WorldWideScience

Sample records for state payer mandates

  1. State Mandated versus a Locally Determined Curriculum.

    Science.gov (United States)

    Ediger, Marlow

    The advantages and disadvantages of state mandated and locally developed curricula are discussed. State mandates emphasize a measurement philosophy of education in which testing is the name of the game to determine how well students are achieving. One of the advantages of a state mandated curriculum is that the curriculum is aligned with the…

  2. Why State Mandates Don't Work.

    Science.gov (United States)

    Kelly, Thomas F.

    1999-01-01

    No external force or authority can make an organization excellent. Leadership's role is to persuade an organization's members to strive for excellence. This explains the failure of coercive state mandates for teacher evaluation, testing, academic standards, and foreign-language requirements. A new leadership model is desperately needed. (MLH)

  3. Mandated State-Level Open Government Training Programs

    Science.gov (United States)

    Kimball, Michele Bush

    2011-01-01

    Although every state in the country has recognized the importance of government transparency by enacting open government provisions, few of those statutes require training programs to encourage records custodians to comply with the law. Ten states mandate training in how to legally respond to public records requests, and some mandates are stronger…

  4. Orphan drug pricing and payer management in the United States: are we approaching the tipping point?

    Science.gov (United States)

    Hyde, Rebecca; Dobrovolny, Diana

    2010-01-01

    The Orphan Drug Act of 1983 paved the way for the development of drugs that treat rare diseases, defined in the United States as those affecting fewer than 200,000 patients. Orphan drugs can cost hundreds of thousands of dollars annually, but insurers have traditionally covered these therapies because the small populations involved did not typically lead to significant cost exposure. Payer sensitivity to the cost of orphan drugs is rising, however, with the accelerated rate of new launches of these agents amid intensified economic pressure. Payers are showing increasing levels of concern and scrutiny about coverage of orphan drugs. A new payer survey conducted between February 2008 and March 2009 provides insights on how payers are managing orphan drugs and the way it is likely to evolve in the future. Survey findings show that the patient share of orphan drug costs is rising and is expected to continue to rise, barring sweeping changes in public health policy. This shift in benefit design could affect patient access to orphan agents and, therefore, drug utilization. Manufacturers will have to invest in research to understand payer impact on the uptake of their orphan drugs in development. They will also benefit from being prepared to develop strategies to ensure patient access to and affordability of their orphan agents.

  5. The state of internal audit’s regulatory mandate

    Directory of Open Access Journals (Sweden)

    Christo Ackermann

    2016-08-01

    Full Text Available The importance of an effective internal audit function in South African municipalities have been recognised insofar as internal audit functions are legally mandated to exist within municipalities. This also means that legally, internal audit has certain mandates which must be fulfilled in order to add value to management and audit committees, and ultimately, to the board of directors. Even though internal audit is sanctioned by this important legal mandate, evidence shows that internal audit does not always fulfil this mandate. This state of affairs has prompted a detailed review of the relevant laws and regulations governing the work of internal audit in South African municipalities in order to determine the extent to which key stakeholders find the regulatory work of internal audit useful in discharging their (stakeholders’ oversight responsibilities. Questionnaires were administered to audit committees. The results summarise the extent to which internal audit’s work assists audit committees in their oversight responsibilities as this ultimately affects the ability of audit committees to fulfil these responsibilities to the board of directors. The results indicate that audit committees are greatly dependent on internal audit as a provider of assurance on a variety of legally mandated variables. The results of this study can be used as a measure of best practice of the legally mandated duties performed by internal audit. It can also be used by other researchers in comparative studies and by practitioners to benchmark their work in order to better serve audit committees and ultimately, the board of directors

  6. Performance Based Education: How One District Handled State Mandates.

    Science.gov (United States)

    Wenzlaff, Terri

    When the North Dakota State Department of Education mandated new guidelines for accreditation, each school district in the state was required to develop and implement student performance standards and measurements for every curricular area. This paper describes one district's approach to developing a performance assessment program. Teacher…

  7. Mandated School Mathematics Testing in the United States: A Survey of State Mathematics Supervisors.

    Science.gov (United States)

    Romberg, Thomas A.; And Others

    This report contains information gathered in the second of a series from the National Center for Research in Mathematical Sciences Education regarding effects of mandated testing. The purpose of the study was to determine for each state: (1) whether mathematics testing was mandated at the state level; (2) the processes of test selection or…

  8. The Effect of a Payer-Mandated Decrease in Buprenorphine Dose on Aberrant Drug Tests and Treatment Retention Among Patients with Opioid Dependence.

    Science.gov (United States)

    Accurso, Anthony J; Rastegar, Darius A

    2016-02-01

    The optimal dose for office-based buprenorphine therapy is not known. This study reports on the effect of a change in payer policy, in which the insurer of a subset of patients in an office-based practice imposed a maximum sublingual buprenorphine dose of 16 mg/day, thereby forcing those patients on higher daily doses to decrease their dose. This situation created conditions for a natural experiment, in which treatment outcomes for patients experiencing this dose decrease could be compared to patients with other insurance who were not challenged with a dose decrease. Subjects were 297 patients with opioid use disorder in a primary care practice who were prescribed buprenorphine continuously for at least 3 months. Medical records were retrospectively reviewed for urine drug test results and treatment retention. Rates of aberrant urine drug tests were calculated in the period before the dose decrease and compared to rate after it with patients serving as their own controls. Comparison groups were formed from patients with the same insurance on buprenorphine doses of 16 mg/day or lower, patients with different insurance on 16 mg/day or lower, and patients with different insurance on greater than 16 mg/day. Rates of aberrant drug tests and treatment retention of patients on 16 mg/day or less of buprenorphine were compared to that of patients on higher daily doses. The rate of aberrant urine drug tests among patients who experienced a dose decrease rose from 27.5% to 34.2% (p=0.043). No comparison group showed any significant change in aberrant drug test rates. Moreover, all groups who were prescribed buprenorphine doses greater than 16 mg/day displayed lower rates of aberrant urine drug tests than groups prescribed lower doses. Retention in treatment was also highest among those prescribed greater than 16 mg/day (100% vs. 86.8%, 90.1%, and 84.4% p=0.010). An imposed buprenorphine dose decrease was associated with an increase in aberrant drug tests. Patients in a

  9. The Little State That Couldn't Could? The Politics of "Single-Payer" Health Coverage in Vermont.

    Science.gov (United States)

    Fox, Ashley M; Blanchet, Nathan J

    2015-06-01

    In May 2011, a year after the passage of the Affordable Care Act (ACA), Vermont became the first state to lay the groundwork for a single-payer health care system, known as Green Mountain Care. What can other states learn from the Vermont experience? This article summarizes the findings from interviews with nearly 120 stakeholders as part of a study to inform the design of the health reform legislation. Comparing Vermont's failed effort to adopt single-payer legislation in 1994 to present efforts, we find that Vermont faced similar challenges but greater opportunities in 2010 that enabled reform. A closely contested gubernatorial election and a progressive social movement opened a window of opportunity to advance legislation to design three comprehensive health reform options for legislative consideration. With a unified Democratic government under the leadership of a single-payer proponent, a high-profile policy proposal, and relatively weak opposition, a framework for a single-payer system was adopted by the legislature - though with many details and political battles to be fought in the future. Other states looking to reform their health systems more comprehensively than national reform can learn from Vermont's design and political strategy. Copyright © 2015 by Duke University Press.

  10. Association between the unemployment rate and inpatient cost per discharge by payer in the United States, 2005-2010.

    Science.gov (United States)

    Maeda, Jared Lane K; Henke, Rachel Mosher; Marder, William D; Karaca, Zeynal; Friedman, Bernard S; Wong, Herbert S

    2014-10-13

    Several reports have linked the 2007-2009 Great Recession in the United States with a slowdown in health care spending and decreased utilization. However, little is known regarding how the recent economic downturn affected hospital costs per inpatient stay for different segments of the population. The purpose of this study was to examine the association between changes in the unemployment rate and inpatient cost per discharge for Medicare and commercial discharges. We used retrospective data at the Core Based Statistical Area (CBSA)-level from 46 states that contributed to the Healthcare Cost and Utilization Project State Inpatient Databases from 2005 to 2010. Unemployment data was derived from the American Community Survey. An instrumental variable two-stage least squares approach with fixed- or random-effects was used to examine the association between unemployment rate and inpatient cost per discharge by payer because of potential endogeneity. The marginal effect of unemployment was associated with an increase in inpatient cost per discharge for both payers. A one percentage point increase in the unemployment rate was associated with a $37 increase for commercial discharges and a $49 increase for Medicare discharges. We find evidence that the inpatient cost per discharge is countercyclical across different segments of the population. The underlying mechanisms by which unemployment affects hospital resource use however, might differ between payer groups.

  11. Myths and memes about single-payer health insurance in the United States: a rebuttal to conservative claims.

    Science.gov (United States)

    Geyman, John P

    2005-01-01

    Recent years have seen the rapid growth of private think tanks within the neoconservative movement that conduct "policy research" biased to their own agenda. This article provides an evidence-based rebuttal to a 2002 report by one such think tank, the Dallas-based National Center for Policy Analysis (NCPA), which was intended to discredit 20 alleged myths about single-payer national health insurance as a policy option for the United States. Eleven "myths" are rebutted under eight categories: access, cost containment, quality, efficiency, single-payer as solution, control of drug prices, ability to compete abroad (the "business case"), and public support for a single-payer system. Six memes (self-replicating ideas that are promulgated without regard to their merits) are identified in the NCPA report. Myths and memes should have no place in the national debate now underway over the future of a failing health care system, and need to be recognized as such and countered by experience and unbiased evidence.

  12. Federally mandating motorcycle helmets in the United States.

    Science.gov (United States)

    Eltorai, Adam E M; Simon, Chad; Choi, Ariel; Hsia, Katie; Born, Christopher T; Daniels, Alan H

    2016-03-09

    Motorcycle helmets reduce both motorcycle-related fatalities and head injuries. Motorcycle crashes are a major public health concern which place economic stress on the U.S. healthcare system. Although statewide universal motorcycle helmet laws effectively increase helmet use, most state helmet laws do not require every motorcycle rider to wear a helmet. Herein, we propose and outline the solution of implementing federal motorcycle helmet law, while addressing potential counterarguments. The decision to ride a motorcycle without a helmet has consequences that affect more than just the motorcyclist. In an effort to prevent unnecessary healthcare costs, injuries, and deaths, public health efforts to increase helmet use through education and legislation should be strongly considered. Helmet use on motorcycles fits squarely within the purview of the federal government public health and economic considerations.

  13. Evaluation of Alabama Public School Wellness Policies and State School Mandate Implementation

    Science.gov (United States)

    Gaines, Alisha B.; Lonis-Shumate, Steven R.; Gropper, Sareen S.

    2011-01-01

    Background: This study evaluated wellness policies created by Alabama public school districts and progress made in the implementation of Alabama State Department of Education (ALSDE) school food and nutrition mandates. Methods: Wellness policies from Alabama public school districts were compared to minimum requirements under the Child Nutrition…

  14. Estimated Budget Impact of Adopting the Affordable Care Act's Required Smoking Cessation Coverage on United States Healthcare Payers.

    Science.gov (United States)

    Baker, Christine L; Ferrufino, Cheryl P; Bruno, Marianna; Kowal, Stacey

    2017-01-01

    Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice. This study presents current cessation patterns, real-world drug costs and plan benefit design data, and estimates the 1- to 5-year pharmacy budget impact of providing ACA-required coverage for smoking cessation products to understand the fiscal impact to a US healthcare plan. A closed cohort budget impact model was developed in Microsoft Excel® to estimate current and projected costs for US payers (commercial, Medicare, Medicaid) covering smoking cessation medicines, with assumptions for coverage and smoking cessation product utilization based on current, real-world national and state-level trends for hypothetical commercial, Medicare, and Medicaid plans with 1 million covered lives. A Markov methodology with five health states captures quit attempt and relapse patterns. Results include the number of smokers attempting to quit, number of successful quitters, annual costs, and cost per-member per-month (PMPM). The projected PMPM cost of providing coverage for smoking cessation medications is $0.10 for commercial, $0.06 for Medicare, and $0.07 for Medicaid plans, reflecting a low incremental PMPM impact of covering two attempts ranging from $0.01 for Medicaid to $0.02 for commercial and Medicare payers. The projected PMPM impact of covering two quit attempts with access to all seven cessation medications at no patient cost share remains low. Results of this study reinforce that the impact of adopting the ACA requirements for smoking cessation coverage will have a limited near-term impact

  15. Exploring Campus Response to State Mandated Change: A Case Study of the Implementation of Legislation Allowing Guns on Campus

    Science.gov (United States)

    Grantham, Ashley Erin

    2016-01-01

    This case study examines the implementation of a state legislative mandate to allow guns on campus at a public higher education institution in the southeastern United States. This study explores the process that one campus underwent to implement an externally mandated change. Additionally, this study examined whether Newcombe and Conrad's (1981)…

  16. Continuously Uncertain Reform Effort: State-Mandated History and Social Science Curriculum and the Perceptions of Teachers

    Science.gov (United States)

    Martell, Christopher

    2010-01-01

    This study examined teachers' attitudes and beliefs in one over-performing urban/suburban high school of the state-mandated curriculum framework under conditions that I label a continuously uncertain reform effort or a top-down mandated curriculum involving constant mixed-messages as to its content, accountability demands, and future existence.…

  17. Controversy undermines support for state mandates on the human papillomavirus vaccine.

    Science.gov (United States)

    Gollust, Sarah E; Dempsey, Amanda F; Lantz, Paula M; Ubel, Peter A; Fowler, Erika Franklin

    2010-11-01

    State actions requiring adolescent girls to receive the human papillomavirus (HPV) vaccine created controversy following the vaccine's approval in 2006. Some health professionals worried that the controversy might dampen public support for those state policies and for other school immunizations in general. We fielded an experimental Internet survey to determine how controversy affects attitudes about vaccines. We discovered that public support for the HPV vaccine mandates wanes when the public is informed that the policies are controversial. However, the experimental survey also revealed that exposure to this policy controversy did not spill over and reduce public support for immunizations in general.

  18. Mandating supplemental intervention services: Is New York state doing enough to help all students succeed?

    Directory of Open Access Journals (Sweden)

    Kieran M. Killeen

    2005-03-01

    Full Text Available As states have become more active in establishing curriculum content standards and related assessments disappointingly little attention has been paid to policy efforts that create learning opportunities for students to meet the new standards. This study examines one state policy designed to bolster the opportunity to learn by mandating additional instruction for students not currently achieving proficiency in the state standards. The results focus on a detailed description of New York State's Academic Intervention Services, including its organizational and instructional elements (e.g., staffing, scheduling, student grouping, instructional strategies across NYS schools. While the majority of states have established curriculum frameworks and linked them to assessment instruments, this experience in NY may be unique for its coordinated emphasis on intervention services (academic and non-academic linked to rigorous learning and accountability standards. However, the caveats identified in this study promote a familiar sense of local discretion in the interpretation and implementation of state policy mandates. The analyses describe how such practices vary by local district context, such as community wealth and geography, and if those practices have equity implications. The primary analyses draw on survey data from a stratified random sample of 764 teachers and principals from 125 school districts, and feature multi-variate methods with proper adjustment for the clustering of responses within districts (i.e., multiple teachers and administrators within each district.

  19. OSTEOPOROSIS DRUGS MARKETED IN THE UNITED STATES: GENERIC COMPETITION, PRICING STRUCTURE, AND DISPERSION AMONG PAYERS.

    Science.gov (United States)

    Balkhi, Bander; Seoane-Vazquez, Enrique; Rodriguez-Monguio, Rosa

    2016-01-01

    Despite the cost of pharmaceuticals, studies assessing prices of osteoporosis drugs are lacking. This study examined trends in prices of osteoporosis drugs in the United States in the period 1988-2014, assessed pricing structure of osteoporosis drugs, and evaluated price trends before and after generic drugs market entry. Data were derived from the U.S. Food and Drug Administration, the RedBook, the Centers for Medicare & Medicaid Services, and the Federal Supply Schedule (FSS). Descriptive statistics and segmented linear regression analyses were performed. In the period 1988-2014, osteoporosis drug prices increased faster than the inflation. The average wholesale price (AWP) of generic products at market entry represented 90 percent of the AWP for the corresponding brand. Prices of brand products continued to increase after generic entry. Drug prices showed a significant variation when compared with the brand AWP. The brand wholesale acquisition cost (WAC) was typically set at 83.3 percent of the AWP. Community pharmacies acquired osteoporosis brand drugs at a median of 80.5 percent of the brand AWP. Significant reductions in brand AWP were observed for Medicare Part B (78.5 percent of the brand AWP), generic National Average Drug Acquisition Cost (33.7 percent), and FSS (22.5 percent). There are significant differences in the manufacturer prices, pharmacy acquisition costs and reimbursement rates of osteoporosis drugs. Pharmaceutical companies listed prices are higher than the pharmacy actual estimated acquisitions costs, and the prices used for reimbursement to providers. Generic drugs entry significantly drives down prices; still, prices of branded drugs facing generic competition continued to increase after generic market entry.

  20. "Prefacing the Script" as an Ethical Response to State-Mandated Abortion Counseling.

    Science.gov (United States)

    Buchbinder, Mara; Lassiter, Dragana; Mercier, Rebecca; Bryant, Amy; Lyerly, Anne Drapkin

    Laws governing abortion provision are proliferating throughout the United States, yet little is known about how these laws affect providers. We investigated the experiences of abortion providers in North Carolina practicing under the 2011 Women's Right to Know Act, which mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. We focus here on a subset of the data to examine one strategy by which providers worked to minimize moral conflicts generated by the counseling procedure. Drawing on Erving Goffman's work on language and social interaction, we highlight how providers communicated moral objections and layered meanings through a practice that we call prefacing the script. We conducted semi-structured interviews with 31 physicians, nurses, physician assistants, and clinic managers who provide abortion care in North Carolina. Audio-recorded interviews were transcribed verbatim and analyzed using an inductive, iterative analytic approach, which included reading for context, interpretive memo-writing, and focused coding. Roughly half of the participants (14/31) reported that they or the clinicians who performed the counseling in their institution routinely prefaced the counseling script with qualifiers, disclaimers, and apologies that clarified their relationship to the state-mandated content. We identified three performative functions of this practice: 1) enacting a frame shift from a medical to a legal interaction, 2) distancing the speaker from the authorial voice of the counseling script, and 3) creating emotional alignment. Prefacing state-mandated abortion counseling scripts constitutes a practical strategy providers use to balance the obligation to comply with state law with personal and professional responsibilities to provide tailored care, emotional support, and serve the patient's best interests. Our findings suggest that language constitutes a powerful resource for navigating and

  1. “Prefacing the Script” as an Ethical Response to State-Mandated Abortion Counseling

    Science.gov (United States)

    Lassiter, Dragana; Mercier, Rebecca; Bryant, Amy; Lyerly, Anne Drapkin

    2016-01-01

    BACKGROUND Laws governing abortion provision are proliferating throughout the United States, yet little is known about how these laws affect providers. We investigated the experiences of abortion providers in North Carolina practicing under the 2011 Women’s Right to Know Act, which mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. We focus here on a subset of the data to examine one strategy by which providers worked to minimize moral conflicts generated by the counseling procedure. Drawing on Erving Goffman’s work on language and social interaction, we highlight how providers communicated moral objections and layered meanings through a practice that we call prefacing the script. METHODS We conducted semi-structured interviews with 31 physicians, nurses, physician assistants, and clinic managers who provide abortion care in North Carolina. Audio-recorded interviews were transcribed verbatim and analyzed using an inductive, iterative analytic approach, which included reading for context, interpretive memo-writing, and focused coding. RESULTS Roughly half of the participants (14/31) reported that they or the clinicians who performed the counseling in their institution routinely prefaced the counseling script with qualifiers, disclaimers, and apologies that clarified their relationship to the state-mandated content. We identified three performative functions of this practice: 1) enacting a frame shift from a medical to a legal interaction, 2) distancing the speaker from the authorial voice of the counseling script, and 3) creating emotional alignment. CONCLUSIONS Prefacing state-mandated abortion counseling scripts constitutes a practical strategy providers use to balance the obligation to comply with state law with personal and professional responsibilities to provide tailored care, emotional support, and serve the patient’s best interests. Our findings suggest that language constitutes a

  2. State-Mandated (Mis)Information and Women's Endorsement of Common Abortion Myths.

    Science.gov (United States)

    Berglas, Nancy F; Gould, Heather; Turok, David K; Sanders, Jessica N; Perrucci, Alissa C; Roberts, Sarah C M

    The extent that state-mandated informed consent scripts affect women's knowledge about abortion is unknown. We examine women's endorsement of common abortion myths before and after receiving state-mandated information that included accurate and inaccurate statements about abortion. In Utah, women presenting for an abortion information visit completed baseline surveys (n = 494) and follow-up interviews 3 weeks later (n = 309). Women answered five items about abortion risks, indicating which of two statements was closer to the truth (as established by prior research) or responding "don't know." We developed a continuous myth endorsement scale (range, 0-1) and, using multivariable regression models, examined predictors of myth endorsement at baseline and change in myth endorsement from baseline to follow-up. At baseline, many women reported not knowing about abortion risks (range, 36%-70% across myths). Women who were younger, non-White, and had previously given birth but not had a prior abortion reported higher myth endorsement at baseline. Overall, myth endorsement decreased after the information visit (0.37-0.31; p endorsement of the myth that was included in the state script-describing inaccurate risks of depression and anxiety-increased at follow-up (0.47-0.52; p < .05). Lack of knowledge about the effects of abortion is common. Knowledge of information that was accurately presented or not referenced in state-mandated scripts increased. In contrast, inaccurate information was associated with decreases in women's knowledge about abortion, violating accepted principles of informed consent. State policies that require or result in the provision of inaccurate information should be reconsidered. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  3. The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes.

    Science.gov (United States)

    Carr, Jillian B; Packham, Analisa

    2017-04-01

    In 2011, the USA had the second highest teen birth rate of any developed nation, according to the World Bank, . In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the causal effects of state-level sex education policies from 2000-2011 on various teen sexual health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  4. Spillover effects of state mandated benefit laws: the case of outpatient breast cancer surgery.

    Science.gov (United States)

    Bian, John; Lipscomb, Joseph; Mello, Michelle M

    This paper examines the "spillover effects" of state laws that mandate inpatient coverage for breast cancer surgery. It looks at outpatient utilization of two types of breast cancer surgery among Medicare fee-for-service patients, who are exempt from state regulation. Using data from the Surveillance, Epidemiology and End Results cancer registries and Medicare claims, we performed difference-in-differences analyses of patients in nine states from 1993 to 2002. The analyses show that state laws had a significant impact on only the likelihood of outpatient mastectomy, which was reduced by five percentage points. Such a spillover effect may diminish the expected impact of federal coverage laws for inpatient breast cancer surgery, which have been proposed to achieve similar ends.

  5. Changes in state prescription contraceptive mandates for insurers: the effect on women's contraceptive use.

    Science.gov (United States)

    Atkins, Danielle N; Bradford, W David

    2014-03-01

    Access to effective contraceptives is critical to reducing levels of unintended childbearing in the United States. Since 1998, more than half the states have passed legislation requiring insurers that cover prescription drugs to cover prescription contraceptives approved by the Food and Drug Administration. An assessment of the impact of these laws on women's contraceptive use is needed to determine whether such policies are effective. Information was collected on state contraceptive coverage policies, and contraceptive use data among women at risk of unintended pregnancy were drawn from Behavioral Risk Factor Surveillance System surveys conducted between 1998 and 2010. Logit regression analysis was used to calculate the marginal effects of state contraceptive coverage laws on insured and uninsured women's use of prescription methods. Insured women who lived in a state with a contraceptive coverage law were 5% more likely than their counterparts in states without such laws to use an effective method (i.e., a prescription method, condoms or sterilization). Among women who used such methods, those in contraceptive coverage states were 5% more likely than women in other states to use any prescription method, and 4% more likely to use the pill. No associations were found between contraceptive mandates and method use by uninsured women. Among both users and nonusers, contraceptive coverage was associated with a 5% increase in pill use. Contraceptive coverage mandates appear to play a role in increasing the use of prescription contraceptives among insured women, and hence may help to reduce the numbers of unintended pregnancies. Copyright © 2014 by the Guttmacher Institute.

  6. Medicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York.

    Science.gov (United States)

    Xu, Hannah F; White, Robert S; Sastow, Dahniel L; Andreae, Michael H; Gaber-Baylis, Licia K; Turnbull, Zachary A

    2017-12-01

    To confirm the relationship between primary payer status as a predictor of increased perioperative risks and post-operative outcomes after total hip replacements. Retrospective cohort study. Administrative database study using 2007-2011 data from California, Florida, and New York from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. 295,572 patients age≥18years old who underwent total hip replacement with non-missing insurance data were collected, using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses and procedures code (ICD-9-CM code 81.51). Patients underwent total hip replacement. Patients were cohorted by insurance type as either Medicare, Medicaid, Uninsured, Other, and Private Insurance. Demographic characteristics and comorbidities were compared. Unadjusted rates of in-hospital mortality, postoperative complications, LOS, 30-day, and 90-day readmission status were compared. Adjusted odds ratios were calculated for our outcomes using multivariate linear and logistic regression models fitted to our data. Medicaid patients incurred a 125% increase in the odds of in-hospital mortality compared to those with Private Insurance (OR 2.25, 99% CI 1.01-5.01). Medicaid payer status was associated with the highest statistically significant adjusted odds of mortality, any complication (OR, 1.26), cardiovascular complications (OR, 1.37), and infectious complications (OR, 1.66) when compared with Private Insurance. Medicaid patients had the highest statistically significant adjusted odds of 30-day (OR, 1.63) and 90-day readmission (OR, 1.58) and the longest adjusted LOS. We found higher unadjusted rates and risk adjusted odds ratios of postoperative mortality, morbidity, LOS, and readmissions for patients with Medicaid insurance as compared to patients with Private Insurance. Our study shows that primary payer status serves as a predictor of

  7. Prospects of Single Tax Payers

    Directory of Open Access Journals (Sweden)

    Tofan Ivan M.

    2014-03-01

    Full Text Available The article speaks about problem aspects of taxation, which were set by the state for the single tax administering due to permanent and system changes in the tax legislation. It shows the necessity of search for alternative methods of administering in the process of taxation of single tax payers by fiscal services. The goal of the article is the study of prospects of further taxation of entrepreneurs – single tax payers on the basis of analysis of conditions and principles created by the state for the business. The article used methods of system analysis, comparison, forecasting and modelling. It analyses the process of evolution of the simplified taxation system, accounting and reporting from the moment of its adoption until today. The article presents the structure of the quantitative composition of single tax payers depending on the selected groups. It marks out and characterises administrative and fiscal factors that do not facilitate further development of entrepreneurship in Ukraine. In the result of the conducted studies the article outlines problem aspects of organisation of taxation of the small business and offers specific and real ways of their overcoming or partial solution.

  8. Using General Outcome Measures to Predict Student Performance on State-Mandated Assessments: An Applied Approach for Establishing Predictive Cutscores

    Science.gov (United States)

    Leblanc, Michael; Dufore, Emily; McDougal, James

    2012-01-01

    Cutscores for reading and math (general outcome measures) to predict passage on New York state-mandated assessments were created by using a freely available Excel workbook. The authors used linear regression to create the cutscores and diagnostic indicators were provided. A rationale and procedure for using this method is outlined. This method…

  9. Increased Incidence of Spinal Abscess and Substance Abuse after Implementation of State Mandated Prescription Drug Legislation.

    Science.gov (United States)

    Nagar, Vittal R; Springer, Joe E; Salles, Sara

    2015-10-01

    To investigate the incidence of spinal abscess and substance abuse in a tertiary care hospital after state legislation titled "House Bill 1" (HB1) mandated stricter regulation of prescription drugs of abuse in Kentucky in 2012. A retrospective case series study design was used to review the incidence of spinal abscess and drug abuse diagnoses admissions from 2010 to 2014. Variances in the incidence of spinal abscess and substance abuse were plotted across this time frame. The incidence of intraspinal abscess increased 1.56-fold in 2011 (n = 26) and 2012 (n = 25) relative to 2010 (n = 16). However, in 2013, the year following implementation of HB1 legislation, the incidence of intraspinal abscess increased 2.38-fold (n = 38) and then 4.19-fold (n = 67) in 2014. The incidence of intraspinal abscess in subjects with drug abuse diagnosis remained constant between 2010 (n = 3) and 2012 (n = 3). However, it increased twofold (n = 7) in 2013 and then ninefold (n = 27) in 2014. A correlation coefficient (rSAD ) of 0.775 revealed a strong association between the increase incidence of intraspinal abscess and diagnosis of drug abuse. The results of this retrospective study demonstrate an increased incidence of intraspinal abscess associated with drug abuse after passage of HB1 legislation regulating prescriptions of controlled medications in Kentucky. This increased incidence may be related to individuals relying on nonprescription drugs of abuse due to more highly regulated access to controlled prescription medications. However, additional factors unrelated to HB1 legislation must be taken into account. Wiley Periodicals, Inc.

  10. The association between state mandates of colorectal cancer screening coverage and colorectal cancer screening utilization among US adults aged 50 to 64 years with health insurance

    Directory of Open Access Journals (Sweden)

    Virgo Katherine

    2011-01-01

    Full Text Available Abstract Background Several states in the US have passed laws mandating coverage of colorectal cancer (CRC screening tests by health insurance plans. The impact of these state mandates on the use of colorectal cancer screening has not been evaluated among an age-eligible target population with access to care (i.e., health care insurance coverage. Methods We collected information on state mandates implemented by December 31, 2008 and used data on insured adults aged 50 and 64 years from the Behavioral Risk Factor Surveillance System between 2002 and 2008 to classify individual-level exposure to state mandates for at least 1 year. Multivariate logistic regression models (with state- and year- fixed effects, and patient demographic and socioeconomic characteristics were used to estimate the effect of state mandates on recent endoscopy screening (either flexible sigmoidoscopy or colonoscopy during the past year. Results From 1999-2008, twenty-two states in the US, including the District of Columbia passed comprehensive laws requiring health insurance coverage of CRC screening including endoscopy tests. Residence in states with CRC screening coverage mandates in place for at least 1 year was associated with a 1.4 percentage point increase in the probability of utilization of recent endoscopy (i.e., 17.5% screening rates in those with mandates versus 16.1% in those without, Adjusted OR = 1.10, 95% CI: 1.02 - 1.20, p = 0.02. Conclusions The findings suggest a positive, albeit small, impact of state mandates on the use of recent CRC screening endoscopy among the target eligible population with health insurance. However, more research is needed to evaluate potential effects of mandates across health insurance types while including controls for other system-level factors (e.g. endoscopy and primary care capacity. National health insurance reform should strive towards a system that expands access to recommended CRC screening tests.

  11. Do biofuel blending mandates reduce gasoline consumption? Implications of state-level renewable fuel standards for energy security

    Science.gov (United States)

    Lim, Shinling

    In an effort to keep America's addiction to oil under control, federal and state governments have implemented a variety of policy measures including those that determine the composition of motor gasoline sold at the pump. Biofuel blending mandates known as Renewable Fuel Standards (RFS) are designed to reduce the amount of foreign crude oil needed to be imported as well as to boost the local ethanol and corn industry. Yet beyond looking at changes in gasoline prices associated with increased ethanol production, there have been no empirical studies that examine effects of state-level RFS implementation on gasoline consumption. I estimate a Generalized Least Squares model for the gasoline demand for the 1993 to 2010 period with state and time fixed effects controlling for RFS. States with active RFS are Minnesota, Hawaii, Missouri, Florida, Washington, and Oregon. I find that, despite the onset of federal biofuel mandates across states in 2007 and the lower energy content of blended gasoline, being in a state that has implemented RFS is associated with 1.5% decrease in gasoline consumption (including blended gasoline). This is encouraging evidence for efforts to lessen dependence on gasoline and has positive implications for energy security.

  12. Parent opinion of sexuality education in a state with mandated abstinence education: does policy match parental preference?

    Science.gov (United States)

    Ito, Kristin E; Gizlice, Ziya; Owen-O'Dowd, Judy; Foust, Evelyn; Leone, Peter A; Miller, William C

    2006-11-01

    Despite public debate about the content of sexuality education in schools, state and federal policy has increasingly financed and legislated abstinence-only education over the past decade. Although public schools strive to meet the needs of parents who, as taxpayers, fund the educational system, little is known about parental desires regarding sexuality education in states with mandated abstinence education. The objective of this study was to assess parental opinion about sexuality education in public schools in North Carolina, a state with mandated abstinence education. Computer-assisted, anonymous, cross-sectional telephone surveys were conducted among 1306 parents of North Carolina public school students in grades K-12. Parental support for sexuality education in public schools and 20 sexuality education topics was measured. We defined comprehensive sexuality education as education that includes a discussion of how to use and talk about contraception with partners. Parents in North Carolina overwhelmingly support sexuality education in public schools (91%). Of these respondents, the majority (89%) support comprehensive sexuality education. Less than a quarter of parents oppose teaching any specific topic, including those typically viewed as more controversial, such as discussions about sexual orientation, oral sex, and anal sex. Parents' level of education was inversely related to support for specific sexuality education topics and comprehensive education, although these differences were small in magnitude. More than 90% of respondents felt that parents and public health professionals should determine sexuality education content and opposed the involvement of politicians. Current state-mandated abstinence sexuality education does not match parental preference for comprehensive sexuality education in North Carolina public schools.

  13. Association of State-Mandated Abstinence-only Sexuality Education with Rates of Adolescent HIV Infection and Teenage Pregnancy.

    Science.gov (United States)

    Elliot, L M; Booth, M M; Patterson, G; Althoff, M; Bush, C K; Dery, M A

    2017-01-01

    Abstinence-only sexuality education (AOSE); is required in the public school systems of many states, raising public health concerns and perpetuating health disparities through school systems. This study aimed to determine the correlations between state-mandated AOSE and the rates of adolescent HIV and teen pregnancy. Using publicly available data on all 50 United States' laws and policies on AOSE, states were ranked according to their level of abstinence emphasis on sexuality education (Level 0 - Level 3);. We calculated the relative proportion of Black students in public schools and the proportion of families below the federal poverty line then ranked them by state. We compared the states' ranks to the incidence of adolescent HIV and teen pregnancy in those states to identify associations between variables. The majority of states (~44 percent ); have legally mandated AOSE policies (Level 3); and adolescent HIV and teen pregnancy rates were highest in these Level 3 states. There were significant, positive correlations between HIV incidence rates of 13-19 year olds, HIV rates of 20-24 year olds, teen pregnancy rates, and AOSE level, with the proportion of the population that lives below the federal poverty level, and whether they attended schools that had a greater than 50 percent of an African American population. These data show a clear association between state sexuality education policies and adolescent HIV and teen pregnancy rates not previously demonstrated. Our data further show that states that have higher proportions of at-risk populations, with higher adolescent HIV and teen pregnancy rates, are more likely to also have restrictive AOSE policies. These populations may be more likely to attend public schools where AOSE is taught, increasing their risk for HIV and teen pregnancy. The World Health Organization considers fact-based Comprehensive Sexuality Education a human right, and the authors believe it is past time to end harmful, discriminatory sexuality

  14. National health care reform and a single-payer system: messiah or pariah?

    Science.gov (United States)

    Norato, J F

    1997-01-01

    U.S. health care spending consumed about 14% of the GDP in 1992 and current trends threaten to boost this figure to 18% by the year 2000 (CBO, 1992). Our health care delivery system needs an overhaul but there is evidently little consensus on what format a new system should follow. Persuasive befuddling, and frequently contradictory, suggestions have ranged from the federal government's active involvement in a single-payer national health care plan to enactment of a nationwide mandate compelling (taxing?) employers to provide a minimum health benefit package to all workers. There were two common objectives shared by the major, recently contending health care reform proposals: first, to provide universal access to health care with assurances that coverage is maintained when economic circumstances change or when someone experiences poor health; second, to stunt the growth rate of health care spending nationally. Single-payer alternatives, previously introduced by Congressman McDermott and others, would have required a heavy federal subsidy, regulation, and blocking directing each state to establish and administer a health care system covering its entire population. Currently, the single-payer system has become a fading contender in a dissolving list of health care reform options that previously included a new, widely publicized option embracing managed care and so-called "managed competition." Most recently, however, the single-payer proposals have apparently gone nowhere, seriously sustaining sound political defeat. Divergent views of proponents and detractors of a single-payer plan, its funding and operation, are presented. It has become extremely difficult to get Congress to advance any particular proposal because of dire, unsubstantiated socioeconomic impact hypothesizing and the unrestrained politicizing of the health policy formulation process. On February 10th, 1994, the prestigious American College of Surgeons literally stunned the national health care

  15. Trends in Shoulder Stabilization Techniques Used in the United States Based on a Large Private-Payer Database

    Science.gov (United States)

    Riff, Andrew J.; Frank, Rachel M.; Sumner, Shelby; Friel, Nicole; Bach, Bernard R.; Verma, Nikhil N.; Romeo, Anthony A.

    2017-01-01

    Background: Arthroscopic stabilization is the most broadly used surgical procedure in the United States for management of recurrent shoulder instability. Latarjet coracoid transfer has been considered a salvage surgical procedure for failed arthroscopic repairs or cases of significant glenoid bone loss; however, with recent literature suggesting reduced risk of recurrent instability with Latarjet, several surgeons have advocated its broader utilization as a primary operation for treatment of shoulder instability. Purpose: To determine trends in shoulder stabilization techniques used in the United States. Study Design: Cross-sectional study. Methods: A retrospective analysis of a publicly available national insurance database was performed to identify shoulder stabilization procedures performed over 9 years (2007-2015). The following Current Procedural Terminology codes were searched: 29806 (arthroscopic stabilization), 23455 (open capsulolabral repair), 23466 (open capsular shift), 23462 (Latarjet coracoid transfer), and 23460 (open anterior capsulorrhaphy with other bone block augmentation). Outcomes of interest included (1) trends in the use of each technique throughout the study interval, (2) age and sex distributions of patients undergoing each technique, and (3) regional predilections for the use of each technique. Results: Arthroscopic stabilization was the most broadly used shoulder stabilization procedure in the database (87%), followed by open Bankart (7%), Latarjet (3.2%), open capsular shift (2.6%), and alternative bone block procedure (0.8%). Throughout the study period, the incidence of arthroscopic stabilization and Latarjet increased (8% and 15% per year, respectively); the incidence of open capsular shift remained relatively constant; and the incidence of open Bankart decreased (9% per year). Arthroscopic stabilization, open Bankart, and Latarjet each had similar sex-based distributions (roughly 70% male), while open capsular shift and alternative

  16. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2014-02-01

    Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Tim Holt,4 John Cummings5 1Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 5Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and originates in the sacroiliac (SI joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US. Methods: A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3, an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date, and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results: The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592 per privately-insured patient (N=78,533. Among patients with lumbar spinal fusion (N=434, attributable 3-year

  17. 32 CFR 220.6 - Certain payers excluded.

    Science.gov (United States)

    2010-07-01

    ... Uniformed Services or other authorized representative for the United States makes a determination, based on...) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.6 Certain...

  18. Observation evaluation to assess race and educational bias in state-mandated standard testing of nurse aides in nursing homes.

    Science.gov (United States)

    Baker, S L; Stoskopf, C H; Ciesla, J R; Glik, D C; Cover, C M

    1996-01-01

    This article presents an assessment of whether race, education, gender, or other testing bias was present in a state-mandated nurse aide competency test. This assessment was carried out with data from two sources: (a) a statewide standardized test for all nurse aides that was given by a nationally known testing company, (b) an independent observational evaluation with a Behaviorally Anchored Rating Scale (BARS) for nurse aides' performance that was carried out by the investigators. The results show that race and education level were predictors of performance on written and manual portions of the standardized test. Gender, age, and years of experience were also shown to predict test success. Comparing data from the two sources suggests that a possible bias in the standardized nurse aid test. The independent observation of performance on the job with the BARS is shown to be less biased.

  19. High school science teacher perceptions of the science proficiency testing as mandated by the State of Ohio Board of Education

    Science.gov (United States)

    Jeffery, Samuel Shird

    There is a correlation between the socioeconomic status of secondary schools and scores on the State of Ohio's mandated secondary science proficiency tests. In low scoring schools many reasons effectively explain the low test scores as a result of the low socioeconomics. For example, one reason may be that many students are working late hours after school to help with family finances; parents may simply be too busy providing family income to realize the consequences of the testing program. There are many other personal issues students face that may cause them to score poorly an the test. The perceptions of their teachers regarding the science proficiency test program may be one significant factor. These teacher perceptions are the topic of this study. Two sample groups ware established for this study. One group was science teachers from secondary schools scoring 85% or higher on the 12th grade proficiency test in the academic year 1998--1999. The other group consisted of science teachers from secondary schools scoring 35% or less in the same academic year. Each group of teachers responded to a survey instrument that listed several items used to determine teachers' perceptions of the secondary science proficiency test. A significant difference in the teacher' perceptions existed between the two groups. Some of the ranked items on the form include teachers' opinions of: (1) Teaching to the tests; (2) School administrators' priority placed on improving average test scores; (3) Teacher incentive for improving average test scores; (4) Teacher teaching style change as a result of the testing mandate; (5) Teacher knowledge of State curriculum model; (6) Student stress as a result of the high-stakes test; (7) Test cultural bias; (8) The tests in general.

  20. Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus among Adult Intensive Care Unit Patients following State-Mandated Active Surveillance.

    Science.gov (United States)

    Lin, Michael Y; Hayden, Mary K; Lyles, Rosie D; Lolans, Karen; Fogg, Louis F; Kallen, Alexander J; Weber, Stephen G; Weinstein, Robert A; Trick, William E

    2017-12-07

    In 2007, Illinois became the first state in the United States to mandate active surveillance of methicillin-resistant Staphylococcus aureus (MRSA). The Illinois law applies to intensive care unit (ICU) patients; contact precautions are required for patients found to be MRSA-colonized. However, the effectiveness of a legislated "search and isolate" approach to reduce MRSA burden among critically ill patients is uncertain. We evaluated whether the prevalence of MRSA colonization declined in the 5 years after the start of mandatory active surveillance. All hospitals with an ICU having ≥10 beds in Chicago, Illinois, USA were eligible to participate in single-day serial point prevalence surveys. We assessed MRSA colonization among adult ICU patients present at time of survey using nasal and inguinal swab cultures. The primary outcome was region-wide MRSA colonization prevalence over time. All 25 eligible hospitals (51 ICUs) participated in serial point prevalence surveys over 8 survey periods (2008 - 2013). A total of 3909 adult ICU patients participated in the point prevalence surveys, with 432 (11.1%) found to be colonized with MRSA (95% confidence interval [CI] 10.1% to 12.0%). The MRSA colonization prevalence among patients was unchanged during the study period; year-over-year relative risk for MRSA colonization was 0.97, 95% CI 0.89 to 1.05, P=0.48). MRSA colonization prevalence among critically ill adult patients did not decline during the time period following legislatively mandated MRSA active surveillance. Our findings highlight the limits of legislated MRSA active surveillance as a strategy to reduce MRSA colonization burden among ICU patients.

  1. Retention of High School Economics Knowledge and the Effect of the California State Mandate

    Science.gov (United States)

    Gill, Andrew M.; Gratton-Lavoie, Chiara

    2011-01-01

    The authors extend the literature on the efficacy of high school economics instruction in two directions. First, they assess how much economic knowledge that California students acquired in their compulsory high school course is retained on their entering college. Second, using as a control group some college students from the state of Washington,…

  2. Weighing in: Rural Iowa Principals' Perceptions of State-Mandated Teaching Evaluation Standards

    Science.gov (United States)

    Lasswell, Terri A.; Pace, Nicholas J.; Reed, Gregory A.

    2008-01-01

    As the accountability movement has gained momentum, policy makers and educators have strived to strike a difficult balance between the sometimes competing demands at the local, state, and federal levels. Efforts to improve accountability and teacher evaluation have taken an especially unique route in Iowa, where local control and resistance to…

  3. "Managed competition" for Ireland? The single versus multiple payer debate.

    LENUS (Irish Health Repository)

    Mikkers, Misja

    2014-09-01

    A persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of \\'managed competition\\' based on the recent reforms in the Netherlands, which would replace many functions of Ireland\\'s public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.

  4. State-Mandated Nutrition, Physical Activity, and Screen Time Policies in Child Care Centers.

    Science.gov (United States)

    Chang-Martinez, Catherina; Ahmed, Nasar U; Natale, Ruby A; Messiah, Sarah E

    2017-09-01

    The child care center (CCC) environment presents opportunities for healthy weight promotion in preschoolers. Our study examined the current state of CCC adherence to nutrition, physical activity, and screen time legislative regulations and the differences in their adherence by center socioeconomic position (SEP: low, middle, high) in Miami-Dade County. In 34 CCC, we used the Environment and Policy Assessment and Observation tool to evaluate nutrition, physical activity, and screen time practices during 1-school day. Twenty-five of the centers (73.5%) were participants of the Child and Adult Care Food Program. Almost 80% of the centers adhered to serving low-fat/fat-free milk to children older than 2 years. Only 34.5% served vegetables and 75.9% served whole fruits during meals/snacks. Ninety-four percent of the centers had quiet and active play incorporated into their daily routines. All centers adhered to the 2-hour screen time limit for children older than 2 years. Low- and middle-SEP centers fared better in the serving of fruits, vegetables, and low-fat/fat-free milk. The centers averaged 1 hour in outdoor play regardless of SEP. High-SEP centers had no TV or screen time during day of observation. CCC practices highlight opportunities for improvement in nutrition, physical activity, and screen time practices in the prevention of overweight in early childhood.

  5. Mid-mandate reports

    CERN Multimedia

    Staff Association

    2011-01-01

    Now half way through his mandate (2009-2013), our Director-General presented on 4th July a glowing report on both the scientific and technical fronts. This gives him, his team, and all CERN staff great satisfaction. Furthermore, despite a rather worrying economic situation in most of our Member States, he has managed to obtain the approval of the 2012 budget and the medium-term plan until 2016, which will allow our social security system, pensions and health insurance, to be considerably consolidated. The mandate of the President of the Staff Association lasts one year. So, where are we at half way through the mandate? Without doubt the pensions issue in particular kept us busy during the first six months. We explained to you during the two series of public meetings in April and June that we did not agree with the Management’s proposals for the new members and beneficiaries of the Fund and we showed you our own fairer proposals. However, under the continuous pressure of the Member States, almost...

  6. Comparison of Height, Weight, and Body Mass Index Data from State-Mandated School Physical Fitness Testing and a Districtwide Surveillance Project

    Science.gov (United States)

    Khaokham, Christina B.; Hillidge, Sharon; Serpas, Shaila; McDonald, Eric; Nader, Philip R.

    2015-01-01

    Background: Approximately one third of California school-age children are overweight or obese. Legislative approaches to assessing obesity have focused on school-based data collection. During 2010-2011, the Chula Vista Elementary School District conducted districtwide surveillance and state-mandated physical fitness testing (PFT) among fifth grade…

  7. Make it so: How low-resourced school districts implement a Virginia state mandate to prepare K-12 teachers to integrate technology into the classroom

    OpenAIRE

    Baker, David

    2003-01-01

    This study investigates how four urban school districts, serving low socioeconomic status (SES) student populations, define, prepare teachers for, and implement integration of computer technology into the K-12 classroom in response to a Virginia state mandate. Factors influencing computer integration into the curriculum were also studied. Semi-structured interviews were conducted with 50 educators representing 2 state-level administrators, 12 district level-administrators, 8 school-level ad...

  8. The Failure of Mandated Disclosures

    Directory of Open Access Journals (Sweden)

    Omri Ben-Shahar

    2017-06-01

    Full Text Available Objective to elaborate the conceptual theoreticallegal provisions and scientific recommendations for the substantiating the inefficiency of mandated disclosure. Methods general dialectic method of cognition as well as the general scientific and specific legal methods of research based on it. Results the article explores the spectacular prevalence and failure of the single most common technique for protecting personal autonomy in modern society mandated disclosure. The article has four parts 1 a comprehensive summary of the recurring use of mandated disclosures in many forms and circumstances in the areas of consumer and borrower protection patient informed consent contract formation and constitutional rights 2 a survey of the empirical literature documenting the failure of the mandated disclosure regime in informing people and in improving their decisions 3 an account of the multitude of reasons mandated disclosures fail focusing on the political dynamics underlying the enactments of these mandates the incentives of disclosers to carry them out and most importantly on the ability of disclosees to use them and 4 an argument that mandated disclosure not only fails to achieve its stated goal but also leads to unintended consequences that often harm the very people it intends to serve. Scientific novelty the article elaborates and introduces into academic sphere the substantiation of the efficiency of mandated disclosure proves the failure of the mandated disclosure regime in informing people and in improving their decisions and reveals the unintended consequences that often harm the very people it intends to serve. Practical significance the provisions ad conclusions of the article can be used in scientific lawmaking and lawenforcement activities and in the educational process of institutions of higher education.

  9. Social learning in a policy-mandated collaboration: Community wildfire protection planning in the eastern United States

    Science.gov (United States)

    Rachel F. Brummel; Kristen C. Nelson; Pamela J. Jakes; Daniel R. Williams

    2010-01-01

    Policies such as the US Healthy Forests Restoration Act (HFRA) mandate collaboration in planning to create benefits such as social learning and shared understanding among partners. However, some question the ability of top-down policy to foster successful local collaboration. Through in-depth interviews and document analysis, this paper investigates social learning and...

  10. The impact of high-stakes, state-mandated student performance assessment on 10th grade English, mathematics, and science teachers' instructional practices

    Science.gov (United States)

    Vogler, Kenneth E.

    The purpose of this study was to determine if the public release of student results on high-stakes, state-mandated performance assessments influence instructional practices, and if so in what manner. The research focused on changes in teachers' instructional practices and factors that may have influenced such changes since the public release of high-stakes, state-mandated student performance assessment scores. The data for this study were obtained from a 54-question survey instrument given to a stratified random sample of teachers teaching at least one section of 10th grade English, mathematics, or science in an academic public high school within Massachusetts. Two hundred and fifty-seven (257) teachers, or 62% of the total sample, completed the survey instrument. An analysis of the data found that teachers are making changes in their instructional practices. The data show notable increases in the use of open-response questions, creative/critical thinking questions, problem-solving activities, use of rubrics or scoring guides, writing assignments, and inquiry/investigation. Teachers also have decreased the use of multiple-choice and true-false questions, textbook-based assignments, and lecturing. Also, the data show that teachers felt that changes made in their instructional practices were most influenced by an "interest in helping my students attain MCAS assessment scores that will allow them to graduate high school" and by an "interest in helping my school improve student (MCAS) assessment scores," Finally, mathematics teachers and teachers with 13--19 years of experience report making significantly more changes than did others. It may be interpreted from the data that the use of state-mandated student performance assessments and the high-stakes attached to this type of testing program contributed to changes in teachers' instructional practices. The changes in teachers' instructional practices have included increases in the use of instructional practices deemed

  11. Prescription Opioid Abuse: Challenges and Opportunities for Payers

    Science.gov (United States)

    Katz, Nathaniel P.; Birnbaum, Howard; Brennan, Michael J.; Freedman, John D.; Gilmore, Gary P.; Jay, Dennis; Kenna, George A.; Madras, Bertha K.; McElhaney, Lisa; Weiss, Roger D.; White, Alan G.

    2013-01-01

    Objective Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Though difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local governments for judicial, emergency, and social services. This manuscript’s objective is to provide payers with strategies to control these costs, while supporting safe use of prescription opioid medications for patients with chronic pain. Method A Tufts Health Care Institute Program on Opioid Risk Management meeting was convened in June 2010 with private and public payer representatives, public health and law enforcement officials, pain specialists, and other stakeholders to present research, and develop recommendations on solutions that payers might implement to combat this problem. Results While protecting access to prescription opioids for patients with pain, private and public payers can implement strategies to mitigate financial risks associated with opioid abuse, using internal strategies, such as formulary controls, claims data surveillance, and claims matching; and external policies and procedures that support and educate physicians on reducing opioid risks among patients with chronic pain. Conclusion Reimbursement policies, incentives, and health technology systems that encourage physicians to use universal precautions, to consult prescription monitoring program (PMP) data, and to implement Screening, Brief Intervention, and Referral to6Treatment protocols, have a high potential to reduce insurer risks while addressing a serious public health problem. PMID:23725361

  12. Prescription opioid abuse: challenges and opportunities for payers.

    Science.gov (United States)

    Katz, Nathaniel P; Birnbaum, Howard; Brennan, Michael J; Freedman, John D; Gilmore, Gary P; Jay, Dennis; Kenna, George A; Madras, Bertha K; McElhaney, Lisa; Weiss, Roger D; White, Alan G

    2013-04-01

    Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Although difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local governments for judicial, emergency, and social services. This manuscript's objective is to provide payers with strategies to control these costs, while supporting safe use of prescription opioid medications for patients with chronic pain. A Tufts Health Care Institute Program on Opioid Risk Management meeting was convened in June 2010 with private and public payer representatives, public health and law enforcement officials, pain specialists, and other stakeholders to present research and develop recommendations on solutions that payers might implement to combat this problem. While protecting access to prescription opioids for patients with pain, private and public payers can implement strategies to mitigate financial risks associated with opioid abuse, using internal strategies such as formulary controls, claims data surveillance, and claims matching; and external policies and procedures that support and educate physicians on reducing opioid risks among patients with chronic pain. Reimbursement policies, incentives, and health technology systems that encourage physicians to use universal precautions, to consult prescription monitoring program (PMP) data, and to implement Screening, Brief Intervention, and Referral to Treatment protocols have a high potential to reduce insurer risks while addressing a serious public health problem.

  13. The Efficiency of a Group-Specific Mandated Benefit Revisited: The Effect of Infertility Mandates

    Science.gov (United States)

    Lahey, Joanna N.

    2012-01-01

    This paper examines the labor market effects of state health insurance mandates that increase the cost of employing a demographically identifiable group. State mandates requiring that health insurance plans cover infertility treatment raise the relative cost of insuring older women of child-bearing age. Empirically, wages in this group are…

  14. Consequences of a Liquid Mandate

    DEFF Research Database (Denmark)

    Sörbom, Adrienne; Garsten, Christina

    This paper describes and answers the question how the WEF creates a strong position for itself in the global arena, without a formal and institutional mandate. Theoretically the paper builds and adds to emerging body of literature regarding partial organization, as framed by Ahrne and Brunsson...... (2011). In order to understand the political form of action that WEF has developed for itself we employ the concept of partial organization, arguing that “membership” is the main organizational element through which they organize their environment. By way of making participants into various forms...... of members the WEF is able to create an organized environment around it self, which it can draw upon in its interest of setting global political agendas, in spite of a lacking nation state based mandate. The paper explains how funders and participants are made into members, and how a partial organization...

  15. Managing Mandated Educational Change

    Science.gov (United States)

    Clement, Jennifer

    2014-01-01

    This paper explores teachers' perspectives on the management of mandated educational change in order to understand how it may be managed more effectively. A case study of teachers' responses to the introduction of a quality teaching initiative in two New South Wales schools found that while some teachers described the strong negative impact of…

  16. Plessy v. Ferguson Mandate.

    Science.gov (United States)

    Mueller, Jean West; Schamel, Wynell Burroughs

    1989-01-01

    Traces the history of the Plessy v. Ferguson case. Includes copies of the U.S. Supreme Court mandate to the Louisiana Supreme Court denying Plessy's request to overturn the Jim Crow law and ordering him to bear the court costs. Provides teaching suggestions for interpreting the document and highlights related topics and questions for research and…

  17. Estimating inpatient hospital prices from state administrative data and hospital financial reports.

    Science.gov (United States)

    Levit, Katharine R; Friedman, Bernard; Wong, Herbert S

    2013-10-01

    To develop a tool for estimating hospital-specific inpatient prices for major payers. AHRQ Healthcare Cost and Utilization Project State Inpatient Databases and complete hospital financial reporting of revenues mandated in 10 states for 2006. Hospital discharge records and hospital financial information were merged to estimate revenue per stay by payer. Estimated prices were validated against other data sources. Hospital prices can be reasonably estimated for 10 geographically diverse states. All-payer price-to-charge ratios, an intermediate step in estimating prices, compare favorably to cost-to-charge ratios. Estimated prices also compare well with Medicare, MarketScan private insurance, and the Medical Expenditure Panel Survey prices for major payers, given limitations of each dataset. Public reporting of prices is a consumer resource in making decisions about health care treatment; for self-pay patients, they can provide leverage in negotiating discounts off of charges. Researchers can also use prices to increase understanding of the level and causes of price differentials among geographic areas. Prices by payer expand investigational tools available to study the interaction of inpatient hospital price setting among public and private payers--an important asset as the payer mix changes with the implementation of the Affordable Care Act. © Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

  18. To what extent have high schools in California been able to implement state-mandated nutrition standards?

    Science.gov (United States)

    Samuels, Sarah E; Bullock, Sally Lawrence; Woodward-Lopez, Gail; Clark, Sarah E; Kao, Janice; Craypo, Lisa; Barry, Jay; Crawford, Patricia B

    2009-09-01

    To determine extent and factors associated with implementation of California's school nutrition standards 1 year after standards became active. Information on competitive foods and beverages available in schools was collected from a representative sample of 56 public high schools in California. Adherence to nutrition standards was calculated for each item and summarized for each school by venue. The association between schools' sociodemographic characteristics and adherence to standards was determined by multivariate analysis. The majority of schools were adhering to the required beverage standards. None of the schools selling competitive foods were 100% adherent to the food standards. Adherence to both standards tended to be highest in food service venues. In univariate analyses, percent nonwhite enrollment, population density, percent free/reduced-price (FRP) meal eligibility, and school size were significantly correlated with the beverage adherence rate. Percent nonwhite enrollment and population density remained significant in the multivariate regression model. Percent nonwhite enrollment and percent FRP meal eligibility were significantly correlated with the food adherence rate in univariate analysis, but neither remained significant in the multiple regression model. California high schools are making progress toward implementation of the state nutrition standards. Beverage standards appear easier to achieve than nutrient-based food standards. Additional support is needed to provide schools with resources to implement and monitor these policies. Simpler standards and/or a reduction in the foods and beverages sold could better enable schools to achieve and monitor adherence.

  19. Comparison of Births by Provider, Place, and Payer in New Hampshire.

    Science.gov (United States)

    Hamlin, Lynette

    2017-05-01

    This study examines maternity care in a rural state by birth attendant, place of birth, and payer of birth. It is a secondary analysis of birth certificate data in New Hampshire between the years 2005 and 2012. Results revealed that in New Hampshire, the majority of births occurred in the hospital setting (98.6%). Physicians attended 75.8% of births, certified nurse midwives attended 17%, and certified professional midwives attended 1%. Medicaid coverage was the payer source for 28% of all births, compared with 44.9% nationally. Women with a private payer source were more likely than women with Medicaid or other payer sources to have a cesarean section. The findings demonstrate quality of care outcomes among a range of clinicians and settings, providing a policy argument for expanding maternity care options.

  20. The Failure of Mandated Disclosures, part 3

    Directory of Open Access Journals (Sweden)

    Omri Ben-Shahar

    2017-09-01

    Full Text Available Objective to elaborate the conceptual theoreticallegal provisions and scientific recommendations for the substantiating the inefficiency of mandated disclosure. Methods general dialectic method of cognition as well as the general scientific and specific legal methods of research based on it. Results the article explores the spectacular prevalence and failure of the single most common technique for protecting personal autonomy in modern society mandated disclosure. The article has four parts 1 a comprehensive summary of the recurring use of mandated disclosures in many forms and circumstances in the areas of consumer and borrower protection patient informed consent contract formation and constitutional rights 2 a survey of the empirical literature documenting the failure of the mandated disclosure regime in informing people and in improving their decisions 3 an account of the multitude of reasons mandated disclosures fail focusing on the political dynamics underlying the enactments of these mandates the incentives of disclosers to carry them out and most importantly on the ability of disclosees to use them and 4 an argument that mandated disclosure not only fails to achieve its stated goal but also leads to unintended consequences that often harm the very people it intends to serve. Scientific novelty the article elaborates and introduces into academic sphere the substantiation of the efficiency of mandated disclosure proves the failure of the mandated disclosure regime in informing people and in improving their decisions and reveals the unintended consequences that often harm the very people it intends to serve. Practical significance the provisions ad conclusions of the article can be used in scientific lawmaking and lawenforcement activities and in the educational process of institutions of higher education.

