P

2018-07-01

At present, the professional skills of the historian are rarely relied upon when health policies are being formulated. There are numerous reasons for this, one of which is the natural desire of decision-makers to break with the past when enacting big bang policy change. This article identifies the strengths professional historians bring to bear on policy development using the establishment and subsequent reform of universal health coverage as an example. Historians provide pertinent and historically informed context; isolate the forces that have historically allowed for major reform; and separate the truly novel reforms from those attempted or implemented in the past. In addition, the historian's use of primary sources allows potentially new and highly salient facts to guide the framing of the policy problem and its solution. This paper argues that historians are critical for constructing a viable narrative of the establishment and evolution of universal health coverage policies. The lack of this narrative makes it difficult to achieve an accurate assessment of systemic gaps in coverage and access, and the design or redesign of universal health coverage that can successfully close these gaps.

Socioeconomic inequalities in breast and cervical screening coverage in England: are we closing the gap?

PubMed

Douglas, Elaine; Waller, Jo; Duffy, Stephen W; Wardle, Jane

2016-06-01

Health policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years. Cross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation. At the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points). Efforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation. © The Author(s) 2015.

Peierls instability as the insulating origin of the Na/Si(111)-(3 × 1) surface with a Na coverage of 2/3 monolayers

NASA Astrophysics Data System (ADS)

Kang, Myung Ho; Kwon, Se Gab; Jung, Sung Chul

2018-03-01

Density functional theory (DFT) calculations are used to investigate the insulating origin of the Na/Si(111)-(3 × 1) surface with a Na coverage of 2/3 monolayers. In the coverage definition, one monolayer refers to one Na atom per surface Si atom, so this surface contains an odd number of electrons (i.e., three Si dangling-bond electrons plus two Na electrons) per 3 × 1 unit cell. Interestingly, this odd-electron surface has been ascribed to a Mott-Hubbard insulator to account for the measured insulating band structure with a gap of about 0.8 eV. Here, we instead propose a Peierls instability as the origin of the experimental band gap. The concept of Peierls instability is fundamental in one-dimensional metal systems but has not been taken into account in previous studies of this surface. Our DFT calculations demonstrate that the linear chain structure of Si dangling bonds in this surface is energetically unstable with respect to a × 2 buckling modulation, and the buckling-induced band gap of 0.79 eV explains well the measured insulating nature.

Coverage of Large-Scale Food Fortification of Edible Oil, Wheat Flour, and Maize Flour Varies Greatly by Vehicle and Country but Is Consistently Lower among the Most Vulnerable: Results from Coverage Surveys in 8 Countries123

PubMed Central

Aaron, Grant J; Friesen, Valerie M; Jungjohann, Svenja; Garrett, Greg S; Myatt, Mark

2017-01-01

Background: Large-scale food fortification (LSFF) of commonly consumed food vehicles is widely implemented in low- and middle-income countries. Many programs have monitoring information gaps and most countries fail to assess program coverage. Objective: The aim of this work was to present LSFF coverage survey findings (overall and in vulnerable populations) from 18 programs (7 wheat flour, 4 maize flour, and 7 edible oil programs) conducted in 8 countries between 2013 and 2015. Methods: A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: 1) poverty, 2) poor dietary diversity, and 3) rural residence. Three measures of coverage were assessed: 1) consumption of the vehicle, 2) consumption of a fortifiable vehicle, and 3) consumption of a fortified vehicle. Individual program performance was assessed based on the following: 1) achieving overall coverage ≥50%, 2) achieving coverage of ≥75% in ≥1 vulnerable group, and 3) achieving equity in coverage for ≥1 vulnerable group. Results: Coverage varied widely by food vehicle and country. Only 2 of the 18 LSFF programs assessed met all 3 program performance criteria. The 2 main program bottlenecks were a poor choice of vehicle and failure to fortify a fortifiable vehicle (i.e., absence of fortification). Conclusions: The results highlight the importance of sound program design and routine monitoring and evaluation. There is strong evidence of the impact and cost-effectiveness of LSFF; however, impact can only be achieved when the necessary activities and processes during program design and implementation are followed. The FACT approach fills an important gap in the availability of standardized tools. The LSFF programs assessed here need to be re-evaluated to determine whether to further invest in the programs, whether other vehicles are appropriate, and whether other approaches are needed. PMID:28404836

Coverage of Large-Scale Food Fortification of Edible Oil, Wheat Flour, and Maize Flour Varies Greatly by Vehicle and Country but Is Consistently Lower among the Most Vulnerable: Results from Coverage Surveys in 8 Countries.

PubMed

Aaron, Grant J; Friesen, Valerie M; Jungjohann, Svenja; Garrett, Greg S; Neufeld, Lynnette M; Myatt, Mark

2017-05-01

Background: Large-scale food fortification (LSFF) of commonly consumed food vehicles is widely implemented in low- and middle-income countries. Many programs have monitoring information gaps and most countries fail to assess program coverage. Objective: The aim of this work was to present LSFF coverage survey findings (overall and in vulnerable populations) from 18 programs (7 wheat flour, 4 maize flour, and 7 edible oil programs) conducted in 8 countries between 2013 and 2015. Methods: A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: 1 ) poverty, 2 ) poor dietary diversity, and 3 ) rural residence. Three measures of coverage were assessed: 1 ) consumption of the vehicle, 2 ) consumption of a fortifiable vehicle, and 3 ) consumption of a fortified vehicle. Individual program performance was assessed based on the following: 1 ) achieving overall coverage ≥50%, 2) achieving coverage of ≥75% in ≥1 vulnerable group, and 3 ) achieving equity in coverage for ≥1 vulnerable group. Results: Coverage varied widely by food vehicle and country. Only 2 of the 18 LSFF programs assessed met all 3 program performance criteria. The 2 main program bottlenecks were a poor choice of vehicle and failure to fortify a fortifiable vehicle (i.e., absence of fortification). Conclusions: The results highlight the importance of sound program design and routine monitoring and evaluation. There is strong evidence of the impact and cost-effectiveness of LSFF; however, impact can only be achieved when the necessary activities and processes during program design and implementation are followed. The FACT approach fills an important gap in the availability of standardized tools. The LSFF programs assessed here need to be re-evaluated to determine whether to further invest in the programs, whether other vehicles are appropriate, and whether other approaches are needed.

Likelihood-based gene annotations for gap filling and quality assessment in genome-scale metabolic models

DOE PAGES

Benedict, Matthew N.; Mundy, Michael B.; Henry, Christopher S.; ...

2014-10-16

Genome-scale metabolic models provide a powerful means to harness information from genomes to deepen biological insights. With exponentially increasing sequencing capacity, there is an enormous need for automated reconstruction techniques that can provide more accurate models in a short time frame. Current methods for automated metabolic network reconstruction rely on gene and reaction annotations to build draft metabolic networks and algorithms to fill gaps in these networks. However, automated reconstruction is hampered by database inconsistencies, incorrect annotations, and gap filling largely without considering genomic information. Here we develop an approach for applying genomic information to predict alternative functions for genesmore » and estimate their likelihoods from sequence homology. We show that computed likelihood values were significantly higher for annotations found in manually curated metabolic networks than those that were not. We then apply these alternative functional predictions to estimate reaction likelihoods, which are used in a new gap filling approach called likelihood-based gap filling to predict more genomically consistent solutions. To validate the likelihood-based gap filling approach, we applied it to models where essential pathways were removed, finding that likelihood-based gap filling identified more biologically relevant solutions than parsimony-based gap filling approaches. We also demonstrate that models gap filled using likelihood-based gap filling provide greater coverage and genomic consistency with metabolic gene functions compared to parsimony-based approaches. Interestingly, despite these findings, we found that likelihoods did not significantly affect consistency of gap filled models with Biolog and knockout lethality data. This indicates that the phenotype data alone cannot necessarily be used to discriminate between alternative solutions for gap filling and therefore, that the use of other information is necessary to obtain a more accurate network. All described workflows are implemented as part of the DOE Systems Biology Knowledgebase (KBase) and are publicly available via API or command-line web interface.« less

Likelihood-Based Gene Annotations for Gap Filling and Quality Assessment in Genome-Scale Metabolic Models

PubMed Central

Benedict, Matthew N.; Mundy, Michael B.; Henry, Christopher S.; Chia, Nicholas; Price, Nathan D.

2014-01-01

Genome-scale metabolic models provide a powerful means to harness information from genomes to deepen biological insights. With exponentially increasing sequencing capacity, there is an enormous need for automated reconstruction techniques that can provide more accurate models in a short time frame. Current methods for automated metabolic network reconstruction rely on gene and reaction annotations to build draft metabolic networks and algorithms to fill gaps in these networks. However, automated reconstruction is hampered by database inconsistencies, incorrect annotations, and gap filling largely without considering genomic information. Here we develop an approach for applying genomic information to predict alternative functions for genes and estimate their likelihoods from sequence homology. We show that computed likelihood values were significantly higher for annotations found in manually curated metabolic networks than those that were not. We then apply these alternative functional predictions to estimate reaction likelihoods, which are used in a new gap filling approach called likelihood-based gap filling to predict more genomically consistent solutions. To validate the likelihood-based gap filling approach, we applied it to models where essential pathways were removed, finding that likelihood-based gap filling identified more biologically relevant solutions than parsimony-based gap filling approaches. We also demonstrate that models gap filled using likelihood-based gap filling provide greater coverage and genomic consistency with metabolic gene functions compared to parsimony-based approaches. Interestingly, despite these findings, we found that likelihoods did not significantly affect consistency of gap filled models with Biolog and knockout lethality data. This indicates that the phenotype data alone cannot necessarily be used to discriminate between alternative solutions for gap filling and therefore, that the use of other information is necessary to obtain a more accurate network. All described workflows are implemented as part of the DOE Systems Biology Knowledgebase (KBase) and are publicly available via API or command-line web interface. PMID:25329157

Response of reptile and amphibian communities to canopy gaps created by wind disturbance in the Southern Appalachians

Treesearch

Cathryn H. Greenberg

2001-01-01

Reptile and amphibian communities were sampled in intact gaps created by wind disturbance, salvage-logged gaps, and closed canopy mature forest (controls). Sampling was conducted during June–October in 1997 and 1998 using drift fences with pitfall and funnel traps. Basal area of live trees, shade, leaf litter coverage, and litter depth was highest in controls and...

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition.

PubMed

Chopra, Mickey; Sharkey, Alyssa; Dalmiya, Nita; Anthony, David; Binkin, Nancy

2012-10-13

Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the effective coverage of essential interventions. First, we identify four different intervention delivery channels--ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to effective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of effective interventions-and, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of financial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources. Copyright © 2012 Elsevier Ltd. All rights reserved.

Trends in insurance coverage and source of private coverage among young adults aged 19-25: United States, 2008-2012.

PubMed

Kirzinger, Whitney K; Cohen, Robin A; Gindi, Renee M

2013-12-01

Data from the National Health Interview Survey, 2008-2012. The percentage of young adults with private health insurance coverage increased from the last 6 months of 2010 through the last 6 months of 2012 (52.0% to 57.9%). Except for an increase in the first 6 months of 2011, the percentage of privately insured young adults who had a gap in coverage during the past 12 months decreased from the first 6 months of 2008 through the last 6 months of 2012 (10.5% to 7.8%). The percentage of privately insured young adults with coverage in their own name decreased from 40.8% in the last 6 months of 2010 to 27.2% in the last 6 months of 2012. The percentage of privately insured young adults with employer-sponsored health insurance increased from the last 6 months of 2010 to the last 6 months of 2012 (85.6% to 92.5%). Young adults often experience instability with regard to work, school, residential status, and financial independence. This could contribute to a lack of or gaps in insurance coverage (1,2). In September 2010, the Affordable Care Act (ACA) extended dependent health coverage to young adults up to age 26. This provision was expected to lead to increases in private coverage for young adults aged 19-25 when they became eligible for coverage through their parents' employment (3,4). This report provides estimates describing the previous insurance status and sources of coverage among privately insured young adults aged 19-25, using data from the 2008-2012 National Health Interview Survey (NHIS). Comparisons are made with adults aged 26-34, the most similar age group that was not affected by the ACA provision. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Vectorial capacity and vector control: reconsidering sensitivity to parameters for malaria elimination.

PubMed

Brady, Oliver J; Godfray, H Charles J; Tatem, Andrew J; Gething, Peter W; Cohen, Justin M; McKenzie, F Ellis; Perkins, T Alex; Reiner, Robert C; Tusting, Lucy S; Sinka, Marianne E; Moyes, Catherine L; Eckhoff, Philip A; Scott, Thomas W; Lindsay, Steven W; Hay, Simon I; Smith, David L

2016-02-01

Major gains have been made in reducing malaria transmission in many parts of the world, principally by scaling-up coverage with long-lasting insecticidal nets and indoor residual spraying. Historically, choice of vector control intervention has been largely guided by a parameter sensitivity analysis of George Macdonald's theory of vectorial capacity that suggested prioritizing methods that kill adult mosquitoes. While this advice has been highly successful for transmission suppression, there is a need to revisit these arguments as policymakers in certain areas consider which combinations of interventions are required to eliminate malaria. Using analytical solutions to updated equations for vectorial capacity we build on previous work to show that, while adult killing methods can be highly effective under many circumstances, other vector control methods are frequently required to fill effective coverage gaps. These can arise due to pre-existing or developing mosquito physiological and behavioral refractoriness but also due to additive changes in the relative importance of different vector species for transmission. Furthermore, the optimal combination of interventions will depend on the operational constraints and costs associated with reaching high coverage levels with each intervention. Reaching specific policy goals, such as elimination, in defined contexts requires increasingly non-generic advice from modelling. Our results emphasize the importance of measuring baseline epidemiology, intervention coverage, vector ecology and program operational constraints in predicting expected outcomes with different combinations of interventions. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

HIV treatment as prevention in Jamaica and Barbados: magic bullet or sustainable response?

PubMed

Barrow, Geoffrey; Barrow, Christine

2015-01-01

This discursive article introduces HIV treatment as prevention (TasP) and identifies various models for its extrapolation to wider population levels. Drawing on HIV surveillance data for Jamaica and Barbados, the article identifies significant gaps in HIV response programming in relation to testing, antiretroviral treatment coverage, and treatment adherence, thereby highlighting the disparity between assumptions and prerequisites for TasP success. These gaps are attributable, in large part, to sociocultural impediments and structural barriers, severe resource constraints, declining political will, and the redefinition of HIV as a manageable, chronic health issue. Antiretroviral treatment and TasP can realize success only within a combination prevention frame that addresses structural factors, including stigma and discrimination, gender inequality and gender-based violence, social inequality, and poverty. The remedicalization of the response compromises outcomes and undermines the continued potential of HIV programming as an entry point for the promotion of sexual, health, and human rights. © The Author(s) 2013.

20 CFR 404.1217 - Continuation of coverage.

Code of Federal Regulations, 2011 CFR

2011-04-01

... employees continues as follows: (a) Absolute coverage group. Generally, the services of an employee covered as a part of an absolute coverage group (see § 404.1205) continue to be covered indefinitely. A position covered as a part of an absolute coverage group continues to be covered even if the position later...

20 CFR 404.1217 - Continuation of coverage.

Code of Federal Regulations, 2010 CFR

2010-04-01

... employees continues as follows: (a) Absolute coverage group. Generally, the services of an employee covered as a part of an absolute coverage group (see § 404.1205) continue to be covered indefinitely. A position covered as a part of an absolute coverage group continues to be covered even if the position later...

High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia.

PubMed

Doshi, Jalpa A; Li, Pengxiang; Huo, Hairong; Pettit, Amy R; Kumar, Rishab; Weiss, Brenda M; Huntington, Scott F

2016-03-01

Specialty drugs often offer medical advances but are frequently subject to high cost sharing. This is particularly true with Medicare Part D, where after meeting a deductible, patients without low-income subsidies (non-LIS) typically face 25% to 33% coinsurance (initial coverage phase with "specialty tier" cost sharing), followed by ~50% coinsurance (coverage gap phase), and then 5% coinsurance (catastrophic phase). Yet, no studies have examined the impact of such high cost sharing on specialty drug initiation under Part D. Oral tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), making it an apt case study. A retrospective claims-based analysis utilizing 2011 to 2013 100% Medicare claims. TKI initiation rates and time to initiation were compared between fee-for-service non-LIS Part D patients newly diagnosed with CML and their LIS counterparts who faced nominal cost sharing of ≤ $5. The first 30-day TKI fill "straddled" benefit phases, for a mean out-of-pocket cost of $2600 or more for non-LIS patients. Non-LIS patients were less likely than LIS patients to have a TKI claim within 6 months of diagnosis (45.3% vs 66.9%; P < .001) and those initiating a TKI took twice as long to fill it (mean = 50.9 vs 23.7 days; P < .001). Cox regressions controlling for sociodemographic, clinical, and plan characteristics confirmed descriptive findings (hazard ratio, 0.59; 95% CI, 0.45-0.76). Extensive sensitivity analyses confirmed the robustness of our findings. High cost sharing was associated with reduced and/or delayed initiation of TKIs. We discuss policy strategies to reduce current financial barriers that adversely impact access to critical therapies under Medicare Part D.

Dental Use and Expenditures for Older Uninsured Americans: The Simulated Impact of Expanded Coverage

PubMed Central

Manski, Richard J; Moeller, John F; Chen, Haiyan; Schimmel, Jody; Pepper, John V; St Clair, Patricia A

2015-01-01

Objective To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans. Data Sources/Study Setting We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS). Study Design We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured. Data Collection/Extraction Methods The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ). Principal Findings We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older. Conclusions Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users. PMID:25040355

Coverage of genomic medicine: information gap between lay public and scientists.

PubMed

Sugawara, Yuya; Narimatsu, Hiroto; Fukao, Akira

2012-01-01

The sharing of information between the lay public and medical professionals is crucial to the conduct of personalized medicine using genomic information in the near future. Mass media, such as newspapers, can play an important role in disseminating scientific information. However, studies on the role of newspaper coverage of genome-related articles are highly limited. We investigated the coverage of genomic medicine in five major Japanese newspapers (Asahi, Mainichi, Yomiuri, Sankei, and Nikkei) using Nikkei Telecom and articles in scientific journals in PubMed from 1995 to 2009. The number of genome-related articles in all five newspapers temporarily increased in 2000, and began continuously decreasing thereafter from 2001 to 2009. Conversely, there was a continuous increasing trend in the number of genome-related articles in PubMed during this period. The numbers of genome-related articles among the five major newspapers from 1995 to 2009 were significantly different (P = 0.002). Commentaries, research articles, and articles about companies were the most frequent in 2001 and 2003, when the number of genome-related articles transiently increased in the five newspapers. This study highlights the significant gap between newspaper coverage and scientific articles in scientific journals.

Socioeconomic inequalities in breast and cervical screening coverage in England: are we closing the gap?

PubMed Central

Douglas, Elaine; Waller, Jo; Duffy, Stephen W

2015-01-01

Objective Health policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years. Methods Cross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation. Results At the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points). Conclusions Efforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation. PMID:26377810

Automated ultrasound scanning on a dual-modality breast imaging system: coverage and motion issues and solutions.

PubMed

Sinha, Sumedha P; Goodsitt, Mitchell M; Roubidoux, Marilyn A; Booi, Rebecca C; LeCarpentier, Gerald L; Lashbrook, Christine R; Thomenius, Kai E; Chalek, Carl L; Carson, Paul L

2007-05-01

We are developing an automated ultrasound imaging-mammography system wherein a digital mammography unit has been augmented with a motorized ultrasound transducer carriage above a special compression paddle. Challenges of this system are acquiring complete coverage of the breast and minimizing motion. We assessed these problems and investigated methods to increase coverage and stabilize the compressed breast. Visual tracings of the breast-to-paddle contact area and breast periphery were made for 10 patients to estimate coverage area. Various motion artifacts were evaluated in 6 patients. Nine materials were tested for coupling the paddle to the breast. Fourteen substances were tested for coupling the transducer to the paddle in lateral-to-medial and medial-to-lateral views and filling the gap between the peripheral breast and paddle. In-house image registration software was used to register adjacent ultrasound sweeps. The average breast contact area was 56%. The average percentage of the peripheral air gap filled with ultrasound gel was 61%. Shallow patient breathing proved equivalent to breath holding, whereas speech and sudden breathing caused unacceptable artifacts. An adhesive spray that preserves image quality was found to be best for coupling the breast to the paddle and minimizing motion. A highly viscous ultrasound gel proved most effective for coupling the transducer to the paddle for lateral-to-medial and medial-to-lateral views and for edge fill-in. The challenges of automated ultrasound scanning in a multimodality breast imaging system have been addressed by developing methods to fill in peripheral gaps, minimize patient motion, and register and reconstruct multisweep ultrasound image volumes.

Historical record of Landsat global coverage

USGS Publications Warehouse

Goward, Samuel; Arvidson, Terry; Williams, Darrel; Faundeen, John; Irons, James; Franks, Shannon

2006-01-01

The long-term, 34+ year record of global Landsat remote sensing data is a critical resource to study the Earth system and human impacts on this system. The National Satellite Land Remote Sensing Data Archive (NSLRSDA) is charged by public law to: “maintain a permanent, comprehensive Government archive of global Landsat and other land remote sensing data for long-term monitoring and study of the changing global environment” (U.S. Congress, 1992). The advisory committee for NSLRSDA requested a detailed analysis of observation coverage within the U.S. Landsat holdings, as well as that acquired and held by International Cooperator (IC) stations. Our analyses, to date, have found gaps of varying magnitude in U.S. holdings of Landsat global coverage data, which appear to reflect technical or administrative variations in mission operations. In many cases it may be possible to partially fill these gaps in U.S. holdings through observations that were acquired and are now being held at International Cooperator stations.

Bridging the communication gap: successes and challenges of mobile phone technology in a health and demographic surveillance system in northern Nigeria.

PubMed

Doctor, Henry V; Olatunji, Alabi; Jumare, Abdul'azeez

2012-01-01

Maternal and child health indicators are generally poor in Nigeria with the northern part of the country having the worst indicators than the southern part. Efforts to address maternal and health challenges in Nigeria include, among others, improvement in health and management information systems. We report on the experience of mobile phone technology in supporting the activities of a health and demographic surveillance system in northern Nigeria. Our experience calls for the need for the Nigerian Government, the mobile network companies, and the international community at large to consolidate their efforts in addressing the mobile network coverage and power supply challenges in order to create an enabling environment for socio-economic development particularly in rural and disadvantaged areas. Unless power and mobile network challenges are addressed, health interventions that rely on mobile phone technology will not have a significant impact in improving maternal and child health.

Educational Gaps in Medical Care and Health Behavior: Evidence from US Natality Data

ERIC Educational Resources Information Center

Price, Joseph; Price, Joshua; Simon, Kosali

2011-01-01

The US Natality files provide information on medical procedures and health related behavior during pregnancy and childbirth. The data set represents nearly the universe of mothers who give birth in the US, providing the most complete coverage possible of medical care and health behavior among a specific patient population. We document gaps in…

Young Adults' Selection and Use of Dependent Coverage under the Affordable Care Act.

PubMed

Chen, Weiwei

2018-01-01

The dependent coverage expansion under the Affordable Care Act (ACA) required health insurance policies that cover dependents to offer coverage for policyholder' children up to age 26. It has been well documented that the provision successfully reduced the uninsured rate among the young adults. However, less is known about whether dependent coverage crowded out other insurance types and whether young adults used dependent coverage as a fill-in-the-gap short-term option. Using data from the Survey of Income and Program Participation 2008 Panel, the paper assesses dependent coverage uptake and duration before and after the ACA provision among young adults aged 19-26 versus those aged 27-30. Regressions for additional coverage outcomes were also performed to estimate the crowd-out rate. It was found that the ACA provision had a significant positive impact on dependent coverage uptake and duration. The estimated crowd-out rate ranges from 27 to 42%, depending on the definition. Most dependent coverage enrollees used the coverage for 1 or 2 years. Differences in dependent coverage uptake and duration remained among racial groups. Less healthy individuals were also less likely to make use of dependent coverage.

Young Adults’ Selection and Use of Dependent Coverage under the Affordable Care Act

PubMed Central

Chen, Weiwei

2018-01-01

The dependent coverage expansion under the Affordable Care Act (ACA) required health insurance policies that cover dependents to offer coverage for policyholder’ children up to age 26. It has been well documented that the provision successfully reduced the uninsured rate among the young adults. However, less is known about whether dependent coverage crowded out other insurance types and whether young adults used dependent coverage as a fill-in-the-gap short-term option. Using data from the Survey of Income and Program Participation 2008 Panel, the paper assesses dependent coverage uptake and duration before and after the ACA provision among young adults aged 19–26 versus those aged 27–30. Regressions for additional coverage outcomes were also performed to estimate the crowd-out rate. It was found that the ACA provision had a significant positive impact on dependent coverage uptake and duration. The estimated crowd-out rate ranges from 27 to 42%, depending on the definition. Most dependent coverage enrollees used the coverage for 1 or 2 years. Differences in dependent coverage uptake and duration remained among racial groups. Less healthy individuals were also less likely to make use of dependent coverage. PMID:29445721

The Roles of Technology in Primary HIV Prevention for Men Who Have Sex with Men.

PubMed

Sullivan, Patrick S; Jones, Jeb; Kishore, Nishant; Stephenson, Rob

2015-12-01

Men who have sex with men (MSM) are at disproportionate risk for HIV infection globally. The past 5 years have seen considerable advances in biomedical interventions to reduce the risk of HIV infection. To be impactful in reducing HIV incidence requires the rapid and expansive scale-up of prevention. One mechanism for achieving this is technology-based tools to improve knowledge, acceptability, and coverage of interventions and services. This review provides a summary of the current gap in coverage of primary prevention services, how technology-based interventions and services can address gaps in coverage, and the current trends in the development and availability of technology-based primary prevention tools for use by MSM. Results from agent-based models of HIV epidemics of MSM suggest that 40-50 % coverage of multiple primary HIV prevention interventions and services, including biomedical interventions like preexposure prophylaxis, will be needed to reduce HIV incidence among MSM. In the USA, current levels of coverage for all interventions, except HIV testing and condom distribution, fall well short of this target. Recent findings illustrate how technology-based HIV prevention tools can be used to provide certain kinds of services at much larger scale, with marginal incremental costs. A review of mobile apps for primary HIV prevention revealed that most are designed by nonacademic, nonpublic health developers, and only a small proportion of available mobile apps specifically address MSM populations. We are unlikely to reach the required scale of HIV prevention intervention coverage for MSM unless we can leverage technologies to bring key services to broad coverage for MSM. Despite an exciting pipeline of technology-based prevention tools, there are broader challenges with funding structures and sustainability that need to be addressed to realize the full potential of this emerging public health field.

Knowledge-based changes to health systems: the Thai experience in policy development.

PubMed

Tangcharoensathien, Viroj; Wibulpholprasert, Suwit; Nitayaramphong, Sanguan

2004-10-01

Over the past two decades the government in Thailand has adopted an incremental approach to extending health-care coverage to the population. It first offered coverage to government employees and their dependents, and then introduced a scheme under which low-income people were exempt from charges for health care. This scheme was later extended to include elderly people, children younger than 12 years of age and disabled people. A voluntary public insurance scheme was implemented to cover those who could afford to pay for their own care. Private sector employees were covered by the Social Health Insurance scheme, which was implemented in 1991. Despite these efforts, 30% of the population remained uninsured in 2001. In October of that year, the new government decided to embark on a programme to provide universal health-care coverage. This paper describes how research into health systems and health policy contributed to the move towards universal coverage. Data on health systems financing and functioning had been gathered before and after the founding of the Health Systems Research Institute in early 1990. In 1991, a contract capitation model had been used to launch the Social Health Insurance scheme. The advantages of using a capitation model are that it contains costs and provides an acceptable quality of service as opposed to the cost escalation and inefficiency that occur under fee-for-service reimbursement models, such as the one used to provide medical benefits to civil servants. An analysis of the implementation of universal coverage found that politics moved universal coverage onto the policy agenda during the general election campaign in January 2001. The capacity for research on health systems and policy to generate evidence guided the development of the policy and the design of the system at a later stage. Because the reformists who sought to bring about universal coverage (who were mostly civil servants in the Ministry of Public Health and members of nongovernmental organizations) were able to bridge the gap between researchers and politicians, an evidence-based political decision was made. Additionally, the media played a part in shaping the societal consensus on universal coverage.

Knowledge-based changes to health systems: the Thai experience in policy development.

PubMed Central

Tangcharoensathien, Viroj; Wibulpholprasert, Suwit; Nitayaramphong, Sanguan

2004-01-01

Over the past two decades the government in Thailand has adopted an incremental approach to extending health-care coverage to the population. It first offered coverage to government employees and their dependents, and then introduced a scheme under which low-income people were exempt from charges for health care. This scheme was later extended to include elderly people, children younger than 12 years of age and disabled people. A voluntary public insurance scheme was implemented to cover those who could afford to pay for their own care. Private sector employees were covered by the Social Health Insurance scheme, which was implemented in 1991. Despite these efforts, 30% of the population remained uninsured in 2001. In October of that year, the new government decided to embark on a programme to provide universal health-care coverage. This paper describes how research into health systems and health policy contributed to the move towards universal coverage. Data on health systems financing and functioning had been gathered before and after the founding of the Health Systems Research Institute in early 1990. In 1991, a contract capitation model had been used to launch the Social Health Insurance scheme. The advantages of using a capitation model are that it contains costs and provides an acceptable quality of service as opposed to the cost escalation and inefficiency that occur under fee-for-service reimbursement models, such as the one used to provide medical benefits to civil servants. An analysis of the implementation of universal coverage found that politics moved universal coverage onto the policy agenda during the general election campaign in January 2001. The capacity for research on health systems and policy to generate evidence guided the development of the policy and the design of the system at a later stage. Because the reformists who sought to bring about universal coverage (who were mostly civil servants in the Ministry of Public Health and members of nongovernmental organizations) were able to bridge the gap between researchers and politicians, an evidence-based political decision was made. Additionally, the media played a part in shaping the societal consensus on universal coverage. PMID:15643796

2007 costs and coverage of antiretrovirals under Medicare Part D for people with HIV/AIDS living in North Carolina.

PubMed

Sengupta, Sohini

2008-01-01

Effective January 1, 2006 Medicare Part D became a new source of prescription drug coverage for people with HIV/AIDS in the United States. The implementation of Part D has affected access to antiretrovirals for people with HIV/AIDS. In North Carolina, access can be difficult because of the state's struggling safety net programs and the growing HIV-infected populations among Blacks and in poor rural counties. This analysis examines Medicare Part D antiretroviral coverage in 2007 for beneficiaries with HIV/AIDS in North Carolina, particularly those who did not qualify as dual eligibles or for a full low-income subsidy. Data describing program coverage were obtained from the Web site www.medicare.gov and descriptive analyses were performed to assess changes in antiretroviral coverage in Part D prescription drug plans in North Carolina. Most of the 26 antiretrovirals are covered in some way by 76 North Carolina prescription drug plans. There may be variability in coverage however associated with (a) antiretroviral classification within formularies; (b) drug premiums; (c) whether premiums can be waived; (d) annual deductibles; and (e) whether coverage is provided in the "doughnut hole." The data may not reflect actual patterns of drug use and realized access to the drugs. The findings are limited to antiretroviral coverage in North Carolina's Part D offerings but could be generalized to other states with similar prescription drug plan costs and coverage. These concerns continue to pose significant challenges to accessing antiretrovirals for Part D beneficiaries with HIV/AIDS in North Carolina. Variability demonstrated within prescription drug plans will continue, and beneficiaries with HIV/AIDS who do not qualify as dual eligibles or for low-income subsidies will need to evaluate these issues when selecting a prescription drug plan in future enrollment periods.

Understanding Adherence and Prescription Patterns Using Large-Scale Claims Data.

PubMed

Bjarnadóttir, Margrét V; Malik, Sana; Onukwugha, Eberechukwu; Gooden, Tanisha; Plaisant, Catherine

2016-02-01

Advanced computing capabilities and novel visual analytics tools now allow us to move beyond the traditional cross-sectional summaries to analyze longitudinal prescription patterns and the impact of study design decisions. For example, design decisions regarding gaps and overlaps in prescription fill data are necessary for measuring adherence using prescription claims data. However, little is known regarding the impact of these decisions on measures of medication possession (e.g., medication possession ratio). The goal of the study was to demonstrate the use of visualization tools for pattern discovery, hypothesis generation, and study design. We utilized EventFlow, a novel discrete event sequence visualization software, to investigate patterns of prescription fills, including gaps and overlaps, utilizing large-scale healthcare claims data. The study analyzes data of individuals who had at least two prescriptions for one of five hypertension medication classes: ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, and diuretics. We focused on those members initiating therapy with diuretics (19.2%) who may have concurrently or subsequently take drugs in other classes as well. We identified longitudinal patterns in prescription fills for antihypertensive medications, investigated the implications of decisions regarding gap length and overlaps, and examined the impact on the average cost and adherence of the initial treatment episode. A total of 790,609 individuals are included in the study sample, 19.2% (N = 151,566) of whom started on diuretics first during the study period. The average age was 52.4 years and 53.1% of the population was female. When the allowable gap was zero, 34% of the population had continuous coverage and the average length of continuous coverage was 2 months. In contrast, when the allowable gap was 30 days, 69% of the population showed a single continuous prescription period with an average length of 5 months. The average prescription cost of the period of continuous coverage ranged from US$3.44 (when the maximum gap was 0 day) to US$9.08 (when the maximum gap was 30 days). Results were less impactful when considering overlaps. This proof-of-concept study illustrates the use of visual analytics tools in characterizing longitudinal medication possession. We find that prescription patterns and associated prescription costs are more influenced by allowable gap lengths than by definitions and treatment of overlap. Research using medication gaps and overlaps to define medication possession in prescription claims data should pay particular attention to the definition and use of gap lengths.

Women and health coverage: the affordability gap.

PubMed

Patchias, Elizabeth M; Waxman, Judy

2007-04-01

Although men and women have some similar challenges with regard to health insurance, women face unique barriers to becoming insured. More significantly, women have greater difficulty affording health care services even once they are insured. On average, women have lower incomes than men and therefore have greater difficulty paying premiums. Women also are less likely than men to have coverage through their own employer and more likely to obtain coverage through their spouses; are more likely than men to have higher out-of-pocket health care expenses; and use more healthcare services than men and consequently are in greater need of comprehensive coverage. Proposals for improving health policy need to address these disparities.

Coverage gaps for Medicaid-eligible children in the wake of federal welfare reform.

PubMed

Haley, Jennifer; Kenney, Genevieve

2003-01-01

Using data from the National Survey of America's Families, this paper examines insurance coverage changes for Medicaid-eligible citizen children between 1997 and 1999, early in the implementation of federal welfare reform. More than 20 million children qualified for Medicaid, but many were uninsured. Insurance coverage deteriorated for eligible children between 1997 and 1999, particularly for those who also qualified for cash assistance; this deterioration in coverage was largely due to dramatic declines in cash assistance participation. This paper shows that following federal welfare reform, states have faced new challenges reaching and enrolling the growing numbers of eligible children who are not connected with the welfare system.

Impact of Medicare Part D on Antidepressant Treatment, Medication Choice and Adherence among Older Adults with Depression

PubMed Central

Donohue, Julie M.; Zhang, Yuting; Men, Aiju; Perera, Subashan; Lave, Judith R.; Hanlon, Joseph T.; Reynolds, Charles F.

2010-01-01

Objectives Depression in older adults is often undertreated due, in part, to medication costs. We examined the impact of improved prescription drug coverage under Medicare Part D on use of antidepressants, medication choice and adherence. Design, Setting and Participants Observational claims-based study of older adults with depression (ICD-9: 296.2, 296.3, 311, 300.4) continuously enrolled in a Medicare managed care plan between 2004–2007. Three groups with limited ($150 or $350 quarterly caps) or no drug coverage in 2004–2005 obtained Part D benefits in 2006. A comparison group had stable employer-sponsored coverage throughout. Measurements Any antidepressant prescription fill, antidepressant choice (tricyclics or monoamine oxidase inhibitors vs. newer antidepressants), and adherence (80% of days covered) in the first 6 months of treatment. Results Part D was associated with increased odds of any antidepressant use among those who previously lacked coverage [Odds Ratio (OR) 1.61, 95% confidence interval (CI) 1.41–1.85] but odds of use did not change among those with limited prior coverage. Use of older antidepressant agents did not change with Part D. All three groups whose coverage improved with Part D had significantly higher odds of 80% of days covered with an antidepressant [OR=1.86 (95% CI, 1.44–2.39) for No coverage, 1.74 (95% CI, 1.25–3.42) for $150 cap; and 1.19 (95% CI 1.06–1.34) for the $350 cap groups]. Conclusions Medicare Part D was associated with improvements in antidepressant use and adherence in depressed older adults who previously had no or limited drug coverage but not with changes in use of older agents. PMID:22123272

Count every newborn; a measurement improvement roadmap for coverage data.

PubMed

Moxon, Sarah G; Ruysen, Harriet; Kerber, Kate J; Amouzou, Agbessi; Fournier, Suzanne; Grove, John; Moran, Allisyn C; Vaz, Lara M E; Blencowe, Hannah; Conroy, Niall; Gülmezoglu, A; Vogel, Joshua P; Rawlins, Barbara; Sayed, Rubayet; Hill, Kathleen; Vivio, Donna; Qazi, Shamim A; Sitrin, Deborah; Seale, Anna C; Wall, Steve; Jacobs, Troy; Ruiz Peláez, Juan; Guenther, Tanya; Coffey, Patricia S; Dawson, Penny; Marchant, Tanya; Waiswa, Peter; Deorari, Ashok; Enweronu-Laryea, Christabel; Arifeen, Shams; Lee, Anne C C; Mathai, Matthews; Lawn, Joy E

2015-01-01

The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.

Spin asymmetric band gap opening in graphene by Fe adsorption

NASA Astrophysics Data System (ADS)

del Castillo, E.; Cargnoni, F.; Achilli, S.; Tantardini, G. F.; Trioni, M. I.

2015-04-01

The adsorption of Fe atom on graphene is studied by first-principles Density Functional Theory. The structural, electronic, and magnetic properties are analyzed at different coverages, all preserving C6v symmetry for the Fe adatom. We observed that binding energies, magnetic moments, and adsorption distances rapidly converge as the size of the supercell increases. Among the considered supercells, those constituted by 3n graphene unit cells show a very peculiar behavior: the adsorption of a Fe atom induces the opening of a spin-dependent gap in the band structure. In particular, the gap amounts to tenths of eV in the majority spin component, while in the minority one it has a width of about 1 eV for the 3 × 3 supercell and remains significant even at very low coverages (0.25 eV for θ ≃ 2%). The charge redistribution upon Fe adsorption has also been analyzed according to state of the art formalisms indicating an appreciable charge transfer from Fe to the graphene layer.

The Impact of Coverage Restrictions on Antipsychotic Utilization Among Low-Income Medicare Part D Enrollees.

PubMed

Roberto, Pamela N; Brandt, Nicole; Onukwugha, Eberechukwu; Perfetto, Eleanor; Powers, Christopher; Stuart, Bruce

2017-11-01

Prior research demonstrates substantial access problems associated with utilization management and formulary exclusions for antipsychotics in Medicaid, but the use and impact of coverage restrictions for these medications in Medicare Part D remains unknown. We assess the effect of coverage restrictions on antipsychotic utilization in Part D by exploiting a unique natural experiment in which low-income beneficiaries are randomly assigned to prescription drug plans with varying levels of formulary generosity. Despite considerable variation in use of coverage restrictions across Part D plans, we find no evidence that these restrictions significantly deter utilization or reduce access to antipsychotics for low-income beneficiaries.

Tetanus disease and deaths in men reveal need for vaccination

PubMed Central

Dalal, Shona; Reed, Jason; Yakubu, Ahmadu; Ncube, Buhle; Baggaley, Rachel

2016-01-01

Abstract With efforts focused on the elimination of maternal and neonatal tetanus, less attention has been given to tetanus incidence and mortality among men. Since 2007 voluntary medical male circumcision has been scaled-up in 14 sub-Saharan African countries as an effective intervention to reduce the risk of human immunodeficiency virus (HIV) acquisition among men. As part of a review of adverse events from these programmes, we identified 13 cases of tetanus from five countries reported to the World Health Organization (WHO) up to March 2016. Eight patients died and only one patient had a known history of tetanus vaccination. Tetanus after voluntary medical male circumcision was rare among more than 11 million procedures conducted. Nevertheless, the cases prompted a review of the evidence on tetanus vaccination coverage and case notifications in sub-Saharan Africa, supplemented by a literature review of non-neonatal tetanus in Africa over the years 2003–2014. The WHO African Region reported the highest number of non-neonatal tetanus cases per million population and lowest historic coverage of tetanus-toxoid-containing vaccine. Coverage of the third dose of diphtheria–tetanus–polio vaccine ranged from 65% to 98% across the 14 countries in 2013. In hospital-based studies, non-neonatal tetanus comprised 0.3–10.7% of admissions, and a median of 71% of patients were men. The identification of tetanus cases following voluntary medical male circumcision highlights a gender gap in tetanus morbidity disproportionately affecting men. Incorporating tetanus vaccination for boys and men into national programmes should be a priority to align with the goal of universal health coverage. PMID:27516639

Tetanus disease and deaths in men reveal need for vaccination.

PubMed

Dalal, Shona; Samuelson, Julia; Reed, Jason; Yakubu, Ahmadu; Ncube, Buhle; Baggaley, Rachel

2016-08-01

With efforts focused on the elimination of maternal and neonatal tetanus, less attention has been given to tetanus incidence and mortality among men. Since 2007 voluntary medical male circumcision has been scaled-up in 14 sub-Saharan African countries as an effective intervention to reduce the risk of human immunodeficiency virus (HIV) acquisition among men. As part of a review of adverse events from these programmes, we identified 13 cases of tetanus from five countries reported to the World Health Organization (WHO) up to March 2016. Eight patients died and only one patient had a known history of tetanus vaccination. Tetanus after voluntary medical male circumcision was rare among more than 11 million procedures conducted. Nevertheless, the cases prompted a review of the evidence on tetanus vaccination coverage and case notifications in sub-Saharan Africa, supplemented by a literature review of non-neonatal tetanus in Africa over the years 2003-2014. The WHO African Region reported the highest number of non-neonatal tetanus cases per million population and lowest historic coverage of tetanus-toxoid-containing vaccine. Coverage of the third dose of diphtheria-tetanus-polio vaccine ranged from 65% to 98% across the 14 countries in 2013. In hospital-based studies, non-neonatal tetanus comprised 0.3-10.7% of admissions, and a median of 71% of patients were men. The identification of tetanus cases following voluntary medical male circumcision highlights a gender gap in tetanus morbidity disproportionately affecting men. Incorporating tetanus vaccination for boys and men into national programmes should be a priority to align with the goal of universal health coverage.

Insurance Coverage for Rehabilitation Therapies and Association with Social Participation Outcomes among Low-Income Children.

PubMed

Mirza, Mansha; Kim, Yoonsang

2016-01-01

(1) To profile children's health insurance coverage rates for specific rehabilitation therapies; (2) to determine whether coverage for rehabilitation therapies is associated with social participation outcomes after adjusting for child and household characteristics; (3) to assess whether rehabilitation insurance differentially affects social participation of children with and without disabilities. We conducted a cross-sectional analysis of secondary survey data on 756 children (ages 3-17) from 370 households living in low-income neighborhoods in a Midwestern U.S. city. Multivariate mixed effects logistic regression models were estimated. Significantly higher proportions of children with disabilities had coverage for physical therapy, occupational therapy, and speech and language pathology, yet gaps in coverage were noted. Multivariate analysis indicated that rehabilitation insurance coverage was significantly associated with social participation (OR = 1.67, 95% CI: 1.013-2.75). This trend was sustained in subgroup analysis. Findings support the need for comprehensive coverage of all essential services under children's health insurance programs.

