Search

This study considers the 2010 Patient Protection and Affordable Care Act (ACA) Medicaid expansion and examines why some states have been reluctant to implement the expansion by focusing on state fiscal factors, including budget solvency, long-run solvency, and federal Medicaid assistance percentages (FMAPs). We used data and samples from multiple sources covering nine years (2012 –2020) and 50 states. Our estimation strategy was an event history analysis with robust standard errors to resolve the possible heteroscedasticity problem. The findings show that states' Medicaid expansion decisions were associated with increased long-run solvency and were marginally associated with decreased budget solvency, providing evidence for the significance of state fiscal capacity in shaping policy decisions. The FMAP influenced the adoption of the Medicaid expansion. [ABSTRACT FROM AUTHOR]

The application of the procedural justice theory is absent from our understanding of environmental policies, particularly in the process of nuclear policy decisions. We explore the relationship between citizen participation and policy acceptance of nuclear facilities by considering community conflict and governmental trustworthiness in the case of South Korea. This study used data collected from citizens who live in the areas where nuclear plants are situated. The results showed that citizen participation may be a predictor of enhanced governmental trustworthiness. Moreover, community members with higher levels of governmental trustworthiness are more likely to allow the construction of additional nuclear plants. [ABSTRACT FROM AUTHOR]

Previous studies have reported a positive relationship between local government spending and health outcomes. However, there is limited scholarly research on how the different policy tools used for delivering public health services affect the health of local residents. This study adopted a comprehensive model, widely utilized in health policy and management research, to control for health behaviors, socioeconomic factors, physical environment, and clinical care. It provides evidence that a county with higher health spending through contracting has a higher health ranking among New York counties, indicating that service provision arrangements affect health outcomes. Thus, county efforts to improve health outcomes should consider the effects of differing service delivery arrangements. [ABSTRACT FROM AUTHOR]

Polluted rivers transport and transform large quantities of anthropogenically-derived organic carbon to coastal regions, and account for an unneglectable share of global CO2 emissions. Effective river water management can enhance water quality and reduce CO2 emissions from the surface water to the atmosphere. However, the effect of water management on future riverine CO2 emissions remains a topic yet to be explored. In this context, the effects of water quality on riverine carbon dynamics were evaluated by examining the temporal variations in carbon fluxes from the Elbe River during a climate base period (around 30 years) from 1984 to 2018. The analysis of long-term data reveals that annual CO2 emissions from the Elbe River have decreased from 3.8±1.7 Tg C yr–1 in 1984 to 1.3±0.6 Tg C yr–1 in 2018 (1 T = 1012), and the largest reduction occurred after the initial decade of reunification of Germany. The changes in wastewater treatment have largely reduced nutrient loads, mitigated eutrophication, impacted the quality of the transported carbon to the ocean, resulting in concurrent decreases in CO2 emissions. The long-term trends in the Elbe River underscore the importance of water quality management for mitigating CO2 emissions from polluted rivers around the globe. [ABSTRACT FROM AUTHOR]

Objective: Brain somatic mutations in mTOR pathway genes are a major genetic etiology of focal cortical dysplasia type II (FCDII). Despite a greater ability to detect low‐level somatic mutations in the brain by deep sequencing and analytics, about 40% of cases remain genetically unexplained. Methods: We included 2 independent cohorts consisting of 21 patients with mutation‐negative FCDII without apparent mutations on conventional deep sequencing of bulk brain. To find ultra‐low level somatic variants or structural variants, we isolated cells exhibiting phosphorylation of the S6 ribosomal protein (p‐S6) in frozen brain tissues using fluorescence‐activated cell sorting (FACS). We then performed deep whole‐genome sequencing (WGS; >90×) in p‐S6+ cells in a cohort of 11 patients with mutation‐negative. Then, we simplified the method to whole‐genome amplification and target gene sequencing of p‐S6+ cells in independent cohort of 10 patients with mutation‐negative followed by low‐read depth WGS (10×). Results: We found that 28.6% (6 of 21) of mutation‐negative FCDII carries ultra‐low level somatic mutations (less than 0.2% of variant allele frequency [VAF]) in mTOR pathway genes. Our method showed ~34 times increase of the average mutational burden in FACS mediated enrichment of p‐S6+ cells (average VAF = 5.84%) than in bulky brain tissues (average VAF = 0.17%). We found that 19% (4 of 21) carried germline structural variations in GATOR1 complex undetectable in whole exome or targeted gene sequencing. Conclusions: Our method facilitates the detection of ultra‐low level somatic mutations, in specifically p‐S6+ cells, and germline structural variations and increases the genetic diagnostic rate up to ~80% for the entire FCDII cohort. ANN NEUROL 2023;93:1082–1093 [ABSTRACT FROM AUTHOR]