  1. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

    Directory of Open Access Journals (Sweden)

    Christine D. Jones MD, MS

    2015-08-01

    Full Text Available Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001, uninsured encounters decreased (18.4% to 6.3%, P < 0.001, and private payer encounters also decreased (14.1% to 13.3%, P = .001. The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001. In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion.

  2. A Study of the Impact of Transformative Professional Development on Hispanic Student Performance on State Mandated Assessments of Science in Elementary School

    Science.gov (United States)

    Johnson, Carla C.; Fargo, Jamison D.

    2014-11-01

    This paper reports the findings of a study of the impact of the transformative professional development (TPD) model on student achievement on state-mandated assessments of science in elementary school. Two schools (one intervention and one control) participated in the case study where teachers from one school received the TPD intervention across a 2-year period while teachers at the other school received no program and continued business as usual. The TPD program includes a focus on the core conceptual framework for effective professional development (Desimone in Educ Res 38:181-199, 2009) as well as an emphasis on culturally relevant pedagogy (CRP) and other effective science instructional strategies. Findings revealed that participation in TPD had a significant impact on student achievement for Burns Elementary with the percentage of proficient students growing from 25 % at baseline to 67 % at the end of the 2-year program, while the comparison school did not experience similar growth. Implications for future research and implementation of professional development programs to meet the needs of teachers in the realm of CRP in science are discussed.

  3. Innovative payer engagement strategies: will the convergence lead to better value creation in personalized medicine?

    Science.gov (United States)

    Akhmetov, Ildar; Bubnov, Rostyslav V

    2017-12-01

    As reimbursement authorities are gaining greater power to influence the prescription behavior of physicians, it remains critical for life science companies focusing on personalized medicine to develop "tailor-made" payer engagement strategies to secure reimbursement and assure timely patient access to their innovative products. Depending on the types of such engagement, pharmaceutical and diagnostic companies may benefit by obtaining access to medical and pharmacy claims data, getting invaluable upfront inputs on evidence requirements and clinical trial design, and strengthening trust by payers, therefore avoiding uncertainties with regards to pricing, reimbursement, and research and development reinvestment. This article aims to study the evolving trend of partnering among two interdependent, yet confronting, stakeholder groups-payers and producers-as well as to identify the most promising payer engagement strategies based on cocreation of value introduced by life science companies in the past few years. We analyzed the recent case studies from both therapeutic and diagnostic realms considered as the "best practices" in payer engagement. The last 5 years were a breakout period for deals between life science companies and reimbursement authorities in the area of personalized medicine with a number of felicitous collaborative practices established already, and many more yet to emerge. We suggest that there are many ways for producers and payers to collaborate throughout the product life cycle-from data exchange and scientific counseling to research collaboration aimed at reducing healthcare costs, addressing adherence issues, and diminishing risks associated with future launches. The presented case studies provide clear insights on how successful personalized medicine companies customize their state-of-the-art payer engagement strategies to ensure closer proximity with payers and establish longer-term trust-based relationships.

  4. Primary payer status is associated with mortality and resource utilization for coronary artery bypass grafting.

    Science.gov (United States)

    LaPar, Damien J; Stukenborg, George J; Guyer, Richard A; Stone, Matthew L; Bhamidipati, Castigliano M; Lau, Christine L; Kron, Irving L; Ailawadi, Gorav

    2012-09-11

    Medicaid and uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes after coronary artery bypass grafting (CABG) in the United States is dependent on primary payer status. From 2003 to 2007, 1,250,619 isolated CABG operations were evaluated using the Nationwide Inpatient Sample (NIS) database. Patients were stratified by primary payer status: Medicare, Medicaid, uninsured, and private insurance. Hierarchical multiple regression models were applied to assess the effect of primary payer status on postoperative outcomes. Unadjusted mortality for Medicare (3.3%), Medicaid (2.4%), and uninsured (1.9%) patients were higher compared with private insurance patients (1.1%, Paccrued the highest unadjusted total costs ($113 380 ± 386, Pincome, hospital features, and operative volume, Medicaid (odds ratio, 1.82; P<0.001) and uninsured (odds ratio, 1.62; P<0.001) payer status independently conferred the highest adjusted odds of in-hospital mortality. In addition, Medicaid payer status was associated with the longest adjusted length of stay and highest adjusted total costs (P<0.001). Medicaid and uninsured payer status confers increased risk adjusted in-hospital mortality for patients undergoing coronary artery bypass grafting operations. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors. Possible explanations include delays in access to care or disparate differences in health maintenance.

  5. Payer Negotiations in the New Healthcare Environment: How to Prepare for and Succeed in a Value-Based World.

    Science.gov (United States)

    Howrigon, Ron

    2016-01-01

    Because of their involvement with the Affordable Care exchanges, the national insurance companies have reported significant financial losses. As a result, there will soon be significant payer pressure to reduce medical expenses. To succeed in future negotiations with the payers, medical practices must understand the needs of the payers and then play to those needs. The author is a former managed care executive with more than 25 years of experience managing provider networks and implementing payer strategies for some of the largest payers in the United States. In this article, he outlines important things medical practices should be doing to prepare for the new world of value-based contracting. Medical practices that embrace this change and work hard to evolve with the future are the ones that are going to survive and succeed.

  6. Fla. Budget Threatens Online Ed. Mandate

    Science.gov (United States)

    Manzo, Kathleen Kennedy

    2009-01-01

    As Florida school districts scramble to meet a looming state mandate to offer full-time online instruction for K-8 students, and as high school enrollments in such courses continue to climb, lawmakers are mulling restrictions and budget cuts for the state's nationally known virtual school. Together, online-learning advocates say, the growing…

  7. "Managed competition" for Ireland? The single versus multiple payer debate.

    Science.gov (United States)

    Mikkers, Misja; Ryan, Padhraig

    2014-09-26

    A persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of 'managed competition' based on the recent reforms in the Netherlands, which would replace many functions of Ireland's public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems. Although Ireland currently lacks key preconditions for effective implementation, the Dutch experience demonstrates that some of these can be implemented over time, such as a more rigorous risk equalization system. A fundamental problem may be Ireland's sparse hospital distribution. This may increase the market power of hospitals and weaken insurers' ability to exclude inefficient or poor quality hospitals from contracts, leading to unwarranted spending growth. To mitigate this, the government proposes to introduce a system of price caps for hospital services.The Dutch system of competition is still in transition and it is premature to judge its success. The new system may have catalyzed increased transparency regarding clinical performance, but outcome measurement remains crude. A multi-payer environment creates some disincentives for quality improvement, one of which is free-riding by insurers on their rivals' quality investments. If a Dutch insurer invests in improving hospital quality, hospitals will probably offer equivalent quality to consumers enrolled with other insurance companies. This enhances equity, but may weaken incentives for improvement. Consequently the Irish government, rather than insurers, may need to assume responsibility for investing in clinical quality. Plans are in place to assure consumers of

  8. Adaptive Pathways: Possible Next Steps for Payers in Preparation for Their Potential Implementation

    Directory of Open Access Journals (Sweden)

    Patricia Vella Bonanno

    2017-08-01

    Full Text Available Medicines receiving a conditional marketing authorization through Medicines Adaptive Pathways to Patients (MAPPs will be a challenge for payers. The “introduction” of MAPPs is already seen by the European Medicines Agency (EMA as a fait accompli, with payers not consulted or involved. However, once medicines are approved through MAPPs, they will be evaluated for funding by payers through different activities. These include Health Technology Assessment (HTA with often immature clinical data and high uncertainty, financial considerations, and negotiations through different types of agreements, which can require monitoring post launch. Payers have experience with new medicines approved through conditional approval, and the fact that MAPPs present additional challenges is a concern from their perspective. There may be some activities where payers can collaborate. The final decisions on whether to reimburse a new medicine via MAPPs will have more variation than for medicines licensed via conventional processes. This is due not only to increasing uncertainty associated with medicines authorized through MAPPs but also differences in legal frameworks between member states. Moreover, if the financial and side-effect burden from the period of conditional approval until granting full marketing authorization is shifted to the post-authorization phase, payers may have to bear such burdens. Collection of robust data during routine clinical use is challenging along with high prices for new medicines during data collection. This paper presents the concept of MAPPs and possible challenges. Concerns and potential ways forward are discussed and a number of recommendations are presented from the perspective of payers.

  9. Child Abuse and Mandated Reporting

    Science.gov (United States)

    Woika, Shirley; Bowersox, Carissa

    2013-01-01

    Teachers and teachers-in-training are mandated reporters; they are legally required to report any suspected child abuse or neglect. This article describes: (1) How to file a report; (2) How prevalent child abuse is; (3) What abuse is; (4) What it means to be a mandated reporter; (5) When the report should be made; and (6) What to do if abuse is…

  10. The HPV vaccine mandate controversy.

    Science.gov (United States)

    Haber, Gillian; Malow, Robert M; Zimet, Gregory D

    2007-12-01

    In this editorial we address the controversies surrounding human papillomavirus (HPV) vaccine school-entry mandate legislation, but differentiate between the mandate debate and issues specific to the vaccine itself. Our goal is not to take a stand in favor of or opposed to mandates, but rather to critically examine the issues. We discuss the following arguments against HPV vaccine school-entry requirements: 1. The public health benefit of mandated HPV vaccination is not sufficient to warrant the intrusion on parental autonomy; 2. A vaccine that prevents a non-casually transmitted infection should not be mandated; 3. Opt-out provisions are inherently unfair to parents who oppose HPV vaccination; 4. Limited health care dollars should not be directed toward cervical cancer prevention; and 5. The vaccine is expensive and potential problems with supply suggest that mandates should not be implemented until insurance coverage and supply issues are resolved. Next, we critically evaluate the following critiques of HPV vaccination itself: 1. Giving girls HPV vaccine implies tacit consent to engage in sexual activity; 2. Giving girls this vaccine will confer a false sense of protection from sexually transmitted infections and will lead to sexual disinhibition; 3. Children already have too many vaccinations on the immunization schedule; 4. Long-term side effects of HPV vaccine are unknown; 5. The vaccine's enduring effectiveness is unknown and booster shots may be required; and 6. It is wrong to only target girls with HPV vaccine; boys should be vaccinated as well.

  11. The economics of employer versus individual mandates.

    Science.gov (United States)

    Krueger, A B; Reinhardt, U E

    This paper reviews the economic implications of employer and individual health insurance mandates. Although the cost of meeting an employer mandate is nominally paid by employers, in the long run much of the cost may be shifted backward to employees in the form of lower wages. We also compare the consequences of hypothetical employer and individual health insurance mandates for families with different income levels. Depending on their structure, an employer mandate may be more or less progressive than an individual mandate.

  12. Payer Perspectives on Patient-Reported Outcomes in Health Care Decision Making: Oncology Examples.

    Science.gov (United States)

    Brogan, Andrew P; DeMuro, Carla; Barrett, Amy M; D'Alessio, Denise; Bal, Vasudha; Hogue, Susan L

    2017-02-01

    Health authorities and payers increasingly recognize the importance of patient perspectives and patient-reported outcomes (PROs) in health care decision making. However, given the broad variety of PRO endpoints included in clinical programs and variations in the timing of PRO data collection and country-specific needs, the role of PRO data in reimbursement decisions requires characterization. To (a) determine the effect of PRO data on market access and reimbursement decisions for oncology products in multiple markets and (b) assess the effect of PRO data collected after clinical progression on payer decision making. A 3-part assessment (targeted literature review, qualitative one-on-one interviews, and online survey) was undertaken. Published literature was identified through searches in PubMed/MEDLINE and Embase. In addition, a targeted search was conducted of health technology assessment (HTA) agency websites in the United States, the United Kingdom, France, and Germany. Qualitative one-on-one interviews were conducted with 16 payers from the RTI Health Solutions global advisory panel in 14 markets (Australia, Brazil, France, Germany, Italy, South Korea, Netherlands, Poland, Spain, Sweden, Taiwan, Turkey, the United Kingdom, and the United States [n = 3]). Of the 200 payers and payer advisors from the global advisory panel invited to participate in the online survey, 20 respondents (China, France, Germany, Spain [n = 2], Taiwan, the United Kingdom, and the United States [n = 13]) completed the survey, and 6 respondents (Australia, South Korea, and the United States [n = 4]) partially completed the survey. Reviews of the literature and publicly available HTAs and reimbursement decisions suggested that HTA bodies and payers have varying experience with and confidence in PRO data. Payers participating in the survey indicated that PRO data may be especially influential in oncology compared with other therapeutic areas. Payers surveyed offered little differentiation

  13. The Catholic Bishops vs. the Contraceptive Mandate

    Directory of Open Access Journals (Sweden)

    Leslie C. Griffin

    2015-12-01

    Full Text Available The Roman Catholic bishops of the United States have publicly opposed artificial contraception since they first issued a public statement condemning it in 1919. Thereafter, the bishops were generally unsuccessful in persuading the public that contraceptive access should be restricted. Recently, however, the bishops succeeded in a campaign to restrict access to contraceptives for Catholic and non-Catholic women alike. Their lobbying and public criticism of the contraceptive mandate of the Affordable Care Act (ACA, which requires employer health plans to offer preventive reproductive care coverage, forced Obama administration officials into a series of accommodations that gutted portions of the law intended to provide contraception to employees without copayment or cost sharing. In contrast to their earlier efforts to restrict reproductive freedom, the bishops successfully characterized their efforts against the ACA as a battle for religious freedom rather than against reproductive rights. This successful strategy may lead to future setbacks for women’s reproductive liberty.

  14. Are Teachers Prepared? Predictors of Teachers' Readiness to Serve as Mandated Reporters of Child Abuse

    Science.gov (United States)

    Greytak, Emily A.

    2009-01-01

    The Child Abuse Prevention and Treatment Act (1974) requires that states receiving U.S. federal funds directed at child abuse implement mandated reporting laws. As a result, all states have adopted legislation requiring teachers and other professionals who deal with children to report suspicions of child abuse. The federal mandate for such…

  15. NCAA concussion education in ice hockey: an ineffective mandate.

    Science.gov (United States)

    Kroshus, Emily; Daneshvar, Daniel H; Baugh, Christine M; Nowinski, Christopher J; Cantu, Robert C

    2014-01-01

    Despite concussion education being increasingly mandated by states and sports leagues, there has been limited evaluation of what education is in fact effective. The National Collegiate Athletic Association (NCAA) currently mandates that institutions provide concussion education, without specifying content or delivery. The present study evaluated the effectiveness of this general mandate, as enacted for male collegiate ice hockey teams within one conference of competition. In a prospective cohort design, 146 players from 6 male collegiate ice hockey teams in one Division 1 conference completed written surveys before and after receiving their institution-determined concussion education. Knowledge, attitudes, perceived norms and behavioural intention were assessed using validated measures. Education content and delivery was assessed by open-ended responses and consultation with team athletic trainers. All teams received concussion education material; however, content and delivery varied. Rates of material recall differed by delivery format. Considering all teams together, there were no significant improvements in knowledge and only a very small decrease in intention to continue playing while experiencing symptoms of a concussion. Pre-education and post-education, there were significant between-team differences in attitudes towards concussion reporting and behavioural intention. The NCAA's general education mandate was divergently enacted; it did not significantly change the constructs of interest nor did it mitigate the pre-education team differences in these constructs. Existing educational materials should be evaluated, theory and evidence-driven materials developed, and mandates extended to, at a minimum, recommend materials found to be effective in changing concussion-reporting behaviour.

  16. External Mandates and Instructional Leadership: School Leaders as Mediating Agents

    Science.gov (United States)

    Louis, Karen Seashore; Robinson, Viviane M.

    2012-01-01

    Purpose: The purpose of this paper is to examine how US school leaders make sense of external mandates, and the way in which their understanding of state and district accountability policies affects their work. It is posited that school leaders' responses to external accountability are likely to reflect a complex interaction between their…

  17. Assisted reproductive technology use, embryo transfer practices, and birth outcomes after infertility insurance mandates: New Jersey and Connecticut.

    Science.gov (United States)

    Crawford, Sara; Boulet, Sheree L; Jamieson, Denise J; Stone, Carol; Mullen, Jewel; Kissin, Dmitry M

    2016-02-01

    To explore whether recently enacted infertility mandates including coverage for assisted reproductive technology (ART) treatment in New Jersey (2001) and Connecticut (2005) increased ART use, improved embryo transfer practices, and decreased multiple birth rates. Retrospective cohort study using data from the National ART Surveillance System. We explored trends in ART use, embryo transfer practices and birth outcomes, and compared changes in practices and outcomes during a 2-year period before and after passing the mandate between mandate and non-mandate states. Not applicable. Cycles of ART performed in the United States between 1996 and 2013. Infertility insurance mandates including coverage for ART treatment passed in New Jersey (2001) and Connecticut (2005). Number of ART cycles performed, number of embryos transferred, multiple live birth rates. Both New Jersey and Connecticut experienced an increase in ART use greater than the non-mandate states. The mean number of embryos transferred decreased significantly in New Jersey and Connecticut; however, the magnitudes were not significantly different from non-mandate states. There was no significant change in ART birth outcomes in either mandate state except for an increase in live births in Connecticut; the magnitude was not different from non-mandate states. The infertility insurance mandates passed in New Jersey and Connecticut were associated with increased ART treatment use but not a decrease in the number of embryos transferred or the rate of multiples; however, applicability of the mandates was limited. Published by Elsevier Inc.

  18. THE SOCIAL MANDATE FOR HIGH SCHOOL

    Directory of Open Access Journals (Sweden)

    Olga L. Lushnikova

    2016-12-01

    Full Text Available Introduction: the problem of formulation of social mandate at the level of primary education is caused by integration, globalisation processes, and introduction of reforms in education. The contemporary society puts forward new requirements to education system which has to meet demands of various social actors, involved in the educational process. Social mandate is a tool of interaction between society and education by which the diverse consumers of educational services can express their educational needs. A student as the main subject of education takes the special place among the consumers of educational services. Clearly defined social mandates ensures quality of education, therefore this article focuses on the attempt of formulating social mandate for the high school on behalf of a learner. Materials and Methods: a theoretical analysis of pedagogical and sociological literature was made in the process of writing the article. Results: the domestic and international experience in elaboration of the social mandate for the high school was explored and summarised. The main targets of social mandate at the level of basic education was analysed. Discussion and Conclusions: the paper describes the specifics of formulation of the social mandate (specific interests, needs, requirements and requests to high school, that high school should work towards to be able to maintain its competitiveness in the modern market society.

  19. Print News Coverage of School-Based Human Papillomavirus Vaccine Mandates

    Science.gov (United States)

    Casciotti, Dana M.; Smith, Katherine C.; Andon, Lindsay; Vernick, Jon; Tsui, Amy; Klassen, Ann C.

    2014-01-01

    Background: In 2007, legislation was proposed in 24 states and the District of Columbia for school-based human papillomavirus (HPV) vaccine mandates, and mandates were enacted in Texas, Virginia, and the District of Columbia. Media coverage of these events was extensive, and media messages both reflected and contributed to controversy surrounding…

  20. Did the US Infertility Health Insurance Mandates Affect the Timing of First Birth?

    NARCIS (Netherlands)

    Ohinata, A.

    2011-01-01

    From 1977-2001, 15 US states mandated health insurance providers to offer coverage for infertility treatment. Although the majority of the past literature has studied impacts on older women who are likely to seek treatment, this paper proposes that the mandates may have had a wider impact on the US

  1. Differences in the rates of patient safety events by payer: implications for providers and policymakers.

    Science.gov (United States)

    Spencer, Christine S; Roberts, Eric T; Gaskin, Darrell J

    2015-06-01

    The reduction of adverse patient safety events and the equitable treatment of patients in hospitals are clinical and policy priorities. Health services researchers have identified disparities in the quality of care provided to patients, both by demographic characteristics and insurance status. However, less is known about the extent to which disparities reflect differences in the places where patients obtain care, versus disparities in the quality of care provided to different groups of patients in the same hospital. In this study, we examine whether the rate of adverse patient safety events differs by the insurance status of patients within the same hospital. Using discharge data from hospitals in 11 states, we compared risk-adjusted rates for 13 AHRQ Patient Safety Indicators by Medicare, Medicaid, and Private payer insurance status, within the same hospitals. We used multivariate regression to assess the relationship between insurance status and rates of adverse patient safety events within hospitals. Medicare and Medicaid patients experienced significantly more adverse safety events than private pay patients for 12 and 7 Patient Safety Indicators, respectively (at P patients had significantly lower event rates than private payers on 2 Patient Safety Indicators. Risk-adjusted Patient Safety Indicator rates varied with patients' insurance within the same hospital. More research is needed to determine the cause of differences in care quality received by patients at the same hospital, especially if quality measures are to be used for payment.

  2. Learning from the Aloha State.

    Science.gov (United States)

    Dukakis, M S; Roseman, C

    1992-01-01

    Since 1974, Hawaii has required its employers to provide health insurance to all employees working at least 20 hours a week. More recently, the state created a new program to cover the "gap group" of 50,000 uninsured residents, along with a new program to create a "seamless system of health care" for all Aloha State residents. And Hawaii has managed to insure nearly all of its citizens while keeping the annual price of health insurance at nearly half of that paid in many mainland states ($1,300 per person and $4,000 per family). At the same time, life expectancy is the highest in the nation and infant mortality is among the lowest. In seeking to reform a dysfunctional national insurance system, policymakers should learn from the Hawaiian experience, which shows that small business can live with an employer mandate, universal coverage can cut costs by encouraging early preventive care, and a dominant payer can reduce administrative expenses.

  3. Biosimilars: How Can Payers Get Long-Term Savings?

    Science.gov (United States)

    Mestre-Ferrandiz, Jorge; Towse, Adrian; Berdud, Mikel

    2016-06-01

    The term 'biosimilar' refers to an alternative similar version of an off-patent innovative originator biotechnology product (the 'reference product'). Several biosimilars have been approved in Europe, and a number of top-selling biological medicines have lost, or will lose, patent protection over the next 5 years. We look at the experience in Europe so far. The USA has finally implemented a regulatory route for biosimilar approval. We recommend that European and US governments and payers take a strategic approach to get value for money from the use of biosimilars by (1) supporting and incentivising generation of high-quality comprehensive outcomes data on the effectiveness and safety of biosimilars and originator products; and (2) ensuring that incentives are in place for budget holders to benefit from price competition. This may create greater willingness on the part of budget holders and clinicians to use biosimilar and originator products with comparable outcomes interchangeably, and may drive down prices. Other options, such as direct price cuts for originator products or substitution rules without outcomes data, are likely to discourage biosimilar entry. With such approaches, governments may achieve a one-off cut in originator prices but may put at risk the creation of a more competitive market that would, in time, produce much greater savings. It was the creation of competitive markets for chemical generic drugs-notably, in the USA, the UK and Germany-rather than price control, that enabled payers to achieve the high discounts now taken for granted.

  4. Consumer, physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network.

    Science.gov (United States)

    Smith, Marie; Cannon-Breland, Michelle L; Spiggle, Susan

    2014-01-01

    Health care reform initiatives are examining new care delivery models and payment reform alternatives such as medical homes, health homes, community-based care transitions teams, medical neighborhoods and accountable care organizations (ACOs). Of particular interest is the extent to which pharmacists are integrated in team-based health care reform initiatives and the related perspectives of consumers, physicians, and payers. To assess the current knowledge of consumers and physicians about pharmacist training/expertise and capacity to provide primary care medication management services in a shared resource network; determine factors that will facilitate/limit consumer interest in having pharmacists as a member of a community-based "health care team;" determine factors that will facilitate/limit physician utilization of pharmacists for medication management services; and determine factors that will facilitate/limit payer reimbursement models for medication management services using a shared resource pharmacist network model. This project used qualitative research methods to assess the perceptions of consumers, primary care physicians, and payers on pharmacist-provided medication management services using a shared resource network of pharmacists. Focus groups were conducted with primary care physicians and consumers, while semi-structured discussions were conducted with a public and private payer. Most consumers viewed pharmacists in traditional dispensing roles and were unaware of the direct patient care responsibilities of pharmacists as part of community-based health teams. Physicians noted several chronic disease states where clinically-trained pharmacists could collaborate as health care team members yet had uncertainties about integrating pharmacists into their practice workflow and payment sources for pharmacist services. Payers were interested in having credentialed pharmacists provide medication management services if the services improved quality of patient

  5. School Accountability and Youth Obesity: Can Physical Education Mandates Make a Difference?

    National Research Council Canada - National Science Library

    Schneider, Helen; Zhang, Ning

    2013-01-01

    .... We also find that state physical education mandates increase physical activity for children in grades 3 through 8 and mitigate the negative effect of accountability pressures on physical activity...

  6. Change of Subsidiary Mandates in Emerging Markets

    DEFF Research Database (Denmark)

    Hansen, Michael W.; Petersen, Bent; Wad, Peter

    2011-01-01

    fails to conceptualize how the specificities of emerging market business environments affect subsidiary mandate evolution. The paper develops a theoretical model for business environment change influence on subsidiary mandates, and demonstrates how the model can capture much of recent years dramatic......In recent years, the activities of Danish MNCs in India have expanded dramatically. Previously dormant subsidiaries have been transformed into integral components in the global strategies of Danish MNCs, either as crucial cash cows catering to the rapidly growing Indian markets, or as platforms...

  7. Markets, not mandates, shape ethanol production

    OpenAIRE

    Nathan Kauffman

    2012-01-01

    The 2012 drought has reignited the food versus fuel debate. After cutting U.S. corn production below recent years’ consumption, the drought sparked a U.S. grain shortage and sent global food prices soaring. As the grain shortage intensified, pressure to relieve the shortage by easing ethanol mandates mounted.

  8. Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism?

    Science.gov (United States)

    Doshi, Pratik; Tilford, J Mick; Ounpraseuth, Songthip; Kuo, Dennis Z; Payakachat, Nalin

    2017-02-01

    Objective The study investigated whether state mandates for private insurers to provide services for children with autism influence racial disparities in outcomes. Methods The study used 2005/2006 and 2009/2010 waves of the National Survey of Children with Special Health Care Needs. Children with a current diagnosis of autism were included in the sample. Children residing in 14 states and the District of Columbia that were not covered by the mandate in the 2005/2006 survey, but were covered in the 2009/2010 survey, served as the mandate group. Children residing in 32 states that were not covered by a mandate in either wave served as the comparison group. Outcome measures assessed included care quality, family economics, and child health. A difference-in-difference-in-differences (DDD) approach was used to assess the impact of the mandates on racial disparities in outcomes. Results Non-white children had less access to family-centered care compared to white children in both waves of data, but this difference was not apparent across mandate and comparison states as only the comparison states had significant differences. Parents of non-white children reported paying less in annual out-of-pocket expenses compared to parents of white children across waves and groups. DDD estimates did not provide evidence that the mandates had statistically significant effects on improving or worsening racial disparities for any outcome measure. Conclusions This study did not find evidence that state mandates on private insurers affected racial disparities in outcomes for children with autism.

  9. Changes to Medicare Secondary Payer (MSP) provisions--HCFA. Notice.

    Science.gov (United States)

    1991-01-11

    This notice describes how subsections 6202(b), (c), and (e) of the Omnibus Budget Reconciliation Act of 1989 (Pub. L. 101-239) affect the Medicare Program These subsections: Create uniform rules for computing Medicare secondary payments for all MSP situations; Exempt from the MSP provisions services performed for a religious order by members of the order who take a vow of poverty; Prohibit group health plans (GHPs) from "taking into account" that an individual is entitled to Medicare when Medicare is the secondary payer; Prohibit GHPs from differentiating, in the services they provide, between individuals with end-stage renal disease (ESRD) and other individuals covered by the plan; Require that GHPs of employers of 20 or more employees provide the same benefits under the same conditions to employees age 65 or older and employees' spouses age 65 or older as they provide to employees and spouses under age 65; Impose a 25 percent excise tax on contributions that employers and employee organizations make to nonconforming GHPs, i.e., plans that do not comply with the MSP provisions; Extend to all MSP situations the Federal Government's right to take legal action to collect double damages if a primary plan fails to comply with the Medicare secondary payment requirements of the law; Make the provisions for special enrollment periods for the disabled parallel to those in effect for the working aged. The statutory changes made by subsections 6202(b), (c), and (e) can be put into effect without first issuing regulations because it is clear on the face of the statute what the Congress intended.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age.

    Science.gov (United States)

    Villelli, Nicolas W; Yan, Hong; Zou, Jian; Barbaro, Nicholas M

    2017-12-01

    OBJECTIVE Several similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors' prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US. METHODS Using the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers' compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control. RESULTS The authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and "other" categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65-84 years old, with a decrease in surgeries for those 18-44 years old. New York showed an increase in all insurance categories and all adult age groups. CONCLUSIONS After the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly

  11. Factors Influencing Compliance with Legislative Mandates within Information Technology Departments

    Science.gov (United States)

    Gioia, Paul J.

    2014-01-01

    Since 2001, information technology (IT) leadership has had to contend with a host of new federal and local regulatory mandates. The purpose of this quantitative study was to identify and assess the possible inefficiencies associated with efforts to comply with recent legislative IT mandates and to model the impact of these mandates on the…

  12. Role of Payers in the Development of Cardiovascular Therapeutics: Misalignment Between Approval and Reimbursement.

    Science.gov (United States)

    Zannad, Faiez; Alonso Garcia, Maria de Los Angeles; Borer, Jeffrey S; Stough, Wendy Gattis; Clutton-Brock, Thomas; Rosenberg, Yves; Packer, Milton

    2017-12-05

    Regulators and payers have contrasting priorities that can lead to divergent decisions and delays in patient access to new treatments. Those involved in coverage decisions have not routinely been integrated in the drug development process. Theoretically, inclusion of payer representatives early in development could help discern discordance among stakeholder priorities; facilitate cooperation to align objectives; foster agreement on the evidence required for approval and reimbursement; improve transparency, accountability, and consistency of payer decision making; and ideally, minimize delays in patient access to new therapies. However, early participation by payers may not provide these expected benefits if payers' decision-making processes are not evidence based or cannot be reliably predicted. This paper describes current interactions among regulatory agencies, payers, sponsors, and investigators and proposes collaboration among all stakeholders earlier in the development process. The premise that a priori discussions might facilitate the delivery of advances in cardiovascular care is a hypothesis worth testing. Copyright © 2017 American College of Cardiology Foundation. All rights reserved.

  13. Comparative analysis on the probability of being a good payer

    Science.gov (United States)

    Mihova, V.; Pavlov, V.

    2017-10-01

    Credit risk assessment is crucial for the bank industry. The current practice uses various approaches for the calculation of credit risk. The core of these approaches is the use of multiple regression models, applied in order to assess the risk associated with the approval of people applying for certain products (loans, credit cards, etc.). Based on data from the past, these models try to predict what will happen in the future. Different data requires different type of models. This work studies the causal link between the conduct of an applicant upon payment of the loan and the data that he completed at the time of application. A database of 100 borrowers from a commercial bank is used for the purposes of the study. The available data includes information from the time of application and credit history while paying off the loan. Customers are divided into two groups, based on the credit history: Good and Bad payers. Linear and logistic regression are applied in parallel to the data in order to estimate the probability of being good for new borrowers. A variable, which contains value of 1 for Good borrowers and value of 0 for Bad candidates, is modeled as a dependent variable. To decide which of the variables listed in the database should be used in the modelling process (as independent variables), a correlation analysis is made. Due to the results of it, several combinations of independent variables are tested as initial models - both with linear and logistic regression. The best linear and logistic models are obtained after initial transformation of the data and following a set of standard and robust statistical criteria. A comparative analysis between the two final models is made and scorecards are obtained from both models to assess new customers at the time of application. A cut-off level of points, bellow which to reject the applications and above it - to accept them, has been suggested for both the models, applying the strategy to keep the same Accept Rate as

  14. Denosumab for Elderly Men with Osteoporosis: A Cost-Effectiveness Analysis from the US Payer Perspective

    Directory of Open Access Journals (Sweden)

    Stuart Silverman

    2015-01-01

    Full Text Available Purpose. To evaluate the cost-effectiveness of denosumab versus other osteoporotic treatments in older men with osteoporosis from a US payer perspective. Methods. A lifetime cohort Markov model previously developed for postmenopausal osteoporosis (PMO was used. Men in the model were 78 years old, with a BMD T-score of −2.12 and a vertebral fracture prevalence of 23%. During each 6-month Markov cycle, patients could have experienced a hip, vertebral or nonhip, nonvertebral (NHNV osteoporotic fracture, remained in a nonfracture state, remained in a postfracture state, or died. Background fracture risks, mortality rates, persistence rates, health utilities, and medical and drug costs were derived from published sources. Previous PMO studies were used for drug efficacy in reducing fracture risk. Lifetime expected costs and quality-adjusted life-years (QALYs were estimated for denosumab, generic alendronate, risedronate, ibandronate, teriparatide, and zoledronate. Results. Denosumab had an incremental cost-effectiveness ratio (ICER of $16,888 compared to generic alendronate and dominated all other treatments. Results were most sensitive to changes in costs of denosumab and the relative risk of hip fracture. Conclusion. Despite a higher annual treatment cost compared to other medications, denosumab is cost-effective compared to other osteoporotic treatments in older osteoporotic US men.

  15. Estimating Nitrogen Load Resulting from Biofuel Mandates

    Directory of Open Access Journals (Sweden)

    Mohammad Alshawaf

    2016-05-01

    Full Text Available The Energy Policy Act of 2005 and the Energy Independence and Security Act (EISA of 2007 were enacted to reduce the U.S. dependency on foreign oil by increasing the use of biofuels. The increased demand for biofuels from corn and soybeans could result in an increase of nitrogen flux if not managed properly. The objectives of this study are to estimate nitrogen flux from energy crop production and to identify the catchment areas with high nitrogen flux. The results show that biofuel production can result in an increase of nitrogen flux to the northern Gulf of Mexico from 270 to 1742 thousand metric tons. Using all cellulosic (hay ethanol or biodiesel to meet the 2022 mandate is expected to reduce nitrogen flux; however, it requires approximately 25% more land when compared to other scenarios. Producing ethanol from switchgrass rather than hay results in three-times more nitrogen flux, but requires 43% less land. Using corn ethanol for 2022 mandates is expected to have double the nitrogen flux when compared to the EISA-specified 2022 scenario; however, it will require less land area. Shifting the U.S. energy supply from foreign oil to the Midwest cannot occur without economic and environmental impacts, which could potentially lead to more eutrophication and hypoxia.

  16. Estimating the national cost of treating people with HIV disease: patient, payer, and provider data.

    Science.gov (United States)

    Hellinger, F J; Fleishman, J A

    2000-06-01

    Existing estimates of the national cost of treating all people with HIV disease use data from a sample of people with HIV disease to extrapolate the cost of treating all people with HIV disease (patient-based approach). This study derives estimates using two novel approaches (i.e., payer-based and provider-based) and compares these with existing estimates. These include the Health Insurance Association of American and the American Council of Life Insurance 1996 HIV survey, the 1996 State Inpatient Databases (SID) maintained by the Agency for Healthcare Research and Quality, and the IMS America Ltd. survey of independent and chain drugstores. The cost of treating all people with HIV disease in 1996 was between $6.7 and $7.8 billion U.S., and the average annual cost of treating a person with HIV disease was between $20,000 and $24,700 U.S. Analysts should derive estimates of the cost of treating people with HIV disease using several different approaches. K

  17. Economic evaluation of sequencing strategies in HER2-positive metastatic breast cancer in Mexico: a contrast between public and private payer perspectives.

    Science.gov (United States)

    Diaby, Vakaramoko; Ali, Askal Ayalew; Williams, Krystal J; Ezendu, Kyrian; Soto-Perez-de-Celis, Enrique; Chavarri-Guerra, Yanin; de Lima Lopes, Gilberto

    2017-12-01

    Breast cancer is the most common malignancy among women in Mexico. A large proportion of Mexican patients present with advanced disease, and 25% have HER2-positive tumors. We performed a cost-effectiveness analysis of different sequencing strategies of HER2-targeted agents in Mexico according to various payer perspectives. A Markov model was constructed to evaluate the cost-effectiveness of four different HER2-targeted treatment sequences among patients with HER2-positive metastatic breast cancer treated in Mexico according to three public and one private payer perspectives. Patients were followed weekly over their remaining life expectancies within the model. Health states considered were progression-free survival (PFS) 1st-3rd lines, and death. Transition probabilities between states were based on published trials. Cost data were obtained from official publications from Mexican healthcare institutions. The evaluated outcomes were PFS, OS, costs, QALYs, and incremental cost effectiveness ratio (ICER). In the public payer perspective, sequences containing pertuzumab or T-DM1 were not cost-effective when compared with a sequence including the combination of trastuzumab/docetaxel as first line without subsequent T-DM1 or pertuzumab, even when utilizing alternate definitions for willingness to pay thresholds. In the private payer perspective, a sequence containing T-DM1 but not pertuzumab proved cost-effective at a lower clinical effectiveness. In Mexico, the use of at least three lines of trastuzumab in combination with other therapies, but not with pertuzumab or TDM-1, represents the most cost-effective option for patients covered by the public healthcare system, and this sequence should be made available for all patients.

  18. The Protos mandate a scientific novel

    CERN Document Server

    Kanas, Nick

    2014-01-01

    In the 25th Century, the effects of overpopulation and global warming on Earth have led to the formation of human colonies on the Moon, Mars and elsewhere in the Solar System, yet the limited number of viable places forces humanity to look to the stars. A crash program has been developed to send Protos 1, a giant multigenerational starship, to a newly discovered Earth-like planet orbiting a nearby star. The plan is for awake crewmembers to run the ship, and for people in suspended animation to be roused before planetfall to use their skills in exploration and colony formation. To fulfill the goals of the mission and ensure that the in-flight population does not deplete the limited resources, the Protos Mandate is set up to govern a tightly controlled social system for the duration of the journey, which will take several generations.  But problems threaten to sabotage the mission during its launch and transit, and what finally awaits the crewmembers shocks them in an unpredictable way.  This novel chronicl...

  19. Provider-Payer Partnerships as an Engine for Continuous Quality Improvement.

    Science.gov (United States)

    Balfour, Margaret E; Zinn, Tylar E; Cason, Karena; Fox, Jerimya; Morales, Myra; Berdeja, Cesar; Gray, Jay

    2018-03-01

    The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers.

  20. California Secondary School Physical Education Teachers' Attitudes toward the Mandated Use of the Fitnessgram

    Science.gov (United States)

    Ferguson, Robert H.; Keating, Xiaofen Deng; Guan, Jianmin; Chen, Li; Bridges, Dwan M.

    2007-01-01

    This study aimed to determine how California secondary physical education teachers perceive the state mandated youth fitness testing for the 5th, 7th, and 9th grades using Fitnessgram. The participants were secondary school physical education teachers (N = 323). A previously validated attitudinal instrument (Keating & Silverman, 2004a) was…

  1. Linking Job-Embedded Professional Development and Mandated Teacher Evaluation: Teacher as Learner

    Science.gov (United States)

    Derrington, Mary Lynne; Kirk, Julia

    2017-01-01

    This study explores the link between individualized, job-embedded professional development and teacher evaluation. Moreover, the study explores and describes job-embedded strategies that principals used to facilitate teacher development while working within a state-mandated evaluation system. The theoretical frame utilized four elements of…

  2. The Phantom Mandate: District Capacity for Reform.

    Science.gov (United States)

    Florian, Judy; Hange, Jane; Copeland, Glenda

    Nearly every state focuses on implementing standards-based systems but supports educational reform in as many different ways as there are states. An examination of 15 districts located in 13 states suggests, however, that some states and districts have policies and practices in common that support a district's capacity for reform, whether there is…

  3. Does hemopericardium after chest trauma mandate sternotomy?

    Science.gov (United States)

    Thorson, Chad M; Namias, Nicholas; Van Haren, Robert M; Guarch, Gerardo A; Ginzburg, Enrique; Salerno, Tomas A; Schulman, Carl I; Livingstone, Alan S; Proctor, Kenneth G

    2012-06-01

    Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether these were rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy. Records were retrospectively reviewed for all patients at a Level I trauma center (December 1996 to November 2011) who sustained chest trauma with pericardial window (PCW, n = 377) and/or median sternotomy (n = 110). Fifty-five (15%) patients with positive PCW proceeded to sternotomy. Penetrating injury was the dominant mechanism (n = 49, 89%). Nineteen (35%) were hypotensive on arrival or during initial resuscitation. Most received surgeon-performed focused cardiac ultrasound examinations (n = 43, 78%) with positive results (n = 25, 58%). Ventricular injuries were most common, with equivalent numbers occurring on the right (n = 16, 29%) and left (n = 15, 27%). Six (11%) with positive PCW had isolated pericardial lacerations, but 21 (38%) had no repairable cardiac or great vessel injury. Those with therapeutic versus nontherapeutic sternotomies were similar with respect to age, mechanisms of injury, injury severity scores, presenting laboratory values, resuscitation fluids, and vital signs. Multiple logistic regression revealed that penetrating trauma (odds ratio: 13.3) and hemodynamic instability (odds ratio: 7.8) were independent predictors of therapeutic sternotomy. Hemopericardium per se may be overly sensitive for diagnosing cardiac or great vessel injuries after chest trauma. Some stable blunt or penetrating trauma patients without continuing intrapericardial bleeding had nontherapeutic sternotomies, suggesting that this intervention could be avoided in selected cases. Therapeutic study, level III. Copyright © 2012 by Lippincott Williams & Wilkins.

  4. Performance-Based Risk-Sharing Arrangements: U.S. Payer Experience.

    Science.gov (United States)

    Goble, Joseph A; Ung, Brian; van Boemmel-Wegmann, Sascha; Navarro, Robert P; Parece, Andrew

    2017-10-01

    As a result of global concern about rising drug costs, many U.S. payers and European agencies such as the National Health Service have partnered with pharmaceutical companies in performance-based risk-sharing arrangements (PBRSAs) by which manufacturers share financial risk with health care purchasing entities and authorities. However, PBRSAs present many administrative and legal challenges that have minimized successful contract experiences in the United States. To (a) identify drug and disease characteristics and contract components that contribute to successful PBRSA experiences and the primary barriers to PBRSA execution and (b) explore solutions to facilitate contract negotiation and execution. A 37-item, web-based survey instrument (Qualtrics), approximately 20 minutes in duration, was open during July and August 2016. The survey was emailed to 90 pharmacy and medical directors of various health care organizations. Statistical analysis included the Kruskal-Wallis test and chi-square tests to examine differences among payer responses. Survey responses were anonymized and data were aggregated. Twenty-seven individuals completed the survey (30% completion rate). The majority of respondents worked for regional health plans (52%, n = 14), covering at least 1 million lives (63%, n = 17), with at least 7 years of managed care experience (81%, n = 22). A total of 51 PBRSAs were active among respondents at the time of the survey. Easily obtainable and evaluable drug data and medical data were the most important drug and disease attributes for successful PBRSAs, respectively. Pharmacy claims and patient demographic data were assessed as "very easy and inexpensive" to collect. Type and amount of manufacturer payment for drug outcome performance failure, endpoint measurement, and necessary clinical data for drug performance measurement were all critical factors for successful PBRSAs. Standardized contract templates and transparent contract financial risk evaluation and

  5. Chronological History of Federal Fleet Actions and Mandates (Brochure)

    Energy Technology Data Exchange (ETDEWEB)

    2011-04-01

    This chronological history of Federal fleet actions and mandates provides a year-by-year timeline of the acts, amendments, executive orders, and other regulations that affect Federal fleets. The fleet actions and mandates included in the timeline span from 1988 to 2009.

  6. The Mandate System for the Belgian Public Prosecution

    Directory of Open Access Journals (Sweden)

    Bruno BROUCKER

    2009-12-01

    Full Text Available The law of 22 December 1998 introduced the mandate system for the heads of the Public Prosecution offices, which were appointed permanent before that. Theoretically, such a system needs to enhance, within the organization, effectiveness, efficiency, responsabilisation, and goal-orientation. However, the mandate system within the Belgian Public Prosecution was introduced prematurely, for dubious reasons and in a precipitate manner. In the current situation, the position of the mandate holder is uncertain, with a bounded autonomy and a low wage increase. Moreover, it remains impossible to intervene in the policy of appointed heads of office (during their mandate, the efficiency and effectiveness is only increased in some prosecution offices and a contract containing actual management responsibilities is absent. In sum: there is a large gap between the theoretical principles of mandate systems and the way it is introduced in the Belgian Public Prosecution.

  7. 78 FR 57800 - Medicare Program; Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web...

    Science.gov (United States)

    2013-09-20

    ...; Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Interim final rule with comment period. SUMMARY: This interim final rule with comment period specifies the process and timeline for expanding CMS' existing...

  8. Gender, Colonialism and Rabbinical Courts in Mandate Palestine

    Directory of Open Access Journals (Sweden)

    Lisa Fishbayn

    2011-11-01

    Full Text Available The distribution of powers between the state and religious groups plays an important role in shaping how controversies over multicultural toleration and women’s rights under religious law can be resolved. Some structures encourage dialogue while others make it difficult. In Israel, the presence of multiple systems of personal religious law limits the possibilities for the transformation of discriminatory religious laws. There is no civil marriage or divorce in Israel. When the modern State of Israel was created, exclusive power over family law disputes involving Jewish citizens was placed in the hands of rabbinical courts. This arrangement has been called one to retain the ‘status quo’. However, it was not a continuation of Jewish tradition or of the arrangements in place during the long period of Ottoman rule in Palestine. It reflected strengthened powers that had been given to rabbinical courts during the period of the British Mandate for Palestine. This article will trace the ways in which British policies for colonial rule and the interests of Jewish religious leaders coalesced to create a regime of religious family law that is resistant to feminist demands for change.

  9. Mandating nutrient menu labeling in restaurants: potential public health benefits.

    Science.gov (United States)

    Stran, Kimberly A; Turner, Lori W; Knol, Linda

    2013-03-01

    Many Americans have replaced home-cooked meals with fast food and restaurants meals. This contributes to increased incidences of overweight and obesity. Implementing policies that require restaurants to disclose nutrition information has the potential to improve nutrition knowledge and food behaviors. The purpose of this paper was to examine the potential health benefits of nutrient menu labeling in restaurants, the progress of this legislation and to provide results regarding the implementation of these policies. Data sources were obtained from a search of multiple databases including PubMed, Science Direct, Academic Search Premier, and Google Scholar. Study inclusion criteria were publication in the past ten years, obesity prevention, and utilization of nutrition labeling on menus in restaurants. The initial policies to provide consumers with nutrition information in restaurant settings began at the state levels in 2006. These laws demonstrated success, other states followed, and a national law was passed and is being implemented. Mandating nutrient menu disclosure has the potential to influence a large number of people; this legislation has the opportunity to impact Americans who dine at a fast food or chain restaurant. Given the growing obesity epidemic, continued research is necessary to gauge the effectiveness of this new law and its effects on the health status of the American people.

  10. The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases.

    Science.gov (United States)

    Rocco, Philip; Kelly, Andrew S; Béland, Daniel; Kinane, Michael

    2017-02-01

    Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs' efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform. Copyright © 2017 by Duke University Press.

  11. Connecticut Hospital Readmissions Related to Chest Pain and Heart Failure: Differences by Race, Ethnicity, and Payer.

    Science.gov (United States)

    Aseltine, Robert H; Yan, Jun; Gruss, Claudia B; Wagner, Catherine; Katz, Matthew

    2015-02-01

    Racial and ethnic disparities in hospital readmissions for several major illnesses and conditions are well-documented. However, due to the data typically used to assess readmission disparities little is known regarding the interplay between race/ethnicity and payer in fostering readmissions. This study used a statewide database of acute-care hospital admissions to examine 30-day readmission rates following hospitalization for chest pain and heart failure byrace/ethnicity and insurance status. Connecticut hospital discharge data for patients admitted for Chest Pain-DRG 313 (n = 23,450) and Heart Failure and Shock-DRG 291 and 292 (n = 39,985) from 2008 - 2012 were analyzed using marginal logistic models for clustered data with generalized estimating equations. Results from logistic models indicated that Black patients were significantly more likely to be readmitted within 30 days of discharge following hospitalization for chest pain (OR = 1.19, CI = 1.04, 1.37) than were White patients. Hispanics, but not Blacks, were significantly more likely to be readmitted within 30 days of discharge following hospitalization for heart failure (OR = 1.30, CI = 1.15, 1.47). Rates of 30-day readmission across these conditions were between 50-100% higher among those covered by Medicaid compared to those covered by private payer. Controlling for patient socioeconomic status, patient comorbidities, and payer substantially reduced Black/White differences in the odds of readmission for chest pain but did not reduce Hispanic-White differences for heart failure. Racial and ethnic disparities were seen in hospital readmission rates for Chest Pain (DRG 313) and Heart Failure and Shock (DRG 291 and 292) when a statewide database that captures all acute care hospital admissions was analyzed. When controlling for patient socioeconomic status, comorbidities, and payer status, the difference in the odds of readmission for chest pain, but not heart failure, was reduced.

  12. Innovative payer engagement strategies: will the convergence lead to better value creation in personalized medicine?

    OpenAIRE

    Akhmetov, Ildar; Bubnov, Rostyslav V

    2017-01-01

    Background As reimbursement authorities are gaining greater power to influence the prescription behavior of physicians, it remains critical for life science companies focusing on personalized medicine to develop ?tailor-made? payer engagement strategies to secure reimbursement and assure timely patient access to their innovative products. Depending on the types of such engagement, pharmaceutical and diagnostic companies may benefit by obtaining access to medical and pharmacy claims data, gett...

  13. Payer Type and Low-Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations.

    Science.gov (United States)

    Colla, Carrie H; Morden, Nancy E; Sequist, Thomas D; Mainor, Alexander J; Li, Zhonghe; Rosenthal, Meredith B

    2017-02-19

    To compare low-value health service use among commercially insured and Medicare populations and explore the influence of payer type on the provision of low-value care. 2009-2011 national Medicare and commercial insurance administrative data. We created claims-based algorithms to measure seven Choosing Wisely-identified low-value services and examined the correlation between commercial and Medicare overuse overall and at the regional level. Regression models explored associations between overuse and regional characteristics. We created measures of early imaging for back pain, vitamin D screening, cervical cancer screening over age 65, prescription opioid use for migraines, cardiac testing in asymptomatic patients, short-interval repeat bone densitometry (DXA), preoperative cardiac testing for low-risk surgery, and a composite of these. Prevalence of four services was similar across the insurance-defined groups. Regional correlation between Medicare and commercial overuse was high (correlation coefficient = 0.540-0.905) for all measures. In both groups, similar region-level factors were associated with low-value care provision, especially total Medicare spending and ratio of specialists to primary care physicians. Low-value care appears driven by factors unrelated to payer type or anticipated reimbursement. These findings suggest the influence of local practice patterns on care without meaningful discrimination by payer type. © Health Research and Educational Trust.

  14. Oxygenated fuels mandate: marketers ponder additive strategy

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, E.V.

    1987-08-03

    When Colorado created its mandatory oxygenated fuels program to combat cold-weather carbon monoxide pollution it did more than just take a giant step toward a cleaner environment. It created a training ground where refiners and producers of oxygenated fuel additives can sharpen their marketing skills for the time when other states and metropolitan areas also might decide to go the oxygenated fuels route. The Colorado oxygenated fuels program was a major reason why officials from more than a dozen states and cities, as well as scores of representatives from concerned companies, were attracted to last month's Conference on New Fuels for Cleaner Air, held in Arlington, VA. Although no one went away with definitive answers to all their questions it became apparent that the Colorado oxygenated fuels market will develop into a one-on-one battle between ethanol and MTBE (methyl tert-butyl ether). The oxygen level of the fuel set by Colorado's new program probably gives MTBE the edge. The advantages of using MTBE are discussed.

  15. Association between payer mix and costs, revenues and profitability: a cross-sectional study of Lebanese hospitals.

    Science.gov (United States)

    Saleh, S; Ammar, W; Natafgi, N; Mourad, Y; Dimassi, H; Harb, H

    2015-09-08

    This study aimed to examine the association between the payer mix and the financial performance of public and private hospitals in Lebanon. The sample comprised 24 hospitals, representing the variety of hospital characteristics in Lebanon. The distribution of the payer mix revealed that the main sources of revenue were public sources (61.1%), out-of-pocket (18.4%) and private insurance (18.2%). Increases in the percentage of revenue from public sources were associated with lower total costs and revenues, but not profit margins. An inverse association was noted between increased revenue from private insurance and profitability, attributed to increased costs. Increased percentage of out of- pocket payments was associated with lower costs and higher profitability. The study provides evidence that payer mix is associated with hospital costs, revenues and profitability. This should initiate/inform discussions between public and private payers and hospitals about the level of payment and its association with hospital sector financial viability.

  16. Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial

    National Research Council Canada - National Science Library

    Molfenter, Todd; Kim, Jee-Seon; Quanbeck, Andrew; Patel-Porter, Terry; Starr, Sandy; McCarty, Dennis

    2013-01-01

    .... The Advancing Recovery Framework offers a multi-level approach to evidence-based practice implementation by aligning purchasing and regulatory policies at the payer level with organizational change...

  17. Discounts and rebates granted to public payers for medicines in European countries.

    Science.gov (United States)

    Vogler, Sabine; Zimmermann, Nina; Habl, Claudia; Piessnegger, Jutta; Bucsics, Anna

    2012-07-01

    The objective of this study was to provide an overview about the existence and types of discounts and rebates granted to public payers by the pharmaceutical industry in European countries. Data were collected via a questionnaire in spring 2011. Officials from public authorities for pharmaceutical pricing and reimbursement represented in the PPRI (Pharmaceutical Pricing and Reimbursement Information) network provided the information and reviewed the compilation. Information is available from 31 European countries. Discounts and rebates granted to public payers by pharmaceutical industry were reported for 25 European countries. Such discounts exist both in the in- and out-patient sectors in 21 countries and in the in-patient sector only in four countries. Six countries reported not having any regulations or agreements regarding the discounts and rebates granted by industry. The most common discounts and rebates are price reductions and refunds linked to sales volume but types such as in-kind support, price-volume and risk-sharing agreements are also in place. A mix of various types of discounts and rebates is common. Many of these arrangements are confidential. Differences regarding types, the organizational and legal framework, validity and frequency of updates and the amount of the discounts and rebates granted exist among the surveyed countries. In Europe, discounts and rebates on medicines granted by pharmaceutical industry to public payers are common tools to contain public pharmaceutical expenditure. They appear to be used as a complimentary measure when price regulation does not achieve the desired results and in the few European countries with no or limited price regulation. The confidential character of many of these arrangements impedes transparency and may lead to a distortion of medicines prices. An analysis of the impact on these measures is recommended.

  18. Payers' Views of the Changes Arising through the Possible Adoption of Adaptive Pathways.

    Science.gov (United States)

    Ermisch, Michael; Bucsics, Anna; Vella Bonanno, Patricia; Arickx, Francis; Bybau, Alexander; Bochenek, Tomasz; van de Casteele, Marc; Diogene, Eduardo; Fürst, Jurij; Garuolienė, Kristina; van der Graaff, Martin; Gulbinovič, Jolanta; Haycox, Alan; Jones, Jan; Joppi, Roberta; Laius, Ott; Langner, Irene; Martin, Antony P; Markovic-Pekovic, Vanda; McCullagh, Laura; Magnusson, Einar; Nilsen, Ellen; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Sauermann, Robert; Schuurman, Ad; Ramos, Ricardo; Vlahovic-Palcevski, Vera; Zara, Corinne; Godman, Brian

    2016-01-01

    Payers are a major stakeholder in any considerations and initiatives concerning adaptive licensing of new medicinal products, also referred to as Medicines Adaptive Pathways to patients (MAPPs). Firstly, the scope and necessity of MAPPs need further scrutiny, especially with regard to the definition of unmet need. Conditional approval pathways already exist for new medicines for seriously debilitating or life-threatening diseases and only a limited number of new medicines are innovative. Secondly, MAPPs will result in new medicines on the market with limited evidence about their effectiveness and safety. Additional data are to be collected after approval. Consequently, adaptive pathways may increase the risk of exposing patients to ineffective or unsafe medicines. We have already seen medicines approved conventionally that subsequently proved ineffective or unsafe amongst a wider, more co-morbid population as well as medicines that could have been considered for approval under MAPPs but subsequently proved ineffective or unsafe in Phase III trials and were never licensed. Thirdly, MAPPs also put high demands on payers. Routine collection of patient level data is difficult with high transaction costs. It is not clear who will fund these. Other challenges for payers include shifts in the risk governance framework, implications for evaluation and HTA, increased complexity of setting prices, difficulty with ensuring equity in the allocation of resources, definition of responsibility and liability and implementation of stratified use. Exit strategies also need to be agreed in advance, including price reductions, rebates, or reimbursement withdrawals when price premiums are not justified. These issues and concerns will be discussed in detail including potential ways forward.

  19. Managing biotechnology in a network-model health plan: a U.S. private payer perspective.

    Science.gov (United States)

    Watkins, John B; Choudhury, Sanchita Roy; Wong, Ed; Sullivan, Sean D

    2006-01-01

    Emerging biotechnology poses challenges to payers, including access, coverage, reimbursement, patient selection, and affordability. Premera Blue Cross, a private regional health plan, developed an integrated cross-functional approach to managing biologics, built around a robust formulary process that is fast, flexible, fair, and transparent to stakeholders. Results are monitored by cost and use reporting from merged pharmacy and medical claims. Utilization management and case management strategies will integrate with specialty pharmacy programs to improve outcomes and cost-effectiveness. Creative approaches to provider reimbursement can align providers' incentives with those of the plan. Redesign of member benefits can also encourage appropriate use of biotechnology.

  20. The HHS Mandate and Religious Liberty: A Primer

    Science.gov (United States)

    Keim, Adele Auxier

    2013-01-01

    "We are in a war," Health and Human Services Secretary Kathleen Sebelius declared to cheers at a 2011 National Abortion and Reproductive Rights Action League (NARAL) Pro-Choice America fund-raiser. Secretary Sebelius was referring in part to the uproar caused by the "HHS Mandate," her agency's rule that employer-provided…

  1. South African educators' mutually inclusive mandates to promote ...

    African Journals Online (AJOL)

    South African educators are mandated by international and national law to observe and promote human rights. However, given the realities of the limited teaching time available, educators cannot fulfil this obligation solely by teaching the curriculum. Another avenue needs to be found for educators to fulfil this obligation.

  2. Legal and Judicial Problems in Mandating Equal Time for Creationism.

    Science.gov (United States)

    Skoog, Gerald

    This paper, presented at the annual meeting of the National Association of Biology Teachers, is focused on legal and judicial problems in mandating equal time for creationism. Past events provide evidence that legislation, policies, and local resolutions that require science textbooks and curricula to include the Genesis account of creation are…

  3. From coercion to contract: reframing the debate on mandated community treatment for people with mental disorders.

    Science.gov (United States)

    Bonnie, Richard J; Monahan, John

    2005-08-01

    Approximately half the people receiving treatment in the public sector for mental disorder have experienced some form of "leverage" in which deprivations such as jail or hospitalization have been avoided, or rewards such as money or housing have been obtained, contingent on treatment adherence. We argue in this essay that framing the legal debate on mandated community treatment primarily in terms of "coercion" has become counterproductive and that the debate should be re-framed in terms of "contract." Language derived from the law of contract often yields a more accurate account of the current state of the law governing mandated community treatment, is more likely to be translated into a useful descriptive vocabulary for empirical research, and is more likely to clarify the policy issues at stake than the currently stalemated form of argumentation based on putative rights. Our hope is that adopting the language of contract may help to identify those types and features of mandated community treatment that are genuinely problematic, rather than perpetuating the unhelpful and misleading assumption that all types of leverage amount to "coercion."