44 CFR 61.1 - Purpose of part.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.1 Purpose of part. This part describes the types of properties eligible for flood insurance coverage...

44 CFR 61.1 - Purpose of part.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.1 Purpose of part. This part describes the types of properties eligible for flood insurance coverage...

44 CFR 61.1 - Purpose of part.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.1 Purpose of part. This part describes the types of properties eligible for flood insurance coverage...

44 CFR 61.1 - Purpose of part.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.1 Purpose of part. This part describes the types of properties eligible for flood insurance coverage...

44 CFR 61.1 - Purpose of part.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.1 Purpose of part. This part describes the types of properties eligible for flood insurance coverage...

Compact Solar Spectrometer Column CO2, and CH4 Observations: Performance Evaluation at Multiple North American TCCON Sites

NASA Astrophysics Data System (ADS)

Parker, H. A.; Hedelius, J.; Viatte, C.; Wunch, D.; Wennberg, P. O.; Chen, J.; Wofsy, S.; Jones, T.; Franklin, J.; Dubey, M. K.; Roehl, C. M.; Podolske, J. R.; Hillyard, P. W.; Iraci, L. T.

2015-12-01

Measurement, reporting and verification (MRV) of anthropogenic emissions and natural sources and sinks of carbon dioxide (CO2) and methane (CH4) are crucial to predict climate change and develop transparent accounting policies to contain climate forcing. Remote sensing technologies are monitoring column averaged dry air mole fractions of CO2 and CH4 (XCO2 & XCH4) from ground and space (OCO-2 and GOSAT) with solar spectroscopy enabling direct MRV. However, current ground based coverage is sparse due to the need for large and expensive high-resolution spectrometers that are part of the Total Column Carbon Observing Network (TCCON, Bruker 125HR). This limits our MRV and satellite validation abilities, both regionally and globally. There are striking monitoring gaps in Asia, South America and Africa where the CO2 emissions are growing and there is a large uncertainty in fluxes from land use change, biomass burning and rainforest vulnerability. To fill this gap we evaluate the precision, accuracy and stability of compact, affordable and easy to use low-resolution spectrometers (Bruker EM27/SUN) by comparing with XCO2 and XCH4 retrieved from much larger high-resolution TCCON instruments. As these instruments will be used in a variety of locations, we evaluate their performance by comparing with 2 previous and 4 current United States TCCON sites in different regions up to 2700 km apart. These sites range from polluted to unpolluted, latitudes of 32 to 46°N, and altitudes of 230 to 2241 masl. Comparisons with some of these sites cover multiple years allowing assessment of the EM27/SUN performance not only in various regions, but also over an extended period of time and with different seasonal influences. Results show that our 2 EM27/SUN instruments capture the diurnal variability of the aforementioned constituents very well, but with offsets from TCCON and long-term variability which may be due in part to the extensive movement these spectrometers were subjected to. These off-the-shelf spectrometers should dramatically expand the coverage of regional XCO2 and XCH4 observations, particularly in gap regions. Increased temporal and spacial resolution on global carbon data will lead to more reliable information when considering climate change policy and funding.

Exploring Characteristics and Health Care Utilization Trends Among Individuals Who Fall in the Health Insurance Assistance Gap in a Medicaid Nonexpansion State.

PubMed

Edward, Jean; Mir, Nageen; Monti, Denise; Shacham, Enbal; Politi, Mary C

2017-11-01

States that did not expand Medicaid under the Affordable Care Act (ACA) in the United States have seen a growth in the number of individuals who fall in the assistance gap, defined as having incomes above the Medicaid eligibility limit (≥44% of the federal poverty level) but below the lower limit (<100%) to be eligible for tax credits for premium subsidies or cost-sharing reductions in the marketplace. The purpose of this article is to present findings from a secondary data analysis examining the characteristics of those who fell in the assistance gap ( n = 166) in Missouri, a Medicaid nonexpansion state, by comparing them with those who did not fall in the assistance gap ( n = 157). Participants completed online demographic questionnaires and self-reported measures of health and insurance status, health literacy, numeracy, and health insurance literacy. A select group completed a 1-year follow-up survey about health insurance enrollment and health care utilization. Compared with the nonassistance gap group, individuals in the assistance gap were more likely to have lower levels of education, have at least one chronic condition, be uninsured at baseline, and be seeking health care coverage for additional dependents. Individuals in the assistance gap had significantly lower annual incomes and higher annual premiums when compared with the nonassistance gap group and were less likely to be insured through the marketplace or other private insurance at the 1-year follow-up. Findings provide several practice and policy implications for expanding health insurance coverage, reducing costs, and improving access to care for underserved populations.

Experience of targeting subsidies on insecticide-treated nets: what do we know and what are the knowledge gaps?

PubMed

Worrall, Eve; Hill, Jenny; Webster, Jayne; Mortimer, Julia

2005-01-01

Widespread coverage of vulnerable populations with insecticide-treated nets (ITNs) constitutes an important component of the Roll Back Malaria (RBM) strategy to control malaria. The Abuja Targets call for 60% coverage of children under 5 years of age and pregnant women by 2005; but current coverage in Africa is unacceptably low. The RBM 'Strategic Framework for Coordinated National Action in Scaling-up Insecticide-Treated Netting Programmes in Africa' promotes coordinated national action and advocates sustained public provision of targeted subsidies to maximise public health benefits, alongside support and stimulation of the private sector. Several countries have already planned or initiated targeted subsidy schemes either on a pilot scale or on a national scale, and have valuable experience which can inform future interventions. The WHO RBM 'Workshop on mapping models for delivering ITNs through targeted subsidies' held in Zambia in 2003 provided an opportunity to share and document these country experiences. This paper brings together experiences presented at the workshop with other information on experiences of targeting subsidies on ITNs, net treatment kits and retreatment services (ITN products) in order to describe alternative approaches, highlight their similarities and differences, outline lessons learnt, and identify gaps in knowledge. We find that while there is a growing body of knowledge on different approaches to targeting ITN subsidies, there are significant gaps in knowledge in crucial areas. Key questions regarding how best to target, how much it will cost and what outcomes (levels of coverage) to expect remain unanswered. High quality, well-funded monitoring and evaluation of alternative approaches to targeting ITN subsidies is vital to develop a knowledge base so that countries can design and implement effective strategies to target ITN subsidies.

Healthcare reforms in Cyprus 2013-2017: Does the crisis mark the end of the healthcare sector as we know it?

PubMed

Petrou, Panagiotis; Vandoros, Sotiris

2018-02-01

As part of a bailout agreement with the International Monetary Fund, the European Commission and the European Central Bank (known as the Troika), Cyprus had to achieve a fiscal surplus through budget constraints and efficiency enhancement. As a result, a number of policy changes were implemented, including a reform of the healthcare sector, and major healthcare reforms are planned for the upcoming years, mainly via the introduction of a National Health System. This paper presents the healthcare sector, provides an overview of recent reforms, assesses the recently implemented policies and proposes further interventions. Recent reforms targeting the demand and supply side included the introduction of clinical guidelines, user charges, introduction of coding for Diagnosis Related Groups (DRGs) and the revision of public healthcare coverage criteria. The latter led to a reduction in the number of people with public healthcare coverage in a time of financial crises, when this is needed the most, while co-payments must be reassessed to avoid creating barriers to access. However, DRGs and clinical guidelines can help improve performance and efficiency. The changes so far are yet to mark the end of the healthcare sector as we know it. A universal public healthcare system must remain a priority and must be introduced swiftly to address important existing coverage gaps. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Staff-related access deficit and antenatal care coverage across the NUTS level 1 regions of Turkey.

PubMed

Yardim, Mahmut S

2010-01-01

At the heart of each health system, the workforce is central to advancing health. The World Health Organization has identified a threshold in workforce density below which high coverage of essential interventions, including those necessary to meet the health-related Millennium Development Goals (MDGs), is very unlikely. The International Labor Organization (ILO) has launched a similar indicator -staff related access deficit- using Thailand's health care professional density as a benchmark. The aim of this study is to assess the staff-related access deficit of the population across the 12 NUTS 1 level regions of Turkey. The main hypothesis is that staff-related access deficit has a correlation with and predicts the gap in antenatal care coverage (percentage of women unable to access to antenatal care) across different regions. Staff-related access deficit, as a threshold indicator, seems to have a linear relationship with the antenatal care coverage gap. The known inequalities in the distribution of the health care workforce among different regions of Turkey were put forward once more in this study using the SRA indicator. The staff-related access deficit indicator can be easily used to monitor the status of distributional inequalities of the health care workforce at different sub-national levels in the future.

Agriculture and nutrition in India: mapping evidence to pathways.

PubMed

Kadiyala, Suneetha; Harris, Jody; Headey, Derek; Yosef, Sivan; Gillespie, Stuart

2014-12-01

In India, progress against undernutrition has been slow. Given its importance for income generation, improving diets, care practices, and maternal health, the agriculture sector is widely regarded as playing an important role in accelerating the reduction in undernutrition. This paper comprehensively maps existing evidence along agriculture-nutrition pathways in India and assesses both the quality and coverage of the existing literature. We present a conceptual framework delineating six key pathways between agriculture and nutrition. Three pathways pertain to the nutritional impacts of farm production, farm incomes, and food prices. The other three pertain to agriculture-gender linkages. After an extensive search, we found 78 research papers that provided evidence to populate these pathways. The literature suggests that Indian agriculture has a range of important influences on nutrition. Agriculture seems to influence diets even when controlling for income, and relative food prices could partly explain observed dietary changes in recent decades. The evidence on agriculture-gender linkages to nutrition is relatively weak. Sizeable knowledge gaps remain. The root causes of these gaps include an interdisciplinary disconnect between nutrition and economics/agriculture, a related problem of inadequate survey data, and limited policy-driven experimentation. Closing these gaps is essential to strengthening the agriculture sector's contribution to reducing undernutrition. © 2014 New York Academy of Sciences.

Utilisation of health services and geography: deconstructing regional differences in barriers to facility-based delivery in Nepal.

PubMed

Hodge, Andrew; Byrne, Abbey; Morgan, Alison; Jimenez-Soto, Eliana

2015-03-01

While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers' education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers' birth history was also noteworthy. Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas.

Women In The United States Experience High Rates Of Coverage 'Churn' In Months Before And After Childbirth.

PubMed

Daw, Jamie R; Hatfield, Laura A; Swartz, Katherine; Sommers, Benjamin D

2017-04-01

Insurance transitions-sometimes referred to as "churn"-before and after childbirth can adversely affect the continuity and quality of care. Yet little is known about coverage patterns and changes for women giving birth in the United States. Using nationally representative survey data for the period 2005-13, we found high rates of insurance transitions before and after delivery. Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month of delivery, but 55 percent of women with that coverage at delivery experienced a coverage gap in the ensuing six months. Risk factors associated with insurance loss after delivery include not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100-185 percent of the poverty level. To minimize the adverse effects of coverage disruptions, states should consider policies that promote the continuity of coverage for childbearing women, particularly those with pregnancy-related Medicaid eligibility. Project HOPE—The People-to-People Health Foundation, Inc.

Automatic Road Gap Detection Using Fuzzy Inference System

NASA Astrophysics Data System (ADS)

Hashemi, S.; Valadan Zoej, M. J.; Mokhtarzadeh, M.

2011-09-01

Automatic feature extraction from aerial and satellite images is a high-level data processing which is still one of the most important research topics of the field. In this area, most of the researches are focused on the early step of road detection, where road tracking methods, morphological analysis, dynamic programming and snakes, multi-scale and multi-resolution methods, stereoscopic and multi-temporal analysis, hyper spectral experiments, are some of the mature methods in this field. Although most researches are focused on detection algorithms, none of them can extract road network perfectly. On the other hand, post processing algorithms accentuated on the refining of road detection results, are not developed as well. In this article, the main is to design an intelligent method to detect and compensate road gaps remained on the early result of road detection algorithms. The proposed algorithm consists of five main steps as follow: 1) Short gap coverage: In this step, a multi-scale morphological is designed that covers short gaps in a hierarchical scheme. 2) Long gap detection: In this step, the long gaps, could not be covered in the previous stage, are detected using a fuzzy inference system. for this reason, a knowledge base consisting of some expert rules are designed which are fired on some gap candidates of the road detection results. 3) Long gap coverage: In this stage, detected long gaps are compensated by two strategies of linear and polynomials for this reason, shorter gaps are filled by line fitting while longer ones are compensated by polynomials.4) Accuracy assessment: In order to evaluate the obtained results, some accuracy assessment criteria are proposed. These criteria are obtained by comparing the obtained results with truly compensated ones produced by a human expert. The complete evaluation of the obtained results whit their technical discussions are the materials of the full paper.

EULER-PCR: finishing experiments for repeat resolution.

PubMed

Mulyukov, Zufar; Pevzner, Pavel A

2002-01-01

Genomic sequencing typically generates a large collection of unordered contigs or scaffolds. Contig ordering (also known as gap closure) is a non-trivial algorithmic and experimental problem since even relatively simple-to-assemble bacterial genomes typically result in large set of contigs. Neighboring contigs maybe separated either by gaps in read coverage or by repeats. In the later case we say that the contigs are separated by pseudogaps, and we emphasize the important difference between gap closure and pseudogap closure. The existing gap closure approaches do not distinguish between gaps and pseudogaps and treat them in the same way. We describe a new fast strategy for closing pseudogaps (repeat resolution). Since in highly repetitive genomes, the number of pseudogaps may exceed the number of gaps by an order of magnitude, this approach provides a significant advantage over the existing gap closure methods.

Tunable and sizable band gap in silicene by surface adsorption

PubMed Central

Quhe, Ruge; Fei, Ruixiang; Liu, Qihang; Zheng, Jiaxin; Li, Hong; Xu, Chengyong; Ni, Zeyuan; Wang, Yangyang; Yu, Dapeng; Gao, Zhengxiang; Lu, Jing

2012-01-01

Opening a sizable band gap without degrading its high carrier mobility is as vital for silicene as for graphene to its application as a high-performance field effect transistor (FET). Our density functional theory calculations predict that a band gap is opened in silicene by single-side adsorption of alkali atom as a result of sublattice or bond symmetry breaking. The band gap size is controllable by changing the adsorption coverage, with an impressive maximum band gap up to 0.50 eV. The ab initio quantum transport simulation of a bottom-gated FET based on a sodium-covered silicene reveals a transport gap, which is consistent with the band gap, and the resulting on/off current ratio is up to 108. Therefore, a way is paved for silicene as the channel of a high-performance FET. PMID:23152944

--No Title--

Science.gov Websites

using mesonet visbility observations and CLARUS QC'd obs; Add ceiling height and sky cover analysis to precipitation coverage gaps near CONUS coastlines; Add significant wave height analysis to OCONUS domains

Global yellow fever vaccination coverage from 1970 to 2016: an adjusted retrospective analysis.

PubMed

Shearer, Freya M; Moyes, Catherine L; Pigott, David M; Brady, Oliver J; Marinho, Fatima; Deshpande, Aniruddha; Longbottom, Joshua; Browne, Annie J; Kraemer, Moritz U G; O'Reilly, Kathleen M; Hombach, Joachim; Yactayo, Sergio; de Araújo, Valdelaine E M; da Nóbrega, Aglaêr A; Mosser, Jonathan F; Stanaway, Jeffrey D; Lim, Stephen S; Hay, Simon I; Golding, Nick; Reiner, Robert C

2017-11-01

Substantial outbreaks of yellow fever in Angola and Brazil in the past 2 years, combined with global shortages in vaccine stockpiles, highlight a pressing need to assess present control strategies. The aims of this study were to estimate global yellow fever vaccination coverage from 1970 through to 2016 at high spatial resolution and to calculate the number of individuals still requiring vaccination to reach population coverage thresholds for outbreak prevention. For this adjusted retrospective analysis, we compiled data from a range of sources (eg, WHO reports and health-service-provider registeries) reporting on yellow fever vaccination activities between May 1, 1939, and Oct 29, 2016. To account for uncertainty in how vaccine campaigns were targeted, we calculated three population coverage values to encompass alternative scenarios. We combined these data with demographic information and tracked vaccination coverage through time to estimate the proportion of the population who had ever received a yellow fever vaccine for each second level administrative division across countries at risk of yellow fever virus transmission from 1970 to 2016. Overall, substantial increases in vaccine coverage have occurred since 1970, but notable gaps still exist in contemporary coverage within yellow fever risk zones. We estimate that between 393·7 million and 472·9 million people still require vaccination in areas at risk of yellow fever virus transmission to achieve the 80% population coverage threshold recommended by WHO; this represents between 43% and 52% of the population within yellow fever risk zones, compared with between 66% and 76% of the population who would have required vaccination in 1970. Our results highlight important gaps in yellow fever vaccination coverage, can contribute to improved quantification of outbreak risk, and help to guide planning of future vaccination efforts and emergency stockpiling. The Rhodes Trust, Bill & Melinda Gates Foundation, the Wellcome Trust, the National Library of Medicine of the National Institutes of Health, the European Union's Horizon 2020 research and innovation programme. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

The impact of the 2007-2009 recession on workers' health coverage.

PubMed

Fronstin, Paul

2011-04-01

IMPACT OF THE RECESSION: The 2007-2009 recession has taken its toll on the percentage of the population with employment-based health coverage. While, since 2000, there has been a slow erosion in the percentage of individuals under age 65 with employment-based health coverage, 2009 was the first year in which the percentage fell below 60 percent, and marked the largest one-year decline in coverage. FEWER WORKERS WITH COVERAGE: The percentage of workers with coverage through their own job fell from 53.2 percent in 2008 to 52 percent in 2009, a 2.4 percent decline in the likelihood that a worker has coverage through his or her own job. The percentage of workers with coverage as a dependent fell from 17 percent in 2008 to 16.3 percent in 2009, a 4.5 percent drop in the likelihood that a worker has coverage as a dependent. These declines occurred as the unemployment rate increased from an average of 5.8 percent in 2008 to 9.3 percent in 2009 (and reached a high of 10.1 percent during 2009). FIRM SIZE/INDUSTRY: The decline in the percentage of workers with coverage from their own job affected workers in private-sector firms of all sizes. Among public-sector workers, the decline from 73.4 percent to 73 percent was not statistically significant. Workers in all private-sector industries experienced a statistically significant decline in coverage between 2008 and 2009. HOURS WORKED: Full-time workers experienced a decline in coverage that was statistically significant while part-time workers did not. Among full-time workers, those employed full year experienced a statistically significant decline in coverage from their own job. Those employed full time but for only part of the year did not experience a statistically significant change in coverage. Among part-time workers, those employed full year experienced a statistically significant increase in the likelihood of having coverage in their own name, as did part-time workers employed for only part of the year. ANNUAL EARNINGS: The decline in the percentage of workers with coverage through their own job was limited to workers with lower annual earnings. Statistically significant declines were not found among any group of workers with annual earnings of at least $40,000. Workers with a high school education or less experienced a statistically significant decline in the likelihood of having coverage. Neither workers with a college degree nor those with a graduate degree experienced a statistically significant decline in coverage through their own job. Workers of all races experienced statistically significant declines in coverage between 2008 and 2009. Both men and women experienced a statistically significant decline in the percentage with health coverage through their own job. IMPACT OF STRUCTURAL CHANGES TO THE WORK FORCE: The movement of workers from the manufacturing industry to the service sector continued between 2008 and 2009. The percentage of workers employed on a full-time basis decreased while the percentage working part time increased. While there was an overall decline in the percentage of full-time workers, that decline was limited to workers employed full year. The percentage of workers employed on a full-time, part-year basis increased between 2008 and 2009. The distribution of workers by annual earnings shifted from middle-income workers to lower-income workers between 2008 and 2009.

32 CFR Appendix C to Part 37 - What Is the Desired Coverage for Periodic Audits of For-Profit Participants To Be Audited by IPAs?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 1 2013-07-01 2013-07-01 false What Is the Desired Coverage for Periodic Audits of For-Profit Participants To Be Audited by IPAs? C Appendix C to Part 37 National Defense Department... INVESTMENT AGREEMENTS Pt. 37, App. C Appendix C to Part 37—What Is the Desired Coverage for Periodic Audits...

Moderate Effects of Same-Sex Legislation on Dependent Employer-Based Insurance Coverage among Sexual Minorities

PubMed Central

Tran, Linda Diem

2016-01-01

A difference-in-difference approach was used to compare the effects of same-sex domestic partnership, civil union, and marriage policies on same- and different-sex partners who could have benefitted from their partners’ employer-based insurance (EBI) coverage. Same-sex partners had 78% lower odds (ME=-21%) of having EBI compared to different-sex partners, adjusting for socioeconomic and health-related factors. Same-sex partners living in states that recognized same-sex marriage or domestic partnership had 89% greater odds of having EBI compared to those in states that did not recognize same-sex unions (ME=5%). The impact of same-sex legislation on increasing take-up of dependent EBI coverage among lesbians, gay men, and bisexual individuals (LGBs) was modest, and domestic partnership legislation was equally as effective as same-sex marriage in increasing same-sex partner EBI coverage. Extending dependent EBI coverage to same-sex partners can mitigate gaps in coverage for a segment of the LGB population but will not eliminate them. PMID:26762647

Accelerating progress towards universal health coverage in Asia and Pacific: improving the future for women and children

PubMed Central

Beattie, Allison; Yates, Robert; Noble, Douglas J

2016-01-01

Universal health coverage generates significant health and economic benefits and enables governments to reduce inequity. Where universal health coverage has been implemented well, it can contribute to nation-building. This analysis reviews evidence from Asia and Pacific drawing out determinants of successful systems and barriers to progress with a focus on women and children. Access to healthcare is important for women and children and contributes to early childhood development. Universal health coverage is a political process from the start, and public financing is critical and directly related to more equitable health systems. Closing primary healthcare gaps should be the foundation of universal health coverage reforms. Recommendations for policy for national governments to improve universal health coverage are identified, including countries spending < 3% of gross domestic product in public expenditure on health committing to increasing funding by at least 0.3%/year to reach a minimum expenditure threshold of 3%. PMID:28588989

29 CFR 9.3 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 1 2014-07-01 2013-07-01 true Coverage. 9.3 Section 9.3 Labor Office of the Secretary of Labor NONDISPLACEMENT OF QUALIFIED WORKERS UNDER SERVICE CONTRACTS General § 9.3 Coverage. This part applies to all service contracts and their solicitations, except those excluded by § 9.4 of this part...

29 CFR 9.3 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false Coverage. 9.3 Section 9.3 Labor Office of the Secretary of Labor NONDISPLACEMENT OF QUALIFIED WORKERS UNDER SERVICE CONTRACTS General § 9.3 Coverage. This part applies to all service contracts and their solicitations, except those excluded by § 9.4 of this part...

Analysis of error in TOMS total ozone as a function of orbit and attitude parameters

NASA Technical Reports Server (NTRS)

Gregg, W. W.; Ardanuy, P. E.; Braun, W. C.; Vallette, B. J.; Bhartia, P. K.; Ray, S. N.

1991-01-01

Computer simulations of orbital scenarios were performed to examine the effects of orbital altitude, equator crossing time, attitude uncertainty, and orbital eccentricity on ozone observations by future satellites. These effects were assessed by determining changes in solar and viewing geometry and earth daytime coverage loss. The importance of these changes on ozone retrieval was determined by simulating uncertainties in the TOMS ozone retrieval algorithm. The major findings are as follows: (1) Drift of equator crossing time from local noon would have the largest effect on the quality of ozone derived from TOMS. The most significant effect of this drift is the loss of earth daytime coverage in the winter hemisphere. The loss in coverage increases from 1 degree latitude for + or - 1 hour from noon, 6 degrees for + or - 3 hours from noon, to 53 degrees for + or - 6 hours from noon. An additional effect is the increase in ozone retrieval errors due to high solar zenith angles. (2) To maintain contiguous earth coverage, the maximum scan angle of the sensor must be increased with decreasing orbital altitude. The maximum scan angle required for full coverage at the equator varies from 60 degrees at 600 km altitude to 45 degrees at 1200 km. This produces an increase in spacecraft zenith angle, theta, which decreases the ozone retrieval accuracy. The range in theta was approximately 72 degrees for 600 km to approximately 57 degrees at 1200 km. (3) The effect of elliptical orbits is to create gaps in coverage along the subsatellite track. An elliptical orbit with a 200 km perigee and 1200 km apogee produced a maximum earth coverage gap of about 45 km at the perigee at nadir. (4) An attitude uncertainty of 0.1 degree in each axis (pitch, roll, yaw) produced a maximum scan angle to view the pole, and maximum solar zenith angle).

High Throughput Transcriptomics @ USEPA (Toxicology ...

EPA Pesticide Factsheets

The ideal chemical testing approach will provide complete coverage of all relevant toxicological responses. It should be sensitive and specific It should identify the mechanism/mode-of-action (with dose-dependence). It should identify responses relevant to the species of interest. Responses should ideally be translated into tissue-, organ-, and organism-level effects. It must be economical and scalable. Using a High Throughput Transcriptomics platform within US EPA provides broader coverage of biological activity space and toxicological MOAs and helps fill the toxicological data gap. Slide presentation at the 2016 ToxForum on using High Throughput Transcriptomics at US EPA for broader coverage biological activity space and toxicological MOAs.

Use of qualitative methods and user-centered design to develop customized health information technology tools within federally qualified health centers to keep children insured.

PubMed

DeVoe, Jennifer; Angier, Heather; Likumahuwa, Sonja; Hall, Jennifer; Nelson, Christine; Dickerson, Kay; Keller, Sara; Burdick, Tim; Cohen, Deborah

2014-01-01

Lack of health insurance negatively impacts children's health. Despite federal initiatives to expand children's coverage and accelerate state outreach efforts, millions of US children remain uninsured or experience frequent gaps in coverage. Most current efforts to enroll and retain eligible children in public insurance programs take place outside of the health care system. This study is a partnership between patients' families, medical informaticists, federally qualified health center (FQHC) staff, and researchers to build and test information technology tools to help FQHCs reach uninsured children and those at risk for losing coverage.

Count every newborn; a measurement improvement roadmap for coverage data

PubMed Central

2015-01-01

Background The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. Methods In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. Results ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. Conclusions The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks. PMID:26391444

Influenza Vaccination Coverage and Its Associated Factors among North Korean Defectors Living in the Republic of Korea.

PubMed

Song, In Gyu; Lee, Haewon; Yi, Jinseon; Kim, Min Sun; Park, Sang Min

2015-09-01

This study aimed to examine influenza vaccination coverage of North Korean defectors (NKD) in the Republic of Korea (Korea) and explore the factors affected the vaccination coverage. Total 378 NKD were analyzed. Four Korean control subjects were randomly matched by age and gender from the Korea National Health and Nutrition Examination Survey V (n = 1,500). The adjusted vaccination coverage revealed no statistical difference between the defectors group and indigenous group (29.1% vs. 29.5%, P = 0.915). In the aged under 50 group, the vaccination coverage of NKD was higher than that of Korean natives (37.8% vs. 25.8%, P = 0.016). However in the aged 50 yr and over group, the vaccination coverage of North Korean defectors was lower than that of the natives (28.0% vs. 37.6%, P = 0.189). Even the gap was wider in the aged 65 yr and over group (36.4% vs. 77.8%, P = 0.007). Gender and medical check-up experience within 2 yr showed association with the vaccination coverage of NKD. Influenza vaccination coverage of aged defectors' group (aged 50 yr and over) was lower than indigenous people though overall vaccination coverage was similar. Further efforts to increase influenza vaccination coverage of this group are needed.

38 CFR 9.3 - Waiver or reduction of coverage.

Code of Federal Regulations, 2010 CFR

2010-07-01

... for the previous period of duty will not apply to the subsequent period of duty. (b) Part-time... duty training on the date the waiver or reduction is filed. (1) When a member insured under part-time... eligible for part-time coverage, unless changed, shall be effective throughout the entire period of part...

Bridging the Communication Gap: Successes and Challenges of Mobile Phone Technology in a Health and Demographic Surveillance System in Northern Nigeria

PubMed Central

Doctor, Henry V.; Olatunji, Alabi; Jumare, Abdul’Azeez

2012-01-01

Maternal and child health indicators are generally poor in Nigeria with the northern part of the country having the worst indicators than the southern part. Efforts to address maternal and health challenges in Nigeria include, among others, improvement in health and management information systems. We report on the experience of mobile phone technology in supporting the activities of a health and demographic surveillance system in northern Nigeria. Our experience calls for the need for the Nigerian Government, the mobile network companies, and the international community at large to consolidate their efforts in addressing the mobile network coverage and power supply challenges in order to create an enabling environment for socio-economic development particularly in rural and disadvantaged areas. Unless power and mobile network challenges are addressed, health interventions that rely on mobile phone technology will not have a significant impact in improving maternal and child health. PMID:23569650

Defining the methodological challenges and opportunities for an effective science of sociotechnical systems and safety.

PubMed

Waterson, Patrick; Robertson, Michelle M; Cooke, Nancy J; Militello, Laura; Roth, Emilie; Stanton, Neville A

2015-01-01

An important part of the application of sociotechnical systems theory (STS) is the development of methods, tools and techniques to assess human factors and ergonomics workplace requirements. We focus in this paper on describing and evaluating current STS methods for workplace safety, as well as outlining a set of six case studies covering the application of these methods to a range of safety contexts. We also describe an evaluation of the methods in terms of ratings of their ability to address a set of theoretical and practical questions (e.g. the degree to which methods capture static/dynamic aspects of tasks and interactions between system levels). The outcomes from the evaluation highlight a set of gaps relating to the coverage and applicability of current methods for STS and safety (e.g. coverage of external influences on system functioning; method usability). The final sections of the paper describe a set of future challenges, as well as some practical suggestions for tackling these. We provide an up-to-date review of STS methods, a set of case studies illustrating their use and an evaluation of their strengths and weaknesses. The paper concludes with a 'roadmap' for future work.

Estimating the coverage of mental health programmes: a systematic review.

PubMed

De Silva, Mary J; Lee, Lucy; Fuhr, Daniela C; Rathod, Sujit; Chisholm, Dan; Schellenberg, Joanna; Patel, Vikram

2014-04-01

The large treatment gap for people suffering from mental disorders has led to initiatives to scale up mental health services. In order to track progress, estimates of programme coverage, and changes in coverage over time, are needed. Systematic review of mental health programme evaluations that assess coverage, measured either as the proportion of the target population in contact with services (contact coverage) or as the proportion of the target population who receive appropriate and effective care (effective coverage). We performed a search of electronic databases and grey literature up to March 2013 and contacted experts in the field. Methods to estimate the numerator (service utilization) and the denominator (target population) were reviewed to explore methods which could be used in programme evaluations. We identified 15 735 unique records of which only seven met the inclusion criteria. All studies reported contact coverage. No study explicitly measured effective coverage, but it was possible to estimate this for one study. In six studies the numerator of coverage, service utilization, was estimated using routine clinical information, whereas one study used a national community survey. The methods for estimating the denominator, the population in need of services, were more varied and included national prevalence surveys case registers, and estimates from the literature. Very few coverage estimates are available. Coverage could be estimated at low cost by combining routine programme data with population prevalence estimates from national surveys.

Deep Space Network and Lunar Network Communication Coverage of the Moon

NASA Technical Reports Server (NTRS)

Lee, Charles H.; Cheung, Kar-Ming

2006-01-01

In this article, we describe the communication coverage analysis for the lunar network and the Earth ground stations. The first part of this article focuses on the direct communication coverage of the Moon from the Earth's ground stations. In particular, we assess the coverage performance of the Moon based on the existing Deep Space Network (DSN) antennas and the complimentary coverage of other potential stations at Hartebeesthoek, South Africa and at Santiago, Chile. We also address the coverage sensitivity based on different DSN antenna scenarios and their capability to provide single and redundant coverage of the Moon. The second part of this article focuses on the framework of the constrained optimization scheme to seek a stable constellation six relay satellites in two planes that not only can provide continuous communication coverage to any users on the Moon surface, but can also deliver data throughput in a highly efficient manner.

42 CFR 423.2315 - Medicare Coverage Gap Discount Program Agreement.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Maintain up-to-date NDC listings with the electronic database vendors for which the manufacturer provides... under this subpart must comply with the requirements imposed by CMS or the third party administrator (as...

42 CFR 423.2315 - Medicare Coverage Gap Discount Program Agreement.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Maintain up-to-date NDC listings with the electronic database vendors for which the manufacturer provides... under this subpart must comply with the requirements imposed by CMS or the third party administrator (as...

42 CFR 423.2315 - Medicare Coverage Gap Discount Program Agreement.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Maintain up-to-date NDC listings with the electronic database vendors for which the manufacturer provides... under this subpart must comply with the requirements imposed by CMS or the third party administrator (as...

Improve EPA's AIRNow Air Quality Index Maps with NASA/NOAA Satellite Data

NASA Astrophysics Data System (ADS)

Pasch, A.; Zahn, P. H.; DeWinter, J. L.; Haderman, M. D.; White, J. E.; Dickerson, P.; Dye, T. S.; Martin, R. V.

2011-12-01

The U.S. Environmental Protection Agency's (EPA) AIRNow program provides maps of real-time hourly Air Quality Index (AQI) conditions and daily AQI forecasts nationwide (http://www.airnow.gov). The public uses these maps to make decisions concerning their respiratory health. The usefulness of the AIRNow air quality maps depends on the accuracy and spatial coverage of air quality measurements. Currently, the maps use only ground-based measurements, which have significant gaps in coverage in some parts of the United States. As a result, contoured AQI levels have high uncertainty in regions far from monitors. To improve the usefulness of air quality maps, scientists at EPA and Sonoma Technology, Inc. are working in collaboration with the National Aeronautics and Space Administration (NASA), the National Oceanic and Atmospheric Administration (NOAA), and university researchers on a project to incorporate additional measurements into the maps via the AIRNow Satellite Data Processor (ASDP). These measurements include estimated surface PM

Measuring Progress Toward Universal Health Coverage: Does the Monitoring Framework of Bangladesh Need Further Improvement?

PubMed

Gupta, Rajat Das; Shahabuddin, Asm

2018-01-08

This review aimed to compare Bangladesh's Universal Health Coverage (UHC) monitoring framework with the global-level recommendations and to find out the existing gaps of Bangladesh's UHC monitoring framework compared to the global recommendations. In order to reach the aims of the review, we systematically searched two electronic databases - PubMed and Google Scholar - by using appropriate keywords to select articles that describe issues related to UHC and the monitoring framework of UHC applied globally and particularly in Bangladesh. Four relevant documents were found and synthesized. The review found that Bangladesh incorporated all of the recommendations suggested by the global monitoring framework regarding mentoring the financial risk protection and equity perspective. However, a significant gap in the monitoring framework related to service coverage was observed. Although Bangladesh has a significant burden of mental illnesses, cataract, and neglected tropical diseases, indicators related to these issues were absent in Bangladesh's UHC framework. Moreover, palliative-care-related indicators were completely missing in the framework. The results of this review suggest that Bangladesh should incorporate these indicators in their UHC monitoring framework in order to track the progress of the country toward UHC more efficiently and in a robust way.

Reliability of Fault Tolerant Control Systems. Part 1

NASA Technical Reports Server (NTRS)

Wu, N. Eva

2001-01-01

This paper reports Part I of a two part effort, that is intended to delineate the relationship between reliability and fault tolerant control in a quantitative manner. Reliability analysis of fault-tolerant control systems is performed using Markov models. Reliability properties, peculiar to fault-tolerant control systems are emphasized. As a consequence, coverage of failures through redundancy management can be severely limited. It is shown that in the early life of a syi1ein composed of highly reliable subsystems, the reliability of the overall system is affine with respect to coverage, and inadequate coverage induces dominant single point failures. The utility of some existing software tools for assessing the reliability of fault tolerant control systems is also discussed. Coverage modeling is attempted in Part II in a way that captures its dependence on the control performance and on the diagnostic resolution.

"Prince Charming Syndrome?" Gender gap in preferences for defined contribution pensions in Japan.

PubMed

Watanabe, Satoshi P

2017-01-01

Using survey data collected by the Japan Institute of Life Insurance in 2002, this study finds that a significant gender gap existed in defined contribution (DC) pension knowledge among workers employed at small- to medium-sized private firms in Japan. Even with similar DC knowledge, however, men and women reveal different preferences for DC pensions, indicating that their perceptional responses may widely differ from actual behaviors. Apart from the knowledge gap, the result shows evidence of the Prince Charming Syndrome among female employees as a significant source of the gender gap in DC participation rates. Among corporate pension-covered employees, the gender difference in the efficacy of DC portability is a more significant gap-generating factor. DC tax advantage is particularly favored by pension-covered female employees over male counterparts, reducing the DC preference gap. No similar evidence is found for employees with no corporate pension coverage.

Reconstruction of Arctic surface temperature in past 100 years using DINEOF

NASA Astrophysics Data System (ADS)

Zhang, Qiyi; Huang, Jianbin; Luo, Yong

2015-04-01

Global annual mean surface temperature has not risen apparently since 1998, which is described as global warming hiatus in recent years. However, measuring of temperature variability in Arctic is difficult because of large gaps in coverage of Arctic region in most observed gridded datasets. Since Arctic has experienced a rapid temperature change in recent years that called polar amplification, and temperature risen in Arctic is faster than global mean, the unobserved temperature in central Arctic will result in cold bias in both global and Arctic temperature measurement compared with model simulations and reanalysis datasets. Moreover, some datasets that have complete coverage in Arctic but short temporal scale cannot show Arctic temperature variability for long time. Data Interpolating Empirical Orthogonal Function (DINEOF) were applied to fill the coverage gap of NASA's Goddard Institute for Space Studies Surface Temperature Analysis (GISTEMP 250km smooth) product in Arctic with IABP dataset which covers entire Arctic region between 1979 and 1998, and to reconstruct Arctic temperature in 1900-2012. This method provided temperature reconstruction in central Arctic and precise estimation of both global and Arctic temperature variability with a long temporal scale. Results have been verified by extra independent station records in Arctic by statistical analysis, such as variance and standard deviation. The result of reconstruction shows significant warming trend in Arctic in recent 30 years, as the temperature trend in Arctic since 1997 is 0.76°C per decade, compared with 0.48°C and 0.67°C per decade from 250km smooth and 1200km smooth of GISTEMP. And global temperature trend is two times greater after using DINEOF. The discrepancies above stress the importance of fully consideration of temperature variance in Arctic because gaps of coverage in Arctic cause apparent cold bias in temperature estimation. The result of global surface temperature also proves that global warming in recent years is not as slow as thought.

Rhea North Polar Maps - January 2011

NASA Image and Video Library

2011-05-02

The northern and southern hemispheres of Rhea are seen in these polar stereographic maps, mosaicked from the best-available NASA Cassini and Voyager images. Six Voyager images fill in gaps in Cassini coverage of the moon north pole.

Rhea South Polar Map - January 2011

NASA Image and Video Library

2011-05-02

The northern and southern hemispheres of Rhea are seen in these polar stereographic maps, mosaicked from the best-available NASA Cassini and Voyager images. Six Voyager images fill in gaps in Cassini coverage of the moon north pole.

Further observations on comparison of immunization coverage by lot quality assurance sampling and 30 cluster sampling.

PubMed

Singh, J; Jain, D C; Sharma, R S; Verghese, T

1996-06-01

Lot Quality Assurance Sampling (LQAS) and standard EPI methodology (30 cluster sampling) were used to evaluate immunization coverage in a Primary Health Center (PHC) where coverage levels were reported to be more than 85%. Of 27 sub-centers (lots) evaluated by LQAS, only 2 were accepted for child coverage, whereas none was accepted for tetanus toxoid (TT) coverage in mothers. LQAS data were combined to obtain an estimate of coverage in the entire population; 41% (95% CI 36-46) infants were immunized appropriately for their ages, while 42% (95% CI 37-47) of their mothers had received a second/ booster dose of TT. TT coverage in 149 contemporary mothers sampled in EPI survey was also 42% (95% CI 31-52). Although results by the two sampling methods were consistent with each other, a big gap was evident between reported coverage (in children as well as mothers) and survey results. LQAS was found to be operationally feasible, but it cost 40% more and required 2.5 times more time than the EPI survey. LQAS therefore, is not a good substitute for current EPI methodology to evaluate immunization coverage in a large administrative area. However, LQAS has potential as method to monitor health programs on a routine basis in small population sub-units, especially in areas with high and heterogeneously distributed immunization coverage.

Moderate Effects of Same-Sex Legislation on Dependent Employer-Based Insurance Coverage Among Sexual Minorities.

PubMed

Tran, Linda Diem

2016-12-01

A difference-in-difference approach was used to compare the effects of same-sex domestic partnership, civil union, and marriage policies on same- and different-sex partners who could have benefitted from their partners' employer-based insurance (EBI) coverage. Same-sex partners had 78% lower odds (Marginal Effect = -21%) of having EBI compared with different-sex partners, adjusting for socioeconomic and health-related factors. Same-sex partners living in states that recognized same-sex marriage or domestic partnership had 89% greater odds of having EBI compared with those in states that did not recognize same-sex unions (ME = 5%). The impact of same-sex legislation on increasing take-up of dependent EBI coverage among lesbians, gay men, and bisexual individuals was modest, and domestic partnership legislation was equally as effective as same-sex marriage in increasing same-sex partner EBI coverage. Extending dependent EBI coverage to same-sex partners can mitigate gaps in coverage for a segment of the lesbians, gay men, and bisexual population but will not eliminate them. © The Author(s) 2016.

Toward a more reliable federal survey for tracking health insurance coverage and access.

PubMed

Kenney, Genevieve; Holahan, John; Nichols, Len

2006-06-01

Examination of the extent to which federal surveys provide the data needed to estimate the coverage/cost impacts of policy alternatives to address the problem of uninsurance. Assessment of the major federal household surveys that regularly provide information on health insurance and access to care based on an examination of each survey instrument and related survey documentation and the methodological literature. Identification of the data needed to address key policy questions on insurance coverage, assessment of how well existing surveys meet this need, definition of the critical elements of an ideal survey, and examination of the potential for building on existing surveys. Collection and critical assessment of pertinent survey documentation and methodological studies. While all the federal surveys examined provide valuable information, the information available to guide key policy decisions still has major gaps. Issues include measurement of insurance coverage and critical content gaps, inadequate sample sizes to support precise state and substate estimates, considerable delays between data collection and availability, and concerns about response rates and item nonresponse. Our assessment is that the Current Population Survey (CPS) and the National Health Interview Survey could be most readily modified to address these issues. The vast resources devoted to health care and the magnitude of the uninsurance problem make it critical that we have a reliable source for tracking health care and coverage at the national and state levels and for major local areas. It is plausible that this could be more cost effectively done by building on existing surveys than by designing and fielding a new one, but further research is needed to make a definitive judgment. At a minimum, the health insurance information collected on the CPS should be revised to address existing measurement problems.

Utilisation of health services and the poor: deconstructing wealth-based differences in facility-based delivery in the Philippines.

PubMed

Hodge, Andrew; Firth, Sonja; Bermejo, Raoul; Zeck, Willibald; Jimenez-Soto, Eliana

2016-07-06

Despite achieving some success, wealth-related disparities in the utilisation of maternal and child health services persist in the Philippines. The aim of this study is to decompose the principal factors driving the wealth-based utilisation gap. Using national representative data from the 2013 Philippines Demographic and Health Survey, we examine the extent overall differences in the utilisation of maternal health services can be explained by observable factors. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect of differences in measurable characteristics on the wealth-based coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was respectively 41.1 % and 74.6 % for poor and non-poor households. Between 67 and 69 % of the wealth-based coverage gap was explained by differences in observed characteristics. After controlling for factors characterising the socioeconomic status of the household (i.e. the mothers' and her partners' education and occupation), the birth order of the child was the major factor contributing to the disparity. Mothers' religion and the subjective distance to the health facility were also noteworthy. This study has found moderate wealth-based disparities in the utilisation of institutional delivery in the Philippines. The results confirm the importance of recent efforts made by the Philippine government to implement equitable, pro-poor focused health programs in the most deprived geographic areas of the country. The importance of addressing the social determinants of health, particularly education, as well as developing and implementing effective strategies to encourage institutional delivery for higher order births, should be prioritised.

