Data Resources for Conducting Health Services and Policy Research.

Rich federal data resources provide essential data inputs for monitoring the health and health care of the US population and are essential for conducting health services policy research. The six household surveys we document in this article cover a broad array of health topics, including health insurance coverage (American Community Survey, Current Population Survey), health conditions and behaviors (National Health Interview Survey, Behavioral Risk Factor Surveillance System), health care utilization and spending (Medical Expenditure Panel Survey), and longitudinal data on public program participation (SIPP). New federal activities are linking federal surveys with administrative data to reduce duplication and response burden. In the private sector, vendors are aggregating data from medical records and claims to enhance our understanding of treatment, quality, and outcomes of medical care. Federal agencies must continue to innovate to meet the continuous challenges of scarce resources, pressures for more granular data, and new multimode data collection methodologies.

The mitigating effect of street trees, urban flora, and the suburban environment on seasonal peak UV indices: A case study from Brisbane, Australia.

Tree shade, particularly shade that obscures direct sunlight near peak periods of midday solar exposure can have a pronounced effect on potentially harmful ultraviolet radiation, and in turn, strongly influence the maximum daily UV index (UVI). In this study, the seasonal influence of tree shade on the UVI is evaluated from 210 hemispherical sky view images collected alongside public walkways and footpaths from 10 residential Brisbane suburbs. The effective sidewalk UV index is calculated underneath planted tree canopies, adjacent residential gardens, buildings and background tree species. Results are presented with respect to seasonal variations in the diurnal solar elevation for each month of the year at Brisbane's latitude. The research also examines the total reduction in UVI due to the presence of individual tree species, showing reductions in the midday UVI of up to 91% of an equivalent unimpeded sky hemisphere when overhead tree canopies are present. Important footpath tree species for peak midday UVI mitigation include Pongamia pinnata, Xanthostemon chrysanthus, Senna siamea, and Libidibia ferrea. The planting and maintenance of existing tree species already growing alongside residential Brisbane streets will improve the shade characteristics of suburbs and enhance UV protection for local residents.

Influence of reflected UV irradiance on occupational exposure from combinations of reflective wall surfaces.

Outdoor workers who occupationally spend large periods of time exposed to ultraviolet irradiance are at increased risk of developing certain types of non-melanoma skin cancer in addition to being prone to erythema and eye damage. UV exposure to workers is affected by a number of factors including geographic location, season, individual biological factors and the local surroundings. Urban environments can provide surrounds that contain surfaces that reflect UV radiation which can enhance UV exposure to construction workers, in both the vertical as well as horizontal plane. However it was unknown how different constructed configurations of the surfaces may additionally influence UV exposure for a worker, such as corners opposed to walls. This study shows that for highly UV reflective surfaces the influence on erythemal UV exposure is approximately the same regardless of constructive type, but there is statistically significant difference observed for lower UV reflecting surfaces in conjunction with constructive type. This is comparable to influence of body site on relative UV exposure, and together may provide a method that may assist in reduction in UV exposures. Regression analysis provides a more effective means to determine a UV reflective factor for a surface type, than previously used averaging methods. Additionally, this knowledge may be used by workers, workplaces and advisory bodies to assist with developing further protective strategies that aim to provide more moderate UV exposures to outdoor workers.

Monitoring health reform efforts: which state-level data to use?

This study compares estimates of health insurance coverage from the American Community Survey (ACS) to those in twelve state-specific surveys. Uninsurance estimates for the nonelderly are consistently higher in the ACS than in state surveys, as are direct purchase insurance estimates. Estimates for employer-sponsored insurance are similar, but public coverage rates are lower in the ACS. The ACS meets some but not all of the states' data needs; its large sample size and inclusion of all U.S. counties in the sample allow for comparison of insurance coverage within and across states. State-specific surveys provide the flexibility to add policy-relevant questions, including questions needed to examine how health insurance translates into access, use, and affordability of health services.