  4. Trial of the University Assistance Program for Alcohol Use Among Mandated Students*

    Science.gov (United States)

    Amaro, Hortensia; Ahl, Marilyn; Matsumoto, Atsushi; Prado, Guillermo; Mulé, Christina; Kemmemer, Amaura; Larimer, Mary E.; Masi, Dale; Mantella, Philomena

    2009-01-01

    Objective: The aim of this study was to investigate the effectiveness of a brief intervention for mandated students in the context of the University Assistance Program, a Student Assistance Program developed and modeled after workplace Employee Assistance Programs. Method: Participants were 265 (196 males and 69 females) judicially mandated college students enrolled in a large, urban university in the northeast United States. All participants were sanctioned by the university's judicial office for an alcohol- or drug-related violation. Participants were randomized to one of two intervention conditions (the University Assistance Program or services as usual) and were assessed at baseline and 3 and 6 months after intervention. Results: Growth curve analyses showed that, relative to services as usual, the University Assistance Program was more efficacious in reducing past-90-day weekday alcohol consumption and the number of alcohol-related consequences while increasing past-90-day use of protective behaviors and coping skills. No significant differences in growth trajectories were found between the two intervention conditions on past-90-day blood alcohol concentration, total alcohol consumption, or weekend consumption. Conclusions: The University Assistance Program may have a possible advantage over services as usual for mandated students. PMID:19538912

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

    Science.gov (United States)

    Shortridge, Emily F; Moore, Jonathan R; Whitmore, Heidi; O'Grady, Michael J; Shen, Angela K

    2011-01-01

    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. This was a qualitative study, using a literature review and semistructured expert interviews with payers. 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. 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.

  6. Delegated Asset Management, Investment Mandates, and Capital Immobility

    OpenAIRE

    Zhiguo He; Wei Xiong

    2008-01-01

    This paper develops a model to explain the widely used investment mandates in the institutional asset management industry based on two insights: First, giving a manager more investment flexibility weakens the link between fund performance and his effort in the designated market, and thus increases agency cost. Second, the presence of outside assets with negatively skewed returns can further increase the agency cost if the manager is incentivized to pursue outside opportunities. These effects ...

  7. How alternative payment models in emergency medicine can benefit physicians, payers, and patients.

    Science.gov (United States)

    Harish, Nir J; Miller, Harold D; Pines, Jesse M; Zane, Richard D; Wiler, Jennifer L

    2017-06-01

    While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system. In this article, we describe a framework for the development of APMs for emergency medicine and present four examples of APMs that may be applicable in emergency medicine. A better understanding of how APMs can work in emergency medicine will help EPs develop new APMs that improve the cost and quality of care, and leverage the value that emergency care brings to the system. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. R&D Subsidiary Mandates of Western MNEs in China:

    DEFF Research Database (Denmark)

    Schulzmann, David; Slepniov, Dmitrij

    2016-01-01

    in the world (Motohashi, 2012). These R&D investments to a large extent are flowing into technological parks with good supporting infrastructure in Beijing, Shanghai, Guangzhou and Shenzhen (Stanley et al., 2013; Walsh, 2007). Aside from the lucrative advantages of offshoring R&D to China, there are numerous...... at contributing to the debate about why many Western MNCs in China struggle to transform their locally-oriented R&D subsidiaries to centers with global competence-creating R&D mandate. There are many well-developed theoretical and practical concepts that provide a good point of departure for this investigation...

  9. The impact of maternity length-of-stay mandates on the labor market and insurance coverage.

    Science.gov (United States)

    Sabik, Lindsay M; Laugesen, Miriam J

    2012-01-01

    To understand the effects of insurance regulation on the labor market and insurance coverage, this study uses a difference-in-difference-in-differences analysis to compare five states that passed minimum maternity length-of-stay laws with states that waited until after a federal law was passed. On average, we do not find statistically significant effects on labor market outcomes such as hours of work and wages. However, we find that employees of small firms in states with maternity length-of-stay mandates experienced a 6.2-percentage-point decline in the likelihood of having employer-sponsored insurance. Implementation of federal health reform that requires minimum benefit standards should consider the implications for firms of differing sizes.

  10. Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act.

    Science.gov (United States)

    Frean, Molly; Gruber, Jonathan; Sommers, Benjamin D

    2017-05-01

    Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014-2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange. The individual mandate's exemptions and penalties had little impact on coverage rates. The law increased Medicaid among individuals gaining eligibility under the ACA and among previously-eligible populations ("woodwork effect") even in non-expansion states, with no resulting reductions in private insurance. Overall, exchange premium subsidies produced 40% of the coverage gains explained by our ACA policy measures, and Medicaid the other 60%, of which 1/2 occurred among previously-eligible individuals. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Are Some of the Cigar Warnings Mandated in the U.S. More Believable Than Others?

    Directory of Open Access Journals (Sweden)

    Kristen L. Jarman

    2017-11-01

    Full Text Available Background: Text warnings are mandated on cigars sold in the United States (U.S., however little published research has examined effectiveness of cigar warnings. This is the first study examining the believability of cigar warnings among adults in the U.S. Methods: Adults in the U.S. (n = 5014 were randomized in a phone survey to receive one of three cigar-specific mandated warning messages (“Cigar smoking can cause cancers of the mouth and throat, even if you do not inhale”, “Cigar smoking can cause lung cancer and heart disease”, and “Cigars are not a safe alternative to cigarettes” with one of four warning sources (no source, Surgeon General, CDC (Centers for Disease Control and Prevention, FDA (Food and Drug Administration. Results: Most adults found the cigar warnings very believable (66.9%. Weighted logistic regression results indicate that the message “Cigar smoking can cause lung cancer and heart disease” was associated with higher odds of being very believable (AOR: 2.05, 95% CI: 1.55, 2.70 and the message “Cigars are not a safe alternative to cigarettes” was associated with lower odds of being very believable (AOR: 0.71, 95% CI: 0.55, 0.92 compared to the message “Cigar smoking can cause cancers of the mouth and throat, even if you do not inhale”. Warning source had no impact on believability. Conclusions: We tested three of the currently mandated cigar warnings in the U.S. and found significant differences in believability between them. Further research on cigar warnings may improve communication to the public on cigar health risks, ultimately preventing uptake of cigars and promoting cessation among cigar users.

  12. Louisiana motorcycle fatalities in the wake of governmentally implemented change: a retrospective analysis of the motorcycle morbidity and mortality before, during, and after the repeal of a statewide helmet mandate.

    Science.gov (United States)

    Strom, Shane F; Ambekar, Sudheer; Madhugiri, Venkatesh S; Nanda, Anil

    2013-06-01

    On August 15, 2004, Louisiana's universal motorcycle helmet mandate was reinstated. Previous studies have shown that mortality and morbidity of motorcycle riders who crashed had increased during the 5 years the mandate was repealed. The objective of this study was to discern whether the reinstatement of the universal helmet mandate has resulted in a subsequent decrease in motorcycle-related mortality and morbidity in the state of Louisiana. A retrospective analysis was performed observing the regularity of helmet use and the associated morbidity and mortality of motorcycle traffic accidents from the time before, during, and after the universal motorcycle helmet mandate was repealed in the state of Louisiana. Fatality statistics were obtained through the National Highway Safety Traffic Association. Injury, helmet use, and collision data were obtained from the Louisiana Highway Safety Commission. Motorcycle registration data were obtained from the Federal Highway Administration. Motorcycle crash-related fatalities increased significantly when the statewide helmet mandate was repealed, and interestingly, after reinstatement, these fatality rates never returned to their previous lows. Motorcycle fatalities have increased out of proportion to the increase in motorbike registrations, even when yearly fatalities are normalized to fatalities per 10,000 registered bikes. An all-time high in fatalities was seen in 2006, a year subsequent to the mandate's reinstatement. Fatalities per collision were elevated significantly after the mandate's repeal but did not return to prerepeal lows after the mandate's reinstatement. Although helmet use after reinstatement has reached all-time highs, fatality rates have remained elevated since the original mandate repeal in 1999. Other achievable changes in state policy and law enforcement should be explored to quell this heightened risk to motorcycle enthusiasts in Louisiana, and states considering changing their own motorcycle helmet

  13. Primary care compensation at an academic medical center: a model for the mixed-payer environment.

    Science.gov (United States)

    Sussman, A J; Fairchild, D G; Coblyn, J; Brennan, T A

    2001-07-01

    The authors' academic medical center, Brigham and Women's Hospital, Boston, Massachusetts, developed a primary care physician (PCP) salary incentive program for employed academic physicians. This program, first implemented in 1999, was needed to meet the financial imperatives placed on the institution by managed care and the Balanced Budget Act of 1997; its goal was to create a set of incentives for PCPs that is consistent with the mission of the academic center and helps motivate and reward PCP's work. The program sought to simultaneously increase productivity while optimizing resource utilization in a mixed-payer environment. The salary incentive program uses work relative-value units (wRVUs) as the measure of productivity. In addition to productivity-derived base pay, bonus incentives are added for efficient medical management, quality of care, teaching, and seniority. The authors report that there was significant concern from several members of the physician staff before the plan was implemented; they felt that the institution's PCPs were already operating at maximum clinical capacity. However, after the first year of operation of this plan, there was an overall 20% increase in PCP productivity. Increases were observed in all PCP subgroups when stratified by professional experience, clinical time commitment, and practice location. The authors conclude that the program has succeeded in giving incentives for academic PCPs to achieve under the growing demands for revenue self-sufficiency, managed care performance, quality of care, and academic commitment.

  14. Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial.

    Science.gov (United States)

    Molfenter, Todd; Kim, Jee-Seon; Quanbeck, Andrew; Patel-Porter, Terry; Starr, Sandy; McCarty, Dennis

    2013-05-10

    More effective methods are needed to implement evidence-based findings into practice. The Advancing Recovery Framework offers a multi-level approach to evidence-based practice implementation by aligning purchasing and regulatory policies at the payer level with organizational change strategies at the organizational level. The Advancing Recovery Buprenorphine Implementation Study is a cluster-randomized controlled trial designed to increase use of the evidence-based practice buprenorphine medication to treat opiate addiction. Ohio Alcohol, Drug Addiction, and Mental Health Services Boards (ADAMHS), who are payers, and their addiction treatment organizations were recruited for a trial to assess the effects of payer and treatment organization changes (using the Advancing Recovery Framework) versus treatment organization changes alone on the use of buprenorphine. A matched-pair randomization, based on county characteristics, was applied, resulting in seven county ADAMHS boards and twenty-five treatment organizations in each arm. Opioid dependent patients are nested within cluster (treatment organization), and treatment organization clusters are nested within ADAMHS county board. The primary outcome is the percentage of individuals with an opioid dependence diagnosis who use buprenorphine during the 24-month intervention period and the 12-month sustainability period. The trial is currently in the baseline data collection stage. Although addiction treatment providers are under increasing pressure to implement evidence-based practices that have been proven to improve patient outcomes, adoption of these practices lags, compared to other areas of healthcare. Reasons frequently cited for the slow adoption of EBPs in addiction treatment include, regulatory issues, staff, or client resistance and lack of resources. Yet the way addiction treatment is funded, the payer's role-has not received a lot of attention in research on EBP adoption.This research is unique because it

  15. Employee perception of a mandated helmet policy at Vail Resorts.

    Science.gov (United States)

    Davis, Christopher B; Brownson, Mark R; Levy, Brent J; Valley, Morgan A; Evans, Bruce; Lowenstein, Steven R

    2013-12-01

    The purpose of this study was to measure support for a mandated helmet policy among resort employees along with the impact of such a policy on job satisfaction, and additionally, to measure the prevalence of barriers to helmet use among this population. In all, 728 Vail Resort employees were surveyed regarding their opinions on the helmet policy and on general helmet use. The majority of the 728 employees surveyed (66.5%; 95% CI: 63% to 70%) agreed with the helmet policy. Only 18% (95% CI: 16% to 21%) reported a negative effect on job satisfaction. Older employees (>25 years old) were more likely to disagree with the policy (odds ratio [OR] 3.1; 95% CI: 2.2 to 4.3) and report a negative effect on job satisfaction (OR 4.8; 95% CI: 3.0 to 7.6). Skiers were much more likely than snowboarders to report a negative effect on job satisfaction (OR 9.8; 95% CI: 5.2 to 18.1). Among resort employees, ski patrollers were more likely to disagree with the mandate (OR 9.8; 95% CI: 6.8 to 13.9) and report a negative effect on job satisfaction (OR 13.2; 95% CI: 8.3 to 21.). Forty-three percent of participants (95% CI: 39% to 46%) agreed with the statement that wearing a helmet encourages reckless behavior whereas 51.0% (95% CI: 47% to 54%) believed that wearing a helmet limits sensory perception. A mandatory helmet use policy was supported by most resort employees. However, ski patrollers and older, more experienced employees were more likely to report a negative effect on job satisfaction. Barriers to helmet use continue to persist in the ski industry and represent a target for further educational efforts. © 2013 Published by Elsevier Inc.

  16. Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives.

    Science.gov (United States)

    Whellan, David J; Reed, Shelby D; Liao, Lawrence; Gould, Stuart D; O'connor, Christopher M; Schulman, Kevin A

    2007-01-15

    Although heart failure disease management (HFDM) programs improve patient outcomes, the implementation of these programs has been limited because of financial barriers. We undertook the present study to understand the economic incentives and disincentives for adoption of disease management strategies from the perspectives of a physician (group), a hospital, an integrated health system, and a third-party payer. Using the combined results of a group of randomized controlled trials and a set of financial assumptions from a single academic medical center, a financial model was developed to compute the expected costs before and after the implementation of a HFDM program by 3 provider types (physicians, hospitals, and health systems), as well as the costs incurred from a payer perspective. The base-case model showed that implementation of HFDM results in a net financial loss to all potential providers of HFDM. Implementation of HFDM as described in our base-case analysis would create a net loss of US dollars 179,549 in the first year for a physician practice, US dollars 464,132 for an integrated health system, and US dollars 652,643 in the first year for a hospital. Third-party payers would be able to save US dollars 713,661 annually for the care of 350 patients with heart failure in a HFDM program. In conclusion, although HFDM programs may provide patients with improved clinical outcomes and decreased hospitalizations that save third-party payers money, limited financial incentives are currently in place for healthcare providers and hospitals to initiate these programs.

  17. Economic Evaluation of PCSK9 Inhibitors in Reducing Cardiovascular Risk from Health System and Private Payer Perspectives.

    Directory of Open Access Journals (Sweden)

    Alejandro Arrieta

    Full Text Available The introduction of Proprotein covertase subtilisin/kexin type 9 (PCSK9 inhibitors has been heralded as a major advancement in reducing low-density lipoprotein cholesterol levels by nearly 50%. However, concerns have been raised on the added value to the health care system in terms of their costs and benefits. We assess the cost-effectiveness of PCSK9 inhibitors based on a decision-analytic model with existing clinical evidence. The model compares a lipid-lowering therapy based on statin plus PCSK9 inhibitor treatment with statin treatment only (standard therapy. From health system perspective, incremental cost per quality adjusted life years (QALYs gained are presented. From a private payer perspective, return-on-investment and net present values over patient lifespan are presented. At the current annual cost of $14,000 to $15,000, PCSK9 inhibitors are not cost-effective at an incremental cost of about $350,000 per QALY. Moreover, for every dollar invested in PCSK9 inhibitors, the private payer loses $1.98. Our study suggests that the annual treatment price should be set at $4,250 at a societal willingness-to-pay of $100,000 per QALY. However, we estimate the breakeven price for private payer is only $600 per annual treatment. At current prices, our study suggests that PCSK9 inhibitors do not add value to the U.S. health system and their provision is not profitable for private payers. To be the breakthrough drug in the fight against cardiovascular disease, the current price of PCSK9 inhibitors must be reduced by more than 70%.

  18. Sharing risk between payer and provider by leasing health technologies: an affordable and effective reimbursement strategy for innovative technologies?

    Science.gov (United States)

    Edlin, Richard; Hall, Peter; Wallner, Klemens; McCabe, Christopher

    2014-06-01

    The challenge of implementing high-cost innovative technologies in health care systems operating under significant budgetary pressure has led to a radical shift in the health technology reimbursement landscape. New reimbursement strategies attempt to reduce the risk of making the wrong decision, that is, paying for a technology that is not good value for the health care system, while promoting the adoption of innovative technologies into clinical practice. The remaining risk, however, is not shared between the manufacturer and the health care payer at the individual purchase level; it continues to be passed from the manufacturer to the payer at the time of purchase. In this article, we propose a health technology payment strategy-technology leasing reimbursement scheme-that allows the sharing of risk between the manufacturer and the payer: the replacing of up-front payments with a stream of payments spread over the expected duration of benefit from the technology, subject to the technology delivering the claimed health benefit. Using trastuzumab (Herceptin) in early breast cancer as an exemplar technology, we show how a technology leasing reimbursement scheme not only reduces the total budgetary impact of the innovative technology but also truly shares risk between the manufacturer and the health care system, while reducing the value of further research and thus promoting the rapid adoption of innovative technologies into clinical practice. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  19. Clinical impact of a home-based palliative care program: a hospice-private payer partnership.

    Science.gov (United States)

    Kerr, Christopher W; Tangeman, John C; Rudra, Carole B; Grant, Pei C; Luczkiewicz, Debra L; Mylotte, Kathleen M; Riemer, William D; Marien, Melanie J; Serehali, Amin M

    2014-11-01

    Outpatient programs have been traditionally offered in the U.S. under programs such as the Medicare Hospice Benefit. Recommendations now emphasize a blended model in which palliative care is offered concurrently with curative approaches at the onset of serious or life-limiting disease. The efficacy of nonhospice outpatient palliative care programs is not well understood. The aim of the study was to evaluate the clinical impact of a home-based palliative care program, Home Connections, implemented as a partnership between a not-for-profit hospice and two private insurers. This was a prospective, observational, database study of 499 Home Connections participants enrolled between July 1, 2008, and May 31, 2013. Measured outcomes were advance directive completion, site of death, symptom severity over time, program satisfaction, and hospice referral and average length of stay. Seventy-one percent of participants completed actionable advance directives after enrollment, and the site of death was home for 47% of those who died during or after participation in the program. Six of eight symptom domains (anxiety, appetite, dyspnea, well-being, depression, and nausea) showed improvement. Patients, caregivers, and physicians gave high program satisfaction scores (93%-96%). Home Connections participants who subsequently enrolled in hospice care had a longer average length of stay of 77.9 days compared with all other hospice referrals (average length of stay 56.5 days). A home-based palliative care program was developed between two local commercial payers and a not-for-profit hospice. Not only did this program improve symptom management, advance directive completion, and satisfaction, but it also facilitated the transition of patients into hospice care, when appropriate. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  20. Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.

    Science.gov (United States)

    Song, Chao; Liu, Emelline; Tackett, Scott; Shi, Lizheng; Marcus, Daniel

    2017-06-01

    This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. A time series study was conducted using the Premier Hospital Perspective(®) Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective. During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective. The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities. Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases

  1. Congress, courts, and commerce: upholding the individual mandate to protect the public's health.

    Science.gov (United States)

    Hodge, James G; Brown, Erin C Fuse; Orenstein, Daniel G; O'Keefe, Sarah

    2011-01-01

    Among multiple legal challenges to the Patient Protection and Affordable Care Act (PPACA) is the premise that PPACA's "individual mandate" (requiring all individuals to obtain health insurance by 2014 or face civil penalties) is inviolate of Congress' interstate commerce powers because Congress lacks the power to regulate commercial "inactivity." Several courts initially considering this argument have rejected it, but federal district courts in Virginia and Florida have concurred, leading to numerous appeals and prospective review of the United States Supreme Court. Despite creative arguments, the dispositive constitutional question is not whether Congress' interstate commerce power extends to commercial inactivity. Rather, it is whether Congress may regulate individual decisions with significant economic ramifications in the interests of protecting and promoting the public's health. This article offers a counter-interpretation of the scope of Congress' interstate commerce power to regulate in furtherance of the public's health. © 2011 American Society of Law, Medicine & Ethics, Inc.

  2. Supporting the advancement of science: Open access publishing and the role of mandates

    Directory of Open Access Journals (Sweden)

    Phelps Lisa

    2012-01-01

    Full Text Available Abstract In December 2011 the United States House of Representatives introduced a new bill, the Research Works Act (H.R.3699, which if passed could threaten the public's access to US government funded research. In a digital age when professional and lay parties alike look more and more to the online environment to keep up to date with developments in their fields, does this bill serve the best interests of the community? Those in support of the Research Works Act argue that government open access mandates undermine peer-review and take intellectual property from publishers without compensation, however journals like Journal of Translational Medicine show that this is not the case. Journal of Translational Medicine in affiliation with the Society for Immunotherapy of Cancer demonstrates how private and public organisations can work together for the advancement of science.

  3. B2, B7 or B10: Which palm-based blend mandate wise to be chosen in Malaysia?

    Science.gov (United States)

    Applanaidu, Shri-Dewi; Abidin, Norhaslinda Zainal; Ali, Anizah Md.

    2015-12-01

    The diminishing fossil energy resources, coupled with heightened interest in the abatement of greenhouse gas emissions and concerns about energy security have motivated Malaysia to produce palm-based biodiesel and it has been started to be exported since 2006. In line with this issue, the government in Malaysia launched the palm-based biodiesel blending mandate of five percent (B5) in the federal administration of Putrajaya on 1st June 2011. This was then followed by four states: Malacca on July 11, Negeri Sembilan on August 1, Kuala Lumpur on September 1 and Selangor on October 1 of the same year but it is yet to be implemented nationwide. However what is the wise blend mandate to be chosen? Thus, this paper seeks to examine the possible impact of various blend mandates implementation (B2, B7 and B10) on the palm oil industry market variables (stock and price) since the main aim of biodiesel industry in Malaysia is to reduce domestic palm oil stock to below one million tones and provide a floor price to support Crude Palm Oil (CPO) prices at RM2,000 per tonne. A structural econometric model consisting of nine structural equations and three identities was proposed in this study. The model has been estimated by two stage least squares (2SLS) method using annual data for the period 1976-2013. The study indicates that counterfactual simulation of a decrease from B5 to B2 predicts a decrease (11.2 per cent) in CPO domestic consumption for biodiesel usage, 731.02 per cent reduction in CPO stock and an increase of 27.41 percent in domestic price of CPO. However the increase in the blend mandate from B5 to B7 and B10 suggest that domestic consumption of CPO for biodiesel purpose increase 7.40 and 18.55 percent respectively. The interesting findings in this study suggest that no matter whether Malaysian government increase or decrease the blend mandate the increase in the price of CPO are the same with an increase of is 27.41 percent. Hence, this study suggests that the

  4. B2, B7 or B10: Which palm-based blend mandate wise to be chosen in Malaysia?

    Energy Technology Data Exchange (ETDEWEB)

    Applanaidu, Shri-Dewi, E-mail: dewi@uum.edu.my; Ali, Anizah Md., E-mail: anizah@uum.edu.my [Department of Economics and Agribusiness, School of Economics, Finance & Banking, UUM (Malaysia); Abidin, Norhaslinda Zainal, E-mail: nhaslinda@uum.edu.my [Department of Decision Sciences, School of Quantitative Sciences, UUM (Malaysia)

    2015-12-11

    The diminishing fossil energy resources, coupled with heightened interest in the abatement of greenhouse gas emissions and concerns about energy security have motivated Malaysia to produce palm-based biodiesel and it has been started to be exported since 2006. In line with this issue, the government in Malaysia launched the palm-based biodiesel blending mandate of five percent (B5) in the federal administration of Putrajaya on 1{sup st} June 2011. This was then followed by four states: Malacca on July 11, Negeri Sembilan on August 1, Kuala Lumpur on September 1 and Selangor on October 1 of the same year but it is yet to be implemented nationwide. However what is the wise blend mandate to be chosen? Thus, this paper seeks to examine the possible impact of various blend mandates implementation (B2, B7 and B10) on the palm oil industry market variables (stock and price) since the main aim of biodiesel industry in Malaysia is to reduce domestic palm oil stock to below one million tones and provide a floor price to support Crude Palm Oil (CPO) prices at RM2,000 per tonne. A structural econometric model consisting of nine structural equations and three identities was proposed in this study. The model has been estimated by two stage least squares (2SLS) method using annual data for the period 1976-2013. The study indicates that counterfactual simulation of a decrease from B5 to B2 predicts a decrease (11.2 per cent) in CPO domestic consumption for biodiesel usage, 731.02 per cent reduction in CPO stock and an increase of 27.41 percent in domestic price of CPO. However the increase in the blend mandate from B5 to B7 and B10 suggest that domestic consumption of CPO for biodiesel purpose increase 7.40 and 18.55 percent respectively. The interesting findings in this study suggest that no matter whether Malaysian government increase or decrease the blend mandate the increase in the price of CPO are the same with an increase of is 27.41 percent. Hence, this study suggests that

  5. The evolution of healthcare quality measurement in the United States.

    Science.gov (United States)

    Burstin, H; Leatherman, S; Goldmann, D

    2016-02-01

    Quality measurement is fundamental to systematic improvement of the healthcare system. Whilst the United States has made significant investments in healthcare quality measurement and improvement, progress has been somewhat limited. Public and private payers in the United States increasingly mandate measurement and reporting as part of pay-for-performance programmes. Numerous issues have limited improvement, including lack of alignment in the use of measures and improvement strategies, the fragmentation of the U.S. healthcare system, and the lack of national electronic systems for measurement, reporting, benchmarking and improvement. Here, we provide an overview of the evolution of U.S. quality measurement efforts, including the role of the National Quality Forum. Important contextual changes such as the growing shift towards electronic data sources and clinical registries are discussed together with international comparisons. In future, the U.S. healthcare system needs to focus greater attention on the development and use of measures that matter. The three-part aim of effective care, affordable care and healthy communities in the U.S. National Quality Strategy focuses attention on population health and reduction in healthcare disparities. To make significant improvements in U.S. health care, a closer connection between measurement and both evolving national data systems and evidence-based improvement strategies is needed. © 2016 The Association for the Publication of the Journal of Internal Medicine.

  6. Mandated empowerment: handing antipoverty policy back to the poor?

    Science.gov (United States)

    Banerjee, Abhijit V; Duflo, Esther

    2008-01-01

    The current trend in antipoverty policy emphasizes mandated empowerment: the poor are being handed the responsibility for making things better for themselves, largely without being asked whether this is what they want. Beneficiary control is now being built into public service delivery, while microcredit and small business promotion are seen as better ways to help the poor. The clear presumption is that the poor are both able and happy to exercise these new powers. This essay uses two examples to raise questions about these strategies. The first example is about entrepreneurship among the poor. Using data from a number of countries, we argue that there is no evidence that the median poor entrepreneur is trying his best to expand his existing businesses, even if we take into account the many constraints he faces. While many poor people own businesses, this seems to be more a survival strategy than something they want to do. The second example comes from an evaluation of a program in India that aims to involve poor rural parents in improving local public schools. The data suggest that despite being informed that they now have both the right to intervene in the school and access to funds for that purpose, and despite being made aware of how little the children were learning, parents opt to not get involved. Both examples raise concerns about committing ourselves entirely to antipoverty strategies that rely on the poor doing a lot of the work.

  7. Mapping Economic Development: The South Seas Government and Sugar Production in Japan’s South Pacific Mandate, 1919–1941

    Directory of Open Access Journals (Sweden)

    Ti Ngo

    2012-03-01

    Full Text Available Japan acquired the Mariana, Caroline, and Marshall Island chains as a League of Nations mandate following World War I. Why did the local administration (the South Seas Government or Nanyōchō heavily subsidize the establishment of a sugar industry? While the South Seas Government did not explicitly state why it chose to support the sugar industry despite the wealth of oceanic resources surrounding the islands, imperial maps of the South Pacific produced by the Japanese navy and the South Seas Government provide a window into how both parties envisioned and planned for the economic future of the mandate. These maps included information regarding the available natural resources, land, and culture level of the Micronesian population. The author argues that in depicting the islands as spaces where a “primitive” nonagricultural population failed to take advantage of the islands’ resources, mapmakers and officials planned for the mass migration of Japanese labor to the mandate in order to support a newly established sugar industry.

  8. Alcohol Use Problems Mediate the Relation between Cannabis Use Frequency and College Functioning among Students Mandated to an Alcohol Diversion Program

    Science.gov (United States)

    McChargue, Dennis E.; Klanecky, Alicia K.; Anderson, Jennifer

    2012-01-01

    The present study examined the degree to which alcohol use problems explained the relationship between cannabis use frequency and college functioning. Undergraduates (N = 546) mandated to an alcohol diversion program at a Midwestern United States university completed screening questionnaires between October 2003 and April 2006. Sobel's (1982) test…

  9. Cost effectiveness of endometrial ablation with the NovaSure® system versus other global ablation modalities and hysterectomy for treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives

    Directory of Open Access Journals (Sweden)

    Miller JD

    2015-01-01

    Full Text Available Jeffrey D Miller,1 Gregory M Lenhart,1 Machaon M Bonafede,1 Cindy M Basinski,2 Andrea S Lukes,3 Kathleen A Troeger4 1Truven Health Analytics, Cambridge, MA, 2Basinski, LLC, Newburgh, IN, 3Carolina Women’s Research and Wellness Center, Durham, NC, 4Hologic, Inc, Marlborough, MA, USA Objectives: Abnormal uterine bleeding (AUB interferes with physical, emotional, and social well-being, impacting the quality of life of more than 10 million women in the USA. Hysterectomy, the most common surgical treatment of AUB, has significant morbidity, low mortality, long recovery, and high associated health care costs. Global endometrial ablation (GEA provides a surgical alternative with reduced morbidity, cost, and recovery time. The NovaSure® system utilizes unique radiofrequency impedance-based GEA technology. This study evaluated cost effectiveness of AUB treatment with NovaSure ablation versus other GEA modalities and versus hysterectomy from the US commercial and Medicaid payer perspectives. Methods: A health state transition (semi-Markov model was developed using epidemiologic, clinical, and economic data from commercial and Medicaid claims database analyses, supplemented by published literature. Three hypothetical cohorts of women receiving AUB interventions were simulated over 1-, 3-, and 5-year horizons to evaluate clinical and economic outcomes for NovaSure, other GEA modalities, and hysterectomy. Results: Model analyses show lower costs for NovaSure-treated patients than for those treated with other GEA modalities or hysterectomy over all time frames under commercial payer and Medicaid perspectives. By Year 3, cost savings versus other GEA were $930 (commercial and $3,000 (Medicaid; cost savings versus hysterectomy were $6,500 (commercial and $8,900 (Medicaid. Coinciding with a 43%–71% reduction in need for re-ablation, there were 69%–88% fewer intervention/reintervention complications for NovaSure-treated patients versus other GEA modalities

  10. Impact of Virginia's School-Entry Vaccine Mandate on Human Papillomavirus Vaccination Among 13-17-Year-Old Females.

    Science.gov (United States)

    Pierre-Victor, Dudith; Page, Timothy F; Trepka, Mary Jo; Stephens, Dionne P; Li, Tan; Madhivanan, Purnima

    2017-03-01

    The link between human papillomavirus (HPV) and anogenital cancers is well established in the literature. Many states have passed laws requiring funding for HPV education or vaccination. Mandatory HPV vaccination policies have been considered and passed in several states; yet their effectiveness has not been evaluated. This study sought to assess the impact of Virginia's HPV vaccine mandate for school-entry on HPV vaccine uptake among females aged 13-17 years. Data from the National Immunization Survey-Teen for the 2008-2012 period were used, and 3,203 adolescent females were included in the analysis. We performed difference-in-differences estimation and logistic regression with a policy and period interaction term. Virginia was considered the treatment state, and South Carolina and Tennessee were the comparison states to account for nonpolicy factors that may have affected vaccination rates during the time period considered in the analysis. There was no evidence of an effect of Virginia's HPV vaccine mandate for school-entry on vaccination rates or on physician vaccination recommendation using either the difference-by-differences analysis or the policy and period interaction term in the logistic regression. Physician recommendation was the factor most strongly associated with vaccination in the Virginia-South Carolina analysis (adjusted odds ratio [aOR] = 9.33; 95% confidence interval [CI]: 6.11-14.3) and in the Virginia-Tennessee analysis (aOR = 9.33; 95% CI: 6.11-14.3). Study findings suggest that Virginia's HPV vaccine mandate for school-entry did not lead to a significant increase in HPV vaccination among adolescent females or physician recommendations. However, physician recommendation was the factor most strongly associated with vaccination.

  11. 24 CFR 5.233 - Mandated use of HUD's Enterprise Income Verification (EIV) System.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Mandated use of HUD's Enterprise... and Verification of Social Security Numbers and Employer Identification Numbers; Procedures for... § 5.233 Mandated use of HUD's Enterprise Income Verification (EIV) System. (a) Programs subject to...

  12. Evaluation of Web-Based and Counselor-Delivered Feedback Interventions for Mandated College Students

    Science.gov (United States)

    Doumas, Diana M.; Workman, Camille R.; Navarro, Anabel; Smith, Diana

    2011-01-01

    This study evaluated the efficacy of 2 brief personalized feedback interventions aimed at reducing drinking among mandated college students. Results indicated significant reductions in drinking for students in both conditions. Findings provide support for web-based interventions for mandated college students. (Contains 1 table.)

  13. Clinical outcomes of a brief motivational intervention for heavy drinking mandated college students: a pilot study.

    Science.gov (United States)

    Terlecki, Meredith A; Larimer, Mary E; Copeland, Amy L

    2010-01-01

    The aim of this study was to evaluate a brief motivational intervention (BMI) for reducing risky alcohol use and alcohol-related problems among mandated (M) and voluntary (V) student drinkers to determine (a) whether BMI-mandated students report greater decreases in alcohol use and related problems, relative to no treatment; (b) whether a BMI is comparably effective for mandated and voluntary students; and (c) whether a mandated control group shows greater changes in alcohol use and related problems relative to a voluntary control group. Participants were undergraduate student research volunteers (62% male) who met heavy drinking criteria and completed measures of alcohol use and alcohol problems at baseline and 4 weeks after intervention. Participants (N = 84) were randomly assigned to treatment (T) or assessment-only control (C) conditions (mandated students were assigned to a brief wait list). Participants assigned to treatment reported consuming fewer drinks after the intervention (MT: M = 14.11 drinks; VT: M = 14.05) relative to control groups (MC: M = 20.71; VC: M = 16.53). Evaluation of alcohol-related problems indicated a significant effect of referral status, such that mandated students reported significantly fewer problems at the follow-up assessment relative to volunteers. BMIs are comparably effective for mandated and voluntary students and may result in larger reductions in alcohol use than disciplinary attention alone. More longitudinal research is needed to evaluate the long-term impact of a BMI among mandated students.

  14. Direct and indirect costs for adverse drug events identified in medical records across care levels, and their distribution among payers.

    Science.gov (United States)

    Natanaelsson, Jennie; Hakkarainen, Katja M; Hägg, Staffan; Andersson Sundell, Karolina; Petzold, Max; Rehnberg, Clas; Jönsson, Anna K; Gyllensten, Hanna

    2016-11-19

    Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is known about costs caused by ADEs outside hospitals, effects on productivity, and how the costs are distributed among payers. To describe the direct and indirect costs caused by ADEs, and their distribution among payers. Furthermore, to describe the distribution of patient out-of-pocket costs and lost productivity caused by ADEs according to socio-economic characteristics. In a random sample of 5025 adults in a Swedish county, prevalence-based costs for ADEs were calculated. Two different methods were used: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by comparing costs among individuals with ADEs to costs among matched controls. Payers of costs caused by ADEs were identified in medical records among those with ADEs (n = 596), and costs caused to individual patients were described by socio-economic characteristics. Costs for resource use caused by ADEs were €505 per patient with ADEs (95% confidence interval €345-665), of which 38% were indirect costs. Compared to matched controls, the costs attributable to ADEs were €1631, of which €410 were indirect costs. The local health authorities paid 58% of the costs caused by ADEs. Women had higher productivity loss than men (€426 vs. €109, p = 0.018). Out-of-pocket costs displaced a larger proportion of the disposable income among low-income earners than higher income earners (0.7% vs. 0.2%-0.3%). We used two methods to identify costs for ADEs, both identifying indirect costs as an important component of the overall costs for ADEs. Although the largest payers of costs caused by ADEs were the local health authorities responsible for direct costs, employers and patients costs for lost productivity contributed substantially. Our results indicate inequalities in costs caused by ADEs, by sex and income. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. An electric mandate. The EU procedure for harmonising cross-border network codes for electricity

    Energy Technology Data Exchange (ETDEWEB)

    Jevnaker, Torbjoerg

    2012-07-01

    The research question addressed in this report is why the EU procedure for developing network codes for electricity was enacted in its particular form. Passed by the EU in 2009, European organisations partly outside of the formal EU structure were given a mandate to make rules that would apply across the EU. This was puzzling given the observed resistance on part of the member states to let go of national control over energy issues. Drawing on institutionalist perspectives, the analysis shows that the procedure would not have been passed without support from and compromise among the Commission, European Parliament and the member states in Council; that parts of the procedure imitated existing practices within related policy areas; that horizontal and vertical specialization within the nation-states along with a Commission actively promoting transnational cooperation changed the feedback mechanisms, which changed the direction of European energy market regulation; and finally, that the new actors played an active role vis-a-vis EU bodies as the latter were legislating on the procedure. (Author)

  16. Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

    Science.gov (United States)

    Weisner, Constance; Lu, Yun; Hinman, Agatha; Monahan, John; Bonnie, Richard J.; Moore, Charles D.; Chi, Felicia W.; Appelbaum, Paul S.

    2010-01-01

    Objective This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. Methods The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary least-squares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years. Results Overall, participants with a workplace mandate had one- and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlled for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. Conclusions Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence. PMID:19411353

  17. Transformative Use of an Improved All-Payer Hospital Discharge Data Infrastructure for Community-Based Participatory Research: A Sustainability Pathway.

    Science.gov (United States)

    Salemi, Jason L; Salinas-Miranda, Abraham A; Wilson, Roneé E; Salihu, Hamisu M

    2015-08-01

    To describe the use of a clinically enhanced maternal and child health (MCH) database to strengthen community-engaged research activities, and to support the sustainability of data infrastructure initiatives. Population-based, longitudinal database covering over 2.3 million mother-infant dyads during a 12-year period (1998-2009) in Florida. A community-based participatory research (CBPR) project in a socioeconomically disadvantaged community in central Tampa, Florida. Case study of the use of an enhanced state database for supporting CBPR activities. A federal data infrastructure award resulted in the creation of an MCH database in which over 92 percent of all birth certificate records for infants born between 1998 and 2009 were linked to maternal and infant hospital encounter-level data. The population-based, longitudinal database was used to supplement data collected from focus groups and community surveys with epidemiological and health care cost data on important MCH disparity issues in the target community. Data were used to facilitate a community-driven, decision-making process in which the most important priorities for intervention were identified. Integrating statewide all-payer, hospital-based databases into CBPR can empower underserved communities with a reliable source of health data, and it can promote the sustainability of newly developed data systems. © Health Research and Educational Trust.

  18. Using patient encounter logs for mandated clinical encounters in an internal medicine clerkship.

    Science.gov (United States)

    Ferenchick, Gary; Mohmand, Asad; Mireles, Jesus; Solomon, David

    2009-10-01

    Patient encounter logs help assess a student's educational experience. The use of a grading incentive linked to the mandatory documentation of prespecified clinical encounters has been insufficiently studied. Given this, our objectives were to determine (a) if mandating student exposure to patients with 18 key training problems leads to the successful documentation of these encounters, (b) the degree of difficulty students and clerkship directors experienced in meeting these mandates, (c) the accuracy of mandated log entries, and (d) how often the log entries were questioned or rejected by preceptors. Ninety-two 3rd-year internal medicine students and 6 internal medicine clerkship directors at 9 geographically dispersed hospitals and 30 ambulatory sites participated in the study. Over a single academic year, we directly measured the completion rate of mandated logs, the degree of their accuracy as judged against faculty-generated logs of two required videotaped standardized patient encounters, and the percentage of logs that were not validated. We surveyed students and directors on the perceived degree of difficulty in meeting mandated requirements. Ninety-eight percent of students met our mandated requirements and 93.8% of students found it "easy" or "very easy" to meet this requirement. The amount of estimated time spent by clerkship directors helping students meet mandated requirements for the entire year was 4.5 hr. The accuracy of submitted logs was 77%; however, almost all inaccurate log entries were "validated" by preceptors. Mandating encounters is effective in assuring that students document encounters with patients who present with specific clinical problems. The accuracy of our students' mandated logs is similar to previously published data. However, even inaccurate logs were rarely questioned or rejected by preceptors.

  19. Insurance denials for cancer clinical trial participation after the Affordable Care Act mandate.

    Science.gov (United States)

    Mackay, Christine B; Antonelli, Kaitlyn R; Bruinooge, Suanna S; Saint Onge, Jarron M; Ellis, Shellie D

    2017-08-01

    The Affordable Care Act (ACA) includes a mandate requiring most private health insurers to cover routine patient care costs for cancer clinical trial participation; however, the impact of this provision on cancer centers' efforts to accrue patients to clinical trials has not been well described. First, members of cancer research centers and community-based institutions (n = 252) were surveyed to assess the status of insurance denials, and then, a focused survey (n = 77) collected denial details. Univariate and multivariate analyses were used to examine associations between the receipt of denials and site characteristics. Overall, 62.7% of the initial survey respondents reported at least 1 insurance denial during 2014. Sites using a precertification process were 3.04 times more likely to experience denials (95% confidence interval, 1.55-5.99; P ≤ .001), and similar rates of denials were reported from sites located in states with preexisting clinical trial coverage laws versus states without them (82.3% vs 85.1%; χ = 50.7; P ≤ .001). Among the focused survey sites, academic centers reported denials more often than community sites (71.4% vs 46.4%). The failure of plans to cover trial participation was cited as the most common reason provided for denials (n = 33 [80.5%]), with nearly 80% of sites (n = 61) not receiving a coverage response from the insurer within 72 hours. Despite the ACA's mandate for most insurers to cover routine care costs for cancer clinical trial participation, denials and delays continue. Denials may continue because some insurers remain exempt from the law, or they may signal an implementation failure. Delays in coverage may affect patient participation in trials. Additional efforts to eliminate this barrier will be needed to achieve federal initiatives to double the pace of cancer research over the next 5 years. Future work should assess the law's effectiveness at the patient level to inform these efforts

  20. Health Benefits Mandates and Their Potential Impacts on Racial/Ethnic Group Disparities in Insurance Markets.

    Science.gov (United States)

    Charles, Shana Alex; Ponce, Ninez; Ritley, Dominique; Guendelman, Sylvia; Kempster, Jennifer; Lewis, John; Melnikow, Joy

    2017-08-01

    Addressing racial/ethnic group disparities in health insurance benefits through legislative mandates requires attention to the different proportions of racial/ethnic groups among insurance markets. This necessary baseline data, however, has proven difficult to measure. We applied racial/ethnic data from the 2009 California Health Interview Survey to the 2012 California Health Benefits Review Program Cost and Coverage Model to determine the racial/ethnic composition of ten health insurance market segments. We found disproportional representation of racial/ethnic groups by segment, thus affecting the health insurance impacts of benefit mandates. California's Medicaid program is disproportionately Latino (60 % in Medi-Cal, compared to 39 % for the entire population), and the individual insurance market is disproportionately non-Latino white. Gender differences also exist. Mandates could unintentionally increase insurance coverage racial/ethnic disparities. Policymakers should consider the distribution of existing racial/ethnic disparities as criteria for legislative action on benefit mandates across health insurance markets.

  1. Intervention defensiveness as a moderator of drinking outcome among heavy-drinking mandated college students.

    Science.gov (United States)

    Palmer, Rebekka S; Kilmer, Jason R; Ball, Samuel A; Larimer, Mary E

    2010-12-01

    The efficacy of the Alcohol Skills Training Program (ASTP; Miller, et al., 2000) was evaluated in 204 heavy-drinking college students randomly assigned to either ASTP (n=119) or an assessment-only control (n=85) condition. The volunteer ASTP sample (n=119) was also compared to a sample of students mandated to ASTP following a first-time sanction (n=90). At baseline, mandated students reported lower levels of peak drinking, negative consequences, readiness to change and higher defensiveness than voluntary students. However, the voluntary sample showed reductions in problem drinking indicators over time such that there were no differences from mandated students at follow-up. There were no outcome differences between volunteers assigned to ASTP versus assessment-only. A new measure of defensiveness was evaluated and had a significant moderating effect on ASTP outcome for peak drinking consumed on a peak occasion at follow-up among mandated students. Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. An experiment with regulated competition and individual mandates for universal health care: the new Dutch health insurance system.

    Science.gov (United States)

    Rosenau, Pauline Vaillancourt; Lako, Christiaan J

    2008-12-01

    The 2006 Enthoven-inspired Dutch health insurance reform, based on regulated competition with a mandate for individuals to purchase insurance, will interest U.S. policy makers who seek universal coverage. This ongoing experiment includes guaranteed issue, price competition for a standardized basic benefits package, community rating, sliding-scale income-based subsidies for patients, and risk equalization for insurers. Our assessment of the first two years is based on Dutch Central Bank statistics, national opinion polls, consumer surveys, and qualitative interviews with policy makers. The first lesson for the United States is that the new Dutch health insurance model may not control costs. To date, consumer premiums are increasing, and insurance companies report large losses on the basic policies. Second, regulated competition is unlikely to make voters/citizens happy; public satisfaction is not high, and perceived quality is down. Third, consumers may not behave as economic models predict, remaining responsive to price incentives. Finally, policy makers should not underestimate the opposition from health care providers who define their profession as more than simply a job. If regulated competition with individual mandates performs poorly in auspicious circumstances such as the Netherlands, how will this model fare in the United States, where access, quality, and cost challenges are even greater? Might the assumptions of economic theory not apply in the health sector?

  3. Hospital staff perceptions of a legislative mandate for methicillin-resistant Staphylococcus aureus screening.

    Science.gov (United States)

    Wise, Matthew E; Weber, Stephen G; Schneider, Amy; Stojcevski, Meg; France, Anne Marie; Schaefer, Melissa K; Lin, Michael Y; Kallen, Alexander J; Cochran, Ronda L

    2011-06-01

    In August 2007, Illinois passed legislation mandating methicillin-resistant Staphylococcus aureus (MRSA) admission screening for intensive care unit patients. We assessed hospital staff perceptions of the implementation of this law. Mixed-methods evaluation using structured focus groups and questionnaires. Eight Chicago-area hospitals. Three strata of staff (leadership, midlevel, and frontline) at each hospital. All participants completed a questionnaire and participated in a focus group. Focus group transcripts were thematically coded and analyzed. The proportion of staff agreeing with statements about MRSA and the legislation was compared across staff types. Overall, 126 hospital staff participated in 23 focus groups. Fifty-six percent of participants agreed that the legislation had a positive effect at their facility; frontline staff were more likely to agree than midlevel and leadership staff (P draft clear implementation plans. Staff from Chicago-area hospitals perceived that mandatory MRSA screening legislation resulted in some benefits but highlighted implementation challenges. States considering similar initiatives might minimize these challenges by optimizing messaging to patients and healthcare staff, drafting implementation plans, and developing program evaluation strategies.

  4. The estimated impact of California’s urban water conservation mandate on electricity consumption and greenhouse gas emissions

    Science.gov (United States)

    Spang, Edward S.; Holguin, Andrew J.; Loge, Frank J.

    2018-01-01

    In April 2015, the Governor of California mandated a 25% statewide reduction in water consumption (relative to 2013 levels) by urban water suppliers. The more than 400 public water agencies affected by the regulation were also required to report monthly progress towards the conservation goal to the State Water Resources Control Board. This paper uses the reported data to assess how the water utilities have responded to this mandate and to estimate the electricity savings and greenhouse gas (GHG) emissions reductions associated with reduced operation of urban water infrastructure systems. The results show that California succeeded in saving 524 000 million gallons (MG) of water (a 24.5% decrease relative to the 2013 baseline) over the mandate period, which translates into 1830 GWh total electricity savings, and a GHG emissions reduction of 521 000 metric tonnes of carbon dioxide equivalents (MT CO2e). For comparison, the total electricity savings linked to water conservation are approximately 11% greater than the savings achieved by the investor-owned electricity utilities’ efficiency programs for roughly the same time period, and the GHG savings represent the equivalent of taking about 111 000 cars off the road for a year. These indirect, large-scale electricity and GHG savings were achieved at costs that were competitive with existing programs that target electricity and GHG savings directly and independently. Finally, given the breadth of the results produced, we built a companion website, called ‘H2Open’ (https://cwee.shinyapps.io/greengov/), to this research effort that allows users to view and explore the data and results across scales, from individual water utilities to the statewide summary.

  5. Does Mandated Treatment Benefit Youth? A Prospective Investigation of Adolescent Justice System Involvement, Treatment Motivation, and Substance Use Outcomes

    Science.gov (United States)

    Yeterian, Julie D.; Greene, M. Claire; Bergman, Brandon G.; Kelly, John F.

    2013-01-01

    Background The majority of adolescents treated for substance use disorder (SUD) in the United States are now referred by the criminal justice system. Little is known, however, regarding how justice-system involvement relates to adolescent community treatment outcomes. Controversy exists, also, over the extent to which justice system involvement reflects a lack of intrinsic motivation for treatment. This study examined the relation between justice system referral and reported reason for treatment entry and tested the extent to which each predicted treatment response and outcome. Method Adolescent outpatients (N = 127; M age = 16.7, 24% female) with varying levels of justice-system involvement (i.e., no justice system involvement [No-JSI; n = 63], justice-system involved [JSI; n = 40], justice system involved-mandated [JSI-M; n = 24]) and motivation levels (i.e., self-motivated [n = 40], externally-motivated [n = 87]) were compared at treatment intake. Multilevel mixed models tested these groups’ effects on percent days abstinent (PDA) and odds of heavy drinking (HD) over 12 months. Results JSI-M were less likely to be self-motivated compared to No-JSI or JSI (p = 0.009). JSI-M had higher PDA overall, but with significant declines over time, relative to no-JSI. Self-motivated patients did not differ from externally-motivated patients on PDA or HD. Conclusions Mandated adolescent outpatients were substantially less likely to report self-motivated treatment entry. Despite the notion that self-motivated treatment entry would be likely to produce better outcomes, a judicial mandate appears to predict an initially stronger treatment response, although this diminishes over time. Ongoing monitoring and/or treatment may be necessary to help maintain treatment gains for justice system-involved adolescents. PMID:24159252

  6. How have mandated nurse staffing ratios affected hospitals? Perspectives from California hospital leaders.

    Science.gov (United States)

    Chapman, Susan A; Spetz, Joanne; Seago, Jean Ann; Kaiser, Jennifer; Dower, Catherine; Herrera, Carolina

    2009-01-01

    In 1999, California became the first state to pass legislation mandating minimum nurse-to-patient ratios. Regulations detailing specific ratios by type of hospital unit were released in 2002, with phased-in implementation beginning in 2004 and completed in 2008. These ratios were implemented at a time of severe registered nurse (RN) shortage in the state and a worsening financial position for many hospitals. This article presents an analysis of qualitative data from interviews with healthcare leaders about the impact of nurse staffing ratios. Twenty hospitals (including public, not-for-profit, and for-profit institutions) representing major geographic regions of California were approached. Twelve agreed to participate; semistructured in-person and telephone interviews were conducted with 23 hospital leaders. Several key themes emerged from the analysis. Most hospitals found it difficult and expensive to find more RNs to hire to meet the ratios. Meeting the staffing requirements on all units, at all times, was challenging and had negative impacts, such as a backlog of patients in the emergency department and a decrease of other ancillary staff. Hospital leaders do not believe that ratios have had an impact on patient quality of care. Findings related to nurse satisfaction were mixed. Increased RN staffing improved satisfaction with patient workload, but dissatisfaction with issues of decision-making control (e.g., decisions on when best to take a meal break) were taken out of the nurse's hands to meet ratio requirements. Further research should continue to monitor patient outcomes as other states consider similar ratio regulations. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, high-quality care.

  7. Understanding modern energy policy: An evaluation of RPS mandates and behavioral nudges

    Science.gov (United States)

    Brannan, Deborah Lynn Baker

    Climate change has emerged as one of the leading policy issues of the early 21st century. In response, a variety of policies and programs have been adopted encouraging renewable energy, energy efficiency and energy conservation. My dissertation consists of three research papers which evaluate two classes of modern energy policy in the United States: renewable energy mandates and behavioral nudges. The Renewable Portfolio Standard (RPS) is the most prominent state-level renewable energy policy in the United States and has been debated several times at the federal level. Using a fixed-effects panel data model I study the existing experience of the RPS to help inform the policy debate. In contrast with the previous literature that has predominantly studied the average effect of the RPS on renewable capacity investments I explore factors resulting in the heterogeneous effect of the RPS policy. Relying on a basic understanding the electric utility industry and the electricity dispatch process I provide insight into existing experience with the RPS. Spurred by political and economic barriers to adopting renewable energy policy, interest has increased in using motivational techniques informed by behavioral science to encourage reductions in energy consumption. Existing research has predominantly addressed residential energy consumption. The remainder of my dissertation applies well-established motivational techniques to the transportation sector. Using an experimental design, I test whether real-time feedback and social norms can encourage fuel efficient driving behavior. I find that real-time feedback has a large impact on fuel economy, particularly when aggregated across the entire vehicle fleet. I also find some evidence suggesting that social norms can encourage eco-driving, but perhaps more importantly, identify key challenges associated with using social norms in a transportation setting.

  8. The cost effectiveness of rapid-acting insulin aspart compared with human insulin in type 2 diabetes patients: an analysis from the Japanese third-party payer perspective.

    Science.gov (United States)

    Pollock, R F; Valentine, W J; Pilgaard, T; Nishimura, H

    2011-01-01

    The Nippon Ultra-Rapid Insulin and Diabetic Complication Evaluation Study (NICE Study) (NCT00575172) was a 5-year, open-label, randomised controlled trial which compared cardiovascular outcomes in Japanese type 2 diabetes patients intensively treated with regular human insulin or insulin aspart (NovoRapid; Novo Nordisk A/S, Bagsvaerd, Denmark), a rapid-acting insulin analogue. The aim of the present analysis was to evaluate the cost effectiveness of insulin aspart versus regular human insulin from the perspective of a Japanese third-party healthcare payer. A discrete event-simulation model was developed in Microsoft Excel to assess the within-trial cost effectiveness and make longer-term clinical projections in patients treated with regular human insulin or insulin aspart. In addition to severe hypoglycaemia, the model captured myocardial and cerebral infarction events and percutaneous coronary intervention and coronary artery bypass graft procedures. Within-trial mortality, incidence of severe hypoglycaemia and cardiovascular event probabilities were derived from the annual rates observed during the trial period, while post-trial outcomes were calculated using the event rates from the trial, adjusted for increasing patient age. Event costs were accounted from the healthcare payer perspective and expressed in 2008 Japanese yen (JPY), while health-related quality of life (HRQoL) was captured using event and state utilities. Future costs and clinical benefits were discounted at 3% annually. Life expectancy, quality-adjusted life expectancy, cardiovascular event rates and costs were evaluated over 5- and 10-year time horizons and sensitivity analyses were performed to assess variability in model outcomes. Over 5 years of treatment, insulin aspart dominated human insulin both in incremental life expectancy and in incremental quality-adjusted life-years (QALYS). Insulin aspart was associated with a small improvement in discounted life expectancy of 0.005 years (4.688 vs

  9. 32 CFR 220.2 - Statutory obligation of third party payer to pay.

    Science.gov (United States)

    2010-07-01

    ... Uniformed Services makes a claim, appeal, representation, or other filing under the authority of this part... claim, appeal, representation, or other filing must be deemed to be satisfied. A copy of the completed... provision of a law or regulation of a State or political subdivision thereof that purports to establish any...

  10. Green lasers are beyond power limits mandated by safety standards.

    Science.gov (United States)

    Lee, M H; Fox, K; Goldwasser, S; Lau, D W M; Aliahmad, B; Sarossy, M

    2016-08-01

    There has been an increasing number of reports of people losing vision from laser exposure from pocket laser pointers despite the safety limit of 1 milliwatt (1mW) imposed by the Australian government. We hypothesize that this is because commercially available red and green laser pointers are exceeding their labeled power outputs. We tested the power outputs of 4 red and 4 green lasers which were purchased for less than AUD$30 each. The average of 10 measurements was recorded for each laser. We found that 3 out of 4 red lasers conformed to the 1mW safety standard; in contrast, all of the green lasers exceeded this limit, with one of the lasers recording an output of 127.9 mW. This contrast in compliance is explained by the construction of these lasers - green lasers are typically Diode Pumped Solid State (DPSS) lasers that can emit excessive infrared (IR) radiation with poor workmanship or inconsistent adherence to practices of safe design and quality control; red lasers are diode lasers which have limited power outputs due to `Catastrophic Optical Damage' (COD). Relevant professional bodies ought to advocate more strongly for stringent testing, quality control and licensing of DPSS lasers with a view towards government intervention to banning green laser pointer use.

  11. High-dose hemodialysis versus conventional in-center hemodialysis: a cost-utility analysis from a UK payer perspective.

    Science.gov (United States)

    Liu, Frank Xiaoqing; Treharne, Catrin; Arici, Murat; Crowe, Lydia; Culleton, Bruce

    2015-01-01

    To investigate the cost-effectiveness of high-dose hemodialysis (HD) versus conventional in-center HD (ICHD), over a lifetime time horizon from the UK payer's perspective. We used a Markov modeling approach to compare high-dose HD (in-center or at home) with conventional ICHD using current and hypothetical home HD reimbursement tariffs in England. Sensitivity analyses tested the robustness of the results. The main outcome measure was the incremental cost-effectiveness ratio (ICER) expressed as a cost per quality-adjusted life-year (QALY). Over a lifetime, high-dose HD in-center (5 sessions/wk) is associated with higher per-patient costs and QALYs (increases of £108,713 and 0.862, respectively) versus conventional ICHD. The corresponding ICER (£126,106/QALY) indicates that high-dose HD in-center is not cost-effective versus conventional ICHD at a UK willingness-to-pay threshold of £20,000 to £30,000. High-dose HD at home is associated with lower total costs (£522 less per patient) and a per-patient QALY increase of 1.273 compared with ICHD under the current Payment-by Results reimbursement tariff (£456/wk). At an increased home HD tariff (£575/wk), the ICER for high-dose HD at home versus conventional ICHD is £17,404/QALY. High-dose HD at home had a 62% to 84% probability of being cost-effective at a willingness-to-pay threshold of £20,000 to £30,000/QALY. Although high-dose HD has the potential to offer improved clinical and quality-of-life outcomes over conventional ICHD, under the current UK Payment-by Results reimbursement scheme, it would be considered cost-effective from a UK payer perspective only if conducted at home. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. A proposed ethical framework for vaccine mandates: competing values and the case of HPV.

    Science.gov (United States)

    Field, Robert I; Caplan, Arthur L

    2008-06-01

    Debates over vaccine mandates raise intense emotions, as reflected in the current controversy over whether to mandate the vaccine against human papilloma virus (HPV), the virus that can cause cervical cancer. Public health ethics so far has failed to facilitate meaningful dialogue between the opposing sides. When stripped of its emotional charge, the debate can be framed as a contest between competing ethical values. This framework can be conceptualized graphically as a conflict between autonomy on the one hand, which militates against government intrusion, and beneficence, utilitarianism, justice, and nonmaleficence on the other, which may lend support to intervention. When applied to the HPV vaccine, this framework would support a mandate based on utilitarianism, if certain conditions are met and if herd immunity is a realistic objective.

  13. Meeting the New CARB ZEV Mandate Requirements: Grid-Connected Hybrids and City EVs

    OpenAIRE

    Burke, Andrew

    2001-01-01

    In January 2001, the California Air Resources Board adopted significant modifications to the ZEV Mandate. These changes affect the options available to large auto companies marketing cars in California that must meet the requirements of the Mandate starting in 2003. In the new regulations, up to 50% (2% of sales) of the ZEV requirement (4% of sales) may be met with grid-connected, plug-in hybrid vehicles having a 20-mile or longer all-electric range. In addition, city EVs that may or may not ...

  14. Success under duress: policies and practices managers view as keys to profitability in five California hospitals with challenging payer mix.