National red listing beyond the 2010 target.

PubMed

Zamin, Tara J; Baillie, Jonathan E M; Miller, Rebecca M; Rodríguez, Jon Paul; Ardid, Ana; Collen, Ben

2010-08-01

Following creation of the 2010 Biodiversity Target under the Convention on Biological Diversity and adoption of the United Nations Millennium Development Goals, information on status and trends of biodiversity at the national level has become increasingly important to both science and policy. National red lists (NRLs) of threatened species may provide suitable data for reporting on progress toward these goals and for informing national conservation priority setting. This information will also become increasingly important for developing species- and ecosystem-based strategies for climate change adaptation. We conducted a thorough global review of NRLs in 109 countries and analyzed gaps in NRL coverage in terms of geography and taxonomy to determine priority regions and taxonomic groups for further investment. We then examined correlations between the NRL data set and gross domestic product (GDP) and vertebrate species richness. The largest geographic gap was in Oceania, followed by middle Africa, the Caribbean, and western Africa, whereas the largest taxonomic gaps were for invertebrates, fungi, and lichens. The comprehensiveness of NRL coverage within a given country was positively correlated with GDP and negatively correlated with total vertebrate richness and threatened vertebrate richness. This supports the assertion that regions with the greatest and most vulnerable biodiversity receive the least conservation attention and indicates that financial resources may be an integral limitation. To improve coverage of NRLs, we propose a combination of projects that target underrepresented taxa or regions and projects that provide the means for countries to create or update NRLs on their own. We recommend improvements in knowledge transfer within and across regions as a priority for future investment.

Wisps in the outer edge of the Keeler Gap

NASA Astrophysics Data System (ADS)

Tiscareno, Matthew S.; Arnault, Ethan G.

2015-11-01

Superposed upon the relatively smooth outer edge of the Keeler Gap are a system of "wisps," which appear to be ring material protruding inward into the gap, usually with a sharp trailing edge and a smooth gradation back to the background edge location on the leading side (Porco et al. 2005, Science). The radial amplitude of wisps is usually 0.5 to 1 km, and their azimuthal extent is approximately a degree of longitude (~2400 km). Wisps are likely caused by an interplay between Daphnis (and perhaps other moons) and embedded moonlets within the ring, though the details remain unclear.Aside from the wisps, the Keeler Gap outer edge is the only one of the five sharp edges in the outer part of Saturn's A ring that is reasonably smooth in appearance (Tiscareno et al. 2005, DPS), with occultations indicating residuals less than 1 km upon a possibly non-zero eccentricity (R.G. French, personal communication, 2014). The other four (the inner and outer edges of the Encke Gap, the inner edge of the Keeler Gap, and the outer edge of the A ring itself) are characterized by wavy structure at moderate to high spatial frequencies, with amplitudes ranging from 2 to 30 km (Tiscareno et al. 2005, DPS).We will present a catalogue of wisp detections in Cassini images. We carry out repeated gaussian fits of the radial edge location in order to characterize edge structure and visually scan those fitted edges in order to detect wisps. With extensive coverage in longitude and in time, we will report on how wisps evolve and move, both within an orbit period and on longer timescales. We will also report on the frequency and interpretation of wisps that deviate from the standard morphology. We will discuss the implications of our results for the origin and nature of wisps, and for the larger picture of how masses interact within Saturn's rings.

Wisps in the outer edge of the Keeler Gap

NASA Astrophysics Data System (ADS)

Tiscareno, M. S.; Arnault, E. G.

2014-12-01

The outer part of Saturn's A ring contains five sharp edges: the inner and outer edges of the Encke Gap and of the Keeler Gap (which contain the moons Pan and Daphnis, respectively), and the outer edge of the A ring itself. Four of these five edges are characterized by structure at moderate to high spatial frequencies, with amplitudes ranging from 2 to 30 km (Tiscareno et al. 2005, DPS). Only the outer edge of the Keeler Gap is reasonably smooth in appearance (Tiscareno et al. 2005, DPS), with occultations indicating residuals less than 1 km upon a possibly non-zero eccentricity (R.G. French, personal communication, 2014). Superposed upon the relatively smooth outer edge of the Keeler Gap are a system of "wisps," which appear to be ring material protruding inward into the gap, usually with a sharp trailing edge and a smooth gradation back to the background edge location on the leading side (Porco et al. 2005, Science). The radial amplitude of wisps is usually 0.5 to 1 km, and their azimuthal extent is approximately a degree of longitude (~2400 km). Wisps are likely caused by an interplay between Daphnis (and perhaps other moons) and embedded moonlets within the ring, though the details remain unclear. We will present a catalogue of wisp detections in Cassini images. We carry out repeated gaussian fits of the radial edge location in order to characterize edge structure (see Figure, which compares our fitted edge to the figure presented by Porco et al. 2005) and visually scan those fitted edges in order to detect wisps. With extensive coverage in longitude and in time, we will report on how wisps evolve and move, both within an orbit period and on longer timescales. We will also report on the frequency and interpretation of wisps that deviate from the standard morphology. We will discuss the implications of our results for the origin and nature of wisps, and for the larger picture of how masses interact within Saturn's rings.

Map of Rhea - January 2011

NASA Image and Video Library

2011-05-02

This global digital map of Rhea was created using data taken during NASA Cassini and Voyager spacecraft flybys. This map contains data from Cassini Jan. 11, 2011, flyby of Rhea. Six Voyager images fill gaps in Cassini coverage of the north pole.

Low-coverage surface diffusion in complex periodic energy landscapes: Analytical solution for systems with symmetric hops and application to intercalation in topological insulators

NASA Astrophysics Data System (ADS)

Gosálvez, Miguel A.; Otrokov, Mikhail M.; Ferrando, Nestor; Ryabishchenkova, Anastasia G.; Ayuela, Andres; Echenique, Pedro M.; Chulkov, Evgueni V.

2016-02-01

This is the first of two papers that introduce a general expression for the tracer diffusivity in complex, periodic energy landscapes with M distinct hop rates in one-, two-, and three-dimensional diluted systems (low-coverage, single-tracer limit). The present report focuses on the analysis of diffusion in systems where the end sites of the hops are located symmetrically with respect to the hop origins (symmetric hops), as encountered in many ideal surfaces and bulk materials. For diffusion in two dimensions, a number of formulas are presented for complex combinations of the different hops in systems with triangular, rectangular, and square symmetry. The formulas provide values in excellent agreement with kinetic Monte Carlo simulations, concluding that the diffusion coefficient can be directly determined from the proposed expressions without performing the simulations. Based on the diffusion barriers obtained from first-principles calculations and a physically meaningful estimate of the attempt frequencies, the proposed formulas are used to analyze the diffusion of Cu, Ag, and Rb adatoms on the surface and within the van der Waals (vdW) gap of a model topological insulator, Bi2Se3 . Considering the possibility of adsorbate intercalation from the terraces to the vdW gaps at morphological steps, we infer that, at low coverage and room temperature, (i) a majority of the Rb atoms bounce back at the steps and remain on the terraces, (ii) Cu atoms mostly intercalate into the vdW gap, the remaining fraction staying at the steps, and (iii) Ag atoms essentially accumulate at the steps and gradually intercalate into the vdW gap. These conclusions are in good qualitative agreement with previous experiments. The companion report (M. A. Gosálvez et al., Phys. Rev. B, submitted] extends the present study to the description of systems that contain asymmetric hops.

Estimating the coverage of mental health programmes: a systematic review

PubMed Central

De Silva, Mary J; Lee, Lucy; Fuhr, Daniela C; Rathod, Sujit; Chisholm, Dan; Schellenberg, Joanna; Patel, Vikram

2014-01-01

Background The large treatment gap for people suffering from mental disorders has led to initiatives to scale up mental health services. In order to track progress, estimates of programme coverage, and changes in coverage over time, are needed. Methods Systematic review of mental health programme evaluations that assess coverage, measured either as the proportion of the target population in contact with services (contact coverage) or as the proportion of the target population who receive appropriate and effective care (effective coverage). We performed a search of electronic databases and grey literature up to March 2013 and contacted experts in the field. Methods to estimate the numerator (service utilization) and the denominator (target population) were reviewed to explore methods which could be used in programme evaluations. Results We identified 15 735 unique records of which only seven met the inclusion criteria. All studies reported contact coverage. No study explicitly measured effective coverage, but it was possible to estimate this for one study. In six studies the numerator of coverage, service utilization, was estimated using routine clinical information, whereas one study used a national community survey. The methods for estimating the denominator, the population in need of services, were more varied and included national prevalence surveys case registers, and estimates from the literature. Conclusions Very few coverage estimates are available. Coverage could be estimated at low cost by combining routine programme data with population prevalence estimates from national surveys. PMID:24760874

Proposed regulations could limit access to affordable health coverage for workers' children and family members.

PubMed

Jacobs, Ken; Graham-Squire, Dave; Roby, Dylan H; Kominski, Gerald F; Kinane, Christina M; Needleman, Jack; Watson, Greg; Gans, Daphna

2011-12-01

Key Findings. The Patient Protection and Affordable Care Act (ACA) is designed to offer premium subsidies to help eligible individuals and their families purchase insurance coverage when affordable job-based coverage is not available. However, the law is unclear on how this affordability protection is applied in those instances where self-only coverage offered by an employer is affordable but family coverage is not. Regulations recently proposed by the Department of the Treasury would make family members ineligible for subsidized coverage in the exchange if an employee is offered affordable self-only coverage by an employer, even if family coverage is unaffordable. This could have significant financial consequences for low- and moderate-income families that fall in this gap. Using an alternative interpretation of the law could allow the entire family to enter the exchange when family coverage is unaffordable, which would broaden access to coverage. However, this option has been cited as cost prohibitive. In this brief we consider a middle ground alternative that would base eligibility for the individual worker on the cost of self-only coverage, but would use the additional cost to the employee for family coverage as the basis for determining affordability and eligibility for subsidies for the remaining family members. We find that: Under the middle ground alternative scenario an additional 144,000 Californians would qualify for and use premium subsidies in the California Health Benefit Exchange, half of whom are children. Less than 1 percent of those with employer-based coverage would move to subsidized coverage in the California Health Benefit Exchange as a result of having unaffordable coverage on the job.

Influenza Vaccination Coverage among Adults in Korea: 2008–2009 to 2011–2012 Seasons

PubMed Central

Yang, Hye Jung; Cho, Sung-il

2014-01-01

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008–2009 season to the 2011–2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health Survey. We also collected information on socioeconomic status and health behaviors in subpopulations. We tested for linear trends among the data to investigate vaccine coverage before and after the pandemic; and multiple logistic regression analyses were performed to identify predictors of obtaining the influenza vaccination. The results revealed a steady increase in vaccination coverage in every subgroup during four consecutive seasons. The highest rate of vaccine coverage (43.6%) occurred two years after the pandemic. Factors associated with vaccine receipt were: older age; lower education level; lower income; and health behaviors such as regular walking and receiving a health check-up. Smoking and drinking alcohol were inversely associated with vaccination. Having a chronic health condition was also a strong predictor of vaccine receipt. Though vaccination coverage rates were high in high-risk groups; disparities in coverage rates were substantial; particularly in young adults. Interventions are needed to minimize the coverage gaps among subgroups and to improve overall vaccination rates. PMID:25429683

Influenza vaccination coverage among adults in Korea: 2008-2009 to 2011-2012 seasons.

PubMed

Yang, Hye Jung; Cho, Sung-Il

2014-11-25

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008-2009 season to the 2011-2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health Survey. We also collected information on socioeconomic status and health behaviors in subpopulations. We tested for linear trends among the data to investigate vaccine coverage before and after the pandemic; and multiple logistic regression analyses were performed to identify predictors of obtaining the influenza vaccination. The results revealed a steady increase in vaccination coverage in every subgroup during four consecutive seasons. The highest rate of vaccine coverage (43.6%) occurred two years after the pandemic. Factors associated with vaccine receipt were: older age; lower education level; lower income; and health behaviors such as regular walking and receiving a health check-up. Smoking and drinking alcohol were inversely associated with vaccination. Having a chronic health condition was also a strong predictor of vaccine receipt. Though vaccination coverage rates were high in high-risk groups; disparities in coverage rates were substantial; particularly in young adults. Interventions are needed to minimize the coverage gaps among subgroups and to improve overall vaccination rates.

Marital status, spousal coverage, and the gender gap in employer-sponsored health insurance.

PubMed

Buchmueller, T C

Not only do men who work full time earn more than women, but they are more likely to receive employer-sponsored health benefits. This paper provides evidence on the gender gap in employer-sponsored health insurance. The results indicate that the gap is driven largely by the tendency of married women to decline employer-sponsored insurance in favor of being covered through their husbands. Indeed, among single workers, women are more likely than men to be offered insurance. These findings call into question the conclusion made by previous researchers that employers discriminate against women in the provision of health insurance.

New estimates of gaps and transitions in health insurance.

PubMed

Short, Pamela Farley; Graefe, Deborah R; Swartz, Katherine; Uberoi, Namrata

2012-12-01

Changes in individual or family circumstances cause many Americans to experience gaps and transitions in public and private health insurance. Using data from the 2004-2007 Survey of Income and Program Participation, this article updates earlier analyses of insurance gaps and transitions. Eighty-nine million people (one third of nonelderly Americans) were uninsured for at least 1 month during those 4 years. Approximately 23 million lost insurance more than once. The analyses call attention to the continuing instability and insecurity of health insurance, can inform implementation of national reforms, and establish a recent baseline that will be helpful in evaluating the reforms' effects on coverage stability.

5 CFR 890.102 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Coverage. 890.102 Section 890.102... EMPLOYEES HEALTH BENEFITS PROGRAM Administration and General Provisions § 890.102 Coverage. (a) Each...) Paragraph (c) of this section does not deny coverage to: (1) An employee appointed to perform “part-time...

Can investments in health systems strategies lead to changes in immunization coverage?

PubMed

Brenzel, Logan

2014-04-01

National immunization programs in developing countries have made major strides to immunize the world's children, increasing full coverage to 83% of children. However, the World Health Organization estimates that 22 million children less than five years of age are left unvaccinated, and coverage levels have been plateauing for nearly a decade. This paper describes the evidence on factors contributing to low vaccination uptake, and describes the connection between these factors and the documented strategies and interventions that can lead to changes in immunization outcomes. The author suggests that investments in these areas may contribute more effectively to immunization coverage and also have positive spill-over benefits for health systems. The paper concludes that while some good quality evidence exists of what works and may contribute to immunization outcomes, the quality of evidence needs to improve and major gaps need to be addressed.

Covered today, sick tomorrow? Trends and correlates of children's health insurance instability.

PubMed

Hill, Heather D; Shaefer, H Luke

2011-10-01

Many children with health insurance will experience gaps in coverage over time, potentially reducing their access to and use of preventive health care services. This article uses the Survey of Income and Program Participation to examine how the stability of children's health insurance changed between 1990 and 2005 and to identify dynamic aspects of family life associated with transitions in coverage. Children's health insurance instability has increased since the early 1990s, due to greater movement between insured and uninsured states and between private and public insurance coverage. Changes in the employment and marital status of the family head are highly associated with an increased risk of a child losing and gaining public and private coverage, largely in hypothesized directions. The exception is that marital dissolution and job loss are associated with an increased probability of a child losing public insurance, despite there being no clear policy explanation for such a relationship.

Uterotonic use immediately following birth: using a novel methodology to estimate population coverage in four countries.

PubMed

Ricca, Jim; Dwivedi, Vikas; Varallo, John; Singh, Gajendra; Pallipamula, Suranjeen Prasad; Amade, Nazir; de Luz Vaz, Maria; Bishanga, Dustan; Plotkin, Marya; Al-Makaleh, Bushra; Suhowatsky, Stephanie; Smith, Jeffrey Michael

2015-01-22

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in developing countries. While incidence of PPH can be dramatically reduced by uterotonic use immediately following birth (UUIFB) in both community and facility settings, national coverage estimates are rare. Most national health systems have no indicator to track this, and community-based measurements are even more scarce. To fill this information gap, a methodology for estimating national coverage for UUIFB was developed and piloted in four settings. The rapid estimation methodology consisted of convening a group of national technical experts and using the Delphi method to come to consensus on key data elements that were applied to a simple algorithm, generating a non-precise national estimate of coverage of UUIFB. Data elements needed for the calculation were the distribution of births by location and estimates of UUIFB in each of those settings, adjusted to take account of stockout rates and potency of uterotonics. This exercise was conducted in 2013 in Mozambique, Tanzania, the state of Jharkhand in India, and Yemen. Available data showed that deliveries in public health facilities account for approximately half of births in Mozambique and Tanzania, 16% in Jharkhand and 24% of births in Yemen. Significant proportions of births occur in private facilities in Jharkhand and faith-based facilities in Tanzania. Estimated uterotonic use for facility births ranged from 70 to 100%. Uterotonics are not used routinely for PPH prevention at home births in any of the settings. National UUIFB coverage estimates of all births were 43% in Mozambique, 40% in Tanzania, 44% in Jharkhand, and 14% in Yemen. This methodology for estimating coverage of UUIFB was found to be feasible and acceptable. While the exercise produces imprecise estimates whose validity cannot be assessed objectively in the absence of a gold standard estimate, stakeholders felt they were accurate enough to be actionable. The exercise highlighted information and practice gaps and promoted discussion on ways to improve UUIFB measurement and coverage, particularly of home births. Further follow up is needed to verify actions taken. The methodology produces useful data to help accelerate efforts to reduce maternal mortality.

Spatio-Temporal Gap Analysis of OBIS-SEAMAP Project Data: Assessment and Way Forward

PubMed Central

Kot, Connie Y.; Fujioka, Ei; Hazen, Lucie J.; Best, Benjamin D.; Read, Andrew J.; Halpin, Patrick N.

2010-01-01

The OBIS-SEAMAP project has acquired and served high-quality marine mammal, seabird, and sea turtle data to the public since its inception in 2002. As data accumulated, spatial and temporal biases resulted and a comprehensive gap analysis was needed in order to assess coverage to direct data acquisition for the OBIS-SEAMAP project and for taxa researchers should true gaps in knowledge exist. All datasets published on OBIS-SEAMAP up to February 2009 were summarized spatially and temporally. Seabirds comprised the greatest number of records, compared to the other two taxa, and most records were from shipboard surveys, compared to the other three platforms. Many of the point observations and polyline tracklines were located in northern and central Atlantic and the northeastern and central-eastern Pacific. The Southern Hemisphere generally had the lowest representation of data, with the least number of records in the southern Atlantic and western Pacific regions. Temporally, records of observations for all taxa were the lowest in fall although the number of animals sighted was lowest in the winter. Oceanographic coverage of observations varied by platform for each taxa, which showed that using two or more platforms represented habitat ranges better than using only one alone. Accessible and published datasets not already incorporated do exist within spatial and temporal gaps identified. Other related open-source data portals also contain data that fill gaps, emphasizing the importance of dedicated data exchange. Temporal and spatial gaps were mostly a result of data acquisition effort, development of regional partnerships and collaborations, and ease of field data collection. Future directions should include fostering partnerships with researchers in the Southern Hemisphere while targeting datasets containing species with limited representation. These results can facilitate prioritizing datasets needed to be represented and for planning research for true gaps in space and time. PMID:20886047

Spatio-temporal gap analysis of OBIS-SEAMAP project data: assessment and way forward.

PubMed

Kot, Connie Y; Fujioka, Ei; Hazen, Lucie J; Best, Benjamin D; Read, Andrew J; Halpin, Patrick N

2010-09-24

The OBIS-SEAMAP project has acquired and served high-quality marine mammal, seabird, and sea turtle data to the public since its inception in 2002. As data accumulated, spatial and temporal biases resulted and a comprehensive gap analysis was needed in order to assess coverage to direct data acquisition for the OBIS-SEAMAP project and for taxa researchers should true gaps in knowledge exist. All datasets published on OBIS-SEAMAP up to February 2009 were summarized spatially and temporally. Seabirds comprised the greatest number of records, compared to the other two taxa, and most records were from shipboard surveys, compared to the other three platforms. Many of the point observations and polyline tracklines were located in northern and central Atlantic and the northeastern and central-eastern Pacific. The Southern Hemisphere generally had the lowest representation of data, with the least number of records in the southern Atlantic and western Pacific regions. Temporally, records of observations for all taxa were the lowest in fall although the number of animals sighted was lowest in the winter. Oceanographic coverage of observations varied by platform for each taxa, which showed that using two or more platforms represented habitat ranges better than using only one alone. Accessible and published datasets not already incorporated do exist within spatial and temporal gaps identified. Other related open-source data portals also contain data that fill gaps, emphasizing the importance of dedicated data exchange. Temporal and spatial gaps were mostly a result of data acquisition effort, development of regional partnerships and collaborations, and ease of field data collection. Future directions should include fostering partnerships with researchers in the Southern Hemisphere while targeting datasets containing species with limited representation. These results can facilitate prioritizing datasets needed to be represented and for planning research for true gaps in space and time.

Trends and missing parts in the study of movement ecology

PubMed Central

Holyoak, Marcel; Casagrandi, Renato; Nathan, Ran; Revilla, Eloy; Spiegel, Orr

2008-01-01

Movement is important to all organisms, and accordingly it is addressed in a huge number of papers in the literature. Of nearly 26,000 papers referring to movement, an estimated 34% focused on movement by measuring it or testing hypotheses about it. This enormous amount of information is difficult to review and highlights the need to assess the collective completeness of movement studies and identify gaps. We surveyed 1,000 randomly selected papers from 496 journals and compared the facets of movement studied with a suggested framework for movement ecology, consisting of internal state (motivation, physiology), motion and navigation capacities, and external factors (both the physical environment and living organisms), and links among these components. Most studies simply measured and described the movement of organisms without reference to ecological or internal factors, and the most frequently studied part of the framework was the link between external factors and motion capacity. Few studies looked at the effects on movement of navigation capacity, or internal state, and those were mainly from vertebrates. For invertebrates and plants most studies were at the population level, whereas more vertebrate studies were conducted at the individual level. Consideration of only population-level averages promulgates neglect of between-individual variation in movement, potentially hindering the study of factors controlling movement. Terminology was found to be inconsistent among taxa and subdisciplines. The gaps identified in coverage of movement studies highlight research areas that should be addressed to fully understand the ecology of movement. PMID:19060194

29 CFR 2530.201-1 - Coverage; general.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 9 2013-07-01 2013-07-01 false Coverage; general. 2530.201-1 Section 2530.201-1 Labor... Provisions § 2530.201-1 Coverage; general. Coverage of the provisions of part 2 of title I of the Act is... § 2510.3-2). Second, the employee benefit plan must be subject to title I of the Act. Coverage for title...

29 CFR 2530.201-1 - Coverage; general.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 9 2012-07-01 2012-07-01 false Coverage; general. 2530.201-1 Section 2530.201-1 Labor... Provisions § 2530.201-1 Coverage; general. Coverage of the provisions of part 2 of title I of the Act is... § 2510.3-2). Second, the employee benefit plan must be subject to title I of the Act. Coverage for title...

29 CFR 2530.201-1 - Coverage; general.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 9 2014-07-01 2014-07-01 false Coverage; general. 2530.201-1 Section 2530.201-1 Labor... Provisions § 2530.201-1 Coverage; general. Coverage of the provisions of part 2 of title I of the Act is... § 2510.3-2). Second, the employee benefit plan must be subject to title I of the Act. Coverage for title...

A flexible benefits tax credit for health insurance and more.

PubMed

Etheredge, Lynn

2001-01-01

This essay outlines a concept for a "flexible benefits" tax credit for expanding health insurance coverage and other purposes such as retirement savings plans (with potential withdrawals for higher education, first-home ownership, and catastrophic medical expenses). Two examples are presented. The advantages of a flexible benefits tax credit are considered in terms of efficient use of the budget surplus to help meet the varied (and changing) needs of American families, to eliminate major national gaps in health insurance and pension coverage, and to advance other objectives. If the budget surplus is used wisely, political decisionmakers could achieve health insurance coverage for most uninsured workers and children and assure a future with real economic security for American families.

Medicare Part D formulary coverage since program inception: are beneficiaries choosing wisely?

PubMed

Jackson, E Anne; Axelsen, Kirsten J

2008-11-01

To evaluate how Medicare Part D formulary composition has changed since program inception, including comparison of plans eligible for full premium subsidy (ie, benchmark plans) with their counterparts. The study used publicly available data released by the Centers for Medicare & Medicaid Services to generate snapshots of formulary coverage and enrollment levels in each plan year. The analysis included all Part D plans and tracked formulary coverage of 152 of the most common brand name and generic drugs prescribed to seniors. Since 2006, the number of products available without restriction has increased and the number of drugs not on formulary has decreased. However, it appears that beneficiaries (subsidized beneficiaries in particular) may not be using their open-enrollment periods to reevaluate the available plan offerings. Beneficiaries need to reevaluate the Part D options available on an annual basis to maintain enrollment with the most appropriate plan available. Although all plans meet the proscribed formulary requirements, some plans offer richer drug coverage with more drugs available on an unrestricted basis. Benchmark plan status allows Part D plans to maintain or gain significant Medicare enrollment from year to year. Careful oversight should be provided to ensure that the level of formulary coverage offered at benchmark and other plans remains consistent.

The Medicare Drug Benefit (Part D) and Treatment of Heart Failure in Older Adults

PubMed Central

Donohue, Julie M.; Zhang, Yuting; Lave, Judith R.; Gellad, Walid F.; Men, Aiju; Perera, Subashan; Hanlon, Joseph T.

2010-01-01

Background Adherence to pharmacotherapy for heart failure is poor among older adults due, in part, to high prescription drug costs. We examined the impact of improvements in drug coverage under Medicare Part D on utilization of, and adherence to, medications for heart failure in older adults. Methods We used a quasi-experimental approach to analyze pharmacy claims for 6,950 individuals age≥65 years with heart failure enrolled in a Medicare managed care organization two years before and after Part D’s implementation. We compared prescription fill patterns among individuals who moved from limited (quarterly benefits caps of $150 or $350) or no drug coverage to Part D in 2006 to those who had generous employer-sponsored coverage throughout the study period. Results Individuals who previously lacked drug coverage filled approximately 6 more heart failure prescriptions annually after Part D (Adjusted Ratio of Prescription Counts = 1.36, 95% Confidence Interval=CI=1.29-1.44; p<0.0001 relative to the comparison group). Those previously lacking drug coverage were more likely to fill prescriptions for an angiotensin converting enzyme inhibitor/angiotensin II receptor blocker plus a beta blocker after Part D (adjusted ratio of odds ratios=AROR=1.73; 95% CI=1.42-2.10; p<0.0001), and more likely to be adherent to such pharmacotherapy (AROR=2.95; 95% CI=1.85-4.69; p<0.0001) relative to the comparison group. Conclusions Medicare Part D was associated with improved access to medications and adherence to pharmacotherapy in older adults with heart failure. PMID:20598987

Investigating the Equatorial Gaps in Snowball Earth Sea Glaciers

NASA Astrophysics Data System (ADS)

Spaulding-Astudillo, F.; Ashkenazy, Y.; Tziperman, E.; Abbot, D. S.

2017-12-01

The way photosynthetic life survived the Neoproterozoic Snowball Earth events is still a matter of debate that has deep implications for planetary habitability. One option is that gaps in thick, semi-global ice coverage (sea glaciers) could be maintained at the equator by ocean-ice-atmosphere dynamics. We investigate this idea by modifying a global ocean-thick-marine-ice model developed for modeling Neoproterozoic Snowball Events to account for gaps in thick ice and interactions with atmospheric dynamics. Our hypothesis is that in the parameter regime that allows for sea glacier flow, ice flow will make gaps in the thick ice, and therefore an open ocean solution, less likely. This would suggest that oases in thick ice are a more viable survival mechanism for photosynthetic life during a Snowball Earth event.

Superconducting Vacuum-Gap Crossovers for High Performance Microwave Applications

NASA Technical Reports Server (NTRS)

Denis, Kevin L.; Brown, Ari D.; Chang, Meng-Ping; Hu, Ron; U-Yen, Kongpop; Wollack, Edward J.

2016-01-01

The design and fabrication of low-loss wide-bandwidth superconducting vacuum-gap crossovers for high performance millimeter wave applications are described. In order to reduce ohmic and parasitic losses at millimeter wavelengths a vacuum gap is preferred relative to dielectric spacer. Here, vacuum-gap crossovers were realized by using a sacrificial polymer layer followed by niobium sputter deposition optimized for coating coverage over an underlying niobium signal layer. Both coplanar waveguide and microstrip crossover topologies have been explored in detail. The resulting fabrication process is compatible with a bulk micro-machining process for realizing waveguide coupled detectors, which includes sacrificial wax bonding, and wafer backside deep reactive ion etching for creation of leg isolated silicon membrane structures. Release of the vacuum gap structures along with the wax bonded wafer after DRIE is implemented in the same process step used to complete the detector fabrication. ?

Measuring Progress Toward Universal Health Coverage: Does the Monitoring Framework of Bangladesh Need Further Improvement?

PubMed Central

Shahabuddin, ASM

2018-01-01

This review aimed to compare Bangladesh’s Universal Health Coverage (UHC) monitoring framework with the global-level recommendations and to find out the existing gaps of Bangladesh’s UHC monitoring framework compared to the global recommendations. In order to reach the aims of the review, we systematically searched two electronic databases - PubMed and Google Scholar - by using appropriate keywords to select articles that describe issues related to UHC and the monitoring framework of UHC applied globally and particularly in Bangladesh. Four relevant documents were found and synthesized. The review found that Bangladesh incorporated all of the recommendations suggested by the global monitoring framework regarding mentoring the financial risk protection and equity perspective. However, a significant gap in the monitoring framework related to service coverage was observed. Although Bangladesh has a significant burden of mental illnesses, cataract, and neglected tropical diseases, indicators related to these issues were absent in Bangladesh’s UHC framework. Moreover, palliative-care-related indicators were completely missing in the framework. The results of this review suggest that Bangladesh should incorporate these indicators in their UHC monitoring framework in order to track the progress of the country toward UHC more efficiently and in a robust way. PMID:29541562

Revisiting the ichthyodiversity of Java and Bali through DNA barcodes: taxonomic coverage, identification accuracy, cryptic diversity and identification of exotic species.

PubMed

Dahruddin, Hadi; Hutama, Aditya; Busson, Frédéric; Sauri, Sopian; Hanner, Robert; Keith, Philippe; Hadiaty, Renny; Hubert, Nicolas

2017-03-01

Among the 899 species of freshwater fishes reported from Sundaland biodiversity hotspot, nearly 50% are endemics. The functional integrity of aquatic ecosystems is currently jeopardized by human activities, and landscape conversion led to the decline of fish populations in several part of Sundaland, particularly in Java. The inventory of the Javanese ichthyofauna has been discontinuous, and the taxonomic knowledge is scattered in the literature. This study provides a DNA barcode reference library for the inland fishes of Java and Bali with the aim to streamline the inventory of fishes in this part of Sundaland. Owing to the lack of available checklist for estimating the taxonomic coverage of this study, a checklist was compiled based on online catalogues. A total of 95 sites were visited, and a library including 1046 DNA barcodes for 159 species was assembled. Nearest neighbour distance was 28-fold higher than maximum intraspecific distance on average, and a DNA barcoding gap was observed. The list of species with DNA barcodes displayed large discrepancies with the checklist compiled here as only 36% (i.e. 77 species) and 60% (i.e. 24 species) of the known species were sampled in Java and Bali, respectively. This result was contrasted by a high number of new occurrences and the ceiling of the accumulation curves for both species and genera. These results highlight the poor taxonomic knowledge of this ichthyofauna, and the apparent discrepancy between present and historical occurrence data is to be attributed to species extirpations, synonymy and misidentifications in previous studies. © 2016 John Wiley & Sons Ltd.

5 CFR 839.213 - May I make a retirement coverage election if I withdrew all or part of my TSP account after I was...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) CORRECTION OF RETIREMENT COVERAGE ERRORS UNDER THE FEDERAL ERRONEOUS RETIREMENT COVERAGE CORRECTIONS ACT... if your qualifying retirement coverage error was previously corrected to FERS, and you later received...

12 CFR 205.3 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 2 2012-01-01 2012-01-01 false Coverage. 205.3 Section 205.3 Banks and Banking... (REGULATION E) § 205.3 Coverage. (a) General. This part applies to any electronic fund transfer that... explanation of how the amount of the fee will be determined. (c) Exclusions from coverage. The term electronic...

Defining the methodological challenges and opportunities for an effective science of sociotechnical systems and safety

PubMed Central

Waterson, Patrick; Robertson, Michelle M.; Cooke, Nancy J.; Militello, Laura; Roth, Emilie; Stanton, Neville A.

2015-01-01

An important part of the application of sociotechnical systems theory (STS) is the development of methods, tools and techniques to assess human factors and ergonomics workplace requirements. We focus in this paper on describing and evaluating current STS methods for workplace safety, as well as outlining a set of six case studies covering the application of these methods to a range of safety contexts. We also describe an evaluation of the methods in terms of ratings of their ability to address a set of theoretical and practical questions (e.g. the degree to which methods capture static/dynamic aspects of tasks and interactions between system levels). The outcomes from the evaluation highlight a set of gaps relating to the coverage and applicability of current methods for STS and safety (e.g. coverage of external influences on system functioning; method usability). The final sections of the paper describe a set of future challenges, as well as some practical suggestions for tackling these. Practitioner Summary: We provide an up-to-date review of STS methods, a set of case studies illustrating their use and an evaluation of their strengths and weaknesses. The paper concludes with a ‘roadmap’ for future work. PMID:25832121

Hydrocarbon deposition in gaps of tungsten and graphite tiles in Experimental Advanced Superconducting Tokamak edge plasma parameters

NASA Astrophysics Data System (ADS)

Xu, Qian; Yang, Zhongshi; Luo, Guang-Nan

2015-09-01

The three-dimensional (3D) Monte Carlo code PIC-EDDY has been utilized to investigate the mechanism of hydrocarbon deposition in gaps of tungsten tiles in the Experimental Advanced Superconducting Tokamak (EAST), where the sheath potential is calculated by the 2D in space and 3D in velocity particle-in-cell method. The calculated results for graphite tiles using the same method are also presented for comparison. Calculation results show that the amount of carbon deposited in the gaps of carbon tiles is three times larger than that in the gaps of tungsten tiles when the carbon particles from re-erosion on the top surface of monoblocks are taken into account. However, the deposition amount is found to be larger in the gaps of tungsten tiles at the same CH4 flux. When chemical sputtering becomes significant as carbon coverage on tungsten increases with exposure time, the deposition inside the gaps of tungsten tiles would be considerable.

Federally-Assisted Healthcare Coverage among Male State Prisoners with Chronic Health Problems.

PubMed

Rosen, David L; Grodensky, Catherine A; Holley, Tara K

2016-01-01

Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA). We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative sample of prisoners to estimate the number eligible for healthcare coverage at release. There were 643,290 US male prisoners aged 18-64 with a chronic health condition. At release, 73% in Medicaid-expansion states would qualify for Medicaid or tax credits. In non-expansion states, 54% would qualify for tax credits, but 22% (n = 69,827) had incomes of ≤ 100% the federal poverty limit and thus would be ineligible for ACA-mediated healthcare coverage. These prisoners comprise 11% of all male prisoners with a chronic condition. The ACA was projected to provide coverage to most male state prisoners with a chronic health condition; however, roughly 70,000 fall in the "coverage gap" and may require non-routine care at emergency departments. Mechanisms are needed to secure coverage for this at risk group and address barriers to routine utilization of health services.

Tuning the tunneling magnetoresistance by using fluorinated graphene in graphene based magnetic junctions

NASA Astrophysics Data System (ADS)

Meena, Shweta; Choudhary, Sudhanshu

2017-12-01

Spin polarized properties of fluorinated graphene as tunnel barrier with CrO2 as two HMF electrodes are studied using first principle methods based on density functional theory. Fluorinated graphene with different fluorine coverages is explored as tunnel barriers in magnetic tunnel junctions. Density functional computation for different fluorine coverages imply that with increase in fluorine coverages, there is increase in band gap (Eg) of graphene, Eg ˜ 3.466 e V was observed when graphene sheet is fluorine adsorbed on both-side with 100% coverage (CF). The results of CF graphene are compared with C4F (fluorination on one-side of graphene sheet with 25% coverage) and out-of-plane graphene based magnetic tunnel junctions. On comparison of the results it is observed that CF graphene based structure offers high TMR ˜100%, and the transport of carrier is through tunneling as there are no transmission states near Fermi level. This suggests that graphene sheet with both-side fluorination with 100% coverages acts as a perfect insulator and hence a better barrier to the carriers which is due to negligible spin down current (I ↓ ) in both Parallel Configuration (PC) and Antiparallel Configuration (APC).

Predictors, help-seeking behaviour and treatment coverage for depression in adults in Sehore district, India

PubMed Central

Lyngdoh, Tanica; Murhar, Vaibhav; Samudre, Sandesh; Krafft, Thomas

2017-01-01

Background National Mental Health Survey found that in India, the point prevalence of major depressive disorder (MDD) was 2.7% and the treatment gap was 85.2%, whereas in Madhya Pradesh the point prevalence of MDD was 1.4% and the treatment gap was 80%. Aims To describe the baseline prevalence of depression among adults, association of various demographic and socioeconomic variables with depression and estimation of contact coverage for the same. Method Population-based cross-sectional survey of 3220 adults in Sehore district of Madhya Pradesh, India. The outcome of interest was a probable diagnosis of depression that was measured using the Patient Health Questionnaire (PHQ-9) and the proportion of individuals with depression (PHQ-9>9) who sought care for the same. The data were analysed using simple and multiple log-linear regression. Results Low educational attainment, unemployment and indebtedness were associated with both moderate/severe depression (PHQ-9 score >9) and severe depression only (PHQ-9 score >14), whereas age, caste and marital status were associated with only moderate or severe depression. Religion, type of house, land ownership and amount of loan taken were not associated with either moderate/severe or only severe depression. The contact coverage for moderate/severe depression was 13.08% (95% CI 10.2–16.63). Conclusions There is an urgent need to bridge the treatment gap by targeting individuals with social vulnerabilities and integrating evidence-based interventions in primary care. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:28904815

A systematic review and meta-analysis of community and facility-based approaches to address gaps in HIV testing and linkage in sub-Saharan Africa

PubMed Central

Sharma, Monisha; Ying, Roger; Tarr, Gillian; Barnabas, Ruanne

2016-01-01

HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention. PMID:26633769

Is there still an immunity gap in high-level national immunization coverage, Iran?

PubMed

Zahraei, Seyed Mohsen; Eshrati, Babak; Gouya, Mohammad Mehdi; Mohammadbeigi, Abolfazl; Kamran, Aziz

2014-10-01

As there is a significant number of Iranian immigrant and illegal refugees living in marginal areas of large cities that might induce immunization gap in these areas.  The aim of this study was to provide reliable information on vaccination status of these people. A cross sectional study was conducted on children 24-47 month old who lived in the suburb areas of five large cities of Iran in 2013. Proportional cluster sampling method was used in each city and standard questionnaire of the World Health Organization applied for the purpose of data collection. The survey counts immunizations based on immunization card plus the history of vaccination according to the mother's memory. All gathered data were analyzed using SPSS software (version 16). Overall, 4502 children (49.2% female) aged 24-47 month participated in this survey among which 88.1% were Iranian and 11.9% were Afghan or other nationalities. Totally, 4479 (99.4%, CI 95%: 99.2%-99.6%) of the children had a vaccination card while 828 (18.5%, CI 95%; 15.8%-21.1%) could not present it to the interviewers. 96.8% of children were fully immunized, 3.2% were partially immunized and 0.1% were not immunized. There was no significant difference in terms of vaccine coverage among males and females. The prevalence of partially immunization in non-Iranian children was six fold of Iranian children (11.9% vs. 2%). Immunization program is implemented appropriately with high coverage rates in suburb areas of the country. However, there is still an immunity gap in non-Iranian immigrants, which should be a health system considered as a high-risk group by the health system.

Reduction of racial/ethnic disparities in vaccination coverage, 1995-2011.

PubMed

Walker, Allison T; Smith, Philip J; Kolasa, Maureen

2014-04-18

The Presidential Childhood Immunization Initiative was developed in 1993 to address major gaps in childhood vaccination coverage in the United States. Eliminating the cost of vaccines as a barrier to vaccination was one strategy of the Childhood Immunization Initiative; it led to Congressional legislation that authorized creation of the Vaccines for Children program (VFC) in 1994. CDC analyzed National Immunization Survey data for 1995-2011 to evaluate trends in disparities in vaccination coverage rates between non-Hispanic white children and children of other racial/ethnic groups. VFC has been effective in ireducing disparities in vaccination coverage among U.S. children. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that has been effective in reducing childhood vaccination coverage-related disparities in the United States. At its inception in 1994, VFC was implemented in 78 Immunization Action Plan areas that covered the entire United States; within each area, concerted efforts were made to improve childhood vaccination coverage. The findings in this report demonstrate that there have been no racial/ethnic disparities in vaccine coverage for measles-mumps-rubella and poliovirus in the United States since 2005. Disparities in coverage for the diphtheria-tetanus-pertussis/diphtheria-tetanus-acellular pertussis vaccine were absent, declining, or inconsistent during this period, depending on the racial/ethnic group examined. The results in this report highlight the effectiveness of VFC.

The implication of the shortage of health workforce specialist on universal health coverage in Kenya.

PubMed

Miseda, Mumbo Hazel; Were, Samuel Odhiambo; Murianki, Cirindi Anne; Mutuku, Milo Peter; Mutwiwa, Stephen N

2017-12-01

Globally, there is an acute shortage of human resources for health (HRH), and the greatest burden is borne by low-income countries especially in sub-Saharan Africa and some parts of Asia. This shortage has not only considerably constrained the achievement of health-related development goals but also impeded accelerated progress towards universal health coverage (UHC). Like any other low-income country, Kenya is experiencing health workforce shortage particularly in specialized healthcare workers to cater for the rapidly growing need for specialized health care (MOH Training Needs Assessment report (2015)). Efficient use of the existing health workforce including task shifting is under consideration as a short-term stop gap measure while deliberate efforts are being put on retention policies and increased production of HRH. The Ministry of Health (MOH) with support from the United States Agency for International Development-funded FUNZOKenya project and MOH/Japan International Cooperation Agency (JICA) project conducted a country-wide training needs assessment (TNA) to identify skill gaps in the provision of specialized health care in private and public hospitals in 46 out of Kenya's 47 counties between April and June 2015. A total of 99 respondents participated in the TNA. Structured questionnaires were used to undertake this assessment. The assessment sought to determine the extent of skill gaps on the basis of the national guidelines and as perceived by the County Directors of Health (CDH). The questionnaires were posted to and received by all the respondents a week prior to a face-to-face interview with the respondents for familiarization. Data analysis was done using SPSS statistical package. Overall, the findings revealed average skill gaps on selected specialists (healthcare professional whose practice is limited to a particular area, such as a branch of medicine, surgery, or nursing, especially, one who by virtue of advanced training is certified by a specialty board as being qualified to so limit his or her practice, Free dictionary) at 85 and 62% when compared to the guideline and as perceived by the CDH respectively. It also revealed that gynecologists exceeded the requirements by 88 and 246% against the guidelines and as perceived by the CDH respectively. There is an overall huge gap in health specialists across the 46 counties, and the focus of training should be on the following specialists: cardio-surgeons, neurosurgeons, oncologists, nephrologists, lung and skin clinical officers, anesthetic clinical officers, cardiology nurses, forensic nurses, dental nurses, accident and emergency nurses, and oncology nurses. More innovative approaches, including the use of technology, need to be considered to address this challenge in the immediate, medium, and long terms. Policies and legal frameworks should be developed to facilitate cross-county sharing of specialist expertise. Efforts need to be made to ensure harmonized skill gaps revealed by the guideline and as perceived by the CDHs to inform the development of mitigation strategies.

