Advocacy in Health Proceedings in New York State

Individuals and communities navigating the healthcare system without an advocate often experience devastating outcomes and become burdened with unnecessary costs. These negative outcomes undermine the very utility of our healthcare system. The creation of a legal right to counsel for individuals with critical health related claims would meet an important and unmet need in our health and legal systems by empowering patients, improving the quality of health for many, and preventing unnecessary costs to the health care system. A dedicated group of healthcare advocates, lawyers, public policy analysts, and other concerned individuals gathered together at Touro Law Center to strategize around creating a civil right to counsel in New York State. At this conference, entitled An Obvious Truth: Creating an Action Blueprint for a Civil Right to Counsel in New York State, participants split into panel sessions to discuss the various issue areas in which such a right could attach. One such panel discussed how establishing a right to counsel in health related proceedings could improve patients\u27 healthcare experiences and produce greater benefits to the health care system as a whole. This reflection emerges from that discussion as an exploration of the issues and questions raised therein. The creation of a legal right to counsel for individuals with critical health related claims would meet a crucial and overlooked need in society. Not only would creation of such a right potentially improve healthcare for individuals, it would also improve the functionality of the health care system as a whole. This Article explores strategic considerations and challenges involved with establishing a right to representation in health-related adjudications. First, it asks, in what type of proceedings are health related decisions being made, and in which of those proceedings would a civil right to counsel be beneficial? Second, what are the potential benefits and savings to anticipate from establishing this right? Third, what are the risks or stakes involved for individuals in these proceedings who do not have access to counsel? And fourth, what barriers or limitations would prevent people from obtaining access to counsel even if the right were established? As advocates address practical concerns about financing and implementing a right to counsel in health proceedings, they also must identify the core values that mandate the creation of this right. This includes values for human dignity, the human right to health, and fundamental fairness and accountability in the systems upon which we rely for our safety and security. It is the panel\u27s hope that this reflection will launch a larger, sustained conversation among healthcare advocates, patients, and access to counsel advocates about how to meet this important need. By working together to articulate a vision for civil legal and public health systems that work effectively and equitably for all people, regardless of their income or background, health and right to counsel advocates can achieve the progress necessary to create a civil right to counsel in health proceedings

Advocacy in Health Proceedings in New York State

Individuals and communities navigating the healthcare system without an advocate often experience devastating outcomes and become burdened with unnecessary costs. These negative outcomes undermine the very utility of our healthcare system. The creation of a legal right to counsel for individuals with critical health related claims would meet an important and unmet need in our health and legal systems by empowering patients, improving the quality of health for many, and preventing unnecessary costs to the health care system. A dedicated group of healthcare advocates, lawyers, public policy analysts, and other concerned individuals gathered together at Touro Law Center to strategize around creating a civil right to counsel in New York State. At this conference, entitled An Obvious Truth: Creating an Action Blueprint for a Civil Right to Counsel in New York State, participants split into panel sessions to discuss the various issue areas in which such a right could attach. One such panel discussed how establishing a right to counsel in health related proceedings could improve patients\u27 healthcare experiences and produce greater benefits to the health care system as a whole. This reflection emerges from that discussion as an exploration of the issues and questions raised therein. The creation of a legal right to counsel for individuals with critical health related claims would meet a crucial and overlooked need in society. Not only would creation of such a right potentially improve healthcare for individuals, it would also improve the functionality of the health care system as a whole. This Article explores strategic considerations and challenges involved with establishing a right to representation in health-related adjudications. First, it asks, in what type of proceedings are health related decisions being made, and in which of those proceedings would a civil right to counsel be beneficial? Second, what are the potential benefits and savings to anticipate from establishing this right? Third, what are the risks or stakes involved for individuals in these proceedings who do not have access to counsel? And fourth, what barriers or limitations would prevent people from obtaining access to counsel even if the right were established? As advocates address practical concerns about financing and implementing a right to counsel in health proceedings, they also must identify the core values that mandate the creation of this right. This includes values for human dignity, the human right to health, and fundamental fairness and accountability in the systems upon which we rely for our safety and security. It is the panel\u27s hope that this reflection will launch a larger, sustained conversation among healthcare advocates, patients, and access to counsel advocates about how to meet this important need. By working together to articulate a vision for civil legal and public health systems that work effectively and equitably for all people, regardless of their income or background, health and right to counsel advocates can achieve the progress necessary to create a civil right to counsel in health proceedings

Contemplative Practices: A Strategy to Improve Health and Reduce Disparities.