    Science.gov (United States)

    Rundall, Thomas; Oberlin, Shelley; Thygesen, Brian; Janus, Katharina

    2012-01-01

    Hospitals with a challenging payer mix (CPM)-high proportions of uninsured and Medicaid patients and a low proportion of commercially insured patients-are an important source of care for low-income, uninsured people. Achieving profitability is difficult for CPM hospitals. From 2005 through 2008, only one-third of 67 CPM hospitals in California reported positive total margins. In-depth group interviews were completed with the management leadership teams of a diverse group of five profitable CPM hospitals to identify the management strategies and practices that the hospitals' leadership teams credited for their financial success. Twelve management policy and practice topics were identified. Four of the policies and practices that managers identified involve organizational actions to increase hospital revenue or operational efficiency. These factors are consistent with those identified in previous research. However, managers also identified eight factors not previously revealed in research on hospital profitability, including management policies and practices that establish the organizational culture, workforce, relationships, monitoring systems, and governance necessary to ensure that hospital employees and affiliated physicians support and successfully implement organizational actions necessary to achieve profitability.

  15. Angina and associated healthcare costs following percutaneous coronary intervention: A real-world analysis from a multi-payer database.

    Science.gov (United States)

    Ben-Yehuda, Ori; Kazi, Dhruv S; Bonafede, Machaon; Wade, Sally W; Machacz, Susanne F; Stephens, Leslie A; Hlatky, Mark A; Hernandez, John B

    2016-12-01

    To study the contemporary, real-world clinical and economic burden associated with angina after percutaneous coronary intervention (PCI). Angina adversely affects quality of life and medical costs, yet data on real-world prevalence of angina following PCI and its associated economic consequences are limited. In a multi-payer administrative claims database, we identified adults with incident inpatient PCI admissions between 2008 and 2011 who had at least 12 months of continuous medical and pharmacy benefits before and after the procedure. Patients were followed for up to 36 months. Using claims, we ascertained post-PCI outcomes: angina or chest pain, acute myocardial infarction, acute coronary syndrome, repeat PCI, healthcare service utilization, and costs. Among 51,710 study patients (mean age 61.8, 72% male), post-PCI angina or chest pain was present in 28% by 12 months and 40% by 36 months. Compared with patients who did not experience chest pain, angina or ACS, total healthcare costs in the first year after the index PCI were 1.8 times greater for patients with angina or chest pain ($32,437 vs. $17,913, P < 0.001). These cost differentials continued to 36 months. Angina after PCI is a frequent and expensive outcome. Further research is needed to identify risk factors and potentially improve outcomes for post-PCI angina. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  16. Time Trends and Payer Differences in Lengths of Initial Hospitalization for Preterm Infants, Arkansas 2004–2010

    Science.gov (United States)

    Ounpraseuth, Songthip; Bronstein, Janet; Gauss, Clinton H.; Wingate, Martha S.; Hall, Richard W.; Nugent, Richard R.

    2015-01-01

    Objective To examine the time trend in length of stay (LOS) and explore potential differences in neonatal LOS by insurance type for preterm infants in Arkansas between 2004 and 2010. Study Design There were 18,712 preterm infants included in our analyses. Accelerated failure time (AFT) models were used to model neonatal LOS as a function of insurance type and discharge year while adjusting for key maternal and infant characteristics, and complication/anomaly indicators. Results Prior to adjusting for the complication/anomaly indicators, the LOS for preterm infants delivered to mothers in the Medicaid group was 3.2% shorter than those in the private payer group. Furthermore, each subsequent year was associated with a 1.6% increase in the expected LOS. However, after accounting for complications and anomalies, insurance coverage differences in neonatal LOS were not statistically significant while the trend in LOS persisted at a 0.59% increase for each succeeding year. Conclusion All of the apparent differences in LOS by insurance type and more than half of the apparent increase in LOS over time are accounted for by higher rates of complications among privately insured preterm infants and increasing rates of complications for all surviving preterm infants between 2004 and 2010. PMID:24792767

  17. A Nationwide Survey of State-Mandated Evaluation Practices for Domestic Violence Agencies

    Science.gov (United States)

    Riger, Stephanie; Staggs, Susan L.

    2011-01-01

    Many agencies serving survivors of domestic violence are required to evaluate their services. Three possible evaluation strategies include: a) process measurement, which typically involves a frequency count of agency activities, such as the number of counseling hours given; b) outcome evaluation, which measures the impact of agency activities on…

  18. Elizabeth J. Perry, Challenging the Mandate of Heaven. Social Protest and State Power in China

    OpenAIRE

    Rocca, Jean-Louis

    2007-01-01

    This book is in reality a collection of articles and contributions that have been published previously and partially rewritten by the author. An introduction is intended to bring some coherence to the whole. The chapters address various facets of “social protest” (violence between peasant communities, anti-tax revolts, worker agitation) in different historical contexts (the end of the Qing dynasty, the republican era, the socialist period and post-Mao China). A complete panorama is thus offer...

  19. Understanding Local Instructional Responses to Federal and State Accountability Mandates: A Typology of Extended Learning Time

    Science.gov (United States)

    Midkiff, Brooke; Cohen-Vogel, Lora

    2015-01-01

    For the past dozen years, the federal government has held schools accountable for students' achievement in reading and mathematics. Schools that have not demonstrated improved student scores have faced heavy sanctions, including reconstitution and closure. In response to this high-stakes environment, schools appear to have extended the time…

  20. Mandated Psychological Assessments for Suicide Risk in a College Population: A Pilot Study

    Science.gov (United States)

    Kirchner, Grace L.; Marshall, Donn; Poyner, Sunney R.

    2017-01-01

    This study was conducted to evaluate the impact of a protocol mandating psychological assessment of college students exhibiting specific signs of suicide risk and/or nonsuicidal self-harm. Thirty-seven current and former students who had been documented as at risk completed a structured interview in person or by phone. Outcomes suggest this…

  1. More than "An Apple a Day": New Mandates for School Wellness

    Science.gov (United States)

    Woods, Amelia Mays; Weasmer, Jerie

    2006-01-01

    In this article, the authors discuss how, due to the increasing problems of obesity and sedentary lifestyles among children, schools have been mandated to instruct students on the importance of good nutritional habits and daily physical activity. Approaches to stimulating faculty to integrate wellness concepts and activities into curricula depend…

  2. The impact of defensiveness and incident reactions on post-sanction drinking behaviors among mandated students.

    Science.gov (United States)

    Logan, Diane E; Lewis, Melissa A; Mastroleo, Nadine R; Kilmer, Jason R; Larimer, Mary E

    2015-09-01

    Prior studies with mandated students (students referred for an intervention following violation of a campus alcohol policy) have suggested that decreases in drinking behaviors may occur before clinical intervention. Others studies have suggested that greater reductions were associated with lower defensiveness and stronger incident reactions, such as responsibility and aversiveness. The current study sought to integrate these findings and examine the influence of pre-sanction drinking and perceptions on mandated students' post-sanction drinking levels prior to attending a brief intervention. Data were collected as part of a longitudinal study of brief interventions in a mandated student sample (N=61, 43% female, 97% White). Participants completed demographic measures, scales measuring incident reactions and defensiveness, and a Time Line Follow Back assessing drinking quantity and frequency both pre- and post-sanction. Analyses revealed significant post-sanction decreases in quantity (average total drinks per month) and frequency (number of monthly drinking days). Pre-sanction drinking quantity and frequency significantly predicted post-sanction quantity and frequency, respectively. Interaction effects suggest higher post-sanction quantities among moderate and heavier drinkers with higher defensiveness and lower aversiveness perceptions, while perceptions did not influence outcomes among light drinkers. None of the interactions involving blame or responsibility, or predicting post-sanction frequency, were significant. These findings suggest a complex relationship between pre-sanction drinking and student reactions. Implications for mandated student interactions and future research directions are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Intelligence Testing: The Mystique, the Myth, the Maelstrom, and the Mandate.

    Science.gov (United States)

    Burton, Thomas A.

    1983-01-01

    The value of intelligence testing was extended beyond its intent, and psychologists were not answerable to any measure of accountability. Recently, the value of testing has been challenged in the courts and is now restricted by legislative mandate. Continued resistance by psychologists may lead to the demise of standardized intelligence tests.…

  4. South African Educators' Mutually Inclusive Mandates to Promote Human Rights and Positive Discipline

    Science.gov (United States)

    Coetzee, Susan; Mienie, Cathrine

    2013-01-01

    South African educators are mandated by international and national law to observe and promote human rights. However, given the realities of the limited teaching time available, educators cannot fulfill this obligation solely by teaching the curriculum. Another avenue needs to be found for educators to fulfill this obligation. Educators are also…

  5. Addressing Alcohol Use and Problems in Mandated College Students: A Randomized Clinical Trial Using Stepped Care

    Science.gov (United States)

    Borsari, Brian; Hustad, John T. P.; Mastroleo, Nadine R.; Tevyaw, Tracy O'Leary; Barnett, Nancy P.; Kahler, Christopher W.; Short, Erica Eaton; Monti, Peter M.

    2012-01-01

    Objective: Over the past 2 decades, colleges and universities have seen a large increase in the number of students referred to the administration for alcohol policies violations. However, a substantial portion of mandated students may not require extensive treatment. Stepped care may maximize treatment efficiency and greatly reduce the demands on…

  6. A roadmap for navigating voluntary and mandated programs for building energy efficiency

    NARCIS (Netherlands)

    Peterman, A.; Kourula, A.; Levitt, R.

    2012-01-01

    Commercial building owners and managers often face the challenge of selecting the appropriate combination of voluntary and mandated programs for commercial building energy efficiency. Using a mixed-method, both quantitative and qualitative approach, this study finds that barriers to energy

  7. The Gap between Actual and Mandated Use of an Electronic Medication Record Three Years after Deployment

    DEFF Research Database (Denmark)

    Granlien, Maren Fich; Hertzum, Morten; Gudmundsen, Jette

    2008-01-01

    Three years after the hospitals in one of Denmark's five healthcare regions deployed an electronic medication record (EMR) four of eight main system facilities are used consistently by only 3%-37% of the hospital wards. Furthermore, four of eight mandated work procedures involving the EMR are fol...

  8. The Games Concept Approach (GCA) as a Mandated Practice: Views of Singaporean Teachers

    Science.gov (United States)

    Rossi, Tony; Fry, Joan M.; McNeill, Mike; Tan, Clara W. K.

    2007-01-01

    This paper reports on the views of Singaporean teachers of a mandated curriculum innovation aimed at changing the nature of games pedagogy within the physical education curriculum framework in Singapore. Since its first appearance over 20 years ago, Teaching Games for Understanding (TGfU), as an approach to games pedagogy has gathered support…

  9. Summer Versus School-Year Alcohol Use Among Mandated College Students.

    Science.gov (United States)

    Miller, Mary Beth; Merrill, Jennifer E; Yurasek, Ali M; Mastroleo, Nadine R; Borsari, Brian

    2016-01-01

    Longitudinal research examining college students' alcohol use during the summer months, especially in at-risk individuals, is limited. The current study evaluated changes in mandated college students' alcohol use and related consequences over the summer. Participants (n = 305, 67% male) who had violated campus alcohol policy and were subsequently mandated to treatment completed follow-up assessments at 3, 6, and 9 months. For the majority of students, one of these follow-up assessments occurred over the summer. Hierarchical linear modeling was used to examine changes in alcohol use and related consequences during the school year and summer. Participants reported consuming significantly fewer drinks per occasion, reaching lower peak blood alcohol concentrations, and experiencing fewer alcohol-related consequences during the summer months. All outcomes were mediated by summer housing, indicating that summer influenced alcohol use indirectly through participants' tendency to live at home. Despite small but significant decreases in alcohol consumption and related consequences when living with a parent/guardian, mandated college students continue to exhibit risky drinking and consequences during the summer months. Given these findings, summer may be an appropriate time to implement prevention and intervention strategies with mandated and other at-risk populations.

  10. Decision Making on Medical Innovations in a Changing Health Care Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies.

    Science.gov (United States)

    Trosman, Julia R; Weldon, Christine B; Douglas, Michael P; Deverka, Patricia A; Watkins, John B; Phillips, Kathryn A

    2017-01-01

    New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations. We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs' decision making in terms of achieving a balance between the components of the Triple Aim-improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs' decisions and ACOs' insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients' interest in personalized medicine. As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  11. Saving tax payers' money

    DEFF Research Database (Denmark)

    Staak, Thorsten; Günzel, Franziska

    During the last years major market-oriented economies have installed differently designed promoting institutions. Most of them declare in their statutes ‘correcting market failure’ as a fundamental goal regarding start-up support. But recent studies have shown that other economic goals outrank th...

  12. The new regulator in town : The effect of Walmart’s sustainability mandate on supplier shareholder value

    NARCIS (Netherlands)

    Gielens, K.J.P.; Geyskens, Inge; Deleersnyder, Barbara; Nohe, Max

    Suppliers are increasingly forced by dominant retailers to clean up their supply chains. While these retailers argue that their sustainability mandates may translate into profits for suppliers, many suppliers are cynical about these mandates because the onus to undertake the required investments is

  13. [Comparison of the cost of treatment of premature labor with atosiban or beta-sympathomimetics from the perspective of the health care payer--a pharmacoeconomic model].

    Science.gov (United States)

    Hrubý, K

    2004-03-01

    To evaluate the cost of treating premature delivery with atosiban or beta-sympatomimetic drugs (fenoterol and hexoprenalin) from the perspective of health care payer--the medical insurance company. A pharmaco-economic model based on the results of randomized, controlled clinical study. Hospital Pharmacy at Vitkovice Hospital of Blessed Mary Antonia, Ostrava. The study is based on the application of clinical decision-making analysis, which includes results of a randomized controlled clinical study as well as data on the cost of clinical interventions and cost of drug therapy. The pharmaco-economic model was created from the perspective of the payer of health care--the insurance company. This model presumes the administration of atosiban or beta-sympatomimetic drugs (fenoterol and hexoprenalin) for the period of 18 and 48 h and the therapy of possible untoward effects for the next 72 h after the administration of the drugs. The analysis of sensitivity of pharmacokinetic model also employs so called low and high estimate of supplementary cost for the treatment of untoward effects. After the administration of the drugs for the period of 18 h the total cost of the payer of medical care was in the range of 21,914.5-21,974.4 CKr in atosiban, 19,878.7-22,661.4 CKr in fenoterol and 19,942.9-21,974.4 CKr in hexoprenalin. In the administration of the drugs for 48 h, the overall cost of the payer of medical care was in the range of 43,082.5-43,142.4 CKr in atosiban, 19,960.3-23,150.7 CKr in fenoterol and 20,131.3-23,574.0 in hexoprenalin. This study compared overall cost associated with hospitalization of a premature delivery from the perspective of the medical care payer, i.e. the health insurance company. The authors applied a pharmaco-economic model evaluating hospitalization for the period of 48 h and subsequent therapy of possible untoward effects for the period of up to 72 h. In case of a shorter administration of atosiban (up to 18 h) the overall cost of hospitalization

  14. Does the U.S. biofuels mandate increase the price at the pump?

    Science.gov (United States)

    Bolotin, Stephen R.

    The Renewable Fuel Standard (RFS) as amended by the Energy Independence and Security Act of 2007 created a federal mandate for blending conventional biofuels like corn-based ethanol and advanced biofuels like biodiesel and renewable gasoline into the United States transportation fuel supply. The RFS established yearly blending standards for the obligated parties--refiners and importers of petroleum products--that increase progressively until reaching a high of 36 billion gallons by 2022. Each ethanol-equivalent gallon of biofuel blended is assigned a unique Renewable Identification Number (RIN) through the Environmental Protection Agency's (EPA) Moderated Transaction System (EMTS). At year's close, obligated parties must submit their allotted RIN obligations to the EPA to demonstrate compliance. In the case of under-compliance or over-compliance, RINs can be traded between obligated parties freely through the EMTS or carried over for use in the next year. It follows, then, that a RIN carries a market value reflective of the cost of complying with RFS regulations. Indeed, most biofuels cost more than their fossil-based equivalents. When the price of a corn ethanol RIN went from 2-3 cents each in 2012 to nearly $1.50 in July of 2013 due to a perceived shortage in corn ethanol RINs, obligated parties faced the prospect of multimillion-dollar compliance cost increases. Arguing that RFS makes fuel significantly more expensive for consumers, petroleum companies have begun to advocate for the full repeal of the RFS, winning over some allies in Congress. The future of this program is uncertain. In an attempt to quantify the concerns of RFS critics, this thesis estimated the effect that RIN prices have on the wholesale cost of diesel fuel. Using daily price data from January 2011 through August of 2013 on RINs and crude oil, I specified twelve OLS regression models that predict the passthrough of the diesel RIN price to wholesale diesel price. My statistical analysis

  15. The individual mandate as healthcare regulation: what the Obama Administration should have said in NFIB v. Sebelius.

    Science.gov (United States)

    Moncrieff, Abigail R

    2013-01-01

    There was an argument that the Obama Administration's lawyers could have made--but didn't--in defending Obamacare's individual mandate against constitutional attack. That argument would have highlighted the role of comprehensive health insurance in steering individuals' healthcare savings and consumption decisions. Because consumer-directed healthcare, which reaches its apex when individuals self-insure, suffers from several known market failures and because comprehensive health insurance policies play an unusually aggressive regulatory role in attempting to correct those failures, the individual mandate could be seen as an attempt to eliminate inefficiencies in the healthcare market that arise from individual decisions to self-insure. This argument would done a better job than the Obama Administration's of aligning the individual mandate with existing Commerce Clause and Necessary and Proper Clause precedent, and it would have done a better job of addressing the conservative Justices' primary concerns with upholding the mandate. This Article lays out this forgone defense of the individual mandate.

  16. Access to and use of infertility services in the United States: framing the challenges.

    Science.gov (United States)

    Adashi, Eli Y; Dean, Laura A

    2016-05-01

    An overview of access to and use of general infertility and assisted reproductive technology (ART) services in the United States (U.S.) shows a declining trend for the ever-use of infertility services. Moreover, the use of ART services lags relative to other member nations of the Organization for Economic Co-operation and Development (OECD). Access to and use of general infertility and ART services is primarily undermined by a severely constrained underwriting universe dominated by self-insured employers and by a finite number of state infertility insurance mandates. The contribution of traditional public and private payers to the underwriting of ART is limited. As compared with OECD member nations wherein the access to and underwriting of general infertility and ART services is universal, the current status quo in the U.S. can only be characterized as dismal. Further, the current state of affairs is socially unjust in that the right to build a family in the face of infertility appears to have become a function of economic prowess. Given the dominance of the self-insured employers as underwriters of general infertility and ART services, advocacy directed at this interest group is likely to prove most productive. Improving the state of underwriting of general infertility and ART services in the U.S. must be embraced as a central moral imperative and as an unwavering strategic goal of the professional societies entrusted with the reproductive health of women and men. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  17. THE COVERAGE OF THE FOLHA DE S.PAULO ON THE POSSIBLE THIRD MANDATE

    Directory of Open Access Journals (Sweden)

    Merilyn Escobar de Oliveira

    2009-08-01

    Full Text Available The possibility of a new mandate for President Lula guided the public agenda in the last quarter of 2007 and returned to the media scene in April and the first week of May 2008. This article investigates the aspects of journalistic coverage on the “thesis” of the third mandate giving emphasis to the news making, the framing and the outcome. The importance gained by the “thesis” of re-election related directly of the electoral process of 2010 and the futures expectations of the Workers’ Party (PT. This article supports the hypothesis that rhythm of the journalistic coverage, and more precisely, that the news framing was tendentious. Our corpus contemplates publications of the Folha de S. Paulo, the national newspaper of larger circulation in the country.

  18. Ethical dilemma of mandated contraception in pharmaceutical research at catholic medical institutions.

    Science.gov (United States)

    Casey, Murray Joseph; O'Brien, Richard; Rendell, Marc; Salzman, Todd

    2012-01-01

    The Catholic Church proscribes methods of birth control other than sexual abstinence. Although the U.S. Food and Drug Administration (FDA) recognizes abstinence as an acceptable method of birth control in research studies, some pharmaceutical companies mandate the use of artificial contraceptive techniques to avoid pregnancy as a condition for participation in their studies. These requirements are unacceptable at Catholic health care institutions, leading to conflicts among institutional review boards, clinical investigators, and sponsors. Subjects may feel coerced by such mandates to adopt contraceptive techniques inconsistent with their personal situation and beliefs; women committed to celibacy or who engage exclusively in non-heterosexual activities are negatively impacted. We propose principles to insure informed consent to safeguard the rights of research subjects at Catholic institutions while mitigating this ethical conflict. At the same time, our proposal respects the interests of pharmaceutical research agencies and Catholic moral precepts, and fully abides by regulatory guidance.

  19. Effectiveness of vaccination recommendations versus mandates: Evidence from the hepatitis A vaccine.

    Science.gov (United States)

    Lawler, Emily C

    2017-03-01

    I provide novel evidence on the effectiveness of two vaccination policies - simple non-binding recommendations to vaccinate versus mandates requiring vaccination prior to childcare or kindergarten attendance - in the context of the only disease whose institutional features permit a credible examination of both: hepatitis A. Using provider-verified immunization data I find that recommendations significantly increased hepatitis A vaccination rates among young children by at least 20 percentage points, while mandates increase rates by another 8 percentage points. These policies also significantly reduced population hepatitis A incidence. My results suggest a range of policy options for addressing suboptimally low population vaccination rates. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Predictors of Motivation to Change in Mandated College Students Following a Referral Incident

    OpenAIRE

    Qi, David; Pearson, Matthew R.; Hustad, John T. P.

    2014-01-01

    The purpose of present study was to understand factors that are related to a desire or motivation to change (MTC) alcohol use in a sample of college students mandated to receive an alcohol intervention. We examined characteristics of and reactions to the referral event, typical alcohol use involvement, and alcohol beliefs about the perceived importance of drinking in college (subsequently referred to as the “role of drinking”) assessed by the College Life Alcohol Salience Scale (CLASS; Osberg...

  1. Evaluating two brief substance-use interventions for mandated college students.

    Science.gov (United States)

    White, Helene R; Morgan, Thomas J; Pugh, Lisa A; Celinska, Katarzyna; Labouvie, Erich W; Pandina, Robert J

    2006-03-01

    This study evaluated two brief personal feedback substance-use interventions for students mandated to the Rutgers University Alcohol and Other Drug Assistance Program for Students (ADAPS): (1) a brief motivational interview (BMI) intervention and (2) a written feedback-only (WF) intervention. A key question addressed by this study was whether there is a need for face-to-face feedback in the context of motivational interviewing to affect changes in substance-use behaviors or whether a written personal feedback profile is enough of an intervention to motivate students to change their substance use. The sample consisted of 222 students who were mandated to ADAPS, were eligible for the study, and completed the 3-month follow-up assessment. Eligible students completed a baseline assessment from which a personal feedback profile was created. They were then randomly assigned to the BMI or WF condition. Students were followed 3 months later. Students in both interventions reduced their alcohol consumption, prevalence of cigarette and marijuana use, and problems related to alcohol and drug use between baseline and follow-up. There were no differences between the two intervention conditions in terms of any substance-use outcomes. The results suggest that, under these circumstances and with these students, assessment and WF students changed similarly to those who had an assessment and WF within the context of a BMI. Given the fact that the former is less costly in terms of time and personnel, written profiles may be found to be a cost-effective means of reducing alcohol and drug use and related problems among low- to moderate-risk mandated college students. More research is needed with mandated students to determine the efficacy of feedback interventions and to isolate the effects of interventions from the effects of being caught and being reprimanded to treatment.

  2. In-session processes of brief motivational interventions in two trials with mandated college students.

    Science.gov (United States)

    Borsari, Brian; Apodaca, Timothy R; Jackson, Kristina M; Mastroleo, Nadine R; Magill, Molly; Barnett, Nancy P; Carey, Kate B

    2015-02-01

    Each year, thousands of college students receive mandated intervention as a sanction for alcohol use or alcohol-related behavior. For these mandated students, brief motivational interventions (BMIs) are currently the most efficacious individual intervention. However, little is known about how the technical (therapist behaviors) and relational (e.g., global ratings of therapist empathy) components of BMIs influence client language as well as subsequent change in alcohol use and consequences. This study used the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003) to code BMI sessions from 2 randomized clinical trials that facilitated significant reductions in alcohol use (Study 1, n = 91) and alcohol-related consequences (Study 2, n = 158) in mandated students. There were significant relationships among therapist behaviors, global scores, and client language both for and against change, yet there were no links between in-session client language and subsequent changes in alcohol use or problems. In contrast, relational aspects of motivational interviewing (MI; global ratings of therapist MI Spirit and client self-exploration) were most predictive of postsession alcohol use. Mediation models incorporating both technical and relational components revealed that higher levels of client self-exploration mediated the relationship between higher therapist ratings of MI Spirit and reduced drinking at follow-up. Findings highlight the importance of considering how both technical and relational components of MI may influence alcohol use in mandated college students and also suggest more exact analyses to better understand this complex relationship. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  3. Randomized Controlled Trial of BASICS for Heavy Drinking Mandated and Volunteer Undergraduates: 12-Month Outcomes

    Science.gov (United States)

    Terlecki, Meredith A.; Buckner, Julia D.; Larimer, Mary E.; Copeland, Amy L.

    2014-01-01

    This is the first randomized trial testing whether heavy drinking undergraduates mandated to the Brief Alcohol Screening and Intervention for College Students (BASICS) program following a campus alcohol violation would benefit as much as heavy drinking volunteers up to one year post-intervention using control groups with high-risk drinkers to model disciplinary-related and naturalistic changes in drinking. Participants (61% male; 51% mandated; 84% Caucasian; Mage = 20.14 years) were screened for heavy drinking and randomized to BASICS (n = 115) or assessment-only control (n = 110). Outcome measures (drinking, alcohol problems) were collected at baseline, 4 weeks, 3, 6, and 12 months post-intervention. At 4 weeks post-intervention, intent-to-treat multilevel longitudinal models showed that regardless of referral group (mandated or volunteer) BASICS significantly decreased weekly drinking, typical drinks, and peak drinks relative to controls (ds = .41-.92). BASICS had a large effect on decreases in alcohol problems (d = .87). At 12 months post-intervention, BASICS participants (regardless of referral group) reported significantly fewer alcohol problems (d = .56) compared to controls. Significant long-term intervention gains for peak and typical drinks were sustained in both referral groups relative to controls (ds = .42; .11). Referral group had no significant main effect and did not interact with intervention condition to predict outcomes. Given that BASICS was associated with less drinking and fewer alcohol problems (even among heavier drinking mandated students up to one year post-intervention), provision of BASICS-style programs within disciplinary settings may help reduce heavy and problematic drinking among at-risk students. PMID:25844834

  4. Alcohol interventions for mandated college students: A meta-analytic review.

    Science.gov (United States)

    Carey, Kate B; Scott-Sheldon, Lori A J; Garey, Lorra; Elliott, Jennifer C; Carey, Michael P

    2016-07-01

    When college students violate campus alcohol policies, they typically receive disciplinary sanctions that include alcohol education or counseling. This meta-analysis evaluated the efficacy of these "mandated interventions" to prevent future alcohol misuse. Studies were included if they evaluated an individual- or group-level intervention, sampled students mandated to an alcohol program, used a pretest-posttest design, and assessed alcohol use as an outcome. Thirty-one studies with 68 separate interventions (N = 8,621 participants; 35% women; 85% White) were coded by independent raters with respect to sample, design, methodological features, and intervention content; the raters also calculated weighted mean effect sizes, using random-effects models. A priori predictors were examined to explain variability in effect sizes. In the 5 studies that used assessment-only control groups, mandated students reported significantly less drinking relative to controls (between-groups contrasts), d+ ranged from 0.13-0.20 for quantity and intoxication outcomes. In the 31 studies that provided within-group contrasts, significant effects were observed for all outcomes in the short-term (i.e., ≤ 3 months postintervention), with d+ ranging from 0.14-0.27; however, fewer significant effects appeared at longer follow-ups. Four commercially available intervention protocols (i.e., BASICS, e-CHUG, Alcohol 101, and Alcohol Skills Training Program) were associated with risk reduction. Providing mandated interventions to students who violate campus alcohol policies is an effective short-term risk reduction strategy. Continued research is needed to maintain initial gains, identify the most useful intervention components, and determine the cost-effectiveness of delivery modes. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  5. Drinking Location and Pregaming as Predictors of Alcohol Intoxication Among Mandated College Students.

    Science.gov (United States)

    Miller, Mary Beth; Borsari, Brian; Fernandez, Anne C; Yurasek, Ali M; Hustad, John T P

    2016-07-02

    Both drinking location and pregaming have been associated with heavy alcohol use among college students, yet the manner by which they uniquely contribute to alcohol intoxication remains unclear. The current study examined the unique utility of drinking location and pregaming in predicting alcohol intoxication among college students who violated campus alcohol policy. Between 2011 and 2012, mandated college students who reported drinking prior to their referral events (N = 212, 41% female, 80% White, Mage = 19.4 y) completed a computerized assessment of drinking location and related behaviors as part of larger research trial. Chi-squared statistics, t-tests, one-way analyses of covariance, and regression were used to examine study aims. Participants were most likely (44%) to report drinking in off-campus housing prior to the referral event, and approximately half (47%) reported pregaming. Alcohol intoxication on the night of the referral event differed significantly as a function of both drinking location and pregaming, but pregaming did not moderate the association between drinking location and alcohol intoxication among mandated students. Female birth sex, pregaming, and drinking at either fraternities or off-campus housing predicted greater levels of alcohol intoxication on the night of the referral incident, while drinking in a residence hall/dorm predicted lower intoxication. Drinking location and pregaming are distinct predictors of alcohol intoxication among mandated college students. Future interventions may benefit from targeting both where and how college students consume alcohol.

  6. Two-year continuation of intrauterine devices and contraceptive implants in a mixed-payer setting: a retrospective review.

    Science.gov (United States)

    Sanders, Jessica N; Turok, David K; Gawron, Lori M; Law, Amy; Wen, Lonnie; Lynen, Richard

    2017-06-01

    As the popularity of long-acting reversible contraception increases, so does the need for accurate data on method continuation in diverse clinical settings. We determined 2-year continuation rates for the levonorgestrel 52-mg intrauterine device, the copper T380A intrauterine device, and the 68-mg etonogestrel contraceptive implant in an academic healthcare system with mixed-payer reimbursement. The purpose of this study was to examine the proportion and characteristics of women who continue intrauterine device and implant use to 2 years and to relate continuation to device type when controlling for patient characteristics. This retrospective chart review assessed University of Utah Healthcare System patients who had an intrauterine device or contraceptive implant inserted between January 1, 2004, and December 31, 2012. We identified users and dates of insertions and removals by querying billing, medication, and procedural data in the Electronic Data Warehouse. Multivariable Poisson regression was conducted to estimate incidence risk ratios and to relate the probability of 2-year continuous use to device type. Data on 8603 device insertions were obtained with the following distribution: levonorgestrel 52-mg intrauterine devices (6459; 75.1%), copper T380A intrauterine devices (1136; 13.2%), and 68-mg etonogestrel implant (1008; 11.7%). Two-year continuation rates were 77.8%, 73.1%, and 75.9%, respectively. There was no statistical difference in 2-year continuation between levonorgestrel 52-mg intrauterine device users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0-1.1) and 68-mg etonogestrel implant users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0-1.1) compared with copper device users, after we controlled for age, Hispanic ethnicity, payer type, and year of insertion. Older-age, self-pay, or public payer insurance (reference commercial payer) and Hispanic ethnicity were associated with 2-year continuation. Three-quarters of women with an

  7. Association of a Policy Mandating Physician-Patient Communication With Racial/Ethnic Disparities in Postmastectomy Breast Reconstruction.

    Science.gov (United States)

    Mahmoudi, Elham; Lu, Yiwen; Metz, Allan K; Momoh, Adeyiza O; Chung, Kevin C

    2017-08-01

    With the stabilization of breast cancer incidence and substantial improvement in survival, more attention has focused on postmastectomy breast reconstruction (PBR). Despite its demonstrated benefits, wide disparities in the use of PBR remain. Physician-patient communication has an important role in disparities in health care, especially for elective surgical procedures. Recognizing this, the State of New York enacted Public Health Law (NY PBH Law) 2803-o in 2011 mandating that physicians communicate about reconstructive surgery with patients undergoing mastectomy. To evaluate whether mandated physician-patient communication is associated with reduced racial/ethnic disparities in immediate PBR (IPBR). This retrospective study used state inpatient data from January 1, 2008, through December 31, 2011, in New York and California to evaluate a final sample of 42 346 women aged 20 to 70 years, including 19 364 from New York (treatment group) and 22 982 from California (comparison group). The primary hypothesis tested the effect of the New York law on racial/ethnic disparities, using California as a comparator. The National Academy of Medicine's (formerly Institute of Medicine) definition of a disparity was applied, and a difference-in-differences method (before-and-after comparison design) was used to evaluate the association of NY PBH Law 2803-o mandating physician-patient communication with disparities in IPBR. Data were analyzed from July 1, 2016, to February 24, 2017. New York PBH Law 2803-o was implemented on January 1, 2011. The preexposure period included January 1, 2008, through December 31, 2010 (3 years); the postexposure period, January 1 through December 31, 2011 (1 year). The primary outcome was use of IPBR among white, African American, Hispanic, and other minority groups before and after the implementation of NY PBH Law 2803-o. Among the 42 346 women (mean [SD] age, 53 [10] years), 65.3% (27 654) were white, 12.7% (5365) were Hispanic, 9.4% (3976

  8. Feedback-based alcohol interventions for mandated students: an effectiveness study of three modalities.

    Science.gov (United States)

    Alfonso, Jacqueline; Hall, Thomas V; Dunn, Michael E

    2013-01-01

    The present study used a randomized clinical trial design to examine the effectiveness of personalized alcohol feedback delivered individually, in a group and via computer on alcohol use and related negative consequences in a sample of 173 college students referred for alcohol-related violations. Findings revealed statistically significant reductions in alcohol use and related harms for the individually delivered intervention, with significant reductions in alcohol-related harms for the electronically delivered intervention. No statistically significant results were found for the group-delivered intervention or between groups, and a main effect of time was noted for all outcome variables. This study adds to the literature by being the first randomized clinical trial to include analyses of an empirically supported individually delivered personalized alcohol feedback intervention with more cost-effective group-delivered and electronically delivered feedback formats within a single research design, by expanding the range of participant drinking habits reported at baseline to include all drinking levels and not solely those classified as 'heavy drinking' and by providing anonymity pre-intervention and post-intervention given the potential demand characteristics to underreport illegal and/or illicit behaviours in this vulnerable population. Personalized alcohol feedback delivered in a one-on-one, face-to-face format serves to decrease both alcohol use and harms in mandated college students. The use of web-delivered personalized alcohol feedback may be clinically useful when working with a mandated student population to reduce alcohol-related harms. Personalized alcohol feedback delivered in a group setting may not be indicated for use with a mandated student population as it does not demonstrate decreases in either alcohol use or harms, possibly because of the normalization of deviant behaviour. Copyright © 2012 John Wiley & Sons, Ltd.

  9. Alcohol Use and Problems in Mandated College Students: A Randomized Clinical Trial Using Stepped Care

    Science.gov (United States)

    Borsari, Brian; Hustad, John T.P.; Mastroleo, Nadine R.; Tevyaw, Tracy O’Leary; Barnett, Nancy P.; Kahler, Christopher W.; Short, Erica Eaton; Monti, Peter M.

    2012-01-01

    Objective Over the past two decades, colleges and universities have seen a large increase in the number of students referred to the administration for alcohol policies violations. However, a substantial portion of mandated students may not require extensive treatment. Stepped care may maximize treatment efficiency and greatly reduce the demands on campus alcohol programs. Method Participants in the study (N = 598) were college students mandated to attend an alcohol program following a campus-based alcohol citation. All participants received Step 1: a 15-minute Brief Advice session that included the provision of a booklet containing advice to reduce drinking. Participants were assessed six weeks after receiving the Brief Advice, and those who continued to exhibit risky alcohol use (n = 405) were randomized to Step 2, a 60–90 minute brief motivational intervention (BMI) (n = 211) or an assessment-only control (n = 194). Follow-up assessments were conducted 3, 6, and 9 months after Step 2. Results Results indicated that the participants who received a BMI significantly reduced the number of alcohol-related problems compared to those who received assessment-only, despite no significant group differences in alcohol use. In addition, low risk drinkers (n = 102; who reported low alcohol use and related harms at 6-week follow-up and were not randomized to stepped care) showed a stable alcohol use pattern throughout the follow-up period, indicating they required no additional intervention. Conclusion Stepped care is an efficient and cost-effective method to reduce harms associated with alcohol use by mandated students. PMID:22924334

  10. Cost estimates of an open access mandate for monographs in the UK’s third Research Excellence Framework

    OpenAIRE

    Eve, Martin Paul; Inglis, Kitty; Prosser, David; Speicher, Lara; Stone, Graham

    2017-01-01

    The recent Consultation on the Second Research Excellence Framework (REF) in the United Kingdom contains an annex that signals the extension of the open-access mandate to monographs. In the service of promoting discussion, rather than prescribing a forward route, this article estimates the costs of implementing such a mandate based on REF 2014 volume, taking the criteria signalled in the annex, and identifies funding sources that could support it. We estimate that to publish 75% of anticipate...

  11. Federal Health Coverage Mandates and Health Care Utilization: The Case of the Women's Health and Cancer Rights Act and Use of Breast Reconstruction Surgery.

    Science.gov (United States)

    Xie, Yang; Tang, Yuexin; Wehby, George L

    2015-08-01

    Utilization of breast reconstruction services remains low among women who underwent mastectomy despite the improvement in quality of life associated with this treatment. The objective of this study is to identify the effect of the Women's Health and Cancer Rights Act (WHCRA)-an understudied ongoing federal law that mandated insurance coverage of breast reconstruction following mastectomy beginning in 1999-on use of reconstructive surgery after mastectomy. We use a difference-in-differences (DD) approach to identify the change in breast reconstruction utilization induced by WHCRA by comparing the pre- and post-policy changes in utilization between states that did not have existing laws mandating coverage before the WHCRA (treatment group) and those that had such state laws (control group). The data are from the Surveillance, Epidemiology, and End Results program. The main sample includes 15,737 female patients who were under the age of 64 and underwent mastectomy within 4 months of diagnosis of early stage breast cancer during 1998 and 2000. Based on the DD model, the odds of using reconstruction services in the states without preexisting laws increased after the WHCRA by 31% in 1999 and 36% in 2000 (compared with 1998 before the WHCRA). These effects are masked in a simple pre/post model for change in reconstruction across all states. Additional analyses through 2007 indicate that the WHCRA had long-term effects on utilization. Furthermore, analyses by state indicate that most states in the treatment group experienced a significance increase in utilization. The use of breast reconstruction after mastectomy significantly increased after the WHCRA. At a minimum, our estimates may be considered the lower bound of the real policy effect.

  12. Payers' experiences with confidential pharmaceutical price discounts: A survey of public and statutory health systems in North America, Europe, and Australasia.

    Science.gov (United States)

    Morgan, Steven G; Vogler, Sabine; Wagner, Anita K

    2017-04-01

    Institutional payers for pharmaceuticals worldwide appear to be increasingly negotiating confidential discounts off of the official list price of pharmaceuticals purchased in the community setting. We conducted an anonymous survey about experiences with and attitudes toward confidential discounts on patented pharmaceuticals in a sample of high-income countries. Confidential price discounts are now common among the ten health systems that participated in our study, though some had only recently begun to use these pricing arrangements on a routine basis. Several health systems had used a wide variety of discounting schemes in the past two years. The most frequent discount received by participating health systems was between 20% and 29% of official list prices; however, six participants reported their health system received one or more discount over the past two years that was valued at 60% or more of the list prices. On average, participants reported that confidential discounts were more common, complex, and significant for specialty pharmaceuticals than for primary care pharmaceuticals. Participants had a more favorable view of the impact of confidential discount schemes on their health systems than on the global marketplace. Overall, the frequency, complexity, and scale of confidential discounts being routinely negotiated suggest that the list prices for medicines bear limited resemblance to what many institutional payers actually pay. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  13. Hospital revenue cycle management and payer mix: do Medicare and Medicaid undermine hospitals' ability to generate and collect patient care revenue?

    Science.gov (United States)

    Rauscher, Simone; Wheeler, John R C

    2010-01-01

    The continuing efforts of government payers to contain hospital costs have raised concerns among hospital managers that serving publicly insured patients may undermine their ability to manage the revenue cycle successfully. This study uses financial information from two sources-Medicare cost reports for all US hospitals for 2002 to 2007 and audited financial statements for all bond-issuing, not-for-profit hospitals for 2000 to 2006 to examine the relationship between hospitals' shares of Medicare and Medicaid patients and the amount of patient care revenue they generate as well as the speed with which they collect their revenue. Hospital-level fixed effects regression analysis finds that hospitals with higher Medicare and Medicaid payer mix collect somewhat higher average patient care revenues than hospitals with more privately insured and self-pay patients. Hospitals with more Medicare patients also collect on this revenue faster; serving more Medicaid patients is not associated with the speed of patient revenue collection. For hospital managers, these findings may represent good news. They suggest that, despite increases in the number of publicly insured patients served, managers have frequently been able to generate adequate amounts of patient revenue and collect it in a timely fashion.

  14. Network unites payers, physicians, hospitals. System participants work together to improve access to care and to design cost-saving incentives.

    Science.gov (United States)

    Cassidy, J

    1993-05-01

    Through Sacred Heart Health System (SHHS), Eugene, OR, physicians, payers, and hospitals are designing a network that will integrate care and improve access by reducing healthcare costs. Together, system members design cost-saving incentives and the products the system offers the community. They promote managed care as the most efficient means to coordinate care and reduce costs. All participants share in the risks of a capitated payment system. Since the system pulled together the payers, physician groups, and hospitals, many of these entities' management functions were consolidated at the system level to avoid duplication and reduce administrative costs. Bringing in physicians was the most difficult yet important aspect of forming a successful network. Working with two physician groups in the community, the system's sponsor-the Sisters of St. Joseph of Peace, Health and Hospital Services-developed the Physician Practice Board. The board, representing 300 physicians, meets weekly and makes recommendations on issues that affect physicians. SHHS also added innovative new functions such as an integrated medical cost management and continuous quality improvement program. Another key to success is a clinically oriented information system, which will allow the system to track patients once they leave the hospital. It also will provide a better understanding of what things have an impact on outcomes and will reduce paperwork. A portion of the system's revenue is designated for initiatives to improve access. And the system recently appointed a tack force on access to explore what they can do in cooperation with others in the community.

  15. Re-conceptualising holism in the contemporary nursing mandate: from individual to organisational relationships.

    Science.gov (United States)

    Allen, Davina

    2014-10-01

    Over the last forty years, nursing's claim to professional expertise has been expressed in terms of its care-giving function. Informed by a distinctive 'holistic' approach, models of nursing identify therapeutic relationships as the cornerstone of practice. While 'knowing the patient' has been central to clinicians' occupational identity, research reveals that nurses not only experience significant material constraints in realising these ideals, their contribution to healthcare extends far beyond direct work with patients. Amidst growing concern about healthcare quality, a body of critical commentary has emerged proposing that the contemporary nursing mandate, with its exclusive focus on care-giving, is no longer serving the interests of the profession or the public. Drawing on an ethnographic study of UK hospital nurses' 'organising work' and insights from practice-based approaches and actor network theory, this paper lays the foundations for a re-conceptualisation of holism within the nursing mandate centred on organisational rather than therapeutic relationships. Nurses can be understood as obligatory passage points in health systems and through myriad processes of 'translational mobilisation' sustain the networks through which care is organised. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Examining trauma and posttraumatic stress disorder symptoms in court-mandated intimate partner violence perpetrators.

    Science.gov (United States)

    Maguire, Emily; Macdonald, Alexandra; Krill, Sarah; Holowka, Darren W; Marx, Brian P; Woodward, Halley; Burns, Tony; Taft, Casey T

    2015-09-01

    There is a dearth of empirical literature characterizing the various forms of trauma experienced by men court mandated to intervention for intimate partner violence (IPV) perpetration. We investigated the potentially traumatic events (PTEs) experienced by men (N = 217) court mandated to enroll in a 41-week group IPV perpetrator program, as well as the relationships between PTEs, posttraumatic stress disorder (PTSD) symptoms, and IPV. Findings indicated that 94% of participants reported experiencing at least 1 PTE in their lifetime, and participants experienced an average of over 6 out of 14 types of PTEs. A significant association was found between the number of PTEs experienced and frequency of self-reported perpetration of physical and psychological IPV. PTSD symptoms were also related to both forms of IPV perpetration and mediated the relationship between experiencing PTEs and psychological IPV perpetration. Our findings have implications for understanding how trauma and PTSD symptoms may increase risk for IPV and for developing trauma-informed interventions for this population. (c) 2015 APA, all rights reserved).

  17. Urgent Protection versus Chronic Need: Clarifying the Dual Mandate of Child Welfare Services across Canada

    Directory of Open Access Journals (Sweden)

    Nico Trocmé

    2014-08-01

    Full Text Available This study analyzed data from the 1998, 2003 and 2008 Canadian Incidence Study of reported child abuse and neglect (CIS and compared the profile of children who were reported for an urgent protection investigation versus any other investigation or assessment. As a proportion of all investigations, urgent protection cases have dropped from 28% of all investigations in 1998, to 19% in 2003, to 15% in 2008. Results from the CIS-2008 analysis revealed that 7% of cases involved neglect of a child under four, 4% of cases involved sexual abuse, 2% of cases involved physical abuse of a child under four and 1% of cases involved children who had sustained severe enough physical harm that medical treatment was required. The other 85% of cases of investigated maltreatment involved situations where concerns appear to focus less on immediate safety and more on the long-term effects of a range of family related problems. These findings underscore the importance of considering the dual mandate of child welfare mandates across Canada: intervening to assure the urgent protection and safety of the child versus intervening to promote the development and well-being of the child.

  18. Do cultural and linguistic competence matter in Latinos’ completion of mandated substance abuse treatment?

    Directory of Open Access Journals (Sweden)

    Guerrero Erick G

    2012-08-01

    Full Text Available Abstract Background Increasing evidence suggests that culturally and linguistically responsive programs may improve substance abuse treatment outcomes among Latinos. However, little is known about whether individual practices or culturally and linguistically responsive contexts support efforts by first-time Latino clients to successfully complete mandated treatment. Methods We analyzed client and program data from publicly funded treatment programs contracted through the criminal justice system in California. A sample of 5,150 first-time Latino clients nested within 48 treatment programs was analyzed using multilevel logistic regressions. Results Outpatient treatment, homelessness, and a high frequency of drug use at intake were associated with decreased odds of treatment completion among Latinos. Programs that routinely offered a culturally and linguistically responsive practice—namely, Spanish-language translation—were associated with increased odds of completion of mandated treatment. Conclusions These preliminary findings suggest that concrete practices such as offering Spanish translation improve treatment adherence within a population that is at high risk of treatment dropout.

  19. Alcohol interventions for mandated students: behavioral outcomes from a randomized controlled pilot study.

    Science.gov (United States)

    Logan, Diane E; Kilmer, Jason R; King, Kevin M; Larimer, Mary E

    2015-01-01

    This study investigated the effectiveness of three single-session interventions with high-risk mandated students while considering the influence of motivational interviewing (MI) microskills. This randomized, controlled pilot trial evaluated single-session interventions: Alcohol Skills Training Program (ASTP), Brief Alcohol Screening and Intervention for College Students (BASICS) feedback sessions, and treatment-as-usual Alcohol Diversion Program (ADP) educational groups. Participants were 61 full-time undergraduates at a southern U.S. campus sanctioned to a clinical program following violation of an on-campus alcohol policy (Mage = 19.16 years; 42.6% female). RESULTS revealed a significant effect of time for reductions in estimated blood alcohol concentration (eBAC) and number of weekly drinks but not in alcohol-related consequences. Although ASTP and BASICS participants reported significant decreases in eBAC over time, ADP participant levels did not change (with no intervention effects on quantity or consequences). MI microskills were not related to outcomes. RESULTS from this study suggest equivalent behavioral impacts for the MI-based interventions, although individual differences in outcome trajectories suggest that research is needed to further customize mandated interventions. Given the overall decrease in eBAC following the sanction, the lack of reduction in the ADP condition warrants caution when using education-only interventions.

  20. Constitutionally Mandated Funds for Financing Regional Development in Brazil: An Analysis of the Compensatory Mechanisms Used by Financial Institutions (1995-2013

    Directory of Open Access Journals (Sweden)

    Girley Vieira Damasceno

    2016-04-01

    Full Text Available This paper examines the relationship between constitutionally mandated funds for financing regional development in Brazil and the regional financial institutions that manage them. These constitutionally mandated funds apply a fraction of federal tax revenues in the productive sectors of the North, Northeast and Midwest regions of Brazil. We investigate the occurrence of soft budget constraint on these institutions, induced by compensatory mechanisms for management of the resources of these funds (administration fee and by the assumption of credit risk in lending (del credere. The concept of soft budget constraint, proposed by Hungarian economist Janos Kornai in the context of socialist economies, refers to the expectations for systematic bailout of economic organizations by governments or banks, usually associated with the paternalistic role of the state towards these organizations. Our analysis uses comparative graphics and spreadsheets. The results indicate more remuneration than administrative costs and credit risk assumed by financial institutions and confirm the hypothesis of legal parameters that induce soft budget constraint.

  1. Early impact of the federally mandated Local Wellness Policy on physical activity in rural, low-income elementary schools in Colorado.

    Science.gov (United States)

    Belansky, Elaine S; Cutforth, Nick; Delong, Erin; Ross, Courtney; Scarbro, Sharon; Gilbert, Lynn; Beatty, Bridget; Marshall, Julie A

    2009-01-01

    The What's Working project described the initial impact of the United States' federally mandated Local Wellness Policy in rural, low-income elementary schools located in Colorado. Before and after the Local Wellness Policy mandate went into effect, a survey about school features related to nutrition and physical activity was sent to a random sample of 45 rural elementary schools (i.e., schools located outside of urban areas), in which at least 40% of students qualified for free or reduced-cost lunch. Overall, opportunities for physical activity did not change after the policy went into effect: although time in physical education increased by 14 min per week (P=0.10), time for recess decreased by roughly 19 min per week (P=0.10). Policies supporting student participation in physical education and recess (an unstructured time during school hours when students are allowed to play outside) did not change. The researchers coded Local Wellness Policies and found them to have weak wording that produced minimal impact. Content analysis of key informant interviews suggested several barriers to the impact of the Local Wellness Policies: (1) competing pressures facing school districts, (2) lack of resources devoted to the Local Wellness Policy, (3) principals' lack of knowledge about the policy, and (4) lack of accountability mechanisms to ensure policy implementation. Financial resources and more effective communication about Local Wellness Policies among school districts and principals are needed to elevate the importance of and increase opportunities for physical activity in rural, low-income Colorado elementary schools.

  2. Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes.

    Science.gov (United States)

    Burks, Stephen V; Anderson, Jon E; Bombyk, Matthew; Haider, Rebecca; Ganzhorn, Derek; Jiao, Xueyang; Lewis, Connor; Lexvold, Andrew; Liu, Hong; Ning, Jiachen; Toll, Alice; Hickman, Jeffrey S; Mabry, Erin; Berger, Mark; Malhotra, Atul; Czeisler, Charles A; Kales, Stefanos N

    2016-05-01

    To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes. Data are from the first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry. A retrospective analysis of cohorts was constructed: polysomnogram-diagnosed drivers (OSA positive n = 1,613, OSA negative n = 403) were matched to control drivers unlikely to have OSA (n = 2,016) on two factors affecting crash risk, experience-at-hire and length of job tenure; tenure was matched on the date of each diagnosed driver's polysomnogram. Auto-adjusting positive airway pressure (APAP) treatment was provided to all cases (i.e. OSA positive drivers); treatment adherence was objectively monitored. Cases were grouped by treatment adherence: "Full Adherence" (n = 682), "Partial Adherence" (n = 571), or "No Adherence" (n = 360). Preventable Department-of-Transportation-reportable crashes/100,000 miles were compared across study subgroups. Robustness was assessed. After the matching date, "No Adherence" cases had a preventable Department of Transportation-reportable crash rate that was fivefold greater (incidence rate ratio = 4.97, 95% confidence interval: 2.09, 10.63) than that of matched controls (0.070 versus 0.014 per 100,000 miles). The crash rate of "Full Adherence" cases was statistically similar to controls (incidence rate ratio = 1.02, 95% confidence interval: 0.48, 2.04; 0.014 per 100,000 miles). Nontreatment-adherent OSA-positive drivers had a fivefold greater risk of serious preventable crashes, but were discharged or quit rapidly, being retained only one-third as long as other subjects. Thus, the mandated program removed risky nontreatment-adherent drivers and retained adherent drivers at the study firm. Current regulations allow nonadherent OSA cases to drive at another firm by keeping their diagnosis private. A commentary on this article appears in this issue on page

  3. The public wants information, not board mandates, from comparative effectiveness research.

    Science.gov (United States)

    Gerber, Alan S; Patashnik, Eric M; Doherty, David; Dowling, Conor

    2010-10-01

    We conducted two national surveys of public opinion about comparative effectiveness research and the integration of findings from the research into clinical practice. The first survey found broad support for using research results to provide information, but less support for using them to allocate government resources or mandate treatment decisions. In addition, the public is willing to consider the use of financial incentives to encourage patients to choose cheaper treatments, if research demonstrates that they work as well as more expensive ones. The second survey found that support for comparative effectiveness research dropped in response to general debates about its consequences but that arguments against the research could be effectively countered by specific, targeted rebuttals.

  4. The French press mobilization during Aoun mandate: historical considerations and French internal issues

    Directory of Open Access Journals (Sweden)

    Roy JREIJIRY

    2010-01-01

    Full Text Available The purpose of this research is to analyse, through three national daily newspapers which represent the French press, how this press is related Lebanon, during a turbulent period full of events. This period starts the week of September 19, 1988, the last week of mandate of President Amine Gemayel who appoints a transational government boycotted by the “Muslim side”. It ends on May 13, 1991, date of the signature of cooperation treaty between Lebanon and Syria. The thesis leads, on one hand, to highlighting the links between the representation of Lebanon in the press and the socio-political history of France, its diplomacy and the issues of internal policy, and on the other hand, highlighting the complexity of elaborating a coherent daily information marked by the permanent need of landmarks within a political world.

  5. Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Zinckernagel, Line; Ersbøll, Annette Kjær

    2017-01-01

    BACKGROUND: School cardiopulmonary resuscitation (CPR) training has become mandatory in many countries, but whether legislation has translated into implementation of CPR training is largely unknown. We assessed CPR training of students following 8 years of legislative mandates in Denmark. METHODS...... to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR...... and automated external defibrillator training, respectively. Among leadership, 60.2% (95% CI 56.2% to 64.1%) reported CPR training had occurred during the 3 years prior to the survey. Factors associated with completed CPR training included believing other schools were conducting training (odds ratio [OR] 9...

  6. Analyse de la présidence de Ma Ying-jeou à mi-mandat

    OpenAIRE

    Muyard, Frank

    2011-01-01

    Depuis son élection comme président de Taiwan en 2008, Ma Ying-jeou s’est engagé dans une politique active de rapprochement avec la Chine, conduisant à la signature d’une série d’accords économiques et commerciaux qui ont normalisé et libéralisé les relations économiques inter-détroit. Mais la manière avec laquelle ce rapprochement est mené, combinée à la crise économique qui a frappé Taiwan pendant l’essentiel des deux premières années du mandat de Ma, et une accumulation de faux pas et de g...

  7. Arbitration Board Setting Reimbursement Amounts for Pharmaceutical Innovations in Germany When Price Negations between Payers and Manufacturers Fail: An Empirical Analysis of 5 Years' Experience.

    Science.gov (United States)

    Ludwig, Saskia; Dintsios, Charalabos-Markos

    2016-12-01

    In Germany, an arbitration board is setting reimbursement amounts for drug innovations when price negations between payers and manufacturers fail. To empirically analyze all arbitrations since the reform of Germany's Act to Reorganize the Pharmaceuticals' Market in the Statutory Health Insurance System came into effect. All available relevant documents up to January 2016 were screened and the identified contentious issues between the negotiation parties extracted. Reimbursement requests of both the negotiating parties and the arbitrations were transformed into a comparable format on the basis of defined daily doses and then contrasted among each other. In the given period, 16 arbitrations took place. The arbitration board is implementing the same criteria used in the negotiations between manufacturers and payers. Almost all arbitrations dealt with generic appropriate comparative therapies. Reimbursement amounts set by arbitration were on average 38.4% less than the mean of negotiation parties' requests (69.2% less than the manufacturers' requests). The corresponding prescription volumes were arranged rather centrally. All but one arbitration refer to a 1-year contract period. The arbitration board rarely decided on further technical contentious points. Hence, no heuristics referring to them were derivable. There is some evidence for a quasi-algorithmic approach of the arbitration board, even though it is legally determined that it has to decide while taking the peculiar conditions of each case into due consideration, including the characteristics of the respective therapeutic area. The balance of interests proved to be within a very narrow space albeit it concerns in principle discretionary decisions. Thus, the purpose of arbitration seems not to be achieved sufficiently. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  8. Novel Data Sharing Between a Comprehensive Cancer Center and a Private Payer to Better Understand Care at the End of Life.

    Science.gov (United States)

    Stuver, Sherri O; McNiff, Kristen; Fraile, Bélen; Odejide, Oreofe; Abel, Gregory A; Dodek, Anton; Jacobson, Joseph O

    2016-08-01

    Understanding end-of-life (EOL) care patterns is a prerequisite to improving the experience for cancer patients. EOL measures endorsed by the National Quality Forum (NQF) have been examined in older patients using Medicare claims. To evaluate EOL care for patients treated at a comprehensive cancer center, using private payer claims data. A retrospective cohort study was conducted of Dana-Farber Cancer Institute (DFCI) patients who died between July 2010 and December 2012, and were insured by Blue Cross Blue Shield of Massachusetts. Primary data sources included Blue Cross Blue Shield of Massachusetts claims information and DFCI administrative data. We assessed NQF-endorsed measures of EOL care related to emergency department visits, hospitalizations, and intensive care unit admissions in the last 30 days, chemotherapy in the last 14 days, hospice stay, and death in an acute care setting. Patterns of care by cancer type and service location were determined. Among 674 patients (mean age 58 years), event rates for NQF-endorsed EOL measures were similar to those reported using Medicare claims. Decedents with hematologic malignancies received significantly more intensive care and were less likely to have enrolled in hospice, compared to decedents with solid tumors. Thirty to 45% of EOL events occurred outside of DFCI and its affiliated hospitals. Data sharing between a private payer and a large cancer center proved feasible and informative. High rates of hospital service use outside of our sites of care were unexpected. The findings suggest opportunities to better manage care at the end of life. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. Brief alcohol interventions for mandated college students: comparison of face-to-face counseling and computer-delivered interventions.

    Science.gov (United States)

    Carey, Kate B; Carey, Michael P; Henson, James M; Maisto, Stephen A; DeMartini, Kelly S

    2011-03-01

    College students who violate alcohol policies are often mandated to participate in alcohol-related interventions. This study investigated (i) whether such interventions reduced drinking beyond the sanction alone, (ii) whether a brief motivational intervention (BMI) was more efficacious than two computer-delivered interventions (CDIs) and (iii) whether intervention response differed by gender. Randomized controlled trial with four conditions [brief motivation interventions (BMI), Alcohol 101 Plus™, Alcohol Edu for Sanctions(®), delayed control] and four assessments (baseline, 1, 6 and 12 months). Private residential university in the United States. Students (n = 677; 64% male) who had violated campus alcohol policies and were sanctioned to participate in a risk reduction program. Consumption (drinks per heaviest and typical week, heavy drinking frequency, peak and typical blood alcohol concentration), alcohol problems and recidivism. Piecewise latent growth models characterized short-term (1-month) and longer-term (1-12 months) change. Female but not male students reduced drinking and problems in the control condition. Males reduced drinking and problems after all interventions relative to control, but did not maintain these gains. Females reduced drinking to a greater extent after a BMI than after either CDI, and maintained reductions relative to baseline across the follow-up year. No differences in recidivism were found. Male and female students responded differently to sanctions for alcohol violations and to risk reduction interventions. BMIs optimized outcomes for both genders. Male students improved after all interventions, but female students improved less after CDIs than after BMI. Intervention effects decayed over time, especially for males. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

  10. 75 FR 76706 - Acceptance of Public Submissions on a Study Mandated by the Dodd-Frank Wall Street Reform and...