New Estimates of Gaps and Transitions in Health Insurance

PubMed Central

Short, Pamela Farley; Graefe, Deborah R.; Swartz, Katherine; Uberoi, Namrata

2014-01-01

Changes in individual or family circumstances cause many Americans to experience gaps and transitions in public and private health insurance. Using data from the 2004–2007 Survey of Income and Program Participation, this article updates earlier analyses of insurance gaps and transitions. Eighty-nine million people (one third of non-elderly Americans) were uninsured for at least one month during those four years. Approximately twenty-three million lost insurance more than once. The analyses call attention to the continuing instability and insecurity of health insurance, can inform implementation of national reforms, and establish a recent baseline that will be helpful in evaluating the reforms’ effects on coverage stability. PMID:22833452

The magnitude of and health system responses to the mental health treatment gap in adults in India and China.

PubMed

Patel, Vikram; Xiao, Shuiyuan; Chen, Hanhui; Hanna, Fahmy; Jotheeswaran, A T; Luo, Dan; Parikh, Rachana; Sharma, Eesha; Usmani, Shamaila; Yu, Yu; Druss, Benjamin G; Saxena, Shekhar

2016-12-17

This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate. Copyright © 2016 Elsevier Ltd. All rights reserved.

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries.

PubMed

Leyvraz, Magali; Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark; Neufeld, Lynnette M

2017-05-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d'Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap.

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries123

PubMed Central

Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark

2017-01-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d’Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap. PMID:28404839

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015

PubMed Central

Ogbuanu, Ikechukwu U.; Adegoke, Oluwasegun J.; Scobie, Heather M.; Uba, Belinda V.; Wannemuehler, Kathleen A.; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J.; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F.

2016-01-01

Background Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Methods Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014–2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12–23 months was documented based on vaccination card or caretaker’s recall. District-level coverage estimates were calculated using survey methods. Results Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1–63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%–139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Conclusions Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria. PMID:27936077

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015.

PubMed

Gunnala, Rajni; Ogbuanu, Ikechukwu U; Adegoke, Oluwasegun J; Scobie, Heather M; Uba, Belinda V; Wannemuehler, Kathleen A; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F

2016-01-01

Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014-2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12-23 months was documented based on vaccination card or caretaker's recall. District-level coverage estimates were calculated using survey methods. Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1-63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%-139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria.

45 CFR 148.220 - Excepted benefits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FOR THE INDIVIDUAL HEALTH INSURANCE MARKET Preemption; Excepted Benefits § 148.220 Excepted benefits. The requirements of this part do not apply to individual health insurance coverage in relation to its... part do not apply to individual health insurance coverage described in paragraphs (b)(1) through (b)(6...

Addressing Medicaid/marketplace churn through multimarket plans: assessing the current state of play.

PubMed

Rosenbaum, Sara

2015-02-01

Both before and after the Affordable Care Act (ACA), the US health insurance system is characterized by fragmentation. Pre-ACA, this fragmentation included major coverage gaps, causing significant periods of coverage interruption, especially for lower-income people. The ACA does not end the problem of churning among sources of public financing, but it does hold the potential for enabling people to move among sources of coverage rather than go without insurance. Several strategies for reducing coverage churn exist, but none is foolproof and all are in their early stages. Thus the ability of issuers to participate across multiple public financing arrangements and to offer stable provider networks becomes crucial to achieving continuity of care. Interviews with nine companies involved in developing or operating multimarket strategies confirm the feasibility of this approach while revealing major challenges, especially the challenge of finding providers willing to treat members regardless of the source of coverage. Strategies for increasing multimarket plans and networks represent one of the great areas of future policy and operational focus. Copyright © 2015 by Duke University Press.

ScanIndel: a hybrid framework for indel detection via gapped alignment, split reads and de novo assembly.

PubMed

Yang, Rendong; Nelson, Andrew C; Henzler, Christine; Thyagarajan, Bharat; Silverstein, Kevin A T

2015-12-07

Comprehensive identification of insertions/deletions (indels) across the full size spectrum from second generation sequencing is challenging due to the relatively short read length inherent in the technology. Different indel calling methods exist but are limited in detection to specific sizes with varying accuracy and resolution. We present ScanIndel, an integrated framework for detecting indels with multiple heuristics including gapped alignment, split reads and de novo assembly. Using simulation data, we demonstrate ScanIndel's superior sensitivity and specificity relative to several state-of-the-art indel callers across various coverage levels and indel sizes. ScanIndel yields higher predictive accuracy with lower computational cost compared with existing tools for both targeted resequencing data from tumor specimens and high coverage whole-genome sequencing data from the human NIST standard NA12878. Thus, we anticipate ScanIndel will improve indel analysis in both clinical and research settings. ScanIndel is implemented in Python, and is freely available for academic use at https://github.com/cauyrd/ScanIndel.

A method for the estimate of the wall diffusion for non-axisymmetric fields using rotating external fields

NASA Astrophysics Data System (ADS)

Frassinetti, L.; Olofsson, K. E. J.; Fridström, R.; Setiadi, A. C.; Brunsell, P. R.; Volpe, F. A.; Drake, J.

2013-08-01

A new method for the estimate of the wall diffusion time of non-axisymmetric fields is developed. The method based on rotating external fields and on the measurement of the wall frequency response is developed and tested in EXTRAP T2R. The method allows the experimental estimate of the wall diffusion time for each Fourier harmonic and the estimate of the wall diffusion toroidal asymmetries. The method intrinsically considers the effects of three-dimensional structures and of the shell gaps. Far from the gaps, experimental results are in good agreement with the diffusion time estimated with a simple cylindrical model that assumes a homogeneous wall. The method is also applied with non-standard configurations of the coil array, in order to mimic tokamak-relevant settings with a partial wall coverage and active coils of large toroidal extent. The comparison with the full coverage results shows good agreement if the effects of the relevant sidebands are considered.

75 FR 34537 - Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-17

... 45 CFR Part 147 Group Health Plans and Health Insurance Coverage Relating to Status as a... for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan... group health plans and health insurance coverage in the group and individual markets under provisions of...

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act.

PubMed

Novak, Priscilla; Anderson, Andrew C; Chen, Jie

2018-05-12

The Affordable Care Act (ACA) aims to expand health insurance coverage and minimize financial barriers to receiving health care services for individuals. However, little is known about how the ACA has impacted individuals with mental health conditions. This study finds that the implementation of the ACA is associated with an increase in rate of health insurance coverage among nonelderly adults with serious psychological distress (SPD) and a reduction in delaying and forgoing necessary care. The ACA also reduced the odds of an individual with SPD not being able to afford mental health care. Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014-2016, but gaps remain.

Financing strategies to improve essential public health equalization and its effects in China.

PubMed

Yang, Li; Sun, Li; Wen, Liankui; Zhang, Huyang; Li, Chenyang; Hanson, Kara; Fang, Hai

2016-12-01

In 2009, China launched a health reform to promote the equalization of national essential public health services package (NEPHSP). The present study aimed to describe the financing strategies and mechanisms to improve access to public health for all, identify the strengths and weaknesses of the different approaches, and showed evidence on equity improvement among different regions. We reviewed the relevant literatures and identified 208 articles after screening and quality assessment and conducted six key informants' interviews. Secondary data on national and local government health expenditures, NEPHSP coverage and health indicators in 2003-2014 were collected, descriptive and equity analyses were used. Before 2009, the government subsidy to primary care institutions (PCIs) were mainly used for basic construction and a small part of personnel expenses. Since 2009, the new funds for NEPHSP have significantly expanded service coverage and population coverage. These funds have been allocated by central, provincial, municipal and county governments at different proportions in China's tax distribution system. Due to the fiscal transfer payment, the Central Government allocated more subsides to less-developed western regions and all the funds were managed in a specific account. Several types of payment methods have been adopted including capitation, pay for performance (P4P), pay for service items, global budget and public health voucher, to address issues from both the supply and demand sides. The equalization of NEPHSP did well through the establishment of health records, systematic care of children and maternal women, etc. Our data showed that the gap between the eastern, central and western regions narrowed. However the coverage for migrants was still low and performance was needed improving in effectiveness of managing patients with chronic diseases. The delivery of essential public health services was highly influenced by public fiscal policy, and the implementation of health reform since 2009 has led the public health development towards the right direction. However China still needs to increase the fiscal investments to expand service coverage as well as promote the quality of public health services and equality among regions. Independent scientific monitoring and evaluation are also needed.

Anomalous Elasticity of 4He Films at the Quantum Phase Transition

NASA Astrophysics Data System (ADS)

Shirahama, Keiya; Takahashi, Daisuke; Kogure, Takayuki; Yoshimura, Hitomi; Higashino, Rama

4 He films on solid substrates exhibit a quantum phase transition between localized (nonsuperfluid) and superfluid states by changing coverage n. We have made torsional oscillator (TO) studies for 4He films adsorbed on nanoporous glasses. A TO with localized films showed an apparent ''supersolid'' behavior, an increase in TO frequency f with broad peak in Q-1. Combining with FEM analyses for TO's with different designs, we conclude that the behavior results from the softening of adsorbed 4He films at high temperatures. The features in f and Q-1 are fitted well to a Debye-like activation with a distributed energy gap Δ, so the elasticity is accounted by thermal excitation of localized atoms to an ''extended'' state. As the critical coverage nc approaches the gap decreases to zero with a powerlaw Δ ~(n -nc) 1 . 2 . Assuming that the 4He chemical potential μ (n) is located in the middle of the gap, we can estimate the elastic constant κ-1 =n2 ∂μ / ∂n . The elasticity agrees with shear moduli of 4He films obtained from the FEM analysis within factor of three. The energetics proposed from the elastic behavior naturally explains other properties of He films adsorbed on disordered substrates.

Drug Plan Coverage Rules

MedlinePlus

... the first time Filling a prescription without your new plan card Costs for Medicare drug coverage Joining a health or drug plan How Part D works with other insurance Find health & drug plans Drug plan coverage rules Note Call your Medicare drug plan to find ...

42 CFR 423.566 - Coverage determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Grievances, Coverage Determinations... sponsor. Each Part D plan sponsor must have a procedure for making timely coverage determinations in accordance with the requirements of this subpart regarding the prescription drug benefits an enrollee is...

Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?

PubMed

Henning-Smith, Carrie; Casey, Michelle; Moscovice, Ira

2017-01-01

Although much has been written about Medicare Part D enrollment, much less is known about beneficiaries' personal experiences with choosing a Part D plan, especially among rural residents. This study sought to address this gap by examining geographic differences in Part D enrollees' perceptions of the plan decision-making process, including their confidence in their choice, their knowledge about the program, and their satisfaction with available information. We used data from the 2012 Medicare Current Beneficiary Survey and included adults ages 65 and older who were enrolled in Part D at the time of the survey (n = 3,706). We used ordered logistic regression to model 4 outcomes based on beneficiaries' perceptions of the Part D decision-making and enrollment process, first accounting only for differences by rurality, then adjusting for sociodemographic, health, and coverage characteristics. Overall, half of all beneficiaries were not very confident in their Part D knowledge. Rural beneficiaries had lower odds of being confident in the plan they chose and in being satisfied with the amount of information available to them during the decision-making process. After adjusting for all covariates, micropolitan residents continued to have lower odds of being confident in the plan that they chose. Policy-makers should pay particular attention to making information about Part D easily accessible for all beneficiaries and to addressing unique barriers that rural residents have in accessing information while making decisions, such as reduced Internet availability. Furthermore, confidence in the decision-making process may be improved by simplifying the Part D program. © 2016 National Rural Health Association.

21 CFR 26.63 - General coverage of this part.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false General coverage of this part. 26.63 Section 26.63 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL MUTUAL RECOGNITION OF PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS...

42 CFR 423.464 - Coordination of benefits with other providers of prescription drug coverage.

Code of Federal Regulations, 2011 CFR

2011-10-01

... providing other prescription drug coverage. (d) Cost management tools. The requirements of this subpart do not prevent a Part D sponsor from using cost management tools (including differential payments) under... sought. (h) Reporting requirements. A Part D sponsor must report credible new or changed supplemental...

Development and formative evaluation of an innovative mHealth intervention for improving coverage of community-based maternal, newborn and child health services in rural areas of India

PubMed Central

Modi, Dhiren; Gopalan, Ravi; Shah, Shobha; Venkatraman, Sethuraman; Desai, Gayatri; Desai, Shrey; Shah, Pankaj

2015-01-01

Background A new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low. Objective This article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs. Design The Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural's1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery. Results Inadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for enhancing value and supervision of Primary Health Center (PHC) staff. Conclusions The effectiveness of the improved ImTeCHO intervention will be now tested through a cluster randomized trial. PMID:25697233

A global survey on occupational health services in selected international commission on occupational health (ICOH) member countries.

PubMed

Rantanen, Jorma; Lehtinen, Suvi; Valenti, Antonio; Iavicoli, Sergio

2017-10-05

The United Nations General Assembly (UNGA), the International Labour Organization (ILO), the World Health Organization (WHO), the International Commission on Occupational Health (ICOH), and the European Union (EU) have encouraged countries to organize occupational health services (OHS) for all working people irrespective of the sector of economy, size of enterprise or mode of employment of the worker. The objective of this study was to survey the status of OHS in a sample of countries from all continents. A questionnaire focusing on the main aspects of OHS was developed on the basis of ILO Convention No. 161 and several other questionnaire surveys used in various target groups of OHS. The questionnaire was sent to 58 key informants: ICOH National Secretaries. A total of 49 National Secretaries responded (response rate 84.5%), from countries that employ 70% of the total world labour force. The majority of the respondent countries, 67%, had drawn up an OHS policy and implement it with the help of national occupational safety and health (OSH) authorities, institutes of occupational health or respective bodies, universities, and professional associations. Multidisciplinary expert OHS resources were available in the majority (82%) of countries, but varied widely in quantitative terms. The average OHS coverage of workers was 24.8%, with wide variation between countries. In over two thirds (69%) of the countries, the content of services was mixed, consisting of preventive and curative services, and in 29% preventive only. OHS financing was organized according to a mixed model among 63% and by employers only among 33% of the respondents. The majority of countries have drawn up policies, strategies and programmes for OHS. The infrastructures and institutional and human resources for the implementation of strategies, however, remain insufficient in the majority of countries (implementation gap). Qualitatively, the content and multidisciplinary nature of OHS corresponds to international guidance, but the coverage, comprehensiveness and content of services remain largely incomplete due to a lack of infrastructure and shortage of multiprofessional human resources (capacity gap). The estimated coverage of services in the study group was low; only a quarter of the total employed population (coverage gap).

Full-Coverage High-Resolution Daily PM(sub 2.5) Estimation using MAIAC AOD in the Yangtze River Delta of China

NASA Technical Reports Server (NTRS)

Xiao, Qingyang; Wang, Yujie; Chang, Howard H.; Meng, Xia; Geng, Guannan; Lyapustin, Alexei Ivanovich; Liu, Yang

2017-01-01

Satellite aerosol optical depth (AOD) has been used to assess population exposure to fine particulate matter (PM (sub 2.5)). The emerging high-resolution satellite aerosol product, Multi-Angle Implementation of Atmospheric Correction(MAIAC), provides a valuable opportunity to characterize local-scale PM(sub 2.5) at 1-km resolution. However, non-random missing AOD due to cloud snow cover or high surface reflectance makes this task challenging. Previous studies filled the data gap by spatially interpolating neighboring PM(sub 2.5) measurements or predictions. This strategy ignored the effect of cloud cover on aerosol loadings and has been shown to exhibit poor performance when monitoring stations are sparse or when there is seasonal large-scale missngness. Using the Yangtze River Delta of China as an example, we present a Multiple Imputation (MI) method that combines the MAIAC high-resolution satellite retrievals with chemical transport model (CTM) simulations to fill missing AOD. A two-stage statistical model driven by gap-filled AOD, meteorology and land use information was then fitted to estimate daily ground PM(sub 2.5) concentrations in 2013 and 2014 at 1 km resolution with complete coverage in space and time. The daily MI models have an average R(exp 2) of 0.77, with an inter-quartile range of 0.71 to 0.82 across days. The overall Ml model 10-fold cross-validation R(exp 2) (root mean square error) were 0.81 (25 gm(exp 3)) and 0.73 (18 gm(exp 3)) for year 2013 and 2014, respectively. Predictions with only observational AOD or only imputed AOD showed similar accuracy.Comparing with previous gap-filling methods, our MI method presented in this study performed bette rwith higher coverage, higher accuracy, and the ability to fill missing PM(sub 2.5) predictions without ground PM(sub 2.5) measurements. This method can provide reliable PM(sub 2.5)predictions with complete coverage that can reduce biasin exposure assessment in air pollution and health studies.

Gaps and opportunities for the World Heritage Convention to contribute to global wilderness conservation.

PubMed

Allan, James R; Kormos, Cyril; Jaeger, Tilman; Venter, Oscar; Bertzky, Bastian; Shi, Yichuan; Mackey, Brendan; van Merm, Remco; Osipova, Elena; Watson, James E M

2018-02-01

Wilderness areas are ecologically intact landscapes predominantly free of human uses, especially industrial-scale activities that result in substantial biophysical disturbance. This definition does not exclude land and resource use by local communities who depend on such areas for subsistence and bio-cultural connections. Wilderness areas are important for biodiversity conservation and sustain key ecological processes and ecosystem services that underpin planetary life-support systems. Despite these widely recognized benefits and values of wilderness, they are insufficiently protected and are consequently being rapidly eroded. There are increasing calls for multilateral environmental agreements to make a greater and more systematic contribution to wilderness conservation before it is too late. We created a global map of remaining terrestrial wilderness following the established last-of-the-wild method, which identifies the 10% of areas with the lowest human pressure within each of Earth's 62 biogeographic realms and identifies the 10 largest contiguous areas and all contiguous areas >10,000 km 2 . We used our map to assess wilderness coverage by the World Heritage Convention and to identify gaps in coverage. We then identified large nationally designated protected areas with good wilderness coverage within these gaps. One-quarter of natural and mixed (i.e., sites of both natural and cultural value) World Heritage Sites (WHS) contained wilderness (total of 545,307 km 2 ), which is approximately 1.8% of the world's wilderness extent. Many WHS had excellent wilderness coverage, for example, the Okavango Delta in Botswana (11,914 km 2 ) and the Central Suriname Nature Reserve (16,029 km 2 ). However, 22 (35%) of the world's terrestrial biorealms had no wilderness representation within WHS. We identified 840 protected areas of >500 km 2 that were predominantly wilderness (>50% of their area) and represented 18 of the 22 missing biorealms. These areas offer a starting point for assessing the potential for the designation of new WHSs that could help increase wilderness representation on the World Heritage list. We urge the World Heritage Convention to ensure that the ecological integrity and outstanding universal value of existing WHS with wilderness values are preserved. © 2017 Society for Conservation Biology.

5 CFR 300.402 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 300.402 Section 300.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Use of Commercial Recruiting Firms and Nonprofit Employment Services § 300.402 Coverage. This part applies to...

40 CFR 141.3 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 23 2011-07-01 2011-07-01 false Coverage. 141.3 Section 141.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS General § 141.3 Coverage. This part shall apply to each public water...

5 CFR 339.101 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 339.101 Section 339.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS MEDICAL QUALIFICATION DETERMINATIONS General § 339.101 Coverage. This part applies to all applicants for and employees in competitive...

40 CFR 141.3 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 24 2013-07-01 2013-07-01 false Coverage. 141.3 Section 141.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS General § 141.3 Coverage. This part shall apply to each public water...

40 CFR 141.3 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 24 2012-07-01 2012-07-01 false Coverage. 141.3 Section 141.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS General § 141.3 Coverage. This part shall apply to each public water...

5 CFR 412.101 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 412.101 Section 412.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS SUPERVISORY, MANAGEMENT, AND EXECUTIVE DEVELOPMENT General Provisions § 412.101 Coverage. This part applies to all incumbents of, and...

40 CFR 141.3 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 23 2014-07-01 2014-07-01 false Coverage. 141.3 Section 141.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS General § 141.3 Coverage. This part shall apply to each public water...

40 CFR 141.3 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Coverage. 141.3 Section 141.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS General § 141.3 Coverage. This part shall apply to each public water...

5 CFR 300.402 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 300.402 Section 300.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Use of Commercial Recruiting Firms and Nonprofit Employment Services § 300.402 Coverage. This part applies to...

5 CFR 412.101 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 412.101 Section 412.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS SUPERVISORY, MANAGEMENT, AND EXECUTIVE DEVELOPMENT General Provisions § 412.101 Coverage. This part applies to all incumbents of, and...

5 CFR 412.101 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 412.101 Section 412.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS SUPERVISORY, MANAGEMENT, AND EXECUTIVE DEVELOPMENT General Provisions § 412.101 Coverage. This part applies to all incumbents of, and...

5 CFR 339.101 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 339.101 Section 339.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS MEDICAL QUALIFICATION DETERMINATIONS General § 339.101 Coverage. This part applies to all applicants for and employees in competitive...

5 CFR 300.402 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 300.402 Section 300.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Use of Commercial Recruiting Firms and Nonprofit Employment Services § 300.402 Coverage. This part applies to...

5 CFR 339.101 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 339.101 Section 339.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS MEDICAL QUALIFICATION DETERMINATIONS General § 339.101 Coverage. This part applies to all applicants for and employees in competitive...

5 CFR 300.402 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 300.402 Section 300.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Use of Commercial Recruiting Firms and Nonprofit Employment Services § 300.402 Coverage. This part applies to...

5 CFR 339.101 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 339.101 Section 339.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS MEDICAL QUALIFICATION DETERMINATIONS General § 339.101 Coverage. This part applies to all applicants for and employees in competitive...

5 CFR 412.101 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 412.101 Section 412.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS SUPERVISORY, MANAGEMENT, AND EXECUTIVE DEVELOPMENT General Provisions § 412.101 Coverage. This part applies to all incumbents of, and...

5 CFR 300.402 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 300.402 Section 300.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Use of Commercial Recruiting Firms and Nonprofit Employment Services § 300.402 Coverage. This part applies to...

5 CFR 339.101 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 339.101 Section 339.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS MEDICAL QUALIFICATION DETERMINATIONS General § 339.101 Coverage. This part applies to all applicants for and employees in competitive...

5 CFR 412.101 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 412.101 Section 412.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS SUPERVISORY, MANAGEMENT, AND EXECUTIVE DEVELOPMENT General Provisions § 412.101 Coverage. This part applies to all incumbents of, and...

Towards the 75th Anniversary

ERIC Educational Resources Information Center

Slingsby, David

2016-01-01

The "Journal of Biological Education" is firmly established as the authoritative voice in the world of biological education. The journal aims to bridge the gap between research and practice, providing information, ideas and opinion, in addition to critical examinations of advances in biology research and teaching. Through the coverage of…

Conceptual Gaps in Circuits Textbooks: A Comparative Study

ERIC Educational Resources Information Center

Sangam, Deepika; Jesiek, Brent K.

2015-01-01

Many university-level electrical engineering courses continue to use textbooks as curriculum scaffolds, prescribed texts, and/or reference volumes. Textbook reliance is even more pronounced in courses that teach foundational principles of the discipline, such as introductory circuit theory. This paper reports on the conceptual coverage of…

State of inequality in malaria intervention coverage in sub-Saharan African countries.

PubMed

Galactionova, Katya; Smith, Thomas A; de Savigny, Don; Penny, Melissa A

2017-10-18

Scale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries. Using Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005-2015. There remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions. Economic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity.

Filling in the GAPS: evaluating completeness and coverage of open-access biodiversity databases in the United States

DOE Office of Scientific and Technical Information (OSTI.GOV)

Troia, Matthew J.; McManamay, Ryan A.

Primary biodiversity data constitute observations of particular species at given points in time and space. Open-access electronic databases provide unprecedented access to these data, but their usefulness in characterizing species distributions and patterns in biodiversity depend on how complete species inventories are at a given survey location and how uniformly distributed survey locations are along dimensions of time, space, and environment. Our aim was to compare completeness and coverage among three open-access databases representing ten taxonomic groups (amphibians, birds, freshwater bivalves, crayfish, freshwater fish, fungi, insects, mammals, plants, and reptiles) in the contiguous United States. We compiled occurrence records frommore » the Global Biodiversity Information Facility (GBIF), the North American Breeding Bird Survey (BBS), and federally administered fish surveys (FFS). In this study, we aggregated occurrence records by 0.1° × 0.1° grid cells and computed three completeness metrics to classify each grid cell as well-surveyed or not. Next, we compared frequency distributions of surveyed grid cells to background environmental conditions in a GIS and performed Kolmogorov–Smirnov tests to quantify coverage through time, along two spatial gradients, and along eight environmental gradients. The three databases contributed >13.6 million reliable occurrence records distributed among >190,000 grid cells. The percent of well-surveyed grid cells was substantially lower for GBIF (5.2%) than for systematic surveys (BBS and FFS; 82.5%). Still, the large number of GBIF occurrence records produced at least 250 well-surveyed grid cells for six of nine taxonomic groups. Coverages of systematic surveys were less biased across spatial and environmental dimensions but were more biased in temporal coverage compared to GBIF data. GBIF coverages also varied among taxonomic groups, consistent with commonly recognized geographic, environmental, and institutional sampling biases. Lastly, this comprehensive assessment of biodiversity data across the contiguous United States provides a prioritization scheme to fill in the gaps by contributing existing occurrence records to the public domain and planning future surveys.« less

Filling in the GAPS: evaluating completeness and coverage of open-access biodiversity databases in the United States

DOE PAGES

Troia, Matthew J.; McManamay, Ryan A.

2016-06-12

Primary biodiversity data constitute observations of particular species at given points in time and space. Open-access electronic databases provide unprecedented access to these data, but their usefulness in characterizing species distributions and patterns in biodiversity depend on how complete species inventories are at a given survey location and how uniformly distributed survey locations are along dimensions of time, space, and environment. Our aim was to compare completeness and coverage among three open-access databases representing ten taxonomic groups (amphibians, birds, freshwater bivalves, crayfish, freshwater fish, fungi, insects, mammals, plants, and reptiles) in the contiguous United States. We compiled occurrence records frommore » the Global Biodiversity Information Facility (GBIF), the North American Breeding Bird Survey (BBS), and federally administered fish surveys (FFS). In this study, we aggregated occurrence records by 0.1° × 0.1° grid cells and computed three completeness metrics to classify each grid cell as well-surveyed or not. Next, we compared frequency distributions of surveyed grid cells to background environmental conditions in a GIS and performed Kolmogorov–Smirnov tests to quantify coverage through time, along two spatial gradients, and along eight environmental gradients. The three databases contributed >13.6 million reliable occurrence records distributed among >190,000 grid cells. The percent of well-surveyed grid cells was substantially lower for GBIF (5.2%) than for systematic surveys (BBS and FFS; 82.5%). Still, the large number of GBIF occurrence records produced at least 250 well-surveyed grid cells for six of nine taxonomic groups. Coverages of systematic surveys were less biased across spatial and environmental dimensions but were more biased in temporal coverage compared to GBIF data. GBIF coverages also varied among taxonomic groups, consistent with commonly recognized geographic, environmental, and institutional sampling biases. Lastly, this comprehensive assessment of biodiversity data across the contiguous United States provides a prioritization scheme to fill in the gaps by contributing existing occurrence records to the public domain and planning future surveys.« less

42 CFR 423.308 - Definitions and terminology.

Code of Federal Regulations, 2010 CFR

2010-10-01

... exclude any costs attributable to benefits beyond basic prescription drug coverage, but also to exclude... benefits beyond basic prescription drug coverage, but also to exclude any prescription drug coverage costs... assistance outside the Part D benefit, provided that documentation of such nominal cost-sharing has been...

5 CFR 532.103 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 532.103 Section 532.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS General Provisions § 532.103 Coverage. The provisions of this part shall apply to prevailing rate employees and...

5 CFR 532.103 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 532.103 Section 532.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS General Provisions § 532.103 Coverage. The provisions of this part shall apply to prevailing rate employees and...

25 CFR 700.505 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Coverage. 700.505 Section 700.505 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES Employee Responsibility and Conduct § 700.505 Coverage. The regulations contained in this part apply to all Commission...

5 CFR 532.103 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 532.103 Section 532.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS General Provisions § 532.103 Coverage. The provisions of this part shall apply to prevailing rate employees and...

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

5 CFR 532.103 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 532.103 Section 532.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS General Provisions § 532.103 Coverage. The provisions of this part shall apply to prevailing rate employees and...

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

25 CFR 700.505 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false Coverage. 700.505 Section 700.505 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES Employee Responsibility and Conduct § 700.505 Coverage. The regulations contained in this part apply to all Commission...

25 CFR 700.505 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 2 2012-04-01 2012-04-01 false Coverage. 700.505 Section 700.505 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES Employee Responsibility and Conduct § 700.505 Coverage. The regulations contained in this part apply to all Commission...

5 CFR 532.103 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 532.103 Section 532.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS General Provisions § 532.103 Coverage. The provisions of this part shall apply to prevailing rate employees and...

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

25 CFR 700.505 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 2 2011-04-01 2011-04-01 false Coverage. 700.505 Section 700.505 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES Employee Responsibility and Conduct § 700.505 Coverage. The regulations contained in this part apply to all Commission...

25 CFR 700.505 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 2 2014-04-01 2014-04-01 false Coverage. 700.505 Section 700.505 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES Employee Responsibility and Conduct § 700.505 Coverage. The regulations contained in this part apply to all Commission...

5 CFR 432.102 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 432.102 Section 432.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE BASED REDUCTION IN GRADE AND REMOVAL ACTIONS § 432.102 Coverage. (a) Actions covered. This part covers reduction in grade...

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

5 CFR 432.102 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 432.102 Section 432.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE BASED REDUCTION IN GRADE AND REMOVAL ACTIONS § 432.102 Coverage. (a) Actions covered. This part covers reduction in grade...

5 CFR 432.102 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 432.102 Section 432.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE BASED REDUCTION IN GRADE AND REMOVAL ACTIONS § 432.102 Coverage. (a) Actions covered. This part covers reduction in grade...

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

Impact of cost sharing on prescription drugs used by Medicare beneficiaries.

PubMed

Goedken, Amber M; Urmie, Julie M; Farris, Karen B; Doucette, William R

2010-06-01

Incentive-based prescription drug cost sharing can encourage seniors to use generic medications. Little information exists about prescription drug cost sharing and generic use in employer-sponsored plans after the implementation of Medicare Part D. To compare prescription drug cost sharing across prescription insurance type for Medicare beneficiaries after Medicare Part D, to assess the impact of that cost sharing on the number of medications used, and to examine how generic utilization rates differ before and after Medicare Part D and across the type of insurance. This longitudinal study of Medicare beneficiaries aged 65 years and older used Web-based surveys administered in 2005 and 2007 by Harris Interactive((R)) to collect information on prescription drug coverage and medication use. Co-payment plans were categorized as low, medium, or high co-payment plans. Multiple regression was used to assess the impact of co-payment rank on the number of prescription drugs. t-Tests and analysis of variance were used to compare generic use over time and between coverage types. One thousand two hundred twenty and 1024 respondents completed the baseline and follow-up surveys, respectively. Among 3-tier co-payment plans, brand drug co-payments were higher for Part D plans ($26 for preferred brand and $55 for nonpreferred brand) than employer-based plans ($20 for preferred brand and $39 for nonpreferred brand). Co-payment was not a significant predictor for the number of prescription drugs. Generic use was lowest among beneficiaries in employer plans both before and after Part D. In 2007, generic use among beneficiaries with Part D was not significantly different from the generic use for beneficiaries with no drug coverage. Medicare beneficiaries in Part D had higher cost sharing amounts than those with employer coverage, but higher cost sharing was not significantly linked to lower prescription use. Generic use for Part D beneficiaries was higher than that for beneficiaries with employer coverage but the same as that for beneficiaries without drug coverage. Copyright 2010 Elsevier Inc. All rights reserved.

32 CFR 232.1 - Authority, purpose, and coverage.

Code of Federal Regulations, 2010 CFR

2010-07-01

... consumer credit; (2) Requires creditors to disclose to covered borrowers the cost of the transaction as a... implement 10 U.S.C. 987. (b) Purpose. The purpose of this part is to impose limitations on the cost and... provide additional consumer disclosures for such transactions. (c) Coverage. This part defines the types...

42 CFR 405.212 - Medicare Coverage IDE study criteria.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Medicare coverage of items and services described in § 405.211, a Category A (Experimental) or Category B...) The study design is methodologically appropriate and the anticipated number of enrolled subjects is... CFR parts 50, 56, and 812 and 45 CFR part 46. (7) Where appropriate, the study is not designed to...

42 CFR 423.2340 - Compliance monitoring and civil money penalties.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Compliance monitoring and civil money penalties. 423.2340 Section 423.2340 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... BENEFIT Medicare Coverage Gap Discount Program § 423.2340 Compliance monitoring and civil money penalties...

42 CFR 423.2340 - Compliance monitoring and civil money penalties.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Compliance monitoring and civil money penalties... BENEFIT Medicare Coverage Gap Discount Program § 423.2340 Compliance monitoring and civil money penalties... Agreement. (b) Basis for imposing civil money penalties. CMS imposes a civil money penalty (CMP) on a...

42 CFR 423.2340 - Compliance monitoring and civil money penalties.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Compliance monitoring and civil money penalties... BENEFIT Medicare Coverage Gap Discount Program § 423.2340 Compliance monitoring and civil money penalties... Agreement. (b) Basis for imposing civil money penalties. CMS imposes a civil money penalty (CMP) on a...

Neighborhood Socioeconomic Disadvantage and Access to Health Care

ERIC Educational Resources Information Center

Kirby, James B.; Kaneda, Toshiko

2005-01-01

Most research on access to health care focuses on individual-level determinants such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed care, however, has not received much attention. We address this gap in the literature by examining how neighborhood socioeconomic…

Child health security in China: a survey of child health insurance coverage in diverse areas of the country.

PubMed

Xiong, Juyang; Hipgrave, David; Myklebust, Karoline; Guo, Sufang; Scherpbier, Robert W; Tong, Xuetao; Yao, Lan; Moran, Andrew E

2013-11-01

China embarked on an ambitious health system reform in 2009, and pledged to achieve universal health insurance coverage by 2020. However, there are gaps in access to healthcare for some children in China. We assessed health insurance status and associated variables among children under five in twelve communities in 2010: two urban community health centers and two rural township health centers in each of three municipalities located in China's distinctly different East, Central and Western regions. Information on demographic and socio-economic variables and children's insurance status was gathered from parents or caregivers of all children enrolled in local health programs, and others recruited from the local communities. Only 62% of 1131 children assessed were insured. This figure did not vary across geographic regions, but urban children were less likely to be insured than rural children. In multivariate analysis, infants were 2.44 times more likely to be uninsured than older children and children having at least one migrant parent were 1.90 times more likely to be uninsured than those living with non-migrant parents. Low maternal education was also associated with being uninsured. Gaps in China's child health insurance coverage might be bridged if newborns are automatically covered from birth, and if insurance is extended to all urban migrant children, regardless of the family's residential registration status and size. Copyright © 2013 Elsevier Ltd. All rights reserved.

Surface alloy engineering in 2D trigonal lattice: giant Rashba spin splitting and two large topological gaps

NASA Astrophysics Data System (ADS)

Liu, Zhao; Jin, Yingdi; Yang, Yuchen; Wang, Z. F.; Yang, Jinlong

2018-02-01

We demonstrate that sp 2 based trigonal lattice can exhibit giant Rashba splitting and two large topological gaps simultaneously. First, an effective tight binding model is developed to describe the Rashba spin-orbit coupling (SOC) on a real surface and give a topological phase diagram based on two independent SOC parameters. Second, based on density functional theory calculations, it is proposed that Au/Si(111)-\\sqrt{3}× \\sqrt{3} surface with 1/3 monolayer Bi coverage is a good material candidate to realize both giant Rashba splitting and two large topological gaps. These results would inspire great research interests for searching two-dimensional topological insulator and manipulating Rashba spin splitting through surface alloy engineering.

12 CFR 571.20 - Coverage and definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... public. A solicitation does not include marketing communications that are directed at the general public... Affiliate Marketing § 571.20 Coverage and definitions. (a) Coverage. Subpart C of this part applies to... information” means any information the communication of which would be a consumer report if the exclusions...

12 CFR 717.20 - Coverage and definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., direct mail, e-mail, or other form of marketing communication directed to a particular consumer that is... REPORTING Affiliate Marketing § 717.20 Coverage and definitions. (a) Coverage. Subpart C of this part...) Eligibility information. The term “eligibility information” means any information the communication of which...

29 CFR 9.3 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 1 2012-07-01 2012-07-01 false Coverage. 9.3 Section 9.3 Labor Office of the Secretary of Labor NONDISPLACEMENT OF QUALIFIED WORKERS UNDER SERVICE CONTRACTS (effective date pending) General § 9.3 Coverage. This part applies to all service contracts and their solicitations, except those...

"More Closeted Than Gayness Itself": The Depiction of Same-Sex Couple Violence in Newspaper Media.

PubMed

Estes, Michelle L; Webber, Gretchen R

2017-10-01

Same-sex intimate partner violence (IPV) lacks mainstream news media coverage. News media report on those stories that are most prominent, and these stories are often shaped and presented within a White, heterosexual, upper-class, male framework. This framework largely ignores or misrepresents those that do not fit these characteristics, resulting in a gap in research and coverage of same-sex IPV. This article explores whether U.S. newspapers cover same-sex IPV, how often, and how same-sex couple violence is portrayed in newspapers when covered. Twenty-five newspaper articles published from 2005 to 2015, 10 years prior to the U.S. Supreme Court decision that legalized same-sex marriage, were located and analyzed. Findings indicate sparse newspaper coverage of IPV in same-sex couples. Ten articles highlight the lack of coverage and knowledge related to same-sex couple IPV. Eighteen articles address same-sex IPV as a social issue and highlight resource concerns, police involvement, and heteronormativity and heterosexism. Sixteen articles depict specific instances of IPV in same-sex couples. The overall lack of coverage and how same-sex IPV is covered remains problematic and limited. More mainstream and accurate coverage is needed to effectively address this social issue. Limitations and directions for future research are also discussed.

Less than Expected? How Media Cover Demonstration Turnout

PubMed Central

Wouters, Ruud; Van Camp, Kirsten

2017-01-01

Demonstration turnout is a crucial political resource for social movements. In this article, we investigate how mass media cover demonstration size. We develop a typology of turnout coverage and scrutinize the factors that drive turnout coverage. In addition, we test whether media coverage underestimates, reflects, or exaggerates “guesstimates” by organizers and police forces. Together, these analyses shed light on whether turnout coverage fits a logic of normalization or marginalization. We rely on a unique dataset of 428 demonstrations organized in Brussels (2003–2010). For these demonstrations, we have information on the turnout as reported in national television news, as counted by the police, and as expected by the organizers. We find that media present turnout most often as a fact, rarely as contentious (10 percent). Although few demonstrations pass the media gates, our study yields little to no evidence for a logic of turnout marginalization. Media coverage does not systematically underestimate demonstration size, nor does it blindly follow police counts. Rather, turnout coverage attests of a logic of normalization, following standard news-making practices. The more important the demonstration (size, lead item) and the larger the gap between police and organizer guesstimates, the more attention is paid to turnout in the news. Discussion centers on the generalizability and normative interpretation of the results. PMID:29081881

Coverage and inequalities in maternal and child health interventions in Afghanistan.

PubMed

Akseer, Nadia; Bhatti, Zaid; Rizvi, Arjumand; Salehi, Ahmad S; Mashal, Taufiq; Bhutta, Zulfiqar A

2016-09-12

Afghanistan has made considerable gains in improving maternal and child health and survival since 2001. However, socioeconomic and regional inequities may pose a threat to reaching universal coverage of health interventions and further health progress. We explored coverage and socioeconomic inequalities in key life-saving reproductive, maternal, newborn and child health (RMNCH) interventions at the national level and by region in Afghanistan. We also assessed gains in child survival through scaling up effective community-based interventions across wealth groups. Using data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2010/11, we explored 11 interventions that spanned all stages of the continuum of care, including indicators of composite coverage. Asset-based wealth quintiles were constructed using standardised methods, and absolute inequalities were explored using wealth quintile (Q) gaps (Q5-Q1) and the slope index of inequality (SII), while relative inequalities were assessed with ratios (Q5/Q1) and the concentration index (CIX). The lives saved tool (LiST) modeling used to estimate neonatal and post-neonatal deaths averted from scaling up essential community-based interventions by 90 % coverage by 2025. Analyses considered the survey design characteristics and were conducted via STATA version 12.0 and SAS version 9.4. Our results underscore significant pro-rich socioeconomic absolute and relative inequalities, and mass population deprivation across most all RMNCH interventions studied. The most inequitable are antenatal care with a skilled attendant (ANCS), skilled birth attendance (SBA), and 4 or more antenatal care visits (ANC4) where the richest have between 3.0 and 5.6 times higher coverage relative to the poor, and Q5-Q1 gaps range from 32 % - 65 %. Treatment of sick children and breastfeeding interventions are the most equitably distributed. Across regions, inequalities were highest in the more urbanised East, West and Central regions of the country, while they were lowest in the South and Southeast. About 7700 newborns and 26,000 post-neonates could be saved by scaling up coverage of community outreach interventions to 90 %, with the most gains in the poorest quintiles. Afghanistan is a pervasively poor and conflict-prone nation that has only recently experienced a decade of relative stability. Though donor investments during this period have been plentiful and have contributed to rebuilding of health infrastructure in the country, glaring inequities remain. A resolution to scaling up health coverage in insecure and isolated regions, and improving accessibility for the poorest and marginalised populations, should be at the forefront of national policy and programming efforts.

The Take-Up of Employer-Sponsored Insurance Among Americans with Mental Disorders: Implications for Health Care Reform.

PubMed

Zuvekas, Samuel H

2015-07-01

Little is known about how take-up of private health insurance coverage differs between those with and without mental disorders. This study seeks to fill this gap by using data from the 2004-2008 Medical Expenditure Panel Survey to examine differences in offers and take-up of employer-sponsored insurance (ESI) among adults aged 27-54. Little evidence that mental disorders are associated with take-up of offers of ESI coverage was found. This suggests that take-up rates in the Affordable Care Act (ACA) marketplaces by those with and without mental disorders may be similar. The ACA is especially important to Americans with mental disorders, many of whom lack access to ESI coverage to pay for mental health treatment either through their own job or through a spouse's job.

2010-2011 Performance of the AirNow Satellite Data Processor

NASA Astrophysics Data System (ADS)

Pasch, A. N.; DeWinter, J. L.; Haderman, M. D.; van Donkelaar, A.; Martin, R. V.; Szykman, J.; White, J. E.; Dickerson, P.; Zahn, P. H.; Dye, T. S.