This study offers lessons for overcoming future economic crises by examining whether democratic management helped local governments recover their financial condition. During the Great Recession, local governments were forced to make painful decisions regarding increased taxes and user charges, and cuts in public services. Several case studies provide evidence that citizen participation allows localities to increase property taxes as well as cut public services. However, broader, systematic empirical research is lacking. This study found that local governments with participatory budgeting were more likely to improve their financial condition during the Great Recession. The results allow us to identify the role of citizens in fiscal decision-making, offering lessons on how local governments can overcome possible fiscal crises in the future. [ABSTRACT FROM AUTHOR]

In the present study, it was investigated whether autonomic dysfunction could predict prognosis in light-chain (AL) amyloidosis patients. Seventy-two patients with biopsy-proven AL amyloidosis were included and underwent an autonomic function test (AFT) between January 2016 and June 2019. Autonomic failure was evaluated using the Composite Autonomic Severity Score (CASS). Survival curves and the three-year overall survival (OS) rate were estimated using the Kaplan–Meier curve, and the Cox proportional hazards regression method was used to evaluate the variables that influenced survival. Autonomic dysfunction was observed in 69 (96%) patients with AL amyloidosis, and the three-year OS rate was 67%. Generalised autonomic failure (GAF) was observed in 31 (43%) patients. In the Kaplan–Meier curve, the three-year OS rates in patients with sudomotor dysfunction or GAF were lower than that in control patients (35 vs. 84%, and 33 vs. 81%, respectively). In Cox proportional hazards regression model, female, bone marrow plasma cell percentage, left ventricular systolic dysfunction, and GAF were significant independent variables associated with survival. The results of this study indicate that GAF on the AFT is an independent adverse prognostic factor for survival in AL amyloidosis patients. [ABSTRACT FROM AUTHOR]

As a way to narrow the fiscal disparity across local governments with different revenue capacity, revenue-sharing institutionalizes relatively affluent governments to transfer some revenues for the poor. However, effects of the shared revenue, for both transfer-losing and transfer-gaining governments, on individual governments' service quality are unknown. In this study, we investigate the connection between the shared revenue and government service quality, the concept measured with tangibility, empathy, assurance, responsiveness, and reliability. Using data of 25 districts in Seoul Metropolitan Area from 2008 to 2016, our findings demonstrate the shared revenues are positively associated with all measures of government service quality. [ABSTRACT FROM AUTHOR]

We investigated the impacts of Medicaid expansion on New York county total health spending and specifics of health spending, including health services, public health facilities and public health administration. Little research considered the financial effect of Medicaid expansion on local governments while well reported are its influences on uninsured rates and health services utilization. New York counties have contributed to health in their boundaries by providing or funding public health services, and supporting a part of the non-federal share of Medicaid expenditures and uncompensated care. Medicaid expansion can reduce the size of county expenditures for health by enrolling more previously uninsured population in the program and offering more generous federal funding for the expanded Medicaid. We offer empirical evidence that Medicaid expansion was associated with reduced county health spending. [ABSTRACT FROM AUTHOR]

"Reserve" refers to the individual clinical differences in response to a neuropathological burden. We explored the behavioral reserve (BR) and associated neural substrates in 40 participants with behavioral variant frontotemporal dementia (bvFTD) who were assessed with the frontal behavioral inventory (FBI) and magnetic resonance imaging. Because neuroimaging abnormality showed a high negative correlation with the FBI negative (but not positive) symptom scores, we developed a linear model only to calculate the nBR (BR for negative symptoms) marker using neuroimaging abnormalities and the FBI score. Participants were divided into high nBR and low nBR groups based on the nBR marker. The FBI negative symptom score was lower in the high nBR group than in the low nBR group having the same neuroimaging abnormalities. However, the high nBR group noted a steeper decline in cortical atrophy and showed less atrophy in the left frontotemporal cortices than the low nBR group. In addition, the fractional anisotropy (FA) values were greater in the high nBR than in the low nBR group, except in the sensory-motor and occipital areas. We identified an nBR-related functional network composed of bilateral frontotemporal areas and the left occipital pole. We propose the concept of BR in bvFTD, and these findings can help predict the disease progression. [ABSTRACT FROM AUTHOR]

