Navigating health care: brokerage and access for undocumented Latino immigrants under the 2010 Affordable Care Act

ABSTRACT

Brokerage is a prominent mechanism that explains access for Latino immigrants to many American institutions. However, few studies examine the dual nature of brokerage in answering questions on access to health care for undocumented Latino immigrants. The growing importance of Federally Qualified Health Centers (FQHCs) and ethnic navigators connecting immigrants to health care under the 2010 Affordable Care Act calls attention to the duality of brokers and its role in access. The study draws from 44 in-depth interviews with providers, clinic directors, navigators, and immigrant patients and two years of fieldwork in FQHCs in California’s San Francisco Bay Area (2011–2013). Results show that brokers enable access through coaching and myth-busting but they also hinder it through scrutiny and bureaucratic filtering. The widespread dependence on brokerage, I argue, leads to ersatz brokerage, such as when providers navigate the health-care system for the undocumented without the appropriate linguistic resources or coordination. Furthermore, the study shows that the duality in brokerage generates misinformation, churning, and alienation. Understanding the relational processes that both include and exclude vulnerable populations from needed services enhances theories of immigrant integration and can help design more efficient policies and address inequalities related to documentation status.     

What can microblog exchanges tell us about food safety crises in China?

The affordance of microblogging services has made them an ideal tool for communicating risk and crisis. However, research on social media and risk communication is still in its infancy. This study, following the uses and gratifications framework, attempts to give some insight into the way micro-bloggers communicate about risk by investigating food safety communications on the microblogging service in China. A content analysis was conducted on 6186 microblog posts relating to 12 recent food safety incidents in China. A series of bivariate chi-square tests was conducted to test the association between micro-bloggers and gratifications. The results indicate that different types of micro-bloggers gratify different needs. Compared to other types of micro-bloggers, the general public tends to use microblogging to express opinions on food safety incidents, regulation and/or policy, rather than simply disseminating information; members of the public enjoy fewer multimedia affordances in their microblog posting but express more negative feelings. Although we anticipate growth in the use of social media in environmental health communication, caution is still needed: communication in China still follows a traditional top-down pattern.     

An Agent‐Based Model for Pathogen Persistence and Cross‐Contamination Dynamics in a Food Facility

We used an agent‐based modeling (ABM) framework and developed a mathematical model to explain the complex dynamics of microbial persistence and spread within a food facility and to aid risk managers in identifying effective mitigation options. The model explicitly considered personal hygiene practices by food handlers as well as their activities and simulated a spatially explicit dynamic system representing complex interaction patterns among food handlers, facility environment, and foods. To demonstrate the utility of the model in a decision‐making context, we created a hypothetical case study and used it to compare different risk mitigation strategies for reducing contamination and spread of Listeria monocytogenes in a food facility. Model results indicated that areas with no direct contact with foods (e.g., loading dock and restroom) can serve as contamination niches and recontaminate areas that have direct contact with food products. Furthermore, food handlers’ behaviors, including, for example, hygiene and sanitation practices, can impact the persistence of microbial contamination in the facility environment and the spread of contamination to prepared foods. Using this case study, we also demonstrated benefits of an ABM framework for addressing food safety in a complex system in which emergent system‐level responses are predicted using a bottom‐up approach that observes individual agents (e.g., food handlers) and their behaviors. Our model can be applied to a wide variety of pathogens, food commodities, and activity patterns to evaluate efficacy of food‐safety management practices and quantify contamination reductions associated with proposed mitigation strategies in food facilities.     

三种运营模式下O2O外卖服务供应链质量努力策略研究

O2O外卖作为"互联网+"时代下的新型餐饮模式，日益受到人们的关注。本文研究的O2O外卖服务供应链由一个O2O外卖平台、一个餐饮商家和一个配送骑手构成。O2O外卖平台决策平台的服务质量努力和服务费用，餐饮商家决策产品价格，骑手决策配送服务质量努力程度，同时会受到来自平台或商家的服务质量激励。通过分析商家配送、平台配送和商家自建平台+配送三种运营模式，分别构建O2O外卖服务供应链成员的利润函数，运用博弈理论，优化得到不同模式下O2O外卖服务供应链成员的最优质量控制策略和最优利润。利用公式推导和对比分析，分别探讨了骑手激励金额上限和市场规模对服务供应链最优策略和最优利润的影响。通过数值仿真，可得结论：服务供应链各成员利润均随着市场规模的增大而增大，随着骑手激励金额上限的增加而先增大后减少。当市场规模较小时，平台配送模式下商家最优利润最大。而当市场规模较大时，商家自建平台+配送模式下商家最优利润最大。     

