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  1. Article ; Online: Comparing Health Care Financial Burden With an Alternative Measure of Unaffordability

    Edward S. Kielb BS / Corwin N. Rhyan MPP / James A. Lee MS

    Inquiry: The Journal of Health Care Organization, Provision, and Financing, Vol

    2017  Volume 54

    Abstract: Health insurance plans with high deductibles increase exposure to health care costs, raising concerns about how the growth in these plans may be impacting both the financial burden of health care expenditures on families and their access to health care. ... ...

    Abstract Health insurance plans with high deductibles increase exposure to health care costs, raising concerns about how the growth in these plans may be impacting both the financial burden of health care expenditures on families and their access to health care. We find that foregoing medical care is common among low-income, privately insured families, occurring at a greater rate than those with higher incomes or Medicare coverage. To better understand the relationship between out-of-pocket (OOP) spending and access, we used the 2011-2014 Medical Expenditure Panel Survey (MEPS) data and a logistic model to analyze the likelihood of avoiding or delaying needed medical care based on health insurance design and other individual and family characteristics. We find that avoiding or delaying medical care is strongly correlated with coverage under a high-deductible health plan, and with depression, poor perceived health, or poverty. However, it is relatively independent of the percent of income spent on OOP costs, making the percent of income spent on OOP costs by itself a poor measure of health care unaffordability. Individuals who spend a small percentage of their income on health care costs may still be extremely burdened by their health plan when financial concerns prevent access to health care. This work emphasizes the importance of insurance design as a predictor of access and the need to expand the definition of financial barriers to care beyond expenditures, particularly for the low-income, privately insured population.
    Keywords Public aspects of medicine ; RA1-1270
    Subject code 336 ; 360
    Language English
    Publishing date 2017-10-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Cluster K mycobacteriophages

    Welkin H Pope / Christina M Ferreira / Deborah Jacobs-Sera / Robert C Benjamin / Ariangela J Davis / Randall J DeJong / Sarah C R Elgin / Forrest R Guilfoile / Mark H Forsyth / Alexander D Harris / Samuel E Harvey / Lee E Hughes / Peter M Hynes / Arrykka S Jackson / Marilyn D Jalal / Elizabeth A MacMurray / Coreen M Manley / Molly J McDonough / Jordan L Mosier /
    Larissa J Osterbann / Hannah S Rabinowitz / Corwin N Rhyan / Daniel A Russell / Margaret S Saha / Christopher D Shaffer / Stephanie E Simon / Erika F Sims / Isabel G Tovar / Emilie G Weisser / John T Wertz / Kathleen A Weston-Hafer / Kurt E Williamson / Bo Zhang / Steven G Cresawn / Paras Jain / Mariana Piuri / William R Jacobs / Roger W Hendrix / Graham F Hatfull

    PLoS ONE, Vol 6, Iss 10, p e

    insights into the evolutionary origins of mycobacteriophage TM4.

    2011  Volume 26750

    Abstract: Five newly isolated mycobacteriophages--Angelica, CrimD, Adephagia, Anaya, and Pixie--have similar genomic architectures to mycobacteriophage TM4, a previously characterized phage that is widely used in mycobacterial genetics. The nucleotide sequence ... ...

    Abstract Five newly isolated mycobacteriophages--Angelica, CrimD, Adephagia, Anaya, and Pixie--have similar genomic architectures to mycobacteriophage TM4, a previously characterized phage that is widely used in mycobacterial genetics. The nucleotide sequence similarities warrant grouping these into Cluster K, with subdivision into three subclusters: K1, K2, and K3. Although the overall genome architectures of these phages are similar, TM4 appears to have lost at least two segments of its genome, a central region containing the integration apparatus, and a segment at the right end. This suggests that TM4 is a recent derivative of a temperate parent, resolving a long-standing conundrum about its biology, in that it was reportedly recovered from a lysogenic strain of Mycobacterium avium, but it is not capable of forming lysogens in any mycobacterial host. Like TM4, all of the Cluster K phages infect both fast- and slow-growing mycobacteria, and all of them--with the exception of TM4--form stable lysogens in both Mycobacterium smegmatis and Mycobacterium tuberculosis; immunity assays show that all five of these phages share the same immune specificity. TM4 infects these lysogens suggesting that it was either derived from a heteroimmune temperate parent or that it has acquired a virulent phenotype. We have also characterized a widely-used conditionally replicating derivative of TM4 and identified mutations conferring the temperature-sensitive phenotype. All of the Cluster K phages contain a series of well conserved 13 bp repeats associated with the translation initiation sites of a subset of the genes; approximately one half of these contain an additional sequence feature composed of imperfectly conserved 17 bp inverted repeats separated by a variable spacer. The K1 phages integrate into the host tmRNA and the Cluster K phages represent potential new tools for the genetics of M. tuberculosis and related species.
    Keywords Medicine ; R ; Science ; Q
    Subject code 572
    Language English
    Publishing date 2011-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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