    Science.gov (United States)

    2010-12-09

    ..., Division of Risk, Strategy, and Financial Innovation, Securities and Exchange Commission, 100 F Street, NE... to capture one set of information versus another? 40. Would there be a benefit to making the computer... COMMISSION SECURITIES AND EXCHANGE COMMISSION Acceptance of Public Submissions on a Study Mandated by the...

  11. HPV Vaccination Status and Mandate Support for School-Aged Adolescents among College Females: A Descriptive Study

    Science.gov (United States)

    Wilson, Kelly L.; Smith, Matthew Lee; Rosen, Brittany L.; Pulczinski, Jairus C.; Ory, Marcia G.

    2017-01-01

    The purpose of this study was to describe college-aged females' human papillomavirus (HPV) knowledge and beliefs, perceptions and perceived benefits of the HPV vaccine, and identify characteristics associated with vaccination status and support for HPV vaccine mandates. Data were collected from 1,105 females by an Internet-delivered questionnaire…

  12. 76 FR 44508 - Acceptance of Public Submissions for a Study on International Swap Regulation Mandated by Section...

    Science.gov (United States)

    2011-07-26

    ..., currency swaps, interest rate swaps (IRS),\\22\\ and commodity swaps; \\21\\ For CDS, include: corporate single... contracts, such as CDS, equity swaps, currency swaps, IRS, and commodity swaps; b. For classes and... Submissions for a Study on International Swap Regulation Mandated by Section 719(c) of the Dodd-Frank Wall...

  13. Exploring Asperger's Syndrome, Schlossberg's Transition Theory and Federally Mandated Transition Planning: Seeking Improvements

    Science.gov (United States)

    Spencer, Tracy Lynne Wright Lyons

    2013-01-01

    Federally mandated transition planning has done little to improve the postsecondary outcomes of people with Asperger's syndrome. Current high school transition planning for students with Asperger's attempts to address some of these areas through family involvement, community inclusion, and the active participation of the student in…

  14. Separating Wheat from Chaff: How Secondary School Principals' Core Values and Beliefs Influence Decision-Making Related to Mandates

    Science.gov (United States)

    Larsen, Donald E.; Hunter, Joseph E.

    2014-01-01

    Research conducted by Larsen and Hunter (2013, February) identified a clear pattern in secondary school principals' decision-making related to mandated change: more than half of participants' decisions were based on core values and beliefs, requiring value judgments. Analysis of themes revealed that more than half of administrative decisions…

  15. Perceived Influence of an Instructional Coaching Program on Teacher Self-Efficacy: Voluntary Participation in Comparison to Mandated Participation

    Science.gov (United States)

    Wiedlich, David Matthew

    2017-01-01

    This research study explored perceived influence of an instructional coaching program on teacher self-efficacy based on voluntary participation in comparison to mandated participation. At the time of this study, the literature on instructional coaching incorporated studies that tie instructional coaching to increases in teacher self-efficacy;…

  16. Do as I Say, Not as I Do: Drinking Behaviors and Perceptions of Peer Counselors Working With Mandated College Students

    Science.gov (United States)

    Logan, Diane E.; Mastroleo, Nadine R.; Wood, Mark D.; Borsari, Brian

    2016-01-01

    Little is known about the drinking behaviors and perceptions of the peers facilitating campus alcohol interventions. The current study examined these trajectories in peer counselors (N = 12) providing personalized normative feedback interventions to undergraduates mandated to clinical services. Peer counselors completed four monthly…

  17. Academic Advising, Remedial Courses, and Legislative Mandates: An Exploration of Academic Advising in Florida Community Colleges with Optional Developmental Education

    Science.gov (United States)

    Woods, Chenoa S.; Richard, Keith; Park, Toby; Tandberg, David; Hu, Shouping; Jones, Tamara Bertrand

    2017-01-01

    In this article we report on our exploration of academic advising practices at 19 community colleges in the Florida College System after the implementation of Senate Bill 1720. This bill made developmental education optional for many students and mandated that colleges provide academic advising for all new students. Descriptive statistics of…

  18. Positioning Teachers: A Discourse Analysis of Russian and American Teacher Identities in the Context of Changing National Assessment Mandates

    Science.gov (United States)

    Ignatieva, Raisa P.

    2011-01-01

    The purpose of the study was to uncover the cultural beliefs and values that underlie American and Russian teachers' representations of their professional identities and their understanding of power in education in the context of globally disseminated education reforms and current educational mandates--the No Child Left Behind Act of 2001 (NCLB)…

  19. Women Saw Large Decrease In Out-Of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing.

    Science.gov (United States)

    Becker, Nora V; Polsky, Daniel

    2015-07-01

    The Affordable Care Act mandates that private health insurance plans cover prescription contraceptives with no consumer cost sharing. The positive financial impact of this new provision on consumers who purchase contraceptives could be substantial, but it has not yet been estimated. Using a large administrative claims data set from a national insurer, we estimated out-of-pocket spending before and after the mandate. We found that mean and median per prescription out-of-pocket expenses have decreased for almost all reversible contraceptive methods on the market. The average percentages of out-of-pocket spending for oral contraceptive pill prescriptions and intrauterine device insertions by women using those methods both dropped by 20 percentage points after implementation of the ACA mandate. We estimated average out-of-pocket savings per contraceptive user to be $248 for the intrauterine device and $255 annually for the oral contraceptive pill. Our results suggest that the mandate has led to large reductions in total out-of-pocket spending on contraceptives and that these price changes are likely to be salient for women with private health insurance. Project HOPE—The People-to-People Health Foundation, Inc.

  20. Effectiveness of the Brief Alcohol and Screening Intervention for College Students (BASICS) Program with a Mandated Population

    Science.gov (United States)

    DiFulvio, Gloria T.; Linowski, Sally A.; Mazziotti, Janet S.; Puleo, Elaine

    2012-01-01

    Objective: This study evaluated the effectiveness of a large-scale intervention designed to reduce alcohol abuse among adjudicated college students. Participants: Participants were college students mandated to attend a Brief Alcohol Screening and Intervention for College Students (BASICS) program and a randomly selected comparison group of…

  1. Cardiopulmonary resuscitation training in schools following 8 years of mandating legislation in Denmark

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Zinckernagel, Line; Ersbøll, Annette Kjær

    2017-01-01

    AND RESULTS: A nationwide cross-sectional survey of Danish school leadership (n=1240) and ninth-grade homeroom teachers (n=1381) was carried out for school year 2013-2014. Qualitative interviews and the Theory of Planned Behavior were used to construct the survey. Logistic regression models were employed...... to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR.......68 [95% CI 4.65-20.1]), awareness of mandating legislation (OR 4.19 [95% CI 2.65-6.62]), presence of a school CPR training coordinator (OR 3.01 [95% CI 1.84-4.92]), teacher feeling competent to conduct training (OR 2.78 [95% CI 1.74-4.45]), and having easy access to training material (OR 2.08 [95% CI 1...

  2. Drinking before Drinking: Pre-gaming and Drinking Games in Mandated Students

    Science.gov (United States)

    Boyle, Kelly E.; Hustad, John T. P.; Barnett, Nancy P.; Tevyaw, Tracy O'Leary; Kahler, Christopher W.

    2007-01-01

    Pre-gaming, the practice of consuming alcohol before attending a social function, has not received as much research attention as drinking games among college students. This study investigated the prevalence of both pre-gaming and drinking game participation in a sample of mandated students (N = 334) who had been referred for an alcohol violation. Approximately one-third (31%) of the sample reported pre-gaming on the night of their referral event. Pre-gaming was associated with higher estimated blood alcohol content on that night, along with a greater history of pre-gaming and taking greater responsibility for the incident. A higher proportion of the students (48.7%) reported playing drinking games on the event night and reported the event to be less aversive than non-players. Neither drinking games nor pre-gaming was consistently related to recent alcohol consumption or problems, nor did they frequently occur together on the event night. Pre-gaming was a unique predictor of intoxication on the night of the referral, and drinking games were not. Therefore, pre-gaming and drinking games appear to be distinct activities. This research suggests methods of prevention for both activities as well as promising research directions for future research. PMID:17574344

  3. NGO-Ization and Human Rights Law: The CRPD’s Civil Society Mandate

    Directory of Open Access Journals (Sweden)

    Stephen Meyers

    2016-05-01

    Full Text Available The Convention on the Rights of Persons with Disabilities (CRPD is unique among international human rights instruments for including a “civil society mandate”. Within the convention, disabled persons organizations (DPOs are identified as having the responsibility to “be involved and participate fully in the monitoring process” of the CRPD. In response to this mandate, international funders, NGOs (non-governmental organizations, and networks committed to the CPRD have begun to implement capacity-building programs that target grassroots DPOs with the goal of ensuring they become advocates and monitors of the CRPD. While the goals of these capacity-building programs are admirable, they must be critically assessed. The NGO-ization theory within development studies offers a framework for analyzing the potential unintended consequences of donors providing new funding, NGOs providing training, and global networks integrating local partners. NGO-ization studies have identified how grassroots associations are co-opted by outside actors through formalization and professionalization processes that significantly alter local groups and alienate members, thus making those associations less representative and less responsive to local needs and interests. Human rights scholars and international organizations focused on the CRPD should incorporate an NGO-ization perspective into their research and project-implementation to ensure that grassroots voices are heard and local needs addressed.

  4. Alcohol-related problems and life satisfaction predict motivation to change among mandated college students.

    Science.gov (United States)

    Diulio, Andrea R; Cero, Ian; Witte, Tracy K; Correia, Christopher J

    2014-04-01

    The present study investigated the role specific types of alcohol-related problems and life satisfaction play in predicting motivation to change alcohol use. Participants were 548 college students mandated to complete a brief intervention following an alcohol-related policy violation. Using hierarchical multiple regression, we tested for the presence of interaction and quadratic effects on baseline data collected prior to the intervention. A significant interaction indicated that the relationship between a respondent's personal consequences and his/her motivation to change differs depending upon the level of concurrent social consequences. Additionally quadratic effects for abuse/dependence symptoms and life satisfaction were found. The quadratic probes suggest that abuse/dependence symptoms and poor life satisfaction are both positively associated with motivation to change for a majority of the sample; however, the nature of these relationships changes for participants with more extreme scores. Results support the utility of using a multidimensional measure of alcohol related problems and assessing non-linear relationships when assessing predictors of motivation to change. The results also suggest that the best strategies for increasing motivation may vary depending on the types of alcohol-related problems and level of life satisfaction the student is experiencing and highlight potential directions for future research. Copyright © 2014. Published by Elsevier Ltd.

  5. Evolving trends in nurse regulation: what are the policy impacts for nursing's social mandate?

    Science.gov (United States)

    Duncan, Susan; Thorne, Sally; Rodney, Patricia

    2015-03-01

    We recognize a paradox of power and promise in the context of legislative and organizational changes in nurse regulation which poses constraints on nursing's capacity to bring voice and influence to pressing matters of healthcare and public policy. The profession is at an important crossroads wherein leaders must be well informed in political, economic and legislative trends to harness the profession's power while also navigating forces that may put at risk its central mission to serve society. We present a critical policy analysis of the impact of recent regulatory trends on what the International Council of Nurses considers nursing's three 'pillars' - the profession of nursing, socioeconomic welfare of nurses and nurse regulation. Themes surfacing from this analysis include regulatory discontinuity, a tightening of regulatory control, and an increasingly managerial governance culture. These themes illuminate insights and strategies required to renew and revitalize the social mandate of our profession amidst a climate of urgency in the questioning of nurse scholars with respect to the future of the profession. At this historic juncture, nurses must clearly understand the implications of legislative and organizational regulatory changes to ensure the profession contributes to full capacity in achieving health and health equity globally. © 2014 John Wiley & Sons Ltd.

  6. Rents From the Essential Health Benefits Mandate of Health Insurance Reform.

    Science.gov (United States)

    Mendoza, Roger Lee

    2015-01-01

    The essential health benefits mandate constitutes one of the most controversial health care reforms introduced under the U.S. Affordable Care Act of 2010. It bears important theoretical and practical implications for health care risk and insurance management. These essential health benefits are examined in this study from a rent-seeking perspective, particularly in terms of three interrelated questions: Is there an economic rationale for standardized, minimum health care coverage? How is the scope of essential health services and treatments determined? What are the attendant and incidental costs and benefits of such determination/s? Rents offer ample incentives to business interests to expend considerable resources for health care marketing, particularly when policy processes are open to contestation. Welfare losses inevitably arise from these incentives. We rely on five case studies to illustrate why and how rents are created, assigned, extracted, and dissipated in equilibrium. We also demonstrate why rents depend on persuasive marketing and the bargained decisions of regulators and rentiers, as conditioned by the Tullock paradox. Insights on the intertwining issues of consumer choice, health care marketing, and insurance reform are offered by way of conclusion.

  7. Outcomes and Recidivism in Mandated Batterer Intervention Before and After Introducing a Specialized Domestic Violence Court.

    Science.gov (United States)

    Tutty, Leslie M; Babins-Wagner, Robbie

    2016-05-03

    Both specialized domestic violence (DV) courts and batterer intervention programs were developed to more adequately address intimate partner abuse and recidivism; however, little research has studied them concurrently. The current research examined clinical outcomes and police-reported recidivism in 382 men mandated to attend the Calgary Counselling Centre's Responsible Choices for Men's (RCM) groups between 1998 and 2009, before and after a specialized DV court was established in 2001. The study examines associations between categorical demographic and criminal justice variables, most of which were not correlated with post-group recidivism. Before the specialized court was implemented, 45 RCM members reported significantly more clinical issues at pretest than the 282 RCM members after court implementation (all scores adjusted by social desirability), although the effect sizes were negligible. Regarding group outcomes, depression, anxiety, and self-esteem (adjusted for social desirability) significantly improved on average for all RCM members irrespective of court implementation. Before the specialized DV court was developed, recidivism occurred after RCM program completion for a large proportion of men (41.2%), compared with only 8.2% after court implementation, a significant difference with a moderate effect size. The recidivism results are interpreted in the context of the significant justice and community collaborations entailed in creating the specialized DV court. © The Author(s) 2016.

  8. Predictors of motivation to change in mandated college students following a referral incident.

    Science.gov (United States)

    Qi, David; Pearson, Matthew R; Hustad, John T P

    2014-06-01

    The purpose of present study was to understand factors that are related to a desire or motivation to change (MTC) alcohol use in a sample of college students mandated to receive an alcohol intervention. We examined characteristics of and reactions to the referral event, typical alcohol use involvement, and alcohol beliefs about the perceived importance of drinking in college assessed by the College Life Alcohol Salience Scale (CLASS; Osberg et al., 2010) as predictors of MTC following referral to an alcohol intervention. College students (N = 932) who presented for a mandatory alcohol intervention following a referral event (e.g., citation for underage drinking, medical attention for an alcohol-related incident, or driving under the influence) completed an assessment prior to receiving an alcohol intervention. Higher perceived aversiveness of the referral event and higher personal responsibility one felt for the occurrence of the event were positively related to higher MTC. Although alcohol beliefs about the role of drinking in college were not significantly related to either event aversiveness or responsibility, it was negatively related to MTC even after controlling for alcohol use involvement variables. Alcohol beliefs about the role of drinking in college represent an important construct that is related to increased alcohol use and alcohol-related problems and decreased MTC in a sample of college students. Interventions aimed at reducing alcohol beliefs about the role of drinking in college may be an effective strategy to reduce alcohol use and alcohol-related problems by college students.

  9. The likely effects of employer-mandated complementary health insurance on health coverage in France.

    Science.gov (United States)

    Pierre, Aurélie; Jusot, Florence

    2017-03-01

    In France, access to health care greatly depends on having a complementary health insurance coverage (CHI). Thus, the generalisation of CHI became a core factor in the national health strategy created by the government in 2013. The first measure has been to compulsorily extend employer-sponsored CHI to all private sector employees on January 1st, 2016 and improve its portability coverage for unemployed former employees for up to 12 months. Based on data from the 2012 Health, Health Care and Insurance survey, this article provides a simulation of the likely effects of this mandate on CHI coverage and related inequalities in the general population by age, health status, socio-economic characteristics and time and risk preferences. We show that the non-coverage rate that was estimated to be 5% in 2012 will drop to 4% following the generalisation of employer-sponsored CHI and to 3.7% after accounting for portability coverage. The most vulnerable populations are expected to remain more often without CHI whereas non coverage will significantly decrease among the less risk averse and the more present oriented. With its focus on private sector employees, the policy is thus likely to do little for populations that would benefit most from additional insurance coverage while expanding coverage for other populations that appear to place little value on CHI. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Evolutionary Evaluation: implications for evaluators, researchers, practitioners, funders and the evidence-based program mandate.

    Science.gov (United States)

    Urban, Jennifer Brown; Hargraves, Monica; Trochim, William M

    2014-08-01

    Evolutionary theory, developmental systems theory, and evolutionary epistemology provide deep theoretical foundations for understanding programs, their development over time, and the role of evaluation. This paper relates core concepts from these powerful bodies of theory to program evaluation. Evolutionary Evaluation is operationalized in terms of program and evaluation evolutionary phases, which are in turn aligned with multiple types of validity. The model of Evolutionary Evaluation incorporates Chen's conceptualization of bottom-up versus top-down program development. The resulting framework has important implications for many program management and evaluation issues. The paper illustrates how an Evolutionary Evaluation perspective can illuminate important controversies in evaluation using the example of the appropriate role of randomized controlled trials that encourages a rethinking of "evidence-based programs". From an Evolutionary Evaluation perspective, prevailing interpretations of rigor and mandates for evidence-based programs pose significant challenges to program evolution. This perspective also illuminates the consequences of misalignment between program and evaluation phases; the importance of supporting both researcher-derived and practitioner-derived programs; and the need for variation and evolutionary phase diversity within portfolios of programs. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Mandate for the Nursing Profession to Address Climate Change Through Nursing Education.

    Science.gov (United States)

    Leffers, Jeanne; Levy, Ruth McDermott; Nicholas, Patrice K; Sweeney, Casey F

    2017-11-01

    The adverse health effects from climate change demand action from the nursing profession. This article examines the calls to action, the status of climate change in nursing education, and challenges and recommendations for nursing education related to climate change and human health. Discussion paper. The integration of climate change into nursing education is essential so that knowledge, skills, and insights critical for clinical practice in our climate-changing world are incorporated in curricula, practice, research, and policy. Our Ecological Planetary Health Model offers a framework for nursing to integrate relevant climate change education into nursing curricula and professional nursing education. Nursing education can offer a leadership role to address the mitigation, adaptation, and resilience strategies for climate change. An ecological framework is valuable for nursing education regarding climate change through its consideration of political, cultural, economic, and environmental interrelationships on human health and the health of the planet. Knowledge of climate change is important for integration into basic and advanced nursing education, as well as professional education for nurses to address adverse health impacts, climate change responses policy, and advocacy roles. For current and future nurses to provide care within a climate-changing environment, nursing education has a mandate to integrate knowledge about climate change issues across all levels of nursing education. Competence in nursing practice follows from knowledge and skill acquisition gained from integration of climate change content into nursing education. © 2017 Sigma Theta Tau International.

  12. Assessing mandated credit programs: Case study of the Magna Carta in the Philippines

    Directory of Open Access Journals (Sweden)

    Ryan Jacildo

    2016-09-01

    Full Text Available We examine the effects of a mandated credit program to small and medium enterprises in the Philippines (Magna Carta Law using a panel dataset compiled from official data published by the Bangko Sentral ng Pilipinas. The final sample of 109 financial institutions represented over 90% of total finance sector assets in the Philippines. We highlight three important findings. First, although the total lending levels to micro, small, and medium enterprises (MSMEs grew slightly, the percentage shares of loans allocated to MSMEs declined drastically from a peak of 30% of total loans in 2002 to 16.4% in 2010. Second, following the upwards revision of the loan target (from 6% to 8% for smaller firms in 2008, there was a sharp increase in noncompliance especially amongst universal and commercial banks. On the other hand, total loans to medium enterprises were still more than threefold larger than the targeted 2%. Third, there is an increased heterogeneity in optimal loan portfolio across banks. Most surprisingly, the absolute level of MSME lending by rural and cooperative banks declined since 2008. Direct compliance amongst universal and commercial banks decreased beginning in the late 2007, while that of thrift banks increased to almost 100%. Abolishing the Magna Carta targets for medium-sized enterprise loans would most likely yield little adverse effects. Meanwhile, efforts to improve financial access to MSMEs should focus on alternative nondistortionary ways to increase financing supply, such as improving institutional framework for informational availability and development of equity and bond markets for MSMEs.

  13. Negotiating the coresearcher mandate - service users' experiences of doing collaborative research on mental health.

    Science.gov (United States)

    Moltu, Christian; Stefansen, Jon; Svisdahl, Marit; Veseth, Marius

    2012-01-01

    Traditionally, the voices of service users have been silent in research into mental health issues. A Norwegian research network, however, recognizes the importance of involving service users as coresearchers and initiated a training program in research methodology and design intended to empower them as active participants in research projects. In this article, we explore how these coresearchers with a mental health service user background experience their participation in projects as well as in attending the training: What is it like being a service user coresearcher in collaborative studies on issues in mental health? How do coresearchers negotiate their roles and mandate? We used focus groups as our data collection method, transcribed the group discussions verbatim, and analyzed the transcriptions using qualitative methodology. We then took the preliminary analyses back to the participants for discussion, auditing, and reanalysis. We identified themes that represent important social processes around which the participants developed a consensual understanding: self-definition, constructive differentiation and negotiations. Our findings generate hypotheses on how participatory research into mental health issues can be fruitfully organized, in a way that empowers service users to active and constructive participation.

  14. A cost-effectiveness analysis of pioglitazone plus metformin compared with rosiglitazone plus metformin from a third-party payer perspective in the US.

    Science.gov (United States)

    St Charles, Meaghan; Minshall, Michael E; Pandya, Bhavik J; Baran, Robert W; Tunis, Sandra L

    2009-06-01

    The long-term cost-effectiveness of using pioglitazone plus metformin (Actoplusmet dagger) compared with rosiglitazone plus metformin (Avandamet double dagger) in treating type 2 diabetes (T2DM) was assessed from a US third-party payer perspective. Clinical efficacy (change in HbA(1c) and lipids) and baseline cohort parameters were extracted from a 12-month, randomized clinical trial (Derosa et al., 2006) evaluating the efficacy and tolerability of pioglitazone versus rosiglitazone, both in addition to metformin, in adult T2DM patients with insufficient glucose control (n = 96). A Markov-based model was used to project clinical and economic outcomes over 35 years, discounted at 3% per annum. Costs for complications were taken from published sources. Base-case assumptions were assessed through several sensitivity analyses. Outcomes included incremental life-years, quality-adjusted life-years (QALYs), total direct medical costs, cumulative incidence of complications and associated costs, and incremental cost-effectiveness ratios (ICERs). Compared to rosiglitazone plus metformin, pioglitazone plus metformin was projected to result in a modest improvement in 0.187 quality-adjusted life-years. Over patients' lifetimes, total direct medical costs were projected to be marginally lower with pioglitazone plus metformin (difference -$526.), largely due to reduced CVD complication costs. While costs were higher among renal, ulcer/amputation/neuropathy, and eye complications in the pioglitazone plus metformin group, the cost savings for CVD complications outweighed their economic impact. Pioglitazone plus metformin was found to be a dominant long-term treatment strategy in the US compared to rosiglitazone plus metformin. Sensitivity analyses showed findings to be robust under almost all scenarios, including short-term time horizons, 6% discounting, removal of individual lipid parameters, and modifications of patient cohort to more closely represent a US T2DM population

  15. Marijuana use in the context of alcohol interventions for mandated college students.

    Science.gov (United States)

    Yurasek, Ali M; Merrill, Jennifer E; Metrik, Jane; Miller, Mary Beth; Fernandez, Anne C; Borsari, Brian

    2017-08-01

    Concurrent use of marijuana and alcohol among college students is highly prevalent and associated with negative consequences. It remains unclear whether marijuana use is influenced by or lessens the efficacy of alcohol interventions delivered within a stepped-care approach. Participants were 530 college students who violated campus alcohol policy and were mandated to an alcohol-focused brief advice (BA) session. Participants who reported continued risky alcohol use (4+ heavy drinking episodes and/or 5+ alcohol-related consequences in the past month) six weeks following the BA session were randomized to a brief motivational intervention (BMI; n=211) or assessment only (AO; n=194) condition. Follow-up assessments were conducted 3, 6, and 9months' post-intervention. Multiple regression analyses revealed that marijuana user status did not influence drinking outcomes following the BA session. However, hierarchical linear models suggested that marijuana users who were randomized to BMI or AO reported higher levels of binge drinking, pBAC and consequences compared to non-users, regardless of condition. Despite this, heavy drinking marijuana users and nonusers had equivalent reductions on alcohol use outcomes following the BMI sessions. Marijuana users who received a BMI did not significantly reduce marijuana use frequency compared to participants in the AO group. Use of marijuana did not lessen the efficacy of the BA session on alcohol use or consequences. Findings suggest that marijuana users respond similarly to alcohol interventions as do non-users and can benefit from brief or more intensive alcohol interventions. A marijuana-focused intervention may be warranted to facilitate changes in marijuana use. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Mandate for leadership: policy management in a conservative administration. [report by Heritage Foundation

    Energy Technology Data Exchange (ETDEWEB)

    Heatherly, C.L. (ed.)

    1981-01-01

    Mandate for leadership was conceived in the fall of 1979 as a means of assisting the transition to a new administration in the event that a conservative President were elected in 1980. The premise was that conservatives must be prepared to answer the question, What is the conservative agenda, particularly for the first 100 days. The production of this volume has been an enterprise involving twenty project teams and over three hundred contributors. Three parts are devoted, respectively, to: (I) The Cabinet Departments (13 chapters); (II) Independent Regulatory Agencies (13 chapters); and (III) Other Agencies (6 chapters). Also, there is an epilogue, What the President Can Do by Executive Order. The authors of the chapters in this report were recruited as team chairmen for their respective agencies or groups of agencies; each then recruited a team for the production of the report according to certain guidelines. The principal credit for the success of the project belongs to these authors, who translated the concept of a transition report into a detailed and illuminating study of the executive branch of the federal government. The Environmental Protection Agency was pulled out of the regulatory reform group in mid-stream and established as an independent team with over fifty participants due to the mammoth size and unique character of the agency. Recommendations of this volume are not presented as cure-alls, but the editors feel that what is offered by the authors is a series of proposals which, if implemented, will help revitalize our economy, strengthen our national security, and halt the centralization of power in The Federal government. A separate abstract was prepared for each of three chapters, namely: (1) The Department of Energy; (2) The Department of Transportation; and (3) The Environmental Protection Agency.

  17. Self-selected or mandated, open access increases citation impact for higher quality research.

    Directory of Open Access Journals (Sweden)

    Yassine Gargouri

    Full Text Available BACKGROUND: Articles whose authors have supplemented subscription-based access to the publisher's version by self-archiving their own final draft to make it accessible free for all on the web ("Open Access", OA are cited significantly more than articles in the same journal and year that have not been made OA. Some have suggested that this "OA Advantage" may not be causal but just a self-selection bias, because authors preferentially make higher-quality articles OA. To test this we compared self-selective self-archiving with mandatory self-archiving for a sample of 27,197 articles published 2002-2006 in 1,984 journals. METHDOLOGY/PRINCIPAL FINDINGS: The OA Advantage proved just as high for both. Logistic regression analysis showed that the advantage is independent of other correlates of citations (article age; journal impact factor; number of co-authors, references or pages; field; article type; or country and highest for the most highly cited articles. The OA Advantage is real, independent and causal, but skewed. Its size is indeed correlated with quality, just as citations themselves are (the top 20% of articles receive about 80% of all citations. CONCLUSIONS/SIGNIFICANCE: The OA advantage is greater for the more citable articles, not because of a quality bias from authors self-selecting what to make OA, but because of a quality advantage, from users self-selecting what to use and cite, freed by OA from the constraints of selective accessibility to subscribers only. It is hoped that these findings will help motivate the adoption of OA self-archiving mandates by universities, research institutions and research funders.

  18. 42 CFR 137.65 - May a Self-Governance Tribe receive statutorily mandated grant funding in an annual lump sum...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false May a Self-Governance Tribe receive statutorily mandated grant funding in an annual lump sum advance payment? 137.65 Section 137.65 Public Health PUBLIC... HUMAN SERVICES TRIBAL SELF-GOVERNANCE Statutorily Mandated Grants § 137.65 May a Self-Governance Tribe...

  19. Economic Assessment of Producing Corn and Cellulosic Ethanol Mandate on Agricultural Producers and Consumers in the United States

    Directory of Open Access Journals (Sweden)

    Naveen C. Adusumilli

    2016-01-01

    Full Text Available Strong support for the biofuels program in the USA is expected to influence dedicated biomass crops production. Their production is expected to compete for resources with traditional crops and in turn influence commodity prices, economic surplus, and trade balance. Implications of dedicated biomass crop as bioenergy feedstock, alternative energy policies, and government initiatives on agricultural producers and consumers are evaluated using a national quantitative model, AGSIM. Economic impacts include effect on cropping patterns, crop prices, fertilizer prices, consumer and producer surplus, and trade balance. Economic analyses based on alternative assumptions related to marginal lands currently in conservation use returning to crop production as well as biomass crop yields are conducted. Results indicate that present biofuel policies are associated with large costs to consumers in terms of increased commodity prices and negative trade balance. Increase in net farm income is offset by decrease in consumer surplus. The results represent a robust set of economic impacts, which suggests policy makers to consider the unexpected economic consequences of bioenergy policy and warrants consideration of multiple alternative energy sources to achieve a sustainable energy goal.

  20. A Qualitative Meta-Analysis of the Diffusion of Mandated and Subsidized Technology: United States Energy Security and Independence

    Science.gov (United States)

    Noah, Philip D., Jr.

    2013-01-01

    The purpose of this research project was to explore what the core factors are that play a role in the development of the smart-grid. This research study examined The Energy Independence and Security Act (EISA) of 2007 as it pertains to the smart-grid, the economic and security effects of the smart grid, and key factors for its success. The…

  1. Handbook of emergency management for state-level transportation agencies.

    Science.gov (United States)

    2010-03-01

    The Department of Homeland Security has mandated specific systems and techniques for the management of emergencies in the United States, including the Incident Command System, the National Incident Management System, Emergency Operations Plans, Emerg...

  2. Attorney work product privilege trumps mandated child abuse reporting law: The case of Elijah W. v. Superior Court.

    Science.gov (United States)

    Lareau, Craig R

    2015-01-01

    Forensic psychologists and psychiatrists are licensed in their respective professions, but they perform most of their work with attorneys in the legal arena. Both attorneys and mental health professionals place high value on confidentiality of information, reflected in the ethics of their professions and codified into laws governing their work. In psychology and psychiatry, there are some well-known exceptions to confidentiality; two primary exceptions include the mandated reporting of suspected child abuse and various "Tarasoff" duty to warn or protect laws. Generally, however, the corresponding duty for attorneys to report suspected child abuse or to warn or protect intended victims of threatened harm is not as extensive. This difference in mandated reporting responsibilities can create significant difficulties when attorneys need to retain forensic psychologists and psychiatrists to evaluate their clients, especially in criminal contexts. If the retained psychologist or psychiatrist is required to report suspected abuse or threatened harm, the attorney may be harming his or her client's legal interests by using the forensic psychologist or psychiatrist to evaluate his or her client. This article will briefly review the development of mandated reporting laws for psychologists and psychiatrists and juxtapose those with the legal and ethical requirements of confidentiality for attorneys embodied in the attorney-client privilege and attorney work product privilege. The article will then discuss the California Court of Appeals case in Elijah W. v. Superior Court, where the court addressed the issue of whether retained mental health professionals must report suspected child abuse and threatened harm to others as required by law or if they do not need to report because they come under the umbrella of the attorney work product privilege. This California court ultimately concluded that retained psychologists and psychiatrists work under the attorney work product

  3. Grounded Theory of Barriers and Facilitators to Mandated Implementation of Mental Health Care in the Primary Care Setting

    Directory of Open Access Journals (Sweden)

    Justin K. Benzer

    2012-01-01

    Full Text Available Objective. There is limited theory regarding the real-world implementation of mental health care in the primary care setting: a type of organizational coordination intervention. The purpose of this study was to develop a theory to conceptualize the potential causes of barriers and facilitators to how local sites responded to this mandated intervention to achieve coordinated mental health care. Methods. Data from 65 primary care and mental health staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after an organizational mandate to provide integrated mental health care in the primary care setting. Results. Standardized referral procedures and communication practices between primary care and mental health were influenced by the organizational factors of resources, training, and work design, as well as provider-experienced organizational boundaries between primary care and mental health, time pressures, and staff participation. Organizational factors and provider experiences were in turn influenced by leadership. Conclusions. Our emergent theory describes how leadership, organizational factors, and provider experiences affect the implementation of a mandated mental health coordination intervention. This framework provides a nuanced understanding of the potential barriers and facilitators to implementing interventions designed to improve coordination between professional groups.

  4. Cost estimates of an open access mandate for monographs in the UK’s third Research Excellence Framework

    Directory of Open Access Journals (Sweden)

    Martin Paul Eve

    2017-11-01

    Full Text Available The recent ‘Consultation on the second Research Excellence Framework’ (REF in the UK contains an annex that signals the extension of the open access mandate to monographs. In the service of promoting discussion, rather than prescribing a forward route, this article estimates the costs of implementing such a mandate based on REF 2014 volume, taking the criteria signalled in the annex, and identifies funding sources that could support it. We estimate that to publish 75% of anticipated monographic submission output for the next REF would require approximately £96m investment over the census period. This is equivalent to £19.2m per year. Academic library budgets as they are currently apportioned would not support this cost. However, these sums are but a fraction of the total quality-related funding, Arts and Humanities Research Council and Economic and Social Research Council budgets. We close with a series of provocative suggestions for how the mandate could be implemented.

  5. A pilot study of two supervision approaches for peer-led alcohol interventions with mandated college students.

    Science.gov (United States)

    Mastroleo, Nadine R; Magill, Molly; Barnett, Nancy P; Borsari, Brian

    2014-05-01

    Despite the increasing need to identify and implement effective interventions to reduce drinking with mandated college students, peer-led brief alcohol interventions have received minimal research attention. The current pilot study tested whether enhanced supervision (evidence-based application approach [EAA; group plus individual]) would improve peer counseling skills beyond those acquired by a common practice approach (CPA; group only). Following initial peer counselor skill evaluation, drinking outcomes after intervention were compared between supervision groups with a mandated college student sample (N = 82; 65 men). The relationship between acquired motivational interviewing skills and subsequent drinking behaviors was also assessed. EAA peer counselors showed higher motivational interviewing skill acquisition than CPA peer counselors. Despite differences in counselor skill demonstration, mandated clients in both intervention groups significantly reduced drinking behaviors. Further, higher reflection-to-question ratio and motivational interviewing spirit demonstrated by peer counselors were significantly related to poorer follow-up drinking outcomes. Findings identify supervision practices that may result in optimal peer counselor learning and brief intervention implementation while also offering initial data about the way in which peer counseling session implementation may relate to drinking outcomes. Future research is needed to identify the within-session processes of peer-led interventions that predict drinking outcomes, which may offer additional direction for training approaches.

  6. The Dilemma of Combating Terrorism in Democratizing States: A Case Study of the Republic of Uganda

    Science.gov (United States)

    2015-03-01

    violation of civil liberties, eroding constitutionally mandated checks and balances.163 This contradiction is a major challenge for democratizing states...conducted, judicially, parliament, civil society and the media are constitutionally mandated to be part of the procedure in every incident that takes place...AND THEIR RELATIONSHIP WITH CIVIL LIBERTIES

  7. Florida's Mandated Educational Leadership Program Redesign: The William Cecil Golden Touch

    Science.gov (United States)

    Mountford, Meredith; Acker-Hocevar, Michele A.

    2013-01-01

    In 2007, educational leadership programs in Florida were notified by Florida's Department of Education of a law requiring all programs to align with new legislation, State Rule 6A-5.081. Previously, most state-approved preparation programs were based on Florida's Leadership Preparation Standards, a version of the 1996 Interstate School Leadership…

  8. Administrative divisions of the mandate of Aleppo 1866 - 1918 AD التقسيمات الإدارية لولاية حلب 1866 – 1918م

    Directory of Open Access Journals (Sweden)

    Ban rawei Shiltag م.م بان راوي شلتاغ

    2015-01-01

    Full Text Available returned the mandate of Aleppo States that have undergone the most prominent of the direct influence of the Ottoman Empire , for its proximity to the center of the Ottoman Empire , with limits being coherent with it , its strategic location and outstanding commercial transport on the road , and being the station to the militarization of the Ottoman armies . Ottoman dish States Code , issued in 1864 in the state of Aleppo in 1866 , which has become a broad mandate extended until Anatolia , was of six brigades , the brigade and Mrash Aleppo and Urfa and Qozan and Bias and Adana . This continued until the administrative division in 1870 , it raised them three brigades are Brigade Qozan and Bias and Adana , and raised the administrative class to spend Deir ez-Zor , which was followed by a brigade of Aleppo to the brigade . In 1872 separate brigade of Deir al-Zour on the mandate of Aleppo , and became an independent Provincial Higher directly linked to the door . But he was re- linked state of Aleppo in 1876 , and remained so until 1881. In 1883 was associated with the banner of Aleppo, Deir al-Zour state for the third time and for a period of one year only , as it relates to decode them in 1884 . Continued administrative division of the mandate of Aleppo is composed of three brigades are Brigade Aleppo and Mrash and Urfa even in 1910 , with separate brigade Urfa for the state this year , and became a state composed of two brigades only two Aleppo and Mrash , and remained this division unchanged until the end of Ottoman rule

  9. Controversies over the Pledge of Allegiance in Public Schools: Case Studies Involving State Law, 9/11, and the Culture Wars

    Science.gov (United States)

    Montgomery, Jennifer J.

    2015-01-01

    This dissertation examines state-level efforts to mandate the Pledge of Allegiance in public schools, especially following 9/11. Despite longstanding Supreme Court precedent declaring mandatory flag salutes unconstitutional, various state legislatures sought to institute or strengthen pledge mandates irrespective of students' civil liberties.…

  10. Mandated college students' response to sequentially administered alcohol interventions in a randomized clinical trial using stepped care.

    Science.gov (United States)

    Borsari, Brian; Magill, Molly; Mastroleo, Nadine R; Hustad, John T P; Tevyaw, Tracy O'Leary; Barnett, Nancy P; Kahler, Christopher W; Eaton, Erica; Monti, Peter M

    2016-02-01

    Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to 2 interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-min brief advice (BA) session (Step 1) and a 60- to 90-min brief motivational intervention (BMI) delivered by trained interventionists (Step 2). Analyses were completed in 2 stages. First, 3 types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) 6 weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content compared with assessment only (AO) control over the 3-, 6-, and 9-month follow-ups. Participants reporting lower scores on the Alcohol Use Disorders Identification Test, more benefits to changing alcohol use, and those who fit the "Bad Incident" profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that Bad Incident students who received the BMI reported more HED at 9-month follow-up than those who received AO. Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity. (c) 2016 APA, all rights reserved).

  11. The electric car controversy. A social-constructivist interpretation of the California zero-emission vehicle mandate

    Energy Technology Data Exchange (ETDEWEB)

    Fogelberg, H.

    1998-07-01

    This study focuses the socio-technical dynamics of the attempted reintroduction of electric cars in California. The underlying question is whether or not it is possible to open up an entrenched technological area as car technology, and achieve a radical change. With the perspectives of social constructivist approaches to technological change, this study examines how a large technological controversy was initiated by regulatory action of the air agency in California, the California Air Resources Board, how this controversy developed and stabilized, and how it was ended by the air agency and the auto industry. Based on mainly secondary sources, the definitions that were established on electric cars and gasoline cars at the turn of the 20th century are highlighted, thus showing the existence of two types of automobiles: the city car and the endurance car. The city car did not survive, and was not defined as being a real car. Based on mainly primary sources, the recent electric car controversy is examined, suggesting that the air agency could not force the car industry to re-introduce the city car, and consequently the efforts were directed towards the development of more advanced batteries that could give the electric car a performance close to that of the gasoline car. It also display that electric car technology was enhanced due to the mandate. In ending the controversy, the agency, due to political forces, changed from 'command-and-control' to a 'partnership' strategy. The California Air Resources Board postponed the mandate (from 1998 to 2003), due to the fact that large volume production of advanced batteries was not expected to be in place by 1998. This regulatory relief removed the principal obstacle on behalf of auto manufacturers of not to accept mandated markets, and led General Motors to start to market their purpose built electric sports car by late 1996, and Toyota to promote electric- and electric hybrid car technologies. Thus car

  12. Mandated College Students’ Response to Sequentially-Administered Alcohol Interventions in a Randomized Clinical Trial Using Stepped Care

    Science.gov (United States)

    Borsari, Brian; Magill, Molly; Mastroleo, Nadine R.; Hustad, John T.P.; Tevyaw, Tracy O’Leary; Barnett, Nancy P.; Kahler, Christopher W.; Eaton, Erica; Monti, Peter M.

    2015-01-01

    Objective Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to two interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-minute BA session (BA; Step 1) and a 60–90 minute brief motivational intervention delivered by trained interventionists (BMI; Step 2). Method Analyses were completed in two stages. First, three types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower-risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) six weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content (pBAC) compared to assessment-only control (AO) over the 3, 6, and 9 month follow-ups. Results Participants reporting lower scores on the Alcohol Use Disorders Identification Test (AUDIT), more benefits to changing alcohol use, and those who fit the ‘Bad Incident’ profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that ‘Bad Incident’ students who received the BMI reported more HED at 9-month follow up than those who received AO. Conclusion Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity. PMID:26460571

  13. Le professeur Llewellyn Smith achève son mandat de Directeur général

    CERN Multimedia

    CERN Press Office. Geneva

    1998-01-01

    Speakers representing the world community of particle physics praised the outstanding achievements of Prof. Christopher Llewellyn Smith during his five-year mandate as Director General of CERN. The significance of his achievements whilst Director General are difficult to over-estimate. The approval of the construction of the Large Hadron Collider (LHC) in 1994 and the subsequent decision in 1996 to build the accelerator in a single stage, in a period of great economic difficulty, was in large part due to the leadership and tenacity of the Director General.

  14. Private sector risk-sharing agreements in the United States: trends, barriers, and prospects.

    Science.gov (United States)

    Garrison, Louis P; Carlson, Josh J; Bajaj, Preeti S; Towse, Adrian; Neumann, Peter J; Sullivan, Sean D; Westrich, Kimberly; Dubois, Robert W

    2015-09-01

    Risk-sharing agreements (RSAs) between drug manufacturers and payers link coverage and reimbursement to real-world performance or utilization of medical products. These arrangements have garnered considerable attention in recent years. However, greater use outside the United States raises questions as to why their use has been limited in the US private sector, and whether their use might increase in the evolving US healthcare system. To understand current trends, success factors, and challenges in the use of RSAs, we conducted a review of RSAs, interviews, and a survey to understand key stakeholders' experiences and expectations for RSAs in the US private sector. Trends in the numbers of RSAs were assessed using a database of RSAs. We also conducted in-depth interviews with stakeholders from pharmaceutical companies, payer organizations, and industry experts in the United States and European Union. In addition, we administered an online survey with a broader audience to identify perceptions of the future of RSAs in the United States. Most manufacturers and payers expressed interest in RSAs and see potential value in their use. Due to numerous barriers associated with outcomes-based agreements, stakeholders were more optimistic about financial-based RSAs. In the US private sector, however, there remains considerable interest--improved data systems and shifting incentives (via health reform and accountable care organizations) may generate more action. In the US commercial payer markets, there is continued interest among some manufacturers and payers in outcomes-based RSAs. Despite continued discussion and activity, the number of new agreements is still small.

  15. Estimated burden of cardiovascular disease and value-based price range for evolocumab in a high-risk, secondary-prevention population in the US payer context.

    Science.gov (United States)

    Toth, Peter P; Danese, Mark; Villa, Guillermo; Qian, Yi; Beaubrun, Anne; Lira, Armando; Jansen, Jeroen P

    2017-06-01

    that, accounting for uncertainties, the expected value-based price for evolocumab is higher than its current annual cost, as long as the payer discount off list price is greater than 20%.

  16. Law, Language, and the Multiethnic State.

    Science.gov (United States)

    De Varennes, Fernand

    1996-01-01

    Examines why language policies should be considered in a multiethnic state and suggests that there are human rights issues that mandate some recognition of language demands and usage beyond what some states may provide. The article emphasizes that questions of language, ethnicity, and nationalism must be addressed in a rational and coherent…

  17. The dynamic model on the impact of biodiesel blend mandate (B5) on Malaysian palm oil domestic demand: A preliminary finding

    Science.gov (United States)

    Abidin, Norhaslinda Zainal; Applanaidu, Shri-Dewi; Sapiri, Hasimah

    2014-12-01

    Over the last ten years, world biofuels production has increased dramatically. The biodiesel demand is driven by the increases in fossil fuel prices, government policy mandates, income from gross domestic product and population growth. In the European Union, biofuel consumption is mostly driven by blending mandates in both France and Germany. In the case of Malaysia, biodiesel has started to be exported since 2006. The B5 of 5% blend of palm oil based biodiesel into diesel in all government vehicles was implemented in February 2009 and it is expected to be implemented nationwide in the nearest time. How will the blend mandate will project growth in the domestic demand of palm oil in Malaysia? To analyze this issue, a system dynamics model was constructed to evaluate the impact of blend mandate implementation on the palm oil domestic demand influence. The base run of simulation analysis indicates that the trend of domestic demand will increase until 2030 in parallel with the implementation of 5 percent of biodiesel mandate. Finally, this study depicts that system dynamics is a useful tool to gain insight and to experiment with the impact of changes in blend mandate implementation on the future growth of Malaysian palm oil domestic demand sector.

  18. Healthcare workers under a mandated H1N1 vaccination policy with employment termination penalty: a survey to assess employee perception.

    Science.gov (United States)

    Winston, Lori; Wagner, Stephanie; Chan, Shu

    2014-08-20

    The ethical debate over mandatory healthcare worker (HCW) influenza vaccination is a heated one. Our study hospital instituted a mandatory employee influenza vaccination policy for the 2009-2010 influenza season during the highly publicized pandemic of the H1N1 "Swine Flu." Under this mandate there was no informed declination option, and termination of employment was the consequence for noncompliance. Our objective was to examine HCW perceptions of the H1N1 influenza virus, the vaccine, and the strict mandated vaccination policy. A survey was designed, distributed, and anonymously collected. In total, 202 completed questionnaires were obtained via accidental sampling by the investigators achieving a 100% response rate. Data analysis showed that 31.7% of surveyed HCWs felt the mandate was an infringement on their rights and 3.5% of HCWs would electively seek employment elsewhere. Significantly more nurses and clerks/technicians were opposed to the mandate compared to other types of employees. 96% felt that the mandating hospital should be liable should a significant adverse effect occur from receiving the vaccine. While the mandate helped to increase HCW influenza vaccination rates dramatically, the strict consequence of employment termination created negative feelings of coercion. Adopting a policy that includes a declination option with mandatory masking during influenza season might be a more widely acceptable and still adequate approach. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Making the Case for Primary Care and Mandated Suicide Prevention Education

    Science.gov (United States)

    Stuber, Jennifer; Quinnett, Paul

    2013-01-01

    During its 2012 legislative session, Washington State passed ESHB 2366, otherwise known as the Matt Adler Suicide Assessment, Treatment, and Management Act of 2012. ESHB 2366 is a significant legislative achievement as it is the first law in the country to require certain health professionals to obtain continuing education in the assessment,…

  20. 77 FR 76506 - Notice of Proposed Information Collection for Public Comment: Statutorily-Mandated Collection of...

    Science.gov (United States)

    2012-12-28

    ... of households residing in each property receiving such credits through such agency. New section 36... programs. In 2010, OMB approved the first collection instrument used for the collection of LIHTC household... Affected Public: There are sixty state and local housing finance agencies which allocate low-income housing...

  1. From Policy to Practice: Parent Perceptions of the 2010 Federal School Lunch Mandate

    Science.gov (United States)

    Golembiewski, Elizabeth H.; Askelson, Natoshia M.; Elchert, Daniel M.; Leicht, Erika A.; Scheidel, Carrie A.; Delger, Patti J.

    2015-01-01

    Purpose/Objectives: The purpose of this study was to investigate parent awareness and perceptions of changes to the National School Lunch Program (NSLP) implemented as a result of the Healthy, Hunger-Free Kids Act (HHKA) of 2010. Methods: An online survey of parents of school age (K-12) children in a Midwestern state was conducted (n = 2,189). The…

  2. What Makes Group MET Work? A Randomized Controlled Trial of College Student Drinkers in Mandated Alcohol Diversion

    Science.gov (United States)

    LaChance, Heather; Feldstein Ewing, Sarah W.; Bryan, Angela D.; Hutchison, Kent E.

    2009-01-01

    Nationally, college drinkers exhibit the highest rates of alcohol consumption and represent the largest percentage of problem drinkers. Group motivational enhancement therapy (GMET) has been found to catalyze problem drinking reductions among college student samples. While research supporting the use of single-session GMET in college samples (general and mandated) is emergent, no studies have evaluated a comprehensive model of the potential active ingredients of this group intervention. College students (N = 206; 88% Caucasian; 63% male; M age = 18.6) mandated to a university alcohol diversion program were randomly assigned to one of three conditions: the standard-of-care two-session ‘Focus on Alcohol Concerns’ education group (FAC), a single group motivational enhancement therapy (GMET), or a single Alcohol Information-only control group (AI) to evaluate the role of five putative mediators: readiness to change, self-efficacy, perceived risk, norm estimates, and positive drinking expectancies. At three and six month follow-ups, GMET students demonstrated greater reductions in problem drinking outcomes (drinks per drinking day, hazardous drinking symptoms, and alcohol-related problems). Of the five mediators proposed, only self-efficacy emerged as a significant mediator. PMID:20025366

  3. The Interactive Effects of Antisocial Personality Disorder and Court-Mandated Status on Substance Abuse Treatment Dropout

    Science.gov (United States)

    Daughters, Stacey B.; Stipelman, Brooke A.; Sargeant, Marsha N.; Schuster, Randi; Bornovalova, Marina A.; Lejuez, C.W.

    2013-01-01

    The present study sought to examine the interactive effects of court-mandated (CM) treatment and antisocial personality disorder (ASPD) on treatment dropout among 236 inner-city male substance users receiving residential substance abuse treatment through a pretrial release to treatment program. Of the 236 participants, 39.4% (n = 93) met criteria for ASPD and 72.5 % (n = 171) were mandated to treatment by the court system. Results indicated a significant interaction between ASPD and CM status, such that ASPD patients voluntarily receiving treatment were significantly more likely to drop out of treatment than each of the other groups. Subsequent discrete-time survival analyses to predict days until dropout using Cox proportional hazards regression indicated similar findings, with ASPD patients voluntarily receiving treatment completing fewer days of treatment than each of the other groups. These findings suggest the effectiveness of the court system in retaining ASPD patients, as well as the role of ASPD in predicting treatment dropout for individuals who are voluntarily in treatment. Implications are discussed including the potential value of early implementation of specialized interventions aimed at improving adherence for ASPD patients who are receiving treatment voluntarily. PMID:17869050

  4. Do brief personalized feedback interventions work for mandated students or is it just getting caught that works?

    Science.gov (United States)

    White, Helene Raskin; Mun, Eun Young; Morgan, Thomas J

    2008-03-01

    Studies evaluating the efficacy of brief interventions with mandated college students have reported declines in drinking from baseline to short-term follow-up regardless of intervention condition. A key question is whether these observed changes are due to the intervention or to the incident and/or reprimand. This study evaluates a brief personalized feedback intervention (PFI) for students (N = 230) who were referred to a student assistance program because of infractions of university rules regarding substance use to determine whether observed changes in substance use are attributable to the intervention. Half the students received immediate feedback (at baseline and after the 2-month follow-up), and half received delayed feedback (only after the 2-month follow-up). Students in both conditions generally reduced their drinking and alcohol-related problems from baseline to the 2-month follow-up and from the 2-month to the 7-month follow-up; however, there were no significant between-group differences at either follow-up. Therefore, it appears that the incident and/or reprimand are important instigators of mandated student change and that written PFIs do not enhance these effects on a short-term basis but may on a longer term basis.

  5. Conflicted Identification in the Sex Education Classroom: Balancing Professional Values With Organizational Mandates.

    Science.gov (United States)

    Williams, Elizabeth A; Jensen, Robin E

    2016-09-01

    Despite enormous resources spent on sex education, the United States faces an epidemic of unplanned pregnancy and sexually transmitted infections among young people. Little research has examined the role sex educators play in alleviating or exacerbating this problem. In this study, we interviewed 50 sex educators employed by public schools throughout a Midwestern, U.S. state about their experiences in the sex education classroom. Twenty-two interviewees communicated feelings of conflicted identification and provided examples of the ways in which they experienced this subjectivity in the context of their employment. We find these interviews shed light on the as-yet-understudied communicative experience of conflicted identification by delineating key sources of such conflict and discursive strategies used in its negotiation. Our results suggest that those who experience conflicted identification and who have a sense of multiple or nested identifications within their overarching professional identity may be safeguarded to some extent from eventual organizational disidentification. © The Author(s) 2015.

  6. Mandating responsible flagging practices as a strategy for reducing the risk of coastal oil spills.

    Science.gov (United States)

    Miller, Dana D; Hotte, Ngaio; Sumaila, U Rashid

    2014-04-15

    As human civilization is becoming more aware of the negative impact our actions can inflict upon the natural world, the intensification of fossil fuel extraction and industrial development is being met with increasing opposition. In Western Canada, proposals that would increase the volume of petroleum transported by pipelines and by tankers through the coastal waters of British Columbia have engaged the province in debate. To ease public concern on the risk of a coastal oil spill, there are additional commitments that involved parties could make. There is evidence to show that the practice of registering vessels under foreign flags of states that have exhibited failure in compliance with international obligations is more common amongst petroleum tankers that have been involved in large-scale oil spills. To prove that they are committed to reducing the risk of oil spills, businesses need to stop registering their vessels under flags of foreign, non-compliant states. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. School Accountability and Youth Obesity: Can Physical Education Mandates Make a Difference?

    OpenAIRE

    Helen Schneider; Ning Zhang

    2013-01-01

    This paper explores the effect of accountability laws under No Child Left Behind Act (NCLB) on obesity rates among school-aged children in the United States. Our results show that pressures due to school closures for poor performance, rewards for good performance, and assistance to schools that lag behind lead to lower levels of vigorous physical activity. This effect is significant for high school children only. We find no significant impact of school accountability laws on children in grade...

  8. U.S. National Cyberstrategy and Critical Infrastructure: The Protection Mandate and Its Execution

    Science.gov (United States)

    2013-09-01

    Plan GAO Government Accountability Office GIG Global Information Grid HSPD Homeland Security Presidential Directive HUMINT Human Intelligence...driven economy . These fears and concerns are not exclusively an external problem; the United States (U.S.) has been aware of this vulnerability and...manageable, and minimally detrimental to the economy , human and government services, and national security of the United States” (42 U.S.C. 5195c, sect. c

  9. Biosafety, biosecurity and internationally mandated regulatory regimes: compliance mechanisms for education and global health security.

    Science.gov (United States)

    Sture, Judi; Whitby, Simon; Perkins, Dana

    2013-01-01

    This paper highlights the biosafety and biosecurity training obligations that three international regulatory regimes place upon states parties. The duty to report upon the existence of such provisions as evidence of compliance is discussed in relation to each regime. We argue that such mechanisms can be regarded as building blocks for the development and delivery of complementary biosafety and biosecurity teaching and training materials. We show that such building blocks represent foundations upon which life and associated scientists--through greater awareness of biosecurity concerns--can better fulfil their responsibilities to guard their work from misuse in the future.

  10. Paying for the Orphan Drug System: break or bend? Is it time for a new evaluation system for payers in Europe to take account of new rare disease treatments?

    Science.gov (United States)

    Hughes-Wilson, Wills; Palma, Ana; Schuurman, Ad; Simoens, Steven

    2012-09-26

    higher price-points claimed by orphan drugs are unlikely to meet current cost-effectiveness thresholds. The authors propose the development of a new assessment system based on several evaluation criteria, which would serve as a tool for Member State governments to evaluate each new orphan drug at the time of pricing and reimbursement. These should include rarity, disease severity, the availability of other alternatives (level of unmet medical need), the level of impact on the condition that the new treatment offers, whether the product can be used in one or more indications, the level of research undertaken by the developer, together with other factors, such as manufacturing complexity and follow-up measures required by regulatory or other authorities. This will allow governments to value an orphan drug that fulfilled all the criteria very differently from one that only met some of them. An individual country could determine the (monetary) value that it places on each of the different criteria, according to societal preferences, the national healthcare system and the resources at its disposal - each individual government deciding on the weighting attributed to each of the criteria in question, based on what each individual society values most. Such a systematic and transparent system will help frame a more structured dialogue between manufacturers and payers, with the involvement of the treating physicians and the patients; and foster a more certain environment to stimulate continued investment in the field. A new approach could also offer pricing and reimbursement decision-makers a tool to handle the different characteristics amongst new orphan drugs and to redistribute the national budgets in accordance with the outcome of a differentiated assessment. The authors believe that this could, therefore, facilitate the approach for all stakeholders.

  11. Paying for the Orphan Drug System: break or bend? Is it time for a new evaluation system for payers in Europe to take account of new rare disease treatments?

    Directory of Open Access Journals (Sweden)

    Hughes-Wilson Wills

    2012-09-01

    specificities of orphan drugs given that the higher price-points claimed by orphan drugs are unlikely to meet current cost-effectiveness thresholds. The authors propose the development of a new assessment system based on several evaluation criteria, which would serve as a tool for Member State governments to evaluate each new orphan drug at the time of pricing and reimbursement. These should include rarity, disease severity, the availability of other alternatives (level of unmet medical need, the level of impact on the condition that the new treatment offers, whether the product can be used in one or more indications, the level of research undertaken by the developer, together with other factors, such as manufacturing complexity and follow-up measures required by regulatory or other authorities. This will allow governments to value an orphan drug that fulfilled all the criteria very differently from one that only met some of them. An individual country could determine the (monetary value that it places on each of the different criteria, according to societal preferences, the national healthcare system and the resources at its disposal – each individual government deciding on the weighting attributed to each of the criteria in question, based on what each individual society values most. Such a systematic and transparent system will help frame a more structured dialogue between manufacturers and payers, with the involvement of the treating physicians and the patients; and foster a more certain environment to stimulate continued investment in the field. A new approach could also offer pricing and reimbursement decision-makers a tool to handle the different characteristics amongst new orphan drugs and to redistribute the national budgets in accordance with the outcome of a differentiated assessment. The authors believe that this could, therefore, facilitate the approach for all stakeholders.

  12. Response of heavy-drinking voluntary and mandated college students to a peer-led brief motivational intervention addressing alcohol use.