The Playground Shade Index: A New Design Metric for Measuring Shade and Seasonal Ultraviolet Protection Characteristics of Parks and Playgrounds.

Current shading strategies used to protect outdoor playgrounds from harmful solar radiation include the placement of artificial cloth weaves or permanent roofing over a playground site, planting trees in proximity to playground equipment, and using vegetation or surface texture variations to cool playground surfaces. How and where an artificial shade structure is placed or a tree is planted to maximize the shade protection over specific playground areas, requires careful assessment of local seasonal sun exposure patterns. The Playground Shade Index (PSI) is introduced here as a design metric to enable shade and solar ultraviolet exposure patterns to be derived in an outdoor space using conventional aerial views of suburban park maps. The implementation of the PSI is demonstrated by incorporating a machine learning design tool to classify the position of trees from an aerial image, thus enabling the mapping of seasonal shade and ultraviolet exposure patterns within an existing 7180 m2 parkland. This is achieved by modeling the relative position of the sun with respect to nearby buildings, shade structures, and the identified evergreen and deciduous tree species surrounding an outdoor playground.

Tracking elusive and shifting identities of the global fishing fleet.

Illegal, unreported, and unregulated (IUU) fishing costs billions of dollars per year and is enabled by vessels obfuscating their identity. Here, we combine identities of ~35,000 vessels with a decade of GPS data to provide a global assessment of fishing compliance, reflagging patterns, and fishing by foreign-owned vessels. About 17% of high seas fishing is by potentially unauthorized or internationally unregulated vessels, with hot spots of this activity in the west Indian and the southwest Atlantic Oceans. In addition, reflagging, a tactic often used to obscure oversight, occurs in just a few ports primarily by fleets with high foreign ownership. Fishing by foreign-owned vessels is concentrated in parts of high seas and certain national waters, often flying flags of convenience. These findings can address the global scope of potential IUU fishing and enable authorities to improve oversight.

Escape is a more common mechanism than avidity reduction for evasion of CD8+ T cell responses in primary human immunodeficiency virus type 1 infection.

BACKGROUND: CD8+ T cells play an important role in control of viral replication during acute and early human immunodeficiency virus type 1 (HIV-1) infection, contributing to containment of the acute viral burst and establishment of the prognostically-important persisting viral load. Understanding mechanisms that impair CD8+ T cell-mediated control of HIV replication in primary infection is thus of importance. This study addressed the relative extent to which HIV-specific T cell responses are impacted by viral mutational escape versus reduction in response avidity during the first year of infection. RESULTS: 18 patients presenting with symptomatic primary HIV-1 infection, most of whom subsequently established moderate-high persisting viral loads, were studied. HIV-specific T cell responses were mapped in each individual and responses to a subset of optimally-defined CD8+ T cell epitopes were followed from acute infection onwards to determine whether they were escaped or declined in avidity over time. During the first year of infection, sequence variation occurred in/around 26/33 epitopes studied (79%). In 82% of cases of intra-epitopic sequence variation, the mutation was confirmed to confer escape, although T cell responses were subsequently expanded to variant sequences in some cases. In contrast, < 10% of responses to index sequence epitopes declined in functional avidity over the same time-frame, and a similar proportion of responses actually exhibited an increase in functional avidity during this period. CONCLUSIONS: Escape appears to constitute a much more important means of viral evasion of CD8+ T cell responses in acute and early HIV infection than decline in functional avidity of epitope-specific T cells. These findings support the design of vaccines to elicit T cell responses that are difficult for the virus to escape.

Bim-mediated deletion of antigen-specific CD8 T cells in patients unable to control HBV infection.