High‐frequency, paired measurements of the partial pressure of CO2 (pCO2) and dissolved O2 were combined with dissolved organic matter (DOM) characterization to investigate diurnal (7:00–19:00) and seasonal variations in CO2 dynamics in the lower Ganges River. Diurnal variations in pCO2 shifted seasonally, concurring with changes in DOM optical properties, biodegradable DOM, and O2 departures from atmospheric equilibrium (ΔO2). Increased pCO2 and CO2 flux (FCO2) in August–September corresponded to monsoonal floods carrying more terrestrial materials. Lower dry‐season pCO2 and FCO2 concurred with higher ΔO2, and exhibited strong relationships with DO and pH, indicating a dominant influence of phytoplankton production. Despite large variations in pCO2, the year‐long positive FCO2 implied that the lower Ganges acted as a CO2 source, reaching 122 mmol m−2 d−1. Increasing hydrologic variability and pollution in the Ganges Basin can amplify pCO2 variations linked to seasonal shifts in terrestrial inputs and phytoplankton production. [ABSTRACT FROM AUTHOR]

Summary: Background: NUDT15 polymorphisms are associated with leukopenia during treatment with thiopurines. However, data regarding its effect on treatment outcomes are scarce. Aims: To investigate the outcomes between NUDT15 normal and intermediate metabolisers in paediatric patients with Crohn's disease (CD) treated with a combination therapy of infliximab (IFX) and azathioprine (AZA). Methods: In this retrospective observational study, 143 patients categorised into the NUDT15 normal and intermediate metaboliser groups were compared based on clinical remission (CR), biochemical remission (BR), mucosal healing (MH) at 1 year treatment, IFX trough levels (TLs), antibodies to IFX (ATIs), 6‐thioguanine nucleotide (6‐TGN) levels, loss of response (LOR) and IFX durability. Results: No significant differences were observed between the groups in CR, BR, MH at 1 year, whereas IFX TLs and ATIs and 6‐TGN levels were comparable. However, LOR (6.5% vs 27.7%, P = 0.025) was significantly lower and IFX durability significantly higher (96.8% vs 80.4% P = 0.027) in the intermediate group. Multivariable Cox proportional hazard regression analysis showed that ATI positivity (hazard ratio (HR): 4.76, 95% CI: 2.25‐10.07, P < 0.001) and the NUDT15 metaboliser group was associated with LOR (HR: 0.18, 95% CI: 0.04‐0.76, P = 0.019). The Kaplan‐Meier survival curves showed that the LOR‐free survival rate was significantly lower in normal metabolisers (log‐rank test P = 0.009). Conclusion: NUDT15 intermediate metabolisers were associated with lower LOR in paediatric patients with CD treated with IFX and AZA combination therapy. This finding may partially explain the longer durability of IFX in Korean children than their counterparts in Western countries. [ABSTRACT FROM AUTHOR]

Despite recent interest in transparency, not much scholarly attention has been paid to the determinants of government operation of targeted transparency policies, mandating targeted organizations including corporations or private entities, to disclose data to address market failures. This study explores how targeted organizations and state financial environments affect state operation of All-Payer Claims Databases (APCDs), a targeted transparency policy at the U.S. state level. The establishment and operation of APCDs is a recent state initiative to collect and utilize comparable health data on prices and quality measures from non-governmental actors as well as governmental actors, which can contribute to reducing information asymmetry between state health policymakers and providers and to constrain health care expenditures. We found that the operation of APCD was affected by insurance market competition and enrollment, and state financial environments, as well as by state political context and service demands. Especially, this study encourages future researchers to study how insurers as targeted organizations shape the state operation of the price transparency strategy. [ABSTRACT FROM AUTHOR]

Little scholarly research has paid attention to the collective impact of contracting out on local financial condition. Contracting out can enhance a fiscal state by allowing local officials for more buying power with lower service costs as well as less long-term liabilities. Beyond prior research on the effect of contracting in a service, this research offers evidence that higher levels of contracting out spending improve local financial condition regarding budget solvency and long-run solvency. However, external suppliers can deteriorate financial condition. The findings show that the improvement of budget solvency does not materialize at a certain level of contracting out spending, but this is not the case for long-run solvency. The expectation of financial condition improvement may rely on the degree to which practitioners deliver public services through contracting out. Thus, local officials may want to decide levels of contracting out services strategically. [ABSTRACT FROM AUTHOR]