    Science.gov (United States)

    Mastroleo, Nadine R; Oakley, William C; Eaton, Erica M; Borsari, Brian

    2014-01-01

    Little is known about the way in which mandated and heavy-drinking voluntary students comparatively respond to peer-led brief motivational interventions (BMIs) and the mediators and moderators of intervention effects. Research suggests that mandated students may be more defensive due to their involvement in treatment against their will and this defensiveness, in turn, may relate to treatment outcome. Furthermore, it is not clear how mandated and heavy-drinking voluntary students perceived satisfaction with peer-led BMIs relates to treatment outcomes. Using data from two separate randomized controlled trials, heavy drinking college students (heavy-drinking voluntary, n = 156; mandated, n = 82) completed a peer-led brief motivational intervention (BMI). Both mandated and heavy-drinking volunteer students significantly reduced drinking behaviors at 3-month follow-up, reported high levels of post-intervention session satisfaction, yet no effects for mediation or moderation were found. Findings offer continued support for using peer counselors to deliver BMIs; however, results regarding the mechanisms of change were in contrast to previous findings. Implications for treatment and future areas of research are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Enhancing user acceptance of mandated mobile health information systems: the ePOC (electronic point-of-care project) experience.

    Science.gov (United States)

    Burgess, Lois; Sargent, Jason

    2007-01-01

    From a clinical perspective, the use of mobile technologies, such as Personal Digital Assistants (PDAs) within hospital environments is not new. A paradigm shift however is underway towards the acceptance and utility of these systems within mobile-based healthcare environments. Introducing new technologies and associated work practices has intrinsic risks which must be addressed. This paper contends that intervening to address user concerns as they arise throughout the system development lifecycle will lead to greater levels of user acceptance, while ultimately enhancing the deliverability of a system that provides a best fit with end user needs. It is envisaged this research will lead to the development of a formalised user acceptance framework based on an agile approach to user acceptance measurement. The results of an ongoing study of user perceptions towards a mandated electronic point-of-care information system in the Northern Illawarra Ambulatory Care Team (TACT) are presented.

  14. Effectiveness of the Brief Alcohol and Screening Intervention for College Students (BASICS) program with a mandated population.

    Science.gov (United States)

    DiFulvio, Gloria T; Linowski, Sally A; Mazziotti, Janet S; Puleo, Elaine

    2012-01-01

    This study evaluated the effectiveness of a large-scale intervention designed to reduce alcohol abuse among adjudicated college students. Participants were college students mandated to attend a Brief Alcohol Screening and Intervention for College Students (BASICS) program and a randomly selected comparison group of high-risk drinkers. Data were collected from January 2006 through December 2008. A total of 1,390 (67%) students in the intervention group and 508 (61%) students in the comparison group completed baseline and 6-month follow-up surveys. Male students in the intervention group significantly decreased their drinking at follow-up, whereas those in the comparison group increased their drinking. Women in both the intervention and comparison groups decreased their drinking at 6 months. When implemented with fidelity, BASICS is a generally effective intervention, especially for male adjudicated college students. The intervention was most effective for moderate- and high-risk drinkers.

  15. Association of mandated language access programming and quality of care provided by mental health agencies.

    Science.gov (United States)

    McClellan, Sean R; Snowden, Lonnie

    2015-01-01

    This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

  16. Sheltered Workshops: United States v. Rhode Island

    Science.gov (United States)

    Yell, Mitchell L.; Katsiyannis, Antonis; Prince, Angela

    2017-01-01

    Federal legislation, such as the Americans with Disabilities Act, Section 504, and the Individuals With Disabilities Education Act, mandates that individuals with disabilities be integrated in all aspects of life from education to employment to independent living. A recent development involves a settlement reached between the United States and the…

  17. State Teacher Evaluation and Teacher Education

    Science.gov (United States)

    Marchant, Gregory J.; David, Kristine A.; Rodgers, Deborah; German, Rachel L.

    2015-01-01

    Current accountability trends suggest an increasing role in state mandates regarding teacher evaluation. With various evaluation models and components serving as the basis for quality teaching, teacher education programs need to recognize the role teacher evaluation plays and incorporate aspects where appropriate. This article makes that case and…

  18. Synching the Law to Resolve the Disconnection between Awareness and Action in Legally Mandated Diversity Hiring Practices in Higher Education Institutions

    Science.gov (United States)

    Dejean, Jacqueline Sylvia

    2015-01-01

    Conflicting regulatory demands on higher education institutions (HEIs) contribute to an environment of increasing legal risk for HEIs. In addition, the increasing cost of non-compliance jeopardizes institutional viability as HEIs struggle to adjust to the pressure created by these legally-mandated changes. The legal risk to HEIs can be attributed…

  19. A Text Message Program as a Booster to In-Person Brief Interventions for Mandated College Students to Prevent Weekend Binge Drinking

    Science.gov (United States)

    Suffoletto, Brian; Merrill, Jennifer E.; Chung, Tammy; Kristan, Jeffrey; Vanek, Marian; Clark, Duncan B.

    2016-01-01

    Objective: To evaluate a text message (SMS) program as a booster to an in-person alcohol intervention with mandated college students. Participants: Undergraduates (N = 224; 46% female) who violated an on-campus alcohol policy over a 2-semester period in 2014. Methods: The SMS program sent drinking-related queries each Thursday and Sunday and…

  20. Descriptive Norms and Expectancies as Mediators of a Brief Motivational Intervention for Mandated College Students Receiving Stepped Care for Alcohol Use

    Science.gov (United States)

    Yurasek, Ali M.; Borsari, Brian; Magill, Molly; Mastroleo, Nadine R.; Hustad, John T.P.; Tevyaw, Tracy O'Leary; Barnett, Nancy P.; Kahler, Christopher W.; Monti, Peter M.

    2015-01-01

    Background and Aims Stepped care approaches for mandated college students provide individual Brief Motivational Interventions (BMI) only for individuals who do not respond to an initial, low-intensity level of treatment such as Brief Advice (BA). However, how BMIs facilitate change in this higher-risk group of mandated students remains unclear. Perceived descriptive norms and alcohol-related expectancies are the most commonly examined mediators of BMI efficacy, but have yet to be examined in the context of stepped care. Methods Participants were mandated college students (N = 598) participating in a stepped care trial in which mandated students first received BA. Those who reported continued risky drinking 6 weeks following a BA session were randomized to either a single-session BMI (N=163) or an Assessment-only comparison condition (AO; N = 165). BMI participants reduced alcohol-related problems at the 9 month follow up significantly more than AO participants. Multiple mediation analyses using bootstrapping techniques examined whether perceived descriptive norms and alcohol-related expectancies mediated the observed outcomes. Results Reductions in perceptions of average student drinking (B = -.24; CI = -.61 to -.04) and negative expectancies (B = -.13; CI = -.38 to -.01) mediated the BMI effects. Furthermore, perceived average student norms were reduced after the BMI to levels approximating those of students who had exhibited lower risk drinking following the BA session. Conclusions Findings highlight the utility of addressing perceived norms and expectancies in BMIs, especially for students who have not responded to less intensive prevention efforts. PMID:26098125

  1. Descriptive norms and expectancies as mediators of a brief motivational intervention for mandated college students receiving stepped care for alcohol use.

    Science.gov (United States)

    Yurasek, Ali M; Borsari, Brian; Magill, Molly; Mastroleo, Nadine R; Hustad, John T P; Tevyaw, Tracy O'Leary; Barnett, Nancy P; Kahler, Christopher W; Monti, Peter M

    2015-12-01

    Stepped care approaches for mandated college students provide individual brief motivational interventions (BMI) only for individuals who do not respond to an initial, low-intensity level of treatment such as Brief Advice (BA). However, how BMIs facilitate change in this higher-risk group of mandated students remains unclear. Perceived descriptive norms and alcohol-related expectancies are the most commonly examined mediators of BMI efficacy but have yet to be examined in the context of stepped care. Participants were mandated college students (N = 598) participating in a stepped care trial in which mandated students first received BA. Those who reported continued risky drinking 6 weeks following a BA session were randomized to either a single-session BMI (N = 163) or an assessment-only comparison condition (AO; N = 165). BMI participants reduced alcohol-related problems at the 9 month follow up significantly more than AO participants. Multiple mediation analyses using bootstrapping techniques examined whether perceived descriptive norms and alcohol-related expectancies mediated the observed outcomes. Reductions in perceptions of average student drinking (B = -.24; 95% CI [-.61, -.04]) and negative expectancies (B = -.13; 95% CI [-.38, -.01]) mediated the BMI effects. Furthermore, perceived average student norms were reduced after the BMI to levels approximating those of students who had exhibited lower risk drinking following the BA session. Findings highlight the utility of addressing perceived norms and expectancies in BMIs, especially for students who have not responded to less intensive prevention efforts. (c) 2016 APA, all rights reserved).

  2. Athletes' Perceptions of National Collegiate Athletic Association--Mandated Sickle Cell Trait Screening: Insight for Academic Institutions and College Health Professionals

    Science.gov (United States)

    Lawrence, Raymona H.; Shah, Gulzar H.

    2014-01-01

    Objective: The study objective was to explore athletes' perspectives of National Collegiate Athletic Association (NCAA)--mandated sickle cell trait (SCT)--screening policy by examining race- and gender-related differences in athletes' perceptions regarding risk of having SCT and concern about loss of playing time. Participants: Participants were…

  3. The Role of the Bilingual Community in Mandated Bilingual Education. CAL-ERIC/CLL Series on Languages and Linguistics, No. 49.

    Science.gov (United States)

    Brisk, Maria E.

    It is the purpose of the present report to alert community organizers, school officials, and scholars to their mutual interest in securing community involvement in the planning and execution of bilingual programs. Strategies are proposed for bilingual communities to follow when confronted with mandated bilingual education. The proposed process is…

  4. Improving the effect of FDA-mandated drug safety alerts with Internet-based continuing medical education.

    Science.gov (United States)

    Kraus, Carl N; Baldwin, Alan T; McAllister, R G

    2013-02-01

    The US Food and Drug Administration (FDA) requires risk communication as an element of Risk Evaluation and Mitigation Strategies (REMS) to alert and educate healthcare providers about severe toxicities associated with approved drugs. The educational effectiveness of this approach has not been evaluated. To support the communication plan element of the ipilimumab REMS, a Medscape Safe Use Alert (SUA) letter was distributed by Medscape via email and mobile device distribution to clinicians specified in the REMS. This alert contained the FDA-approved Dear Healthcare Provider (DHCP) letter mandated for distribution. A continuing medical education (CME) activity describing ipilimumab toxicities and the appropriate management was simultaneously posted on the website and distributed to Medscape members. Data were collected over a 6-month period regarding the handling of the letter and the responses to pre- and post-test questions for those who participated in the CME activity. Analysis of the answers to the pre- and posttest questions showed that participation in the CME activity resulted in an improvement in correct answer responses of 47%. Our experience shows that there are likely distinct information sources that are utilized by different HCP groups. The ready availability of a brief CME activity was utilized by 24,063 individuals, the majority of whom showed enhanced understanding of ipilimumab toxicity by improvement in post-test scores, educational data that are not available via implementation of standard safety alert communications. These results demonstrate that improvement in understanding of specific drug toxicities is enhanced by a CME intervention.

  5. Les relacions entre el Parlament Europeu i el Consell Europeu durant el mandat de Van Rompuy (2010-2014

    Directory of Open Access Journals (Sweden)

    Miguel Papí Boucher

    2015-12-01

    Full Text Available Aquest article tracta d'oferir una visió general de l'evolució de les relacions entre el Parlament Europeu i el Consell Europeu durant el mandat del primer president permanent del Consell Europeu, que coincideix amb la VII legislatura del Parlament Europeu (juny 2009-juny 2014. Aquestes relacions van estar condicionades per l'entrada en vigor del Tractat de Lisboa, que reconeix el Consell Europeu com a institució de la Unió i crea la figura del seu president permanent. Tanmateix, el marc jurídic que el Tractat de Lisboa oferia per al desenvolupament de les relacions entre les dues institucions més polítiques de la Unió es va veure superat per l'esclat de la crisi financera del 2008. En efecte, la crisi va obligar als caps d'estat i de Govern de la Unió Europea a dissenyar una resposta europea a la crisi, caracteritzada per un pragmatisme que no sempre ha respectat els límits del Tractat. Aquest pragmatisme, al costat de la necessitat d’omplir les llacunes que el Tractat de Lisboa oferia quant a les relacions entre el Parlament Europeu i el Consell Europeu han provocat un augment de les pràctiques informals institucionals.

  6. Outcome Evaluation of a Policy-Mandated Lifestyle and Environmental Modification Program in a National Job Training Center.

    Science.gov (United States)

    Jimenez, Elizabeth Yakes; Harris, Amanda; Luna, Donald; Velasquez, Daniel; Slovik, Jonathan; Kong, Alberta

    2017-06-01

    Excess weight gain is common when adolescents become young adults, but there are no obesity prevention or weight management interventions that have been tested for emerging adults who follow non-traditional post-secondary paths, such as enrolling in job training programs. We evaluated Healthy Eating & Active Lifestyles (HEALs), a policy-mandated lifestyle education/environmental modification program, at a job training center for low-income 16-24 year olds. We examined average change in body mass index (BMI) z-score from baseline to 6 months for emerging adults (aged 16-24 years) in pre-HEALs implementation (n = 125) and post-HEALs implementation (n = 126) cohorts living at the job training center, by baseline weight status. In both cohorts, average BMI z-score significantly increased from baseline to 6 months for students with BMI < 25. Average BMI z-score significantly decreased for the overweight (BMI 25 to <30; -0.11, p = .03) and obese (BMI ≥ 30; -0.11, p = .001) students only within the post-HEALs cohort; changes within the pre-HEALs cohort and between cohorts were not significant. HEALs may promote positive weight-related trends for overweight/obese students, but prevention efforts for non-overweight/obese students need to be improved.

  7. Men's gendered constructions of intimate partner violence as predictors of court-mandated batterer treatment drop out.

    Science.gov (United States)

    Catlett, Beth S; Toews, Michelle L; Walilko, Vanessa

    2010-03-01

    The purpose of this study was to explore the meaning men make of their violence toward intimate partners and to examine if and how these meanings and constructions of violence predicted who drops out of batterer treatment prior to program completion. We used both qualitative and quantitative data collected from 154 men court-mandated to participate in a batterer intervention program. The qualitative findings indicated that the men in this sample minimized and denied responsibility for the violence they used towards their intimate partners while simultaneously rationalizing and justifying their violent behavior. Such findings provide insight into how denial and minimization and, more broadly, men's constructions of masculinity might predict their tendency to drop out of batterer treatment. Furthermore, building upon our qualitative findings, logistic regression analysis revealed that men who were lower income, no longer intimately involved with the women they abused, and who reported lower levels of physical violence and higher levels of hostility were more likely to drop out of the batterer treatment program.

  8. 75 FR 17859 - Grants to States for Construction or Acquisition of State Home Facilities-Update of Authorized Beds

    Science.gov (United States)

    2010-04-08

    ... require that the ``un-met need'' numbers be based on a 10-year projection of demand for nursing home and... the maximum number of nursing home and domiciliary beds designated for each State and amends the... title 38, U.S.C., mandates that VA prescribe for each State the maximum number of nursing home and...

  9. A 360 degrees evaluation of a night-float system for general surgery: a response to mandated work-hours reduction.

    Science.gov (United States)

    Goldstein, Michael J; Kim, Eugene; Widmann, Warren D; Hardy, Mark A

    2004-01-01

    New York State Code 405 and societal/political pressure have led the RRC and ACGME to mandate strict limitations on resident work hours. In an attempt to meet these limitations, we have switched from the previous Q3 call schedule to a specialized night float (NF) system, the continuity-care system (CCS). The purpose of this CCS is to maximize resident duty time spent on direct patient care, operative experience, and outpatient clinics, while reducing duty hours spent on performing routine tasks and call coverage. The implementation of the CCS is the fundamental step in the restructuring of our residency program. In addition to a change in the call system, we added physician assistants to aid in performing some service tasks. We performed a 360 degrees evaluation of this work in progress. In May 2002, the standard Q3 call system was abolished on the general surgery services at the New York Presbyterian Hospital, Columbia campus. Two dedicated teams were created to provide day and night coverage, a day continuity-care team (DCT) and a night continuity-care team (NCT). The DCTs, consisting of PGY1-5 residents, provide daily in-house coverage from 6 AM to 5 PM with no regular weekday night-call responsibilities. The DCT residents provide Friday night, Saturday, and daytime Sunday call coverage 3 to 4 days per month. The NCT, consisting of 5 PGY1-5 residents, provides nightly continuous care, 5 PM to 6 AM, Sunday through Thursday, with no other weekend call responsibilities. This system creates a schedule with less than 80 duty hours per week, on average, with one 24-hour period off a week, one complete weekend off per month, and no more than 24 hours of consecutive duty time. After 1 year of use, the system was evaluated by a 360 degrees method in which residents, residents' spouses, nurses, and faculty were surveyed using a Likert-type scale. Statistical significance was calculated using the Student t-test. Patient satisfaction was measured both by internal review of

  10. Inequity between male and female coverage in state infertility laws.

    Science.gov (United States)

    Dupree, James M; Dickey, Ryan M; Lipshultz, Larry I

    2016-06-01

    To analyze state insurance laws mandating coverage for male factor infertility and identify possible inequities between male and female coverage in state insurance laws. We identified states with laws or codes related to infertility insurance coverage using the National Conference of States Legislatures' and the National Infertility Association's websites. We performed a primary, systematic analysis of the laws or codes to specifically identify coverage for male factor infertility services. Not applicable. Not applicable. Not applicable. The presence or absence of language in state insurance laws mandating coverage for male factor infertility care. There are 15 states with laws mandating insurance coverage for female factor infertility. Only eight of those states (California, Connecticut, Massachusetts, Montana, New Jersey, New York, Ohio, and West Virginia) have mandates for male factor infertility evaluation or treatment. Insurance coverage for male factor infertility is most specific in Massachusetts, New Jersey, and New York, yet significant differences exist in the male factor policies in all eight states. Three states (Massachusetts, New Jersey, and New York) exempt coverage for vasectomy reversal. Despite national recommendations that male and female partners begin infertility evaluations together, only 8 of 15 states with laws mandating infertility coverage include coverage for the male partner. Excluding men from infertility coverage places an undue burden on female partners and risks missing opportunities to diagnose serious male health conditions, correct reversible causes of infertility, and provide cost-effective treatments that can downgrade the intensity of intervention required to achieve a pregnancy. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  11. High School CPR/AED Training in Washington State.

    Science.gov (United States)

    Salvatierra, Gail G; Palazzo, Steven J; Emery, Allison

    2017-05-01

    Describe the rates of CPR/AED training in high schools in the state of Washington after passage of legislation mandating CPR/AED training. A web-based survey was sent to administrators at 660 public and private high schools in the state of Washington. The survey was completed by 148 schools (22%); 64% reported providing CPR training and 54% provided AED training. Reported barriers to implementation included instructor availability, cost, and a lack of equipment. Descriptive statistics were used to describe the sample characteristics and implementation rates. Mandates without resources and support do not ensure implementation of CPR/AED training in high schools. Full public health benefits of a CPR mandate will not be realized until barriers to implementation are identified and eliminated through use of available, accessible public health resources. © 2016 Wiley Periodicals, Inc.

  12. Personality and Alcohol-Related Outcomes among Mandated College Students: Descriptive Norms, Injunctive Norms, and College-Related Alcohol Beliefs as Mediators

    OpenAIRE

    Pearson, Matthew R.; Hustad, John T. P.

    2014-01-01

    The present study examined three alcohol-perception variables (descriptive norms, injunctive norms, and college-related alcohol beliefs) as mediators of the predictive effects of four personality traits (impulsivity, sensation seeking, anxiety sensitivity, and hopelessness) on alcohol use and alcohol-related consequences in a sample of mandated college students (n = 875). Our findings replicated several findings of a previous study of incoming freshman college students (Hustad et al., in pres...

  13. Gränsöverskridandets praktik och ömsesidighetens mandat:exempel från etnografiska fältarbeten

    OpenAIRE

    Ulf Mellström

    2006-01-01

    THE PRACTICE OF BOUNDARY CROSSING AND THE MANDATE OF RECIPROCITY. EXAMPLESFROM ETHNOGRAPHIC FIELDWORK. In this article, the joint endeavour to con-struct knowledge in ethnographic fieldwork is discussed. It is argued thatsuch a joint project is self-evidently based on mutual recognition betweenanthropologist and informant, and that this recognition needs to be in-corporated into a narrative strategy directed towards a dialogical anthro-pology, in contrast to an analogical/monological traditio...

  14. A Novel Approach for Streamlining Delivery of Brief Motivational Interventions to Mandated College Students: Using Group and Individual Sessions Matched to Level of Risk

    Science.gov (United States)

    Bernstein, Michael H.; Baird, Grayson L.; Yusufov, Miryam; Mastroleo, Nadine R.; Carey, Kate B.; Graney, Daniel D.; Wood, Mark D.

    2017-01-01

    Background Mandated college students (those in violation of a campus alcohol policy) are heterogenous with respect to alcohol consumption. Thus, when universities consider required treatment for mandated students, one promising option is to match treatment intensity according to level of alcohol involvement. The present study evaluates such an approach with minimal resources. Methods Mandated students (N = 285) were required to complete a baseline assessment. Participants identified as high-risk (5+ past month alcohol problems AND 2+ past month heavy drinking episodes) received a one session individual Brief Motivational Intervention (I-BMI) whereas those identified as low-risk (all others) received a one session group Brief Motivational Intervention (G-BMI). I-BMI and G-BMI sessions were delivered by doctoral students in Clinical Psychology. Follow-up assessments were collected 1 month post-intervention (response rate = 73%). Results The vast majority of students complied with their requirement. Participants assigned to I-BMI reported an 82% reduction in drinks per week, a 58% reduction in heavy episodic drinking, and a 74% reduction in alcohol-related problems at a 1 month follow-up. Participants assigned to G-BMI reported a 61% reduction in drinks per week and a 42% reduction in alcohol-related problems at follow-up relative to baseline. Conclusion/Importance We demonstrate that matching intervention intensity on baseline alcohol involvement with mandated students is feasible and associated with short-term reductions in alcohol use and consequences. Universities may wish to consider the procedure outlined here as a way of allocating more resources to those who drink at problematic levels. PMID:28812420

  15. Randomized controlled trial of brief alcohol screening and intervention for college students for heavy-drinking mandated and volunteer undergraduates: 12-month outcomes.

    Science.gov (United States)

    Terlecki, Meredith A; Buckner, Julia D; Larimer, Mary E; Copeland, Amy L

    2015-03-01

    This is the first randomized trial testing whether heavy-drinking undergraduates mandated to the Brief Alcohol Screening and Intervention for College Students (BASICS) program following a campus alcohol violation would benefit as much as heavy-drinking volunteers up to 1 year postintervention using control groups with high-risk drinkers to model disciplinary-related and naturalistic changes in drinking. Participants (61% male; 51% mandated; 84% Caucasian; M age = 20.14 years) were screened for heavy drinking and randomized to BASICS (n = 115) or assessment-only control (n = 110). Outcome measures (drinking, alcohol problems) were collected at baseline, 4 weeks, 3, 6, and 12 months postintervention. At 4 weeks postintervention, intent-to-treat multilevel longitudinal models showed that regardless of referral group (mandated or volunteer), BASICS significantly decreased weekly drinking, typical drinks, and peak drinks relative to controls (ds = .41-.92). BASICS had a large effect on decreases in alcohol problems (d = .87). At 12 months postintervention, BASICS participants (regardless of referral group) reported significantly fewer alcohol problems (d = .56) compared with controls. Significant long-term intervention gains for peak and typical drinks were sustained in both referral groups relative to controls (ds = .42; .11). Referral group had no significant main effect and did not interact with intervention condition to predict outcomes. Given that BASICS was associated with less drinking and fewer alcohol problems (even among heavier drinking mandated students up to 1 year postintervention), provision of BASICS-style programs within disciplinary settings may help reduce heavy and problematic drinking among at-risk students. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  16. Mandating influenza vaccinations for health care workers: analysing opportunities for policy change using Kingdon's agenda setting framework.

    Science.gov (United States)

    Jackson-Lee, Angela; Barr, Neil G; Randall, Glen E

    2016-09-29

    The consequences of annual influenza outbreaks are often underestimated by the general public. Influenza poses a serious public health threat around the world, particularly for the most vulnerable populations. Fortunately, vaccination can mitigate the negative effects of this common infectious disease. Although inoculating frontline health care workers (HCWs) helps minimize disease transmission, some HCWs continue to resist participating in voluntary immunization programs. A potential solution to this problem is government-mandated vaccination for HCWs; however, in practice, there are substantial barriers to the adoption of such policies. The purpose of this paper is to identify the likelihood of adopting a policy for mandatory immunization of HCWs in Ontario based on a historical review of barriers to the agenda setting process. Documents from secondary data sources were analysed using Kingdon's agenda setting framework of three converging streams leading to windows of opportunity for possible policy adoption. The problems, politics, and policies streams of Kingdon's framework have converged and diverged repeatedly over an extended period (policy windows have opened and closed several times). In each instance, a technically feasible solution was available. However, despite the evidence supporting the value of HCW immunization, alignment of the three agenda setting streams occurred for very short periods of time, during which, opposition lobby groups reacted, making the proposed solution less politically acceptable. Prior to the adoption of any new policies, issues must reach a government's decision agenda. Based on Kingdon's agenda setting framework, this only occurs when there is alignment of the problems, politics, and policies streams. Understanding this process makes it easier to predict the likelihood of a policy being adopted, and ultimately implemented. Such learning may be applied to policy issues in other jurisdictions. In the case of mandatory influenza

  17. Teacher Performance Plays Growing Role in Employment Decisions. Teacher Tenure: Trends in State Laws

    Science.gov (United States)

    Thomsen, Jennifer

    2014-01-01

    An increasing number of states are mandating teacher performance be considered in educator employment decisions, including awarding tenure and layoffs, according to a 50-state policy review of teacher tenure laws. Tenure laws have historically granted job protections based on years of employment. The Education Commission of the States (ECS)…

  18. A Comprehensive Analysis of High School Genetics Standards: Are States Keeping Pace with Modern Genetics?

    Science.gov (United States)

    Dougherty, M. J.; Pleasants, C.; Solow, L.; Wong, A.; Zhang, H.

    2011-01-01

    Science education in the United States will increasingly be driven by testing and accountability requirements, such as those mandated by the No Child Left Behind Act, which rely heavily on learning outcomes, or "standards," that are currently developed on a state-by-state basis. Those standards, in turn, drive curriculum and instruction.…

  19. Russian Federation Financial Sector Assessment Program : Role of State in Financial Services

    OpenAIRE

    World Bank; International Monetary Fund

    2016-01-01

    State-owned financial institutions fall into three main groups: commercial banks, hybrid banks, and development institutions. The larger state-owned commercial banks/ groups include Sberbank, the VTB Bank group, and Gazprombank. Like private commercial banks, these institutions do not have a policy mandate and are profit maximizing, and target similar market segments. The main state hybrid...

  20. Direct healthcare costs and cost-effectiveness of acute coronary syndrome secondary prevention with ticagrelor compared to clopidogrel: economic evaluation from the public payer's perspective in Poland based on the PLATO trial results.

    Science.gov (United States)

    Pawęska, Justyna; Macioch, Tomasz; Perkowski, Piotr; Budaj, Andrzej; Niewada, Maciej

    2014-01-01

    Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist designed to reduce clinical thrombotic events in patients with acute coronary syndrome (ACS). Compared to clopidogrel, ticagrelor has been proven to significantly reduce the rate of death from vascular causes, myocardial infarction (MI), or stroke without an increase in the rate of overall major bleeding in patients who have an ACS with or without ST-segment elevation (STEMI and NSTEMI) or unstable angina (UA). To evaluate the cost-effectiveness and healthcare costs associated with secondary prevention of ACS using ticagrelor or clopidogrel in patients after STEMI, NSTEMI and UA. An economic model based on results from the PLATO trial was used to evaluate the cost-effectiveness of one-year therapy with ticagrelor or clopidogrel. The structure of the model consisted of two parts, i.e. the decision tree with one-year PLATO results and the Markov model with lifelong estimations, which exceeded PLATO follow-up data. The model was adjusted to Polish settings with country-specific data on death rates in the general population and direct medical costs calculated from the public payer's perspective. Costs were derived from the National Health Fund (NHF) and the Ministry of Health and presented in PLN 2013 values. Annual mean costs of second and subsequent years after stroke or MI were obtained from the literature. Uncertainty of assumed parameters was tested in scenarios and probabilistic sensitivity analyses. The adopted model allowed the estimation of an incremental cost-effectiveness ratio for life years gained (LYG) and an incremental cost-utility ratio for quality adjusted life years (QALY). Total direct medical costs to the public payer at a one year horizon were 2,905 PLN higher with ticagrelor than with clopidogrel. However, mean healthcare costs at a one year horizon (excluding drug costs and concomitant drugs) were 690 PLN higher for patients treated with clopidogrel. In a lifetime horizon

  1. Comparison of Outcomes before and after Ohio's Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study.

    Science.gov (United States)

    Upadhyay, Ushma D; Johns, Nicole E; Combellick, Sarah L; Kohn, Julia E; Keder, Lisa M; Roberts, Sarah C M

    2016-08-01

    In February 2011, an Ohio law took effect mandating use of the United States Food and Drug Administration (FDA)-approved protocol for mifepristone, which is used with misoprostol for medication abortion. Other state legislatures have passed or enacted similar laws requiring use of the FDA-approved protocol for medication abortion. The objective of this study is to examine the association of this legal change with medication abortion outcomes and utilization. We used a retrospective cohort design, comparing outcomes of medication abortion patients in the prelaw period to those in the postlaw period. Sociodemographic and clinical chart data were abstracted from all medication abortion patients from 1 y prior to the law's implementation (January 2010-January 2011) to 3 y post implementation (February 2011-October 2014) at four abortion-providing health care facilities in Ohio. Outcome data were analyzed for all women undergoing abortion at ≤49 d gestation during the study period. The main outcomes were as follows: need for additional intervention following medication abortion (such as aspiration, repeat misoprostol, and blood transfusion), frequency of continuing pregnancy, reports of side effects, and the proportion of abortions that were medication abortions (versus other abortion procedures). Among the 2,783 medication abortions ≤49 d gestation, 4.9% (95% CI: 3.7%-6.2%) in the prelaw and 14.3% (95% CI: 12.6%-16.0%) in the postlaw period required one or more additional interventions. Women obtaining a medication abortion in the postlaw period had three times the odds of requiring an additional intervention as women in the prelaw period (adjusted odds ratio [AOR] = 3.11, 95% CI: 2.27-4.27). In a mixed effects multivariable model that uses facility-months as the unit of analysis to account for lack of independence by site, we found that the law change was associated with a 9.4% (95% CI: 4.0%-18.4%) absolute increase in the rate of requiring an additional

  2. The state of civil society participation in Parliament | Muntingh | Law ...

    African Journals Online (AJOL)

    This article explores the extent of public participation in the legislative, oversight and accountability mandates of Parliament. From the analysis of data on public participation in the work of Parliament the key conclusion is drawn that the current state of public participation is almost exclusively focussed on the legislative ...

  3. Motivating High School Students to Score Proficient on State Tests

    Science.gov (United States)

    Brown, Sarah Lee

    2015-01-01

    The researcher interviewed two groups of eleventh grade students, in a rural Appalachian setting, who tended to score low on the state mandated high stakes/low stakes test to discover their efforts on the test, specifically in reading, and to obtain their opinions concerning the effects of a specific incentive or consequence. Before the eleventh…

  4. The Implications of State Fiscal Policies for Community Colleges

    Science.gov (United States)

    Dowd, Alicia C.; Shieh, Linda Taing

    2014-01-01

    A variety of policies and practices, including those developed by local boards and administrations, as well as those mandated by state and federal governments, affect budgets and finances at community colleges. Examples include tuition policies, fee structures, performance-based funding, and personnel policies. This chapter explores some of the…

  5. Health economic analysis of human papillomavirus vaccines in women of Chile: perspective of the health care payer using a Markov model.

    Science.gov (United States)

    Gomez, Jorge Alberto; Lepetic, Alejandro; Demarteau, Nadia

    2014-11-26

    In Chile, significant reductions in cervical cancer incidence and mortality have been observed due to implementation of a well-organized screening program. However, it has been suggested that the inclusion of human papillomavirus (HPV) vaccination for young adolescent women may be the best prospect to further reduce the burden of cervical cancer. This cost-effectiveness study comparing two available HPV vaccines in Chile was performed to support decision making on the implementation of universal HPV vaccination. The present analysis used an existing static Markov model to assess the effect of screening and vaccination. This analysis includes the epidemiology of low-risk HPV types allowing for the comparison between the two vaccines (HPV-16/18 AS04-adjuvanted vaccine and the HPV-6/11/16/18 vaccine), latest cross-protection data on HPV vaccines, treatment costs for cervical cancer, vaccine costs and 6% discounting per the health economic guideline for Chile. Projected incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICERs) for the HPV-16/18 AS04-adjuvanted vaccine was 116 United States (US) dollars per quality-adjusted life years (QALY) gained or 147 US dollars per life-years (LY) saved, while the projected ICUR/ICER for the HPV-6/11/16/18 vaccine was 541 US dollars per QALY gained or 726 US dollars per LY saved. Introduction of any HPV vaccine to the present cervical cancer prevention program of Chile is estimated to be highly cost-effective (below 1X gross domestic product [GDP] per capita, 14278 US dollars). In Chile, the addition of HPV-16/18 AS04-adjuvanted vaccine to the existing screening program dominated the addition of HPV-6/11/16/18 vaccine. In the probabilistic sensitivity analysis results show that the HPV-16/18 AS04-adjuvanted vaccine is expected to be dominant and cost-saving in 69.3% and 77.6% of the replicates respectively. The findings indicate that the addition of any HPV vaccine to the current cervical screening

  6. Minimal interruption of cardiopulmonary resuscitation for a single shock as mandated by automated external defibrillations does not compromise outcomes in a porcine model of cardiac arrest and resuscitation.

    Science.gov (United States)

    Ristagno, Giuseppe; Tang, Wanchun; Russell, James K; Jorgenson, Dawn; Wang, Hao; Sun, Shijie; Weil, Max Harry

    2008-11-01

    Current automated external defibrillations require interruptions in chest compressions to avoid artifacts during electrocardiographic analyses and to minimize the risk of accidental delivery of an electric shock to the rescuer. The earlier three-shock algorithm, with prolonged interruptions of chest compressions, compromised outcomes and increased severity of postresuscitation myocardial dysfunction. In the present study, we investigated the effect of timing of minimal automated external defibrillation-mandated interruptions of chest compressions on cardiopulmonary resuscitation outcomes, using a single-shock algorithm. We hypothesized that an 8-sec interruption of chest compressions for a single shock, as mandated by automated external defibrillations, would not impair initial resuscitation and outcomes of cardiopulmonary resuscitation. Randomized prospective animal study. University affiliated research laboratory. Domestic pigs. In 24 domestic male pigs weighing 41 +/- 2 kg, ventricular fibrillation was induced by left anterior descending coronary artery occlusion and untreated for 7 min. Cardiopulmonary resuscitation, including chest compressions and ventilation with oxygen, was then performed for an interval of 2 min before attempted defibrillation. Animals were randomized into three groups: A) interruption immediately before defibrillation; B) interruption after 1 min of cardiopulmonary resuscitation; or C) no interruption. Chest compressions were delivered with the aid of a mechanical chest compressor at a rate of 100 compressions/min and compression/ventilation ratio of 30:2. Defibrillation was attempted with a single biphasic 150-J shock. Each animal was successfully resuscitated and survived for >72 hr. No differences in the number of shocks before return of spontaneous circulation, frequency of recurrent ventricular fibrillation, duration of cardiopulmonary resuscitation, and severity of postresuscitation myocardial dysfunction were observed. In this

  7. Mandated Local Health Networks across the province of Québec: a better collaboration with primary care working in the communities?

    Science.gov (United States)

    Breton, Mylaine; Maillet, Lara; Haggerty, Jeannie; Vedel, Isabelle

    2014-01-01

    Background In 2004, the Québec government implemented an important reform of the healthcare system. The reform was based on the creation of new organisations called Health Services and Social Centres (HSSC), which were formed by merging several healthcare organisations. Upon their creation, each HSSC received the legal mandate to establish and lead a Local Health Network (LHN) with different partners within their territory. This mandate promotes a 'population-based approach' based to the responsibility for the population of a local territory. Objective The aim of this paper is to illustrate and discuss how primary healthcare organisations (PHC) are involved in mandated LHNs in Québec. For illustration, we describe four examples that facilitate a better understanding of these integrated relationships. Results The development of the LHNs and the different collaboration relationships are described through four examples: (1) improving PHC services within the LHN - an example of new PHC models; (2) improving access to specialists and diagnostic tests for family physicians working in the community - an example of centralised access to specialists services; (3) improving chronic-disease-related services for the population of the LHN - an example of a Diabetes Centre; and (4) improving access to family physicians for the population of the LHN - an example of the centralised waiting list for unattached patients. Conclusion From these examples, we can see that the implementation of large-scale reform involves incorporating actors at all levels in the system, and facilitates collaboration between healthcare organisations, family physicians and the community. These examples suggest that the reform provided room for multiple innovations. The planning and organisation of health services became more focused on the population of a local territory. The LHN allows a territorial vision of these planning and organisational processes to develop. LHN also seems a valuable lever when

  8. Alcohol Use, Alcohol-Related Outcome Expectancies, and Partner Aggression Among Males Court-Mandated to Batterer Intervention Programs: A Brief Report.

    Science.gov (United States)

    Brasfield, Hope; Morean, Meghan E; Febres, Jeniimarie; Shorey, Ryan C; Moore, Todd M; Zuckosky Zapor, Heather; Elmquist, JoAnna; Wolford-Clevenger, Caitlin; Labrecque, Lindsay; Plasencia, Maribel; Stuart, Gregory L

    2016-01-01

    Additional work is needed to determine how and/or why the relationship between alcohol use and increased risk of partner aggression (PA) exists. Researchers have begun to examine whether alcohol-related outcome expectancies (i.e., beliefs about the cognitive and behavioral effects of alcohol) are associated with PA irrespective of alcohol use. We examined the relationship between alcohol use, alcohol expectancies, and PA among 360 males arrested for a domestic violence offense and court-mandated to treatment. Results indicate that certain alcohol expectancies do play a role in the relationship between alcohol use and some forms of PA. © The Author(s) 2014.

  9. The Mandate of Heaven 天命 and Emperor Han Gaozu 高祖. A reading from Max Weber and Hok-lam Chan

    OpenAIRE

    Bucher, Greta

    2016-01-01

    The doctrine of the Mandate of Heaven 天命 was the basis of political legitimacy throughout the dynastic China. In order to study its conformation and the basis of the legitimacy of the emperors, I will begin this essay with an account of the origins of the doctrine. Then I will consider the problem of legitimacy during the dynastic China based on the legitimacy concept of sociologist Max Weber and of Hok-lam Chan, a recognized authority of this historical period. While Weber claimed that dynas...

  10. The Role of District Office Leaders in the Adoption and Implementation of the Common Core State Standards in Elementary Schools

    Science.gov (United States)

    Durand, Francesca T.; Lawson, Hal A.; Wilcox, Kristen Campbell; Schiller, Kathryn S.

    2016-01-01

    Purpose: This multiple case study investigated district leaders' orientations and strategies as their elementary schools proceeded with state-mandated implementation of the Common Core State Standards (CCSS). We identified differences between schools achieving above-predicted outcomes on state CCSS assessments ("odds-beaters") and…

  11. Validation of the multivariable In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule within an all-payer inpatient administrative claims database.

    Science.gov (United States)

    Coleman, Craig I; Kohn, Christine G; Crivera, Concetta; Schein, Jeffrey R; Peacock, W Frank

    2015-10-28

    To validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule, in a database consisting only of inpatient claims. Retrospective claims database analysis. The 2012 Healthcare Cost and Utilization Project National Inpatient Sample. Pulmonary embolism (PE) admissions were identified by an International Classification of Diseases, ninth edition (ICD-9) code either in the primary position or secondary position when accompanied by a primary code for a PE complication. The multivariable IMPACT rule, which includes age and 11 comorbidities, was used to estimate patients' probability of in-hospital mortality and classify them as low or higher risk (≤1.5% deemed low risk). The rule's sensitivity, specificity, positive and negative predictive values (PPV and NPV) and area under the receiver operating characteristic curve statistic for predicting in-hospital mortality with accompanying 95% CIs. A total of 34,108 admissions for PE were included, with a 3.4% in-hospital case-fatality rate. IMPACT classified 11, 025 (32.3%) patients as low risk, and low risk patients had lower in-hospital mortality (OR, 0.17, 95% CI 0.13 to 0.21), shorter length of stay (-1.2 days, p99%), low PPV (4.6%) and an AUC of 0.74, 95% CI 0.73 to 0.76. The IMPACT rule appeared valid when used in this all payer, inpatient only administrative claims database. Its high sensitivity and NPV suggest the probability of in-hospital death in those classified as low risk by IMPACT was minimal. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Mentors' and Mentees' Perceptions of a System-Wide Mandated Mentoring Program for First-Year Teachers

    Science.gov (United States)

    Smith, Leann

    2009-01-01

    Throughout the United States school systems are aware of the teacher shortage. The projected need to fill 2.2 million positions by 2010 will increase throughout the educational field, especially in areas of high poverty schools and particular content areas. Therefore, it is crucial to provide the best type of mentoring program to retain the best…

  13. Implications of State Policy Changes on Mental Health Service Models for Students with Disabilities

    Science.gov (United States)

    Lawson, Janelle E.; Cmar, Jennifer L.

    2016-01-01

    For over 25 years, students with disabilities in California received educationally related mental health services through interagency collaboration between school districts and county mental health agencies. After a major change in state policy that eliminated state-mandated interagency collaboration, school districts in California are now solely…

  14. Alliance Helps States Map New Terrain in Educator Evaluation. REL West Research Digest

    Science.gov (United States)

    Regional Educational Laboratory West, 2014

    2014-01-01

    About five years ago, states across the country took on the huge, complex task of developing and implementing new systems to evaluate teacher and principal performance in public schools. In response to a federal mandate aimed at improving student achievement, especially in the lowest performing schools, state boards of education drafted high-level…

  15. State Insurance Parity Legislation for Autism Services and Family Financial Burden

    Science.gov (United States)

    Parish, Susan; Thomas, Kathleen; Rose, Roderick; Kilany, Mona; McConville, Robert

    2012-01-01

    We examined the association between states' legislative mandates that private insurance cover autism services and the health care-related financial burden reported by families of children with autism. Child and family data were drawn from the National Survey of Children with Special Health Care Needs (N = 2,082 children with autism). State policy…

  16. Managing Multiple Mandates: A System of Systems Model to Analyze Strategies for Producing Cellulosic Ethanol and Reducing Riverine Nitrate Loads in the Upper Mississippi River Basin.

    Science.gov (United States)

    Housh, Mashor; Yaeger, Mary A; Cai, Ximing; McIsaac, Gregory F; Khanna, Madhu; Sivapalan, Murugesu; Ouyang, Yanfeng; Al-Qadi, Imad; Jain, Atul K

    2015-10-06

    Implementing public policies often involves navigating an array of choices that have economic and environmental consequences that are difficult to quantify due to the complexity of multiple system interactions. Implementing the mandate for cellulosic biofuel production in the Renewable Fuel Standard (RFS) and reducing hypoxia in the northern Gulf of Mexico by reducing riverine nitrate-N loads represent two such cases that overlap in the Mississippi River Basin. To quantify the consequences of these interactions, a system of systems (SoS) model was developed that incorporates interdependencies among the various subsystems, including biofuel refineries, transportation, agriculture, water resources and crop/ethanol markets. The model allows examination of the impact of imposing riverine nitrate-N load limits on the biofuel production system as a whole, including land use change and infrastructure needs. The synergies of crop choice (first versus second generation biofuel crops), infrastructure development, and environmental impacts (streamflow and nitrate-N load) were analyzed to determine the complementarities and trade-offs between environmental protection and biofuel development objectives. For example, the results show that meeting the cellulosic biofuel target in the RFS using Miscanthus x giganteus reduces system profits by 8% and reduces nitrate-N loads by 12% compared to the scenario without a mandate. However, greater water consumption by Miscanthus is likely to reduce streamflow with potentially adverse environmental consequences that need to be considered in future decision making.

  17. Fee-for-service and managed care for seniors and people with disabilities on Medicaid: implications for the managed care mandate in California.

    Science.gov (United States)

    Graham, Carrie L; Kurtovich, Elaine; Ivey, Susan L; Neuhauser, Linda

    2011-11-01

    To assess differences in perceived quality of care between fee-for-service (FFS) and managed care Medicaid (MMC) by seniors and persons with disabilities (SPD) and to generate hypotheses for future evaluations of the new managed care mandate for SPD in California. A cross-sectional telephone survey of 403 SPD Medicaid beneficiaries comparing perceived access to, satisfaction with, and quality of care between beneficiaries who had voluntarily enrolled in MMC with those who had remained in FFS. Beneficiaries in MMC were more likely to be "very satisfied" with their benefits than those in FFS. There was no significant difference on any measure of access to care. Most beneficiaries in MMC reported their access to and quality of health care was either the same or better than it had been in FFS. On most measures, MMC was rated either the same or better than FFS by SPD beneficiaries who voluntarily enrolled in MMC.

  18. Personality and alcohol-related outcomes among mandated college students: descriptive norms, injunctive norms, and college-related alcohol beliefs as mediators.

    Science.gov (United States)

    Pearson, Matthew R; Hustad, John T P

    2014-05-01

    The present study examined three alcohol-perception variables (descriptive norms, injunctive norms, and college-related alcohol beliefs) as mediators of the predictive effects of four personality traits (impulsivity, sensation seeking, anxiety sensitivity, and hopelessness) on alcohol use and alcohol-related consequences in a sample of mandated college students (n=875). Our findings replicated several findings of a previous study of incoming freshman college students (Hustad et al., in press) in that impulsivity and hopelessness had direct effects on alcohol-related problems, sensation seeking and impulsivity had indirect effects on alcohol-related outcomes via college-related alcohol beliefs, and college-related alcohol beliefs predicted both alcohol use and alcohol-related problems. We discuss the implications of our findings for global college student interventions as well as personality-targeted interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Drug testing in the workplace: could a positive test for one of the mandated drugs be for reasons other than illicit use of the drug?

    Science.gov (United States)

    elSohly, M A; Jones, A B

    1995-10-01

    This manuscript reviews data available in the scientific literature relative to drug testing for the five mandated drug classes and circumstances other than abuse of the drug itself that could result in a positive test. For marijuana, passive inhalation, unknowing oral ingestion, and the use of Marinol are discussed. Data are presented on the concentration of delta9-tetrahydrocannabinol (THC) and its precursors, acid-A and acid-B, in illicit marijuana and the extent of extraction of THC in boiled (tea) or cooked products. For cocaine, passive inhalation and passive exposure issues are reviewed. For opiates, poppy seed ingestion and guidelines for exclusion of poppy seeds as a cause for a positive test are discussed. For amphetamines, issues such as the presence of other phenethylamines, l-methamphetamine (Vicks' inhalers), and other prescription drugs are discussed. Although passive inhalation of methamphetamine and phencyclidine is theoretically possible, no data were available on these issues.

  20. Iowa Chiropractic Students Outlook for Practitioners and Need for State-Funded Assistance.

    Science.gov (United States)

    Greiner, Keith

    This state-mandated study examined the needs of Iowa chiropractic students and the Iowa demand for chiropractic health care in order to determine the feasibility of establishing a chiropractic forgivable loan program. The project used financial aid data and repayment rate data to evaluate the need for financial aid for chiropractic students;…

  1. Forest structure and fire hazard in dry forests of the Western United States

    Science.gov (United States)

    David L. Peterson; Morris C. Johnson; James K. Agee; Theresa B. Jain; Donald McKenzie; Elizabeth D. Reinhardt

    2005-01-01

    Fire, in conjunction with landforms and climate, shapes the structure and function of forests throughout the Western United States, where millions of acres of forest lands contain accumulations of flammable fuel that are much higher than historical conditions owing to various forms of fire exclusion. The Healthy Forests Restoration Act mandates that public land...

  2. Forest resources of the United States, 2002: mapping the renewable resource planning act data

    Science.gov (United States)

    Cassandra M. Kurtz; Daniel J. Kaisershot; Dale D. Gormanson; Jeffery S. Wazenegger

    2009-01-01

    Forest Inventory and Analysis (FIA), a national program of the Forest Service, U.S. Department of Agriculture conducts and maintains comprehensive inventories of the forest resources in the United States. The Forest and Rangeland Renewable Resources Planning Act (RPA) of 1974 mandates a comprehensive assessment of past trends, current status, and the future potential...

  3. 75 FR 17644 - Update to NFPA 101, Life Safety Code, for State Home Facilities

    Science.gov (United States)

    2010-04-07

    ... diem for providing nursing home care to eligible Veterans will be required to meet certain provisions... the physical environment of facilities for which VA pays per diem to a State for providing nursing...) raise novel legal or policy issues arising out of legal mandates, the President's priorities, or the...

  4. The Cultural Context of Educational Policy: Brazil and the United States.

    Science.gov (United States)

    Dias, Jose Augusto; Lynch, Patrick D.

    Both Brazil's and the United States's educational policies are influenced by centralization of administration and formal objectives mandated by law. Arising from a long division in Brazilian life between government and people, public schools have been seen to be the concern of the government, which has preserved the antiquated division of…

  5. The Status of Plain Language Legislation in the Fifty States and President Carter's Executive Order 12044.

    Science.gov (United States)

    Grogan, Lina

    A study was conducted to examine plain language legislation in the 50 states and to evaluate the progress made in simplifying government regulations as a result of President Carter's executive order mandating the use of clear language in regulations. In the first part of the study, laws and bills relating to plain language in consumer contracts…

  6. Migration, Language Diversity and Education Policy: A Contextualized Analysis of Inequality, Risk and State Effects

    Science.gov (United States)

    Collins, James

    2015-01-01

    "No Child Left Behind" is federal education legislation consisting of implementation programs intended to reconcile the goals of insuring equality while promoting competition in public education in the United States. Immigrant students whose primary languages are not English are included in the mandate of "NCLB," categorized as…

  7. The Legal Situation of Latin American and Caribbean Women as Defined according to the Resolutions and Mandates of the United Nations System. Volume II: File Sheets of Resolutions on the Legal Situation of Women.

    Science.gov (United States)

    United Nations Economic and Social Council, New York, NY.

    This document contains a systematized inventory of the measures relating to the legal and social status of women adopted in various regional and world forums. The inventory was used to study the legal situation of Latin American and Caribbean women, defined according to the resolutions and mandates of the United Nations system. Organized by forum…

  8. Gränsöverskridandets praktik och ömsesidighetens mandat. Exempel från etnografiska fältarbeten

    Directory of Open Access Journals (Sweden)

    Ulf Mellström

    2006-01-01

    Full Text Available THE PRACTICE OF BOUNDARY CROSSING AND THE MANDATE OF RECIPROCITY. EXAMPLESFROM ETHNOGRAPHIC FIELDWORK. In this article, the joint endeavour to con-struct knowledge in ethnographic fieldwork is discussed. It is argued thatsuch a joint project is self-evidently based on mutual recognition betweenanthropologist and informant, and that this recognition needs to be in-corporated into a narrative strategy directed towards a dialogical anthro-pology, in contrast to an analogical/monological tradition. The article, basedon one year of fieldwork among the Chinese diaspora of Penang, Malaysia,also discusses the reciprocity of ethnographic fieldwork and the reciprocalmaking of an ethnography in relation to an anthropological perspective onthe political economy of knowledge production. The article introduces thenotion of ”eduscapes”, conceptualizing global cultural flows in higher edu-cation and research. It is argued that these global flows are part of thecultural imagery of the diaspora and are incorporated into the local under-standing of the intervening anthropologist.

  9. O professor e seu mandato de mediador, herdeiro, intérprete e crítico The teacher and his mandate: medatior, heir, interpreter, critic

    Directory of Open Access Journals (Sweden)

    M'hammed Mellouki

    2004-08-01

    Full Text Available Este artigo visa a mostrar que a escola é uma instituição cultural no sentido pleno do termo e que os professores são seus principais atores. A demonstração desta asserção repousa sobre três argumentos principais: a a cultura não se reduz a uma soma de conhecimentos; b os professores têm a incumbência de velar cotidianamente pela aprendizagem cultural de seus alunos; c os professores são intelectuais, ou seja, depositários, intérpretes e críticos da cultura.The point of this article is to show that schools are cultural institutions, in the full sense of the term, where teachers are the most important actors. This assertion relies on three main points: a culture does not boil down to the sum of someone's knowledge; b teachers have the daily mandate of making sure their students receive cultural information; c teachers are intellectuals, i.e., they convey, interpret and analyze culture.

  10. Humane Education: A Forgotten Mandate

    Science.gov (United States)

    Quinn, Peter J.

    1977-01-01

    Discusses the importance of humane education (i.e., the teaching of the principles of justice, goodwill, and respect for all living creatures) and offers suggestions for integrating humane education in the elementary school curriculum. (JG)

  11. Toward an Asbestos Ban in the United States

    Directory of Open Access Journals (Sweden)

    Richard A. Lemen

    2017-10-01

    Full Text Available Many developed countries have banned the use of asbestos, but not the United States. There have, however, been multiple efforts in the US to establish strict exposure standards, to limit asbestos use, and to seek compensation through the courts for asbestos-injured workers’ In consequence of these efforts, asbestos use has declined dramatically, despite the absence of a legally mandated ban. This manuscript presents a historical review of these efforts.

  12. Disparities in Assisted Reproductive Technology Utilization by Race and Ethnicity, United States, 2014: A Commentary.

    Science.gov (United States)

    Dieke, Ada C; Zhang, Yujia; Kissin, Dmitry M; Barfield, Wanda D; Boulet, Sheree L

    2017-06-01

    Disparities in infertility and access to infertility treatments, such as assisted reproductive technology (ART), by race/ethnicity, have been reported. However, identifying disparities in ART usage may have been hampered by missing race/ethnicity information in ART surveillance. We review infertility prevalence and treatment disparities, use recent data to examine ART use in the United States by race/ethnicity and residency in states with mandated insurance coverage for in vitro fertilization (IVF), and discuss approaches for reducing disparities. We used 2014 National ART Surveillance System (NASS) data to calculate rates of ART procedures per million women 15-44 years of age, a proxy measure of ART utilization, for Census-defined racial/ethnic groups in the United States; rates were further stratified by the presence of insurance mandates for IVF treatment. Missing race/ethnicity data (35.6% of cycles) were imputed. Asian/Pacific Islander (A/PI) women had the highest rates of ART utilization at 5883 ART procedures per million women 15-44 years of age in 2014, whereas American Indian/Alaska Native non-Hispanic women had the lowest rates at 807 per million, compared with other racial/ethnic groups. In each racial/ethnic category, ART utilization rates were higher for women in states with an insurance mandate for IVF treatment versus those without. In 2014, A/PI women had the highest rates of ART utilization. ART utilization for all racial/ethnic groups was higher in states with insurance mandates for IVF than those without, although disparities were still evident. Although mandates may increase access to infertility treatments, they are not sufficient to eliminate these disparities.

  13. Moving beyond Compliance: Promoting Research-Based Professional Discretion in the Implementation of the Common Core State Standards in English Language Arts

    Science.gov (United States)

    Woodard, Rebecca; Kline, Sonia

    2015-01-01

    State- and local-level mandates are currently being implemented to ensure strict compliance to the new national Common Core State Standards for English Language Arts (CCSS for ELA) and related assessments. These standards provide many potential opportunities to improve literacy education nationally and locally. However, the CCSS for ELA will…

  14. La implementación de programas de educación en medios: el caso Ontario Implementing Mandates in Media Education: The Ontario Experience

    Directory of Open Access Journals (Sweden)

    Barry Duncan

    2009-03-01

    Full Text Available Este artículo expone un informe sobre la educación en alfabetización mediática en Ontario. Brinda una visión general del plan de estudios para la alfabetización mediática propuesta por el gobierno regional. Específicamente, describe varias aproximaciones para la enseñanza acerca de los medios, así como la teoría que apuntala los documentos del plan de estudios y las prácticas en el aula. También describe el trabajo de organizaciones y asociaciones clave que ayudaron a priorizar la educación en alfabetización mediática, y ofrece sugerencias para el desarrollo exitoso y la implementación de programas de alfabetización mediática. La conclusión discute los retos y el curso futuro de la alfabetización mediática más allá del caso Ontario, centrándose en nueve tesis clave para el éxito en su implementación en todo el mundo. This analysis presents a report on media literacy education in Ontario. It provides an overview of the curriculum for media literacy that is mandated by the provincial government. Specifically, it describes various approaches for teaching about the media as well as the theory that underpins curriculum documents and classroom practices. The analysis also describes the work of key organizations and partnerships that helped prioritize media literacy education, and offers suggestions for the successful development and implementation of media literacy programs. The conclusion discusses the challenges and future directions for media literacy beyond the Ontario case, focusing on nine key tenets for success in its implementation worldwide.

  15. Does Student Proficiency on Local Reading Assessment Measures Align with State Mandated Reading Proficiency Standards? An Investigation of the Relationship between the Developmental Reading Assessment, Reading Curriculum Based Measurement, and Maze, with the New York State English Language Arts Exam

    Science.gov (United States)

    Weschler, Michael J.

    2016-01-01

    Data from three reading assessment tools--the Developmental Reading Assessment (DRA), Reading Curriculum Based Measurement (R-CBM), and Maze--were compiled from 61 fourth grade and 59 fifth grade students across Fall and Spring administrations in order to determine how proficiency on these measures was associated with proficiency on the New York…

  16. The Future of Cesarean Delivery Rates in the United States.

    Science.gov (United States)

    Clapp, Mark A; Barth, William H

    2017-12-01

    The US cesarean delivery rate remains 30%-32%. Increases in maternal age, obesity, and diabetes put upward pressure on this rate. Alternatives to cesarean delivery, vaginal birth after cesarean (VBAC), and operative vaginal delivery, are underutilized and there are substantial challenges to their resurgence. Practice guidelines offer promise, but demonstrate only minor reductions in cesarean delivery. We estimate that the overall rate in the US will remain 27%-30% for the immediate future. As more states move to recognize the independent practice of midwifery and more payers seek lower cost options for childbirth, we anticipate the overall rate will drop to 20% or 25%, but not for another 15 years or more.

  17. Colonial Guilt and the Recycling of Oppression: The Merit of Unofficial History in Transforming the State's Narrative

    Science.gov (United States)

    Habashi, Janette

    2012-01-01

    This article juxtaposes colonial guilt with selective historical memory of Palestinian narratives as presented in the Israeli state-mandated history textbooks. The advancement of colonial guilt imposes a particular subjective truth of oppressed groups' historical memories. The purpose of colonial guilt is to keep the power structure intact by…

  18. Une mission sacrée pour qui ? Quelques réflexions sur l’Intégration Nationale et le Mandat britannique en Irak

    Directory of Open Access Journals (Sweden)

    Peter Sluglett

    2007-07-01

    Full Text Available L’idée d’un objectif moral était inhérente à la création des mandats au Proche-Orient au lendemain de la guerre. Il s’agissait en particulier pour les Grandes Puissances de préparer activement à l’indépendance dans un futur qui ne soit pas trop éloigné les pays dont ils avaient la charge. Pratiquement, à l’opposé des idéaux entourant leur création, les nouvelles structures qui émergèrent étaient largement le reflet du désir des grandes puissances de forger des institutions à travers lesquelles elles puissent exercer leur contrôle. En Irak, les considérations économiques dictèrent la formation d’une lourde armée nationale soutenue, si nécessaire, par la puissance de la Royal Air Force. Cela conduisit à l’emploi de la force dans des situations pour lesquelles des solutions administratives auraient été plus appropriées et, en fin de compte, à l’échec des efforts de création des structures institutionnelles qui auraient été capables de résister à la domination de petites cliques militaires. De même, la politique britannique a été de gouverner par l’intermédiaire de l’“aristocratie de service” arabe sunnite, en accordant un statut de minoritaire à la majorité chiite de la population. Si cela a été toléré tant que les chiites sont restés en bas de la hiérarchie socio-économique, l’élévation du niveau d’éducation et les progrès de la conscience politique ont représenté une menace pour le statu quo, d’abord sous la monarchie puis sous la république.