一生多半在车船--李笠翁“苦游”四海

李笠翁一生不断搬家和出游，自谓“一生多半在车船”，当是实录。单说长游，就有五次：最早的一次是康熙三四年间游粤；紧接着是康熙五至七年游京师连着游晋秦；回金陵住了一年多后，于康熙九年游闽；又隔一年，游楚；最后是康熙十二至十三年第二次游京师。此外，笠翁还在68岁高龄时，于贫病交加之中作了一次湖州之游。在别人，外出大都是“乐”游；而在笠翁，则是“苦”游。在别人，是衣食无忧，到外面长见识，增阅历，或观赏大自然的美景；而在笠翁，则是去“就食”，即像牧民“逐水草而居”找饭吃。别人是“吃饱了饭”去游玩“消食”；而笠翁却是“饿着肚子”出游“找食”，自谓“为饥驱而走四方”。当然，“苦”中有乐，“饥驱四方，遍历名胜”；同时也有收获———除“化缘”得“食”之外，还收获了诗文，也收获了友谊。但是，笠翁出游，“苦”是主打，“乐”是陪衬；“苦”是正业，“乐”是副产品。     

Understanding Community Resilience from a PRA Perspective Using Binary Decision Diagrams

Probabilistic risk assessment (PRA) is a useful tool to assess complex interconnected systems. This article leverages the capabilities of PRA tools developed for industrial and nuclear risk analysis in community resilience evaluations by modeling the food security of a community in terms of its built environment as an integrated system. To this end, we model the performance of Gilroy, CA, a moderate‐size town, with regard to disruptions in its food supply caused by a severe earthquake. The food retailers of Gilroy, along with the electrical power network, water network elements, and bridges are considered as components of a system. Fault and event trees are constructed to model the requirements for continuous food supply to community residents and are analyzed efficiently using binary decision diagrams (BDDs). The study also identifies shortcomings in approximate classical system analysis methods in assessing community resilience. Importance factors are utilized to rank the importance of various factors to the overall risk of food insecurity. Finally, the study considers the impact of various sources of uncertainties in the hazard modeling and performance of infrastructure on food security measures. The methodology can be applicable for any existing critical infrastructure system and has potential extensions to other hazards.     

A qualitative investigation of risk and protective factors for interpersonal violence in adults on the autism spectrum

Abstract

Individuals on the autism spectrum are at an increased risk of experiencing violence. This study sought to understand the opinions of adults on the spectrum regarding potential risk and protective factors for interpersonal violence. Twenty-two adults (12 men; 18 to 53 years of age) participated in semi-structured qualitative interviews. Interviews were recorded, transcribed, and analysed. The results of the qualitative analysis identified individual and contextual risk and protective factors. Protective themes focused on individual needs (awareness of the self and the environment, interpersonal knowledge/skills, skill building strategies) and supportive contexts (benefits of a trusted person, advocates, fostering acceptance and inclusion). There is a need for strategies to decrease the vulnerability to, and the impact of, interpersonal violence. Individuals on the spectrum have the capacity to provide important information regarding safety promotion and risk factors for interpersonal violence, and their expertise should play a role in guiding efforts that promote safety.     

Food in Foster Families: Care,Communication and Conflict

This study explores the significance of food and mealtimes in relation to the transition into foster care and the therapeutic settling of the child in a new family. In doing so, we draw upon an in‐depth, qualitative case study of 10 experienced foster families in the UK focusing on what helped them to be successful. At the time of the study, there were 16 foster children, aged 9–16, living with the families. Data collection included semi‐structured qualitative interviews and audio‐diaries with all family members who wished to be involved as well as eco‐maps produced by the young people. Thematic analysis and data extracts are reproduced in the study to demonstrate that meals and food preferences can function to affirm identities, membership and boundaries of family life as well as provide a site of conflict and control.     

农村校车安全事故背后的教育公平问题

近年来农村校车事故频发,使得校车安全问题浮出了水面。其实,校车不够规范只是校车事故频发的表层原因,而更深层次的原因却在于城乡教育资源配置的不公平。所以要解决校车安全问题,不仅在于规范校车、提高校车的质量,还在于合理配置教育资源,实现城乡教育公平。     

Impact of a continuing professional development intervention on midwifery academics’ awareness of cultural safety

Background

Cultural safety in higher education learning and teaching environments is paramount to positive educational outcomes for Aboriginal and/or Torres Strait Islander (hereafter called First Peoples) students. There is a lack of research evaluating the impact of continuing professional development on midwifery academics' awareness of cultural safety.