Comparison of small-area deprivation measures as predictors of chronic disease burden in a low-income population.

BACKGROUND: Measures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators. METHODS: To derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of census indicators most highly correlated with a set of five chronic disease conditions among South Carolina Medicaid enrollees. In separate validation studies, we used both logistic and spatial regression methods to assess the ability of Palmetto SADI to predict chronic disease burden among state Medicaid recipients relative to four alternative small-area socioeconomic deprivation measures: the Townsend index of material deprivation; a single-variable poverty indicator; and two small-area designations of health care resource deprivation, Primary Care Health Professional Shortage Area and Medically Underserved Area/Medically Underserved Population. RESULTS: Palmetto SADI was the best predictor of chronic disease burden (presence of at least one condition and presence of two or more conditions) among state Medicaid recipients compared to all alternative deprivation measures tested. CONCLUSIONS: A low-cost, regionally optimized socioeconomic deprivation index, Palmetto SADI can be used to identify areas in South Carolina at high risk for chronic disease burden among Medicaid recipients and other low-income Medicaid-eligible populations for targeted prevention, screening, diagnosis, disease self-management, and care coordination activities.

Small-area Variation in Hypertension Prevalence among Black and White Medicaid Enrollees.

OBJECTIVES: To examine within-state geographic heterogeneity in hypertension prevalence and evaluate associations between hypertension prevalence and small-area contextual characteristics for Black and White South Carolina Medicaid enrollees in urban vs rural areas. DESIGN: Ecological. SETTING: South Carolina, United States. MAIN OUTCOME MEASURES: Hypertension prevalence. METHODS: Data representing adult South Carolina Medicaid recipients enrolled in fiscal year 2013 (N=409,907) and ZIP Code Tabulation Area (ZCTA)-level contextual measures (racial segregation, rurality, poverty, educational attainment, unemployment and primary care physician adequacy) were linked in a spatially referenced database. Optimized Getis-Ord hotspot mapping was used to visualize geographic clustering of hypertension prevalence. Spatial regression was performed to examine the association between hypertension prevalence and small-area contextual indicators. RESULTS: Significant (alpha=.05) hotspot spatial clustering patterns were similar for Blacks and Whites. Black isolation was significantly associated with hypertension among Blacks and Whites in both urban (Black, b=1.34, P<.01; White, b=.66, P<.01) and rural settings (Black, b=.71, P=.02; White, b=.70, P<.01). Primary care physician adequacy was associated with hypertension among urban Blacks (b=-2.14, P<.01) and Whites (b=-1.74, P<.01). CONCLUSIONS: The significant geographic overlap of hypertension prevalence hotspots for Black and White Medicaid enrollees provides an opportunity for targeted health intervention. Provider adequacy findings suggest the value of ACA network adequacy standards for Medicaid managed care plans in ensuring health care accessibility for persons with hypertension and related chronic conditions.

The evolution and development of consciousness: the subject-object emergence hypothesis.

A strategy for investigating consciousness that has proven very productive has focused on comparing brain processes that are accompanied by consciousness with processes that are not. But comparatively little attention has been given to a related strategy that promises to be even more fertile. This strategy exploits the fact that as individuals develop, new classes of brain processes can transition from operating 'in the dark' to becoming conscious. It has been suggested that these transitions occur when a new class of brain processes becomes object to a new, emergent, higher-level subject. Similar transitions are likely to have occurred during evolution. An evolutionary/developmental research strategy sets out to identify the nature of the transitions in brain processes that shift them from operating in the dark to 'lighting up'. The paper begins the application of this strategy by extrapolating the sequence of transitions back towards its origin. The goal is to reconstruct a minimally-complex, subject-object subsystem that would be capable of giving rise to consciousness and providing adaptive benefits. By focusing on reconstructing a subsystem that is simple and understandable, this approach avoids the homunculus fallacy. The reconstruction suggests that the emergence of such a minimally-complex subsystem was driven by its capacity to coordinate body-environment interactions in real time e.g. hand-eye coordination. Conscious processing emerged initially because of its central role in organising real-time sensorimotor coordination. The paper goes on to identify and examine a number of subsequent major transitions in consciousness, including the emergence of capacities for conscious mental modelling. Each transition is driven by its potential to solve adaptive challenges that cannot be overcome at lower levels. The paper argues that mental modelling arose out of a pre-existing capacity to use simulations of motor actions to anticipate the consequences of the actions. As the capacity developed, elements of the simulations could be changed, and the consequences of these changes could be 'thought through' consciously. This enabled alternative motor responses to be evaluated. The paper goes on to predict significant new major transitions in consciousness.