Water pollution disrupts the ecological integrity of urbanized river systems, but its impacts on riverine metabolic processes and carbon fluxes are poorly studied in developing countries. Three seasonal field surveys were combined with two high-resolution measurements and an in situ incubation experiment to investigate the effects of untreated wastewater on organic matter biodegradation and the partial pressure of CO2 (pCO2) along the Mekong–Tonle Sap network around Phnom Penh. High-resolution measurements during the dry-season survey exhibited large downstream increases in pCO2 along the Mekong reaches receiving Tonle Sap inflows carrying urban sewage, contrasting with little spatial variation during a monsoon survey when the Mekong floodwater reversed the Tonle Sap flow. The monsoonal and dry-season surveys revealed flooding-induced homogenization and large spatial divergences in dissolved organic carbon (DOC) concentration and its δ13C and Δ14C between the Tonle Sap and connected Mekong reaches. During the 3-day incubation of Mekong waters, alone or mixed with sewage, a large initial nocturnal increase in pCO2 in sewage-supplemented river water exceeded the subsequent daytime CO2 uptake by phytoplankton photosynthesis varying with light exposure. This, combined with the preferential consumption of labile DOC components displaying protein-like fluorescence, implies sewage-enhanced biodegradation of riverine organic matter. These results suggest that neglecting wastewater-enhanced CO2 production in urbanized river basins during long dry periods can result in a significant underestimation of riverine CO2 emissions. [ABSTRACT FROM AUTHOR]

Despite growing research on greenhouse gas (GHG) emissions from inland waters, few systematic efforts have been made to assess the regional‐scale GHG emissions from Asian rivers under increasing anthropogenic stress. We examined factors controlling longitudinal and seasonal variations in the partial pressure of CO2 (pCO2), and CH4 and N2O concentrations in the Ganges, Mekong, and Yellow River by simultaneously measuring gas concentrations and stable C isotopes, and optical properties of dissolved organic matter (DOM) from 2016 to 2019. The levels of pCO2 and CH4 were distinctively higher in polluted tributaries and affected reaches of the Ganges and Mekong than in the Yellow River. The highest levels of N2O were found in the Ganges, followed by the Yellow River and Mekong. Across these basins, dry‐season mean concentrations of CO2, CH4, and N2O were 1.6, 2, and 7 times higher than those measured in the monsoon season, respectively. This seasonality was consistent with that of δ13C‐CO2, while δ13C‐CH4 showed an opposite pattern. GHG concentrations exhibited significant positive relationships with DOM concentrations and optical properties including fluorescence index and protein‐like fluorescence, implying the contribution of anthropogenic, labile DOM to production of GHGs in the polluted reaches. Graphical mixing models of δ13C‐CO2 and δ13C‐CH4 support the stronger impact of wastewater on the Ganges and Mekong than on the Yellow River. The overall results suggest that neglecting localized pollution impacts on GHG emissions from increasingly urbanized river basins can result in a substantial underestimation of global riverine GHG emissions. Plain Language Summary: Rapid urbanization and poor wastewater infrastructure are turning many large rivers in Asia into significant sources of greenhouse gases (GHGs). We examined controlling factors for the concentrations of CO2, CH4, and N2O in the Ganges, Mekong, and Yellow River by simultaneously measuring gas concentrations and stable carbon isotopes, and optical properties of dissolved organic matter (DOM). The concentrations of CO2 and CH4 were distinctively higher in polluted tributaries and affected sections of the Ganges and Mekong than in the Yellow River. N2O concentration was highest in the Ganges, followed by the Yellow River and Mekong. Across these basins, the concentrations of the three gases were generally higher during dry periods than in the monsoon season. GHG concentrations were positively related to DOM optical properties indicating the contribution of easily degradable DOM from pollution sources. The stable carbon isotope ratios of CO2 and CH4 support the stronger impact of wastewater on the Ganges and Mekong than on the Yellow River. The overall results suggest that neglecting local pollution impacts on GHG emissions from increasingly urbanized river basins can result in a substantial underestimation of global riverine GHG emissions. Key Points: High CO2, CH4, and N2O concentrations in urbanized river reaches reflect influences from local tributaries carrying wastewaterSeasonality in stable C isotopes and dissolved organic matter properties corresponds to higher dry‐season greenhouse gas concentrations than in the monsoonStable C isotopes and their relationships with CO2 and CH4 concentrations support localized wastewater effects on urbanized rivers [ABSTRACT FROM AUTHOR]