Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses

Examines how a rise in unemployment affects Medicaid and SCHIP (State Children's Health Insurance Program) enrollment and costs, the number of uninsured, and state revenues. Considers general and targeted fiscal relief for states to prevent program cuts

A Review of Selected Lease Clauses

The mineral lease is quite possibly the most frequently used contract in any mineral producing jurisdiction. There are innumerable forms currently in use including both standard and custom drafted lease forms. Within the myriad of lease forms certain standard clauses have emerged, such as the habendem clause, royalty clause, Pugh clause, and Mother Hubbard clause, but even these standard clauses vary widely. No specific meaning may be given to any clause without an examination of its particular terms and provisions. And, as with any contract, careful drafting is necessary in light of the issues that have been raised by the jurisprudence addressing the clauses. It would takes weeks of time and hundreds of pages to give even the most cursory treatment to every standard clause contained in ary of the many standard lease forms. This paper will not endeavor to provide the reader with exhaustive treatment of each provision of the mineral lease but, instead, will address selected issues arising under the habendum clause, the shut-in royalty clause, the Pugh clause, the Mother Hubbard clause, and the adjacent land clause by examining Louisiana case law where our courts have addressed issues arising thereunder and examining case law in other states where Louisiana courts have yet to address an important issue

Optimizing measurement for neurobehavioural rehabilitation services: A multisite comparison study and response to UKROC

To evaluate the efficacy of neurobehavioural rehabilitation (NbR) programmes, services should employ valid, reliable assessment tools; the ability to detect change on repeated assessment is a particular requirement. The United Kingdom Rehabilitation Outcomes Collaborative (UKROC) requires neurorehabilitation services to collect data using a standardised basket of measures, but the responsiveness and usefulness of using these in the context of NbR remains unknown. Anonymous data collected at two assessments for 123 people was studied using multiple methods to determine responsiveness of four outcome measures routinely used in NbR (HoNOS-ABI, FIM+FAM UK, MPAI-4, SASNOS). Predictive validity of two measures of rehabilitation complexity (RCS-E, SRS) regarding the extent of difference scores on these outcome measures at reassessment was also determined. All four outcome measures demonstrated responsiveness, with higher levels for SASNOS and MPAI-4 when only participants categorised as “most likely to change” at first assessment were analysed. Predictive validity of the RCS-E and SRS in estimating the extent of change was variable. SRS was only predictive of improvement on the MPAI-4 whilst RCS-E was not predictive at all. Recommendations are made regarding ideal characteristics of NbR outcome measures, along with the need to develop measures of rehabilitation complexity specifically conceptualised for these programmes

The use of repetitive transcranial magnetic stimulation (rTMS) following traumatic brain injury (TBI): A scoping review

There is continued interest in developing effective and innovative treatment approaches to manage and improve outcomes after traumatic brain injury (TBI). Included in this, is the potential use of repetitive transcranial magnetic stimulation (rTMS), a neuromodulatory tool currently recommended by the National Institute for Health and Care Excellence as a treatment for depression. This review considers the application of rTMS after TBI, focussing on its therapeutic efficacy for a broad range of sequalae, whether an optimal and safe rTMS protocol can be determined, and recommendations for future clinical and research work. Five research databases (MEDLINE, CINAHL, PsychINFO, SCOPUS, and Web of Science) were electronically searched, identifying 30 empirical studies (single and multiple subject case reports; randomized controlled trials) for the full review. Evidence suggests that rTMS has the potential to be an efficacious therapeutic intervention for multiple symptoms after TBI, including depression, dizziness, central pain, and visual neglect. However, the picture is less encouraging for prolonged disorders of consciousness and mixed for cognitive outcomes. Overall, rTMS was well-tolerated by patients, although some incidents of side effects and seizures have been reported. Recommendations are made for more comprehensive guidelines and sufficient reporting of rTMS parameters and procedures

Geographical location and stage of breast cancer diagnosis: A systematic review of the literature

Objective: To examine systematically the literature on the effect of geographical location variation on breast cancer stage at diagnosis, race/ethnicity, and socioeconomic status. Methods. Eight electronic databases were searched using combination of key words. Of the 312 articles retrieved from the search, 36 studies from 12 countries were considered eligible for inclusion. Results. This review identified 17 (47%) of 36 studies in which breast cancer patients residing in geographically remote/rural areas had more late-stage diagnosis than urban women. Ten (28%) studies reported higher proportions of women diagnosed with breast cancer resided in urban than rural counties. Nine (25%) studies reported no statistically significant association between place of residence and stage at diagnosis for breast cancer patients residing in rural and urban areas. Conclusions. Cancer patients residing in rural and disadvantaged areas were more likely to be diagnosed with distant breast metastasis. Efforts to reduce these inequalities and subsequent mortality are needed

Incremental Cost Estimates for the Patient-Centered Medical Home

Based on data from thirty-five primary care practices, analyzes the costs associated with the medical home model, in which primary care practices also provide care coordination, patient education, and related services. Considers implications

A serial mediation model of the relationship between alexithymia and BMI: The role of negative affect, negative urgency and emotional eating

Difficulty identifying and describing emotions (alexithymia) has been related to impulsiveness and negative affect, emotional eating and obesity. However, previous research findings concerning the relationship between alexithymia and obesity have been mixed and inconsistent, raising the possibility that the relationship is indirect and mediated by multiple unknown factors. The aim of the study was to comprehensively explore the potential pathways between alexithymia and obesity via a novel theoretical model, and for the first time, incorporate negative affect, impulsiveness and emotional eating as potential mediating factors. Two questionnaire-based studies were conducted; the first as an exploratory analysis within a student sample (N=125), and the second as a self-replication within a more representative general population sample (N=342). Study One revealed that difficulty identifying feelings predicted Body Mass Index (BMI) both directly (B = .1694, CI = .0194-.3194) and indirectly via impulsiveness and emotional eating (B = .0074, CI = .0001-.0315). In contrast, Study Two revealed that alexithymia predicted BMI indirectly via negative affect (when depression was included in the model; B = .0335, CI = .0019-.0660) or impulsiveness (when anxiety was included in the model; B = .0021, CI = .0001-.0066). Our findings provide partial support for the hypothesised model and offer original insight into the relationship between alexithymia and obesity. Additionally, our findings highlight important methodological considerations for future research and suggest that ways to address an individual’s ability to identify, describe and regulate emotions should be considered when designing interventions to assist weight loss and management