The Establishment of Fibrolytic Bacteria in the Foal Gastrointestinal Tract Is Related to the Occurrence of Coprophagy by Foals.

The consumption of maternal feces (coprophagy) is commonly observed in healthy foals and is a proposed contributor to microbial colonization of the foal's gastrointestinal tract (GIT). This study investigated the role of coprophagy in the establishment of fibrolytic bacteria in the foal GIT. Nine thoroughbred mares were dosed with chromic oxide, an indigestible marker, as a method to detect the occurrence of coprophagy by their foals. Foal fecal samples were collected from 12 h to 21 d after birth to measure chromic oxide and neutral detergent fiber (NDF) and to enumerate cellulolytic bacteria using culture-based techniques. Milk yield was estimated at 7 and 14 d postpartum. Coprophagy was detected as early as 3 d after birth and detected in all foals by 7 d of age. There were strong relationships between coprophagy and cellulolytic bacteria and NDF in foal feces at 7 d of age (r = 0.9703 and r = 0.7878, respectively; p < 0.05). Fecal NDF and chromic oxide concentrations were negatively related to milk yield (r = -0.8144 and r = -0.6966, respectively; p < 0.05), suggesting milk availability affected the incidence of coprophagy. Based on the relationships identified, maternal feces are an important source of fiber and live microbes for the foal, contributing to the development of the microbial community.

Defendants with intellectual disability and autism spectrum conditions: the perspective of clinicians working across three jurisdictions.

The treatment of vulnerable defendants by criminal justice systems or correctional systems varies within and between countries. The purpose of this paper is to examine three legal jurisdictions - New South Wales in Australia; Norway; England and Wales - to understand the extent of variation in practice within the court systems for defendants with intellectual disabilities (ID) and/or autism spectrum conditions (ASC). Two of the jurisdictions had a process for screening in place, either in police custody or at court, but this was not universally implemented across each jurisdiction. All three jurisdictions had a process for supporting vulnerable defendants through the legal system. Across the three jurisdictions, there was variation in disposal options from a mandatory care setting to hospital treatment to a custodial sentence for serious offences. This variation requires further international exploration to ensure the rights of defendants with ID or ASC are understood and safeguarded.

Technical Note: A method for determination of titanium dioxide concentration in fecal samples.

Titanium dioxide has been used as a marker for determining diet digestibility indirectly, but some authors have expressed difficulty in measuring TiO2 concentrations in fecal material. We developed an accurate and precise method to determine TiO2 concentrations in equine feces. The method includes dry-ashing samples, digestion with (NH4)2SO4 in concentrated sulfuric acid, followed by the addition of H2O2 to produce a yellow to orange color that can be read spectrophotometrically. Accuracy was tested by spike recovery, and precision was tested by examining the coefficient of variation (CV) between duplicates of 449 individual samples. The method described here was compared with a previously published method by examining CV between duplicates of samples analyzed using both methods and comparing them using a paired t-test. Titanium dioxide spike recovery averaged 106%, and the CV between duplicates averaged 4.0%, with 79% of sample pairs having a CV of <5%. When compared with a previously published method, the method described here had a lower CV between duplicates (P < 0.0001). The method described here provides an accurate and precise quantitative analytical procedure for TiO2 in equine fecal samples.

Titanium dioxide is a marker fed to animals to help determine diet digestibility indirectly by measuring the concentration of TiO2 in fecal samples. This paper describes an accurate and precise method to analyze TiO2 in equine feces. The precision of this method is demonstrated by the low variation between sample duplicates. This method requires fewer sample replicates for analysis, leading to less labor, expense, and waste in the laboratory.

Predictors of loss due to pharmaceutical fraud: evidence from the U.S.