Health has many dimensions, and intolerance and lack of compassion may contribute to the poor health and disparities in our nation. Tolerance can convey an inherent paradox or dissonance that can be associated with stress. However, tolerance has a dimension of acceptance, an acknowledgement and acceptance of what "is" at the present moment, that can relieve tension associated with differing beliefs and practices. Compassionate consideration of others can be combined with acceptance to create harmony within and across individuals. In this article, we explore how contemplative practices can cultivate tolerance and compassion and contribute to improvements in individual and population health

Natural killer cells and natural killer T cells in Lyme arthritis

Introduction: Natural killer (NK) and natural killer T (NKT) cells provide a first line of defense against infection. However, these cells have not yet been examined in patients with Lyme arthritis, a late disease manifestation. Lyme arthritis usually resolves with antibiotic treatment. However, some patients have persistent arthritis after spirochetal killing, which may result from excessive inflammation, immune dysregulation and infection-induced autoimmunity. Methods: We determined the frequencies and phenotypes of NK cells and invariant NKT (iNKT) cells in paired peripheral blood (PB) and synovial fluid (SF) samples from eight patients with antibiotic-responsive arthritis and fifteen patients with antibiotic-refractory arthritis using flow cytometry and cytokine analyses. Results: In antibiotic-responsive patients, who were seen during active infection, high frequencies of CD56bright NK cells were found in SF, the inflammatory site, compared with PB (P <0.001); at both sites, a high percentage of cells expressed the activation receptor NKG2D and the chaperone CD94, a low percentage expressed inhibitory killer immunoglobulin-like receptors (KIR), and a high percentage produced IFN-γ. In antibiotic-refractory patients, who were usually evaluated near the conclusion of antibiotics when few if any live spirochetes remained, the phenotype of CD56bright cells in SF was similar to that in patients with antibiotic-responsive arthritis, but the frequency of these cells was significantly less (P = 0.05), and the frequencies of CD56dim NK cells tended to be higher. However, unlike typical NKdim cells, these cells produced large amounts of IFN-γ, suggesting that they were not serving a cytotoxic function. Lastly, iNKT cell frequencies in the SF of antibiotic-responsive patients were significantly greater compared with that of antibiotic-refractory patients where these cells were often absent (P = 0.003). Conclusions: In patients with antibiotic-responsive arthritis, the high percentage of activated, IFN-γ-producing CD56bright NK cells in SF and the presence of iNKT cells suggest that these cells still have a role in spirochetal killing late in the illness. In patients with antibiotic-refractory arthritis, the frequencies of IFN-γ-producing CD56bright and CD56dim NK cells remained high in SF, even after spirochetal killing, suggesting that these cells contribute to excessive inflammation and immune dysregulation in joints, and iNKT cells, which may have immunomodulatory effects, were often absent

On Optimizing Compatible Security Policies in Wireless Networks

This paper deals with finding the maximum number of security policies without conflicts. By doing so we can remove security loophole that causes security violation. We present the problem of maximum compatible security policy and its relationship to the problem of maximum acyclic subgraph, which is proved to be NP-hard. Then we present a polynomial-time approximation algorithm and show that our result has approximation ratio for any integer with complexity

Psychometric Properties of the Altarum Consumer Engagement (ACE) Measure of Activation in Patients with Prediabetes.

