Modelling ecosystem adaptation and dangerous rates of global warming.

We are in a period of relatively rapid climate change. This poses challenges for individual species and threatens the ecosystem services that humanity relies upon. Temperature is a key stressor. In a warming climate, individual organisms may be able to shift their thermal optima through phenotypic plasticity. However, such plasticity is unlikely to be sufficient over the coming centuries. Resilience to warming will also depend on how fast the distribution of traits that define a species can adapt through other methods, in particular through redistribution of the abundance of variants within the population and through genetic evolution. In this paper, we use a simple theoretical 'trait diffusion' model to explore how the resilience of a given species to climate change depends on the initial trait diversity (biodiversity), the trait diffusion rate (mutation rate), and the lifetime of the organism. We estimate theoretical dangerous rates of continuous global warming that would exceed the ability of a species to adapt through trait diffusion, and therefore lead to a collapse in the overall productivity of the species. As the rate of adaptation through intraspecies competition and genetic evolution decreases with species lifetime, we find critical rates of change that also depend fundamentally on lifetime. Dangerous rates of warming vary from 1°C per lifetime (at low trait diffusion rate) to 8°C per lifetime (at high trait diffusion rate). We conclude that rapid climate change is liable to favour short-lived organisms (e.g. microbes) rather than longer-lived organisms (e.g. trees).

Policy implications of first-dollar coverage: a qualitative examination from the payer perspective.

OBJECTIVES: Immunization against potentially life-threatening illnesses for children and adults has proved to be one of the great public health successes of the 20th century and is extremely cost-effective. The Patient Protection and Affordable Care Act includes a number of provisions to increase coverage and access to immunizations for the consumer, including a provision for health plans to cover all Advisory Committee on Immunization Practices-recommended vaccines at first dollar, or without cost sharing. In this study, we examined payers' perspectives on first-dollar coverage of vaccines and strategies to improve vaccination rates. METHODS: This was a qualitative study, using a literature review and semistructured expert interviews with payers. RESULTS: Four key themes emerged, including (1) the cost implications of the first-dollar change; (2) the importance of examining barriers to children, adolescents, and adults separately to focus interventions more strategically; (3) the importance of provider knowledge and education in increasing immunization; and (4) the effect of first-dollar coverage on those who decline vaccination for personal reasons. CONCLUSIONS: We determined that, while reducing financial barriers through first-dollar coverage is an important first step to increasing immunization rates, there are structural and cultural barriers that also will require collaborative, strategic work among all vaccine stakeholders.

Use of emergency departments for conditions related to poor oral healthcare: implications for rural and low-resource urban areas for three states.

Persistent and worsening shortages of oral healthcare providers in rural areas, combined with limited acceptance of Medicaid and State Children's Health Insurance Programs, have left many patients without adequate access to dental care. Evidence suggests that such patients seek treatment in emergency departments (EDs) for problems that might have been prevented given adequate oral healthcare. This finding has public policy questions that are explored by this study. To investigate these questions, the State Emergency Department Databases available as part of the Healthcare Cost and Utilization Project and Area Resource Files were used, along with communication with state Medicaid offices for three diverse states: Utah, Vermont, and Wisconsin. While overall patterns of oral healthcare-seeking among the three states are similar, our research discovered important differences with implications for healthcare policy: In states with less generous Medicaid reimbursements, Medicaid beneficiaries in rural areas have ED care-seeking patterns like those of the uninsured. In more generous states, they seek care more like the privately insured. This suggests that Medicaid policy is one important tool in providing low-income and other vulnerable populations with access to higher-quality dental care.