BACKGROUND: Globally and in the U.S. in particular, pharmaceutical fraud account for a large number out of all crimes in health care, which result into severe costs to the society. The Academy of Managed Care Pharmacists (Fraud, waste, and abuse in prescription drug benefits. 2019. Posted May 20. https://www.amcp.org/policy-advocacy/policy-advocacy-focus-areas/where-we-stand-position-statements/fraud-waste-and-abuse-prescription-drug-benefits .) estimate that pharmacy fraud is 1% of costs, therefore estimating that pharmacy fraud costs at $3.5 billion, given that pharmacy costs are $358 billion (Statista. Prescription drug expenditure in the United States from 1960 to 2020. 2021. https://www.statista.com/statistics/184914/prescription-drug-expenditures-in-the-us-since-1960/ ). AIM: This exploratory study aims to demonstrate a fraudster's profile as well as to estimate average consequences in terms of costs and identify the loss predictors' hierarchy in the pharmaceutical industry in the U.S. MATERIALS AND METHODS: Data from the Corporate Prosecution Registry and mixed-effects models are utilized for this purpose. The dataset covers years 2001-2020 and 75 cases, falling into one of the following broad sub-categories: misbranding, counterfeit, off-label use of drugs/deceptive marketing; violation of the Food, Drug and Cosmetic Act. RESULTS: The main factors positively associated with loss due to pharmaceutical fraud are: (i) duration of , and (ii) the scheme and scheme being executed at a U.S. public company. Surprisingly, presence of collusion negatively and significantly effects the cost. Potential factors include: (a) principal perpetrator being a white American and/or male, and (b) number of employees at individual and organizational level respectively. CONCLUSION: This study empirically justifies considering loss, due to pharmaceutical fraud, from a multi-level perspective. Identified profiles of a typical fraudster helped to elaborate on specific practical recommendations aimed at pharmaceutical fraud prevention in the U.S.

Evaluation of Racial, Ethnic, and Socioeconomic Disparities in Initiation of Kidney Failure Treatment During the First 4 Months of the COVID-19 Pandemic.

Importance: Persons with kidney failure require treatment (ie, dialysis or transplantation) for survival. The burden of the COVID-19 pandemic and pandemic-related disruptions in care have disproportionately affected racial and ethnic minority and socially disadvantaged populations, raising the importance of understanding disparities in treatment initiation for kidney failure during the pandemic. Objective: To examine changes in the number and demographic characteristics of patients initiating treatment for incident kidney failure following the COVID-19 pandemic by race and ethnicity, county-level COVID-19 mortality rate, and neighborhood-level social disadvantage. Design, Setting, and Participants: This cross-sectional time-trend study used data from US patients who developed kidney failure between January 1, 2018, and June 30, 2020. Data were analyzed between January and July 2021. Exposures: COVID-19 pandemic. Main Outcomes and Measures: Number of patients initiating treatment for incident kidney failure and mean estimated glomerular filtration rate (eGFR) at treatment initiation. Results: The study population included 127 149 patients with incident kidney failure between January 1, 2018, and June 30, 2020 (mean [SD] age, 62.8 [15.3] years; 53 021 [41.7%] female, 32 932 [25.9%] non-Hispanic Black, and 19 835 [15.6%] Hispanic/Latino patients). Compared with the pre-COVID-19 period, in the first 4 months of the pandemic (ie, March 1 through June 30, 2020), there were significant decreases in the proportion of patients with incident kidney failure receiving preemptive transplantation (1805 [2.1%] pre-COVID-19 vs 551 [1.4%] during COVID-19; P < .001) and initiating hemodialysis treatment with an arteriovenous fistula (2430 [15.8%] pre-COVID-19 vs 914 [13.4%] during COVID-19; P < .001). The mean (SD) eGFR at initiation declined from 9.6 (5.0) mL/min/1.73 m2 to 9.5 (4.9) mL/min/1.73 m2 during the pandemic (P < .001). In stratified analyses by race/ethnicity, these declines were exclusively observed among non-Hispanic Black patients (mean [SD] eGFR: 8.4 [4.6] mL/min/1.73 m2 pre-COVID-19 vs 8.1 [4.5] mL/min/1.73 m2 during COVID-19; P < .001). There were significant declines in eGFR at initiation for patients residing in counties in the highest quintile of COVID-19 mortality rates (9.5 [5.0] mL/min/1.73 m2 pre-COVID-19 vs 9.2 [5.0] mL/min/1.73 m2 during COVID-19; P < .001), but not for patients residing in other counties. The number of patients initiating treatment for incident kidney failure was approximately 30% lower than projected in April 2020. Conclusions and Relevance: In this cross-sectional study of US adults, the COVID-19 pandemic was associated with a substantially lower number of patients initiating treatment for incident kidney failure and treatment initiation at lower levels of kidney function during the first 4 months, particularly for Black patients and people living in counties with high COVID-19 mortality rates.