BackgroundPatient activation is associated with better outcomes in chronic conditions.ObjectiveWe evaluated the psychometric properties of the 12-item Altarum Consumer Engagement™ Measure (ACE-12) in patients with prediabetes.ParticipantsACE-12 was administered to patients in the Prediabetes Informed Decisions and Education Study.Main measuresWe conducted an exploratory factor analysis followed by confirmatory factor analytic models. We evaluated item response categories using item characteristic curves. Construct validity was assessed by examining correlations of the ACE-12 scales with education, depressive symptoms, self-rated health, hemoglobin A1c, body mass index, and weight loss.Key resultsParticipants (n = 515) had a median age of 58; 56% were female; 17% Hispanic; 54% were non-White. The scree plot and Tucker and Lewis reliability coefficient (0.95) suggested three factors similar to the original scales. One item loaded on the navigation rather than the informed choice scale. Ordinal alpha coefficients for the original scales were commitment (0.75); informed choice (0.71); and navigation (0.54). ICCs indicated that one or more of the response categories for 5 of the 12 items were never most likely to be selected. Patients with lower education were less activated on the commitment (r = - 0.124, p = 0.004), choice (r = - 0.085, p = 0.009), and overall score (r = - 0.042, p = 0.011). Patients with depressive symptoms had lower commitment (r = - 0.313, p ≤ 0.001) and overall scores (r = - 0.172, p = 0.012). Patients with poorer health scored lower on the Commitment (r = - 0.308, p ≤ 0.001), Navigation (r = - 0.137, p ≤ 0.001), and overall score (r = - 0.279, p ≤ 0.001).ConclusionThe analyses provide some support for the psychometric properties of the ACE-12 in prediabetic patients. Future research evaluating this tool among patients with other chronic conditions are needed to determine whether Q1 (I spend a lot of time learning about health) should remain in the informed choice or be included in the navigation scale. Additional items may be needed to yield acceptable reliability for the navigation scale

Minimax mean estimator for the trine

We explore the question of state estimation for a qubit restricted to the $x$-$z$ plane of the Bloch sphere, with the trine measurement. In our earlier work [H. K. Ng and B.-G. Englert, eprint arXiv:1202.5136[quant-ph] (2012)], similarities between quantum tomography and the tomography of a classical die motivated us to apply a simple modification of the classical estimator for use in the quantum problem. This worked very well. In this article, we adapt a different aspect of the classical estimator to the quantum problem. In particular, we investigate the mean estimator, where the mean is taken with a weight function identical to that in the classical estimator but now with quantum constraints imposed. Among such mean estimators, we choose an optimal one with the smallest worst-case error-the minimax mean estimator-and compare its performance with that of other estimators. Despite the natural generalization of the classical approach, this minimax mean estimator does not work as well as one might expect from the analogous performance in the classical problem. While it outperforms the often-used maximum-likelihood estimator in having a smaller worst-case error, the advantage is not significant enough to justify the more complicated procedure required to construct it. The much simpler adapted estimator introduced in our earlier work is still more effective. Our previous work emphasized the similarities between classical and quantum state estimation; in contrast, this paper highlights how intuition gained from classical problems can sometimes fail in the quantum arena.Comment: 18 pages, 3 figure

1,2-Di-2-quinolylethene

The title compound, C20H14N2, comprises two crystallographically independent centrosymmetric mol­ecules (A and B) with different conformations due to the disorder of molecule B. The whole of mol­ecule B is disordered over two sets of positions, corresponding to a 180° rotation of the molecule, with a site-occupancy ratio of 0.780 (6):0.220 (6). The minor component of the disordered part in B has the same configuration as mol­ecule A, but the major component is different. The dihedral angle between the planes of mol­ecule A and mol­ecule B (major component) is 63.22 (3)°. The crystal structure is stabilized by inter­molecular C—H⋯π inter­actions

Estimating cortical thickness trajectories in children across different scanners using transfer learning from normative models

This work illustrates the use of normative models in a longitudinal neuroimaging study of children aged 6–17 years and demonstrates how such models can be used to make meaningful comparisons in longitudinal studies, even when individuals are scanned with different scanners across successive study waves. More specifically, we first estimated a large-scale reference normative model using Hierarchical Bayesian Regression from N = 42,993 individuals across the lifespan and from dozens of sites. We then transfer these models to a longitudinal developmental cohort (N = 6285) with three measurement waves acquired on two different scanners that were unseen during estimation of the reference models. We show that the use of normative models provides individual deviation scores that are independent of scanner effects and efficiently accommodate inter-site variations. Moreover, we provide empirical evidence to guide the optimization of sample size for the transfer of prior knowledge about the distribution of regional cortical thicknesses. We show that a transfer set containing as few as 25 samples per site can lead to good performance metrics on the test set. Finally, we demonstrate the clinical utility of this approach by showing that deviation scores obtained from the transferred normative models are able to detect and chart morphological heterogeneity in individuals born preterm.</p