HBV-specific CD8(+) T cells are critical for a successful immune response to HBV infection. They are markedly diminished in number in patients who fail to control the virus, but the mechanisms resulting in their depletion remain ill defined. Here, we dissected the defective HBV-specific CD8(+) T cell response associated with chronic HBV infection by gene expression profiling. We found that HBV-specific CD8(+) T cells from patients with different clinical outcomes could be distinguished by their patterns of gene expression. Microarray analysis revealed that overlapping clusters of functionally related apoptotic genes were upregulated in HBV-specific CD8(+) T cells from patients with chronic compared with resolved infection. Further analysis confirmed that levels of the proapoptotic protein Bcl2-interacting mediator (Bim) were upregulated in HBV-specific CD8(+) T cells from patients with chronic HBV infection. Blocking Bim-mediated apoptosis enhanced recovery of HBV-specific CD8(+) T cells both in culture and directly ex vivo. Consistent with evidence that Bim mediates apoptosis of CD8(+) T cells expressing low levels of CD127 (IL-7R), the few surviving HBV-specific CD8(+) T cells were CD127(hi )and had elevated levels of the antiapoptotic protein Mcl1, suggesting they were amenable to IL-7-mediated rescue from apoptosis. We therefore postulate that Bim-mediated attrition of HBV-specific CD8(+) T cells contributes to the inability of these cell populations to persist and control viral replication.

Evaluation of the Long-term Cumulative UVA Facial Exposure of Queensland School Teachers derived for an Extended Period from the OMI Satellite Irradiance.

This research presents a novel methodology for deriving the total daily broadband solar UVA (320-400 nm) received by school teachers during their working day from Ozone Monitoring Instrument (OMI) satellite solar noon UVA irradiance measurements for a Queensland subtropical site (27.5°S, 152°E). Daily UVA exposures are weighted to the anatomical human cheek (anterior infra-orbital region) for teachers wearing and not wearing broad-brimmed hats. The method utilizes the OMI UVA irradiance data collected daily at high temporal resolution over 2005 to 2016 to derive the total daily UVA exposure to a horizontal plane. These horizontal plane exposures are scaled by factors to take into account the timing of outdoor activity. The relationship between exposures to a horizontal plane and those to a vertical plane and the protection provided by a broad-brimmed hat was assessed to evaluate the total daily UVA exposures to the cheek for classroom and physical education teaching staff expected to be outside at different periods of the day. The developed method enables the total daily UVA exposure to specific anatomical sites to be evaluated from the satellite solar noon irradiance at locations that do not have access to surface-based instrumentation capable of recording in the solar UVA waveband.

New Zealand COPD Guidelines: Quick Reference Guide.

The purpose of the Asthma and Respiratory Foundation of New Zealand's COPD Guidelines: Quick Reference Guide is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment, and management of chronic obstructive pulmonary disease (COPD) in clinical practice. The intended users are health professionals responsible for delivering acute and chronic COPD care in community and hospital settings, and those responsible for the training of such health professionals.

Meeting the cervical cancer screening needs of underserved women: the National Breast and Cervical Cancer Early Detection Program, 2004-2006.

OBJECTIVE: To examine the extent to which the only national organized screening program in the US, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), has helped to meet the cervical cancer screening needs of underserved women. METHODS: Low-income, uninsured women 18-64 years of age are eligible for free cervical cancer screening services through NBCCEDP. We used data from the US Census Bureau to estimate the number of eligible women, based on insurance status and income. The estimates were adjusted for hysterectomy status using the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. We used administrative data from NBCCEDP to obtain the number of women receiving NBCCEDP-funded Papanicolaou (Pap) tests. We then calculated the percentage of NBCCEDP-eligible women who received free cervical cancer screening through NBCCEDP. We also used the NHIS to calculate the percentage of NBCCEDP-eligible women screened nationally and the percentage unscreened. RESULTS: In 2004-2006, nearly 9% (775,312 of 8.9 million) of NBCCEDP-eligible women, received NBCCEDP-funded Pap test. Rates varied substantially by age groups, race, and ethnicity. NBCCEDP-eligible women 40-64 years of age had a higher screening rate (22.6%) than eligible women 18-39 years of age (2.3%). Non-Hispanic women had a higher screening rate (9.3%) than Hispanic women (7.3%). Among non-Hispanics, the screening rate was highest among American Indian and Alaska Native (AIAN) women (36.1%) and lowest among women of different race combinations (4.6%), The percentage of eligible women screened in each state ranged from 2.0 to 38.4%. CONCLUSIONS: Although NBCCEDP provided cervical cancer screening services to 775,312 low-income, uninsured women, this number represented a small percentage of those eligible. In 2005, more than 34% of NBCCEDP-eligible women (3.1 million women) did not receive recommended Pap tests from either NBCCEDP or other sources.