Diabetes and the socioeconomic and built environment: geovisualization of disease prevalence and potential contextual associations using ring maps.

BACKGROUND: Efforts to stem the diabetes epidemic in the United States and other countries must take into account a complex array of individual, social, economic, and built environmental factors. Increasingly, scientists use information visualization tools to "make sense" of large multivariate data sets. Recently, ring map visualization has been explored as a means of depicting spatially referenced, multivariate data in a single information graphic. A ring map shows multiple attribute data sets as separate rings of information surrounding a base map of a particular geographic region of interest. In this study, ring maps were used to evaluate diabetes prevalence among adult South Carolina Medicaid recipients. In particular, county-level ring maps were used to evaluate disparities in diabetes prevalence among adult African Americans and Whites and to explore potential county-level associations between diabetes prevalence among adult African Americans and five measures of the socioeconomic and built environment--persistent poverty, unemployment, rurality, number of fast food restaurants per capita, and number of convenience stores per capita. Although Medicaid pays for the health care of approximately 15 percent of all diabetics, few studies have examined diabetes in adult Medicaid recipients at the county level. The present study thus addresses a critical information gap, while illustrating the utility of ring maps in multivariate investigations of population health and environmental context. RESULTS: Ring maps showed substantial racial disparity in diabetes prevalence among adult Medicaid recipients and suggested an association between adult African American diabetes prevalence and rurality. Rurality was significantly positively associated with diabetes prevalence among adult African American Medicaid recipients in a multivariate statistical model. CONCLUSIONS: Efforts to reduce diabetes among adult African American Medicaid recipients must extend to rural African Americans. Ring maps can be used to integrate diverse data sets, explore attribute associations, and achieve insights critical to the promotion of population health.

Spatial visualization of multivariate datasets: an analysis of STD and HIV/AIDS diagnosis rates and socioeconomic context using ring maps.

OBJECTIVES: We used existing data systems to examine sexually transmitted disease (STD) and HIV/AIDS diagnosis rates and explore potential county-level associations between HIV/AIDS diagnosis rates and socioeconomic disadvantage. METHODS: Using South Carolina county data, we constructed multivariate ring maps to spatially visualize syphilis, gonorrhea, chlamydia, and HIV/AIDS diagnosis rates; gender- and race-specific HIV/AIDS diagnosis rates; and three measures of socioeconomic disadvantage-an unemployment index, a poverty index, and the Townsend index of social deprivation. Statistical analyses were performed to quantitatively assess potential county-level associations between HIV/AIDS diagnosis rates and each of the three indexes of socioeconomic disadvantage. RESULTS: Ring maps revealed substantial spatial association in STD and HIV/AIDS diagnosis rates and highlighted large gender and racial disparities in HIV/AIDS across the state. The mean county-level HIV/AIDS diagnosis rate (per 100,000 population) was 24.2 for males vs. 11.2 for females, and 34.8 for African Americans vs. 5.2 for white people. In addition, ring map visualization suggested a county-level association between HIV/AIDS diagnosis rates and socioeconomic disadvantage. Significant positive bivariate relationships were found between HIV/AIDS rate categories and each increase in poverty index category (odds ratio [OR] = 2.03; p=0.006), as well as each increase in Townsend index of social deprivation category (OR=4.98; p<0.001). A multivariate ordered logistic regression model in which all three socioeconomic disadvantage indexes were included showed a significant positive association between HIV/AIDS and Townsend index categories (adjusted OR=6.10; p<0.001). CONCLUSIONS: Ring maps graphically depicted the spatial coincidence of STD and HIV/AIDS and revealed large gender and racial disparities in HIV/AIDS across South Carolina counties. This spatial visualization method used existing data systems to highlight the importance of social determinants of health in program planning and decision-making processes.

Associations between mental health and diabetes: findings from the South Carolina Medicaid managed care program in 2006-2008.