Analysing Texture in Portraits.

This case study is an initial exploration as to whether the depiction of texture in a set of portraits, all portraying the same Sitter, is related to the familiar likeness assessments reported in a companion paper containing a principal component analysis (PCA) of the portraits' depiction of shape. Somewhat unexpectedly, a texture PCA failed to discriminate the high from low likeness portraits, despite experimentation with different pre-processing methods to reduce the portraits' high level of uninformative, image-level texture variability. There were some findings arising from these analyses, and while only indicative at this stage, include that linear histogram matching is effective in reducing variability in portrait brightness; that depicting, and perhaps exaggerating, shading relating to lighting direction may enhance portrait likeness; and, that whether minimised or exaggerated, lighting direction can be portrayed somewhat anomalously. Furthermore, and in agreement with findings from photographs, shape and texture were not found to be independent variables, and shape-free image registration, while very usefully enabling a comparison of closely corresponding pixel coordinate values, could itself be a confounding factor for undertaking a texture PCA with portraits produced under relatively ambient conditions.

COVID-19 Contact Tracing in Two Counties - North Carolina, June-July 2020.

Contact tracing is a strategy implemented to minimize the spread of communicable diseases (1,2). Prompt contact tracing, testing, and self-quarantine can reduce the transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (3,4). Community engagement is important to encourage participation in and cooperation with SARS-CoV-2 contact tracing (5). Substantial investments have been made to scale up contact tracing for COVID-19 in the United States. During June 1-July 12, 2020, the incidence of COVID-19 cases in North Carolina increased 183%, from seven to 19 per 100,000 persons per day* (6). To assess local COVID-19 contact tracing implementation, data from two counties in North Carolina were analyzed during a period of high incidence. Health department staff members investigated 5,514 (77%) persons with COVID-19 in Mecklenburg County and 584 (99%) in Randolph Counties. No contacts were reported for 48% of cases in Mecklenburg and for 35% in Randolph. Among contacts provided, 25% in Mecklenburg and 48% in Randolph could not be reached by telephone and were classified as nonresponsive after at least one attempt on 3 consecutive days of failed attempts. The median interval from specimen collection from the index patient to notification of identified contacts was 6 days in both counties. Despite aggressive efforts by health department staff members to perform case investigations and contact tracing, many persons with COVID-19 did not report contacts, and many contacts were not reached. These findings indicate that improved timeliness of contact tracing, community engagement, and increased use of community-wide mitigation are needed to interrupt SARS-CoV-2 transmission.

Likeness, Familiarity, and the Ambient Portrait Average.

This artist-led research project involved 10 visual artists producing 10 ambient portraits and a portrait average of a locally familiar Sitter, and 10 ambient portraits and a portrait average of a less locally familiar Sitter. All were then assessed for likeness by more than 150 members of the general public attending an exhibition during Australia's 2018 National Science Week. The results of this study are that portrait averages can be highly shape accurate and tend to be seen as a good likeness by all viewers. However, the portrait average is not necessarily the best likeness. Extending and validating our previous findings regarding the relationship of likeness, familiarity, and shape accuracy (as measured using geometric morphometrics) in portraiture, unfamiliar viewers favouring shape accurate depictions of a Sitter attained statistical significance. Familiar viewers, however, although also tending to view shape accurate depictions a good to very good likeness, were shown to have a stronger preference for portraits that exaggerate a Sitter's facial distinctiveness, including an exaggeration of their head pose, providing such exaggerations are in approximate proportional agreement.

