The effects of state policy design features on take-up and crowd-out rates for the State Children's Health Insurance Program.

We evaluate the effects of state policy design features on SCHIP take-up rates and on the degree to which SCHIP benefits crowd out private benefits. The results indicate overall program take-up rates of approximately 10 percent. However, there is considerable heterogeneity across states, suggesting a potential role of inter-state variation in policy design. We find that several design mechanisms have significant and substantial positive effects on take-up. For example, eliminating asset tests, offering continuous coverage, simplifying the application and renewal processes, and extending benefits to parents all have sizable and positive effects on take-up rates. Mandatory waiting periods, on the other hand, consistently reduce take-up rates. In all, inter-state differences in outreach and anti-crowd-out efforts explain roughly one-quarter of the cross-state variation in take-up rates. Concerning the crowding out of private health insurance benefits, we find that between one-quarter and one-third of the increase in public health insurance coverage for SCHIP-eligible children is offset by a decline in private health coverage. We find little evidence that the policy-induced variation in take-up is associated with a significant degree of crowd out, and no evidence that the negative effect on private coverage caused by state policy choices is any greater than the overall crowding-out effect. This suggests that states are not augmenting take-up rates by enrolling children that are relatively more likely to have private health insurance benefits.     

Problem boys in young adulthood: Teachers' ratings and twelve-year follow-up

In an earlier paper we reported that teachers' ratings of child guidance clinic children were associated with the children's global adjustment in young adulthood. Teachers' ratings, especially the peer relations measure, far surpassed other data sources in predicting general adult mental status. Other sources were developmental history, social history, family information, and psychiatric and psychological evaluations. The purposes of the present investigation were to evaluate mother-son reliability on adulthood information, and to determine whether teacher-rated behaviors of clinic boys predicted specific adult behaviors or were only globally related. Interviewed separately when sons were young adults, mothers and sons closely agreed on sons' adult behavior, with mothers somewhat underreporting sons' negative behaviors. The major finding was that one teacher-rated item,fails to get along with other children, was closely associated with a wide spectrum of adult behaviors. This was not due to the peer relations indicator serving as a global statistic reflecting general childhood impairment. It was also found that composite scores of childhood and adulthood bad conduct were significantly related to each other.Data collection was funded by NIMH Grant #MH-23441-02A1, and by the William T. Grant Foundation, Loretta K. Cass, Principal Investigator. The authors bear sole responsibility for the data analyses and interpretation presented here.Received Ph.D. from University of Oklahoma. Current research interests are in prediction of adult mental status from childhood indexes.Received Ph.D. from Washington University. Current research interests are in life history research, particularly alcoholism and schizophrenia.Received B. A. from Washington University.     

Detection of a primer-binding site polymorphism for the STR locus D16S539 using the Powerplex 1.1 system and validation of a degenerate primer to correct for the polymorphism

Quality assurance samples submitted from the NCSBI as part of a contract with TBTG to outsource DNA Database samples showed unexpected discrepancies for the locus D16S539 when all other loci yielded identical results. Discrepancies observed included allele drop out and an imbalance in sister alleles with samples returned from TBTG. This led to a comprehensive review of the technical procedures used between the two laboratories to determine the cause of the discrepancies noted for the locus D16S539, since both laboratories were using the PowerPlex 1.1 typing kit from the Promega Corporation. The NCSBI and the TBTG utilize different extraction methods (organic extraction vs. FTA) and amplification conditions (AmpliTaq vs AmpliTaq Gold), respectively, so the exact cause of discrepancy observed was not immediately apparent. Experiments at the NCSBI associated the observed allele drop out and the imbalance of the sister alleles with the use of AmpliTaq Gold and a hot start procedure. Sequencing data revealed that a point mutation resides on the D16S539 primer-binding site that reaches polymorphic levels in African-American populations. This led to the development of a degenerate primer by the Promega Corporation to detect "missing" alleles when AmpliTaq Gold is used. The degenerate primer was then thoroughly tested to show its efficacy in detecting the "true" D16S539 profile when used.     

Skin penetration assessment of less lethal kinetic energy munitions

The development of less-lethal technologies has provided law enforcement personnel with an alternative to lethal force. Although the less lethal projectile was produced to engender non-penetrating wounds, case studies show that there have been a number of reported penetrating injuries ranging from minor to significant in morbidity. The objective of this study was to determine the energy per unit area required to penetrate various regions of the body. Eight unembalmed postmortem human specimens were procured for this testing. Each specimen sustained a maximum of 25 impacts consisting of shots to the anterior and posterior thorax, abdomen, and legs. A 12-gauge, fin-stabilized, rubber rocket round was used as the impactor for all of the conducted tests. The energy density required for 50% risk of penetration varied from 23.99 J/cm2 for the location on the anterior rib (p = 0.000) to 52.74 J/cm2 for the location on the posterior rib (p = 0.001).     

Sudden Cardiac Death in a Young Man with Migraine-associated Arrhythmia

A 31-year-old man with migraine-induced syncope and bradycardia with subsequent pacemaker implantation died unexpectedly. Clinically unsuspected cardiac anomalies were found at autopsy including myocardial bridging of the left anterior descending artery and shelf-like coronary artery ostia. Nortriptyline was identified by toxicologic analysis. A review of the autopsy findings, the historical information, and the effects of the possible arrhythmogenic circumstances is undertaken and the potential contributions to the death are discussed. Cardiac arrhythmias have been documented during migraines. Coronary artery bridging has been known to lead to ischemia and infarction, ventricular tachycardia, and sudden death; however, these are very rare sequelae. Congenital coronary artery anomalies have been linked to sudden cardiac death, but only rarely cause death in people younger than 31 years. Migraines and the autopsy findings described have been associated with cardiac arrhythmia and sudden death. Altogether, they led to the unexpected death of this young man.     

Social integration: Approaches and issues

The World Summit for Social Development, to be held in Copenhagen in March 1995, will consider three closely inter-related themes: decreasing poverty, reducing unemployment, and enhancing social integration. With the support of the United Nations Development Programme, the United Nations Research Institute for Social Development (UNRISD) has been mobilising its worldwide network of scholars, activists, and development practitioners to promote reflection on major social issues, channel new information and ideas into the Summit preparatory process, and build public support for a successful Summit. To illustrate some of this work, we reproduce below the Summary of a Briefing Paper written by Cynthia Hewitt de Alcántara.     

Track II Diplomacy: From a Track I Perspective

Huge changes are taking place in international diplomacy which have created an opening and a certain appreciation for the contributions that can be made by private citizens to international peacemaking. This article provides a snapshot of diplomatic thinking about Track II/nonofficial diplomacy, from interviews with distinguished American diplomats. As thoughts of two-way collaboration develop, it becomes increasingly important to be clear about the limits and potentially unique contributions of Track II. Open respectful dialogue between Tracks I and II is also necessary to overcome past resentments and to develop mechanisms by which the skills and insights of Track II can be fed into Track I, with greater effectiveness and integrity.