II.

Background: This article presents the extent to which providers enrolled in California's Family Planning, Access, Care, and Treatment (Family PACT) program offer contraceptive methods onsite, thus eliminating one important access barrier. Family PACT has a diverse provider network, including public-sector providers receiving Title X funding, public-sector providers not receiving Title X funding, and private-sector providers. We explored whether Title X funding enhances providers' ability to offer contraceptive methods that require specialized skills onsite. Methods: Data were derived from 1,072 survey responses to a 2010 provider-capacity survey matched by unique identifier to administrative claims data. Results: A significantly greater proportion of Title X-funded providers compared to non-Title X public and private providers offered onsite services for the following studied methods: intrauterine contraceptives (90% Title X, 51% public non-Title X, 38% private); contraceptive implants (58% Title X, 19% public non-Title X, 7% private); vasectomy (8% Title X, 4% public non-Title X, 1% private); and fertility-awareness methods (69% Title X, 55% public non-Title X, 49% private) (all p < 0.0001). The association between onsite provision and Title X funding remained after stratifying individually by clinic specialty, facility capacity to provide reproductive health services (based on staffing), and rural/urban location. Conclusions: Extra funding for publicly funded family-planning programs, through mechanisms such as Title X, appears to be associated with increased onsite access to a wide range of contraceptive services, including those that require special skills and training.

In multifocal visually evoked potentials (mfVEP), we find reversals in waveform near the horizontal meridian due to convolutions in the cortex. This renders the mfVEP very sensitive to small changes in gaze position. In this study we tested the effects of very small amounts of fixation instability on the mfVEP topography under controlled conditions using four normal subjects. In order to simulate unstable fixation, subjects were instructed to move their fixation point systematically in a clockwise direction between the endpoints of a fixation cross every few seconds (two degree diameter cross = one degree fixation error). Results were compared against a control condition with stable, central fixation. The effects of 0.5 degrees fixation error are small, but 1.0 degrees fixation error can produce a large decrease in root mean square signal amplitude (e.g., 60%) in the central foveal region (i.e., within 1.4 degrees eccentricity). The size of the effect drops off rapidly with eccentricity and varies greatly between areas within a subject, and between the four subjects. Beyond 3.0 degrees eccentricity the effects are minimal. Unstable fixation with relatively small fixation errors caused a dramatic decrease in mfVEP amplitude within three degrees of eccentricity, which can be misinterpreted as loss of macular function. Fixation monitoring is essential to obtain accurate results in the macular area when recording mfVEPs.

No abstract