Interrelationships Between Age and Trace Element Concentration in Horse Mane Hair and Whole Blood.

The use of hair as a sample matrix to determine the mineral status of an animal has received a lot of interest. The objective of this study was to determine if the trace element content in horse mane hair changed with age when evaluated in a group of horses representing a large age range. As a second objective, whole blood trace element content was evaluated, and its relationship to mane hair trace element content, as well as age, were tested. Therefore, mane hair and whole blood samples were obtained from 59 horses, ranging from 2 months to 26 years in age, housed on the same farm. Mane hair samples were washed, and hair and blood digested and analyzed for 11 trace elements. Weak correlations (P < .05) between age and mane hair trace element content was detected for arsenic (r = 0.29), copper (r = -0.39) and selenium (r = -0.27). While the mane hair color did not affect trace element concentration, greater variability was detected in the black mane hair samples. This resulted in outliers that were removed from the final statistical analysis. However, data is presented to the reader both ways. Correlations were also detected (P < .05) between age and whole blood iron (r = 0.62), selenium (r = 0.76) and zinc (r = 0.47). This is similar to what has been reported in horses using serum or plasma. The trace element concentrations of mane hair and whole blood were not correlated (P > .05) in this study. However, the concentrations of trace elements in mane hair were higher than that of blood. Trace elements, specifically chromium and lead, that were below detection levels in the blood, were detectable in mane hair. This suggests that mane hair may be a potential means to investigate suspected exposure to excessive levels of trace minerals or heavy metals that are difficult to detect in blood.

Relationships Between Measurements of Body Fat in Thoroughbred Horses.

Equine obesity is increasing in prevalence, and weight loss diets are frequently recommended for these horses. However, there are also management situations in which horses are deemed to be too thin. To monitor the efficacy of weight change programs, estimates of body fat are often made. There are several systems available to estimate body fat, and there are benefits and challenges to using each method. The objective of this study was to compare four different methods of estimating body fat in Thoroughbred horses. In 14 mature Thoroughbred horses, relationships among body condition score (BCS), morphometric measurements, ultrasonic measures of subcutaneous fat depots, and estimation of total body fat (BFD) via measurement of total body water through deuterium oxide dilution were evaluated. Body condition scores ranged from 4.5 to 6.5 on a 9-point scale. Body condition score, heart girth-to-body weight ratio, and BFD were all positively correlated with each other (P < .05). Subcutaneous fat depth at the tailhead tended to be positively related to BFD when only horses with BCS ≥ 5 were included (P = .0680). These data suggest that BCS remains a simple means of monitoring adiposity in mature horses in moderate condition. Tailhead fat depots may become useful for monitoring changes in body fat in Thoroughbreds with a BCS above 5, although more work with animals of higher adiposity is required and at different times of year.

Phosphorus excretion by mares post-lactation.

Across the equine literature, estimates of true P digestibility range from -23% to 79%. This large range cannot be explained by differences in P intake or phytate-P intake alone. However, differences in endogenous P secretion into the GI tract may explain the variation. In horses, excess absorbed P is not excreted in the urine but is re-secreted into the GI tract, increasing faecal P and leading to estimates of low P digestibility. Thus, accurate estimates of P digestibility can only be obtained if absorbed P is retained in the horse. The objective of this study was to examine P digestibility in post-lactational mares and control mares that were fed similar amounts of P. It was hypothesized that post-lactational mares would have greater P retention and higher apparent P digestibility than control mares. Prior to the study, four lactating and four non-lactating mares were fed a diet that provided 100% of the control mares' P requirement, but only 55% of the lactating mares' P requirement. During the study, both groups were fed P at the rate recommended for non-lactating mares. Post-lactational mares did not retain more P than control mares but tended to excrete more P than control mares (p = .082), presumably due to differences in endogenous P secretion into the GI tract. Metabolic changes occurring during mammary gland involution may have contributed to the increase in P excretion. However, faecal P excretion exceeded P intake in both groups (p = .08) and both groups lost weight during the study. Tissue mobilization during weight loss may have influenced P secretion into the GI tract.