A review on the ability of smartphones to detect ultraviolet (UV) radiation and their potential to be used in UV research and for public education purposes.

The effects of ultraviolet (UV) radiation on life on Earth have continuously been the subject of research. Over-exposure to UV radiation is harmful, but small amounts of exposure are required for good health. It is, therefore, crucial for humans to optimise their own UV exposure and not exceed UV levels that are sufficient for essential biological functions. Exceeding those levels may increase risk of developing health problems including skin cancer and cataracts. Smartphones have been previously investigated for their ability to detect UV radiation with or without additional devices that monitor personal UV exposure, in order to maintain safe exposure times by individuals. This review presents a comprehensive overview of the current state of smartphones' use in UV radiation monitoring and prediction. There are four main methods for UV radiation detection or prediction involving the use smartphones, depending on the requirements of the user: devoted software applications developed for smartphones to predict UV Index (UVI), wearable and non-wearable devices that can be used with smartphones to provide real-time UVI, and the use of smartphone image sensors to detect UV radiation. The latter method has been a growing area of research over the last decade. Built-in smartphone image sensors have been investigated for UV radiation detection and the quantification of related atmospheric factors (including aerosols, ozone, clouds and volcanic plumes). The overall practicalities, limitations and challenges are reviewed, specifically in regard to public education. The ubiquitous nature of smartphones can provide an interactive tool when considering public education on the effects and individual monitoring of UV radiation exposure, although social and geographic areas with low socio-economic factors could challenge the usefulness of smartphones. Overall, the review shows that smartphones provide multiple opportunities in different forms to educate users on personal health with respect to UV radiation.

Measurements of the upper body ultraviolet exposure to golfers: non-melanoma skin cancer risk, and the potential benefits of exposure to sunlight.

BACKGROUND: Geographically, Queensland presents an extreme ultraviolet exposure climate to members of the public engaged in outdoor recreational activity. The risk of developing a skin cancer or an eye disease as a result of incidental exposure to naturally occurring ultraviolet radiation in the outdoor environment is proportionately high in a Queensland population compared with fair-skinned population groups residing in comparable Northern Hemisphere latitudes. In contrast to these risks, elderly members of this high growth population group have been reported to be vitamin D deficient. The risks and potential benefits of exposure to sunlight in southern Queensland are assessed in this study with respect to recreational golfing. This sport is a popular recreational activity for the Queensland population and must be played during daylight hours. METHODS: The erythemal and vitamin D effective ultraviolet exposure measured to the forearm, upper back and vertex are presented for individuals playing golf under various atmospheric conditions in a 7-month period extending from summer to winter. RESULTS: Mean summertime exposures were measured in the 2008 study period as be 1.4, 2.2 and 3.2 standard erythema doses (SED) at forearm, upper back and vertex sites, respectively, compared with respective wintertime forearm, upper back and vertex exposures of 0.2, 0.3 and 0.5 SED, where summertime exposures were recorded in the mean solar zenith angle (SZA) ranges of 56-59 degrees and wintertime exposures were recorded in the mean SZA range 74-83 degrees. Vitamin D(3) effective exposures were determined to vary from between 225, 325 and 475 J/m(2) during summer and 48, 59 and 88 J/m(2) during winter for the respective forearm, upper back and vertex body sites measured in the above mean SZA ranges. CONCLUSION: Exposures to ambient ultraviolet during winter on the golf course between 15:00 and 17:30 hours could be beneficial for office workers for the production of vitamin D. Optimizing exposure periods to late afternoon in the winter months and taking adequate sun protection measures in the summer months are important strategies that golfers can utilize for long-term preventative health.