2012-12-01

The U.S. Environmental Protection Agency's (EPA) AirNow program provides maps of real time hourly Air Quality Index (AQI) conditions and daily AQI forecasts nationwide (http://www.airnow.gov). The public uses these maps to make health-based decisions. The usefulness of the AirNow air quality maps depends on the accuracy and spatial coverage of air quality measurements. Currently, the maps use only ground-based measurements, which have significant gaps in coverage in some parts of the United States. As a result, contoured AQI levels have high uncertainty in regions far from monitors. To improve the usefulness of air quality maps, scientists at EPA, Dalhousie University, and Sonoma Technology, Inc. have been working in collaboration with the National Aeronautics and Space Administration (NASA) and the National Oceanic and Atmospheric Administration (NOAA) to incorporate satellite-estimated surface PM2.5 concentrations into the maps via the AirNow Satellite Data Processor (ASDP). These satellite estimates are derived using NASA/NOAA satellite aerosol optical depth (AOD) retrievals and GEOS-Chem modeled ratios of surface PM2.5 concentrations to AOD. GEOS-Chem is a three-dimensional chemical transport model for atmospheric composition driven by meteorological input from the Goddard Earth Observing System (GOES). The ASDP can fuse multiple PM2.5 concentration data sets to generate AQI maps with improved spatial coverage. The goal of ASDP is to provide more detailed AQI information in monitor-sparse locations and augment monitor-dense locations with more information. We will present a statistical analysis for 2010-2011 of the ASDP predictions of PM2.5 focusing on performance at validation sites. In addition, we will present several case studies evaluating the ASDP's performance for multiple regions and seasons, focusing specifically on days when large spatial gradients in AQI and wildfire smoke impact were observed.

Benchmarking health system performance across regions in Uganda: a systematic analysis of levels and trends in key maternal and child health interventions, 1990-2011.

PubMed

Roberts, D Allen; Ng, Marie; Ikilezi, Gloria; Gasasira, Anne; Dwyer-Lindgren, Laura; Fullman, Nancy; Nalugwa, Talemwa; Kamya, Moses; Gakidou, Emmanuela

2015-12-03

Globally, countries are increasingly prioritizing the reduction of health inequalities and provision of universal health coverage. While national benchmarking has become more common, such work at subnational levels is rare. The timely and rigorous measurement of local levels and trends in key health interventions and outcomes is vital to identifying areas of progress and detecting early signs of stalled or declining health system performance. Previous studies have yet to provide a comprehensive assessment of Uganda's maternal and child health (MCH) landscape at the subnational level. By triangulating a number of different data sources - population censuses, household surveys, and administrative data - we generated regional estimates of 27 key MCH outcomes, interventions, and socioeconomic indicators from 1990 to 2011. After calculating source-specific estimates of intervention coverage, we used a two-step statistical model involving a mixed-effects linear model as an input to Gaussian process regression to produce regional-level trends. We also generated national-level estimates and constructed an indicator of overall intervention coverage based on the average of 11 high-priority interventions. National estimates often veiled large differences in coverage levels and trends across Uganda's regions. Under-5 mortality declined dramatically, from 163 deaths per 1,000 live births in 1990 to 85 deaths per 1,000 live births in 2011, but a large gap between Kampala and the rest of the country persisted. Uganda rapidly scaled up a subset of interventions across regions, including household ownership of insecticide-treated nets, receipt of artemisinin-based combination therapies among children under 5, and pentavalent immunization. Conversely, most regions saw minimal increases, if not actual declines, in the coverage of indicators that required multiple contacts with the health system, such as four or more antenatal care visits, three doses of oral polio vaccine, and two doses of intermittent preventive therapy during pregnancy. Some of the regions with the lowest levels of overall intervention coverage in 1990, such as North and West Nile, saw marked progress by 2011; nonetheless, sizeable disparities remained between Kampala and the rest of the country. Countrywide, overall coverage increased from 40% in 1990 to 64% in 2011, but coverage in 2011 ranged from 57% to 70% across regions. The MCH landscape in Uganda has, for the most part, improved between 1990 and 2011. Subnational benchmarking quantified the persistence of geographic health inequalities and identified regions in need of additional health systems strengthening. The tracking and analysis of subnational health trends should be conducted regularly to better guide policy decisions and strengthen responsiveness to local health needs.

5 CFR 610.101 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 610.101 Section 610.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS HOURS OF DUTY Weekly and Daily Scheduling of Work § 610.101 Coverage. This subpart applies to each employee to whom subpart A of part 550...

5 CFR 610.101 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 610.101 Section 610.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS HOURS OF DUTY Weekly and Daily Scheduling of Work § 610.101 Coverage. This subpart applies to each employee to whom subpart A of part 550...

5 CFR 1320.4 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Coverage. 1320.4 Section 1320.4 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES CONTROLLING PAPERWORK BURDENS ON THE PUBLIC § 1320.4 Coverage. (a) The requirements of this part apply to all agencies as defined in § 1320.3...

5 CFR 1320.4 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Coverage. 1320.4 Section 1320.4 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES CONTROLLING PAPERWORK BURDENS ON THE PUBLIC § 1320.4 Coverage. (a) The requirements of this part apply to all agencies as defined in § 1320.3...

5 CFR 610.101 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 610.101 Section 610.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS HOURS OF DUTY Weekly and Daily Scheduling of Work § 610.101 Coverage. This subpart applies to each employee to whom subpart A of part 550...

5 CFR 1320.4 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Coverage. 1320.4 Section 1320.4 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES CONTROLLING PAPERWORK BURDENS ON THE PUBLIC § 1320.4 Coverage. (a) The requirements of this part apply to all agencies as defined in § 1320.3...

5 CFR 610.101 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 610.101 Section 610.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS HOURS OF DUTY Weekly and Daily Scheduling of Work § 610.101 Coverage. This subpart applies to each employee to whom subpart A of part 550...

5 CFR 1320.4 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Coverage. 1320.4 Section 1320.4 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES CONTROLLING PAPERWORK BURDENS ON THE PUBLIC § 1320.4 Coverage. (a) The requirements of this part apply to all agencies as defined in § 1320.3...

5 CFR 1320.4 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Coverage. 1320.4 Section 1320.4 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES CONTROLLING PAPERWORK BURDENS ON THE PUBLIC § 1320.4 Coverage. (a) The requirements of this part apply to all agencies as defined in § 1320.3...

5 CFR 610.101 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 610.101 Section 610.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS HOURS OF DUTY Weekly and Daily Scheduling of Work § 610.101 Coverage. This subpart applies to each employee to whom subpart A of part 550...

12 CFR 1024.5 - Coverage of RESPA.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Coverage of RESPA. 1024.5 Section 1024.5 Banks and Banking BUREAU OF CONSUMER FINANCIAL PROTECTION REAL ESTATE SETTLEMENT PROCEDURES ACT (REGULATION X) § 1024.5 Coverage of RESPA. (a) Applicability. RESPA and this part apply to all federally related...

The Effects of Cost Sharing on Adherence to Medications Prescribed for Concurrent Use: Do Definitions Matter?

PubMed

Sacks, Naomi C; Burgess, James F; Cabral, Howard J; McDonnell, Marie E; Pizer, Steven D

2015-08-01

Accurate estimates of the effects of cost sharing on adherence to medications prescribed for use together, also called concurrent adherence, are important for researchers, payers, and policymakers who want to reduce barriers to adherence for chronic condition patients prescribed multiple medications concurrently. But measure definition consensus is lacking, and the effects of different definitions on estimates of cost-related nonadherence are unevaluated. To (a) compare estimates of cost-related nonadherence using different measure definitions and (b) provide guidance for analyses of the effects of cost sharing on concurrent adherence. This is a retrospective cohort study of Medicare Part D beneficiaries aged 65 years and older who used multiple oral antidiabetics concurrently in 2008 and 2009. We compared patients with standard coverage, which contains cost-sharing requirements in deductible (100%), initial (25%), and coverage gap (100%) phases, to patients with a low-income subsidy (LIS) and minimal cost-sharing requirements. Data source was the IMS Health Longitudinal Prescription Database. Patients with standard coverage were propensity matched to controls with LIS coverage. Propensity score was developed using logistic regression to model likelihood of Part D standard enrollment, controlling for sociodemographic and health status characteristics. For analysis, 3 definitions were used for unadjusted and adjusted estimates of adherence: (1) patients adherent to All medications; (2) patients adherent on Average; and (3) patients adherent to Any medication. Analyses were conducted using the full study sample and then repeated in analytic subgroups where patients used (a) 1 or more costly branded oral antidiabetics or (b) inexpensive generics only. We identified 12,771 propensity matched patients with Medicare Part D standard (N = 6,298) or LIS (N = 6,473) coverage who used oral antidiabetics in 2 or more of the same classes in 2008 and 2009. In this sample, estimates of the effects of cost sharing on concurrent adherence varied by measure definition, coverage type, and proportion of patients using more costly branded drugs. Adherence rates ranged from 37% (All: standard patients using 1+ branded) to 97% (Any: LIS using generics only). In adjusted estimates, standard patients using branded drugs had 0.63 (95% CI = 0.57-0.70) and 0.70 (95% CI = 0.63-0.77) times the odds of concurrent adherence using All and Average definitions, respectively. The Any subgroup was not significant (OR = 0.89, 95% CI = 0.87-1.17). Estimates also varied in the full-study sample (All: OR = 0.79, 95% CI = 0.74-0.85; Average: OR = 0.83, 95% CI = 0.77-0.89) and generics-only subgroup, although cost-sharing effects were smaller. The Any subgroup generated no significant estimates. Different concurrent adherence measure definitions lead to markedly different findings of the effects of cost sharing on concurrent adherence, with All and Average subgroups sensitive to these effects. However, when more study patients use inexpensive generics, estimates of these effects on adherence to branded medications with higher cost-sharing requirements may be diluted. When selecting a measure definition, researchers, payers, and policy analysts should consider the range of medication prices patients face, use a measure sensitive to the effects of cost sharing on adherence, and perform subgroup analyses for patients prescribed more medications for which they must pay more, since these patients are most vulnerable to cost-related nonadherence.

The Near and Far-IR SEDs of Spitzer GTO ULIRGs

NASA Astrophysics Data System (ADS)

Marshall, Jason; Armus, Lee; Spoon, Henrik

2008-03-01

Spectra of a sample of 109 ultraluminous infrared galaxies (ULIRGs) have been obtained as part of the Spitzer IRS GTO program, providing a dataset with which to study the underlying obscured energy source(s) (i.e., AGN and/or starburst activity) powering ULIRGs in the local universe, and providing insight into the high-redshift infrared-luminous galaxies responsible for the bulk of the star-formation energy density at z = 2-3. As part of this effort, we have developed the CAFE spectral energy distribution decomposition tool to analyze the UV to sub-mm SEDs of these galaxies (including their IRS spectra). Sufficient photometry for these decompositions exists for approximately half of the GTO ULIRGs. However, we lack crucial data for the other half of the sample in either or both the 2-5 micron gap between the near-IR passbands and the start of the IRS wavelength coverage and the far-IR beyond 100 microns. These spectral regions provide critical constraints on the amount of hot dust near the dust sublimation temperature (indicating the presence of an AGN) and the total luminosity and mass of dust in the galaxy (dominated by the coldest dust emitting at far-IR wavelengths). We therefore propose to obtain IRAC observations in all channels and MIPS observations at 70 and 160 microns for the 37 and 17 GTO ULIRGs lacking data in these wavelength ranges, respectively. Considering its very low cost of 7.3 total hours of observation, the scientific return from this program is enormous: nearly doubling the number of GTO ULIRGs with full spectral coverage, and completing a dataset that is sure to be an invaluable resource well beyond the lifetime of Spitzer.

Where to Go Next? Identifying Target Areas in the North Atlantic for Future Seafloor Mapping Initiatives

NASA Astrophysics Data System (ADS)

Woelfl, A. C.; Jencks, J.; Johnston, G.; Varner, J. D.; Devey, C. W.

2017-12-01

Human activities are rapidly expanding into the oceans, yet detailed bathymetric maps do not exist for most of the seafloor that would permit governments to formulate sensible usage rules. Changing this situation will require an enormous international mapping effort. To ensure that this effort is directed towards the regions most in need of mapping, we need to know which areas have already been mapped and which areas are potentially most interesting. Despite various mapping efforts in recent years, large parts of the Atlantic still lack detailed bathymetric information. To successfully plan for future mapping efforts to fill these gaps, knowledge of current data coverage is imperative to avoid duplication of effort. While certain datasets are publically available online (e.g. NOAA's NCEI, EMODnet, IHO-DCDB, LDEO's GMRT), many are not. However, with the limited information we do have at hand, the question remains, where should we map next? And what criteria should we take into account? In 2016, a study was taken on as part of the efforts of the International Atlantic Seabed Mapping Working Group (ASMIWG). The ASMIWG, established by the Tri-Partite Galway Statement Implementation Committee, was tasked to develop a cohesive seabed mapping strategy for the Atlantic Ocean. The aim of our study was to develop a reproducible process for identifying and evaluating potential target areas within the North Atlantic that represent suitable sites for future bathymetric surveys. The sites were selected by applying a GIS-based suitability analysis that included specific user group-based parameters of the marine environment. Furthermore, information regarding current data coverage were gathered to take into account in the selection process. The results reveal the suitability of sites within the North Atlantic based on the selected criteria. Three potential target sites should be seen as flexible suggestions for future mapping initiatives rather than a rigid, defined set of areas. This methodology can be adjusted to other areas of interest and can include a variety of parameters based on stakeholder interest. Further this work only included accessible and displayable information about multibeam data coverage and would certainly benefit from more easily available and discoverable data sets or at least from location information.

A review of measles supplementary immunization activities and the implications for Pacific Island countries and territories.

PubMed

Clements, C John; Soakai, Taniela Sunia; Sadr-Azodi, Nahad

2017-02-01

Standard measles control strategies include achieving high levels of measles vaccine coverage using routine delivery systems, supplemented by mass immunization campaigns as needed to close population immunity gaps. Areas covered: This review looks at how supplementary immunization activities (SIAs) have contributed to measles control globally, and asks whether such a strategy has a place in Pacific Islands today. Expert commentary: Very high coverage with two doses of measles vaccine seems to be the optimal strategy for controlling measles. By 2015, all but two Pacific Islands had introduced a second dose in the routine schedule; however, a number of countries have not yet reached high coverage with their second dose. The literature and the country reviews reported here suggest that a high coverage SIA combined with one dose of measles vaccine given in the routine system will also do the job. The arguments for and against the use of SIAs are complex, but it is clear that to be effective, SIAs need to be well designed to meet specific needs, must be carried out effectively and safely with very high coverage, and should, when possible, carry with them other public health interventions to make them even more cost-effective.

The 5As: A practical taxonomy for the determinants of vaccine uptake.

PubMed

Thomson, Angus; Robinson, Karis; Vallée-Tourangeau, Gaëlle

2016-02-17

Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that "countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage". However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 23 primary determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

The public cost of expanding coverage.

PubMed

Sheils, J F; Baxter, R J; Haught, R A

1995-01-01

The 103d Congress considered several health care reform bills that would encourage voluntary expansions of coverage through insurance market reforms, new tax deductions for premiums, and direct premium subsidies for low-income persons. We found that insurance reforms alone will do little to expand coverage. We also found that most of the proposed tax deductions would go to persons who already have insurance and would have little impact on coverage. Premium subsidies for low-income persons would greatly increase coverage. However, coverage would change little for those who would have to pay all or part of the premium.

P-polarized reflectance spectroscopy: A high sensitive real-time monitoring technique to study surface kinetics under steady state epitaxial deposition conditions

NASA Technical Reports Server (NTRS)

Dietz, Nikolaus; Bachmann, Klaus J.

1995-01-01

This paper describes the results of real-time optical monitoring of epitaxial growth processes by p-polarized reflectance spectroscopy (PRS) using a single wavelength application under pulsed chemical beam epitaxy (PCBE) condition. The high surface sensitivity of PRS allows the monitoring of submonolayer precursors coverage on the surface as shown for GaP homoepitaxy and GaP on Si heteroepitaxy as examples. In the case of heteroepitaxy, the growth rate and optical properties are revealed by PRS using interference oscillations as they occur during growth. Super-imposed on these interference oscillations, the PRS signal exhibits a fine structure caused by the periodic alteration of the surface chemistry by the pulsed supply of chemical precursors. This fine structure is modeled under conditions where the surface chemistry cycles between phosphorus supersaturated and phosphorus depleted surfaces. The mathematical model describes the fine structure using a surface layer that increases during the tertiarybutyl phosphine (TBP) supply and decreases during and after the triethylgallium (TEG) pulse, which increases the growing GaP film thickness. The imaginary part of the dielectric function of the surface layer is revealed from the turning points in the fine structure, where the optical response to the first precursor pulse in the cycle sequence changes sign. The amplitude of the fine structure is determined by the surface layer thickness and the complex dielectric functions for the surface layer with the underlying bulk film. Surface kinetic data can be obtained by analyzing the rise and decay transients of the fine structure.

Medicare Part D: successes and continuing challenges. Impact of Medicare Part D on Massachusetts health programs and beneficiaries.

PubMed

Thomas, Cindy Parks; Sussman, Jeffrey

2007-05-30

On January 1, 2006, the Centers for Medicare and Medicaid Services (CMS) implemented the Medicare Drug Benefit, or "Medicare Part D." The program offers prescription drug coverage for the one million Medicare beneficiaries in Massachusetts. Part D affects Massachusetts state health programs and beneficiaries in a number of ways. The program: (1) provides prescription drug insurance, including catastrophic coverage, through a choice of private prescription drug plans (PDPs) or integrated Medicare Advantage (MA-PD) health plans; (2) shifts prescription drug coverage for dual-eligible Medicare / Medicaid beneficiaries from Medicaid to Medicare Part D drug plans; (3) requires a maintenance-of-effort, or "clawback" payments from states to CMS designed to capture a portion of states' Medicaid savings to help finance the benefit; (4) offers additional help for premiums and cost sharing to low income beneficiaries through the Low Income Subsidy (LIS); and (5) provides a subsidy to employer groups that maintain their own prescription drug coverage for retired beneficiaries. This paper summarizes the activities involved in implementing Medicare Part D, the impact it has had on Massachusetts health programs, and the experiences of beneficiaries and others conducting outreach and enrollment. The data are drawn from interviews with officials and documents provided by state health programs, CMS and the Social Security Administration, and representatives of provider and advocacy groups involved in the enrollment and ongoing support of Medicare beneficiaries.

Issues in Data Fusion for Satellite Aerosol Measurements for Applications with GIOVANNI System at NASA GES DISC

NASA Technical Reports Server (NTRS)

Gopalan, Arun; Zubko, Viktor; Leptoukh, Gregory G.

2008-01-01

We look at issues, barriers and approaches for Data Fusion of satellite aerosol data as available from the GES DISC GIOVANNI Web Service. Daily Global Maps of AOT from a single satellite sensor alone contain gaps that arise due to various sources (sun glint regions, clouds, orbital swath gaps at low latitudes, bright underlying surfaces etc.). The goal is to develop a fast, accurate and efficient method to improve the spatial coverage of the Daily AOT data to facilitate comparisons with Global Models. Data Fusion may be supplemented by Optimal Interpolation (OI) as needed.

49 CFR 272.7 - Coverage of a critical incident stress plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Coverage of a critical incident stress plan. 272.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CRITICAL INCIDENT STRESS PLANS General § 272.7 Coverage of a critical incident stress plan. The critical incident stress plan of a railroad subject to this part shall...

20 CFR 726.5 - Effective date of insurance coverage.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Effective date of insurance coverage. 726.5... MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED BLACK LUNG BENEFITS; REQUIREMENTS FOR COAL MINE OPERATOR'S INSURANCE General § 726.5 Effective date of insurance coverage. Pursuant to section 422(c) of part...

20 CFR 703.202 - Identification of significant gaps in State guaranty fund coverage for LHWCA obligations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... STATUTES INSURANCE REGULATIONS Insurance Carrier Security Deposit Requirements § 703.202 Identification of... carrier's required security deposit, the Office will consider the extent to which a State guaranty fund... fully and immediately secure LHWCA obligations and will post its findings on the Internet at http://www...

20 CFR 703.202 - Identification of significant gaps in State guaranty fund coverage for LHWCA obligations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... STATUTES INSURANCE REGULATIONS Insurance Carrier Security Deposit Requirements § 703.202 Identification of... carrier's required security deposit, the Office will consider the extent to which a State guaranty fund... fully and immediately secure LHWCA obligations and will post its findings on the Internet at http://www...

20 CFR 703.202 - Identification of significant gaps in State guaranty fund coverage for LHWCA obligations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... STATUTES INSURANCE REGULATIONS Insurance Carrier Security Deposit Requirements § 703.202 Identification of... carrier's required security deposit, the Office will consider the extent to which a State guaranty fund... fully and immediately secure LHWCA obligations and will post its findings on the Internet at http://www...

20 CFR 703.202 - Identification of significant gaps in State guaranty fund coverage for LHWCA obligations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... STATUTES INSURANCE REGULATIONS Insurance Carrier Security Deposit Requirements § 703.202 Identification of... carrier's required security deposit, the Office will consider the extent to which a State guaranty fund... fully and immediately secure LHWCA obligations and will post its findings on the Internet at http://www...

The Employed Uninsured and the Role of Public Policy. National Health Care Expenditures Study.

ERIC Educational Resources Information Center

Monheit, Alan C.; And Others

1985-01-01

This paper notes that, although most private health insurance is obtained through the workplace, important gaps remain in the present system of employment-related coverage. National survey data are presented which revealed that more than 9 million persons with employment experience were uninsured, who, with their uninsured dependents, accounted…

Ex situ conservation priorities for the wild relatives of potato (Solanum L. section Petota)

USDA-ARS?s Scientific Manuscript database

We analyzed the contemporary ex situ conservation coverage of the wild relatives of cultivated potato (Solanum section Petota) to set priorities and guide future collections and conservation. We conducted a gap analysis for 73 taxa involving seven, 63 and three species from the primary, secondary an...

Medicare Prescription Drug Coverage

MedlinePlus

Part D is the name of Medicare's prescription drug coverage. It's insurance that helps people pay for prescription drugs. It is available to everyone who has Medicare. It provides protection if you ...

12 CFR 230.1 - Authority, purpose, coverage, and effect on state laws.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Authority, purpose, coverage, and effect on..., and effect on state laws. (a) Authority. This part, known as Regulation DD, is issued by the Board of... advertising rules in § 230.8 of this part apply to any person who advertises an account offered by a...

10 CFR 40.2a - Coverage of inactive tailings sites.

Code of Federal Regulations, 2011 CFR

2011-01-01

... materials as defined in this part that are located at a site where milling operations are no longer active... defined in this part that is located at a site where milling operations are no longer active, if such site... 10 Energy 1 2011-01-01 2011-01-01 false Coverage of inactive tailings sites. 40.2a Section 40.2a...

10 CFR 40.2a - Coverage of inactive tailings sites.

Code of Federal Regulations, 2012 CFR

2012-01-01

... materials as defined in this part that are located at a site where milling operations are no longer active... defined in this part that is located at a site where milling operations are no longer active, if such site... 10 Energy 1 2012-01-01 2012-01-01 false Coverage of inactive tailings sites. 40.2a Section 40.2a...

10 CFR 40.2a - Coverage of inactive tailings sites.

Code of Federal Regulations, 2014 CFR

2014-01-01

... materials as defined in this part that are located at a site where milling operations are no longer active... defined in this part that is located at a site where milling operations are no longer active, if such site... 10 Energy 1 2014-01-01 2014-01-01 false Coverage of inactive tailings sites. 40.2a Section 40.2a...

10 CFR 40.2a - Coverage of inactive tailings sites.

Code of Federal Regulations, 2013 CFR

2013-01-01

... materials as defined in this part that are located at a site where milling operations are no longer active... defined in this part that is located at a site where milling operations are no longer active, if such site... 10 Energy 1 2013-01-01 2013-01-01 false Coverage of inactive tailings sites. 40.2a Section 40.2a...

Bridging the climate-induced water gap in the twenty-first century: adaptation support based on water supply, demand, adaptation and financing.

NASA Astrophysics Data System (ADS)

Straatsma, Menno; Droogers, Peter; Brandsma, Jaïrus; Buytaert, Wouter; Karssenberg, Derek; Van Beek, Rens; Wada, Yoshihide; Sutanudjaja, Edwin; Vitolo, Claudia; Schmitz, Oliver; Meijer, Karen; Van Aalst, Maaike; Bierkens, Marc

2014-05-01

Water scarcity affects large parts of the world. Over the course of the twenty-first century, water demand is likely to increase due to population growth and associated food production, and increased economic activity, while water supply is projected to decrease in many regions due to climate change. Despite recent studies that analyze the effect of climate change on water scarcity, e.g. using climate projections under representative concentration pathways (RCP) of the fifth assessment report of the IPCC (AR5), decision support for closing the water gap between now and 2100 does not exist at a meaningful scale and with a global coverage. In this study, we aimed (i) to assess the joint impact of climatic and socio-economic change on water scarcity, (ii) to integrate impact and potential adaptation in one workflow, (iii) to prioritize adaptation options to counteract water scarcity based on their financial, regional socio-economic and environmental implications, and (iv) to deliver all this information in an integrated user-friendly web-based service. To enable the combination of global coverage with local relevance, we aggregated all results for 1604 water provinces (food producing units) delineated in this study, which is five times smaller than previous food producing units. Water supply was computed using the PCR-GLOBWB hydrological and water resources model, parameterized at 5 arcminutes for the whole globe, excluding Antarctica and Greenland. We ran PCR-GLOBWB with a daily forcing derived from five different GCM models from the CMIP5 (GFDL-ESM2M, Hadgem2-ES, IPSL-CMA5-LR, MIROC-ESM-CHEM, NorESM1-M) that were bias corrected using observation-based WATCH data between 1960-1999. For each of the models all four RCPs (RCP 2.6, 4.5, 6.0, and 8.5) were run, producing the ensemble of 20 future projections. The blue water supply was aggregated per month and per water province. Industrial, domestic and irrigation water demands were computed for a limited number of realistic combinations of a shared socio-economic pathways (SSPs) and RCPs. Our Water And Climate Adaptation Model (WatCAM) was used to compute the water gap based on reservoir capacity, water supply, and water demand. WatCam is based on the existing ModSim (Labadie, 2010) water allocation model, and facilitated the evaluation of nine technological and infrastructural adaptation measures to assess the investments needed to bridge the future water gap. Regional environmental and socio-economic effects of these investments, such as environmental flows or downstream effects, were evaluated. A scheme was developed to evaluate the strategies on robustness and flexibility under climate change and scenario uncertainty, and each measure was linked to possibilities for investment and financing mechanisms. The WatCAM is available as a web modeling service from www.water2invest.com, and enables user specified adaptation measures and the creation of an ensemble of water gap forecasts.

Linking high parity and maternal and child mortality: what is the impact of lower health services coverage among higher order births?

PubMed

Sonneveldt, Emily; DeCormier Plosky, Willyanne; Stover, John

2013-01-01

A number of data sets show that high parity births are associated with higher child mortality than low parity births. The reasons for this relationship are not clear. In this paper we investigate whether high parity is associated with lower coverage of key health interventions that might lead to increased mortality. We used DHS data from 10 high fertility countries to examine the relationship between parity and coverage for 8 child health intervention and 9 maternal health interventions. We also used the LiST model to estimate the effect on maternal and child mortality of the lower coverage associated with high parity births. Our results show a significant relationship between coverage of maternal and child health services and birth order, even when controlling for poverty. The association between coverage and parity for maternal health interventions was more consistently significant across countries all countries, while for child health interventions there were fewer overall significant relationships and more variation both between and within countries. The differences in coverage between children of parity 3 and those of parity 6 are large enough to account for a 12% difference in the under-five mortality rate and a 22% difference in maternal mortality ratio in the countries studied. This study shows that coverage of key health interventions is lower for high parity children and the pattern is consistent across countries. This could be a partial explanation for the higher mortality rates associated with high parity. Actions to address this gap could help reduce the higher mortality experienced by high parity birth.

Benefits | NREL

Science.gov Websites

benefits package for full- and part-time employees includes medical, dental, and vision coverage effective assignment of 12 months or longer are eligible for: Medical/Dental Insurance Vision Coverage Personal Time

Older women's health and financial vulnerability: implications of the Medicare benefit structure.

PubMed

Sofaer, S; Abel, E

1990-01-01

Elderly women and men have different patterns of disease and utilize health services differently. This essay examines the extent to which Medicare covers the specific conditions and services associated with women and men. Elderly women experience higher rates of poverty than elderly men; consequently, elderly women are especially likely to be unable to pay high out-of-pocket costs for health care. Using a new method for simulating out-of-pocket costs, the Illness Episode Approach, the essay shows that Medicare provides better coverage for illnesses which predominate among men than for those which predominate among women. In addition, women on Medicare who supplement their basic coverage by purchasing a typical private insurance "Medigap" policy do not receive as much of an advantage from their purchases as do men. The calculations also show that the Medicare Catastrophic Coverage Act would have had little impact on the gender gap in financial vulnerability.

Mechanical properties of graphene oxides.

PubMed

Liu, Lizhao; Zhang, Junfeng; Zhao, Jijun; Liu, Feng

2012-09-28

The mechanical properties, including the Young's modulus and intrinsic strength, of graphene oxides are investigated by first-principles computations. Structural models of both ordered and amorphous graphene oxides are considered and compared. For the ordered graphene oxides, the Young's modulus is found to vary from 380 to 470 GPa as the coverage of oxygen groups changes, respectively. The corresponding variations in the Young's modulus of the amorphous graphene oxides with comparable coverage are smaller at 290-430 GPa. Similarly, the ordered graphene oxides also possess higher intrinsic strength compared with the amorphous ones. As coverage increases, both the Young's modulus and intrinsic strength decrease monotonically due to the breaking of the sp(2) carbon network and lowering of the energetic stability for the ordered and amorphous graphene oxides. In addition, the band gap of the graphene oxide becomes narrower under uniaxial tensile strain, providing an efficient way to tune the electronic properties of graphene oxide-based materials.

Community-Provider Partnerships to Reduce Immunization Disparities: Field Report From Northern Manhattan

PubMed Central

Findley, Sally E.; Irigoyen, Matilde; See, Donna; Sanchez, Martha; Chen, Shaofu; Sternfels, Pamela; Caesar, Arturo

2003-01-01

In 1996 we launched a community–provider partnership to raise immunization coverage for children aged younger than 3 years in Northern Manhattan, New York City. The partnership was aimed at fostering provider knowledge and accountability, practice improvements, and community outreach. By 1999 the partnership included 26 practices and 20 community groups. Between 1996 and 1999, immunization coverage rates increased in Northern Manhattan 5 times faster than in New York City and 8 times faster than in the United States (respectively, 3.4% vs 0.4% [t = 6.05, p < 0.001] and vs 0.6% [t = 5.65, p < 0.001]). The coverage rate for Northern Manhattan stayed constant through 2000, although it declined during this period for the United States and New York City. We attribute the success at reducing the gap to the effectiveness of our partnership. PMID:12835176

The Moderating Effects of Ethnicity and Employment Type on Insurance Coverage: Four Asian Subgroups in California.

PubMed

Nguyen, Duy; Choi, Sunha; Park, So Young

2015-10-01

Despite nearly universal insurance coverage for older Americans over the age of 65, the preretirement age cohort is susceptible to gaps in coverage. Related to the Patient Protection and Affordable Care Act (ACA), this study investigated heterogeneity in insurance status for preretirement Asian immigrants by examining the interacting effects of Asian ethnicity and employment type, which is a major factor that determines an individual's insurance status in the U.S. Data from the 2009 California Health Interview Survey, which included 1,024 Asians between the ages of 50 and 64, were analyzed. Our findings indicate significant moderating effects of employment type and Asian ethnicity. However, regardless of employment type, Koreans had the highest rate of being uninsured. To effectively reach the ACA's goal of reducing the number of uninsured individuals, targeted interventions specific to Asian subgroups are essential. © The Author(s) 2013.

Measuring effective coverage of curative child health services in rural Burkina Faso: a cross-sectional study

PubMed Central

Koulidiati, Jean-Louis; Nesbitt, Robin C; Ouedraogo, Nobila; Hien, Hervé; Robyn, Paul Jacob; Compaoré, Philippe; Souares, Aurélia; Brenner, Stephan

2018-01-01

Objective To estimate both crude and effective curative health services coverage provided by rural health facilities to under 5-year-old (U5YO) children in Burkina Faso. Methods We surveyed 1298 child health providers and 1681 clinical cases across 494 primary-level health facilities, as well as 12 497 U5YO children across 7347households in the facilities’ catchment areas. Facilities were scored based on a set of indicators along three quality-of-care dimensions: management of common childhood diseases, management of severe childhood diseases and general service readiness. Linking service quality to service utilisation, we estimated both crude and effective coverage of U5YO children by these selected curative services. Results Measured performance quality among facilities was generally low with only 12.7% of facilities surveyed reaching our definition of high and 57.1% our definition of intermediate quality of care. The crude coverage was 69.5% while the effective coverages indicated that 5.3% and 44.6% of children reporting an illness episode received services of only high or high and intermediate quality, respectively. Conclusion Our study showed that the quality of U5YO child health services provided by primary-level health facilities in Burkina Faso was low, resulting in relatively ineffective population coverage. Poor adherence to clinical treatment guidelines combined with the lack of equipment and qualified clinical staff that performed U5YO consultations seemed to be contributors to the gap between crude and effective coverage. PMID:29858415

Automated inspection of gaps on the free-form shape parts by laser scanning technologies

NASA Astrophysics Data System (ADS)

Zhou, Sen; Xu, Jian; Tao, Lei; An, Lu; Yu, Yan

2018-01-01

In industrial manufacturing processes, the dimensional inspection of the gaps on the free-form shape parts is critical and challenging, and is directly associated with subsequent assembly and terminal product quality. In this paper, a fast measuring method for automated gap inspection based on laser scanning technologies is presented. The proposed measuring method consists of three steps: firstly, the relative position is determined according to the geometric feature of measuring gap, which considers constraints existing in a laser scanning operation. Secondly, in order to acquire a complete gap profile, a fast and effective scanning path is designed. Finally, the range dimension of the gaps on the free-form shape parts including width, depth and flush, correspondingly, is described in a virtual environment. In the future, an appliance machine based on the proposed method will be developed for the on-line dimensional inspection of gaps on the automobile or aerospace production line.

Medicare Part D and the Federal Employees Health Benefits Program: A Comparison of Prescription Drug Coverage

PubMed Central

Lovett, Annesha

2013-01-01

Background There is much debate currently about how to restructure the Medicare program to achieve better value for the money. Many have cited the Federal Employees Health Benefits Program (FEHBP) as a model for reform. Objective To compare drug coverage and cost-sharing between Medicare Part D and the FEHBP plans. Methods A cross-sectional comparison was conducted of January 2009 data obtained from the Centers for Medicare & Medicaid Services, the Office of Personnel Management, and 3 health plan websites. Regression analysis and t-tests were used to examine drug coverage, copayment, and coinsurance amounts among Medicare Part D and FEHBP plans. The final study sample of Medicare Part D plans consisted of 19 formularies, covering 63% of total Part D enrollment. These 19 formularies represented 232 stand-alone prescription drug plans. In addition, 5 prescription drug plans or formularies in the FEHBP plans were included, which represents 70% of total FEHBP enrollment. Results The results of this study reveal that formulary coverage of the top drugs dispensed and sold in the United States in 2009 ranged from 72% to 94% (average, 84%) in Medicare Part D plans and from 85% to 99% (average, 94%) in the FEHBP plans (P <.01). The mean copayment for generic drugs in Medicare Part D plans was $4.53 compared with a mean of $7.67 (P <.05) in the FEHBP plans. The difference between the 2 programs in mean copayment for brand-name drugs was nonsignificant. For generic drugs, the mean coinsurance rate was 17% for Medicare Part D plans and a mean of 20% for the FEHBP plans (P <.05). Conclusions This analysis shows that there are differences in prescription drug coverage and cost-sharing among plans within Medicare Part D and the FEHBP. To avoid extreme increases in payroll taxes and other revenues or major cutbacks in services, Medicare must explore ways to change the healthcare system to achieve better value for the money. The experience of the FEHBP suggests a possible means of accomplishing this objective. PMID:24991346

SU-F-T-442: Dose Distribution Comparison for Post-Laryngectomy Stoma Area Between Conventional AP and VMAT Plans with Or Without Bolus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, B; Zhang, J; Cho-Lim, J

Purpose: To compare dose distributions of conventional AP vs. VMAT treatment plans with or without bolus around post-laryngectomy stoma. Methods: Radiation dose coverage for post-laryngectomy stoma was analyzed using a set of real-case CT-simulation images. After meticulous contouring of the catheter cuff, stoma lumen, peri-stoma skin and subclinical tumor bed at the larynx, the resulting dosimetry plans were analyzed with or without a 5 mm bolus placement. Wet gauze was used to minimize the effect of any air gap. Four plans were generated: AP superclavicular (SCV) plan with or without bolus, and VMAT plan with or without bolus. A dosemore » of 60Gy in 30 fractions was prescribed at 3 cm depth for AP SCV plan, and to 95% of the PTV volume for VMAT plan. Results: For the conventional AP SCV plan, the peri-stoma skin dose is sensitive to bolus placement as well as air gap compensation by wetted gauze (V95% of 20.7%, 33.0% and 94.8% for no bolus, bolus without and with air gap compensation, respectively). For stoma lumen, the dose drops off rapidly in depth. The catheter cuff may have certain dose-buildup effect, but air gap around it and under the bolus placed can pose a more serious problem. The dose distributions of the two VMAT plans are moderately different for peri-stoma skin (V95% of 95.0% with bolus and air gap compensation, and 82.3% without bolus), but nearly identical for stoma lumen (V95% of 91.5% and 92.0%, respectively). VMAT allows beamlets with different angles of incidence that helped achieve such dose distribution around the stoma even without bolus placement. Conclusion: Overall, the dose coverage around the stoma in the VMAT plan is better than the conventional AP SCV plan. To achieve optimal dose distribution, it is still recommended to place physical bolus and reduce the air gaps.« less

MIPPA: First Broad Changes to Medicare Part D Plan Operations.

PubMed

LeMasurier, Jean D; Edgar, Babette

2009-04-01

In July 2008, as part of broad Medicare reform, Congress passed the first major legislative changes to Medicare Part D since its enactment in 2003-the Medicare Improvements for Patients and Providers Act. This new legislation has significant implications for how Part D plans can market and enroll Medicare beneficiaries. The new legislation also strengthened beneficiary protections, expanded the low-income subsidy provisions originally included in Part D, and expanded Part D coverage. These changes have significant implications for the operation of Part D plans and can affect those involved in benefit design, including specialty pharmacy coverage. This article discusses the major changes that took effect on January 1, 2009, and have immediate implications for Part D plan sponsors, including Medicare Advantage plans and stand-alone prescription drug plans.

MIPPA: First Broad Changes to Medicare Part D Plan Operations

PubMed Central

LeMasurier, Jean D.; Edgar, Babette

2009-01-01

In July 2008, as part of broad Medicare reform, Congress passed the first major legislative changes to Medicare Part D since its enactment in 2003—the Medicare Improvements for Patients and Providers Act. This new legislation has significant implications for how Part D plans can market and enroll Medicare beneficiaries. The new legislation also strengthened beneficiary protections, expanded the low-income subsidy provisions originally included in Part D, and expanded Part D coverage. These changes have significant implications for the operation of Part D plans and can affect those involved in benefit design, including specialty pharmacy coverage. This article discusses the major changes that took effect on January 1, 2009, and have immediate implications for Part D plan sponsors, including Medicare Advantage plans and stand-alone prescription drug plans. PMID:25126279

7 CFR 18.2 - Purpose, applicability and coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... equal opportunity in employment to each individual without regard to race, color, national origin, sex... operating a Cooperative Extension Service. (c) Coverage. This part applies to all positions in all units of...

Supporting the Teaching and Assessment of Working Scientifically

ERIC Educational Resources Information Center

Mepsted, James

2018-01-01

The author created a project aimed to develop and implement the assessment of working scientifically (WS) skills at Victoria Park Primary School. The author had previously identified a gap in the curriculum coverage and assessment of WS skills and his goal was to address the lack of provision for assessing children's WS skills and raise the…

Spanish Society. Government and Political Economy: A Bibliographic Essay. Occasional Paper Series.

ERIC Educational Resources Information Center

Agranoff, Robert

This bibliographic essay is designed to help the student begin to investigate both context and content of contemporary Spanish society, government, politics, and economy. Coverage is selective because the focus is on sources in English, although where important subject matter gaps exist, Spanish sources are provided. Many of these are available in…

20 CFR 703.202 - Identification of significant gaps in State guaranty fund coverage for LHWCA obligations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... RELATED STATUTES INSURANCE REGULATIONS Insurance Carrier Security Deposit Requirements § 703.202... amount of a carrier's required security deposit, the Office will consider the extent to which a State... Internet at http://www.dol.gov/esa/owcp/dlhwc/lstable.htm. These findings will indicate the extent of any...

Poliomyelitis Outbreak,Pointe-Noire, Republic of the Congo, September 2010–February 2011

PubMed Central

Llosa, Augusto E.; Mouniaman-Nara, Isabelle; Kouassi, Felix; Ngala, Joseph; Boxall, Naomi; Porten, Klaudia; Grais, Rebecca F.

2011-01-01

On November 4, 2010, the Republic of the Congo declared a poliomyelitis outbreak. A cross-sectional survey in Pointe-Noire showed poor sanitary conditions and low vaccination coverage (55.5%), particularly among young adults. Supplementary vaccination should focus on older age groups in countries with evidence of immunity gaps. PMID:21801636

Consumers' Use of UMLS Concepts on Social Media: Diabetes-Related Textual Data Analysis in Blog and Social Q&A Sites.

PubMed

Park, Min Sook; He, Zhe; Chen, Zhiwei; Oh, Sanghee; Bian, Jiang

2016-11-24

The widely known terminology gap between health professionals and health consumers hinders effective information seeking for consumers. The aim of this study was to better understand consumers' usage of medical concepts by evaluating the coverage of concepts and semantic types of the Unified Medical Language System (UMLS) on diabetes-related postings in 2 types of social media: blogs and social question and answer (Q&A). We collected 2 types of social media data: (1) a total of 3711 blogs tagged with "diabetes" on Tumblr posted between February and October 2015; and (2) a total of 58,422 questions and associated answers posted between 2009 and 2014 in the diabetes category of Yahoo! Answers. We analyzed the datasets using a widely adopted biomedical text processing framework Apache cTAKES and its extension YTEX. First, we applied the named entity recognition (NER) method implemented in YTEX to identify UMLS concepts in the datasets. We then analyzed the coverage and the popularity of concepts in the UMLS source vocabularies across the 2 datasets (ie, blogs and social Q&A). Further, we conducted a concept-level comparative coverage analysis between SNOMED Clinical Terms (SNOMED CT) and Open-Access Collaborative Consumer Health Vocabulary (OAC CHV)-the top 2 UMLS source vocabularies that have the most coverage on our datasets. We also analyzed the UMLS semantic types that were frequently observed in our datasets. We identified 2415 UMLS concepts from blog postings, 6452 UMLS concepts from social Q&A questions, and 10,378 UMLS concepts from the answers. The medical concepts identified in the blogs can be covered by 56 source vocabularies in the UMLS, while those in questions and answers can be covered by 58 source vocabularies. SNOMED CT was the dominant vocabulary in terms of coverage across all the datasets, ranging from 84.9% to 95.9%. It was followed by OAC CHV (between 73.5% and 80.0%) and Metathesaurus Names (MTH) (between 55.7% and 73.5%). All of the social media datasets shared frequent semantic types such as "Amino Acid, Peptide, or Protein," "Body Part, Organ, or Organ Component," and "Disease or Syndrome." Although the 3 social media datasets vary greatly in size, they exhibited similar conceptual coverage among UMLS source vocabularies and the identified concepts showed similar semantic type distributions. As such, concepts that are both frequently used by consumers and also found in professional vocabularies such as SNOMED CT can be suggested to OAC CHV to improve its coverage. ©Min Sook Park, Zhe He, Zhiwei Chen, Sanghee Oh, Jiang Bian. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 24.11.2016.