Effect of Starch Source in Pelleted Concentrates on Fecal Bacteria in Prepartum and Postpartum Mares.

Dietary starch source has been shown to affect fecal bacterial communities of horses fed minimally processed cereal grains. However, processing may increase foregut starch digestibility, reducing effects of starch source on fecal bacterial communities. This study aimed to determine the effect of starch source in pelleted concentrates on fecal Lactobacillus spp., amylolytic bacteria, and cellulolytic bacteria in broodmares mares, during the prepartum and postpartum period. Thoroughbred mares (n = 18) were paired by last breeding date then randomly assigned to either an oat-based or a corn and wheat middlings-based pelleted concentrate fed with forage. Mares were fed their assigned concentrates beginning on 310 days of gestation, and fecal samples were collected at 324 days of gestation, before parturition, 1 day, 14 days, and 28 days postpartum. Fecal samples were enumerated by serial dilution and inoculation into selective, enriched media for Lactobacillus spp., amylolytic bacteria, and cellulolytic bacteria. Data were log transformed then analyzed using a mixed model ANOVA with repeated measures (SAS 9.3) to test the main effects of treatment, time of sample, and treatment by time interaction. Starch source did not affect enumerated bacterial communities (P > .05); thus, pelleting concentrates may alter some of the effects of starch sources on the hindgut microbiota. Sample date did not affect amylolytic bacteria (P > .05); however, lactobacilli and cellulolytic bacteria decreased 1 day postpartum (P < .05). Although we did not observe an effect of starch source on fecal bacteria in mares, parturition did appear to alter the hindgut microbiota.

Effect of maternal diet on select fecal bacteria of foals.

Adult horses depend on the microbial community in the hindgut to digest fiber and produce short-chain fatty acids that are use for energy. Colonization of the foal gastrointestinal tract is essential to develop this symbiosis. However, factors affecting colonization are not well understood. The objectives of this study were to evaluate the age-related changes and effects of maternal diet on select fecal bacterial groups in foals from 1 to 28 d of age. Thoroughbred foals (n = 18) were from dams fed forage and one of two concentrates: an oat-based (OB) or corn and wheat middlings-based (CWB) pelleted concentrate. The mares had access to assigned concentrates, along with a mixed hay and cool-season grass pasture, 28 d before and 28 d after parturition. Fecal samples were collected from foals at 1 d (14 to 36 h), 4, 14, and 28 d after birth. Fecal samples were serially diluted with phosphate-buffered saline before inoculation of enriched, selective media to enumerate Lactobacillus spp., amylolytic bacteria, and cellulolytic bacteria. Enumeration data were log-transformed then analyzed with mixed model analysis of variance with repeated measures (SAS 9.3) to test the main effects of maternal diet (OB or CWB), time of sample, and interaction between maternal diet and time. Cellulolytic bacteria first appeared in foal feces between 4 and 14 d of age and increased with age (P < 0.05). Amylolytic bacteria and lactobacilli were abundant at 1 d and then increased with age (P < 0.05). There was an interaction between maternal diet and time for Lactobacillus spp. with OB foals having more lactobacilli than CWB foals at 1 and 4 d (P < 0.05); however, there were no differences observed at 14 d (P > 0.05). Maternal diet did not influence amylolytic or cellulolytic bacteria (P > 0.05). These results indicate that colonization of the hindgut is a sequential process beginning early in the foal's life and that maternal diet may influence some bacteria in the gastrointestinal tract of foals.

