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.     

A reduced form of the Workplace Bullying Scale – the EAPA-T-R: A useful instrument for daily diary and experience sampling studies

The need for more longitudinal studies (i.e. daily diary and experience sampling studies) focused on counterproductive work behaviours such as bullying requires shorter scales that at the same time do not compromise their content validity. Our main objective is to develop and validate a reduced version of the Workplace Bullying Scale (Escala de Abuso Psicológico Aplicado en el Lugar de Trabajo): the EAPA-T-R. Two studies (Study 1: 1506 and Study 2: 932 employees, respectively) were conducted to evaluate its psychometric properties and to ensure the external validity of the EAPA-T-R. Correlation and regression analyses were performed to reduce the current 12-item scale to a more parsimonious 4-item scale. Moreover, the psychometric properties of potential models were compared. Subsequently, the new scale was assessed using confirmatory factor analysis. Likewise, statistically significant relationships were found between the EAPA-T-R and other dimensions evaluated, such as job characteristics, transformational leadership, engagement, job satisfaction, and subjective performance. Moreover, bullying mediated the relationship between transformational leadership and burnout. To sum up, the EAPA-T-R showed good reliability and validity across studies, supporting its use in future research. The benefits of this short scale for daily diary and experience sampling studies and when using large surveys are discussed.     

Open innovation and quality management: the moderating role of interorganisational IT infrastructure and complementary learning styles

This study seeks to explain the influence of quality management on the relationship between open innovation and performance. We propose that, to contribute to open innovation performance, an organisation’s commitment to quality improvement must rely on the combination of its own resources and capabilities and its open innovation partners’ resources and capabilities. Specifically, we examine the moderating role of an interorganisational IT infrastructure and the complementarity of learning styles among an organisation committed to quality improvement and its supply network. Using data from 270 managers of European firms, our results show that the negative effects of quality management on open innovation performance can be overcome by complementing the organisation’s learning style with that of its open innovation partner, particularly, its supply network, and, most importantly, obtaining information technologies compatible with those of its supply network members.     

Generating a smallest binary tree by proper selection of the longest edges to bisect in a unit simplex refinement

In several areas like global optimization using branch-and-bound methods for mixture design, the unit n-simplex is refined by longest edge bisection (LEB). This process provides a binary search tree. For \(n>2\), simplices appearing during the refinement process can have more than one longest edge (LE). The size of the resulting binary tree depends on the specific sequence of bisected longest edges. The questions are how to calculate the size of one of the smallest binary trees generated by LEB and how to find the corresponding sequence of LEs to bisect, which can be represented by a set of LE indices. Algorithms answering these questions are presented here. We focus on sets of LE indices that are repeated at a level of the binary tree. A set of LEs was presented in Aparicio et al. (Informatica 26(1):17–32, 2015), for \(n=3\). An additional question is whether this set is the best one under the so-called \(m_k\)-valid condition.     

Fast parallel $$\alpha $$-stable distribution function evaluation and parameter estimation using OpenCL in GPGPUs

\(\alpha \)-Stable distributions are a family of probability distributions found to be suitable to model many complex processes and phenomena in several research fields, such as medicine, physics, finance and networking, among others. However, the lack of closed expressions makes their evaluation analytically intractable, and alternative approaches are computationally expensive. Existing numerical programs are not fast enough for certain applications and do not make use of the parallel power of general purpose graphic processing units. In this paper, we develop novel parallel algorithms for the probability density function and cumulative distribution function—including a parallel Gauss–Kronrod quadrature—, quantile function, random number generator and maximum likelihood estimation of \(\alpha \)-stable distributions using OpenCL, achieving significant speedups and precision in all cases. Thanks to the use of OpenCL, we also evaluate the results of our library with different GPU architectures.     

Statistical modeling for Bayesian extrapolation of adult clinical trial information in pediatric drug evaluation

Children represent a large underserved population of “therapeutic orphans,” as an estimated 80% of children are treated off‐label. However, pediatric drug development often faces substantial challenges, including economic, logistical, technical, and ethical barriers, among others. Among many efforts trying to remove these barriers, increased recent attention has been paid to extrapolation; that is, the leveraging of available data from adults or older age groups to draw conclusions for the pediatric population. The Bayesian statistical paradigm is natural in this setting, as it permits the combining (or “borrowing”) of information across disparate sources, such as the adult and pediatric data. In this paper, authored by the pediatric subteam of the Drug Information Association Bayesian Scientific Working Group and Adaptive Design Working Group, we develop, illustrate, and provide suggestions on Bayesian statistical methods that could be used to design improved pediatric development programs that use all available information in the most efficient manner. A variety of relevant Bayesian approaches are described, several of which are illustrated through 2 case studies: extrapolating adult efficacy data to expand the labeling for Remicade to include pediatric ulcerative colitis and extrapolating adult exposure‐response information for antiepileptic drugs to pediatrics.     

The gender gap in pensions in Latin America

Lower female lifetime labour market participation rates, greater interruptions during their working lives, and wage gaps contribute to create gender gaps in pensions at the time of retirement. The design of social security systems may reinforce or attenuate these gaps. This article provides new evidence on gender gaps in access to pensions and in pension income in four Southern Cone countries in Latin America and analyses their evolution between 2000 and 2013, showing significant improvements in both gaps, with differential patterns by countries. The decrease in the gender gap in pension income has been particularly significant in Argentina and Brazil. In both cases, the largest increases in pension values during the period correspond to the lowest income percentiles, where women are overrepresented. The application of redistributive policies in these countries, aimed at reducing poverty and inequality but not necessarily focused on gender equity, has had positive and probably unintended consequences in terms of reduction in gender gaps in pensions.     

Bayesian robustness of the compound Poisson distribution under bidimensional prior: an application to the collective risk model

The distribution of the aggregate claims in one year plays an important role in Actuarial Statistics for computing, for example, insurance premiums when both the number and size of the claims must be implemented into the model. When the number of claims follows a Poisson distribution the aggregated distribution is called the compound Poisson distribution. In this article we assume that the claim size follows an exponential distribution and later we make an extensive study of this model by assuming a bidimensional prior distribution for the parameters of the Poisson and exponential distribution with marginal gamma. This study carries us to obtain expressions for net premiums, marginal and posterior distributions in terms of some well-known special functions used in statistics. Later, a Bayesian robustness study of this model is made. Bayesian robustness on bidimensional models was deeply treated in the 1990s, producing numerous results, but few applications dealing with this problem can be found in the literature.     

The t-information and its use in multivariate problems and time-series analysis

The second moment of recently introduced scalar inference function can be viewed as generalized Fisher information of the continuous probability distributions. In this paper we call it the t-information and give some possible applications of the new concept.