Consumers’ Use of UMLS Concepts on Social Media: Diabetes-Related Textual Data Analysis in Blog and Social Q&A Sites

PubMed Central

Chen, Zhiwei; Oh, Sanghee; Bian, Jiang

2016-01-01

Background The widely known terminology gap between health professionals and health consumers hinders effective information seeking for consumers. Objective The aim of this study was to better understand consumers’ usage of medical concepts by evaluating the coverage of concepts and semantic types of the Unified Medical Language System (UMLS) on diabetes-related postings in 2 types of social media: blogs and social question and answer (Q&A). Methods We collected 2 types of social media data: (1) a total of 3711 blogs tagged with “diabetes” on Tumblr posted between February and October 2015; and (2) a total of 58,422 questions and associated answers posted between 2009 and 2014 in the diabetes category of Yahoo! Answers. We analyzed the datasets using a widely adopted biomedical text processing framework Apache cTAKES and its extension YTEX. First, we applied the named entity recognition (NER) method implemented in YTEX to identify UMLS concepts in the datasets. We then analyzed the coverage and the popularity of concepts in the UMLS source vocabularies across the 2 datasets (ie, blogs and social Q&A). Further, we conducted a concept-level comparative coverage analysis between SNOMED Clinical Terms (SNOMED CT) and Open-Access Collaborative Consumer Health Vocabulary (OAC CHV)—the top 2 UMLS source vocabularies that have the most coverage on our datasets. We also analyzed the UMLS semantic types that were frequently observed in our datasets. Results We identified 2415 UMLS concepts from blog postings, 6452 UMLS concepts from social Q&A questions, and 10,378 UMLS concepts from the answers. The medical concepts identified in the blogs can be covered by 56 source vocabularies in the UMLS, while those in questions and answers can be covered by 58 source vocabularies. SNOMED CT was the dominant vocabulary in terms of coverage across all the datasets, ranging from 84.9% to 95.9%. It was followed by OAC CHV (between 73.5% and 80.0%) and Metathesaurus Names (MTH) (between 55.7% and 73.5%). All of the social media datasets shared frequent semantic types such as “Amino Acid, Peptide, or Protein,” “Body Part, Organ, or Organ Component,” and “Disease or Syndrome.” Conclusions Although the 3 social media datasets vary greatly in size, they exhibited similar conceptual coverage among UMLS source vocabularies and the identified concepts showed similar semantic type distributions. As such, concepts that are both frequently used by consumers and also found in professional vocabularies such as SNOMED CT can be suggested to OAC CHV to improve its coverage. PMID:27884812

Equity in disease prevention: Vaccines for the older adults - a national workshop, Australia 2014.

PubMed

Raina MacIntyre, C; Menzies, Robert; Kpozehouen, Elizabeth; Chapman, Michael; Travaglia, Joanne; Woodward, Michael; Jackson Pulver, Lisa; Poulos, Christopher J; Gronow, David; Adair, Timothy

2016-11-04

On the 20th June, 2014 the National Health and Medical Research Council's Centre for Research Excellence in Population Health "Immunisation in under Studied and Special Risk Populations", in collaboration with the Public Health Association of Australia, hosted a workshop "Equity in disease prevention: vaccines for the older adults". The workshop featured international and national speakers on ageing and vaccinology. The workshop was attended by health service providers, stakeholders in immunisation, ageing, primary care, researchers, government and non-government organisations, community representatives, and advocacy groups. The aims of the workshop were to: provide an update on the latest evidence around immunisation for the older adults; address barriers for prevention of infection in the older adults; and identify immunisation needs of these groups and provide recommendations to inform policy. There is a gap in immunisation coverage of funded vaccines between adults and infants. The workshop reviewed provider misconceptions, lack of Randomised Control Trials (RCT) and cost-effectiveness data in the frail elderly, loss of autonomy, value judgements and ageism in health care and the need for an adult vaccination register. Workshop recommendations included recognising the right of elderly people to prevention, the need for promotion in the community and amongst healthcare workers of the high burden of vaccine preventable diseases and the need to achieve high levels of vaccination coverage, in older adults and in health workers involved in their care. Research into new vaccine strategies for older adults which address poor coverage, provider attitudes and immunosenescence is a priority. A well designed national register for tracking vaccinations in older adults is a vital and basic requirement for a successful adult immunisation program. Eliminating financial barriers, by addressing inequities in the mechanisms for funding and subsidising vaccines for the older adults compared to those for children, is important to improve equity of access and vaccination coverage. Vaccination coverage rates should be included in quality indicators of care in residential aged care for older adults. Vaccination is key to healthy ageing, and there is a need to focus on reducing the immunisation gap between adults and children. Copyright © 2016.

Overview of the gaps in the health care legislation in Georgia: short-, medium-, and long-term priorities.

PubMed

Kiknadze, Nino; Beletsky, Leo

2013-12-12

After gaining independence following the dissolution of the Soviet Union, Georgia has aspired to become the region's leader in progressive legal reform. Particularly in the realm of health care regulation, Georgia has proceeded with extensive legislative reforms intended to modernize its health care system, and bring it in line with international standards. As part of a larger project to improve human rights in patient care, we conducted a study designed to identify gaps in the current Georgian health care legislation. Using a cross-site research framework based on the European Charter of Patients’ Rights, an interdisciplinary working group oversaw a comprehensive review of human rights legislation pertinent to health care settings using various sources, such as black letter law, expert opinions, court cases, research papers, reports, and complaints. The study identified a number of serious inconsistencies, gaps, and conflicts in the definition and coverage of terms used in the national legislative canon pertinent to human rights in patient care. These include inconsistent definitions of key terms "informed consent" and "medical malpractice" across the legislative landscape. Imprecise and overly broad drafting of legislation has left concepts like patient confidentiality and implied consent wide open to abuse. The field of health care provider rights was entirely missing from existing Georgian legislation. To our knowledge, this is the first study of its kind in Georgia. Gaps and inconsistencies uncovered were categorized based on a short-, medium-, and long-term action framework. Results were presented to key decision makers in Georgian ministerial and legislative institutions. Several of the major recommendations are currently being considered for inclusion into future legal reform. Copyright © 2013 Kiknadze and Beletsky. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

39 CFR 601.103 - Applicability and coverage.

Code of Federal Regulations, 2010 CFR

2010-07-01

...: INTELLECTUAL PROPERTY RIGHTS OTHER THAN PATENTS PURCHASING OF PROPERTY AND SERVICES § 601.103 Applicability and coverage. The regulations contained in this part apply to all Postal Service acquisition of property (except real property) and services. ...

39 CFR 601.103 - Applicability and coverage.

Code of Federal Regulations, 2011 CFR

2011-07-01

...: INTELLECTUAL PROPERTY RIGHTS OTHER THAN PATENTS PURCHASING OF PROPERTY AND SERVICES § 601.103 Applicability and coverage. The regulations contained in this part apply to all Postal Service acquisition of property (except real property) and services. ...

Overview of employer capitation activities

PubMed Central

Moley, Kevin E.

1986-01-01

This article addresses a new initiative of the Health Care Financing Administration (HCFA) to contract on a group basis with: employer self-insurance plans, unions, group health insurance companies, and Taft-Hartley Health and Welfare Funds for groups of Medicare beneficiaries. Under this new concept, Medicare beneficiaries may elect in the future to obtain Medicare coverage through their group insurance plan rather than through traditional Medicare, with HCFA paying the premiums. This Medicare demonstration will bridge the gap between employer plans, which coordinate with traditional Medicare coverage, and employer-sponsored health benefit plans. This will make available to Medicare-eligible retirees similar, if not the same, managed-care alternatives as are currently available to active employees. PMID:10311924

Nucleation and growth in one dimension

NASA Astrophysics Data System (ADS)

Ben-Naim, E.; Krapivsky, P. L.

1996-10-01

We study statistical properties of the Kolmogorov-Avrami-Johnson-Mehl nucleation-and-growth model in one dimension. We obtain exact results for the gap density as well as the island distribution. When all nucleation events occur simultaneously, we show that the island distribution has discontinuous derivatives on the rays xn(t)=nt, n=1,2,3... . We introduce an accelerated growth mechanism with growth rate increasing linearly with the island size. We solve for the interisland gap density and show that the system reaches complete coverage in a finite time and that the near-critical behavior of the system is robust; i.e., it is insensitive to details such as the nucleation mechanism.

Effect of the curvature parameter on least-squares prediction within poor data coverage: case study for Africa

NASA Astrophysics Data System (ADS)

Abd-Elmotaal, Hussein; Kühtreiber, Norbert

2016-04-01

In the framework of the IAG African Geoid Project, there are a lot of large data gaps in its gravity database. These gaps are filled initially using unequal weight least-squares prediction technique. This technique uses a generalized Hirvonen covariance function model to replace the empirically determined covariance function. The generalized Hirvonen covariance function model has a sensitive parameter which is related to the curvature parameter of the covariance function at the origin. This paper studies the effect of the curvature parameter on the least-squares prediction results, especially in the large data gaps as appearing in the African gravity database. An optimum estimation of the curvature parameter has also been carried out. A wide comparison among the results obtained in this research along with their obtained accuracy is given and thoroughly discussed.

Bathymetry Offshore Sumatra First Comprehensive map of International Data Sets

NASA Astrophysics Data System (ADS)

Gaedicke, C.; Ladage, S.; Soh, W.; Weinrebe, W.; Tappin, D. R.; Henstock, T.; McNeill, L.; Sibuet, J.; Klingelhoefer, F.; Singh, S.; Flueh, E.; Djajadihardja, Y.

2006-12-01

Knowledge of the bathymetry offshore Sumatra is of great importance for geohazard risk assessment, modelling of tsunami runup heights and development of tsunami early warning systems as well as for the general understanding of plate boundary processes and morphotectonic features. Since the devastating December 26, 2004 Sumatra-Andaman Islands earthquake and tsunami a number of marine expeditions, funded by Canada, France, Germany, India, Indonesia, Japan, United Kingdom and the United States have acquired bathymetric data over the southern part of the earthquake rupture zone but also along strike the whole Sunda trench. Here we present the first compilation of these bathymetric data sets as one bathymetric map. The bathymetric data acquired up to date covers a vast part of the trench, continental slope and in part also of the fore arc basins. The map incorporates the newest data sets from 2005 of the British high-resolution HMS SCOTT survey, the French Marion-Dufresene "Aftershocks" and the Japanese Natsushima cruises. While these surveys concentrated on the southern rupture zone of the Dec. 26th, 2004 earthquake, the German RV SONNE SeaCause and Sumatra cruises in 2005 and 2006 mapped the March 28th 2005 rupture area as well as large parts of the central Sunda trench and slope and in part the fore arc basins. Surveys reaching back to 1997 covering parts of the Sunda Strait and offshore southern Sumatra are also incorporated. A nearly complete coverage of the Sunda trench and slope area in the north is achieved. In the south data gaps on the slope still exist. This map compilation is a collaborative international effort initiated and partly funded by InterMARGINS. It is a major contribution to the Indonesian and international science community.

Universal health care and equity: evidence of maternal health based on an analysis of demographic and household survey data.

PubMed

Neal, Sarah; Channon, Andrew Amos; Carter, Sarah; Falkingham, Jane

2015-06-16

The drive toward universal health coverage (UHC) is central to the post 2015 agenda, and is incorporated as a target in the new Sustainable Development Goals. However, it is recognised that an equity dimension needs to be included when progress to this goal is monitored. WHO have developed a monitoring framework which proposes a target of 80% coverage for all populations regardless of income and place of residence by 2030, and this paper examines the feasibility of this target in relation to antenatal care and skilled care at delivery. We analyse the coverage gap between the poorest and richest groups within the population for antenatal care and presence of a skilled attendant at birth for countries grouped by overall coverage of each maternal health service. Average annual rates of improvement needed for each grouping (disaggregated by wealth quintile and urban/rural residence) to reach the goal are also calculated, alongside rates of progress over the past decades for comparative purposes. Marked inequities are seen in all groups except in countries where overall coverage is high. As the monitoring framework has an absolute target countries with currently very low coverage are required to make rapid and sustained progress, in particular for the poorest and those living in rural areas. The rate of past progress will need to be accelerated markedly in most countries if the target is to be achieved, although several countries have demonstrated the rate of progress required is feasible both for the population as a whole and for the poorest. For countries with currently low coverage the target of 80% essential coverage for all populations will be challenging. Lessons should be drawn from countries who have achieved rapid and equitable progress in the past.

Identification of copy number variants in whole-genome data using Reference Coverage Profiles

PubMed Central

Glusman, Gustavo; Severson, Alissa; Dhankani, Varsha; Robinson, Max; Farrah, Terry; Mauldin, Denise E.; Stittrich, Anna B.; Ament, Seth A.; Roach, Jared C.; Brunkow, Mary E.; Bodian, Dale L.; Vockley, Joseph G.; Shmulevich, Ilya; Niederhuber, John E.; Hood, Leroy

2015-01-01

The identification of DNA copy numbers from short-read sequencing data remains a challenge for both technical and algorithmic reasons. The raw data for these analyses are measured in tens to hundreds of gigabytes per genome; transmitting, storing, and analyzing such large files is cumbersome, particularly for methods that analyze several samples simultaneously. We developed a very efficient representation of depth of coverage (150–1000× compression) that enables such analyses. Current methods for analyzing variants in whole-genome sequencing (WGS) data frequently miss copy number variants (CNVs), particularly hemizygous deletions in the 1–100 kb range. To fill this gap, we developed a method to identify CNVs in individual genomes, based on comparison to joint profiles pre-computed from a large set of genomes. We analyzed depth of coverage in over 6000 high quality (>40×) genomes. The depth of coverage has strong sequence-specific fluctuations only partially explained by global parameters like %GC. To account for these fluctuations, we constructed multi-genome profiles representing the observed or inferred diploid depth of coverage at each position along the genome. These Reference Coverage Profiles (RCPs) take into account the diverse technologies and pipeline versions used. Normalization of the scaled coverage to the RCP followed by hidden Markov model (HMM) segmentation enables efficient detection of CNVs and large deletions in individual genomes. Use of pre-computed multi-genome coverage profiles improves our ability to analyze each individual genome. We make available RCPs and tools for performing these analyses on personal genomes. We expect the increased sensitivity and specificity for individual genome analysis to be critical for achieving clinical-grade genome interpretation. PMID:25741365

Designing Health Information Technology Tools to Prevent Gaps in Public Health Insurance.

PubMed

Hall, Jennifer D; Harding, Rose L; DeVoe, Jennifer E; Gold, Rachel; Angier, Heather; Sumic, Aleksandra; Nelson, Christine A; Likumahuwa-Ackman, Sonja; Cohen, Deborah J

2017-06-23

Changes in health insurance policies have increased coverage opportunities, but enrollees are required to annually reapply for benefits which, if not managed appropriately, can lead to insurance gaps. Electronic health records (EHRs) can automate processes for assisting patients with health insurance enrollment and re-enrollment. We describe community health centers' (CHC) workflow, documentation, and tracking needs for assisting families with insurance application processes, and the health information technology (IT) tool components that were developed to meet those needs. We conducted a qualitative study using semi-structured interviews and observation of clinic operations and insurance application assistance processes. Data were analyzed using a grounded theory approach. We diagramed workflows and shared information with a team of developers who built the EHR-based tools. Four steps to the insurance assistance workflow were common among CHCs: 1) Identifying patients for public health insurance application assistance; 2) Completing and submitting the public health insurance application when clinic staff met with patients to collect requisite information and helped them apply for benefits; 3) Tracking public health insurance approval to monitor for decisions; and 4) assisting with annual health insurance reapplication. We developed EHR-based tools to support clinical staff with each of these steps. CHCs are uniquely positioned to help patients and families with public health insurance applications. CHCs have invested in staff to assist patients with insurance applications and help prevent coverage gaps. To best assist patients and to foster efficiency, EHR based insurance tools need comprehensive, timely, and accurate health insurance information.

Global biodiversity monitoring: from data sources to essential biodiversity variables

USGS Publications Warehouse

Proenca, Vania; Martin, Laura J.; Pereira, Henrique M.; Fernandez, Miguel; McRae, Louise; Belnap, Jayne; Böhm, Monika; Brummitt, Neil; Garcia-Moreno, Jaime; Gregory, Richard D.; Honrado, Joao P; Jürgens, Norbert; Opige, Michael; Schmeller, Dirk S.; Tiago, Patricia; van Sway, Chris A

2016-01-01

Essential Biodiversity Variables (EBVs) consolidate information from varied biodiversity observation sources. Here we demonstrate the links between data sources, EBVs and indicators and discuss how different sources of biodiversity observations can be harnessed to inform EBVs. We classify sources of primary observations into four types: extensive and intensive monitoring schemes, ecological field studies and satellite remote sensing. We characterize their geographic, taxonomic and temporal coverage. Ecological field studies and intensive monitoring schemes inform a wide range of EBVs, but the former tend to deliver short-term data, while the geographic coverage of the latter is limited. In contrast, extensive monitoring schemes mostly inform the population abundance EBV, but deliver long-term data across an extensive network of sites. Satellite remote sensing is particularly suited to providing information on ecosystem function and structure EBVs. Biases behind data sources may affect the representativeness of global biodiversity datasets. To improve them, researchers must assess data sources and then develop strategies to compensate for identified gaps. We draw on the population abundance dataset informing the Living Planet Index (LPI) to illustrate the effects of data sources on EBV representativeness. We find that long-term monitoring schemes informing the LPI are still scarce outside of Europe and North America and that ecological field studies play a key role in covering that gap. Achieving representative EBV datasets will depend both on the ability to integrate available data, through data harmonization and modeling efforts, and on the establishment of new monitoring programs to address critical data gaps.

Ethnobotanical Knowledge Is Vastly Under-Documented in Northwestern South America

PubMed Central

Cámara-Leret, Rodrigo; Paniagua-Zambrana, Narel; Balslev, Henrik; Macía, Manuel J.

2014-01-01

A main objective of ethnobotany is to document traditional knowledge about plants before it disappears. However, little is known about the coverage of past ethnobotanical studies and thus about how well the existing literature covers the overall traditional knowledge of different human groups. To bridge this gap, we investigated ethnobotanical data-collecting efforts across four countries (Colombia, Ecuador, Peru, Bolivia), three ecoregions (Amazon, Andes, Chocó), and several human groups (including Amerindians, mestizos, and Afro-Americans). We used palms (Arecaceae) as our model group because of their usefulness and pervasiveness in the ethnobotanical literature. We carried out a large number of field interviews (n = 2201) to determine the coverage and quality of palm ethnobotanical data in the existing ethnobotanical literature (n = 255) published over the past 60 years. In our fieldwork in 68 communities, we collected 87,886 use reports and documented 2262 different palm uses and 140 useful palm species. We demonstrate that traditional knowledge on palm uses is vastly under-documented across ecoregions, countries, and human groups. We suggest that the use of standardized data-collecting protocols in wide-ranging ethnobotanical fieldwork is a promising approach for filling critical information gaps. Our work contributes to the Aichi Biodiversity Targets and emphasizes the need for signatory nations to the Convention on Biological Diversity to respond to these information gaps. Given our findings, we hope to stimulate the formulation of clear plans to systematically document ethnobotanical knowledge in northwestern South America and elsewhere before it vanishes. PMID:24416449

Use and Spending for Biologic Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among US Medicare Beneficiaries.

PubMed

Yazdany, Jinoos; Tonner, Chris; Schmajuk, Gabriela

2015-09-01

Biologic therapies have assumed an important role in treating rheumatoid arthritis (RA). We sought to investigate use, spending, and patient cost-sharing for Medicare beneficiaries using biologic drugs for RA, comparing patients exposed to minimal cost-sharing because of a Part D low-income subsidy (LIS) to those facing substantial out-of-pocket costs (OOP). We performed a retrospective, nationwide study using 2009 Medicare claims for a 5% random sample of beneficiaries with RA who had at least 1 RA drug dispensed. We analyzed biologic drug utilization and costs across the Part B (medical benefit) and Part D (pharmacy benefit) programs by LIS status using multinomial regression. We also projected OOP costs as the Affordable Care Act (ACA) mandates closure of the Part D coverage gap by 2020. Among 6,932 beneficiaries, 1,812 (26.1%) received a biologic drug. LIS beneficiaries were significantly more likely to obtain Part D home-administered biologics (relative risk ratio [RRR] 2.98, 95% confidence interval [95% CI] 2.50-3.56), while non-LIS beneficiaries were less likely to receive Part D biologic agents (RRR 0.58, 95% CI 0.48-0.69). OOP costs in Part D were lower, as expected, for LIS beneficiaries ($72 versus $3,751 per year for non-LIS). Non-LIS beneficiaries had lower costs for Part B facility-administered biologic agents (range $0-$2,584) than for Part D home-administered biologic agents. ACA reforms will narrow OOP differences between Part D and B for non-LIS beneficiaries. In contrast to LIS beneficiaries who receive mostly Part D home-administered biologic DMARDs, nonsubsidized beneficiaries have significant cost-based incentives to obtain facility-administered biologic DMARDs through Part B. The ACA will result in only slightly lower costs for Part D biologic drugs for these beneficiaries. © 2015, American College of Rheumatology.

Impact of Medicare on the Use of Medical Services by Disabled Beneficiaries, 1972-1974

PubMed Central

Deacon, Ronald W.

1979-01-01

The extension of Medicare coverage in 1973 to disabled persons receiving cash benefits under the Social Security Act provided an opportunity to examine the impact of health insurance coverage on utilization and expenses for Part B services. Data on medical services used both before and after coverage, collected through the Current Medicare Survey, were analyzed. Results indicate that access to care (as measured by the number of persons using services) increased slightly, while the rate of use did not. The large increase in the number of persons eligible for Medicare reflected the large increase in the number of cash beneficiaries. Significant increases also were found in the amount charged for medical services. The absence of large increases in access and service use may be attributed, in part, to the already existing source of third party payment available to disabled cash beneficiaries in 1972, before Medicare coverage. PMID:10316939

Networked sensors for the combat forces

NASA Astrophysics Data System (ADS)

Klager, Gene

2004-11-01

Real-time and detailed information is critical to the success of ground combat forces. Current manned reconnaissance, surveillance, and target acquisition (RSTA) capabilities are not sufficient to cover battlefield intelligence gaps, provide Beyond-Line-of-Sight (BLOS) targeting, and the ambush avoidance information necessary for combat forces operating in hostile situations, complex terrain, and conducting military operations in urban terrain. This paper describes a current US Army program developing advanced networked unmanned/unattended sensor systems to survey these gaps and provide the Commander with real-time, pertinent information. Networked Sensors for the Combat Forces plans to develop and demonstrate a new generation of low cost distributed unmanned sensor systems organic to the RSTA Element. Networked unmanned sensors will provide remote monitoring of gaps, will increase a unit"s area of coverage, and will provide the commander organic assets to complete his Battlefield Situational Awareness (BSA) picture for direct and indirect fire weapons, early warning, and threat avoidance. Current efforts include developing sensor packages for unmanned ground vehicles, small unmanned aerial vehicles, and unattended ground sensors using advanced sensor technologies. These sensors will be integrated with robust networked communications and Battle Command tools for mission planning, intelligence "reachback", and sensor data management. The network architecture design is based on a model that identifies a three-part modular design: 1) standardized sensor message protocols, 2) Sensor Data Management, and 3) Service Oriented Architecture. This simple model provides maximum flexibility for data exchange, information management and distribution. Products include: Sensor suites optimized for unmanned platforms, stationary and mobile versions of the Sensor Data Management Center, Battle Command planning tools, networked communications, and sensor management software. Details of these products and recent test results will be presented.

Does Health Insurance Coverage Lead to Better Health and Educational Outcomes? Evidence from Rural China. NBER Working Paper No. 16417

ERIC Educational Resources Information Center

Chen, Yuyu; Jin, Ginger Zhe

2010-01-01

Many governments advocate nationwide health insurance coverage but the effects of such a program are less known in developing countries. We use part of the 2006 China Agricultural Census (CAC) to examine whether the recent health insurance coverage in rural China has affected children mortality, pregnancy mortality, and the school enrollment of…

The gap between entitlement and access to healthcare: An analysis of "candidacy" in the help-seeking trajectories of asylum seekers in Montreal.

PubMed

Chase, Liana E; Cleveland, Janet; Beatson, Jesse; Rousseau, Cécile

2017-06-01

In 2012 the Canadian government made significant cuts to its historically strong federal refugee health coverage plan. While this policy had negligible effects on the level of coverage provided to asylum seekers in Quebec, there is evidence that this group nonetheless experienced reduced healthcare access during the period of polarized national debate that ensued. This study engaged the "candidacy" model of healthcare access to illuminate factors contributing to the observed gap between entitlement and access. Twenty-five semi-structured interviews were conducted with asylum seekers in Montreal to elicit narrative accounts of difficulties encountered in the pursuit of healthcare. Thematic content analysis in conjunction with a holistic examination of help-seeking trajectories revealed several important barriers to obtaining care, including widespread confusion and misinformation about refugee health coverage, cumbersome administrative procedures specific to asylum seekers, and long wait times. Feelings of marginalization and insecurity associated with precarious migratory status appeared to amplify the effects of these barriers to care such that even a minor access difficulty could have dramatic effects on future help-seeking and access outcomes. Demonstrating awareness of public discourses interrogating their deservingness of health coverage, participants often interpreted access difficulties as evidence of health professionals' unwillingness to serve them. Such interpretations conspired with fears associated with the asylum claim process to suppress self-advocacy, further help-seeking, and at times even information-seeking. This finding is particularly significant in that it suggests a mechanism through which hostile public representations of forced migrants-increasingly prevalent in Western host countries-can themselves endanger the physical, psychological, and social health of highly disadvantaged populations, even in the presence of strong entitlement policies. We close with reflections on how theoretical models of healthcare access might be adjusted to better accommodate the unique experiences of precarious status migrants. Copyright © 2017 Elsevier Ltd. All rights reserved.

Inside France: Three Missing Pages from Your Students' Textbook.

ERIC Educational Resources Information Center

Conniffe, Patricia, Ed.

This mini-unit seeks to fill the gap in textbooks that exists when teaching about modern France. Many textbooks end their coverage of France with the chapter on World War II. This unit offers high school students a unique introduction to France in the mid-1990s. The mini-unit includes a two-sided poster, teaching tips, and student pages. Student…

The Employer Potential of MOOCs: A Mixed-Methods Study of Human Resource Professionals' Thinking on MOOCs

ERIC Educational Resources Information Center

Radford, Alexandria Walton; Robles, Jessica; Cataylo, Stacey; Horn, Laura; Thornton, Jessica; Whitfield, Keith E.

2014-01-01

While press coverage of MOOCs (massive open online courses) has been considerable and major MOOC providers are beginning to realize that employers may be a market for their courses, research on employers' receptivity to using MOOCs is scarce. To help fill this gap, the Finding and Developing Talent study surveyed 103 employers and interviewed a…

Bringing together raptor collections in Europe for contaminant research and monitoring in relation to chemicals regulations.

PubMed

Movalli, Paola; Dekker, René; Koschorreck, Jan; Treu, Gabriele

2017-11-01

Raptors are good sentinels of environmental contamination and there is good capability for raptor biomonitoring in Europe. Raptor biomonitoring can benefit from natural history museums (NHMs), environmental specimen banks (ESBs) and other collections (e.g. specialist raptor specimen collections). Europe's NHMs, ESBs and other collections hold large numbers of raptor specimens and samples, covering long periods of time. These collections are potentially a valuable resource for contaminant studies over time and space. There are strong needs to monitor contaminants in the environment to support EU and national chemical management. However, data on raptor specimens in NHMs, ESBs and other collections are dispersed, few are digitised, and they are thus not easy to access. Specimen coverage is patchy in terms of species, space and time. Contaminant research with raptors would be facilitated by creating a framework to link relevant collections, digitising all collections, developing a searchable meta-database covering all existing collections, making them more visible and accessible for contaminant research. This would also help identify gaps in coverage and stimulate specimen collection to fill gaps in support of prioritised contaminant monitoring. Collections can further support raptor biomonitoring by making samples available for analysis on request.

Determinants of utilisation of intrapartum obstetric care services in Cambodia, and gaps in coverage.

PubMed

Chomat, Anne Marie; Grundy, John; Oum, Sophal; Bermudez, Odilia I

2011-01-01

Facility delivery and skilled birth attendance are two of the most effective strategies for decreasing maternal mortality. The objectives of this study were to further define utilisation of these services in Cambodia and to uncover socio-economic or location-specific coverage gaps that may exist. We performed a cross-sectional analysis of the 2005 Cambodia Demographic Health Survey (CDHS) to determine prevalence, and determinants, of service utilisation. Out of 6069 women aged 15-49 years, 77% delivered at home, three-fourths without a skilled birth attendant. Poverty, lower education and rural residence were associated with the highest likelihood of poor utilisation of services. Discussion. While there has been an overall increase in facility deliveries and skilled birth attendance since 2000, improvements have been spread unevenly across the population, benefiting mostly urban, wealthier and better educated women. While recent financing initiatives and health system developments appear to have further increased service utilisation since 2005, the extent of their reach to the most vulnerable populations, and their ultimate impact on maternal mortality reduction, remain to be elucidated. Further expanding successful initiatives, particularly among vulnerable populations, is essential. Longitudinal evaluation of ongoing strategies and their impact remains critical.

How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries.

PubMed

Willink, Amber; Shoen, Cathy; Davis, Karen

2018-01-01

The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values. Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.

Promising Practices and Unfinished Business: Fostering Equity and Excellence for Black and Latino Males

ERIC Educational Resources Information Center

Tung, Rosann; Carlo, Vivian Dalila; Colón, Melissa; Del Razo, Jaime L.; Diamond, John B.; Raynor, Alethea Frazier; Graves, Daren; Kuttner, Paul J.; Miranda, Helena; St. Rose, Andresse

2015-01-01

Boston Public Schools (BPS) commissioned companion studies as part of its efforts to address achievement gaps for Black and Latino males. The first study revealed the increasing diversity of Black and Latino males and stark opportunity gaps throughout the system that contribute in large part to wide attainment gaps for these students. We…

Accelerating Maternal and Child Health Gains in Papua New Guinea: Modelled Predictions from Closing the Equity Gap Using LiST.

PubMed

Byrne, Abbey; Hodge, Andrew; Jimenez-Soto, Eliana

2015-11-01

Many priority countries in the countdown to the millennium development goals deadline are lagging in progress towards maternal and child health (MCH) targets. Papua New Guinea (PNG) is one such country beset by challenges of geographical inaccessibility, inequity and health system weakness. Several countries, however, have made progress through focused initiatives which align with the burden of disease and overcome specific inequities. This study identifies the potential impact on maternal and child mortality through increased coverage of prioritised interventions within the PNG health system. The burden of disease and health system environment of PNG was documented to inform prioritised MCH interventions at community, outreach, and clinical levels. Potential reductions in maternal and child mortality through increased intervention coverage to close the geographical equity gap were estimated with the lives saved tool. A set community-level interventions, with highest feasibility, would yield significant reductions in newborn and child mortality. Adding the outreach group delivers gains for maternal mortality, particularly through family planning. The clinical services group of interventions demands greater investment but are essential to reach MCH targets. Cumulatively, the increased coverage is estimated to reduce the rates of under-five mortality by 19 %, neonatal mortality by 26 %, maternal mortality ratio by 10 % and maternal mortality by 33 %. Modest investments in health systems focused on disadvantaged populations can accelerate progress in maternal and child survival even in fragile health systems like PNG. The critical approach may be to target interventions and implementation appropriately to the sensitive context of lagging countries.

The economic impact of Medicare Part D on congestive heart failure.

PubMed

Dall, Timothy M; Blanchard, Tericke D; Gallo, Paul D; Semilla, April P

2013-05-01

Medicare Part D has had important implications for patient outcomes and treatment costs among beneficiaries with congestive heart failure (CHF). This study finds that improved medication adherence associated with expansion of drug coverage under Part D led to nearly $2.6 billion in reductions in medical expenditures annually among beneficiaries diagnosed with CHF and without prior comprehensive drug coverage, of which over $2.3 billion was savings to Medicare. Further improvements in adherence could potentially save Medicare another $1.9 billion annually, generating upwards of $22.4 billion in federal savings over 10 years.

Comparing and decomposing differences in preventive and hospital care: USA versus Taiwan.

PubMed

Hsiou, Tiffany R; Pylypchuk, Yuriy

2012-07-01

As the USA expands health insurance coverage, comparing utilization of healthcare services with countries like Taiwan that already have universal coverage can highlight problematic areas of each system. The universal coverage plan of Taiwan is the newest among developed countries, and it is known for readily providing access to care at low costs. However, Taiwan experiences problems on the supply side, such as inadequate compensation for providers, especially in the area of preventive care. We compare the use of preventive, hospital, and emergency care between the USA and Taiwan. The rate of preventive care use is much higher in the USA than in Taiwan, whereas the use of hospital and emergency care is about the same. Results of our decomposition analysis suggest that higher levels of education and income, along with inferior health status in the USA, are significant factors, each explaining between 7% and 15% of the gap in preventive care use. Our analysis suggests that, in addition to universal coverage, proper remuneration schemes, education levels, and cultural attitudes towards health care are important factors that influence the use of preventive care. Copyright © 2011 John Wiley & Sons, Ltd.

Economic reforms and health insurance in China.

PubMed

Du, Juan

2009-08-01

During the 1990s, Chinese state-owned enterprises (SOEs) and collective enterprises continually decreased coverage of public health insurance to their employees. This paper investigates this changing pattern of health insurance coverage in China using panel data from the China Nutrition and Health Survey (1991-2000). It is the first attempt in this literature that tries to identify precisely the effects of specific policies and reforms on health insurance coverage in the transitional period of China. The fixed effects linear model clustering at the province level is used for estimation, and results are compared to alternative models, including pooled OLS, random effects GLS model and fixed effects logit model. Strong empirical evidence is found that unemployment as a side effect of the Open Door Policy, and the deregulation of SOE and collective enterprises were the main causes for the decreasing trend. For example, urban areas that were highly affected by the Open Door Policy were associated with 17 percentage points decrease in the insurance coverage. Moreover, I found evidence that the gaps between SOE and non-SOE employees, collective and non-collective employees, urban and rural employees have considerably decreased during the ten years.

National and state-specific health insurance disparities for adults in same-sex relationships.

PubMed

Gonzales, Gilbert; Blewett, Lynn A

2014-02-01

We examined national and state-specific disparities in health insurance coverage, specifically employer-sponsored insurance (ESI) coverage, for adults in same-sex relationships. We used data from the American Community Survey to identify adults (aged 25-64 years) in same-sex relationships (n = 31,947), married opposite-sex relationships (n = 3,060,711), and unmarried opposite-sex relationships (n = 259,147). We estimated multinomial logistic regression models and state-specific relative differences in ESI coverage with predictive margins. Men and women in same-sex relationships were less likely to have ESI than were their married counterparts in opposite-sex relationships. We found ESI disparities among adults in same-sex relationships in every region, but we found the largest ESI gaps for men in the South and for women in the Midwest. ESI disparities were narrower in states that had extended legal same-sex marriage, civil unions, and broad domestic partnerships. Men and women in same-sex relationships experience disparities in health insurance coverage across the country, but residing in a state that recognizes legal same-sex marriage, civil unions, or broad domestic partnerships may improve access to ESI for same-sex spouses and domestic partners.

5 CFR 250.201 - Coverage and purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

....201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT IN AGENCIES Strategic Human Capital Management § 250.201 Coverage and purpose. The Chief Human... effective and efficient operation of Government. As a part of OPM's overall leadership responsibilities in...

76 FR 21265 - Interest on Deposits; Deposit Insurance Coverage

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

... of interest on demand deposits, effective one year from the date of the DFA's enactment, July 21... COVERAGE 2. The authority for part 330 continues to read as follows: 12 U.S.C. 1813(l), 1813(m), 1817(i...

Endocrine therapy use among elderly hormone receptor-positive breast cancer patients enrolled in Medicare Part D

PubMed Central

Riley, Gerald F.; Warren, Joan L.; Harlan, Linda C.; Blackwell, Steven A.

2011-01-01

Background Clinical guidelines recommend that women with hormone-receptor positive breast cancer receive endocrine therapy (selective estrogen receptor modulators [SERMs] or aromatase inhibitors [AIs]) for five years following diagnosis. Objective To examine utilization and adherence to therapy for SERMs and AIs in Medicare Part D prescription drug plans. Data Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Study design We identified 15,542 elderly women diagnosed with hormone-receptor positive breast cancer in years 2003-2005 (the latest SEER data at the time of the study) and enrolled in a Part D plan in 2006 or 2007 (the initial years of Part D). This permitted us to compare utilization and adherence to therapy at various points within the recommended five-year timeframe for endocrine therapy. SERM and AI use was measured from claim records. Non-adherence to therapy was defined as a medication possession ratio of less than 80 percent. Principal findings Between May 2006 and December 2007, 22 percent of beneficiaries received SERM, 52 percent AI, and 26 percent received neither. The percent receiving any endocrine therapy decreased with time from diagnosis. Among SERM and AI users, 20-30 percent were non-adherent to therapy; out-of-pocket costs were higher for AI than SERM and were strongly associated with non-adherence. For AI users without a low income subsidy, adherence to therapy deteriorated after reaching the Part D coverage gap. Conclusions Many elderly breast cancer patients were not receiving therapy for the recommended five years following diagnosis. Choosing a Part D plan that minimizes out-of-pocket costs is critical to ensuring beneficiary access to essential medications. PMID:22340780

Optimal allocation of Red List assessments to guide conservation of biodiversity in a rapidly changing world.

PubMed

Hermoso, Virgilio; Januchowski-Hartley, Stephanie Renee; Linke, Simon; Dudgeon, David; Petry, Paulo; McIntyre, Peter

2017-09-01

The IUCN Red List is the most extensive source of conservation status assessments for species worldwide, but important gaps in coverage remain. Here, we demonstrate the use of a spatial prioritization approach to efficiently prioritize species assessments to achieve increased and up-to-date coverage efficiently. We focus on freshwater fishes, which constitute a significant portion of vertebrate diversity, although comprehensive assessments are available for only 46% of species. We used marxan to identify ecoregions for future assessments that maximize the coverage of species while accounting for anthropogenic stress. We identified a set of priority regions that would help assess one-third (ca 4000 species) of all freshwater fishes in need of assessment by 2020. Such assessments could be achieved without increasing current investment levels. Our approach is suitable for any taxon and can help ensure that species threat assessments are sufficiently complete to guide global conservation efforts in a rapidly changing world. © 2017 John Wiley & Sons Ltd.

Lot quality assurance sampling to monitor supplemental immunization activity quality: an essential tool for improving performance in polio endemic countries.

PubMed

Brown, Alexandra E; Okayasu, Hiromasa; Nzioki, Michael M; Wadood, Mufti Z; Chabot-Couture, Guillaume; Quddus, Arshad; Walker, George; Sutter, Roland W

2014-11-01

Monitoring the quality of supplementary immunization activities (SIAs) is a key tool for polio eradication. Regular monitoring data, however, are often unreliable, showing high coverage levels in virtually all areas, including those with ongoing virus circulation. To address this challenge, lot quality assurance sampling (LQAS) was introduced in 2009 as an additional tool to monitor SIA quality. Now used in 8 countries, LQAS provides a number of programmatic benefits: identifying areas of weak coverage quality with statistical reliability, differentiating areas of varying coverage with greater precision, and allowing for trend analysis of campaign quality. LQAS also accommodates changes to survey format, interpretation thresholds, evaluations of sample size, and data collection through mobile phones to improve timeliness of reporting and allow for visualization of campaign quality. LQAS becomes increasingly important to address remaining gaps in SIA quality and help focus resources on high-risk areas to prevent the continued transmission of wild poliovirus. © Crown copyright 2014.

Federal Parity In The Evolving Mental Health And Addiction Care Landscape.

PubMed

Barry, Colleen L; Goldman, Howard H; Huskamp, Haiden A

2016-06-01

The intent of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 is to eliminate differences between health insurance coverage of mental health and substance use disorder benefits and coverage of medical or surgical benefits. The Affordable Care Act significantly extended the reach of the Wellstone-Domenici law by applying it to new insurance markets. We summarize the evolution of legislative and regulatory actions to bring about federal insurance parity. We also summarize available evidence on how the Wellstone-Domenici law has contributed to addressing insurance discrimination; rectifying market inefficiencies due to adverse selection; and altering utilization, spending, and health outcomes for people with mental health and substance use disorders. In addition, we highlight important gaps in knowledge about how parity has been implemented, describe the groups still lacking parity-level coverage, and make recommendations on steps to improve the likelihood that the Wellstone-Domenici law will fulfill the aims of its architects. Project HOPE—The People-to-People Health Foundation, Inc.

Strengthening routine immunization systems to improve global vaccination coverage.

PubMed

Sodha, S V; Dietz, V

2015-03-01

Global coverage with the third dose of diphtheria-tetanus-pertussis vaccine among children under 1 year of age stagnated at ∼ 83-84% during 2008-13. Annual World Health Organization and UNICEF-derived national vaccination coverage estimates. Incomplete vaccination is associated with poor socioeconomic status, lower education, non-use of maternal-child health services, living in conflict-affected areas, missed immunization opportunities and cancelled vaccination sessions. Vaccination platforms must expand to include older ages including the second year of life. Immunization programmes, including eradication and elimination initiatives such as those for polio and measles, must integrate within the broader health system. The Global Vaccine Action Plan (GVAP) 2011-20 is a framework for strengthening immunization systems, emphasizing country ownership, shared responsibility, equity, integration, sustainability and innovation. Immunization programmes should identify, monitor and evaluate gaps and interventions within the GVAP framework. Published by Oxford University Press 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Use of comparative effectiveness research in drug coverage and pricing decisions: a six-country comparison.

PubMed

Sorenson, Corinna

2010-07-01

Comparative effectiveness research (CER) has assumed an increasing role in drug coverage and, in some cases, pricing decisions in Europe, as decision-makers seek to obtain better value for money. This issue brief comparatively examines the use of CER across six countries--Denmark, England, France, Germany, the Netherlands, and Sweden. With CER gaining traction in the United States, these international experiences offer insights and potential lessons. Investing in CER can help address the current gap in publicly available, credible, up-to-date, and scientifically based comparative information on the effectiveness of drugs and other health interventions. This information can be used to base coverage and pricing decisions on evidence of value, thereby facilitating access to and public and private investment in the most beneficial new drugs and technologies. In turn, use of CER creates incentives for more efficient, high-quality health care and encourages development of innovative products that offer measurable value to patients.

Analysing news media coverage of the 2015 Nepal earthquake using a community capitals lens: implications for disaster resilience.

PubMed

Dhakal, Subas P

2018-04-01

South Asia is one of the regions of the world most vulnerable to natural disasters. Although news media analyses of disasters have been conducted frequently in various settings globally, there is little research on populous South Asia. This paper begins to fill this gap by evaluating local and foreign news media coverage of the earthquake in Nepal on 25 April 2015. It broadens the examination of news media coverage of disaster response beyond traditional framing theory, utilising community capitals (built, cultural, financial, human, natural, political, and social) lens to perform a thematic content analysis of 405 news items. Overall, financial and natural capital received the most and the least emphasis respectively. Statistically significant differences between local and foreign news media were detected vis-à-vis built, financial, and political capital. The paper concludes with a discussion of the social utility of news media analysis using the community capitals framework to inform disaster resilience. © 2018 The Author(s). Disasters © Overseas Development Institute, 2018.

Comparative Estimates of Crude and Effective Coverage of Measles Immunization in Low-Resource Settings: Findings from Salud Mesoamérica 2015.