  19. Medical Device Regulation: A Comparison of the United States and the European Union.

    Science.gov (United States)

    Maak, Travis G; Wylie, James D

    2016-08-01

    Medical device regulation is a controversial topic in both the United States and the European Union. Many physicians and innovators in the United States cite a restrictive US FDA regulatory process as the reason for earlier and more rapid clinical advances in Europe. The FDA approval process mandates that a device be proved efficacious compared with a control or be substantially equivalent to a predicate device, whereas the European Union approval process mandates that the device perform its intended function. Stringent, peer-reviewed safety data have not been reported. However, after recent high-profile device failures, political pressure in both the United States and the European Union has favored more restrictive approval processes. Substantial reforms of the European Union process within the next 5 to 10 years will result in a more stringent approach to device regulation, similar to that of the FDA. Changes in the FDA regulatory process have been suggested but are not imminent.

  20. Independence and interdependence predict health and wellbeing: divergent patterns in the United States and Japan

    Directory of Open Access Journals (Sweden)

    Shinobu Kitayama

    2010-12-01

    Full Text Available A cross-cultural survey was used to examine two hypotheses designed to link culture to well-being and health. The first hypothesis states that people are motivated toward prevalent cultural mandates of either independence (personal control in the United States or interdependence (relational harmony in Japan. As predicted, Americans with compromised personal control and Japanese with strained relationships reported high perceived constraint. The second hypothesis holds that people achieve well-being and health through actualizing the respective cultural mandates in their modes of being. As predicted, the strongest predictor of well-being and health was personal control in the United States, but the absence of relational strain in Japan. All analyses controlled for age, gender, and personality traits. The overall pattern of findings underscores culturally distinct pathways (independent versus interdependent in achieving these positive life outcomes.

  1. Independence and interdependence predict health and wellbeing: divergent patterns in the United States and Japan.

    Science.gov (United States)

    Kitayama, Shinobu; Karasawa, Mayumi; Curhan, Katherine B; Ryff, Carol D; Markus, Hazel Rose

    2010-01-01

    A cross-cultural survey was used to examine two hypotheses designed to link culture to wellbeing and health. The first hypothesis states that people are motivated toward prevalent cultural mandates of either independence (personal control) in the United States or interdependence (relational harmony) in Japan. As predicted, Americans with compromised personal control and Japanese with strained relationships reported high perceived constraint. The second hypothesis holds that people achieve wellbeing and health through actualizing the respective cultural mandates in their modes of being. As predicted, the strongest predictor of wellbeing and health was personal control in the United States, but the absence of relational strain in Japan. All analyses controlled for age, gender, educational attainment, and personality traits. The overall pattern of findings underscores culturally distinct pathways (independent versus interdependent) in achieving the positive life outcomes.

  2. Budget Impact Analysis of Prolonged Half-Life Recombinant FVIII Therapy for Hemophilia in the United States.

    Science.gov (United States)

    McMullen, Suzanne; Buckley, Brieana; Hall, Eric; Kendter, Jon; Johnston, Karissa

    2017-01-01

    Hemophilia A is a factor VIII deficiency, associated with spontaneous, recurrent bleeding episodes. This may lead to comorbidities such as arthropathy and joint replacement, which contribute to morbidity and increased health care expenditure. Recombinant factor VIII Fc fusion protein (rFVIIIFc), a prolonged half-life factor therapy, requires fewer infusions, resulting in reduced treatment burden. Use a budget impact analysis to assess the potential economic impact of introducing rFVIIIFc to a formulary from the perspective of a private payer in the United States. The budget impact model was developed to estimate the potential economic impact of adding rFVIIIFc to a private payer formulary across a 2-year time period. The eligible patient population consisted of inhibitor-free adults with severe hemophilia A, receiving recombinant-based episodic or prophylaxis treatment regimens. Patients were assumed to switch from conventional recombinant factor treatment to rFVIIIFc. Only medication costs were included in the model. The introduction of rFVIIIFc is estimated to have a budget impact of 1.4% ($0.12 per member per month) across 2 years for a private payer population of 1,000,000 (estimated 19.7 individuals receiving treatment for hemophilia A). The introduction of rFVIIIFc is estimated to prevent 124 bleeds across 2 years at a cost of $1891 per bleed avoided. Hemophilia A is a rare disease with a low prevalence; therefore, the overall cost to society of introducing rFVIIIFc is small. Considerations for comprehensively assessing the budget impact of introducing rFVIIIFc should include episodic and prophylaxis regimens, bleed avoidance, and annual factor consumption required under alternative scenarios. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Best Practices for Determining Subgroup Size in Accountability Systems While Protecting Personally Identifiable Student Information. Institute of Education Sciences Congressionally Mandated Report. IES 2017-147

    Science.gov (United States)

    Seastrom, Marilyn

    2017-01-01

    The Every Student Succeeds Act (ESSA) of 2015 (Public Law 114-95) requires each state to create a plan for its statewide accountability system. In particular, ESSA calls for state plans that include strategies for reporting education outcomes by grade for all students and for economically disadvantaged students, students from major racial and…

  4. 78 FR 46603 - Final Agency Action To Transfer Title From the United States to the Pechanga Band of Luiseño...

    Science.gov (United States)

    2013-08-01

    ... Band of Luise o Mission Indians and to San Diego Gas & Electric Company, California AGENCY: Bureau of... Pechanga Band of Luise o Mission Indians of the State of California and the Federal lands transferred to San Diego Gas & Electric Company as mandated by Congress in Section 2(f) of the Pechanga Band of Luise...

  5. Preparing Students for College and Career in the United States: The Effects of Career-Themed Programs of Study on High School Performance

    Science.gov (United States)

    Castellano, Marisa E.; Richardson, George B.; Sundell, Kirsten; Stone, James R., III

    2017-01-01

    In the United States, education policy calls for every student to graduate from high school prepared for college and a career. National legislation has mandated programs of study (POS), which offer aligned course sequences spanning secondary and postsecondary education, blending standards-based academic and career and technical education (CTE)…

  6. Variations in State Laws Governing School Reintegration Following Concussion.

    Science.gov (United States)

    Thompson, Leah L; Lyons, Vivian H; McCart, Melissa; Herring, Stanley A; Rivara, Frederick P; Vavilala, Monica S

    2016-12-01

    We sought to examine the prevalence, scope, and specificity of provisions governing school reintegration in current state concussion laws. State concussion laws as of May 2016 were independently assessed and classified by 2 trained coders. Statutes were classified as "Return-to-Learn" (RTL) laws if they contained language mandating institutional action at the state, district, or school level related to academic reintegration of youth who have sustained a concussion. All statutes classified as RTL laws were further analyzed to determine scope, required actions, and delineation of responsibility. RTL laws were uncommon, present in only 8 states. Most (75%) of these laws held schools responsible for RTL management but mandated RTL education for school personnel was less frequent, present in only one-quarter of the laws. None of the RTL laws provided guidance on support of students with persistent postconcussive symptoms, and only 1 recommended an evidence-based standard for RTL guidelines. Our review of state concussion laws indicates scant and vague legal guidance regarding RTL. These findings suggest an opportunity for legislative action on the issue of RTL, and reveal the need for better integration of laws and research, so that laws reflect existing best-practice recommendations and remain current as the evidence base develops. Copyright © 2016 by the American Academy of Pediatrics.

  7. A National Mandate for Education Abroad: Getting on with the Task. Report of the National Task Force on Undergraduate Education Abroad.

    Science.gov (United States)

    Council on International Educational Exchange, New York, NY.

    This report addresses the proposition that higher education must provide more international content, and that the United States, at present, is ill-prepared for the changes in business, manufacturing, diplomacy, science, and technology that have come with an intensely interdependent world. Five major recommendations are presented and discussed:…

  8. Farmers’ Willingness to Grow Sweet Sorghum as a Cellulosic Bioenergy Crop: A Stated Choice Approach

    OpenAIRE

    Bergtold, Jason S.; Fewell, Jason E.; Williams, Jeffery R.

    2011-01-01

    Biofuel production must increase to 36 billion gallons by the year 2022, according to government mandates. The majority of this fuel must be produced from “advanced” or second-generation biofuel feedstocks after 2015. Advanced biofuel feedstocks include annual crops such as sweet sorghum. Kansas farmers are poised to be major producers of sweet sorghum for biofuels. A stated choice survey was administered to Kansas farmers to assess their willingness to grow sweet sorghum for biofuels under v...

  9. The tobacco industry, state politics, and tobacco education in California.

    Science.gov (United States)

    Begay, M E; Traynor, M; Glantz, S A

    1993-01-01

    OBJECTIVES. Proposition 99 added 25 cents to the California state cigarette tax and mandated that 20% of the new revenues be spent on tobacco education and prevention programs. This paper examines the implementation of these programs and the tobacco industry's response to Proposition 99. METHODS. Political expenditure data for twelve tobacco firms and associations were gathered from California's Fair Political Practices Commission and secretary of state's Political Reform Division. Tobacco education expenditure data were collected from Governor's Budgets and the Department of Finance. RESULTS. Since Proposition 99 passed, tobacco industry political expenditures in California have risen 10-fold, from $790,050 in the 1985-1986 election to $7,615,091 in the 1991-1992 election. The tobacco industry is contributing more heavily to the California legislature than to Congress. A statistical analysis of data on campaign contributions indicates that California legislators' policy-making is influenced by campaign contributions from the tobacco industry. Since fiscal year 1989-1990, the state has ignored the voters' mandate and spent only 14.7% of the new revenues to tobacco education. Medical care programs received more money than permitted by the voters. CONCLUSIONS. The tobacco industry has become politically active in California following the passage of Proposition 99. One result may be that the state has underfunded tobacco education by $174.7 million through the 1993-1994 fiscal year. The estimated redirection of funds to medical care would essentially eliminate the tobacco education campaign by the year 2000. PMID:8362994

  10. Annual Report on the State of the DOE National Laboratories

    Energy Technology Data Exchange (ETDEWEB)

    None

    2017-01-01

    This first Annual Report to Congress on the State of the DOE National Laboratories provides a comprehensive overview of the Lab system, covering S&T programs, management and strategic planning. The Department committed to prepare this report in response to recommendations from the Congressionally mandated Commission to Review the Effectiveness of the National Energy Laboratories (CRENEL) that the Department should better communicate the value that the Laboratories provide to the Nation. We expect that future annual reports will be much more compact, building on the extensive description of the Laboratories and of the governance structures that are part of this first report.

  11. The Power of PreK-3rd: How a Small Foundation Helped Push Washington State to the Forefront of the PreK-3rd Movement. FCD Case Study

    Science.gov (United States)

    Nyhan, Paul

    2011-01-01

    The New School Foundation was not born from a commission, legislative mandate, research project, think tank, or even the mind of a leading education scholar. One of Washington state's pioneering PreK-3rd initiatives began as the brainchild of a wealthy Seattle businessman, Stuart Sloan, 20 years ago. The New School Foundation and its ideas were…

  12. Self-archiving to Institutional Repositories Is Improved by Assisted and Mandated Deposit; Disciplinary Culture is not a Factor. A Review of: Xia, Jingfeng. “Assessment of Self-Archiving in Institutional Repositories: Across Disciplines.” The Journal of Academic Librarianship 33.6 (Dec. 2007: 647-54.

    Directory of Open Access Journals (Sweden)

    Gaby Haddow

    2008-06-01

    QUT, where deposit into the IR is mandatory, self-archiving rates are high for the three disciplines for which findings are reported. The self-archiving rate for chemistry was 68.3%, sociology 46.3%, and physics 42.9%. A librarian was responsible for the majority of the remaining deposits. Conclusion – This research tested the proposition that disciplines familiar with subject-based open access repositories, such as physics and economics, are more likely to contribute to IRs. Its findings did not support this view. Instead, the study found no particular pattern of deposit rate across the four disciplines of chemistry, physics, economics and sociology in the seven IRs. Operational aspects of IRs, such as assisted and mandated deposit, appear to have a more significant effect on deposit rates. Assisted deposit, either through departmental administrative staff or librarians, accounted for relatively high deposit rates for economics in the Queensland and Melbourne IRs. Deposit date information in the Queensland IR suggests administrative staff of theeconomics department deposit to the IR on an ongoing basis. Students showed a high rate of self-archiving for theses and dissertations. It might be speculated that a mandate policy at Queensland University of Technology is responsible for the high self-archiving rates seen for economics, chemistry and sociology. However, librarians have assisted in the process, depositing over half the items for physics and sociology. The author recognises the value of both assisted and mandated deposit, but raises questions about how this will affect faculty use of IRs. For example, in cases where faculty have no role in contributing to an IR and therefore no familiarity with it, will they in fact use it? Another important consideration is the policy approach taken to temporary faculty and a mobile academic workforce. In conclusion, the author states,“Institutional repositories need a mandate policy to ensure success”.

  13. State Fairgrounds

    Data.gov (United States)

    Department of Homeland Security — This shapefile is a point shapefile that displays the locations of the major state/regional agricultural fairs held throughout the United States. Some states (e.g.,...

  14. Incremental Effect of the Addition of Prescriber Restrictions on a State Medicaid's Pharmacy-Only Patient Review and Restriction Program.

    Science.gov (United States)

    Keast, Shellie L; Pham, Timothy; Teel, Ashley; Nesser, Nancy J

    2017-08-01

    Patient review and restriction programs (PRRPs), used by state Medicaid programs to limit potential abuse and misuse of opioids and related controlled medications, often restrict members to a single pharmacy for controlled medications. While most states use a restricted pharmacy access model, not all states include restricted prescriber access. Oklahoma Medicaid (MOK) added a restricted prescriber access feature to its PRRP in July 2014. To evaluate the incremental effect that the addition of a prescriber restriction to MOK's pharmacy-only PRRP had on the pharmacy and resource utilization of the enrolled members. MOK members with at least 6 months of enrollment in the pharmacy-only PRRP were restricted to a maximum of 3 prescribers for controlled substances in July 2014 and were identified as "cases." Using a propensity score method, cases were matched to controls from the MOK non-PRRP enrolled population based on demographics and baseline health care utilization. Data from January 1, 2014, through December 31, 2014, were evaluated. Each member's monthly health care resource utilization, defined in terms of medical and pharmacy costs, prescription counts, and opioid use per member per month (PMPM), was analyzed. A difference-indifferences (DID) regression estimated the change in resource utilization following the July 2014 policy change. This study included 378 controls and 126 cases after propensity matching. No differences were noted for daily morphine equivalents, benzodiazepine prescriptions, or maintenance prescriptions. There were decreases in mean PMPM use for both groups for short-acting opioid (SAO) claims (P incremental change to SAO, prescriber, and pharmacy use in the PRPP population. Use of PRRPs may be an effective tool in reducing inappropriate use of prescription opioids within payer systems. The question remains whether these changes result in long-term changes to behavior outside the payer system. Future research into the effects of PRRPs on

  15. “A Shmita Manifesto”: a radical sabbatical approach to Jewish food reform in the United States

    OpenAIRE

    Adrienne Krone

    2015-01-01

    A revolutionary movement recently cropped up with a vision to revitalize American Jewish environmentalism through food reform. This movement implemented shmita (sabbatical) year practices, which Jewish law mandates only inside the land of Israel, in the United States during the shmita year that began in September 2014. This article offers a brief historical overview of shmita and then utilizes the main texts of the shmita movement to explore how the Shmita Project connects- the diverse worlds...

  16. US health care: single-payer or market reform.

    Science.gov (United States)

    Himmelstein, David U; Woolhandler, Steffie

    2009-02-01

    The authors advocate a fundamental change in health care financing-national health insurance (NHI). NHI would reorient the way we pay for care, bringing the hundreds of billions now squandered on malignant bureaucracy back to the bedside. NHI could restore the physician-patient relationship, offer patients a free choice of physicians and hospitals, and free physicians from the hassles of insurance paperwork.

  17. FAILED STATE

    African Journals Online (AJOL)

    Dr. Miles R. Cone

    Empirical criteria for statehood points towards the domestic dimension of the state and focuses on state-society ... offer high levels of security from political and criminal violence, ensure political freedom and civil liberties, and ... This section mentioned a number of indices of state performance, which is the translation of state ...

  18. The labeling debate in the United States.

    Science.gov (United States)

    Marchant, Gary E; Cardineau, Guy A

    2013-01-01

    The mandatory labeling of genetically modified (GM) food has become the predominant policy issue concerning biotechnology in the United States. The controversy over GM labeling is being debated at several different levels and branches of government. At the federal level, the Food and Drug Administration, which has primary jurisdiction over food safety and labeling, has steadfastly refused to require labeling of GM foods since 1992 based on its conclusion that GM foods as a category present no unique or higher risks than other foods. Proposed legislation has been repeatedly introduced in the US. Congress over the years to mandate GM labeling, but has made very little progress. With federal labeling requirements apparently stalled, the main activity has switched to the state level, where numerous individual states are considering mandatory GM labeling, either through legislation or proposition. The debate over GM labeling, at both the federal and state levels, has focused on five issues: (1) public opinion; (2) the legality of labeling requirements; (3) the risks and benefits of GM foods; (4) the costs and burdens of GM labeling; and (5) consumer choice. While the pro-labeling forces argue that all of these factors weigh in favor of mandatory GM labeling, a more careful evaluation of the evidence finds that all five factors weigh decisively against mandatory GM labeling requirements.

  19. O  papel das subsidiárias e a internacionalização das atividades tecnológicas pelas Empresas Transnacionais (ETNs The subsidiary mandate and the internationalization of technological activities by Transnational Enterprises

    Directory of Open Access Journals (Sweden)

    Rogério Gomes

    2003-12-01

    Full Text Available Este estudo se propõe a analisar os mandatos das subsidiárias de empresas transnacionais (ETNs no estrangeiro por intermédio dos mecanismos de alocação das atividades de pesquisa e desenvolvimento (P&D entre os centros descentralizados de pesquisa. Iniciamos o trabalho com a apresentação de uma síntese das diferentes perspectivas encontradas na literatura econômica sobre a subordinação (ou condicionamentos da autonomia administrativa e tecnológica das filiais. Tal síntese permite estabelecer uma hierarquia entre as subsidiárias e uma tipologia para evolução (retrocesso de mandatos construída, principalmente, para as ETNs estruturadas em forma de rede corporativa. A seguir, a partir de pesquisas realizadas sobre as atividades dos laboratórios de P&D da indústria de equipamentos de telecomunicações no Brasil, procuramos mostrar que: a a descentralização das atividades tecnológicas é um fato que não está restrito apenas aos países centrais; b as tecnologias de informação permitiram que as subsidiárias no país se integrassem aos laboratórios centrais das ETNs, dando-lhes condições de desenvolver e participar de outras atividades tecnológicas, além das tradicionais funções de adaptação de processo e de produtos.This paper tries to analyze mandates of Transnational Enterprises (TNEs subsidiaries in the foreigner through the mechanisms of allocating activities of R&D (Research and Development between decentralized centers of research. We initiate the work by presenting a synthesis of the different perspectives found in economic literature on the subordination (or conditionings administrative and technological of the subsidiaries. Such synthesis allows us to establish a hierarchy between subsidiaries and a typology for evolution (retrocession of mandates constructed, mainly, for the TNEs that are structuralized in form of a corporative network. Then, from researches on the activities of laboratories of R&D in the

  20. Payment - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment measures – state data. This data set includes state-level data for the payment measures associated with an episode of care for heart attack, heart failure,...

  1. Power and Persuasion in the Vaccine Debates: An Analysis of Political Efforts and Outcomes in the United States, 1998-2012

    Science.gov (United States)

    Lillvis, Denise F; Kirkland, Anna; Frick, Anna

    2014-01-01

    Context This article examines trends in state-level childhood vaccine policies in the United States from 1998 to 2012 and explains the trajectories for both vaccine-critical and proimmunization legislative efforts. Successful mobilization by vaccine critics during the height of the autism and thimerosal scares (roughly 1998 to 2003) yielded a few state-level expansions for the most permissive type of exemption from vaccine mandates for public school attendance, those based on personal beliefs. Vaccine-critical positions, however, have largely become discredited. How has vaccine critics’ ability to advance preferred policies and prevent the passage of unfavorable legislation changed over time? Methods We created a unique data set of childhood vaccine bills (n = 636), introduced from 1998 to 2012 across the 50 state legislatures, and coded them by type of effort (exemption, mandate, mercury ban, and information policies) and outcome. We then mapped out the trends in vaccine policies over time. In order to contextualize the trends we identified, we also reviewed numerous primary sources and conducted interviews with stakeholders. Findings In general, we found that vaccine critics’ legislative success has begun to wane. In only 20 bills in our data set were vaccine critics able to change policy in their preferred direction via the legislative process. Only 5 of those wins were significant (such as obtaining a new philosophical exemption to vaccine mandates), and the last of these was in 2007. Critics were more successful at preventing passage of proimmunization legislation, such as mandates for the human papillomavirus (HPV) vaccine. Conclusions Recent legislation in California, Oregon, and Washington that tightened philosophical exemptions by means of informational requirements suggests that vaccine politics may be entering another phase, one in which immunization supporters may be able to counter increasing opt-out rates, particularly in states with recent

  2. As estratégias de retórica na disputa pela Prefeitura de São Paulo em 2004: PT, mandatário, versus PSDB, desafiante

    Directory of Open Access Journals (Sweden)

    Luciana Fernandes Veiga

    2007-06-01

    Full Text Available A experiência do PT no governo (nos âmbitos nacional e local suscitou a curiosidade sobre possíveis alterações no seu discurso eleitoral na disputa pela Prefeitura de São Paulo. O foco desta análise está nas continuidades e rupturas das estratégias retóricas elaboradas a partir dos eixos ideológico (esquerda e direita e pragmático (mandatário e desafiante. A preocupação central é o discurso do PT, e a análise da comunicação apresentada pelo PSDB tem um caráter complementar. Todos os programas e spots veiculados pelas campanhas do PT e do PSDB em São Paulo foram analisados a partir de métodos qualitativos e quantitativos.The experience of the Worker's Party at the Brazilian national and local governments has estimuladted the curiosity about changings in its electoral discourse at the elections for the São Paulo Mayor. This article focuses on the changes and continuities of rethorical strategieand the analysis is based on campaign 'spots' veiculated by the Worker's Party and the Brazilian Social Democratic Party.

  3. Culture change and mandating quality improvement.

    Science.gov (United States)

    Bartlett, Thomas; Hewertson, Edward; Vassallo, Michael

    2018-01-10

    A mandatory programme of quality improvement (QI) education was developed for newly qualified Foundation Year 1 (FY1) doctors to complete their curriculum requirements. Their perceptions were evaluated to refine the programme. The programme delivered theoretical and experiential learning. Participants were asked to form groups and to come up with their own projects addressing the areas of need that they had identified. The 9-month group project included formal teaching and a formal presentation to the hospital. There was access to facilitation and teaching throughout. Self-rating questionnaires were used to measure the effects of the programme on knowledge and motivation. In a quasi-experimental design, data were compared before and after the programme, and comparison data were collected from the FY1 of the previous year. Across the domains of knowledge, attitudes and motivations, there were no significant differences between the pre-intervention group and the comparison group. Pre- and post-intervention [mean (SD) median] there was a significant increase in overall QI knowledge [2.1 (0.76) 2.0 versus 3.2 (0.62) 3.0; p = 0.000]; however, by the end the FY1s were less motivated to complete the projects [3.9 (0.54) 4.0 versus 3.4 (0.91) 4.0; p = 0.02] and were less positive about them [2.3 (0.69) 2.0 versus 3.0 (0.77) 3.0; p = 0.005]. They felt that the projects were less important for their professional development [3.89 (0.66) 4.0 versus 3.1 (0.73) 3.0; p = 0.000] and were less likely to generate positive change in the long term [2.72 (0.61) 3.0 versus 3.4 (0.92) 3.5; p = 0.007]. Doctors perceptions [of QI] were evaluated to refine a mandatory programme DISCUSSION: Despite delivering a successful theoretical and experiential QI teaching programme with more trainee involvement, the results suggest that mandatory participation for the completion of training risks losing the innovative and creative force of junior doctors and, for some, reducing it to a tick-box exercise. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  4. Counter - Drug: Mandate for the Army.

    Science.gov (United States)

    1991-03-01

    active and reserve forces, and restart the Military Assistance Training Advisor ( MATA ) course at Fort Bragg. (5) Provide positive examples of CONUS...reduced or no charge, and at either US or host country sites. Develop a CONUS-based training course for source country security forces (El Salvador ...JAG Judge Advocate General JRTC Joint Readiness Training Center JTF joint task force LEA law enforcement agency MACOM major Army command MATA Military

  5. Elusive Mandate: UNICEF and Educational Development

    Science.gov (United States)

    Jones, Phillip W.

    2006-01-01

    The United Nations Children's Fund has rapidly gained prominence as a UN agency promoting educational development. Detailed analysis is presented of UNICEF's transition from being a supplier of emergency goods and services, to a humanitarian role that has diversified to embrace development assistance and promoting the rights of children and women.…

  6. Excited states

    CERN Document Server

    Lim, Edward C

    1974-01-01

    Excited States, Volume I reviews radiationless transitions, phosphorescence microwave double resonance through optical spectra in molecular solids, dipole moments in excited states, luminescence of polar molecules, and the problem of interstate interaction in aromatic carbonyl compounds. The book discusses the molecular electronic radiationless transitions; the double resonance techniques and the relaxation mechanisms involving the lowest triplet state of aromatic compounds; as well as the optical spectra and relaxation in molecular solids. The text also describes dipole moments and polarizab

  7. Regulation of firearm dealers in the United States: an analysis of state law and opportunities for improvement.

    Science.gov (United States)

    Vernick, Jon S; Webster, Daniel W; Bulzacchelli, Maria T; Mair, Julie Samia

    2006-01-01

    Firearms were associated with 30, 136 deaths in the United States in 2003. Most guns are initially sold to the public through a network of retail dealers. Licensed firearm dealers are an important source of guns for criminals and gun traffickers. Just one percent of licensed dealers were responsible for more than half of all guns traced to crime. Federal law makes it difficult for ATF to inspect and revoke the licenses of problem gun dealers. State licensing systems, however, are a greatly under-explored opportunity for firearm dealer oversight. We identify and categorize these state systems to identify opportunities for interventions to prevent problem dealers from supplying guns to criminals, juveniles, or gun traffickers. Just seventeen states license gun dealers. Twenty-three states permit routine inspections of dealers but only two mandate that those inspections occur on a regular basis. Twenty-six states impose record-keeping requirements for gun sales. Only thirteen states require some form of store security measures to minimize firearm theft. We conclude with recommendations for a comprehensive system of state licensing and oversight of gun dealers. Our findings can be useful for the coalition of more than fifty U.S. mayors that recently announced it would work together to combat illegal gun trafficking.

  8. Fragile States

    DEFF Research Database (Denmark)

    Holm, Hans-Henrik; Sørensen, Georg; Stohl, Michael

    What does state fragility means and how is it adressed. Case studies of where it went wrong and where it did not......What does state fragility means and how is it adressed. Case studies of where it went wrong and where it did not...

  9. Operações de Paz: novos mandatos e suas implicações para os países contribuintes com tropas * Peace operations: new mandates and their implications for troops contributing countries

    Directory of Open Access Journals (Sweden)

    SÉRGIO LUIZ CRUZ AGUILAR

    2015-03-01

    Full Text Available Resumo: O artigo apresenta as alterações nas operações de paz contemporâneas conduzidas pela Organização das Nações Unidas (ONU e suas implicações para o Brasil. Baseada em bibliografia sobre o assunto e documentos das Nações Unidas o texto apresenta o apoio conceitual e jurídico para a implementação dessas operações e descreve a evolução dos mandatos e do uso da força pelo componente militar. Com base nas alterações recentes, o texto discorre sobre tendências na aprovação e condução das operações e suas implicações para os países contribuintes com tropa. Palavras-chave: Operações de Paz; Nações Unidas; Segurança Internacional. Abstract: The article presents the changes in contemporary peacekeeping operations conducted by the United Nations (UN in a historical perspective and its implications for the troops contributing countries. Based on literature of the subject and UN documents the text presents the conceptual and legal support for the implementation of these operations and describes the evolution of mandates and the use of force by the military component. Based on recent changes, we discuss trends in the approval and conduct of operations and their implications for the troops contributing countries.Keywords: Peace Operations; United Nations; International Security.

  10. Reporting Melanoma: A Nationwide Surveillance of State Cancer Registries

    Directory of Open Access Journals (Sweden)

    Kehinde O. Raji

    2015-01-01

    Full Text Available The goal of our study was to determine current melanoma reporting methods available to dermatologists and dermatopathologists and quantify changes in reporting methods from 2012 to 2014. A cross-sectional study design was utilized consisting of website perusal of reporting procedures, followed up by telephone and email inquiry of reporting methods from every state cancer registry. This study was conducted over a six-month period from February to August 2014. A previous similar survey was conducted in 2012 over the same time frame and results were compared. Kansas state cancer registry provided no data. As of August 2014, 96% of 49 state cancer registries had electronic methods available to all designated reporters. Seven (14% states required an electronic-only method of reporting melanoma cases. Eighty-six percent allowed hard copy pathology report submission. Compared to the 2012 survey, 2 additional states were found to have initiated electronic reporting methods by 2014. In conclusion, a variety of methods exist for reporting diagnosed melanoma cases. Although most state cancer registries were equipped for electronic transmission of cases for mandated reporters, a number of states were ill-equipped for electronic submission from outpatient dermatologists. There was a general trend towards electronic versus nonelectronic reporting from 2012 to 2014.

  11. State laws related to billing third parties for healthcare services at public STD clinics in the United States.

    Science.gov (United States)

    Cramer, Ryan; Loosier, Penny S; Krasner, Andee; Kawatu, Jennifer

    2018-02-07

    Health departments (HDs) cite state laws as barriers to billing third parties for sexually transmitted disease (STD) services, but the association between legal/policy barriers and third party HD billing has not been examined. This study investigates the relationship between laws that may limit HDs' ability to bill, clinic perceptions of billing barriers, and billing practices. Two surveys (1) clinic managers [N=246], 2) STD program managers [N=63]) conducted via a multi-regional needs assessment of federally funded HD clinics' capacity to bill for STD services, billing/reimbursement practices, and perceived barriers were combined with an analysis of state laws regarding third party billing for STD services. Statistical analyses examined relationships between laws that may limit HDs' ability to bill, clinic perceptions, and billing practices. Clinic managers reported clinics were less likely to bill Medicaid and other third parties in jurisdictions with a state law limiting their ability to bill compared to respondents who billed neither or one payer (OR=0.31, CI=0.10,0.97) and cited practical concerns as a primary barrier to billing (OR=2.83 CI=1.50,5.37). STD program managers' reports that staff believed STD services should be free (OR=0.34, CI=0.13, 0.90) was associated with not billing (not sure versus no resistance to billing); confidentiality concerns was not a reported barrier to billing among either sample. Practical concerns and clinic staff beliefs that STD services should be free emerged as possible barriers to billing, and laws less so. Attempts to initiate HD billing for STD services may benefit from staff education as well as addressing perceived legal barriers and staff concerns.

  12. State Antifeminism

    Directory of Open Access Journals (Sweden)

    Francis Dupuis-Déri

    2016-06-01

    Full Text Available ‘State feminism’ is a concept that refers to the integration of feminists and feminist issues into the state apparatus. Yet, while the feminist movement must regularly contend with an antifeminist counter-movement, it is worth considering whether a ‘state antifeminism’ is also present or emerging, and how this presence or emergence is affecting efforts by feminist organizations to address the needs of women and advance women's equality. With this objective in mind, this article focuses chiefly on two Western countries and is based on more than twenty semi-structured interviews with feminists in Belgium and Quebec, Canada.

  13. Use of court-ordered supervised disulfiram therapy at DVA medical centers in the United States.

    Science.gov (United States)

    Martin, Brandon; Mangum, Laura; Beresford, Thomas P

    2005-01-01

    Having reported high adherence to court-mandated disulfiram treatment, we hypothesized that other Department of Veterans Affairs (DVA) medical centers would report frequent use of this modality. Telephone interviews with DVA substance abuse clinics in 48 of the 50 states matched the national DVA frequencies. Phone survey responders reported disulfiram prescription as never/rarely 63%, sometimes 32%, and often 5%, while court-ordered disulfiram was used never/rarely 95%, sometimes 3%, and often 2%. Nationally, disulfiram prescriptions covered only 0.07% of all veterans seen. These data suggest a need for a re-evaluation of disulfiram as an underused treatment for alcohol dependence.

  14. Feasibility of Producing and Using Biomass-Based Diesel and Jet Fuel in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Milbrandt, A. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Kinchin, C. [National Renewable Energy Lab. (NREL), Golden, CO (United States); McCormick, R. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-12-01

    The study summarizes the best available public data on the production, capacity, cost, market demand, and feedstock availability for the production of biomass-based diesel and jet fuel. It includes an overview of the current conversion processes and current state-of-development for the production of biomass-based jet and diesel fuel, as well as the key companies pursuing this effort. Thediscussion analyzes all this information in the context of meeting the RFS mandate, highlights uncertainties for the future industry development, and key business opportunities.

  15. Wireless communication and spectrum sharing for public safety in the United States.

    Science.gov (United States)

    Kapucu, Naim; Haupt, Brittany; Yuksel, Murat

    2016-01-01

    With the vast number of fragmented, independent public safety wireless communication systems, the United States is encountering major challenges with enhancing interoperability and effectively managing costs while sharing limited availability of critical spectrum. The traditional hierarchical approach of emergency management does not always allow for needed flexibility and is not a mandate. A national system would reduce equipment needs, increase effectiveness, and enrich quality and coordination of response; however, it is dependent on integrating the commercial market. This article discusses components of an ideal national wireless public safety system consists along with key policies in regulating wireless communication and spectrum sharing for public safety and challenges for implementation.

  16. State Climatologist

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Quarterly newsletter published by the American Association of State Climatologists. Library includes volumes 1 through 21, for the years 1977-1997.

  17. State Averages

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of a variety of averages for each state or territory as well as the national average, including each quality measure, staffing, fine amount and number of...

  18. Telehealth among US hospitals: several factors, including state reimbursement and licensure policies, influence adoption.

    Science.gov (United States)

    Adler-Milstein, Julia; Kvedar, Joseph; Bates, David W

    2014-02-01

    Telehealth is widely believed to hold great potential to improve access to, and increase the value of, health care. Gaining a better understanding of why some hospitals adopt telehealth technologies while others do not is critically important. We examined factors associated with telehealth adoption among US hospitals. Data from the Information Technology Supplement to the American Hospital Association's 2012 annual survey of acute care hospitals show that 42 percent of US hospitals have telehealth capabilities. Hospitals more likely to have telehealth capabilities are teaching hospitals, those equipped with additional advanced medical technology, those that are members of a larger system, and those that are nonprofit institutions. Rates of hospital telehealth adoption by state vary substantially and are associated with differences in state policy. Policies that promote private payer reimbursement for telehealth are associated with greater likelihood of telehealth adoption, while policies that require out-of-state providers to have a special license to provide telehealth services reduce the likelihood of adoption. Our findings suggest steps that policy makers can take to achieve greater adoption of telehealth by hospitals.

  19. The rise of the regulatory state in health care: a comparative analysis of The Netherlands, England and Italy.

    Science.gov (United States)

    Helderman, Jan-Kees; Bevan, Gwyn; France, George

    2012-01-01

    In a relatively short time, regulation has become a significant and distinct feature of how modern states wish to govern and steer their economy and society. Whereas the former 'dirigiste' state used to be closely related to public ownership (e.g. hospitals), planning (volume and capacity planning) and centralised administration (e.g. fixed prices and budgets), the new regulatory state relies mainly on the instrument of regulation to achieve its objectives. In this paper, we wish to relate the rise of the 'regulatory state' to the path-dependent trajectories and institutional legacies of discrete European health-care systems. For this purpose, we compared the Dutch corporatist social health insurance system, the strongly centralised National Health Service (NHS) of England and federal regionalised NHS system of Italy. Comparing these three different health-care systems suggests that it is indeed possible to identify a general trend towards the rise of the regulatory state in health care in the last two decades. However, although the three countries examined in this paper face similar problems of multilevel governance of networks of third-party payers and providers, each system also gives rise to its own distinct regulatory challenges. © Cambridge University Press 2012

  20. Wellness general of the United States: a creative approach to promote family and community health.

    Science.gov (United States)

    Haber, David

    2002-10-01

    This article offers a creative approach to promote family and community health, beginning with the conversion of the office of Surgeon General of the United States into the Wellness General of the United States. The content ranges from federal initiatives to promote quality health research to individuals and families who will be the beneficiaries at medical clinics and community health programs. The proposal recommends changes to institutions and policies, including junk food taxes, the National Institutes of Health, the United States Preventive Services Task Force, the Healthy People 2010 initiative, the Health Plan Employer Data and Information Set, the Medicare Coverage Advisory Committee, state health mandates, local health plans, community medical clinics, and community health programs. The goal is to stimulate ideas and actions among policymakers, researchers, practitioners, educators, and students.

  1. 32 CFR 220.5 - Records available.

    Science.gov (United States)

    2010-07-01

    ... to representatives of any third party payer from which the United States seeks payment under 10 U.S.C... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.5 Records available...

  2. State Treasure

    Science.gov (United States)

    Olson, Cathy Applefeld

    2013-01-01

    When a music teacher is named Teacher of the Year for an entire state, one just know a special story awaits. The narrative of Heidi Welch, director of music at Hillsboro-Deering High School in New Hampshire, does not disappoint. Welch, who grew up in abject poverty and was often homeless, developed her love of music through memorizing and singing…

  3. FAILED STATE

    African Journals Online (AJOL)

    Dr. Miles R. Cone

    communications infrastructure, education, medical and social services, water, energy and environmental protection. The extent to which ... context and continuous dependency (Doornbos, 1990: 180). In an economic sense ... important aspects of contemporary European state theory to Africa. Doctrines concerned with the ...

  4. Can hepatitis C be eradicated in the United States?

    Science.gov (United States)

    Edlin, Brian R; Winkelstein, Emily R

    2014-10-01

    The advent of highly effective antiviral regimens will make the eradication of hepatitis C in high-income countries such as the United States technically feasible. But eradicating hepatitis C will require escalating our response to the epidemic in key domains, including surveillance and epidemiology, prevention, screening, care and treatment, policy, research, and advocacy. Surveillance must be nimble enough to quickly assess the magnitude of new transmission patterns as they emerge. Basic prevention strategies - community-based outreach and education, testing and counseling, and access to sterile injection equipment and opioid substitution therapies - must be scaled up and adapted to target groups in which new epidemics are emerging. All adults should be screened for hepatitis C, but special efforts must focus on groups with increased prevalence through community outreach and rapid testing. Government, industry, and payers must work together to assure full access to health services and antiviral drugs for everyone who is infected. Access to the new regimens must not be compromised by excessively high prices or arbitrary payer restrictions. Partnerships must be forged between hepatitis providers and programs that serve people who inject illicit drugs. Healthcare providers and systems, especially primary care practitioners, need education and training in treating hepatitis C and caring for substance-using populations. Services must be provided to the disadvantaged and stigmatized members of society who bear a disproportionate burden of the epidemic. Environments must be created where people who use drugs can receive prevention and treatment services without shame or stigma. Action is needed to end the policy of mass incarceration of people who use drugs, reduce the stigma associated with substance use, support the human rights of people who use drugs, expand social safety net services for the poor and the homeless, remove the legal barriers to hepatitis C prevention

  5. State prescription drug price Web sites: how useful to consumers?

    Science.gov (United States)

    Tu, Ha T; Corey, Catherine G

    2008-02-01

    To aid consumers in comparing prescription drug costs, many states have launched Web sites to publish drug prices offered by local retail pharmacies. The current push to make retail pharmacy prices accessible to consumers is part of a much broader movement to increase price transparency throughout the health-care sector. Efforts to encourage price-based shopping for hospital and physician services have encountered widespread concerns, both on grounds that prices for complex services are difficult to measure and compare accurately and that quality varies substantially across providers. Experts agree, however, that prescription drugs are much easier to shop for than other, more complex health services. However, extensive gaps in available price information--the result of relying on Medicaid data--seriously hamper the effectiveness of state drug price-comparison Web sites, according to a new study by the Center for Studying Health System Change (HSC). An alternative approach--requiring pharmacies to submit price lists to the states--would improve the usefulness of price information, but pharmacies typically oppose such a mandate. Another limitation of most state Web sites is that price information is restricted to local pharmacies, when online pharmacies, both U.S. and foreign, often sell prescription drugs at substantially lower prices. To further enhance consumer shopping tools, states might consider expanding the types of information provided, including online pharmacy comparison tools, lists of deeply discounted generic drugs offered by discount retailers, and lists of local pharmacies offering price matches.

  6. Reform and the politics of hybridization in mature health care states.

    Science.gov (United States)

    Tuohy, Carolyn Hughes

    2012-08-01

    This article examines the cases of three health care states -- two of which (Britain and the Netherlands) have undergone major policy reform and one of which (Canada) has experienced only marginal adjustments. The British and Dutch reforms have variously altered the balance of power, the mix of instruments of control, and the organizing principles. As a result, mature systems representing the ideal-typical health care state categories of national health systems and social insurance (Britain and the Netherlands, respectively) were transformed into distinctive national hybrids. These processes have involved a politics of redesign that differs from the politics of earlier phases of establishment and retrenchment. In particular, the redesign phase is marked by the activity of institutional entrepreneurs who exploit specific opportunities afforded by public programs to combine public and private resources in innovative organizational arrangements. Canada stands as a counterpoint: no window of opportunity for major change occurred, and the bilateral monopoly created by its prototypical single-payer model provided few footholds for entrepreneurial activity. The increased significance of institutional entrepreneurs gives greater urgency to one of the central projects of health policy: the design of accountability frameworks to allow for an assessment of performance against objectives.

  7. A three-state kinetic agent-based model to analyze tax evasion dynamics

    Science.gov (United States)

    Crokidakis, Nuno

    2014-11-01

    In this work we study the problem of tax evasion on a fully-connected population. For this purpose, we consider that the agents may be in three different states, namely honest tax payers, tax evaders and undecided, that are individuals in an intermediate class among honests and evaders. Every individual can change his/her state following a kinetic exchange opinion dynamics, where the agents interact by pairs with competitive negative (with probability q) and positive (with probability 1-q) couplings, representing agreement/disagreement between pairs of agents. In addition, we consider the punishment rules of the Zaklan econophysics model, for which there is a probability pa of an audit each agent is subject to in every period and a length of time k detected tax evaders remain honest. Our results suggest that below the critical point qc=1/4 of the opinion dynamics the compliance is high, and the punishment rules have a small effect in the population. On the other hand, for q>qc the tax evasion can be considerably reduced by the enforcement mechanism. We also discuss the impact of the presence of the undecided agents in the evolution of the system.

  8. State of the States 2016: Arts Education State Policy Summary

    Science.gov (United States)

    Aragon, Stephanie

    2016-01-01

    The "State of the States 2016" summarizes state policies for arts education identified in statute or administrative code for all 50 states and the District of Columbia. Information is based on a comprehensive search of state education statute and codes on each state's relevant websites. Complete results from this review are available in…

  9. United States Holocaust Museums: Pathos, Possession, Patriotism

    Directory of Open Access Journals (Sweden)

    Rob Baum

    2011-12-01

    Full Text Available This article examines the role of United States holocaust museums in directing (American knowledge and memory of World War II, and demonstrates how signifiers of race, colour and Jewishness are played out and theatricalised. Erected in two principal U.S. cities of Los Angeles and Washington, D.C., the Holocaust Museum and Museum of Tolerance uphold very different mandates: the first dedicated to revealing European civilian tragedies during WWII; the latter dealing with Jewish persecution and the L.A. Riots of 1991, with references to other cultural catastrophes. While these projects are different, they are not opposed; both museums locate the American perspective of events and their meanings at the forefront. American holocaust museums seem to challenge spaces between memory and its direction, vision and revision. Within the gruesome context of holocaust portrayal, interrogate the valences of memory’s play and expose American holocaust museums as theatres of pornographic memory. The seduction of feeling does not invite change so much as purgation, what Aristotle identified as catharsis — an emotional and physical release, unfortunately replicating the seductive techniques used by Goebbels for the glorification of Hitler. Through manipulation of viewers as automatic audiences, these museums function as centres for pathos I question the policy and polity of presenting genocide as an entertainment leading to catharsis, recognizing that the final act of purgation is all too easily negation.

  10. Synopsis of the history of sea otter conservation in the United States

    Science.gov (United States)

    VanBlaricom, Glenn R.

    2015-01-01

    In the late 1860s, declining US sea otter populations elicited concern because of prior excessive harvests. Congress mandated protection of Alaskan sea otters in 1868, but hunting continued unrestrained. The Fur Seal Treaty of 1911 (abrogated in 1941) protected sea otters in international waters, but was not applicable to most sea otter habitats and failed to terminate all legal sea otter harvests. Between 1941 and 1972 only the State of California was consistently engaged in sea otter conservation, based on a 1913 state law. Trends in cultural values toward protection of species based on imperiled status rather than economics led to the Marine Mammal Protection Act (1972), giving sea otters unambiguous protection in all US territorial waters. Sea otter habitat protection by the US government began in the 1890s. State marine protected areas potentially support sea otter conservation, particularly when paired with adjacent federal protected entities in or near sea otter habitat.

  11. Association between U.S. state AIDS Drug Assistance Program (ADAP features and HIV antiretroviral therapy initiation, 2001-2009.

    Directory of Open Access Journals (Sweden)

    David B Hanna

    Full Text Available U.S. state AIDS Drug Assistance Programs (ADAPs are federally funded to provide antiretroviral therapy (ART as the payer of last resort to eligible persons with HIV infection. States differ regarding their financial contributions to and ways of implementing these programs, and it remains unclear how this interstate variability affects HIV treatment outcomes.We analyzed data from HIV-infected individuals who were clinically-eligible for ART between 2001 and 2009 (i.e., a first reported CD4+ <350 cells/uL or AIDS-defining illness from 14 U.S. cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD. Using propensity score matching and Cox regression, we assessed ART initiation (within 6 months following eligibility and virologic suppression (within 1 year based on differences in two state ADAP features: the amount of state funding in annual ADAP budgets and the implementation of waiting lists. We performed an a priori subgroup analysis in persons with a history of injection drug use (IDU.Among 8,874 persons, 56% initiated ART within six months following eligibility. Persons living in states with no additional state contribution to the ADAP budget initiated ART on a less timely basis (hazard ratio [HR] 0.73, 95% CI 0.60-0.88. Living in a state with an ADAP waiting list was not associated with less timely initiation (HR 1.12, 95% CI 0.87-1.45. Neither additional state contributions nor waiting lists were significantly associated with virologic suppression. Persons with an IDU history initiated ART on a less timely basis (HR 0.67, 95% CI 0.47-0.95.We found that living in states that did not contribute additionally to the ADAP budget was associated with delayed ART initiation when treatment was clinically indicated. Given the changing healthcare environment, continued assessment of the role of ADAPs and their features that facilitate prompt treatment is needed.

  12. United States

    Directory of Open Access Journals (Sweden)

    Stephen Bernow

    1998-12-01

    Full Text Available This paper presents and discusses an integrated set of policies designed to reduce U.S. carbon emissions over the next four decades. This innovation path also aims to promote environmental quality, particularly by reducing emissions of criteria air pollutants, to reduce U.S. dependence on imported oil, and to induce technological innovation and diffusion in energy production and consumption. The innovation path would reduce economy-wide carbon emissions by 26% below baseline projections for 2010 and by 62% below baseline projections for 2030; this translates into 10% below 1990 levels in 2010 and 45% below 1990 levels in 2030. Emissions of criteria pollutants also would be significantly reduced, as would petroleum imports by the United States. Moreover, the innovation path would yield cumulative net savings for the United States of $218 billion (1993 dollars through 2010, or $19 billion on a leveled annual basis, and would result in 800,000 additional jobs nationwide by 2010. Although the overall findings from the innovation path analysis are robust, the results should be taken as indicative, rather than precisely predictive, owing to uncertainties in future costs, prices, technology performance, and consumer behavior.

  13. State of the States, 2012: Arts Education State Policy Summary

    Science.gov (United States)

    Arts Education Partnership (NJ1), 2012

    2012-01-01

    The "State of the States 2012" summarizes state policies for arts education identified in statute or code for all 50 states and the District of Columbia. Information is based primarily on results from the AEP Arts Education State Policy Survey conducted in 2010-11, and updated in April 2012.

  14. Implementation of state solar incentives: a preliminary assessment

    Energy Technology Data Exchange (ETDEWEB)

    Ashworth, J.; Green, B.; Pollock, P.; Odland, R.; Saltonstall, R.; Perelman, L.J.

    1979-01-01

    This paper reports the findings of a six-month pilot project designed to gather, analyze, and disseminate information on the operation of state incentives for solar energy. The primary purpose of this report is to provide timely and practical information on the lessons learned from and the problems encountered to date in state incentive programs for solar energy diffusion, adoption, and commercialization. The secondary intent of this SERI program is to identify those research areas within the broad spectrum of implementation experience which require more-extensive future examination to improve the effectiveness of state solar energy incentive programs. The focus of this study is the implementation of official state solar energy incentives programs. Questions of incentive design and program effectiveness are addressed in certain portions of the text, but the bulk of the research effort is directed toward examining how laws and legislative mandates have been transformed into rules, regulations, eligibility criteria, standards, comprehensive land-use plans, grants, tax deductions, and demonstration projects. Most of the programs discussed will be official governmental actions, although the roles of private groups, advisory councils, and universities are addressed. Programs were examined in Arizona, California, Florida, Maine, Massachusetts, Minnesota, Montana, New Mexico, and Oregon. (MCW)

  15. Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception.

    Science.gov (United States)

    Trussell, James; Henry, Nathaniel; Hassan, Fareen; Prezioso, Alexander; Law, Amy; Filonenko, Anna

    2013-02-01

    This study evaluated the total costs of unintended pregnancy (UP) in the United States (US) from a third-party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all women requiring reversible contraception in the US: the pattern of contraceptive use and the rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. Annual medical costs of UP in the United States were estimated to be $4.6 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20-29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. Imperfect contraceptive adherence leads to substantial UP and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

    Science.gov (United States)

    Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

    2014-09-01

    In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers

  17. Universal health insurance that really works: foreign lessons for the United States.

    Science.gov (United States)

    Glaser, W A

    1993-01-01

    The United States has serious and worsening problems in the delivery and financing of health. The debate about reform has inspired many schemes that are persuasive in their presentation, but they are unrealistic: some cannot be enacted by Congress, others would not improve existing arrangements, most are imaginary inventions with uncertain outcomes. The most politically prudent and the most effective course is to emulate the methods used successfully and available for full analysis in other developed countries. America created its successful social security system in this fashion, and statutory health insurance should be added now. All or most groups would be required to join. Financing would come from social security payroll taxes, supplemented by government subsidies. Basic acute care services would be equally available to all. The existing insurance companies would remain as fiscal intermediaries. Doctors and hospitals would continue to work much as they do now. They would prosper from more utilization, few bad debts, and less administrative trouble. The payment and work of doctors would be governed by collective negotiations between the insurance carriers and the medical associations. The payment and work of hospitals would be governed by a mixture of government regulations and negotiations with the carriers. Costs would be controlled by coordinated decision making by the payers, the providers, and government. The system would not turn over services and financing to government.

  18. Dietary supplements quality analysis tools from the United States Pharmacopeia.

    Science.gov (United States)

    Sarma, Nandakumara; Giancaspro, Gabriel; Venema, Jaap

    2016-01-01

    The United States Food and Drug Administration (FDA) issued the dietary supplement (DS) current good manufacturing practice (GMP) regulations in compliance with the mandate from the Dietary Supplements Health and Education Act (DSHEA), with the intention of protecting public health by ensuring the quality of DS. The GMP regulations require manufacturers to establish their own quality specifications for identity, purity, strength, composition, and absence of contaminants. Numerous FDA-conducted GMP inspections found that the private specifications set by these manufacturers are often insufficient to ensure adequate quality of dietary ingredients and DS. Wider use of the public standards developed by the United States Pharmacopeial Convention (USP), in conjunction with GMP compliance, can help ensure quality and consistency of DS as they do for medicines. Public health protection could be enhanced by strengthening the GMP provisions to require conformance with relevant United States Pharmacopeia-National Formulary (USP-NF) standards, or in the absence of USP standards, other public compendial standards. Another serious concern is the presence of synthetic drugs and drug analogues in products marketed as DS. Use of the new USP General Chapter Adulteration of Dietary Supplements with Drugs and Drug Analogs may reduce the exposure of consumers to dangerous drugs disguised as DS. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  19. Use patterns of a state health care price transparency web site: what do patients shop for?

    Science.gov (United States)

    Mehrotra, Ateev; Brannen, Tyler; Sinaiko, Anna D

    2014-01-01

    To help people shop for lower cost providers, several states have created their own price transparency Web sites or passed legislation mandating health plans provide such information. New Hampshire's HealthCost Web site is on the forefront of such initiatives. Despite the growing interest in price transparency, little is known about such efforts, including how often these tools are used and for what reason. We examined the use of New Hampshire HealthCost over a 3-year period. Approximately 1% of the state's residents used the Web site, and the most common searches were for outpatient visits, magnetic resonance imaging (MRI) or computed tomography (CT) scans, and emergency department visits. The results provide a cautionary note on the level of potential interest among consumers in this information but may guide others on practically what are the most "shop-able" services for patients. © The Author(s) 2014.

  20. Overview of contact lens postmarket surveillance in the United States: system and recent study results.

    Science.gov (United States)

    Chalmers, Robin L; Gleason, William

    2013-01-01

    This is an overview of the US contact lens (CL) postmarket surveillance systems and surveillance study results that include silicone hydrogel CLs. As 30-night continuous wear silicone hydrogel and rigid gas-permeable (RGP) CLs were approved for use in the United States in 2001, the Food and Drug Administration (FDA) mandated large postmarket surveillance studies to assess the risk of microbial keratitis with those products when worn with the 30-night wearing schedule. Since the time of the approvals, RGP 30-night wear has been used sparingly and a shift from 30-night wear has occurred for silicone hydrogel lenses. Several silicone hydrogel lenses have been approved and most of these lenses are being prescribed for daily or flexible wear and not for 30-night wear. With daily wear and less overnight use, silicone hydrogel lenses are regularly exposed to lens care products, lens cases, and improper handling, all of which may introduce sources of microbial contamination that could trigger lens-related complications. This summary of CL postmarket surveillance system and methods gives results of FDA-mandated surveillance and of recent US studies that observed "real-world" populations for safety results outside the bounds of highly controlled prospective clinical trials.

  1. Assessment of energy research, development, and demonstration priorities for New York State. Interim report. Volume I

    Energy Technology Data Exchange (ETDEWEB)

    Allentuck, J; Appleman, J; Carroll, T O; Palmedo, P F; Nathans, R

    1977-11-01

    In compliance with its mandate to accelerate the development and use of energy technologies in furtherance of the state's economic growth and the best interests of its population, the New York State Energy Research and Development Authority (NYSERDA) initiated, in March 1977, an assessment of energy research and development priorities. This report presents a view of the energy supply-demand future of the state, and the ways in which this future can be affected by external contingencies and concerted policies. That view takes into consideration energy supplies that may be available to the state as well as energy demands as they are affected by demographic and economic changes within the state. Also included are the effects of national energy policies and technological developments as they modify both supplies and demands in New York State. Finally, this report proceeds to identify those general technological areas in which the Authority's program can be of greatest potential benefit to the state's social and economic well being. This effort aims at a cost/benefit analysis determination of RD and D priorities. The preliminary analysis thus far indicates these areas as being of highest priority: energy conservation in buildings (promotion and execution of RD and D) and industry; district heating; fuel cell demonstration;solar heating and cooling (analysis, demonstration, and information dissemination); energy-environment interaction (analysis); energy information services; and, in general, the attraction of Federal RD and D programs to the state.

  2. Utilizing GIS to Examine the Relationship Between State Renewable Portfolio Standards and the Adoption of Renewable Energy Technologies

    Directory of Open Access Journals (Sweden)

    Chelsea Schelly

    2013-12-01

    Full Text Available In the United States, there is no comprehensive energy policy at the federal level. To address issues as diverse as climate change, energy security, and economic development, individual states have increasingly implemented Renewable Portfolio Standards (RPSs, which mandate that utility providers include a specified amount of electricity from renewable energy sources in their total energy portfolios. Some states have included incentives for individual energy technologies in their RPS, such as solar electric (also called photovoltaic or PV technology. Here, we use GIS to visualize adoption of RPSs and electricity generation from renewable energy sources in the US and examine changes in renewable electricity and solar electric generation over time with the goal of informing future policies aimed at promoting the adoption of renewable energy technologies.

  3. An Evaluation of the Cybersecurity Policies for the United States Health & Human Services Department: Criteria, Regulations, and Improvements

    Directory of Open Access Journals (Sweden)

    Derek Mohammed

    2014-04-01

    Full Text Available This paper examines the criteria necessary for the evaluation of the cybersecurity policies for the United States Health and Human Services Department of the Federal Government. The overall purpose of cybersecurity policies and procedures is supported through compliance with Federal mandated regulation and standards, which serve to protect the organizational services and goals of the United States Health and Human Services Department, and to promote the best possible security practices in the protection of information systems from unauthorized actors and cyber-threats. The criteria of the cybersecurity evaluation is identified and analyzed for quality, strengths, weaknesses, and future applicability. Topics within the criteria include organizational operation, regulations and industrial standards compliance, service delivery to national customers, and the prevention and mitigation of IT system and security failure. This analysis determines the strengths and weaknesses, and makes recommendations for revising the cybersecurity policies within the United States Health and Human Services Department.

  4. Estimate of the direct and indirect annual cost of bacterial conjunctivitis in the United States.

    Science.gov (United States)

    Smith, Andrew F; Waycaster, Curtis

    2009-11-25

    The aim of this study was to estimate both the direct and indirect annual costs of treating bacterial conjunctivitis (BC) in the United States. This was a cost of illness study performed from a U.S. healthcare payer perspective. A comprehensive review of the medical literature was supplemented by data on the annual incidence of BC which was obtained from an analysis of the National Ambulatory Medical Care Survey (NAMCS) database for the year 2005. Cost estimates for medical visits and laboratory or diagnostic tests were derived from published Medicare CPT fee codes. The cost of prescription drugs was obtained from standard reference sources. Indirect costs were calculated as those due to lost productivity. Due to the acute nature of BC, no cost discounting was performed. All costs are expressed in 2007 U.S. dollars. The number of BC cases in the U.S. for 2005 was estimated at approximately 4 million yielding an estimated annual incidence rate of 135 per 10,000. Base-case analysis estimated the total direct and indirect cost of treating patients with BC in the United States at $ 589 million. One- way sensitivity analysis, assuming either a 20% variation in the annual incidence of BC or treatment costs, generated a cost range of $ 469 million to $ 705 million. Two-way sensitivity analysis, assuming a 20% variation in both the annual incidence of BC and treatment costs occurring simultaneously, resulted in an estimated cost range of $ 377 million to $ 857 million. The economic burden posed by BC is significant. The findings may prove useful to decision makers regarding the allocation of healthcare resources necessary to address the economic burden of BC in the United States.

  5. Estimate of the direct and indirect annual cost of bacterial conjunctivitis in the United States

    Directory of Open Access Journals (Sweden)

    Smith Andrew F

    2009-11-01

    Full Text Available Abstract Background The aim of this study was to estimate both the direct and indirect annual costs of treating bacterial conjunctivitis (BC in the United States. This was a cost of illness study performed from a U.S. healthcare payer perspective. Methods A comprehensive review of the medical literature was supplemented by data on the annual incidence of BC which was obtained from an analysis of the National Ambulatory Medical Care Survey (NAMCS database for the year 2005. Cost estimates for medical visits and laboratory or diagnostic tests were derived from published Medicare CPT fee codes. The cost of prescription drugs was obtained from standard reference sources. Indirect costs were calculated as those due to lost productivity. Due to the acute nature of BC, no cost discounting was performed. All costs are expressed in 2007 U.S. dollars. Results The number of BC cases in the U.S. for 2005 was estimated at approximately 4 million yielding an estimated annual incidence rate of 135 per 10,000. Base-case analysis estimated the total direct and indirect cost of treating patients with BC in the United States at $ 589 million. One- way sensitivity analysis, assuming either a 20% variation in the annual incidence of BC or treatment costs, generated a cost range of $ 469 million to $ 705 million. Two-way sensitivity analysis, assuming a 20% variation in both the annual incidence of BC and treatment costs occurring simultaneously, resulted in an estimated cost range of $ 377 million to $ 857 million. Conclusion The economic burden posed by BC is significant. The findings may prove useful to decision makers regarding the allocation of healthcare resources necessary to address the economic burden of BC in the United States.