Assessment of Biologically Effective Solar Ultraviolet Exposures for Court Staff and Competitors During a Major Australian Tennis Tournament.

Sport is an integral and enduring part of many societies, such as Australia. Participation in outdoor sports, such as tennis, comes with a very real risk of dangerous solar ultraviolet exposure which can result in erythema (sunburn), serious conditions such as skin cancer, including melanoma, and eye conditions such as cataracts and pterygium. This study remotely assesses the effective ultraviolet exposures in response to the increased sun safety awareness at a major summertime tennis tournament in Australia. The assessment only uses publicly accessible data and information. It was found that tournament organizers have effectively adopted sun-safe protocols into the uniform policy that the court officials (judges and ball kids) are mandated to follow. The combination of sun-participant geometry and the photoprotection provided by uniforms significantly reduced the ambient ultraviolet exposure, which was recorded to be as high as 9.9 SED h-1 , to just 1.0 and 0.5 SED h-1 for ball kids and judges, respectively, compared to up to 2.0 SED h-1 for players. Even though caution is needed against complacency with sun safety, with the need for the court officials and the players to still apply sunscreen, the court officials provided persistent visual role modeling of sun-safe behaviors.

Ultraviolet Radiation Albedo and Reflectance in Review: The Influence to Ultraviolet Exposure in Occupational Settings.

Ultraviolet (UV) albedo and UV reflectance are defined, compared and contrasted, to explain their roles and place in studies focusing on UV radiation and exposure measurements, in the context of localised albedo measurement and human UV exposure studies. This review recommends that the term UV albedo be used when investigating natural horizontal surfaces when the albedo is not known to change significantly over time. The term UV reflectance should be mostly used for non-natural surfaces and non-horizontal measurements and will change with respect to the geometry of the irradiances reflected and received, and due to the intrinsic nature of the surface itself. UV albedo measurements made in the literature have been compiled, in both broadband and spectral UV albedo measurements. Broadband measurements have been tabulated and spectral UV measurements have been displayed visually. The methodology of measurements is briefly discussed. Finally, studies that consider how high albedo or reflectance sites influence UV exposure are reviewed. It was concluded that there is currently no known relationship between the albedo or reflectance of a surface and the resulting influence it has on individual UV exposure. This presents an opportunity for researchers to continue exploring the influence of reflective UV surfaces.

Distributed Task Rescheduling With Time Constraints for the Optimization of Total Task Allocations in a Multirobot System.

This paper considers the problem of maximizing the number of task allocations in a distributed multirobot system under strict time constraints, where other optimization objectives need also be considered. It builds upon existing distributed task allocation algorithms, extending them with a novel method for maximizing the number of task assignments. The fundamental idea is that a task assignment to a robot has a high cost if its reassignment to another robot creates a feasible time slot for unallocated tasks. Multiple reassignments among networked robots may be required to create a feasible time slot and an upper limit to this number of reassignments can be adjusted according to performance requirements. A simulated rescue scenario with task deadlines and fuel limits is used to demonstrate the performance of the proposed method compared with existing methods, the consensus-based bundle algorithm and the performance impact (PI) algorithm. Starting from existing (PI-generated) solutions, results show up to a 20% increase in task allocations using the proposed method.

Evaluated UVA Irradiances over a Twelve-year Period at a Subtropical Site from Ozone Monitoring Instrument Data Including the Influence of Cloud.