Are people with amyotrophic lateral sclerosis (ALS) particularly nice? An international online case-control study of the Big Five personality factors.

BACKGROUND: Many people with ALS have been suggested to have a "nice" personality, but most ALS personality studies to date have had limited numbers of participants and have not taken into account personality differences between genders. We used Big Five Inventory data obtained from an online questionnaire looking for risk factors for ALS to investigate personality traits in large numbers of people with ALS and controls. METHODS: A total of 741 questionnaire respondents aged 40 years and over indicated the extent to which they agreed with each of the 44 Big Five Inventory statements. Respondents were 339 with ALS (212 male, 127 female) who responded to the statements as they applied to them before their diagnosis and 402 controls (120 male, 282 female). Unpaired t tests with 95% confidence intervals were used to compare mean values of Big Five-factor scores. RESULTS: Female respondents taken together had higher mean scores for Agreeableness and Neuroticism than all male respondents. Male ALS respondents had higher mean scores than male controls for Conscientiousness and Extraversion. Female ALS respondents had higher mean scores than female controls for Agreeableness, Conscientiousness, and Extraversion, and a lower score for Neuroticism. CONCLUSIONS: Many people with ALS have personality traits that are likely to underlie the perception they are particularly "nice." This raises the possibility that genetic polymorphisms that influence personality could play a role in ALS. Furthermore, different personality traits could underlie lifestyle choices that are currently thought to be risk factors for ALS.

Is psychological stress a predisposing factor for amyotrophic lateral sclerosis (ALS)? An online international case-control study of premorbid life events, occupational stress, resilience and anxiety.

Psychological stress has been suggested to be relevant to the pathogenesis of neurodegenerative disorders, possibly via the generation of oxygen free radicals. We therefore sought to determine whether people with amyotrophic lateral sclerosis (ALS) had been subjected to more potentially stressful life events or occupations than controls, and whether they had differences in resilience or trait anxiety that would moderate their responses to these stressors. An online anonymous multilingual questionnaire was used to collect data on significant life events from people with and without ALS, using items from a modified Social Readjustment Rating Scale and from self-described significant events, which were combined to create a Life Events Inventory. Inventory scores were subdivided into 0-20 years and 21-40 years age ranges, and for the preceding 2, 5 and 10 years. Respondents also rated levels of stress experienced during different occupations. Resilience was measured using the Connor-Davidson Resilience Scale, and trait anxiety with a modified Geriatric Anxiety Inventory. Scores were compared using nonparametric statistics. Data from 400 ALS (251 male, 149 female) and 450 control (130 male, 320 female) respondents aged 40 years and over showed that Life Events Inventory scores were similar in male ALS respondents and controls, but lower in female ALS respondents than female controls for the preceding 5-year and 10-year periods. Occupational stress did not differ between ALS respondents and controls. Both male and female ALS respondents had higher resilience scores than controls. Anxiety scores did not differ between ALS and control groups. In conclusion, people with ALS reported no raised levels of potentially stressful premorbid life events or occupational stress, and did not have reduced levels of resilience, or increased levels of anxiety, that would augment the deleterious effects of stressors. On the contrary, ALS respondents had higher resilience than controls, though this conclusion relies on ALS respondents recalling their premorbid status. These results do not support the hypothesis that psychological stress from significant life events or occupational stress plays a role in the pathogenesis of ALS.

Variation and Likeness in Ambient Artistic Portraiture.