PubMed

Colson, K Ellicott; Zúñiga-Brenes, Paola; Ríos-Zertuche, Diego; Conde-Glez, Carlos J; Gagnier, Marielle C; Palmisano, Erin; Ranganathan, Dharani; Usmanova, Gulnoza; Salvatierra, Benito; Nazar, Austreberta; Tristao, Ignez; Sanchez Monin, Emmanuelle; Anderson, Brent W; Haakenstad, Annie; Murphy, Tasha; Lim, Stephen; Hernandez, Bernardo; Lozano, Rafael; Iriarte, Emma; Mokdad, Ali H

2015-01-01

Timely and accurate measurement of population protection against measles is critical for decision-making and prevention of outbreaks. However, little is known about how survey-based estimates of immunization (crude coverage) compare to the seroprevalence of antibodies (effective coverage), particularly in low-resource settings. In poor areas of Mexico and Nicaragua, we used household surveys to gather information on measles immunization from child health cards and caregiver recall. We also collected dried blood spots (DBS) from children aged 12 to 23 months to compare crude and effective coverage of measles immunization. We used survey-weighted logistic regression to identify individual, maternal, household, community, and health facility characteristics that predict gaps between crude coverage and effective coverage. We found that crude coverage was significantly higher than effective coverage (83% versus 68% in Mexico; 85% versus 50% in Nicaragua). A large proportion of children (19% in Mexico; 43% in Nicaragua) had health card documentation of measles immunization but lacked antibodies. These discrepancies varied from 0% to 100% across municipalities in each country. In multivariate analyses, card-positive children in Mexico were more likely to lack antibodies if they resided in urban areas or the jurisdiction of De Los Llanos. In contrast, card-positive children in Nicaragua were more likely to lack antibodies if they resided in rural areas or the North Atlantic region, had low weight-for-age, or attended health facilities with a greater number of refrigerators. Findings highlight that reliance on child health cards to measure population protection against measles is unwise. We call for the evaluation of immunization programs using serological methods, especially in poor areas where the cold chain is likely to be compromised. Identification of within-country variation in effective coverage of measles immunization will allow researchers and public health professionals to address challenges in current immunization programs.

Comparative Estimates of Crude and Effective Coverage of Measles Immunization in Low-Resource Settings: Findings from Salud Mesoamérica 2015

PubMed Central

Colson, K. Ellicott; Zúñiga-Brenes, Paola; Ríos-Zertuche, Diego; Conde-Glez, Carlos J.; Gagnier, Marielle C.; Palmisano, Erin; Ranganathan, Dharani; Usmanova, Gulnoza; Salvatierra, Benito; Nazar, Austreberta; Tristao, Ignez; Sanchez Monin, Emmanuelle; Anderson, Brent W.; Haakenstad, Annie; Murphy, Tasha; Lim, Stephen; Hernandez, Bernardo; Lozano, Rafael

2015-01-01

Timely and accurate measurement of population protection against measles is critical for decision-making and prevention of outbreaks. However, little is known about how survey-based estimates of immunization (crude coverage) compare to the seroprevalence of antibodies (effective coverage), particularly in low-resource settings. In poor areas of Mexico and Nicaragua, we used household surveys to gather information on measles immunization from child health cards and caregiver recall. We also collected dried blood spots (DBS) from children aged 12 to 23 months to compare crude and effective coverage of measles immunization. We used survey-weighted logistic regression to identify individual, maternal, household, community, and health facility characteristics that predict gaps between crude coverage and effective coverage. We found that crude coverage was significantly higher than effective coverage (83% versus 68% in Mexico; 85% versus 50% in Nicaragua). A large proportion of children (19% in Mexico; 43% in Nicaragua) had health card documentation of measles immunization but lacked antibodies. These discrepancies varied from 0% to 100% across municipalities in each country. In multivariate analyses, card-positive children in Mexico were more likely to lack antibodies if they resided in urban areas or the jurisdiction of De Los Llanos. In contrast, card-positive children in Nicaragua were more likely to lack antibodies if they resided in rural areas or the North Atlantic region, had low weight-for-age, or attended health facilities with a greater number of refrigerators. Findings highlight that reliance on child health cards to measure population protection against measles is unwise. We call for the evaluation of immunization programs using serological methods, especially in poor areas where the cold chain is likely to be compromised. Identification of within-country variation in effective coverage of measles immunization will allow researchers and public health professionals to address challenges in current immunization programs. PMID:26136239

Treatment gaps in Parkinson's disease care in the Philippines.

PubMed

Jamora, Roland Dominic G; Miyasaki, Janis M

2017-08-01

Neurological services and resources are scarce in low-income and developing countries, such as the Philippines. We looked into the treatment gaps in Parkinson's disease (PD) care in the Philippines in the following areas: epidemiology, healthcare, financial coverage, pharmacotherapy, surgical treatment and manpower. We collected relevant data on the above-mentioned areas. There is no available Philippine data on PD prevalence. Philippine healthcare is paid through user fees at the point of service. The average consultation fee in Manila ranges from US$10.57-31.74. The average minimum daily wage is US$9.39-10.17. Philippine healthcare is devolved to the local government units. Deep brain stimulation surgery is only available in Manila. Most PD medications are available in the Philippines. There are only nine movement disorder specialists for a population of 100.98 million. Gaps and challenges in PD care in the Philippines still exist.

Vaccination coverage among foreign-born and U.S.-born adolescents in the United States: Successes and gaps - National Immunization Survey-Teen, 2012-2014.

PubMed

Healy, Jessica; Rodriguez-Lainz, Alfonso; Elam-Evans, Laurie D; Hill, Holly A; Reagan-Steiner, Sarah; Yankey, David

2018-03-20

An overall increase has been reported in vaccination rates among adolescents during the past decade. Studies of vaccination coverage have shown disparities when comparing foreign-born and U.S.-born populations among children and adults; however, limited information is available concerning potential disparities in adolescents. The National Immunization Survey-Teen is a random-digit-dialed telephone survey of caregivers of adolescents aged 13-17 years, followed by a mail survey to vaccination providers that is used to estimate vaccination coverage among the U.S. population of adolescents. Using the National Immunization Survey-Teen data, we assessed vaccination coverage during 2012-2014 among adolescents for routinely recommended vaccines for this age group (≥1 dose tetanus and diphtheria toxoids and acellular pertussis [Tdap] vaccine, ≥1 dose quadrivalent meningococcal conjugate [MenACWY] vaccine, ≥3 doses human papillomavirus [HPV] vaccine) and for routine childhood vaccination catch-up doses (≥2 doses measles, mumps, and rubella [MMR] vaccine, ≥2 doses varicella vaccine, and ≥3 doses hepatitis B [HepB] vaccine). Vaccination coverage prevalence and vaccination prevalence ratios were estimated. Of the 58,090 respondents included, 3.3% were foreign-born adolescents. Significant differences were observed between foreign-born and U.S.-born adolescents for insurance status, income-to-poverty ratio, education, interview language, and household size. Foreign-born adolescents had significantly lower unadjusted vaccination coverage for HepB (89% vs. 93%), and higher coverage for the recommended ≥3 doses of HPV vaccine among males, compared with U.S.-born adolescents (22% vs. 14%). Adjustment for demographic and socioeconomic factors accounted for the disparity in HPV but not HepB vaccination coverage. We report comparable unadjusted vaccination coverage among foreign-born and U.S.-born adolescents for Tdap, MenACWY, MMR, ≥2 varicella. Although coverage was high for HepB vaccine, it was significantly lower among foreign-born adolescents, compared with U.S.-born adolescents. HPV and ≥2-dose varicella vaccination coverage were low among both groups. Published by Elsevier Ltd.

Band gap engineering for graphene by using Na{sup +} ions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sung, S. J.; Lee, P. R.; Kim, J. G.

2014-08-25

Despite the noble electronic properties of graphene, its industrial application has been hindered mainly by the absence of a stable means of producing a band gap at the Dirac point (DP). We report a new route to open a band gap (E{sub g}) at DP in a controlled way by depositing positively charged Na{sup +} ions on single layer graphene formed on 6H-SiC(0001) surface. The doping of low energy Na{sup +} ions is found to deplete the π* band of graphene above the DP, and simultaneously shift the DP downward away from Fermi energy indicating the opening of E{sub g}.more » The band gap increases with increasing Na{sup +} coverage with a maximum E{sub g}≥0.70 eV. Our core-level data, C 1s, Na 2p, and Si 2p, consistently suggest that Na{sup +} ions do not intercalate through graphene, but produce a significant charge asymmetry among the carbon atoms of graphene to cause the opening of a band gap. We thus provide a reliable way of producing and tuning the band gap of graphene by using Na{sup +} ions, which may play a vital role in utilizing graphene in future nano-electronic devices.« less

Direct visualization of atomically precise nitrogen-doped graphene nanoribbons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Yi; Zhang, Yanfang; Li, Geng

2014-07-14

We have fabricated atomically precise nitrogen-doped chevron-type graphene nanoribbons by using the on-surface synthesis technique combined with the nitrogen substitution of the precursors. Scanning tunneling microscopy and spectroscopy indicate that the well-defined nanoribbons tend to align with the neighbors side-by-side with a band gap of 1.02 eV, which is in good agreement with the density functional theory calculation result. The influence of the high precursor coverage on the quality of the nanoribbons is also studied. We find that graphene nanoribbons with sufficient aspect ratios can only be fabricated at sub-monolayer precursor coverage. This work provides a way to construct atomically precisemore » nitrogen-doped graphene nanoribbons.« less

Financing adolescent health care: the role of Medicaid and CHIP.

PubMed

English, A; Kaplan, D; Morreale, M

2000-02-01

Financing health care for adolescents involves a combination of public and private sources of payment and, in the public sector, a combination of insurance coverage and categorical programs. In recent years, the importance of health insurance coverage has increased along with the potential for insuring more adolescents. Medicaid and the new State Children's Health Insurance Program (CHIP) offer numerous options for reducing the proportion of uninsured adolescents and for increasing adolescents' access to necessary health care. This article explores the potential of Medicaid and CHIP for meeting adolescents' needs, the extent to which they have done so already, and the gaps or missing links that remain. It also reviews issues that cut across funding sources related to managed care, consent, and confidentiality.

Setting priorities to address cardiovascular diseases through universal health coverage in low- and middle-income countries.

PubMed

Watkins, David A; Nugent, Rachel A

2017-01-01

Over the past decade, universal health coverage (UHC) has emerged as a major policy goal for many low- and middle-income country governments. Yet, despite the high burden of cardiovascular diseases (CVD), relatively little is known about how to address CVD through UHC. This review covers three major topics. First, we define UHC and provide some context for its importance, and then we illustrate its relevance to CVD prevention and treatment. Second, we discuss how countries might select high-priority CVD interventions for a UHC health benefits package drawing on economic evaluation methods. Third, we explore some implementation challenges and identify research gaps that, if addressed, could improve the inclusion of CVD into UHC.

Energy band gap and optical transition of metal ion modified double crossover DNA lattices.

PubMed

Dugasani, Sreekantha Reddy; Ha, Taewoo; Gnapareddy, Bramaramba; Choi, Kyujin; Lee, Junwye; Kim, Byeonghoon; Kim, Jae Hoon; Park, Sung Ha

2014-10-22

We report on the energy band gap and optical transition of a series of divalent metal ion (Cu(2+), Ni(2+), Zn(2+), and Co(2+)) modified DNA (M-DNA) double crossover (DX) lattices fabricated on fused silica by the substrate-assisted growth (SAG) method. We demonstrate how the degree of coverage of the DX lattices is influenced by the DX monomer concentration and also analyze the band gaps of the M-DNA lattices. The energy band gap of the M-DNA, between the lowest unoccupied molecular orbital (LUMO) and the highest occupied molecular orbital (HOMO), ranges from 4.67 to 4.98 eV as judged by optical transitions. Relative to the band gap of a pristine DNA molecule (4.69 eV), the band gap of the M-DNA lattices increases with metal ion doping up to a critical concentration and then decreases with further doping. Interestingly, except for the case of Ni(2+), the onset of the second absorption band shifts to a lower energy until a critical concentration and then shifts to a higher energy with further increasing the metal ion concentration, which is consistent with the evolution of electrical transport characteristics. Our results show that controllable metal ion doping is an effective method to tune the band gap energy of DNA-based nanostructures.

Promising Practices and Unfinished Business: Fostering Equity and Excellence for Black and Latino Males. Executive Summary

ERIC Educational Resources Information Center

Tung, Rosann; Carlo, Vivian Dalila; Colón, Melissa; Del Razo, Jaime L.; Diamond, John B.; Raynor, Alethea Frazier; Graves, Daren; Kuttner, Paul J.; Miranda, Helena; St. Rose, Andresse

2015-01-01

Boston Public Schools (BPS) commissioned companion studies as part of its efforts to address achievement gaps for Black and Latino males. The first study revealed the increasing diversity of Black and Latino males and stark opportunity gaps throughout the system that contribute in large part to wide attainment gaps for these students. We…

The effect of gap fluctuations on interacting and non-interacting polarization for nano-superconducting grains in electron- and hole-doped cuprates

NASA Astrophysics Data System (ADS)

Afzali, R.; Alizadeh, A.

2017-12-01

The behavior of non-interacting and interacting polarization under influence of fluctuations of the superconducting gap with D-wave symmetry and under consideration of the gap dependence on nano- grain size is obtained in terms of the frequency, temperature and the size at zero and finite temperatures for rectangular cuprate nano-superconducting grains. By using Eliashberg equations and applying the relations of the fermionic dispersion for the hole-doped and electron-doped cuprates, we numerically compute the real part of size-dependent polarization for both types of cuprates. We show that the peak of real part of polarization moves to higher frequency by including the additional fluctuating part of gap (or the nano-size effect). Also, we obtain the temperatures for different frequencies, in which the effect of gap fluctuations fades. In the case of size-dependent gap, there is a critical frequency; for frequencies lower (higher) than the critical frequency, the nano-effect weakens (improves) the superconducting state. Moreover, it is concluded that the real part of polarization for hole- doped cuprates in terms of the grain size has more significant amount in comparison with electron-doped ones.

Insurance Churning Rates For Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful For Many.

PubMed

Sommers, Benjamin D; Gourevitch, Rebecca; Maylone, Bethany; Blendon, Robert J; Epstein, Arnold M

2016-10-01

Changes in insurance coverage over time, or "churning," may have adverse consequences, but there has been little evidence on churning since implementation of the major coverage expansions in the Affordable Care Act (ACA) in 2014. We explored the frequency and implications of churning through surveying 3,011 low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a "private option" expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. We also compared 2015 churning rates in these states to survey data from 2013, before the coverage expansions. Nearly 25 percent of respondents in 2015 changed coverage during the previous twelve months-a rate lower than some previous predictions. We did not find significantly different churning rates in the three states over time. Common causes of churning were job-related changes and loss of eligibility for Medicaid or Marketplace subsidies. Churning was associated with disruptions in physician care and medication adherence, increased emergency department use, and worsening self-reported quality of care and health status. Even churning without gaps in coverage had negative effects. Churning remains a challenge for many Americans, and policies are needed to reduce its frequency and mitigate its negative impacts. Project HOPE—The People-to-People Health Foundation, Inc.

Enhanced surface modification engineering (H, F, Cl, Br, and NO{sub 2}) of CdS nanowires with and without surface dangling bonds

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zeng, Yijie; Xing, Huaizhong, E-mail: xinghz@dhu.edu.cn; Lu, Aijiang

2015-08-07

Semiconductor nanowires (NWs) can be applied in gas sensing and cell detection, but the sensing mechanism is not clearly understood. In this study, surface modification effect on the electronic properties of CdS NWs for different diameters with several species (H, F, Cl, Br, and NO{sub 2}) is investigated by first principles calculations. The surface dangling bonds and halogen elements are chosen to represent the environment of the surface. Halogen passivation drastically changes the band gaps due to the strong electronegativity and the energy level of halogen atoms. Density of states analysis indicates that valence band maximum (VBM) of halogen-passivated NWsmore » is formed by the p states of halogen atoms, while VBM of H-passivated NWs is originated from Cd 4d and S 3p orbitals. To illustrate that surface modification can be applied in gas sensing, NO{sub 2}-absorbed NWs with different coverage are calculated. Low coverage of NO{sub 2} introduces a deep p-type dopant-like level, while high coverage introduces a shallow n-type dopant-like level into the band structure. The transformation is due to that at low coverage the adsorption is chemical while at high coverage is physical. These findings might promote the understanding of surface modification effect and the sensing mechanism of NWs as gas sensors.« less

An Audit to Evaluate the Image Quality of Magnetic Resonance of Knee at Radiology Department of a Tertiary Care Hospital.

PubMed

Mansoor, Ali; Ramzan, Amaila; Chaudhary, Aamer Nadeem

2017-04-01

light of recommendations of ACR. Aclinical audit. Department of Radiology, Jinnah Hospital, Lahore, from August 2015 to February 2016. Scans of 20 patients who underwent MRI of knee in August 2015 were studied retrospectively to assess the quality of images obtained in the first audit. Based on the findings of this audit, recommendations were made and re audit was done 6 months later in February 2016 to look for improvement in local practice. In the first audit, images were acquired in all the three necessary planes and the sagittal and coronal images had appropriate slice thickness, interslice gap as well as adequate anatomical coverage in all the patients. However, FOV (field of view) was appropriately set in 66% of cases in axial plane, 5% in sagittal plane, and 0% in coronal plane. Also, the anatomical coverage was not upto the mark in axial plane with 13 studies (66%) having adequate superior coverage, and 16 cases (80%) having recommended inferior anatomical coverage. The re audit performed 6 months later showed improvement with 100% compliance to standards. The first audit showed many shortcomings in acquiring of MRI data in patients undergoing knee MRI with FOV requiring a decrease in all planes and anatomical coverage increase in axial plane. These recommendations were made in departmental meetings and re-audit was done after 6 months. This second audit showed 100 % compliance.

A Performance Analysis of Public Expenditure on Maternal Health in Mexico.

PubMed

Servan-Mori, Edson; Avila-Burgos, Leticia; Nigenda, Gustavo; Lozano, Rafael

2016-01-01

We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio--adjusted by coverage of adequate ANC--observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003-2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship.

A Performance Analysis of Public Expenditure on Maternal Health in Mexico

PubMed Central

Servan-Mori, Edson; Avila-Burgos, Leticia; Nigenda, Gustavo; Lozano, Rafael

2016-01-01

We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio -adjusted by coverage of adequate ANC- observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003–2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship. PMID:27043819

45 CFR 148.101 - Basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FOR THE INDIVIDUAL HEALTH INSURANCE MARKET General Provisions § 148.101 Basis and purpose. This part... individual health insurance coverage for certain eligible individuals who previously had group coverage, and... and protects all individuals and family members who have, or seek, individual health insurance...

Low vaccination coverage of Greek Roma children amid economic crisis: national survey using stratified cluster sampling

PubMed Central

Petraki, Ioanna; Arkoudis, Chrisoula; Terzidis, Agis; Smyrnakis, Emmanouil; Benos, Alexis; Panagiotopoulos, Takis

2017-01-01

Abstract Background: Research on Roma health is fragmentary as major methodological obstacles often exist. Reliable estimates on vaccination coverage of Roma children at a national level and identification of risk factors for low coverage could play an instrumental role in developing evidence-based policies to promote vaccination in this marginalized population group. Methods: We carried out a national vaccination coverage survey of Roma children. Thirty Roma settlements, stratified by geographical region and settlement type, were included; 7–10 children aged 24–77 months were selected from each settlement using systematic sampling. Information on children’s vaccination coverage was collected from multiple sources. In the analysis we applied weights for each stratum, identified through a consensus process. Results: A total of 251 Roma children participated in the study. A vaccination document was presented for the large majority (86%). We found very low vaccination coverage for all vaccines. In 35–39% of children ‘minimum vaccination’ (DTP3 and IPV2 and MMR1) was administered, while 34–38% had received HepB3 and 31–35% Hib3; no child was vaccinated against tuberculosis in the first year of life. Better living conditions and primary care services close to Roma settlements were associated with higher vaccination indices. Conclusions: Our study showed inadequate vaccination coverage of Roma children in Greece, much lower than that of the non-minority child population. This serious public health challenge should be systematically addressed, or, amid continuing economic recession, the gap may widen. Valid national estimates on important characteristics of the Roma population can contribute to planning inclusion policies. PMID:27694159

Low vaccination coverage of Greek Roma children amid economic crisis: national survey using stratified cluster sampling.

PubMed

Papamichail, Dimitris; Petraki, Ioanna; Arkoudis, Chrisoula; Terzidis, Agis; Smyrnakis, Emmanouil; Benos, Alexis; Panagiotopoulos, Takis

2017-04-01

Research on Roma health is fragmentary as major methodological obstacles often exist. Reliable estimates on vaccination coverage of Roma children at a national level and identification of risk factors for low coverage could play an instrumental role in developing evidence-based policies to promote vaccination in this marginalized population group. We carried out a national vaccination coverage survey of Roma children. Thirty Roma settlements, stratified by geographical region and settlement type, were included; 7-10 children aged 24-77 months were selected from each settlement using systematic sampling. Information on children's vaccination coverage was collected from multiple sources. In the analysis we applied weights for each stratum, identified through a consensus process. A total of 251 Roma children participated in the study. A vaccination document was presented for the large majority (86%). We found very low vaccination coverage for all vaccines. In 35-39% of children 'minimum vaccination' (DTP3 and IPV2 and MMR1) was administered, while 34-38% had received HepB3 and 31-35% Hib3; no child was vaccinated against tuberculosis in the first year of life. Better living conditions and primary care services close to Roma settlements were associated with higher vaccination indices. Our study showed inadequate vaccination coverage of Roma children in Greece, much lower than that of the non-minority child population. This serious public health challenge should be systematically addressed, or, amid continuing economic recession, the gap may widen. Valid national estimates on important characteristics of the Roma population can contribute to planning inclusion policies. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Challenges in Estimating Vaccine Coverage in Refugee and Displaced Populations: Results From Household Surveys in Jordan and Lebanon

PubMed Central

Roberton, Timothy; Weiss, William; Doocy, Shannon

2017-01-01

Ensuring the sustained immunization of displaced persons is a key objective in humanitarian emergencies. Typically, humanitarian actors measure coverage of single vaccines following an immunization campaign; few measure routine coverage of all vaccines. We undertook household surveys of Syrian refugees in Jordan and Lebanon, outside of camps, using a mix of random and respondent-driven sampling, to measure coverage of all vaccinations included in the host country’s vaccine schedule. We analyzed the results with a critical eye to data limitations and implications for similar studies. Among households with a child aged 12–23 months, 55.1% of respondents in Jordan and 46.6% in Lebanon were able to produce the child’s EPI card. Only 24.5% of Syrian refugee children in Jordan and 12.5% in Lebanon were fully immunized through routine vaccination services (having received from non-campaign sources: measles, polio 1–3, and DPT 1–3 in Jordan and Lebanon, and BCG in Jordan). Respondents in Jordan (33.5%) and Lebanon (40.1%) reported difficulties obtaining child vaccinations. Our estimated immunization rates were lower than expected and raise serious concerns about gaps in vaccine coverage among Syrian refugees. Although our estimates likely under-represent true coverage, given the additional benefit of campaigns (not captured in our surveys), there is a clear need to increase awareness, accessibility, and uptake of immunization services. Current methods to measure vaccine coverage in refugee and displaced populations have limitations. To better understand health needs in such groups, we need research on: validity of recall methods, links between campaigns and routine immunization programs, and improved sampling of hard-to-reach populations. PMID:28805672

Progress toward measles preelimination--African Region, 2011-2012.

PubMed

Masresha, Balcha G; Kaiser, Reinhard; Eshetu, Messeret; Katsande, Reggis; Luce, Richard; Fall, Amadou; Dosseh, Annick R G A; Naouri, Boubker; Byabamazima, Charles R; Perry, Robert; Dabbagh, Alya J; Strebel, Peter; Kretsinger, Katrina; Goodson, James L; Nshimirimana, Deo

2014-04-04

In 2008, the 46 member states of the World Health Organization (WHO) African Region (AFR) adopted a measles preelimination goal to reach by the end of 2012 with the following targets: 1) >98% reduction in estimated regional measles mortality compared with 2000, 2) annual measles incidence of fewer than five reported cases per million population nationally, 3) >90% national first dose of measles-containing vaccine (MCV1) coverage and >80% MCV1 coverage in all districts, and 4) >95% MCV coverage in all districts by supplementary immunization activities (SIAs). Surveillance performance objectives were to report two or more cases of nonmeasles febrile rash illness per 100,000 population, one or more suspected measles cases investigated with blood specimens in ≥80% of districts, and 100% completeness of surveillance reporting from all districts. This report updates previous reports and describes progress toward the measles preelimination goal during 2011-2012. In 2012, 13 (28%) member states had >90% MCV1 coverage, and three (7%) reported >90% MCV1 coverage nationally and >80% coverage in all districts. During 2011-2012, four (15%) of 27 SIAs with available information met the target of >95% coverage in all districts. In 2012, 16 of 43 (37%) member states met the incidence target of fewer than five cases per million, and 19 of 43 (44%) met both surveillance performance targets. In 2011, the WHO Regional Committee for AFR established a goal to achieve measles elimination by 2020. To achieve this goal, intensified efforts to identify and close population immunity gaps and improve surveillance quality are needed, as well as committed leadership and ownership of the measles elimination activities and mobilization of adequate resources to complement funding from global partners.

Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015.

PubMed

Afnan-Holmes, Hoviyeh; Magoma, Moke; John, Theopista; Levira, Francis; Msemo, Georgina; Armstrong, Corinne E; Martínez-Álvarez, Melisa; Kerber, Kate; Kihinga, Clement; Makuwani, Ahmad; Rusibamayila, Neema; Hussein, Asia; Lawn, Joy E

2015-07-01

Tanzania is on track to meet Millennium Development Goal (MDG) 4 for child survival, but is making insufficient progress for newborn survival and maternal health (MDG 5) and family planning. To understand this mixed progress and to identify priorities for the post-2015 era, Tanzania was selected as a Countdown to 2015 case study. We analysed progress made in Tanzania between 1990 and 2014 in maternal, newborn, and child mortality, and unmet need for family planning, in which we used a health systems evaluation framework to assess coverage and equity of interventions along the continuum of care, health systems, policies and investments, while also considering contextual change (eg, economic and educational). We had five objectives, which assessed each level of the health systems evaluation framework. We used the Lives Saved Tool (LiST) and did multiple linear regression analyses to explain the reduction in child mortality in Tanzania. We analysed the reasons for the slower changes in maternal and newborn survival and family planning, to inform priorities to end preventable maternal, newborn, and child deaths by 2030. In the past two decades, Tanzania's population has doubled in size, necessitating a doubling of health and social services to maintain coverage. Total health-care financing also doubled, with donor funding for child health and HIV/AIDS more than tripling. Trends along the continuum of care varied, with preventive child health services reaching high coverage (≥85%) and equity (socioeconomic status difference 13-14%), but lower coverage and wider inequities for child curative services (71% coverage, socioeconomic status difference 36%), facility delivery (52% coverage, socioeconomic status difference 56%), and family planning (46% coverage, socioeconomic status difference 22%). The LiST analysis suggested that around 39% of child mortality reduction was linked to increases in coverage of interventions, especially of immunisation and insecticide-treated bednets. Economic growth was also associated with reductions in child mortality. Child health programmes focused on selected high-impact interventions at lower levels of the health system (eg, the community and dispensary levels). Despite its high priority, implementation of maternal health care has been intermittent. Newborn survival has gained attention only since 2005, but high-impact interventions are already being implemented. Family planning had consistent policies but only recent reinvestment in implementation. Mixed progress in reproductive, maternal, newborn, and child health in Tanzania indicates a complex interplay of political prioritisation, health financing, and consistent implementation. Post-2015 priorities for Tanzania should focus on the unmet need for family planning, especially in the Western and Lake regions; addressing gaps for coverage and quality of care at birth, especially in rural areas; and continuation of progress for child health. Government of Canada, Foreign Affairs, Trade, and Development; US Fund for UNICEF; and the Bill & Melinda Gates Foundation. Copyright © 2015 Afnan-Holmes et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Proceedings of the Annual Meeting of the Association for Education in Journalism and Mass Communication (74th, Boston, Massachusetts, August 7-10, 1991). Part X: United States Coverage of International News.

ERIC Educational Resources Information Center

Association for Education in Journalism and Mass Communication.

The United States Coverage of International News section of the proceedings contains the following 15 papers: "TV News and U.S. Public Opinion about Foreign Countries: The Impact of Exposure and Attention" (Holli A. Semetko and others); "The World of U.S. Network Television News: Eighteen Years of Foreign News Coverage"…

CHEMICAL/BIOLOGICAL-CAPABLE RPA THREATS AND NATIONAL SECURITY IMPLICATIONS

DTIC Science & Technology

2016-02-07

iv Abstract The technological landscape of the 21st century is evolving at an ever-increasing pace . Autonomous remotely piloted...chemical and biological conventions must occur to address existing coverage gaps in an effort to keep pace with the ongoing advances of science and...21st century is evolving at an ever-increasing pace . Autonomous remotely piloted aircrafts (RPAs) continue to become increasingly sophisticated in

Long-term drought sensitivity of trees in second-growth forests in a humid region

Treesearch

Neil Pederson; Kacie Tackett; Ryan W. McEwan; Stacy Clark; Adrienne Cooper; Glade Brosi; Ray Eaton; R. Drew Stockwell

2012-01-01

Classical field methods of reconstructing drought using tree rings in humid, temperate regions typically target old trees from drought-prone sites. This approach limits investigators to a handful of species and excludes large amounts of data that might be useful, especially for coverage gaps in large-scale networks. By sampling in more “typical” forests, network...

Principal facts for gravity data collected in South Dakota: a web site for distribution of data

USGS Publications Warehouse

Kucks, Robert P.; Zawislak, Ronald L.

2001-01-01

Principal facts for 12266 new gravity stations and 2880 stations previously released in paper form (Klasner and Kucks, 1988) for the state of South Dakota are presented. These data were contracted to fill a gap in existing data coverage for the state. Observed and Bouguer anomaly data for this regional compilation are available here in digital form.

A consensus genetic map of sorghum that integrates multiple component maps and high-throughput diversity array technology (DArT) markers

USDA-ARS?s Scientific Manuscript database

This final consensus map has allowed us to map a larger number of markers than possible in any individual map of sorghum, to obtain a more complete coverage of the sorghum genome and to fill a number of gaps on individual maps. In addition to overall general consistency of marker order across indiv...

Investing in health systems for universal health coverage in Africa.

PubMed

Sambo, Luis Gomes; Kirigia, Joses Muthuri

2014-10-28

This study focused on the 47 Member States of the World Health Organization (WHO) African Region. The specific objectives were to prepare a synthesis on the situation of health systems' components, to analyse the correlation between the interventions related to the health Millennium Development Goals (MDGs) and some health systems' components and to provide overview of four major thrusts for progress towards universal health coverage (UHC). The WHO health systems framework and the health-related MDGs were the frame of reference. The data for selected indicators were obtained from the WHO World Health Statistics 2014 and the Global Health Observatory. African Region's average densities of physicians, nursing and midwifery personnel, dentistry personnel, pharmaceutical personnel, and psychiatrists of 2.6, 12, 0.5, 0.9 and 0.05 per 10 000 population were about five-fold, two-fold, five-fold, five-fold and six-fold lower than global averages. Fifty-six percent of the reporting countries had fewer than 11 health posts per 100 000 population, 88% had fewer than 11 health centres per 100 000 population, 82% had fewer than one district hospital per 100 000 population, 74% had fewer than 0.2 provincial hospitals per 100 000 population, and 79% had fewer than 0.2 tertiary hospitals per 100 000 population. Some 83% of the countries had less than one MRI per one million people and 95% had fewer than one radiotherapy unit per million population. Forty-six percent of the countries had not adopted the recommendation of the International Taskforce on Innovative Financing to spend at least US$ 44 per person per year on health. Some of these gaps in health system components were found to be correlated to coverage gaps in interventions for maternal health (MDG 5), child health (MDG 4) and HIV/AIDS, TB and malaria (MDG 6). Substantial gaps exist in health systems and access to MDG-related health interventions. It is imperative that countries adopt the 2014 Luanda Commitment on UHC in Africa as their long-term vision and back it with sound policies and plans with clearly engrained road maps for strengthening national health systems and addressing the social determinants of health.

A national streamflow network gap analysis

USGS Publications Warehouse

Kiang, Julie E.; Stewart, David W.; Archfield, Stacey A.; Osborne, Emily B.; Eng, Ken

2013-01-01

The U.S. Geological Survey (USGS) conducted a gap analysis to evaluate how well the USGS streamgage network meets a variety of needs, focusing on the ability to calculate various statistics at locations that have streamgages (gaged) and that do not have streamgages (ungaged). This report presents the results of analysis to determine where there are gaps in the network of gaged locations, how accurately desired statistics can be calculated with a given length of record, and whether the current network allows for estimation of these statistics at ungaged locations. The analysis indicated that there is variability across the Nation’s streamflow data-collection network in terms of the spatial and temporal coverage of streamgages. In general, the Eastern United States has better coverage than the Western United States. The arid Southwestern United States, Alaska, and Hawaii were observed to have the poorest spatial coverage, using the dataset assembled for this study. Except in Hawaii, these areas also tended to have short streamflow records. Differences in hydrology lead to differences in the uncertainty of statistics calculated in different regions of the country. Arid and semiarid areas of the Central and Southwestern United States generally exhibited the highest levels of interannual variability in flow, leading to larger uncertainty in flow statistics. At ungaged locations, information can be transferred from nearby streamgages if there is sufficient similarity between the gaged watersheds and the ungaged watersheds of interest. Areas where streamgages exhibit high correlation are most likely to be suitable for this type of information transfer. The areas with the most highly correlated streamgages appear to coincide with mountainous areas of the United States. Lower correlations are found in the Central United States and coastal areas of the Southeastern United States. Information transfer from gaged basins to ungaged basins is also most likely to be successful when basin attributes show high similarity. At the scale of the analysis completed in this study, the attributes of basins upstream of USGS streamgages cover the full range of basin attributes observed at potential locations of interest fairly well. Some exceptions included very high or very low elevation areas and very arid areas.

The syringe gap: an assessment of sterile syringe need and acquisition among syringe exchange program participants in New York City

PubMed Central

Heller, Daliah I; Paone, Denise; Siegler, Anne; Karpati, Adam

2009-01-01

Background Programmatic data from New York City syringe exchange programs suggest that many clients visit the programs infrequently and take few syringes per transaction, while separate survey data from individuals using these programs indicate that frequent injecting – at least daily – is common. Together, these data suggest a possible "syringe gap" between the number of injections performed by users and the number of syringes they are receiving from programs for those injections. Methods We surveyed a convenience sample of 478 injecting drug users in New York City at syringe exchange programs to determine whether program syringe coverage was adequate to support safer injecting practices in this group. Results Respondents reported injecting a median of 60 times per month, visiting the syringe exchange program a median of 4 times per month, and obtaining a median of 10 syringes per transaction; more than one in four reported reusing syringes. Fifty-four percent of participants reported receiving fewer syringes than their number of injections per month. Receiving an inadequate number of syringes was more frequently reported by younger and homeless injectors, and by those who reported public injecting in the past month. Conclusion To improve syringe coverage and reduce syringe sharing, programs should target younger and homeless drug users, adopt non-restrictive syringe uptake policies, and establish better relationships with law enforcement and homeless services. The potential for safe injecting facilities should be explored, to address the prevalence of public injecting and resolve the 'syringe gap' for injecting drug users. PMID:19138414

20 CFR 404.1212 - Police officers and firefighters.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Section 404.1212 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... May Be Covered § 404.1212 Police officers and firefighters. (a) General. For Social Security coverage... officers' and firefighters' positions not under a retirement system as part of an absolute coverage group...

76 FR 4813 - Deposit Insurance Regulations; Unlimited Coverage for Noninterest-Bearing Transaction Accounts...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-27

... FEDERAL DEPOSIT INSURANCE CORPORATION 12 CFR Part 330 RIN 3064-AD37 Deposit Insurance Regulations; Unlimited Coverage for Noninterest-Bearing Transaction Accounts; Inclusion of Interest on Lawyers Trust Accounts AGENCY: Federal Deposit Insurance Corporation (FDIC). ACTION: Final rule. [[Page 4814

45 CFR 144.101 - Basis and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.101 Basis and purpose. (a) Part 146 of this... is to improve access to individual health insurance coverage for certain individuals who previously...

45 CFR 144.102 - Scope and applicability.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.102 Scope and applicability. (a) For purposes of 45 CFR parts 144 through 148, all health insurance coverage is generally divided into...

45 CFR 144.102 - Scope and applicability.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.102 Scope and applicability. (a) For purposes of 45 CFR parts 144 through 148, all health insurance coverage is generally divided into...

45 CFR 144.102 - Scope and applicability.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.102 Scope and applicability. (a) For purposes of 45 CFR parts 144 through 148, all health insurance coverage is generally divided into...

45 CFR 144.101 - Basis and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.101 Basis and purpose. (a) Part 146 of this... is to improve access to individual health insurance coverage for certain individuals who previously...

45 CFR 144.102 - Scope and applicability.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.102 Scope and applicability. (a) For purposes of 45 CFR parts 144 through 148, all health insurance coverage is generally divided into...

45 CFR 144.101 - Basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.101 Basis and purpose. (a) Part 146 of this... is to improve access to individual health insurance coverage for certain individuals who previously...

Oral Cholera Vaccine Coverage during an Outbreak and Humanitarian Crisis, Iraq, 2015.

PubMed

Lam, Eugene; Al-Tamimi, Wasan; Russell, Steven Paul; Butt, Muhammad Obaid-Ul Islam; Blanton, Curtis; Musani, Altaf Sadrudin; Date, Kashmira

2017-01-01

During November-December 2015, as part of the 2015 cholera outbreak response in Iraq, the Iraqi Ministry of Health targeted ≈255,000 displaced persons >1 year of age with 2 doses of oral cholera vaccine (OCV). All persons who received vaccines were living in selected refugee camps, internally displaced persons camps, and collective centers. We conducted a multistage cluster survey to obtain OCV coverage estimates in 10 governorates that were targeted during the campaign. In total, 1,226 household and 5,007 individual interviews were conducted. Overall, 2-dose OCV coverage in the targeted camps was 87% (95% CI 85%-89%). Two-dose OCV coverage in the 3 northern governorates (91%; 95% CI 87%-94%) was higher than that in the 7 southern and central governorates (80%; 95% CI 77%-82%). The experience in Iraq demonstrates that OCV campaigns can be successfully implemented as part of a comprehensive response to cholera outbreaks among high-risk populations in conflict settings.

Getting It Right from the Start: The Case for Early Parenthood Education

ERIC Educational Resources Information Center

Sticht, Thomas G.

2012-01-01

Hearing language is the first step in learning to read, write, and make sense of the world. The language gap that results in the achievement gap begins at home. Schools can and should do their part to close this gap, but parents, by reading to children and interacting with them in positive and encouraging ways, need to do their part, too. The idea…

Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post–Myocardial Infarction Medicare Beneficiaries

PubMed Central

Choudhry, Niteesh K.; Patrick, Amanda R.; Antman, Elliott M.; Avorn, Jerry; Shrank, William H.

2009-01-01

Background Effective therapies for the secondary prevention of coronary heart disease–related events are significantly underused, and attempts to improve adherence have often yielded disappointing results. Elimination of patient out-of-pocket costs may be an effective strategy to enhance medication use. We sought to estimate the incremental cost-effectiveness of providing full coverage for aspirin, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins (combination pharmacotherapy) to individuals enrolled in the Medicare drug benefit program after acute myocardial infarction. Methods and Results We created a Markov cost-effectiveness model to estimate the incremental cost-effectiveness of providing Medicare beneficiaries with full coverage for combination pharmacotherapy compared with current coverage under the Medicare Part D program. Our analysis was conducted from the societal perspective and considered a lifetime time horizon. In a sensitivity analysis, we repeated our analysis from the perspective of Medicare. In the model, post–myocardial infarction Medicare beneficiaries who received usual prescription drug coverage under the Part D program lived an average of 8.21 quality-adjusted life-years after their initial event, incurring coronary heart disease–related medical costs of $114 000. Those who received prescription drug coverage without deductibles or copayments lived an average of 8.56 quality-adjusted life-years and incurred $111 600 in coronary heart disease–related costs. Compared with current prescription drug coverage, full coverage for post–myocardial infarction secondary prevention therapies would result in greater functional life expectancy (0.35 quality-adjusted life-year) and less resource use ($2500). From the perspective of Medicare, full drug coverage was highly cost-effective ($7182/quality-adjusted life-year) but not cost saving. Conclusions Our analysis suggests that providing full coverage for combination therapy to post–myocardial infarction Medicare beneficiaries would save both lives and money from the societal perspective. PMID:18285564

Finding the gap: revealing local disparities in coverage of maternal, newborn and child health services in South Sudan using lot quality assurance sampling.

PubMed

Valadez, Joseph J; Berendes, Sima; Lako, Richard; Gould, Simon; Vargas, William; Milner, Susan

2015-12-01

We adapted a rapid monitoring method to South Sudan, a new nation with one of the world's highest maternal and child mortality rates, aiming to assess coverage of maternal, neonatal and child health (MNCH) services at the time of independence, and introducing a monitoring and evaluation system (M&E) for equity-sensitive tracking of progress related to Millennium Development Goals (MDG) 4 and 5 at national, state and county levels to detect local variability. We conducted a national cross-sectional household survey among women from six client populations in all, but six of South Sudan's 79 counties. We used lot quality assurance sampling (LQAS) to measure coverage with diverse MNCH indicators to obtain information for national-, state- and county-level health system management decision-making. National coverage of MNCH services was low for all maternal and neonatal care, child immunisation, and child care indicators. However, results varied across states and counties. Central Equatoria State (CES), where the capital is located, showed the highest coverage for most indicators (e.g. ≥4 antenatal care visits range: 4.5% in Jonglei to 40.1% in CES). Urban counties often outperformed rural ones. This adaptation of LQAS to South Sudan demonstrates how it can be used in the future as an M&E system to track progress of MDGs at national, state and county levels to detect local disparities. Overall, our data reveal a desperate need for improving MNCH service coverage in all states. © 2015 The Authors.Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

A shared responsibility. US employers and the provision of health insurance to employees.

PubMed

Collins, Sara R; Davis, Karen; Ho, Alice

2005-01-01

Employer-based health insurance is the backbone of the U.S. system of health insurance coverage. Yet it has been slowly eroding, and if these trends continue greater numbers of Americans are likely to be uninsured or without affordable coverage. Employer coverage has marked advantages, including benefits to employers and a natural risk pool that offers better benefits at lower cost than individual coverage, and is highly valued by employees. The shift of health care costs from employers who do not cover their workers to other parts of the economy is substantial. Very little attention has been given to policies that might strengthen and expand employer coverage. It will be important to shore up employer coverage both to curb its recent erosion and to build toward a more comprehensive system of health insurance.

Reliability of Fault Tolerant Control Systems. Part 2

NASA Technical Reports Server (NTRS)

Wu, N. Eva

2000-01-01

This paper reports Part II of a two part effort that is intended to delineate the relationship between reliability and fault tolerant control in a quantitative manner. Reliability properties peculiar to fault-tolerant control systems are emphasized, such as the presence of analytic redundancy in high proportion, the dependence of failures on control performance, and high risks associated with decisions in redundancy management due to multiple sources of uncertainties and sometimes large processing requirements. As a consequence, coverage of failures through redundancy management can be severely limited. The paper proposes to formulate the fault tolerant control problem as an optimization problem that maximizes coverage of failures through redundancy management. Coverage modeling is attempted in a way that captures its dependence on the control performance and on the diagnostic resolution. Under the proposed redundancy management policy, it is shown that an enhanced overall system reliability can be achieved with a control law of a superior robustness, with an estimator of a higher resolution, and with a control performance requirement of a lesser stringency.

