Examining the Evidentiary Basis of Congress's Commerce Clause Power to Address Individuals' Health Insurance Status

Outlines the issues involved in whether the 2010 Affordable Care Act's individual mandate is constitutional under the commerce clause, presents research literature on the effect of uninsurance on the broader economy, and reviews the lower courts' rulings

Examining the evidentiary basis of Congress\u27s commerce clause power to address individuals\u27 health insurance status

Chief among the issues that the United States Supreme Court considers in United States Department of Health and Human Services et al. v Florida et al. is the questionof whether Congress has the constitutional power to apply a “minimum essential coverage requirement” on most nonelderly Americans. Opponents of the provision (referred to under the Act as the “Individual Responsibility” requirement) argue that compelling individuals to buy affordable health insurance coverage exceeds Congressional powers. By contrast, the United States Department of Justice and supporters of the law assert that the minimum coverage requirement is consistent with a long line of Supreme Court decisions regarding the power of Congress to regulate individual conduct. The Administration, in a brief filed on January 9, 2012, argues that Congressional authority to act can be found under both its taxing powers as well as its power under the Commerce Clause and Necessary and Proper Clause to regulate interstate commerce. The Commerce Clause arguments are of special interest, because it is this basis of power that has received so much attention in the lower court decisions to date

Examining the evidentiary basis of Congress\u27s commerce clause power to address individuals\u27 health insurance status

Chief among the issues that the United States Supreme Court considers in United States Department of Health and Human Services et al. v Florida et al. is the questionof whether Congress has the constitutional power to apply a “minimum essential coverage requirement” on most nonelderly Americans. Opponents of the provision (referred to under the Act as the “Individual Responsibility” requirement) argue that compelling individuals to buy affordable health insurance coverage exceeds Congressional powers. By contrast, the United States Department of Justice and supporters of the law assert that the minimum coverage requirement is consistent with a long line of Supreme Court decisions regarding the power of Congress to regulate individual conduct. The Administration, in a brief filed on January 9, 2012, argues that Congressional authority to act can be found under both its taxing powers as well as its power under the Commerce Clause and Necessary and Proper Clause to regulate interstate commerce. The Commerce Clause arguments are of special interest, because it is this basis of power that has received so much attention in the lower court decisions to date

Calibration of the CMS hadron calorimeters using proton-proton collision data at root s=13 TeV

Methods are presented for calibrating the hadron calorimeter system of theCMSetector at the LHC. The hadron calorimeters of the CMS experiment are sampling calorimeters of brass and scintillator, and are in the form of one central detector and two endcaps. These calorimeters cover pseudorapidities vertical bar eta vertical bar ee data. The energy scale of the outer calorimeters has been determined with test beam data and is confirmed through data with high transverse momentum jets. In this paper, we present the details of the calibration methods and accuracy.Peer reviewe

The handbook for standardized field and laboratory measurements in terrestrial climate change experiments and observational studies (ClimEx)

1. Climate change is a world‐wide threat to biodiversity and ecosystem structure, functioning and services. To understand the underlying drivers and mechanisms, and to predict the consequences for nature and people, we urgently need better understanding of the direction and magnitude of climate change impacts across the soil–plant–atmosphere continuum. An increasing number of climate change studies are creating new opportunities for meaningful and high‐quality generalizations and improved process understanding. However, significant challenges exist related to data availability and/or compatibility across studies, compromising opportunities for data re‐use, synthesis and upscaling. Many of these challenges relate to a lack of an established ‘best practice’ for measuring key impacts and responses. This restrains our current understanding of complex processes and mechanisms in terrestrial ecosystems related to climate change. 2. To overcome these challenges, we collected best‐practice methods emerging from major ecological research networks and experiments, as synthesized by 115 experts from across a wide range of scientific disciplines. Our handbook contains guidance on the selection of response variables for different purposes, protocols for standardized measurements of 66 such response variables and advice on data management. Specifically, we recommend a minimum subset of variables that should be collected in all climate change studies to allow data re‐use and synthesis, and give guidance on additional variables critical for different types of synthesis and upscaling. The goal of this community effort is to facilitate awareness of the importance and broader application of standardized methods to promote data re‐use, availability, compatibility and transparency. We envision improved research practices that will increase returns on investments in individual research projects, facilitate second‐order research outputs and create opportunities for collaboration across scientific communities. Ultimately, this should significantly improve the quality and impact of the science, which is required to fulfil society's needs in a changing world