OBJECTIVES: To assess differences in services associated with mental health status and prescriptions among Medicaid patients diagnosed with diabetes mellitus. DESIGN: Secondary data analyses of South Carolina (SC) Medicaid enrollees. PARTICIPANTS: SC Medicaid enrollees with a diagnosis of diabetes mellitus (N = 555) continuously enrolled in either managed care (MC) or fee for service (FFS) programs between 2006 and 2008. MAIN OUTCOME MEASURES: Health Plan Employer Data and Information Set (HEDIS)-based diabetes management service outcomes including: 1) whether the recipient received a nephrology exam; 2) the number of eye exams received; 3) the number of low-density lipoprotein cholesterol services received; and 4) the number of Hemoglobin A1c blood tests conducted. Outcomes were fitted to regression models adjusting for sex, race, health program provider type (MC or FFS), rurality, poverty indexes, clinical risk group status, whether there was a female head of household, and indicators for classes of prescription pharmaceuticals (antipsychotics, antidepressants, and anticonvulsants). RESULTS: There are significant differences in the incidence of diabetes management service-use between enrollees in management plans and between recipients of classes of pharmaceuticals and mental health status. Enrollees in FFS have fewer claims associated with diabetes management services compared to counterparts in MC. CONCLUSIONS: Our early findings demonstrate the importance of efforts to collect HEDIS measures data and their potential as a resource for assessing quality of care. More importantly, this study illustrates the association between mental health status and associated pharmaceutical prescriptions.

Towards a general theory of the major cooperative evolutionary transitions.

Major Cooperative Evolutionary Transitions occur when smaller-scale entities cooperate together to give rise to larger-scale entities that evolve and adapt as coherent wholes. Key examples of cooperative transitions are the emergence of the complex eukaryote cell from communities of simpler cells, the transition from eukaryote cells to multicellular organisms, and the organization of humans into complex, modern societies. A number of attempts have been made to develop a general theory of the major cooperative transitions. This paper begins by critiquing key aspects of these previous attempts. Largely, these attempts comprise poorly-integrated collections of separate models that were each originally developed to explain particular transitions. In contrast, this paper sets out to identify processes that are common to all cooperative transitions. It develops an alternative theoretical framework known as Management Theory. This general framework suggests that all major cooperative transitions are the result of the emergence of powerful, evolvable 'managers' that derive benefit from using their power to organize smaller-scale entities into larger-scale cooperatives. Management Theory is a contribution to the development of a general, "all levels" understanding of major cooperative transitions that is capable of identifying those features that are level-specific, those that are common across levels and those that are involved in trends across levels.

Analysis of artificial radiocarbon in different skeletal and dental tissue types to evaluate date of death.

Radiocarbon dating, with special reference to the modern bomb-curve, can provide useful information to elucidate the date of death of skeletonized human remains. Interpretation can be enhanced with analysis of different types of tissues within a single skeleton because of the known variability of formation times and remodeling rates. Analysis of radiocarbon content of teeth, especially the enamel in tooth crowns, provides information about the date of formation in the childhood years and in consideration of the known timing of tooth formation can be used to estimate the birth date after 1950 ad. Radiocarbon analysis of modern cortical and trabecular bone samples from the same skeleton may allow proper placement on the pre-1963 or post-1963 sides of the bomb-curve as most trabecular bone generally undergoes more rapid remodeling than does most cortical bone. Pre-1963 bone formation would produce higher radiocarbon values for most trabecular bone than for most cortical bone. This relationship is reversed for formation after 1963. Radiocarbon analysis was conducted in this study on dental, cortical, and trabecular bone samples from two adult individuals of known birth (1925 and 1926) and death dates (1995 and 1959). As expected, the dental results correspond to prebomb-curve values reflecting conditions during the childhoods of the individuals. The radiocarbon content of most bone samples reflected the higher modern bomb-curve values. Within the bone sample analyses, the values of the trabecular bone were higher than those of cortical bone and supported the known placement on the pre-1963 side of the bomb-curve.

Evaluation of a multicapillary electrophoresis instrument for mitochondrial DNA typing.

Laser-induced detection of fluorescent labeled PCR products and multi-wavelength detection (i.e., multicolor analysis) enables rapid generation of mtDNA sequencing profiles. Traditionally, polyacrylamide slab gels have been used as the electrophoretic medium for mtDNA sequencing in forensic analyses. Replacement of slab gel electrophoresis with capillary electrophoresis (CE) can facilitate automation of the analytical process. Automation and high throughput can be further enhanced by using multicapillary electrophoretic systems. The use of the ABI Prism 3100 Genetic Analyzer (ABI 3100, Applied Biosystems, Foster City, CA) as well as the ABI Prism 310 Genetic Analyzer (ABI 310, Applied Biosystems, Foster City, CA) were evaluated for mtDNA sequencing capabilities and compared with sequencing results obtained on the platform currently in use in the FBI Laboratory (the ABI Prism 377 DNA Sequencer, ABI 377, Applied Biosystems, Foster City, CA). Various studies were performed to assess the utility of the ABI 3100, as well as the ABI 310 for mtDNA sequencing. The tests included: comparisons of results obtained among the ABI 3100, the ABI 310 and the ABI 377 instruments; comparisons of results obtained within and between capillary arrays; evaluation of capillary length; evaluation of sample injection time; evaluation of the resolution of mixtures/heteroplasmic samples; and evaluation of the sensitivity of detection of a minor component with reduced template on the ABI 3100. In addition, other studies were performed to improve sample preparation; these included: comparison of template suppression reagent (TSR, Applied Biosystems, Foster City, CA) versus formamide; the use of Performa DTR Gel Filtration Cartridges (Edge BioSystems Inc., Gaithersburg, MD) versus Centri-Sep Spin Columns (Princeton Separations, Adelphia, NJ) for product purification after cycle sequencing; and sample stability after denaturation. The data support that valid and reliable results can be obtained using either capillary electrophoresis instrument, and the quality of sequencing results are comparable to or better than those obtained from the ABI 377 instrument.