[Effects of forest gap size on the architecture of Quercus variablis seedlings on the south slope of Qinling Mountains, west China].

PubMed

Yu, Bi-yun; Zhang, Wen-hui; He, Ting; You, Jian-jian; Li, Gang

2014-12-01

Typical sampling method was conducted to survey the effects of forest gap size on branch architecture, leaf characteristics and their vertical distribution of Quercus variablis seedlings from different size gaps in natural secondary Q. variablis thinning forest, on the south slope of Qinling Mountains. The results showed that gap size significantly affected the diameter, crown area of Q. variablis seedlings. The gap size positively correlated with diameter and negatively correlated with crown area, while it had no significant impact on seedling height, crown length and crown rates. The overall bifurcation ratio, stepwise bifurcation ratio, and ratio of branch diameter followed as large gap > middle gap > small gap > understory. The vertical distribution of first-order branches under different size gaps mainly concentrated at the middle and upper part of trunk, larger diameter first-order branches were mainly distributed at the lower part of trunk, and the angle of first-order branch increased at first and then declined with the increasing seedling height. With the increasing forest gap size, the leaf length, leaf width and average leaf area of seedlings all gradually declined, while the average leaf number per plant and relative total leaf number increased, the leaf length-width ratio kept stable, the relative leaf number was mainly distributed at the middle and upper parts of trunk, the changes of leaf area index was consistent with the change of the relative total number of leaves. There was no significant difference between the diameters of middle gap and large gap seedlings, but the diameter of middle gap seedlings was higher than that of large gap, suggesting the middle gap would benefit the seedlings regeneration and high-quality timber cultivation. To promote the regeneration of Q. variabilis seedlings, and to cultivate high-quality timber, appropriate thinning should be taken to increase the number of middle gaps in the management of Q. variabilis forest.

42 CFR 410.160 - Part B annual deductible.

Code of Federal Regulations, 2013 CFR

2013-10-01

... hepatitis b vaccines and their administration. (3) Federally qualified health center services. (4) ASC... services as described in § 410.34 (c) and (d). (6) Screening pelvic examinations as described in § 410.56... services identified for coverage through the national coverage determination (NCD) process. (c) Application...

42 CFR 410.160 - Part B annual deductible.

Code of Federal Regulations, 2014 CFR

2014-10-01

... hepatitis b vaccines and their administration. (3) Federally qualified health center services. (4) ASC... services as described in § 410.34 (c) and (d). (6) Screening pelvic examinations as described in § 410.56... services identified for coverage through the national coverage determination (NCD) process. (c) Application...

77 FR 4734 - Servicemembers' Group Life Insurance-Stillborn Child Coverage

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-31

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 9 RIN 2900-AO30 Servicemembers' Group Life Insurance... Department of Veterans Affairs (VA) proposes to amend its Servicemembers' Group Life Insurance (SGLI... to ``RIN 2900-AO30--Servicemembers' Group Life Insurance--Stillborn Child Coverage.'' Copies of...

45 CFR 144.103 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.103 Definitions. For purposes of parts 146... health insurance coverage provided by an HMO becomes effective, and during which the HMO is not required to provide benefits. Applicable State authority means, with respect to a health insurance issuer in a...

45 CFR 144.102 - Scope and applicability.

Code of Federal Regulations, 2010 CFR

2010-10-01

... REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.102 Scope and applicability. (a) For purposes of 45 CFR parts 144 through 148, all health insurance coverage is generally divided into... and employers (and other sponsors of health insurance offered in connection with a group health plan...

Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5?

PubMed

Moucheraud, Corrina; Owen, Helen; Singh, Neha S; Ng, Courtney Kuonin; Requejo, Jennifer; Lawn, Joy E; Berman, Peter

2016-09-12

Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress. Applying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing). The majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30-40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns -- which require higher-level health workers, more infrastructure, and increased community engagement -- showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers. These Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts.

Determinants of apparent rural-urban differentials in measles vaccination uptake in Indonesia.

PubMed

Fernandez, Renae C; Awofeso, Niyi; Rammohan, Anu

2011-01-01

Regional differences in vaccination uptake are common in both developed and developing countries, and are often linked to the availability of healthcare services and socioeconomic factors. In 2007, 0.9 million eligible Indonesian children missed measles vaccination, and 19 456 cases of measles were documented among Indonesian children. The authors investigated rural-urban differentials in measles vaccination coverage among young Indonesian children, and sought to identify key factors influencing the probability of a child receiving the first dose of measles vaccination in Indonesia. Data used in the analyses were sourced from the nationally representative Indonesia Demographic and Health Survey 2007. The influence of location of residence, household wealth, maternal and paternal education, total children ever born and use of skilled birth attendants on measles vaccination coverage was investigated using bivariate analysis and chi-square tests. The independent effects of these variables were established using binomial logistic regression analysis. Indonesia's 2007 first-dose measles national vaccination coverage was, at 72.8%, lower than the 2008 global first-dose measles vaccination average coverage of 82%. Bivariate analysis revealed that the first-dose measles vaccination coverage in rural areas of Indonesia was 68.5%, compared with 80.1% in urban regions (p < 0.001). The apparent significance of rural residence in impairing vaccination coverage was marginal after controlling for the sex of the child, maternal age, maternal and paternal education, wealth, and access to skilled health workers. Apart from sustainable initiatives to increase measles vaccination coverage globally, it is important to close the rural-urban gap in Indonesia's measles vaccination uptake. Addressing critical determinants of inferior measles vaccination coverage in Indonesia's rural regions will facilitate major improvements in Indonesia's child health trends. This article suggests initiatives for addressing three of such determinants in Indonesia's rural areas: poverty, parental education and access to skilled health workers.

42 CFR 6.3 - Eligible entities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Eligible entities. 6.3 Section 6.3 Public Health... COVERAGE OF CERTAIN GRANTEES AND INDIVIDUALS § 6.3 Eligible entities. (a) Grantees. Entities eligible for coverage under this part are public and nonprofit private entities receiving Federal funds under any of the...

42 CFR 6.3 - Eligible entities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Eligible entities. 6.3 Section 6.3 Public Health... COVERAGE OF CERTAIN GRANTEES AND INDIVIDUALS § 6.3 Eligible entities. (a) Grantees. Entities eligible for coverage under this part are public and nonprofit private entities receiving Federal funds under any of the...

76 FR 37049 - Improving Wireless Coverage Through the Use of Signal Boosters

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-24

... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Parts 1, 2, 22, 24, 27, 90 and 95 [WT Docket No. 10-4; DA 11-1078] Improving Wireless Coverage Through the Use of Signal Boosters AGENCY: Federal Communications Commission. ACTION: Proposed rule; extension of comment period. SUMMARY: The Federal...

A Persistent Perch: USSOCOMs Use of Organic Space Based ISR

DTIC Science & Technology

2015-05-01

requests, and precious orbits of MQ-1 Predator and MQ-9 Reaper Remotely Piloted Aircraft ( RPA ) are fought over daily by Combatant Commander’s...such a unique mission that simply jockeying for position to share RPA orbits or Satellite time blocks can create gaps in coverage requirements...sic] Eye program will extend the Unmanned Aerial Vehicle ( UAV ) paradigm into space: a dramatically lower unit cost and proliferated numbers of

Genetic conservation planning for forest tree species in Western North America under future climate change: Employing a novel approach to identify conservation gaps

Treesearch

L.K. Gray; E.J. Russell; Q.E. Barber; A. Hamann

2017-01-01

Among the 17 provinces, territories, and states that comprise western North America, approximately 18 percent of the 8.4 million km2 of forested land base is designated as protected areas to ensure the in situ conservation of forest biodiversity. Jurisdictions vary substantially however, in their responsibilities, protected area coverage, and conservation policies....

Toward Independence: An Assessment of Federal Laws and Programs Affecting Persons with Disabilities--with Legislative Recommendations. Appendix: Topic Papers. A Report to the President and the Congress of the United States.

ERIC Educational Resources Information Center

National Council on the Handicapped, Washington, DC.

Ten topic papers examine federal laws and programs affecting persons with disabilities and make recommendations for improved use of federal money. The papers cover: (1) equal opportunity laws, examining the status of disability-related equal opportunity laws and identifying gaps in coverage, shortcomings and inconsistencies in interpretation and…

A study of actions in operative notes.

PubMed

Wang, Yan; Pakhomov, Serguei; Burkart, Nora E; Ryan, James O; Melton, Genevieve B

2012-01-01

Operative notes contain rich information about techniques, instruments, and materials used in procedures. To assist development of effective information extraction (IE) techniques for operative notes, we investigated the sublanguage used to describe actions within the operative report 'procedure description' section. Deep parsing results of 362,310 operative notes with an expanded Stanford parser using the SPECIALIST Lexicon resulted in 200 verbs (92% coverage) including 147 action verbs. Nominal action predicates for each action verb were gathered from WordNet, SPECIALIST Lexicon, New Oxford American Dictionary and Stedman's Medical Dictionary. Coverage gaps were seen in existing lexical, domain, and semantic resources (Unified Medical Language System (UMLS) Metathesaurus, SPECIALIST Lexicon, WordNet and FrameNet). Our findings demonstrate the need to construct surgical domain-specific semantic resources for IE from operative notes.

Coverage evolution of the unoccupied Density of States in sulfur superstructures on Ru(0001)

NASA Astrophysics Data System (ADS)

Pisarra, M.; Bernardo-Gavito, R.; Navarro, J. J.; Black, A.; Díaz, C.; Calleja, F.; Granados, D.; Miranda, R.; Martín, F.; Vázquez de Parga, A. L.

2018-03-01

Sulfur adsorbed on Ru(0001) presents a large number of ordered structures. This characteristic makes S/Ru(0001) the ideal system to investigate the effect of different periodicities on the electronic properties of interfaces. We have performed scanning tunneling microscopy/spectroscopy experiments and density functional theory calculations showing that a sulfur adlayer generates interface states inside the Γ directional gap of Ru(0001) and that the position of such states varies monotonically with sulfur coverage. This is the result of the interplay between band folding effects arising from the new periodicity of the system and electron localization on the sulfur monolayer. As a consequence, by varying the amount of sulfur in S/Ru(0001) one can control the electronic properties of these interfacial materials.

Daytime Sky Brightness Characterization for Persistent GEO SSA

NASA Astrophysics Data System (ADS)

Thomas, G.; Cobb, R. G.

Space Situational Awareness (SSA) is fundamental to operating in space. SSA for collision avoidance ensures safety of flight for both government and commercial spacecraft through persistent monitoring. A worldwide network of optical and radar sensors gather satellite ephemeris data from the nighttime sky. Current practice for daytime satellite tracking is limited exclusively to radar as the brightening daytime sky prevents the use of visible-band optical sensors. Radar coverage is not pervasive and results in significant daytime coverage gaps in SSA. To mitigate these gaps, optical telescopes equipped with sensors in the near-infrared band (0.75-0.9m) may be used. The diminished intensity of the background sky radiance in the near-infrared band may allow for daylight tracking further into the twilight hours. To determine the performance of a near-infrared sensor for daylight custody, the sky background radiance must first be characterized spectrally as a function of wavelength. Using a physics-based atmospheric model with access to near-real time weather, we developed a generalized model for the apparent sky brightness of the Geostationary satellite belt. The model results are then compared to measured data collected from Dayton, OH through various look and Sun angles for model validation and spectral sky radiance quantification in the visible and near-infrared bands.

Detection-gap-independent optical sensor design using divergence-beam-controlled slit lasers for wearable devices

NASA Astrophysics Data System (ADS)

Yoon, Young Zoon; Kim, Hyochul; Park, Yeonsang; Kim, Jineun; Lee, Min Kyung; Kim, Un Jeong; Roh, Young-Geun; Hwang, Sung Woo

2016-09-01

Wearable devices often employ optical sensors, such as photoplethysmography sensors, for detecting heart rates or other biochemical factors. Pulse waveforms, rather than simply detecting heartbeats, can clarify arterial conditions. However, most optical sensor designs require close skin contact to reduce power consumption while obtaining good quality signals without distortion. We have designed a detection-gap-independent optical sensor array using divergence-beam-controlled slit lasers and distributed photodiodes in a pulse-detection device wearable over the wrist's radial artery. It achieves high biosignal quality and low power consumption. The top surface of a vertical-cavity surface-emitting laser of 850 nm wavelength was covered by Au film with an open slit of width between 500 nm and 1500 nm, which generated laser emissions across a large divergence angle along an axis orthogonal to the slit direction. The sensing coverage of the slit laser diode (LD) marks a 50% improvement over nonslit LD sensor coverage. The slit LD sensor consumes 100% more input power than the nonslit LD sensor to obtain similar optical output power. The slit laser sensor showed intermediate performance between LD and light-emitting diode sensors. Thus, designing sensors with multiple-slit LD arrays can provide useful and convenient ways for incorporating optical sensors in wrist-wearable devices.

42 CFR 426.310 - LCD and NCD reviews and individual claim appeals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL... set forth in part 405, subparts G and H; part 417, subpart Q; and part 422, subpart M of this chapter...

National and State-Specific Health Insurance Disparities for Adults in Same-Sex Relationships

PubMed Central

Blewett, Lynn A.

2014-01-01

Objectives. We examined national and state-specific disparities in health insurance coverage, specifically employer-sponsored insurance (ESI) coverage, for adults in same-sex relationships. Methods. We used data from the American Community Survey to identify adults (aged 25–64 years) in same-sex relationships (n = 31 947), married opposite-sex relationships (n = 3 060 711), and unmarried opposite-sex relationships (n = 259 147). We estimated multinomial logistic regression models and state-specific relative differences in ESI coverage with predictive margins. Results. Men and women in same-sex relationships were less likely to have ESI than were their married counterparts in opposite-sex relationships. We found ESI disparities among adults in same-sex relationships in every region, but we found the largest ESI gaps for men in the South and for women in the Midwest. ESI disparities were narrower in states that had extended legal same-sex marriage, civil unions, and broad domestic partnerships. Conclusions. Men and women in same-sex relationships experience disparities in health insurance coverage across the country, but residing in a state that recognizes legal same-sex marriage, civil unions, or broad domestic partnerships may improve access to ESI for same-sex spouses and domestic partners. PMID:24328616

Evaluation of a pilot intervention to redesign the decentralised vaccine supply chain system in Nigeria.

PubMed

Molemodile, Shola; Wotogbe, Maruchi; Abimbola, Seye

2017-05-01

Responsibility for immunisation in Nigeria is decentralised to sub-national governments. So far, they have failed to achieve optimal coverage for their populations. We evaluated a pilot intervention implemented between 2013 and 2014 to redesign a vaccine supply chain management system in Kano, Nigeria. The intervention included financing immunisation services from a designated pool of government and donor funds, a visibility tool to track vaccine stock, and a private vendor engaged to deliver vaccines directly to health facilities. The number of local government areas within the state with adequate vaccine stock increased from 21% to 98% after 10 months. To understand how the intervention achieved this outcome, we analysed immunisation coverage for the period and interviewed 18 respondents across different levels of government. We found that the intervention worked by improving ownership and accountability for immunisation by sub-national governments and their capacity for generating resources and management (of data and the supply chain). While the intervention focused on improving immunisation coverage, we identified gaps in the demand for services. Efforts to improve immunisation coverage and vaccine supply systems should streamline decentralised structures, empower sub-national governments with financial and technical capacity, and promote strategies to improve the demand and use of services.

Spatial and temporal allocation of ship exhaust emissions in Australian coastal waters using AIS data: Analysis and treatment of data gaps

NASA Astrophysics Data System (ADS)

Goldsworthy, Brett

2017-08-01

Ship exhaust emissions need to be allocated accurately in both space and time in order to examine many of the associated impacts, including on air quality and health. Data on ship activity from the Automatic Identification System (AIS) allow ship exhaust emissions to be calculated with fine spatial and temporal resolution. However, there are spatial gaps in the coverage afforded by the coastal network of ground stations that are used to collect the AIS data. This paper focuses on the problem of allocating emissions to the coastal gap regions. Allocating emissions to these regions involves generating interpolated ship tracks that both span the gaps and avoid coming too close to land. In most cases, a simple shortest path or straight line interpolation produces tracks that do not overlap or come too close to land. Where the simple method does not produce acceptable results, vessel tracks are steered around land on shortest available paths using a combination of visibility graphs and Dijkstra's algorithm. A geographical cluster analysis is first used to identify the boundary regions of the data gaps. The properties of the data gaps are summarised in terms of the length, duration and speed of the spanning tracks. The interpolation methods are used to improve the spatial distribution of emissions. It is also shown that emissions in the gap regions can contribute substantially to the total ship exhaust emissions in close proximity to highly populated areas.

EXPLAINING THE GAP IN ANTENATAL CARE SERVICE UTILIZATION BETWEEN YOUNGER AND OLDER MOTHERS IN GHANA.

PubMed

Boamah, Sheila A; Amoyaw, Jonathan; Luginaah, Isaac

2016-05-01

Over two-thirds of pregnant women (69%) have at least one antenatal care (ANC) coverage contact in sub-Saharan Africa. However, to achieve the full life-saving potential that ANC promises for women and babies, a nuanced understanding of age-specific gaps in utilization of ANC services is required. Using the 2008 Ghana Demographic and Health Survey of 1456 individuals, this study examined the disparities in the use of ANC services between younger and older mothers by applying four counterfactual decomposition techniques. The results show that cross-group differences in the explanatory variables largely account for the differentials in ANC service utilization between younger and older mothers. Birth order (parity) accounts for the largest share of the contribution to the overall explained gap in ANC utilization between the younger and older mothers, suggesting that ANC differentials between the two groups are probably due to biosocial factors. To a lesser extent, wealth status of the two groups also contributes to the overall explained gap in ANC service utilization. The policy implications of these findings are that in order to bridge the ANC service utilization gap between the two groups, policymakers must systematically address gaps in cross-group differences in the explanatory variables in order to increase the utilization of ANC to attain the minimum recommendation of four visits as per World Health Organization guidelines.

Evidence development and publication planning: strategic process.

PubMed

Wittek, Michael R; Jo Williams, Mary; Carlson, Angeline M

2009-11-01

A number of decisions in the health care field rely heavily on published clinical evidence. A systematic approach to evidence development and publication planning is required to develop a portfolio of evidence that includes at minimum information on efficacy, safety, durability of effect, quality of life, and economic outcomes. The approach requires a critical assessment of available literature, identification of gaps in the literature, and a strategic plan to fill the gaps to ensure the availability of evidence demanded for clinical decisions, coverage/payment decisions and health technology assessments. The purpose of this manuscript is to offer a six-step strategic process leading to a portfolio of evidence that meets the informational needs of providers, payers, and governmental agencies concerning patient access to a therapy.

45 CFR 1155.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false What does this part do? 1155.100 Section 1155.100... ASSISTANCE) Purpose and Coverage § 1155.100 What does this part do? This part carries out the portion of the... matter of Federal Government policy. ...

49 CFR 32.100 - What does this part do?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false What does this part do? 32.100 Section 32.100... (FINANCIAL ASSISTANCE) Purpose and Coverage § 32.100 What does this part do? This part carries out the... awards, as a matter of Federal Government policy. ...

22 CFR 1509.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true What does this part do? 1509.100 Section 1509... WORKPLACE (FINANCIAL ASSISTANCE) Purpose and Coverage § 1509.100 What does this part do? This part carries... assistance awards, as a matter of Federal Government policy. ...

20 CFR 439.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What does this part do? 439.100 Section 439... WORKPLACE (FINANCIAL ASSISTANCE) Purpose and Coverage § 439.100 What does this part do? This part carries... assistance awards, as a matter of Federal Government policy. ...

22 CFR 1008.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true What does this part do? 1008.100 Section 1008... (FINANCIAL ASSISTANCE) Purpose and Coverage § 1008.100 What does this part do? This part carries out the... awards, as a matter of Federal Government policy. ...

22 CFR 1008.100 - What does this part do?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true What does this part do? 1008.100 Section 1008... (FINANCIAL ASSISTANCE) Purpose and Coverage § 1008.100 What does this part do? This part carries out the... awards, as a matter of Federal Government policy. ...

45 CFR 1155.100 - What does this part do?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 3 2011-10-01 2011-10-01 false What does this part do? 1155.100 Section 1155.100... ASSISTANCE) Purpose and Coverage § 1155.100 What does this part do? This part carries out the portion of the... matter of Federal Government policy. ...

22 CFR 1509.100 - What does this part do?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true What does this part do? 1509.100 Section 1509... WORKPLACE (FINANCIAL ASSISTANCE) Purpose and Coverage § 1509.100 What does this part do? This part carries... assistance awards, as a matter of Federal Government policy. ...

49 CFR 32.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false What does this part do? 32.100 Section 32.100... (FINANCIAL ASSISTANCE) Purpose and Coverage § 32.100 What does this part do? This part carries out the... awards, as a matter of Federal Government policy. ...

Sealing a Loosely Fitting Valve Assembly

NASA Technical Reports Server (NTRS)

Goff, L.; Tellier, G.

1986-01-01

Double-ring seal avoids expense of remachining or redesigning valve parts. Mating fittings on valve sealed by pair of rings - one O-ring and backup ring. Backup ring fills relatively large gap between parts. Prevents softer O-ring from being pushed into and through gap.

Communication strategies to promote the uptake of childhood vaccination in Nigeria: a systematic map

PubMed Central

Oku, Afiong; Oyo-Ita, Angela; Glenton, Claire; Fretheim, Atle; Ames, Heather; Muloliwa, Artur; Kaufman, Jessica; Hill, Sophie; Cliff, Julie; Cartier, Yuri; Bosch-Capblanch, Xavier; Rada, Gabriel; Lewin, Simon

2016-01-01

Background Effective communication is a critical component in ensuring that children are fully vaccinated. Although numerous communication interventions have been proposed and implemented in various parts of Nigeria, the range of communication strategies used has not yet been mapped systematically. This study forms part of the ‘Communicate to vaccinate’ (COMMVAC) project, an initiative aimed at building research evidence for improving communication with parents and communities about childhood vaccinations in low- and middle-income countries. Objective This study aims to: 1) identify the communication strategies used in two states in Nigeria; 2) map these strategies against the existing COMMVAC taxonomy, a global taxonomy of vaccination communication interventions; 3) create a specific Nigerian country map of interventions organised by purpose and target; and 4) analyse gaps between the COMMVAC taxonomy and the Nigerian map. Design We conducted the study in two Nigerian states: Bauchi State in Northern Nigeria and Cross River State in Southern Nigeria. We identified vaccination communication interventions through interviews carried out among purposively selected stakeholders in the health services and relevant agencies involved in vaccination information delivery; through observations and through relevant documents. We used the COMMVAC taxonomy to organise the interventions we identified based on the intended purpose of the communication and the group to which the intervention was targeted. Results The Nigerian map revealed that most of the communication strategies identified aimed to inform and educate and remind or recall. Few aimed to teach skills, enhance community ownership, and enable communication. We did not identify any intervention that aimed to provide support or facilitate decision-making. Many interventions had more than one purpose. The main targets for most interventions were caregivers and community members, with few interventions directed at health workers. Most interventions identified were used in the context of campaigns rather than routine immunisation programmes. Conclusions The identification and development of the Nigerian vaccination communication interventions map could assist programme managers to identify gaps in vaccination communication. The map may be a useful tool as part of efforts to address vaccine hesitancy and improve vaccination coverage in Nigeria and similar settings. PMID:26880154

Communication strategies to promote the uptake of childhood vaccination in Nigeria: a systematic map.

PubMed

Oku, Afiong; Oyo-Ita, Angela; Glenton, Claire; Fretheim, Atle; Ames, Heather; Muloliwa, Artur; Kaufman, Jessica; Hill, Sophie; Cliff, Julie; Cartier, Yuri; Bosch-Capblanch, Xavier; Rada, Gabriel; Lewin, Simon

2016-01-01

Effective communication is a critical component in ensuring that children are fully vaccinated. Although numerous communication interventions have been proposed and implemented in various parts of Nigeria, the range of communication strategies used has not yet been mapped systematically. This study forms part of the 'Communicate to vaccinate' (COMMVAC) project, an initiative aimed at building research evidence for improving communication with parents and communities about childhood vaccinations in low- and middle-income countries. This study aims to: 1) identify the communication strategies used in two states in Nigeria; 2) map these strategies against the existing COMMVAC taxonomy, a global taxonomy of vaccination communication interventions; 3) create a specific Nigerian country map of interventions organised by purpose and target; and 4) analyse gaps between the COMMVAC taxonomy and the Nigerian map. We conducted the study in two Nigerian states: Bauchi State in Northern Nigeria and Cross River State in Southern Nigeria. We identified vaccination communication interventions through interviews carried out among purposively selected stakeholders in the health services and relevant agencies involved in vaccination information delivery; through observations and through relevant documents. We used the COMMVAC taxonomy to organise the interventions we identified based on the intended purpose of the communication and the group to which the intervention was targeted. The Nigerian map revealed that most of the communication strategies identified aimed to inform and educate and remind or recall. Few aimed to teach skills, enhance community ownership, and enable communication. We did not identify any intervention that aimed to provide support or facilitate decision-making. Many interventions had more than one purpose. The main targets for most interventions were caregivers and community members, with few interventions directed at health workers. Most interventions identified were used in the context of campaigns rather than routine immunisation programmes. The identification and development of the Nigerian vaccination communication interventions map could assist programme managers to identify gaps in vaccination communication. The map may be a useful tool as part of efforts to address vaccine hesitancy and improve vaccination coverage in Nigeria and similar settings.

Coverage and prior authorization of psychotropic drugs under Medicare Part D.

PubMed

Huskamp, Haiden A; Stevenson, David G; Donohue, Julie M; Newhouse, Joseph P; Keating, Nancy L

2007-03-01

This study examined formulary coverage and use of utilization management tools for three classes of psychotropic medications (antidepressants, antipsychotics, and anticonvulsants) among Medicare Part D prescription drug plans serving individuals dually eligible for the Medicare and Medicaid programs. Plans must cover "all or substantially all" molecules (distinct drugs) in these classes. Plans serving "dual eligibles" generally covered at least one formulation of all molecules in the three classes. However, certain product formulations were not covered by a number of plans, and use of prior authorization was common for a minority of plans. The effect of Part D will depend on the restrictiveness of the prior authorization and appeals processes, which is currently unknown.

42 CFR 423.464 - Coordination of benefits with other providers of prescription drug coverage.

Code of Federal Regulations, 2010 CFR

2010-10-01

... per capita basis) for Part D eligible individuals enrolled in the Part D plan and the SPAP or entity... Part D eligible individuals; (ii) Provides assistance to Part D eligible individuals in all Part D plans without discriminating based upon the Part D plan in which an individual enrolls; (iii) Meets the...

Training and education in religion/spirituality within APA-accredited clinical psychology programs: 8 years later.

PubMed

Schafer, Rachel M; Handal, Paul J; Brawer, Peter A; Ubinger, Megan

2011-06-01

This study was a follow up investigation of Brawer et al.'s (Prof Psychol Res Pr 33(2):203-206, 2002) survey of education and training of clinical psychologists in religion/spirituality. Directors of clinical training were surveyed to determine whether changes had occurred in the coverage of religion and spirituality through course work, research, supervision, and in the systematic coverage of the content area. Results indicated an increased coverage in the areas of supervision, dedicated courses, inclusion as part of another course, and research. There was no increase in systematic coverage, but significantly more programs provided at least some coverage. The current study also assesses other areas of incorporation as well as directors' opinions regarding the importance of religion/spirituality in the field of psychology.

Research gaps identified during systematic reviews of clinical trials: glass-ionomer cements.

PubMed

Mickenautsch, Steffen

2012-06-29

To report the results of an audit concerning research gaps in clinical trials that were accepted for appraisal in authored and published systematic reviews regarding the application of glass-ionomer cements (GIC) in dental practice Information concerning research gaps in trial precision was extracted, following a framework that included classification of the research gap reasons: 'imprecision of information (results)', 'biased information', 'inconsistency or unknown consistency' and 'not the right information', as well as research gap characterization using PICOS elements: population (P), intervention (I), comparison (C), outcomes (O) and setting (S). Internal trial validity assessment was based on the understanding that successful control for systematic error cannot be assured on the basis of inclusion of adequate methods alone, but also requires empirical evidence about whether such attempt was successful. A comprehensive and interconnected coverage of GIC-related clinical topics was established. The most common reasons found for gaps in trial precision were lack of sufficient trials and lack of sufficient large sample size. Only a few research gaps were ascribed to 'Lack of information' caused by focus on mainly surrogate trial outcomes. According to the chosen assessment criteria, a lack of adequate randomisation, allocation concealment and blinding/masking in trials covering all reviewed GIC topics was noted (selection- and detection/performance bias risk). Trial results appear to be less affected by loss-to-follow-up (attrition bias risk). This audit represents an adjunct of the systematic review articles it has covered. Its results do not change the systematic review's conclusions but highlight existing research gaps concerning the precision and internal validity of reviewed trials in detail. These gaps should be addressed in future GIC-related clinical research.

Childhood Illness and the Gender Gap in Adolescent Education in Low- and Middle-Income Countries.

PubMed

Alsan, Marcella; Xing, Anlu; Wise, Paul; Darmstadt, Gary L; Bendavid, Eran

2017-07-01

Achieving gender equality in education is an important development goal. We tested the hypothesis that the gender gap in adolescent education is accentuated by illnesses among young children in the household. Using Demographic and Health Surveys on 41 821 households in 38 low- and middle-income countries, we used linear regression to estimate the difference in the probability adolescent girls and boys were in school, and how this gap responded to illness episodes among children <5 years old. To test the hypothesis that investments in child health are related to the gender gap in education, we assessed the relationship between the gender gap and national immunization coverage. In our sample of 120 708 adolescent boys and girls residing in 38 countries, girls were 5.08% less likely to attend school than boys in the absence of a recent illness among young children within the same household (95% confidence interval [CI], 5.50%-4.65%). This gap increased to 7.77% (95% CI, 8.24%-7.30%) and 8.53% (95% CI, 9.32%-7.74%) if the household reported 1 and 2 or more illness episodes, respectively. The gender gap in schooling in response to illness was larger in households with a working mother. Increases in child vaccination rates were associated with a closing of the gender gap in schooling (correlation coefficient = 0.34, P = .02). Illnesses among children strongly predict a widening of the gender gap in education. Investments in early childhood health may have important effects on schooling attainment for adolescent girls. Copyright © 2017 by the American Academy of Pediatrics.

Gap Assessment (FY 13 Update)

DOE Data Explorer

Getman, Dan

2013-09-30

To help guide its future data collection efforts, The DOE GTO funded a data gap analysis in FY2012 to identify high potential hydrothermal areas where critical data are needed. This analysis was updated in FY2013 and the resulting datasets are represented by this metadata. The original process was published in FY 2012 and is available here: https://pangea.stanford.edu/ERE/db/GeoConf/papers/SGW/2013/Esposito.pdf Though there are many types of data that can be used for hydrothermal exploration, five types of exploration data were targeted for this analysis. These data types were selected for their regional reconnaissance potential, and include many of the primary exploration techniques currently used by the geothermal industry. The data types include: 1. well data 2. geologic maps 3. fault maps 4. geochemistry data 5. geophysical data To determine data coverage, metadata for exploration data (including data type, data status, and coverage information) were collected and catalogued from nodes on the National Geothermal Data System (NGDS). It is the intention of this analysis that the data be updated from this source in a semi-automated fashion as new datasets are added to the NGDS nodes. In addition to this upload, an online tool was developed to allow all geothermal data providers to access this assessment and to directly add metadata themselves and view the results of the analysis via maps of data coverage in Geothermal Prospector (http://maps.nrel.gov/gt_prospector). A grid of the contiguous U.S. was created with 88,000 10-km by 10-km grid cells, and each cell was populated with the status of data availability corresponding to the five data types. Using these five data coverage maps and the USGS Resource Potential Map, sites were identified for future data collection efforts. These sites signify both that the USGS has indicated high favorability of occurrence of geothermal resources and that data gaps exist. The uploaded data are contained in two data files for each data category. The first file contains the grid and is in the SHP file format (shape file.) Each populated grid cell represents a 10k area within which data is known to exist. The second file is a CSV (comma separated value) file that contains all of the individual layers that intersected with the grid. This CSV can be joined with the map to retrieve a list of datasets that are available at any given site. The attributes in the CSV include: 1. grid_id : The id of the grid cell that the data intersects with 2. title: This represents the name of the WFS service that intersected with this grid cell 3. abstract: This represents the description of the WFS service that intersected with this grid cell 4. gap_type: This represents the category of data availability that these data fall within. As the current processing is pulling data from NGDS, this category universally represents data that are available in the NGDS and are ready for acquisition for analytic purposes. 5. proprietary_type: Whether the data are considered proprietary 6. service_type: The type of service 7. base_url: The service URL

Work-related trauma, PTSD, and workers compensation legislation: Implications for practice and policy.

PubMed

Wise, Edward A; Beck, J Gayle

2015-09-01

The current review examines work-related traumatic events, with particular focus on posttraumatic stress disorder (PTSD) as a potential mental health outcome. Despite considerable empirical knowledge about trauma and PTSD, a gap exists with respect to laws undergirding Workers Compensation (WC) insurance coverage for work-related mental health injuries. In this article, state and federal WC statutes are examined with an eye toward coverage of PTSD following work-related trauma. Examples of differences between states, as well as state-specific idiosyncratic facets of WC laws, are discussed. Federal WC programs are also examined. Two policy issues are highlighted: (a) lack of parity between WC coverage for work-related physical versus mental health injuries and (b) lack of reliance on psychological science in scripting legislation and determining WC benefits. The cost of untreated PTSD following work-related trauma is examined, focusing on costs to the individual, the employer, and society at large. The authors provide 3 recommendations designed to address discrepancies related to compensable psychological injuries following work-related trauma exposure. (c) 2015 APA, all rights reserved).

Efficient Genome-Wide Sequencing and Low-Coverage Pedigree Analysis from Noninvasively Collected Samples

PubMed Central

Snyder-Mackler, Noah; Majoros, William H.; Yuan, Michael L.; Shaver, Amanda O.; Gordon, Jacob B.; Kopp, Gisela H.; Schlebusch, Stephen A.; Wall, Jeffrey D.; Alberts, Susan C.; Mukherjee, Sayan; Zhou, Xiang; Tung, Jenny

2016-01-01

Research on the genetics of natural populations was revolutionized in the 1990s by methods for genotyping noninvasively collected samples. However, these methods have remained largely unchanged for the past 20 years and lag far behind the genomics era. To close this gap, here we report an optimized laboratory protocol for genome-wide capture of endogenous DNA from noninvasively collected samples, coupled with a novel computational approach to reconstruct pedigree links from the resulting low-coverage data. We validated both methods using fecal samples from 62 wild baboons, including 48 from an independently constructed extended pedigree. We enriched fecal-derived DNA samples up to 40-fold for endogenous baboon DNA and reconstructed near-perfect pedigree relationships even with extremely low-coverage sequencing. We anticipate that these methods will be broadly applicable to the many research systems for which only noninvasive samples are available. The lab protocol and software (“WHODAD”) are freely available at www.tung-lab.org/protocols-and-software.html and www.xzlab.org/software.html, respectively. PMID:27098910

National Institutes of Health Blood and Marrow Transplant Late Effects Initiative: The Healthcare Delivery Working Group Report

PubMed Central

Hashmi, Shahrukh K; Bredeson, Christopher; Duarte, Rafael F; Farnia, Stephanie; Ferrey, Susan; Fitzhugh, Courtney; Flowers, Mary ED; Gajewski, James; Gastineau, Dennis; Greenwald, Melissa; Jagasia, Madan; Martin, Patricia; Rizzo, J Douglas; Schmit-Pokorny, Kimberly; Majhail, Navneet S

2016-01-01

Hematopoietic cell transplantation (HCT) survivors are at risk for development of late complications and require lifelong monitoring for screening and prevention of late effects. There is an increasing appreciation of the issues related to healthcare delivery and coverage that are faced by HCT survivors. The 2016 National Institutes of Health Blood and Marrow Transplant Late Effects Initiative included an international and broadly representative Healthcare Delivery Working Group that was tasked with identifying research gaps pertaining to healthcare delivery and to identify initiatives that may yield a better understanding of the long-term value and costs of care for HCT survivors. There is a paucity of literature in this area. Critical areas in need of research include pilot studies of novel and information technology supported models of care delivery and coverage for HCT survivors along with development and validation of instruments that capture patient reported outcomes. Investment in infrastructure to support this research such as linkage of databases including electronic health records and routine inclusion of endpoints that will inform analyses focused around care delivery and coverage are required. PMID:27713091

Oxygen adsorption on the Al0.25Ga0.75N (0001) surface: A first-principles study

NASA Astrophysics Data System (ADS)

Fu, Jiaqi; Song, Tielei; Liang, Xixia; Zhao, Guojun

2018-04-01

To understand the interaction mechanism for the oxygen adsorption on AlGaN surface, herein, we built the possible models of oxygen adsorption on Al0.25Ga0.75N (0001) surface. For different oxygen coverage, three kinds of adsorption site are considered. Then the favorable adsorption sites are characterized by first principles calculation for (2 × 2) supercell of Al0.25Ga0.75N (0001) surface. On basis of the optimal adsorption structures, our calculated results show that all the adsorption processes are exothermic, indicating that the (0001) surface orientation is active towards the adsorption of oxygen. The doping of Al is advantage to the adsorption of O atom. Additionally, the adsorption energy decreases with reducing the oxygen coverage, and the relationship between them is approximately linear. Owing to the oxygen adsorption, the surface states in the fundamental band gap are significant reduced with respect to the free Al0.25Ga0.75N (0001) surface. Moreover, the optical properties on different oxygen coverage are also discussed.

Assessing the Value of Enhancing AirNow Data with NASA Satellite Data

NASA Astrophysics Data System (ADS)

Pasch, A. N.; Burke, B.; Huang, S.; Dye, T.; Dawes, S. S.; DeWinter, J. L.; Zahn, P. H.; Haderman, M.; Szykman, J.; White, J. E.; Dickerson, P.; van Donkelaar, A.; Martin, R.

2013-12-01

We will describe the methodology and findings from a study that addressed how satellite-enhanced air quality information provided through the U.S. Environmental Protection Agency's (EPA) AirNow Satellite Data Processor (ASDP) program could contribute to greater socioeconomic benefits. This study was funded by the National Aeronautics and Space Administration (NASA) and conducted, in partnership with the EPA, by the Center for Technology in Government at the University at Albany (CTG) and Sonoma Technology, Inc. (STI). AirNow is the national repository of real-time air quality data and forecasts for the United States. While mainly a public outreach and awareness tool, AirNow relies on the same network of ground-based air quality monitors that is used by federal, state, local, and tribal governments throughout the United States. Extensive as the monitoring network is, considerable gaps exist in certain parts of the United States. Even areas with monitors considered adequate for regulatory purposes can lack information needed to resolve localized air quality issues or give forecasters sufficient confidence about the potential air quality impact of specific events. Monitors are expensive to deploy and maintain; thus, EPA is seeking other ways to improve coverage and detail. Satellite-estimated data can provide information for many places where ground monitors do not exist, and supplement ground monitors, providing additional information for use in analysis and forecasting. ASDP uses satellite-derived estimates for fine-particle pollution (PM2.5) and provides coverage for a small window of time during the day. As satellite capabilities improve in terms of different types of sensors and increased coverage throughout the day, the ASDP program is prepared to extend its scope to additional pollutants and provide greater enhancements to the ground-based networks. In this study, CTG assessed the socioeconomic benefits of air quality data at a community level through three case studies in the Denver, Atlanta, and Kansas City regions by interviewing people at EPA regional offices, state environmental and public health agencies, local public health authorities, regional planning and non-profit outreach organizations, and universities. The interviews focused on the existing uses of air quality information and the potential value of incorporating NASA satellite-enhanced AirNow data to support and enhance the missions of the organizations interviewed. STI analyzed the economic benefit of using satellite data to fill in gaps in the current air quality monitoring network used to provide information to the public. This presentation will discuss how the findings can be used to improve estimation of the socioeconomic benefits derived from Earth observation science in policy and management decisions.

21 CFR 1405.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false What does this part do? 1405.100 Section 1405.100... WORKPLACE (FINANCIAL ASSISTANCE) Purpose and Coverage § 1405.100 What does this part do? This part carries... assistance awards, as a matter of Federal Government policy. ...

22 CFR 210.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false What does this part do? 210.100 Section 210.100... (FINANCIAL ASSISTANCE) Purpose and Coverage § 210.100 What does this part do? This part carries out the... awards, as a matter of Federal Government policy. ...

28 CFR 83.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false What does this part do? 83.100 Section 83...-FREE WORKPLACE (GRANTS) Purpose and Coverage § 83.100 What does this part do? This part carries out the... awards, as a matter of Federal Government policy. ...

28 CFR 83.100 - What does this part do?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false What does this part do? 83.100 Section 83...-FREE WORKPLACE (GRANTS) Purpose and Coverage § 83.100 What does this part do? This part carries out the... awards, as a matter of Federal Government policy. ...

21 CFR 1405.100 - What does this part do?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 9 2011-04-01 2011-04-01 false What does this part do? 1405.100 Section 1405.100... WORKPLACE (FINANCIAL ASSISTANCE) Purpose and Coverage § 1405.100 What does this part do? This part carries... assistance awards, as a matter of Federal Government policy. ...

22 CFR 133.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false What does this part do? 133.100 Section 133.100... (FINANCIAL ASSISTANCE) Purpose and Coverage § 133.100 What does this part do? This part carries out the... awards, as a matter of Federal Government policy. ...

22 CFR 210.100 - What does this part do?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false What does this part do? 210.100 Section 210.100... (FINANCIAL ASSISTANCE) Purpose and Coverage § 210.100 What does this part do? This part carries out the... awards, as a matter of Federal Government policy. ...

5 CFR 890.806 - When can former spouses change enrollment or reenroll and what are the effective dates?

Code of Federal Regulations, 2014 CFR

2014-01-01

... § 890.804 loses coverage under another enrollment under this part or under another group health benefits... federally-sponsored health benefits program; (3) Loss of coverage due to the termination of membership in an... OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH...

5 CFR 890.806 - When can former spouses change enrollment or reenroll and what are the effective dates?

Code of Federal Regulations, 2013 CFR

2013-01-01

... § 890.804 loses coverage under another enrollment under this part or under another group health benefits... federally-sponsored health benefits program; (3) Loss of coverage due to the termination of membership in an... OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH...

5 CFR 890.806 - When can former spouses change enrollment or reenroll and what are the effective dates?

Code of Federal Regulations, 2011 CFR

2011-01-01

... § 890.804 loses coverage under another enrollment under this part or under another group health benefits... federally-sponsored health benefits program; (3) Loss of coverage due to the termination of membership in an... OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH...

42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

Code of Federal Regulations, 2011 CFR

2011-10-01

... percentage increase in average per capita aggregate expenditures for Part D drugs in the United States for... 42 Public Health 3 2011-10-01 2011-10-01 false Requirements related to qualified prescription drug coverage. 423.104 Section 423.104 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

26 CFR 54.9801-4 - Rules relating to creditable coverage.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Subtitle K, and without regard to whether the coverage is offered in the group market, the individual market, or otherwise). (iii) Part A or B of title XVIII of the Social Security Act (Medicare). (iv) Title... complete application for a health insurance policy in the individual market. E's application is accepted...

78 FR 13575 - Coverage of Certain Preventive Services Under the Affordable Care Act; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-28

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 54 [REG-120391-10] RIN 1545-BJ60 Coverage of Certain Preventive Services Under the Affordable Care Act; Correction AGENCY: Internal Revenue... Protection and Affordable Care Act, as amended, and incorporated into the Employee Retirement Income Security...