  6. Estimate of the direct and indirect annual cost of bacterial conjunctivitis in the United States

    Science.gov (United States)

    2009-01-01

    Background The aim of this study was to estimate both the direct and indirect annual costs of treating bacterial conjunctivitis (BC) in the United States. This was a cost of illness study performed from a U.S. healthcare payer perspective. Methods A comprehensive review of the medical literature was supplemented by data on the annual incidence of BC which was obtained from an analysis of the National Ambulatory Medical Care Survey (NAMCS) database for the year 2005. Cost estimates for medical visits and laboratory or diagnostic tests were derived from published Medicare CPT fee codes. The cost of prescription drugs was obtained from standard reference sources. Indirect costs were calculated as those due to lost productivity. Due to the acute nature of BC, no cost discounting was performed. All costs are expressed in 2007 U.S. dollars. Results The number of BC cases in the U.S. for 2005 was estimated at approximately 4 million yielding an estimated annual incidence rate of 135 per 10,000. Base-case analysis estimated the total direct and indirect cost of treating patients with BC in the United States at $ 589 million. One- way sensitivity analysis, assuming either a 20% variation in the annual incidence of BC or treatment costs, generated a cost range of $ 469 million to $ 705 million. Two-way sensitivity analysis, assuming a 20% variation in both the annual incidence of BC and treatment costs occurring simultaneously, resulted in an estimated cost range of $ 377 million to $ 857 million. Conclusion The economic burden posed by BC is significant. The findings may prove useful to decision makers regarding the allocation of healthcare resources necessary to address the economic burden of BC in the United States. PMID:19939250

  7. Human papillomavirus (HPV), HPV-associated oropharyngeal cancer, and HPV vaccine in the United States--do we need a broader vaccine policy?

    Science.gov (United States)

    Osazuwa-Peters, N

    2013-11-12

    Human papillomavirus (HPV) is a sexually transmitted infection (STI) of global importance; it is the most prevalent STI in the United States, with strains causally linked to oropharyngeal and other cancers. Efforts to prevent HPV have been made to varying degrees by policies implemented by different state governments; however, HPV and associated oropharyngeal cancer continue to show increasing incidence rates in the US. A narrative review based on search on SciVerse, PubMed/Medline, Google Scholar, and EMBASE databases, as well as literature/documents from the World Health Organization, Centers for Disease Control and Prevention, American Cancer Society, National Conference of State legislatures, and the U.S. Department of Health and Human Services relevant to HPV and HPV vaccine policy in the US. Vaccination has proved to be a successful policy in the US, and an extant recommendation aimed at preventing HPV and associated cervical and other anogenital cancers is the routine use of HPV vaccines for males and females. However, HPV vaccines are presently not recommended for preventing oropharyngeal cancer, although they have been shown to be highly effective against the HPV strains that are most commonly found in the oropharynx. And while there is a history of successful vaccine mandate in the US with resulting decrease in occurrence of infectious diseases, implementing HPV vaccine mandate has proved to be very unpopular. With emerging evidence of the efficacy of the use of the HPV vaccine in preventing oral-HPV, more focus should be put on extending HPV vaccine to present oral HPV infection and oropharyngeal cancer. Also, implementing a broader HPV vaccine policy that include mandating HPV vaccines as a school-entry requirement for both sexes may increase vaccine use in the US for the greater good of the public. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Sweeping the State Space

    DEFF Research Database (Denmark)

    Mailund, Thomas

    The thesis describes the sweep-line method, a newly developed reduction method for alleviating the state explosion problem inherent in explicit-state state space exploration. The basic idea underlying the sweep-line method is, when calculating the state space, to recognise and delete states...... that are not reachable from the currently unprocessed states. Intuitively we drag a sweep-line through the state space with the invariant that all states behind the sweep-line have been processed and are unreachable from the states in front of the sweep-line. When calculating the state space of a system we iteratively...

  9. Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending.

    Science.gov (United States)

    Wouters, Olivier J; Kanavos, Panos G; McKEE, Martin

    2017-09-01

    Policy Points: Our study indicates that there are opportunities for cost savings in generic drug markets in Europe and the United States. Regulators should make it easier for generic drugs to reach the market. Regulators and payers should apply measures to stimulate price competition among generic drugmakers and to increase generic drug use. To meaningfully evaluate policy options, it is important to analyze historical context and understand why similar initiatives failed previously. Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. We compared generic drug prices and market shares in 13 European countries, using data from 2013, to assess the amount of variation that exists between countries. To place these results in context, we reviewed evidence from recent studies on the prices and use of generics in Europe and the United States. We also surveyed peer-reviewed studies, gray literature, and books published since 2000 to (1) outline existing generic drug policies in European countries and the United States; (2) identify ways to increase generic drug use and to promote price competition among generic drug companies; and (3) explore barriers to implementing reform of generic drug policies, using a historical example from the United States as a case study. The prices and market shares of generics vary widely across Europe. For example, prices charged by manufacturers in Switzerland are, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. The proportion of prescriptions filled with generics ranges from 17% in Switzerland to 83% in the United Kingdom. By comparison, the United States has historically had low generic drug prices and high rates of generic drug use (84% in 2013), but has in recent years experienced sharp price increases for some off-patent products. There are policy

  10. State Variations in United States Divorce Rates

    Science.gov (United States)

    Fenelon, Bill

    1971-01-01

    The "frontier atmosphere" explanation of high divorce rates in western areas of the United States was partially vindicated when comparisons were made between divorce rates in states having high migration rates and lower social costs with those states having low migration rates and higher social costs. (Author/CG)

  11. A Comprehensive Analysis of High School Genetics Standards: Are States Keeping Pace with Modern Genetics?

    Science.gov (United States)

    Dougherty, M.J.; Pleasants, C.; Solow, L.; Wong, A.; Zhang, H.

    2011-01-01

    Science education in the United States will increasingly be driven by testing and accountability requirements, such as those mandated by the No Child Left Behind Act, which rely heavily on learning outcomes, or “standards,” that are currently developed on a state-by-state basis. Those standards, in turn, drive curriculum and instruction. Given the importance of standards to teaching and learning, we investigated the quality of life sciences/biology standards with respect to genetics for all 50 states and the District of Columbia, using core concepts developed by the American Society of Human Genetics as normative benchmarks. Our results indicate that the states’ genetics standards, in general, are poor, with more than 85% of the states receiving overall scores of Inadequate. In particular, the standards in virtually every state have failed to keep pace with changes in the discipline as it has become genomic in scope, omitting concepts related to genetic complexity, the importance of environment to phenotypic variation, differential gene expression, and the differences between inherited and somatic genetic disease. Clearer, more comprehensive genetics standards are likely to benefit genetics instruction and learning, help prepare future genetics researchers, and contribute to the genetic literacy of the U.S. citizenry. PMID:21885828

  12. The US Opioid Crisis: Current Federal and State Legal Issues.

    Science.gov (United States)

    Soelberg, Cobin D; Brown, Raeford E; Du Vivier, Derick; Meyer, John E; Ramachandran, Banu K

    2017-11-01

    The United States is in the midst of a devastating opioid misuse epidemic leading to over 33,000 deaths per year from both prescription and illegal opioids. Roughly half of these deaths are attributable to prescription opioids. Federal and state governments have only recently begun to grasp the magnitude of this public health crisis. In 2016, the Centers for Disease Control and Prevention released their Guidelines for Prescribing Opioids for Chronic Pain. While not comprehensive in scope, these guidelines attempt to control and regulate opioid prescribing. Other federal agencies involved with the federal regulatory effort include the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), and the Department of Justice. Each federal agency has a unique role in helping to stem the burgeoning opioid misuse epidemic. The DEA, working with the Department of Justice, has enforcement power to prosecute pill mills and physicians for illegal prescribing. The DEA could also implement use of prescription drug monitoring programs (PDMPs), currently administered at the state level, and use of electronic prescribing for schedule II and III medications. The FDA has authority to approve new and safer formulations of immediate- and long-acting opioid medications. More importantly, the FDA can also ask pharmaceutical companies to cease manufacturing a drug. Additionally, state agencies play a critical role in reducing overdose deaths, protecting the public safety, and promoting the medically appropriate treatment of pain. One of the states' primary roles is the regulation of practice of medicine and the insurance industry within their borders. Utilizing this authority, states can both educate physicians about the dangers of opioids and make physician licensure dependent on registering and using PDMPs when prescribing controlled substances. Almost every state has implemented a PDMP to some degree; however, in addition to mandating their use, increased interstate

  13. Nationwide trends of hospital admissions for acute cholecystitis in the United States

    Science.gov (United States)

    Wadhwa, Vaibhav; Jobanputra, Yash; Garg, Sushil K; Patwardhan, Soumil; Mehta, Dhruv

    2017-01-01

    Background and aims: Acute cholecystitis is a fairly common inpatient diagnosis among the gastrointestinal disorders. The aim of this study was to use a national database of US hospitals to evaluate the incidence and costs of hospital admissions associated with acute cholecystitis. Method: We analyzed the National Inpatient Sample Database (NIS) for all patients in which acute cholecystitis (ICD-9 codes: 574.00, 574.01, 574.30, 574.31, 574.60, 574.61 or 575.0) was the principal discharge diagnosis from 1997 to 2012. The NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, lengths of stay and associated hospital costs over the study period was determined by using the Chi-square test for trends. Results: In 1997, there were 149 661 hospital admissions with a principal discharge diagnosis of acute cholecystitis, which increased to 215 995 in 2012 ( P acute cholecystitis decreased by 17% between 1997 and 2012 (i.e. from 4.7 days to 3.9 days; (P acute cholecystitis has increased significantly in the United States over the last 16 years, along with a great increase in the associated hospital charges. However, there has been a gradual decline in the mean length of stay. Inpatient costs associated with acute cholecystitis contribute significantly to the total healthcare bill. Further research on cost-effective evaluation and management of acute cholecystitis is required. PMID:27174434

  14. AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for United States Coast Guard Headquarters

    Energy Technology Data Exchange (ETDEWEB)

    Schey, Stephen [Idaho National Lab. (INL), Idaho Falls, ID (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-05-01

    Federal agencies are mandated to purchase alternative fuel vehicles, increase consumption of alternative fuels, and reduce petroleum consumption. Available plug-in electric vehicles (PEVs) provide an attractive option in the selection of alternative fuel vehicles. PEVs, which consist of both battery electric vehicles (BEVs) and plug-in hybrid electric vehicles (PHEVs), have significant advantages over internal combustion engine (ICE) vehicles in terms of energy efficiency, reduced petroleum consumption, and reduced production of greenhouse gas (GHG) emissions, and they provide performance benefits with quieter, smoother operation. This study intended to evaluate the extent to which the United States Coast Guard Headquarters (USCG HQ) could convert part or all of their fleet of vehicles from petroleum-fueled vehicles to PEVs.

  15. Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States, 2000–2010

    Science.gov (United States)

    O’Keefe, Eileen B.; Meltzer, Jeremy P.; Bethea, Traci N.

    2015-01-01

    Declining cancer incidence and mortality rates in the United States (U.S.) have continued through the first decade of the twenty-first century. Reductions in tobacco use, greater uptake of prevention measures, adoption of early detection methods, and improved treatments have resulted in improved outcomes for both men and women. However, Black Americans continue to have the higher cancer mortality rates and shorter survival times. This review discusses and compares the cancer mortality rates and mortality trends for Blacks and Whites. The complex relationship between socioeconomic status and race and its contribution to racial cancer disparities is discussed. Based on current trends and the potential and limitations of the patient protection and affordable care act with its mandate to reduce health care inequities, future trends, and challenges in cancer mortality disparities in the U.S. are explored. PMID:25932459

  16. Use Patterns of a State Health Care Price Transparency Web Site

    Directory of Open Access Journals (Sweden)

    Ateev Mehrotra MD

    2014-12-01

    Full Text Available To help people shop for lower cost providers, several states have created their own price transparency Web sites or passed legislation mandating health plans provide such information. New Hampshire’s HealthCost Web site is on the forefront of such initiatives. Despite the growing interest in price transparency, little is known about such efforts, including how often these tools are used and for what reason. We examined the use of New Hampshire HealthCost over a 3-year period. Approximately 1% of the state’s residents used the Web site, and the most common searches were for outpatient visits, magnetic resonance imaging (MRI or computed tomography (CT scans, and emergency department visits. The results provide a cautionary note on the level of potential interest among consumers in this information but may guide others on practically what are the most “shop-able” services for patients.

  17. State of Data Guidance in Journal Policies: A Case Study in Oncology

    Directory of Open Access Journals (Sweden)

    Deborah H. Charbonneau

    2015-06-01

    Full Text Available This article reports the results of a study examining the state of data guidance provided to authors by 50 oncology journals. The purpose of the study was the identification of data practices addressed in the journals’ policies. While a number of studies have examined data sharing practices among researchers, little is known about how journals address data sharing. Thus, what was discovered through this study has practical implications for journal publishers, editors, and researchers. The findings indicate that journal publishers should provide more meaningful and comprehensive data guidance to prospective authors. More specifically, journal policies requiring data sharing, should direct researchers to relevant data repositories, and offer better metadata consultation to strengthen existing journal policies. By providing adequate guidance for authors, and helping investigators to meet data sharing mandates, scholarly journal publishers can play a vital role in advancing access to research data.

  18. Digital Signal Processing State-of-the-Art at CERN and Recommendations

    CERN Document Server

    Angoletta, Maria Elena; Peschardt, E; Serrano, J

    2002-01-01

    Dramatic hardware performance improvements over the last decades have paved the way to the ascent of digital techniques for processing signals, with a concurrent and parallel interest in Digital Signal Processing (DSPing) and in the use of Digital Signal Processors (DSPs). Recent discussions within PS showed that there are needs for DSP-qualified manpower in new projects that cannot be fully satisfied internally. In order to determine how PS can best profit from the growing importance and efficiency of DSP technologies, with an effort compatible with the available divisional resources, a DSP working group was created. Its mandate is to advise PS management on the best way to proceed in the DSPs and DSPing domains. In particular, the issues targeted are wide-ranging, from evaluating the state-of-the-art at CERN to hardware standardisation and required training. This report gives the findings of the working group and presents its closing recommendations.

  19. Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies - United States, 2007-2014.

    Science.gov (United States)

    Faul, Mark; Bohm, Michele; Alexander, Caleb

    2017-03-31

    Drug overdose is a leading cause of injury death in the United States; 47,055 fatal drug overdoses were reported in 2014, a 6.5% increase from the previous year (1), driven by opioid use disorder (2,3). Methadone is an opioid prescribed for pain management and is also provided through opioid treatment programs to treat opioid use disorders. Because methadone might remain in a person's system long after the pain-relieving benefits have been exhausted, it can cause slow or shallow breathing and dangerous changes in heartbeat that might not be perceived by the patient (4,5). In December 2006, the Food and Drug Administration issued a Public Health Advisory that alerted health care professionals to reports of death and life-threatening adverse events, such as respiratory depression and cardiac arrhythmias, in patients receiving methadone (4); in January 2008, a voluntary manufacturer restriction limited distribution of the 40 mg formulation of methadone.* CDC analyzed state mortality and health care data and preferred drug list (PDL) policies to 1) compare the percentage of deaths involving methadone with the rate of prescribing methadone for pain, 2) characterize variation in methadone prescribing among payers and states, and 3) assess whether an association existed between state Medicaid reimbursement PDL policies and methadone overdose rates. The analyses found that, from 2007 to 2014, large declines in methadone-related overdose deaths occurred. Prescriptions for methadone accounted for 0.85% of all opioid prescriptions for pain in the commercially insured population and 1.1% in the Medicaid population. In addition, an association was observed between Medicaid PDLs requiring prior authorization for methadone and lower rates of methadone overdose among Medicaid enrollees. PDL policies requiring prior authorization might help to reduce the number of methadone overdoses.

  20. State Park Trails

    Data.gov (United States)

    Minnesota Department of Natural Resources — This data set is a collection of ArcView shapefiles (by park) of trails within statutory boundaries of individual MN State Parks, State Recreation Areas and State...

  1. State Park Statutory Boundaries

    Data.gov (United States)

    Minnesota Department of Natural Resources — Legislative statutory boundaries for sixty six state parks, six state recreation areas, and eight state waysides. These data are derived principally from DNR's...

  2. Stats of the States

    Science.gov (United States)

    ... for firearm-related fatalities. Death Rates from Homicide: United States, 2013 - The latest state-based age-adjusted death rates for fatal drug poisonings. Infant Mortality Rates by State, 2013 - The number of deaths ...

  3. Prevalence and Quality of Individual Placement and Support (IPS) Supported Employment in the United States.

    Science.gov (United States)

    Johnson-Kwochka, Annalee; Bond, Gary R; Becker, Deborah R; Drake, Robert E; Greene, Mary Ann

    2017-05-01

    The individual placement and support (IPS) model of supported employment for people with serious mental illness is an evidence-based practice. Factors including a national learning community promoting IPS and enforcement of the Supreme Court's Olmstead decision have spurred the growth of IPS nationwide. In this study we first evaluated the national prevalence and quality of IPS programs. We then evaluated the impact of learning community membership and Olmstead settlements on IPS program penetration and quality across the United States. We interviewed representatives from 48 state behavioral health agencies and 51 state vocational rehabilitation agencies. Survey questions examined the number of IPS programs in each state, the presence of an Olmstead settlement mandating employment services for people with serious mental illness, and the presence of three indicators of quality in IPS programs: collaboration between state behavioral health and vocational rehabilitation agencies, regular, independent fidelity monitoring, and technical assistance and training for IPS programs. Respondents from 38 (75%) states, including 19 states in the IPS Learning Community and 19 outside the learning community, reported a total of 523 IPS programs nationwide (M = 14, SD = 16). The state IPS program penetration rate (number of IPS programs per 1,000,000 people) ranged from 0.05 to 16.62 (M = 3.61, SD = 3.62) among states with IPS. The penetration rate was similar for learning community and non-learning community states with IPS, but learning community states were much more likely than non-learning community states with IPS to report the presence of each of three quality indicators. Eleven states reported Olmstead or other settlements that positively impacted employment services for people with serious mental illness, but among the 38 states with IPS programs, Olmstead states did not differ from non-Olmstead states in IPS program penetration or on the quality

  4. Going Tobacco-Free: Predictors of Clinician Reactions and Outcomes of the NY State OASAS Tobacco-Free Regulation

    Science.gov (United States)

    de Tormes Eby, Lillian Turner; George, Kerrin; Brown, B. Lindsay

    2012-01-01

    In an effort to reduce patient tobacco dependence and create healthier work environments, New York State (NYS) mandated 100% tobacco-free addiction treatment programs for state funded or certified facilities in 2008. We present the results of a longitudinal study examining how local implementation features shape clinician reactions to the regulation and influence post-regulation clinician behavior and strain. A cohort of 147 clinicians associated with 13 treatment organizations throughout NYS completed a survey prior to the passage of the regulation and again approximately 1 year post-regulation. Findings reveal that local implementation features of clinician participation in the planning for change, the provision of change-related information, and perceived organizational support predicted perceptions of change management fairness, which in turn predicted clinical practice behaviors to support smoking cessation, as well as psychological and behavioral strain. In contrast, self-efficacy for change was neither related to local implementation or clinician outcomes. Practical implications are discussed. PMID:22959978

  5. Impact of a State Law on Physician Practice in Sports-Related Concussions.

    Science.gov (United States)

    Flaherty, Michael R; Raybould, Toby; Jamal-Allial, Aziza; Kaafarani, Haytham M A; Lee, Jarone; Gervasini, Alice; Ginsburg, Richard; Mandell, Mark; Donelan, Karen; Masiakos, Peter T

    2016-11-01

    To determine physician-reported adherence to and support of the 2010 Massachusetts youth concussion law, as well as barriers to care and clinical practice in the context of legislation. Primary care physicians (n = 272) in a large pediatric network were eligible for a cross-sectional survey in 2014. Survey questions addressed key policy and practice provisions: concussion knowledge, state regulations and training, practice patterns, referrals, patient characteristics, and barriers to care. Analyses explored relationships between practice and policy, adjusting for physician demographic and practice characteristics. The survey response rate was 64% among all responders (173 of 272). A total of 146 respondents who had evaluated, treated, or referred patients with a suspected sports-related concussion in the previous year were eligible for analysis. The vast majority (90%) of providers agreed that the current Massachusetts laws regarding sports concussions are necessary and support the major provisions. Three-quarters (74%) had taken a required clinician training course on concussions. Those who took training courses were significantly more likely to develop individualized treatment plans (OR, 3.6; 95% CI, 1.1-11.0). Physician training did not improve screening of youth with concussion for depression or substance use. Most physicians (77%) advised patients to refrain from computer, telephone, or television for various time periods. Physicians reported limited communication with schools. Primary care physicians report being comfortable with the diagnosis and management of concussions, and support statewide regulations; however, adherence to mandated training and specific legal requirements varied. Broader and more frequent training may be necessary to align current best evidence with clinical care and state-mandated practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Budget impact of perampanel as adjunctive treatment of uncontrolled partial-onset and primary generalized tonic-clonic seizures in the United States.

    Science.gov (United States)

    Tremblay, Gabriel; Barghout, Victoria; Patel, Vardhaman; Tsong, Wan; Wang, Zhixiao

    2017-03-01

    To evaluate the budget impact (BI) of adopting perampanel for adjunctive treatment of partial-onset seizures (POS), with or without secondarily generalized seizures, and the adjunctive treatment of primary generalized tonic-clonic seizures (PGTCS) in patients 12years or older in the United States. A BI model was developed to estimate the potential BI of adopting adjunctive perampanel from a US payer (direct costs only) and societal (direct and indirect costs) perspective over a 5-year period. Efficacy data for perampanel and antiepileptic drug (AED) maintenance therapy were obtained from perampanel phase III clinical trials. Drug, direct medical (healthcare provider, emergency room, and hospitalizations), and indirect (productivity loss) costs were obtained from appropriate sources (e.g., AnalySource® Online [wholesale acquisition costs], 2013 Optum Insight Clinformatics Database [market share percentages, direct medical costs per unit], and 2011-2013 National Health and Wellness Survey [NHWS; healthcare resource utilization, overall work impairment, and baseline distribution of patients across the 4 health states]). Mapping of seizure frequency to medical resource utilization and work impairment was obtained from Kantar Health's NHWS. In a hypothetical health plan of 1 million members, 660 (0.066%) members ≥12years old had uncontrolled POS (395 [59.8%]) or PGTCS (265 [40.2%]). During the first 5years of adoption of perampanel, absolute BI (including drug, direct medical, and indirect costs) was $852, $2124, $3855, $5318, and $6397, respectively, for a cumulative absolute BI of $18,545. Drug cost was estimated to increase by $13,888, $34,646, $62,863, $86,728, and $104,326, respectively; however, this cost would be mostly offset by decreases in direct medical ($5041, $12,576, $22,818, $31,481, and $37,869, respectively) and indirect ($7995, $19,946, $36,190, $49,929, and $60,060, respectively) costs. Total per-member-per-month cost (drug and direct medical costs

  7. Legal Policy Of Corruption Eradication At State-Owned Enterprises Sector In Indonesia

    Directory of Open Access Journals (Sweden)

    Zulkipli

    2015-08-01

    Full Text Available A mandate of the constitution of the Republic of Indonesia as the highest law is the creation of Indonesia people that is just and prosperous and then the development in all sectors becomes a necessity for achieving that goal. To achieve continuity and development success the enforcement of law supremacy in the form of prevention and eradication of corruption is a necessary condition condition sine qua non. Type of legal research conducted is normative. This research was carried out by discussion of concepts doctrine and theory principles as well as legislation which is correlated to the philosophical construction on state finances. The results of the research indicated that law enforcement of corruption against the management of limited state-owned enterprises during this that damage SEOs state is one of the important parts in the form of control the management of SOEs whose responsible and integrity. Though on the other hand the debate over the use of the criminal instruments in resolving the problems that occurred in the transaction of SOEs state that damage will continue to occur but against the actor of state-owned companies still put forward the principle of prudence in running the business because in some judicial practice has been expandingconstructing carelessness be a part of unlawful action in corruption crime.

  8. Analytical approaches used in stream benthic macroinvertebrate biomonitoring programs of State agencies in the United States

    Science.gov (United States)

    Carter, James L.; Resh, Vincent H.

    2013-01-01

    Biomonitoring programs based on benthic macroinvertebrates are well-established worldwide. Their value, however, depends on the appropriateness of the analytical techniques used. All United States State, benthic macroinvertebrate biomonitoring programs were surveyed regarding the purposes of their programs, quality-assurance and quality-control procedures used, habitat and water-chemistry data collected, treatment of macroinvertebrate data prior to analysis, statistical methods used, and data-storage considerations. State regulatory mandates (59 percent of programs), biotic index development (17 percent), and Federal requirements (15 percent) were the most frequently reported purposes of State programs, with the specific tasks of satisfying the requirements for 305b/303d reports (89 percent), establishment and monitoring of total maximum daily loads, and developing biocriteria being the purposes most often mentioned. Most states establish reference sites (81 percent), but classify them using State-specific methods. The most often used technique for determining the appropriateness of a reference site was Best Professional Judgment (86 percent of these states). Macroinvertebrate samples are almost always collected by using a D-frame net, and duplicate samples are collected from approximately 10 percent of sites for quality assurance and quality control purposes. Most programs have macroinvertebrate samples processed by contractors (53 percent) and have identifications confirmed by a second taxonomist (85 percent). All States collect habitat data, with most using the Rapid Bioassessment Protocol visual-assessment approach, which requires ~1 h/site. Dissolved oxygen, pH, and conductivity are measured in more than 90 percent of programs. Wide variation exists in which taxa are excluded from analyses and the level of taxonomic resolution used. Species traits, such as functional feeding groups, are commonly used (96 percent), as are tolerance values for organic pollution

  9. Job Patterns for Minorities and Women in State and Local Government, 2009 EEO-4Data Table: US by State Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  10. Job Patterns for Minorities and Women in State and Local Government, 2011 EEO-4Data Table: US by State Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  11. Job Patterns for Minorities and Women in State and Local Government, 2015 EEO-4Data Table: US by State Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  12. Job Patterns for Minorities and Women in State and Local Government, 2009 EEO-4 Data Table: State by Function Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  13. Job Patterns for Minorities and Women in State and Local Government, 2015 EEO-4 Data Table: State by Function Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  14. Job Patterns for Minorities and Women in State and Local Government, 2011 EEO-4 Data Table: State by Function Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  15. Tomography of nonclassical states

    NARCIS (Netherlands)

    Bazrafkan, MR; Man'ko, [No Value

    2003-01-01

    A review of the symplectic tomography method is presented. Superpositions of different types of photon states are considered within the framework of the tomography approach. Such nonclassical photon states as even and odd coherent states, crystallized Schrodinger cat states, and other superposition

  16. Solid state video cameras

    CERN Document Server

    Cristol, Y

    2013-01-01

    Solid State Video Cameras reviews the state of the art in the field of solid-state television cameras as compiled from patent literature. Organized into 10 chapters, the book begins with the basic array types of solid-state imagers and appropriate read-out circuits and methods. Documents relating to improvement of picture quality, such as spurious signal suppression, uniformity correction, or resolution enhancement, are also cited. The last part considerssolid-state color cameras.

  17. The Use of Performance Contracts for Delivery of Social Services in the United States

    Directory of Open Access Journals (Sweden)

    Maria P. Aristigueta

    2009-03-01

    Full Text Available Devolution and the New Public Management has increased the privatization of government service and enhanced the role for the nonprofit sector in the United States. Performance contracts are viewed as a method for holding service providers accountable for outcomes. This paper outlines the findings of a two year study which took place at the University of Delaware between September 2005 and April 2007, entitled The Forward Together Project. Ad hoc implementation of performance contracts are found in the state; some as a result of federal mandates, others as championed by leadership. Ingredients desirable for successful performance contracts are explored in this paper. Although the research cannot conclusively attribute performance contract to more effective and efficient service delivery, it does provide evidence of expanded use of performance contracts and the potential for improved accountability and service delivery relationship between state government and nonprofits.In part as a result of the New Public Management, government organizations are devolving their responsibilities for services. This includes from the national government to states to local governments, as well as from government to non-profit and for profit organizations. The phenomenon of increasingly privatized government services and its implication for an enhanced role for the nonprofit sector in the United States is well-documented throughout much of the public administration literature.Performance contracts are viewed as a method for holding service providers accountable for outcomes. Yet, despite their increasing popularity, many questions about this emerging trend have remained largely unanswered. A team of researchers(1 from the University of Delaware has been involved in studying various aspects of the relationship in the contractual arrangement between state government, human service agencies and non-profit organizations.This paper will focus on the performance contract

  18. The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.

    Science.gov (United States)

    Michaelidis, Constantinos I; Fine, Michael J; Lin, Chyongchiou Jeng; Linder, Jeffrey A; Nowalk, Mary Patricia; Shields, Ryan K; Zimmerman, Richard K; Smith, Kenneth J

    2016-11-08

    Ambulatory antibiotic prescribing contributes to the development of antibiotic resistance and increases societal costs. Here, we estimate the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States. In an exploratory analysis, we used published data to develop point and range estimates for the hidden societal cost of antibiotic resistance (SCAR) attributable to each ambulatory antibiotic prescription in the United States. We developed four estimation methods that focused on the antibiotic-resistance attributable costs of hospitalization, second-line inpatient antibiotic use, second-line outpatient antibiotic use, and antibiotic stewardship, then summed the estimates across all methods. The total SCAR attributable to each ambulatory antibiotic prescription was estimated to be $13 (range: $3-$95). The greatest contributor to the total SCAR was the cost of hospitalization ($9; 69 % of the total SCAR). The costs of second-line inpatient antibiotic use ($1; 8 % of the total SCAR), second-line outpatient antibiotic use ($2; 15 % of the total SCAR) and antibiotic stewardship ($1; 8 %). This apperars to be an error.; of the total SCAR) were modest contributors to the total SCAR. Assuming an average antibiotic cost of $20, the total SCAR attributable to each ambulatory antibiotic prescription would increase antibiotic costs by 65 % (range: 15-475 %) if incorporated into antibiotic costs paid by patients or payers. Each ambulatory antibiotic prescription is associated with a hidden SCAR that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.

  19. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  20. The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis

    Directory of Open Access Journals (Sweden)

    Constantinos I. Michaelidis

    2016-11-01

    Full Text Available Abstract Background Ambulatory antibiotic prescribing contributes to the development of antibiotic resistance and increases societal costs. Here, we estimate the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States. Methods In an exploratory analysis, we used published data to develop point and range estimates for the hidden societal cost of antibiotic resistance (SCAR attributable to each ambulatory antibiotic prescription in the United States. We developed four estimation methods that focused on the antibiotic-resistance attributable costs of hospitalization, second-line inpatient antibiotic use, second-line outpatient antibiotic use, and antibiotic stewardship, then summed the estimates across all methods. Results The total SCAR attributable to each ambulatory antibiotic prescription was estimated to be $13 (range: $3–$95. The greatest contributor to the total SCAR was the cost of hospitalization ($9; 69 % of the total SCAR. The costs of second-line inpatient antibiotic use ($1; 8 % of the total SCAR, second-line outpatient antibiotic use ($2; 15 % of the total SCAR and antibiotic stewardship ($1; 8 %. This apperars to be an error.; of the total SCAR were modest contributors to the total SCAR. Assuming an average antibiotic cost of $20, the total SCAR attributable to each ambulatory antibiotic prescription would increase antibiotic costs by 65 % (range: 15–475 % if incorporated into antibiotic costs paid by patients or payers. Conclusions Each ambulatory antibiotic prescription is associated with a hidden SCAR that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.

  1. Are Quantum States Real?

    Science.gov (United States)

    Hardy, Lucien

    2013-01-01

    In this paper we consider theories in which reality is described by some underlying variables, λ. Each value these variables can take represents an ontic state (a particular state of reality). The preparation of a quantum state corresponds to a distribution over the ontic states, λ. If we make three basic assumptions, we can show that the distributions over ontic states corresponding to distinct pure states are nonoverlapping. This means that we can deduce the quantum state from a knowledge of the ontic state. Hence, if these assumptions are correct, we can claim that the quantum state is a real thing (it is written into the underlying variables that describe reality). The key assumption we use in this proof is ontic indifference — that quantum transformations that do not affect a given pure quantum state can be implemented in such a way that they do not affect the ontic states in the support of that state. In fact this assumption is violated in the Spekkens toy model (which captures many aspects of quantum theory and in which different pure states of the model have overlapping distributions over ontic states). This paper proves that ontic indifference must be violated in any model reproducing quantum theory in which the quantum state is not a real thing. The argument presented in this paper is different from that given in a recent paper by Pusey, Barrett and Rudolph. It uses a different key assumption and it pertains to a single copy of the system in question.

  2. State cigarette excise taxes - United States, 2009.

    Science.gov (United States)

    2010-04-09

    Increasing the price of cigarettes can reduce smoking substantially by discouraging initiation among youths and young adults, prompting quit attempts, and reducing average cigarette consumption among those who continue to smoke. Increasing cigarette excise taxes is one of the most effective tobacco control policies because it directly increases cigarette prices, thereby reducing cigarette use and smoking-related death and disease. All states and the District of Columbia (DC) impose an excise tax on cigarettes. Because many states increased their cigarette excise taxes in 2009, CDC conducted a survey of these tax increases. For this report, CDC reviewed data contained in a legislative database to identify cigarette excise tax legislation that was enacted during 2009 by the 50 states and DC. During that period, 15 states (including DC), increased their state excise tax on cigarettes, increasing the national mean from $1.18 per pack in 2008 to $1.34 per pack in 2009. However, none of the 15 states dedicated any of the new excise tax revenue by statute to tobacco control. Additionally, for the first time, two states (Connecticut and Rhode Island) had excise tax rates of at least $3.00 per pack. Additional increases in cigarette excise taxes, and dedication of all resulting revenues to tobacco control and prevention programs at levels recommended by CDC, could result in further reductions in smoking and associated morbidity and mortality.

  3. Prescription opioid abuse: a literature review of the clinical and economic burden in the United States.

    Science.gov (United States)

    Meyer, Roxanne; Patel, Anisha M; Rattana, Stacy K; Quock, Tiffany P; Mody, Samir H

    2014-12-01

    Between 2002 and 2007, the nonmedical use of prescription pain relievers grew from 11.0 million to 12.5 million people in the United States. Societal costs attributable to prescription opioid abuse were estimated at $55.7 billion in 2007. The purpose of this study was to comprehensively review the recent clinical and economic evaluations of prescription opioid abuse. A comprehensive literature search was conducted for studies published from 2002 to 2012. Articles were included if they were original research studies in English that reported the clinical and economic burden associated with prescription opioid abuse. A total of 23 studies (183 unique citations identified, 54 articles subjected to full text review) were included in this review and analysis. Findings from the review demonstrated that rates of opioid overdose-related deaths ranged from 5528 deaths in 2002 to 14,800 in 2008. Furthermore, overdose reportedly results in 830,652 years of potential life lost before age 65. Opioid abusers were generally more likely to utilize medical services, such as emergency department, physician outpatient visits, and inpatient hospital stays, relative to non-abusers. When compared to a matched control group (non-abusers), mean annual excess health care costs for opioid abusers with private insurance ranged from $14,054 to $20,546. Similarly, the mean annual excess health care costs for opioid abusers with Medicaid ranged from $5874 to $15,183. The issue of opioid abuse has significant clinical and economic consequences for patients, health care providers, commercial and government payers, and society as a whole.

  4. Choosing wisely: prevalence and correlates of low-value health care services in the United States.

    Science.gov (United States)

    Colla, Carrie H; Morden, Nancy E; Sequist, Thomas D; Schpero, William L; Rosenthal, Meredith B

    2015-02-01

    Specialty societies in the United States identified low-value tests and procedures that contribute to waste and poor health care quality via implementation of the American Board of Internal Medicine Foundation's Choosing Wisely initiative. To develop claims-based algorithms, to use them to estimate the prevalence of select Choosing Wisely services and to examine the demographic, health and health care system correlates of low-value care at a regional level. Using Medicare data from 2006 to 2011, we created claims-based algorithms to measure the prevalence of 11 Choosing Wisely-identified low-value services and examined geographic variation across hospital referral regions (HRRs). We created a composite low-value care score for each HRR and used linear regression to identify regional characteristics associated with more intense use of low-value services. Fee-for-service Medicare beneficiaries over age 65. Prevalence of selected Choosing Wisely low-value services. The national average annual prevalence of the selected Choosing Wisely low-value services ranged from 1.2% (upper urinary tract imaging in men with benign prostatic hyperplasia) to 46.5% (preoperative cardiac testing for low-risk, non-cardiac procedures). Prevalence across HRRs varied significantly. Regional characteristics associated with higher use of low-value services included greater overall per capita spending, a higher specialist to primary care ratio and higher proportion of minority beneficiaries. Identifying and measuring low-value health services is a prerequisite for improving quality and eliminating waste. Our findings suggest that the delivery of wasteful and potentially harmful services may be a fruitful area for further research and policy intervention for HRRs with higher per-capita spending. These findings should inform action by physicians, health systems, policymakers, payers and consumer educators to improve the value of health care by targeting services and areas with greater use of

  5. Increasing Utilization Of Pediatric Epilepsy Surgery In The United States Between 1997 and 2009

    Science.gov (United States)

    Pestana Knight, Elia M.; Schiltz, Nicholas K.; Bakaki, Paul M.; Koroukian, Siran M.; Lhatoo, Samden D.; Kaiboriboon, Kitti

    2014-01-01

    SUMMARY OBJECTIVE To examine national trends of pediatric epilepsy surgery usage in the United States between 1997 and 2009. METHODS We performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids’ Inpatient Database from 1997 to 2009. The rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year were calculated based on the number of prevalent epilepsy cases in the corresponding year. The age-race-sex adjusted rates of surgeries were also estimated. Mann-Kendall trend test was used to test for changes in the rates of surgeries over time. Multivariable regression analysis was also performed to estimate the effect of time, age, race, and sex on the annual incidence of epilepsy surgery. RESULTS The rates of pediatric epilepsy surgery significantly increased from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009. An increment in the rates of epilepsy surgeries was noted across all age groups, in boys and girls, all races, and all payer types. The rate of increase was lowest in blacks and in children with public insurance. The overall number of surgical cases for each study year was lower than 35% of children who were expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. SIGNIFICANCE In contrast to adults, pediatric epilepsy surgery numbers have increased significantly in the past decade. However, epilepsy surgery remains an underutilized treatment for children with epilepsy. In addition, black children and those with public insurance continue to face disparities in the receipt of epilepsy surgery. PMID:25630252

  6. Prescription Opioid Abuse: A Literature Review of the Clinical and Economic Burden in the United States

    Science.gov (United States)

    Patel, Anisha M.; Rattana, Stacy K.; Quock, Tiffany P.; Mody, Samir H.

    2014-01-01

    Abstract Between 2002 and 2007, the nonmedical use of prescription pain relievers grew from 11.0 million to 12.5 million people in the United States. Societal costs attributable to prescription opioid abuse were estimated at $55.7 billion in 2007. The purpose of this study was to comprehensively review the recent clinical and economic evaluations of prescription opioid abuse. A comprehensive literature search was conducted for studies published from 2002 to 2012. Articles were included if they were original research studies in English that reported the clinical and economic burden associated with prescription opioid abuse. A total of 23 studies (183 unique citations identified, 54 articles subjected to full text review) were included in this review and analysis. Findings from the review demonstrated that rates of opioid overdose-related deaths ranged from 5528 deaths in 2002 to 14,800 in 2008. Furthermore, overdose reportedly results in 830,652 years of potential life lost before age 65. Opioid abusers were generally more likely to utilize medical services, such as emergency department, physician outpatient visits, and inpatient hospital stays, relative to non-abusers. When compared to a matched control group (non-abusers), mean annual excess health care costs for opioid abusers with private insurance ranged from $14,054 to $20,546. Similarly, the mean annual excess health care costs for opioid abusers with Medicaid ranged from $5874 to $15,183. The issue of opioid abuse has significant clinical and economic consequences for patients, health care providers, commercial and government payers, and society as a whole. (Population Health Management 2014;17:372–387) PMID:25075734

  7. Increasing utilization of pediatric epilepsy surgery in the United States between 1997 and 2009.

    Science.gov (United States)

    Pestana Knight, Elia M; Schiltz, Nicholas K; Bakaki, Paul M; Koroukian, Siran M; Lhatoo, Samden D; Kaiboriboon, Kitti

    2015-03-01

    To examine national trends of pediatric epilepsy surgery usage in the United States between 1997 and 2009. We performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids' Inpatient Database from 1997 to 2009. The rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year were calculated based on the number of prevalent epilepsy cases in the corresponding year. The age-race-sex adjusted rates of surgeries were also estimated. Mann-Kendall trend test was used to test for changes in the rates of surgeries over time. Multivariable regression analysis was also performed to estimate the effect of time, age, race, and sex on the annual incidence of epilepsy surgery. The rates of pediatric epilepsy surgery increased significantly from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009. An increment in the rates of epilepsy surgeries was noted across all age groups, in boys and girls, all races, and all payer types. The rate of increase was lowest in blacks and in children with public insurance. The overall number of surgical cases for each study year was lower than 35% of children who were expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. In contrast to adults, pediatric epilepsy surgery numbers have increased significantly in the past decade. However, epilepsy surgery remains an underutilized treatment for children with epilepsy. In addition, black children and those with public insurance continue to face disparities in the receipt of epilepsy surgery. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  8. Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices: United States, 2013.

    Science.gov (United States)

    Hing, Esther; Kurtzman, Ellen; Lau, Denys T; Taplin, Caroline; Bindman, Andrew B

    2017-02-01

    Objective-This report describes the characteristics of primary care physicians in patient-centered medical home (PCMH) practices and compares these characteristics with those of primary care physicians in non-PCMH practices. Methods-The data presented in this report were collected during the induction interview for the 2013 National Ambulatory Medical Care Survey, a national probability sample survey of nonfederal physicians who see patients in office settings in the United States. Analyses exclude anesthesiologists, radiologists, pathologists, and physicians in community health centers. In this report, PCMH status is self-defined as having been certified by one of the following organizations: Accreditation Association for Ambulatory Health Care, The Joint Commission, National Committee for Quality Assurance, URAC, or other certifying bodies. Estimates exclude physicians missing information on PCMH status. Sample data are weighted to produce national estimates of physicians and characteristics of their practices. Results-In 2013, 18.0% of office-based primary care physicians worked in practices certified as PCMHs. A higher percentage of primary care physicians in PCMH practices (68.8%) had at least one physician assistant, nurse practitioner, or certified nurse midwife on staff compared with non-PCMH practices (47.7%). A higher percentage of primary care physicians in PCMH practices reported electronic transmission (69.6%) as the primary method for receiving information on patients hospitalized or seen in emergency departments compared with non-PCMH practices (41.5%). The percentage of primary care physicians in practices reporting quality measures or quality indicators to payers or organizations monitoring health care quality was higher in PCMH practices (86.8%) compared with non-PCMH practices (70.2%). All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

  9. Association between U.S. State AIDS Drug Assistance Program (ADAP) Features and HIV Antiretroviral Therapy Initiation, 2001–2009

    Science.gov (United States)

    Hanna, David B.; Buchacz, Kate; Gebo, Kelly A.; Hessol, Nancy A.; Horberg, Michael A.; Jacobson, Lisa P.; Kirk, Gregory D.; Kitahata, Mari M.; Korthuis, P. Todd; Moore, Richard D.; Napravnik, Sonia; Patel, Pragna; Silverberg, Michael J.; Sterling, Timothy R.; Willig, James H.; Collier, Ann; Samji, Hasina; Thorne, Jennifer E.; Althoff, Keri N.; Martin, Jeffrey N.; Rodriguez, Benigno; Stuart, Elizabeth A.; Gange, Stephen J.

    2013-01-01

    Background U.S. state AIDS Drug Assistance Programs (ADAPs) are federally funded to provide antiretroviral therapy (ART) as the payer of last resort to eligible persons with HIV infection. States differ regarding their financial contributions to and ways of implementing these programs, and it remains unclear how this interstate variability affects HIV treatment outcomes. Methods We analyzed data from HIV-infected individuals who were clinically-eligible for ART between 2001 and 2009 (i.e., a first reported CD4+ <350 cells/uL or AIDS-defining illness) from 14 U.S. cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Using propensity score matching and Cox regression, we assessed ART initiation (within 6 months following eligibility) and virologic suppression (within 1 year) based on differences in two state ADAP features: the amount of state funding in annual ADAP budgets and the implementation of waiting lists. We performed an a priori subgroup analysis in persons with a history of injection drug use (IDU). Results Among 8,874 persons, 56% initiated ART within six months following eligibility. Persons living in states with no additional state contribution to the ADAP budget initiated ART on a less timely basis (hazard ratio [HR] 0.73, 95% CI 0.60–0.88). Living in a state with an ADAP waiting list was not associated with less timely initiation (HR 1.12, 95% CI 0.87–1.45). Neither additional state contributions nor waiting lists were significantly associated with virologic suppression. Persons with an IDU history initiated ART on a less timely basis (HR 0.67, 95% CI 0.47–0.95). Conclusions We found that living in states that did not contribute additionally to the ADAP budget was associated with delayed ART initiation when treatment was clinically indicated. Given the changing healthcare environment, continued assessment of the role of ADAPs and their features that facilitate prompt treatment is needed. PMID:24260137

  10. Drug Poisoning Mortality by State: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset describes drug poisoning deaths at the U.S. and state level by selected demographic characteristics, and includes age-adjusted death rates for drug...

  11. State of the art of expert searching: results of a Medical Library Association survey.

    Science.gov (United States)

    Holst, Ruth; Funk, Carla J

    2005-01-01

    Medical Library Association (MLA) members were surveyed to gather background about the current state of expert searching in institutions. The survey results were intended to guide the recommendations of the Task Force on Expert Searching for promoting the importance of expert searching and implementing those recommendations. MLA members were surveyed, and data obtained from the survey were compiled and analyzed to answer three general questions: what is the perceived value of searching skills to the institution, how do health sciences librarians maintain and improve their searching skills, and how are searching services promoted and/or mandated in the institution. There were 256 responses to the survey. Over 95% of the respondents saw their expert-searching skills were of value to their institutions, primarily through performing mediated searches and search consultations. Over 83% of the respondents believed that their searching skills had improved over the past 10 years. Most indicated that continued training was very important in maintaining and improving their skills. Respondents promoted searching services most frequently through orientations, brochures, and the libraries' Web pages. No respondent's institution mandated expert searching. Less than 2% of respondents' institutions had best practice guidelines related to expert searching, and only about 8% had guidelines or policies that identified situations where expert searching was recommended. The survey supports the belief that health sciences librarians still play a valuable role in searching, particularly in answering questions about treatment options and in providing education. It also highlights the need for more expert searching courses. There has been minimal discussion about the perceived need for expert-searching guidelines in the institutions represented by survey respondents.

  12. Heart Attack Payment - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – state data. This data set includes state-level data for payments associated with a 30-day episode of care for heart...

  13. State responsibility and counterterrorism

    National Research Council Canada - National Science Library

    Taylor, Isaac

    2016-01-01

    .... Yet, what each state is required to do in this project is unclear and contested. This article examines a number of bases on which we might assign responsibilities to conduct counterterrorist operations to states...

  14. Sleep State Switching

    National Research Council Canada - National Science Library

    Saper, Clifford B; Fuller, Patrick M; Pedersen, Nigel P; Lu, Jun; Scammell, Thomas E

    2010-01-01

    We take for granted the ability to fall asleep or to snap out of sleep into wakefulness, but these changes in behavioral state require specific switching mechanisms in the brain that allow well-defined state transitions...

  15. State transportation statistics 2009

    Science.gov (United States)

    2009-01-01

    The Bureau of Transportation Statistics (BTS), a part of DOTs Research and : Innovative Technology Administration (RITA), presents State Transportation : Statistics 2009, a statistical profile of transportation in the 50 states and the : District ...

  16. Complications and Deaths - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Complications and deaths - state data. This data set includes state-level data for the hip/knee complication measure, the Agency for Healthcare Research and Quality...

  17. State Program Integrity Reviews

    Data.gov (United States)

    U.S. Department of Health & Human Services — State program integrity reviews play a critical role in how CMS provides effective support and assistance to states in their efforts to combat provider fraud and...

  18. STATE_SYSTEM

    Data.gov (United States)

    Kansas Data Access and Support Center — This dataset is a single centerline highway network representation of the 10,000 miles Kansas State Highway System (Interstate, U.S., and Kansas routes). The state...

  19. Malaria Treatment (United States)

    Science.gov (United States)

    ... a CDC Malaria Branch clinician. malaria@cdc.gov Malaria Treatment (United States) Recommend on Facebook Tweet Share Compartir Treatment of Malaria: Guidelines For Clinicians (United States) Download PDF version ...

  20. State Water Districts

    Data.gov (United States)

    California Department of Resources — State Water Project District boundaries are areas where state contracts provide water to the district in California. This database is designed as a regions polygon...

  1. Region 7 States

    Data.gov (United States)

    U.S. Environmental Protection Agency — NAVTEQ Administrative Area Boundaries 2 (State Boundaries) for the United States. This layer is used for map visualisation. This dataset is a subset of the full...

  2. 77 FR 43347 - Federally Mandated Exclusions From Income

    Science.gov (United States)

    2012-07-24

    ... of 1966, provides: The value of assistance to children under this Act shall not be considered to be... sources for the maintenance of food programs for children shall not be diminished as a result of funds... HUD programs. (i) The value of the allotment provided to an eligible household under the Food Stamp...

  3. Pandora and Pollyanna: Some Comments on 'The Rush to Mandate'.

    Science.gov (United States)

    Bracey, Gerald W.

    1986-01-01

    Criticizes the previous author's assertions about teacher testing and the performance of minority students on Scholastic Achievement Tests. Also discusses the possible implications intended in a statement made in that article about the lack of minorities in the teaching force. Thirteen references are cited. (MD)

  4. Enrollment Management's Sleeping Giant: The Net Price Calculator Mandate

    Science.gov (United States)

    Fallon, Mary A. C.

    2011-01-01

    Enrollment managers will be watching to see how recruitment strategies change when higher education's sleeping giant--net price calculators (NPCs)--wakes in the fall of 2011. Some predict yield projections may be more difficult and reputations will be challenged as prospective students, their families, high school counselors, and independent…

  5. Anti-plagiarism certification be an academic mandate

    Digital Repository Service at National Institute of Oceanography (India)

    Lakshminarayana, S.

    .Journal of American Society for Information Science and Technology, 54(3), 203–215. Martin, B.R.(2007).Keeping plagiarism at bay—A salutary tale.Research Policy, 36(7), 905–911. Ottenstein, K.J. (1976). An algorithmic approach to the detection and prevention...

  6. an unusual self-damaging behavior mandating neurosurgery

    African Journals Online (AJOL)

    sustained brain damage prior to the beginning of their hospital addiction. Since their motivation is unknown, personality disorder and psychopathy have been suggested as probable causes.3 ... Deprivation and physical or sexual abuse, feelings of ... problems, such bizarre self-damaging behavior should be borne in mind.

  7. Delivering the International Olympic Committee's mandate on Youth ...

    African Journals Online (AJOL)

    The International Olympic Committee (IOC) is currently planning the historic Youth Olympic Games (YOG), an international mul ti-sport event that will be inaugurated in Singapore in 2010. On the 6t h of July 2007, the establishment of the YOG was approved and will feature 14 to 18 year-old athletes. The purpose of the YOG ...

  8. Refracted Gazes: A Woman Photographer during Mandate Lebanon

    Directory of Open Access Journals (Sweden)

    Yasmine Nachabe

    2012-11-01

    This paper explores the relationship between modernity and femininity as manifest through the women’s activity, gaze and attire in Marie al-Khazen as well as other photographs taken in the Middle East region between the 1930s and the 1940s. Al-Khazen and the women represented in the photographs of this period were part of a cosmopolitan sensibility that reveals the Middle East region to be far more international than one might have imagined. Caught between projecting a self-image of the cosmopolitan woman and one of the traditional bedouin, these photographs provide a rich field for tracking the ambiguities of the modern.

  9. Deciding to opt out of childhood vaccination mandates.

    Science.gov (United States)

    Gullion, Jessica Smartt; Henry, Lisa; Gullion, Greg

    2008-01-01

    We explore the attitudes and beliefs of parents who consciously choose not to vaccinate their children and the ways in which these parents process information on the pros and cons of vaccines. In-depth, semistructured interviews were conducted. The study population consisted of 25 parents who do not vaccinate their children, identified through snowball and targeted sampling. Participants were asked about their processes and actions when choosing not to vaccinate their children. Interviews were taped and transcribed, and the content was analyzed for emergent themes. Two predominant themes emerged in our data: a desire to collect information on vaccines and trust issues with the medical community. Evidence of sophisticated data collection and information processing was a repeated theme in the interview data. Simultaneously, while participants placed a high value on scientific knowledge, they also expressed high levels of distrust of the medical community. The challenge for public health is to balance scientific data with popular epidemiology and to maintain legitimacy. Understanding the differences in lay versus expert knowledge has implications for crafting health messages. How experts frame knowledge for consumption has an important impact on this group and their decision-making processes.

  10. The Struggle for Teacher Professionalism in a Mandated Literacy Curriculum

    Science.gov (United States)

    Costello, Marsha; Costello, David

    2016-01-01

    This article reports on a study investigating how elementary teachers experienced the literacy initiatives that have been implemented in schools across PEI over the past five years. Such initiatives included the implementation of standardized instructional and assessment materials across the board and the emphasis on consistency of program use,…

  11. Tuskegee redux: evolution of legal mandates for human experimentation.

    Science.gov (United States)

    Levine, Robert S; Williams, Jamila C; Kilbourne, Barbara A; Juarez, Paul D

    2012-11-01

    Human health experiments systematically expose people to conditions beyond the boundaries of medical evidence. Such experiments have included legal-medical collaboration, exemplified in the U.S. by the Public Health Service (PHS) Syphilis Study (Tuskegee). That medical experiment was legal, conforming to segregationist protocols and specific legislative authorization which excluded a selected group of African Americans from any medical protection from syphilis. Subsequent corrective action outlawed unethical medical experiments but did not address other forms of collaboration, including PHS submission to laws which may have placed African American women at increased risk from AIDS and breast cancer. Today, anti-lobbying law makes it a felony for PHS workers to openly challenge legally anointed suspension of medical evidence. African Americans and other vulnerable populations may thereby face excess risks-not only from cancer, but also from motor vehicle crashes, firearm assault, end stage renal disease, and other problems-with PHS workers as silent partners.

  12. an unusual self-damaging behavior mandating neurosurgery

    African Journals Online (AJOL)

    3. Neurosurgery related cases of Munchausen's syndrome generally involve chronic back pain4, post- surgery Munchausen's syndrome5, or head trauma and intracranial hemorrhage.6 These patients spend most of their lives in hospitals with ...

  13. When confidentiality mandates a secret be kept: a case report.

    Science.gov (United States)

    Hough, G

    1992-01-01

    The success of group psychotherapy is impeded when group members maintain secrets and fail to self-disclose to other group members. However, revealing secrets sometimes conflicts with the legal and ethical constraints of confidentiality, thus placing a greater burden on the group. The case reported here illustrates how complex the dynamics of group therapy become when one group member maintains a secret. In this case, one member maintained a secret about another to preserve that individual's right to privacy and confidentiality. This case also details the group member's deliberations and confusion about the effect his secret had on the group's success, as well as the burden he experienced by choosing to preserve confidentiality at the expense of successful therapy for himself.

  14. 17 CFR 232.101 - Mandated electronic submissions and exceptions.

    Science.gov (United States)

    2010-04-01

    ....480 of this chapter) filed or submitted under § 230.801 or 230.802 of this chapter or § 240.13e-4(h)(8... is of the type typically returned by the staff pursuant to Rule 418(b) of Regulation C (§ 230.418(b...) Promotional and sales material submitted pursuant to Securities Act Industry Guide 5 (§ 229.801(e) of this...

  15. Neuroscience in the HBSE Sequence: Mandate and Methodology

    Science.gov (United States)

    Combs-Orme, Terri; Lefmann, Tess; Pilkay, Stefanie; Strong, Joe; Thompson, Phyllis; Veerman, Tara

    2017-01-01

    Important findings from neuroscience research provide valuable knowledge for social work practice, and although these findings are already being incorporated into practice in many other disciplines, social work has been slow to integrate this content into foundation professional education. This article describes how one social work program…

  16. The constitutional mandate for social welfare – systemic differences ...

    African Journals Online (AJOL)

    ... imperative to provide stronger land and housing rights. Important connections exist between these divergent constitutional imperatives that should be acknowledged to ensure the efficient realisation of social welfare concerns. KEYWORDS: property law; constitutional property law; land law; land reform; restorative justice; ...

  17. Towards the Dual Mandate of Ecotourism in Africa: Comparative ...

    African Journals Online (AJOL)

    This article compares the impacts of ecotourism based on a study of Kakum National Park and Boabeng-Fiema Monkey Sanctuary in Ghana. The study employed a mixed-method approach, which involved 200 semi-structured interviews with randomly selected residents from the study communities. Furthermore, the study ...

  18. What Color Helmet? Reforming Security Council Peacekeeping Mandates

    Science.gov (United States)

    1997-08-01

    in its internal affairs. UNOGIL observers ensured that personn el, arms, an d materials were not inftltrated across Lebanese borders. The mission...a general peace agreement between the government of Mozambique and the Resistencia Nacional Mocambicana (RENAMO) that ended 1 4 years of civil war...Engineers units serving as Green Helmets may make available to the White Helmets the personnel and material needed to build water purification

  19. Skred i marts: S minus seks mandater, SF plus ni

    DEFF Research Database (Denmark)

    Thomsen, Søren Risbjerg

    2008-01-01

    NYHED: "Tilslutningen til S går ad helvede til", skriver professor Søren Risbjerg Thomsen om snittet af meningsmålinger i marts.......NYHED: "Tilslutningen til S går ad helvede til", skriver professor Søren Risbjerg Thomsen om snittet af meningsmålinger i marts....

  20. Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception

    Directory of Open Access Journals (Sweden)

    Carla L. DeSisto

    2017-11-01

    Full Text Available Abstract Background Implementation strategies are imperative for the successful adoption and sustainability of complex evidence-based public health practices. Creating a learning collaborative is one strategy that was part of a recently published compilation of implementation strategy terms and definitions. In partnership with the Centers for Disease Control and Prevention and other partner agencies, the Association of State and Territorial Health Officials recently convened a multi-state Learning Community to support cross-state collaboration and provide technical assistance for improving state capacity to increase access to long-acting reversible contraception (LARC in the immediate postpartum period, an evidence-based practice with the potential for reducing unintended pregnancy and improving maternal and child health outcomes. During 2015–2016, the Learning Community included multi-disciplinary, multi-agency teams of state health officials, payers, clinicians, and health department staff from 13 states. This qualitative study was conducted to better understand the successes, challenges, and strategies that the 13 US states in the Learning Community used for increasing access to immediate postpartum LARC. Methods We conducted telephone interviews with each team in the Learning Community. Interviews were semi-structured and organized by the eight domains of the Learning Community. We coded transcribed interviews for facilitators, barriers, and implementation strategies, using a recent compilation of expert-defined implementation strategies as a foundation for coding the latter. Results Data analysis showed three ways that the activities of the Learning Community helped in policy implementation work: structure and accountability, validity, and preparing for potential challenges and opportunities. Further, the qualitative data demonstrated that the Learning Community integrated six other implementation strategies from the literature: organize