This research investigated the influence of cloud on the broadband UVA solar noon irradiances evaluated from the solar noon satellite-based OMI spectral UV data that were compared to the irradiances of a ground-based radiometer from 1 October 2004 to 31 December 2016. The correlation between ground-based radiometer data and the evaluated OMI broadband UVA data evaluated with a model were dependent on whether or not the solar disk was obscured by the presence of cloud and the total sky cloud fraction. For conditions when the sun was not obscured by cloud, the evaluated satellite and the ground-based UVA irradiance correlation was best for cloud cover between 0 and 2 octa (R2  = 0.77) and the worst for high cloud cover of >4-8 octa (R2 between 0.3 and 0.4). The R2 reduced with increasing cloud amount and showed significantly weaker correlation when the sun was obscured. The correlation between the evaluated satellite broadband UVA and the ground-based measurements over the twelve years for total cloud cover conditions of 4 or less octa confirmed that the broadband UVA satellite evaluation model for the OMI spectral data is valid for approximately 71% of the days at the Southern Hemisphere subtropical study site.

Health Care Coverage and Access Among Children, Adolescents, and Young Adults, 2010-2016: Implications for Future Health Reforms.

PURPOSE: We examine changes to health insurance coverage and access to health care among children, adolescents, and young adults since the implementation of the Affordable Care Act. METHODS: Using the National Health Interview Survey, bivariate and logistic regression analyses were conducted to compare coverage and access among children, young adolescents, older adolescents, and young adults between 2010 and 2016. RESULTS: We show significant improvements in coverage among children, adolescents, and young adults since 2010. We also find some gains in access during this time, particularly reductions in delayed care due to cost. While we observe few age-group differences in overall trends in coverage and access, our analysis reveals an age-gradient pattern, with incrementally worse coverage and access rates for young adolescents, older adolescents, and young adults. CONCLUSIONS: Prior analyses often group adolescents with younger children, masking important distinctions. Future reforms should consider the increased coverage and access risks of adolescents and young adults, recognizing that approximately 40% are low income, over a third live in the South, where many states have not expanded Medicaid, and over 15% have compromised health.

Validation of Ozone Monitoring Instrument UV Satellite Data Using Spectral and Broadband Surface Based Measurements at a Queensland Site.

This research reconstructed and validated the broadband UVA irradiances derived from discrete spectral irradiance data retrieved from the Ozone Monitoring Instrument (OMI) satellite from 1 January to 31 December 2009. OMI data at solar noon were compared to ground-based spectral irradiances at Toowoomba (27°36' S 151°55' E), Australia, at 310, 324 and 380 nm for both cloud-free and all sky conditions. There was a strong relationship between the ground-based UV spectroradiometer data and satellite-based measurements with an R2 of 0.89 or better in each waveband for cloud-free days. The data show an overestimate of the satellite-derived spectral irradiances compared to the ground-based data. The models developed for the subtropical site data account for this overestimation and are essential for any data correlation between satellite- and ground-based measurements. Additionally, this research has compared solar noon broadband UVA irradiances evaluated with a model and the discrete satellite spectral irradiances for the solar noon values of cloud-free days to those measured with a ground-based UVA radiometer. An R2 of 0.86 was obtained confirming that for cloud-free days the broadband UVA can be evaluated from the OMI satellite spectral irradiances.

Minimum exposure limits and measured relationships between the vitamin D, erythema and international commission on non-ionizing radiation protection solar ultraviolet.

The International Commission on Non-Ionizing Radiation Protection (ICNIRP) has established guidelines for exposure to ultraviolet radiation in outdoor occupational settings. Spectrally weighted ICNIRP ultraviolet exposures received by the skin or eye in an 8 h period are limited to 30 J m(-2). In this study, the time required to reach the ICNIRP exposure limit was measured daily in 10 min intervals upon a horizontal plane at a subtropical Australian latitude over a full year and compared with the effective Vitamin D dose received to one-quarter of the available skin surface area for all six Fitzpatrick skin types. The comparison of measured solar ultraviolet exposures for the full range of sky conditions in the 2009 measurement period, including a major September continental dust event, show a clear relationship between the weighted ICNIRP and the effective vitamin D dose. Our results show that the horizontal plane ICNIRP ultraviolet exposure may be used under these conditions to provide minimum guidelines for the healthy moderation of vitamin D, scalable to each of the six Fitzpatrick skin types.