An artist-led exploration of portrait accuracy and likeness involved 12 Artists producing 12 portraits referencing a life-size 3D print of the same Sitter. The works were assessed during a public exhibition, and the resulting likeness assessments were compared to portrait accuracy as measured using geometric morphometrics (statistical shape analysis). Our results are that, independently of the assessors' prior familiarity with the Sitter's face, the likeness judgements tended to be higher for less morphologically accurate portraits. The two highest rated were the portrait that most exaggerated the Sitter's distinctive features, and a portrait that was a more accurate (but not the most accurate) depiction. In keeping with research showing photograph likeness assessments involve recognition, we found familiar assessors rated the two highest ranked portraits even higher than those with some or no familiarity. In contrast, those lacking prior familiarity with the Sitter's face showed greater favour for the portrait with the highest morphological accuracy, and therefore most likely engaged in face-matching with the exhibited 3D print. Furthermore, our research indicates that abstraction in portraiture may not enhance likeness, and we found that when our 12 highly diverse portraits were statistically averaged, this resulted in a portrait that is more morphologically accurate than any of the individual artworks comprising the average.

What's at Stake: States' Progress on Health Coverage and Access to Care, 2013­2016.

Issue: Given uncertainty about the future of the Affordable Care Act, it is useful to examine the progress in coverage and access made under the law. Goal: Compare state trends in access to affordable health care between 2013 and 2016. Methods: Analysis of recent data from the U.S. Census Bureau and the Behavioral Risk Factor Surveillance System. Findings and Conclusions: Between 2013 and 2016, the uninsured rate for adults ages 19 to 64 declined in all states and the District of Columbia, and fell by at least 5 percentage points in 47 states. Among children, uninsured rates declined by at least 2 percentage points in 33 states. There were reductions of at least 2 percentage points in the share of adults age 18 and older who reported skipping care because of costs in the past year in 36 states and D.C., with greater declines, on average, in Medicaid expansion states. The share of at-risk adults without a recent routine checkup, and of nonelderly individuals who spent a high portion of income on medical care, declined in at least of half of states and D.C. These findings offer evidence that the ACA has improved access to health care for millions of Americans. However, actions at the federal level ­ including a shortened open enrollment period for marketplace coverage, a failure to extend CHIP funding, and a potential repeal of the individual mandate's penalties ­ could jeopardize the gains made to date.

Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference?

ISSUE: Prior to the Affordable Care Act (ACA), blacks and Hispanics were more likely than whites to face barriers in access to health care. GOAL: Assess the effect of the ACA's major coverage expansions on disparities in access to care among adults. METHODS: Analysis of nationally representative data from the American Community Survey and the Behavioral Risk Factor Surveillance System. FINDINGS AND CONCLUSIONS: Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider. Disparities were narrower, and the average rate on each of the three indicators for whites, blacks, and Hispanics was lower in both 2013 and 2015 in states that expanded Medicaid under the ACA than in states that did not expand. Among Hispanics, disparities tended to narrow more between 2013 and 2015 in expansion states than nonexpansion states. The ACA's coverage expansions were associated with increased access to care and reduced racial and ethnic disparities in access to care, with generally greater improvements in Medicaid expansion states.

A geometric morphometric evaluation of the Belanglo 'Angel' facial approximation.

In August 2011, a 2D facial approximation was undertaken of remains discovered in Australia's Belanglo State Forrest; in October 2015, the young woman was identified. Referencing three photographs of the young woman as she appeared in life and a database of 64 sex, age, head pose and population matched images, the facial approximation is evaluated for relative shape accuracy through the application of geometric morphometrics. The results are that the facial approximation is significantly similar to the images of the young woman in facial morphology (p=0.002) when most of the variance due to depicted head pose is removed from the analyses. The geometric morphometric analyses, however, also highlight the facial approximation's face and feature discrepancies, some of which would have likely disrupted familiar face recognition. Although predominantly verified methods were applied in 2011, they are limited in their predictive accuracy, not every feature of the face has a verified method to apply, and practitioner errors as well as photographic distortions are apparent. Furthermore, an assumption that the verified methods require inter-feature agreement (in this instance eye spacing and mouth width) was proved to be false. Overall this study shows that it is possible to assess the morphological accuracy of a forensic facial approximation when a number of antemortem images are available, though the influence of photographic distortion within 2D photographs will always preclude a precise metric assessment.