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Bringing Evidence Into Practice: Lessons From a Behavioral Health Care Model Redesign

Purpose: The rapid change and instability omnipresent in the health care delivery and payment systems present a formidable challenge for clinicians and managers tasked with mental health and substance use disorder care delivery. Bringing evidence based practice into the clinical routine can be extremely challenging. The purpose of this project was to meet the needs of the changing health care landscape through a behavioral health care model redesign. Methods: This article reviews a case study of one organization’s experience in reforming mental health care delivery, and describes the implementation of a care model redesign in behavioral health. The case study emphasizes how the organizational structure and process were reshaped to address systems-level challenges, such as overburdened providers and lengthy patient wait times. Results: Since launching the behavioral health care (BH) model redesign in February 2016, the site-wide triage system evaluates roughly 1,600 patients each month. Average time to triage is 2.1 days, ranging by site from 1.4 to 4.1 days. The average wait time for therapist appointments dropped from over 60 days to approximately 10 days. Average therapist caseloads have decreased from 120 to 35 patients. The days between visits fell 40%, from an average of 24.9 days in 2015 to 15.9 days in 2017. Over 1,100 continuing education credits have been awarded as part of redesign process. Five care facilitators were hired and deployed to the sites with the highest perceived need. The care facilitator program is still in the pilot phase, but initial return on investment analyses have indicated savings of $112 per member per month. The department currently has signed letters of agreement with many community provider partners, who receive, on average, 260 referrals monthly. More than 60 therapy groups have been designed and initiated to augment medication and individual therapy interventions. These groups currently support over 350 patients’ treatment. Patient willingness to recommend the BH practice rose from 77.2% in January 2016 to 79.9% in December 2016. Additionally, psychopharmacology practices have been standardized across the BH sites, to ensure excellent care delivery to all patients. Conclusions: Significant hurdles, such as complexities associated with scale stakeholder engagement, were encountered in rolling out the care model redesign process. Despite these obstacles, the model redesign has been successful in the initial phase based on results documented to date. We hope this model may serve as a platform for other organizations to innovate through BH care redesign.Scholarly Projec

Cervical Cancer Screening Preferences Among Trans-Masculine Individuals: Patient-Collected Human Papillomavirus Vaginal Swabs Versus Provider-Administered Pap Tests

Purpose: Trans-masculine (TM, i.e. persons who have a masculine spectrum gender identity but are assigned female sex at birth) individuals face disparities in cervical cancer screening rates compared to non-transgender women. Some unique barriers to screening in this population are specific to Pap tests. Introduction of self-collected frontal (i.e., vaginal) swabs for human papillomavirus (HPV) testing as a screening strategy may help to alleviate these barriers. This study elucidates cervical cancer screening preferences among TM individuals. Methods: TM individuals participated in in-depth interviews (n=31) and online surveys (n=32) to explore perceptions and experiences regarding cervical cancer screening, including the acceptability of self-collected frontal HPV swabs compared to provider-administered Pap tests. Provider-collected frontal HPV swab acceptability was also explored. Results: Most TM individuals (92% in-person and 91% online participants) preferred either the self- or provider-collected frontal HPV swab to the Pap test. Participants perceived self- and provider-collected frontal HPV swabs to be less invasive, provoke less gender discordance, and promote a greater sense of agency compared to Pap tests. However, some participants expressed concern about HPV swab accuracy and, regarding the self-collected swab, discomfort about the need to engage with genitals they may not want to acknowledge. Individuals who reported positive provider relationships found Pap tests and provider-administered frontal swabs more acceptable than those who did not. Conclusion: Frontal HPV swabs have the potential to promote regular cervical cancer screening among TM individuals and to narrow screening disparities. Work is ongoing to establish swab accuracy and develop shared decision-making tools