The direction of evolution: the rise of cooperative organization.

Two great trends are evident in the evolution of life on Earth: towards increasing diversification and towards increasing integration. Diversification has spread living processes across the planet, progressively increasing the range of environments and free energy sources exploited by life. Integration has proceeded through a stepwise process in which living entities at one level are integrated into cooperative groups that become larger-scale entities at the next level, and so on, producing cooperative organizations of increasing scale (for example, cooperative groups of simple cells gave rise to the more complex eukaryote cells, groups of these gave rise to multi-cellular organisms, and cooperative groups of these organisms produced animal societies). The trend towards increasing integration has continued during human evolution with the progressive increase in the scale of human groups and societies. The trends towards increasing diversification and integration are both driven by selection. An understanding of the trajectory and causal drivers of the trends suggests that they are likely to culminate in the emergence of a global entity. This entity would emerge from the integration of the living processes, matter, energy and technology of the planet into a global cooperative organization. Such an integration of the results of previous diversifications would enable the global entity to exploit the widest possible range of resources across the varied circumstances of the planet. This paper demonstrates that it's case for directionality meets the tests and criticisms that have proven fatal to previous claims for directionality in evolution.

Team knowledge research: emerging trends and critical needs.

OBJECTIVE: This article provides a systematic review of the team knowledge literature and guidance for further research. BACKGROUND: Recent research has called attention to the need for the improved study and understanding of team knowledge. Team knowledge refers to the higher level knowledge structures that emerge from the interactions of individual team members. METHOD: We conducted a systematic review of the team knowledge literature, focusing on empirical work that involves the measurement of team knowledge constructs. For each study, we extracted author degree area, study design type, study setting, participant type, task type, construct type, elicitation method, aggregation method, measurement timeline, and criterion domain. RESULTS: Our analyses demonstrate that many of the methodological characteristics of team knowledge research can be linked back to the academic training of the primary author and that there are considerable gaps in our knowledge with regard to the relationships between team knowledge constructs, the mediating mechanisms between team knowledge and performance, and relationships with criteria outside of team performance, among others. We also identify categories of team knowledge not yet examined based on an organizing framework derived from a synthesis of the literature. CONCLUSION: There are clear opportunities for expansion in the study of team knowledge; the science of team knowledge would benefit from a more holistic theoretical approach. APPLICATION: Human factors researchers are increasingly involved in the study of teams. This review and the resulting organizing framework provide researchers with a summary of team knowledge research over the past 10 years and directions for improving further research.

HVI and HVII mitochondrial DNA data in Apaches and Navajos.

Most mtDNA studies on Native Americans have concentrated on hypervariable region I (HVI) sequence data. Mitochondrial DNA haplotype data from hypervariable regions I and II (HVI and HVII) have been compiled from Apaches (N=180) and Navajos (N=146). The inclusion of HVII data increases the amount of information that can be obtained from low diversity population groups. Less mtDNA variation was observed in the Apaches and Navajos than in major population groups. The majority of the mtDNA sequences were observed more than once; only 17.8% (32/180) of the Apache sequences and 25.8% of the Navajo sequences were observed once. Most of the haplotypes in Apaches and Navajos fall into the A and B haplogroups. Although a limited number of haplogroups were observed, both sample populations exhibit sufficient variation for forensic mtDNA typing. Genetic diversity was 0.930 in the Apache sample and 0.963 in the Navajo sample. The random match probability was 7.48% in the Apache sample and 4.40% in the Navajo sample. The average number of nucleotide differences between individuals in a database is 9.0 in the Navajo sample and 7.7 in the Apache sample. The data demonstrate that mtDNA sequencing can be informative in forensic cases where Native American population data are used.