No equity, no triple aim: strategic proposals to advance health equity in a volatile policy environment

Health professionals, including social workers, community health workers, public health workers, and licensed health care providers, share common interests and responsibilities in promoting health equity and improving social determinants of health—the conditions in which we live, work, play, and learn. This article summarizes underlying causes of health inequity and comparatively poor health outcomes in the U.S. It describes barriers to realizing the hope embedded in the 2010 Patient Protection and Affordable Care Act that moving away from fee-for-service payments will naturally drive care upstream as providers respond to greater financial risk for the health of their patients by undertaking greater prevention efforts. The article asserts that health equity should serve as the guiding framework for achieving the Triple Aim of health care reform. It outlines practical opportunities for improving care and for promoting stronger efforts to address social determinants of health. These proposals include developing a dashboard of measures to assist providers committed to health equity and community-based prevention and to promote institutional accountability for addressing socio-economic factors that influence health

No equity, no triple aim: strategic proposals to advance health equity in a volatile policy environment

Health professionals, including social workers, community health workers, public health workers, and licensed health care providers, share common interests and responsibilities in promoting health equity and improving social determinants of health—the conditions in which we live, work, play, and learn. This article summarizes underlying causes of health inequity and comparatively poor health outcomes in the U.S. It describes barriers to realizing the hope embedded in the 2010 Patient Protection and Affordable Care Act that moving away from fee-for-service payments will naturally drive care upstream as providers respond to greater financial risk for the health of their patients by undertaking greater prevention efforts. The article asserts that health equity should serve as the guiding framework for achieving the Triple Aim of health care reform. It outlines practical opportunities for improving care and for promoting stronger efforts to address social determinants of health. These proposals include developing a dashboard of measures to assist providers committed to health equity and community-based prevention and to promote institutional accountability for addressing socio-economic factors that influence health

The mixed problem for the Lam\'e system in two dimensions

We consider the mixed problem for $L$ the Lam\'e system of elasticity in a bounded Lipschitz domain $\Omega\subset\reals ^2$. We suppose that the boundary is written as the union of two disjoint sets, $\partial\Omega =D\cup N$. We take traction data from the space $L^p(N)$ and Dirichlet data from a Sobolev space $W^{1,p}(D)$ and look for a solution $u$ of $Lu =0$ with the given boundary conditions. We give a scale invariant condition on $D$ and find an exponent $p_0 >1$ so that for $1<p<p_0$, we have a unique solution of this boundary value problem with the non-tangential maximal function of the gradient of the solution in $L^ p(\partial\Omega)$. We also establish the existence of a unique solution when the data is taken from Hardy spaces and Hardy-Sobolev spaces with $p$ in $(p_1,1]$ for some $p_1 <1$

Patterns and emerging trends in global ocean health.

International and regional policies aimed at managing ocean ecosystem health need quantitative and comprehensive indices to synthesize information from a variety of sources, consistently measure progress, and communicate with key constituencies and the public. Here we present the second annual global assessment of the Ocean Health Index, reporting current scores and annual changes since 2012, recalculated using updated methods and data based on the best available science, for 221 coastal countries and territories. The Index measures performance of ten societal goals for healthy oceans on a quantitative scale of increasing health from 0 to 100, and combines these scores into a single Index score, for each country and globally. The global Index score improved one point (from 67 to 68), while many country-level Index and goal scores had larger changes. Per-country Index scores ranged from 41-95 and, on average, improved by 0.06 points (range -8 to +12). Globally, average scores increased for individual goals by as much as 6.5 points (coastal economies) and decreased by as much as 1.2 points (natural products). Annual updates of the Index, even when not all input data have been updated, provide valuable information to scientists, policy makers, and resource managers because patterns and trends can emerge from the data that have been updated. Changes of even a few points indicate potential successes (when scores increase) that merit recognition, or concerns (when scores decrease) that may require mitigative action, with changes of more than 10-20 points representing large shifts that deserve greater attention. Goal scores showed remarkably little covariance across regions, indicating low redundancy in the Index, such that each goal delivers information about a different facet of ocean health. Together these scores provide a snapshot of global ocean health and suggest where countries have made progress and where a need for further improvement exists

Factors Associated with Arkansans’ First Use of Telehealth during the COVID-19 Pandemic

Objective. To examine the factors associated with the first use of telehealth during the COVID-19 pandemic using Andersen’s Model of Healthcare Utilization. Andersen’s Model of Healthcare Utilization allowed the categorization of the independent variables into the following: (1) predisposing factors, including sociodemographic variables and health beliefs; (2) enabling factors, including socioeconomic status and access to care; and (3) need for care, including preexisting or newly diagnosed conditions and reasons to seek out care or to utilize a new mode of care. Methods. Potential respondents (n = 4,077) were identified for recruitment from a volunteer registry in Arkansas. Recruitment emails provided a study description, the opportunity to verify meeting the study’s inclusion criteria and to consent for participation, and a link to follow to complete the survey online. The online survey responses were collected between July and August of 2020 (n = 1,137). Results. Telehealth utilization included two categories: (1) utilizers reported the first use of telehealth services during the pandemic, and (2) nonutilizers reported they had never used telehealth. Lower odds of reporting telehealth utilization during the pandemic were associated with race (Black; OR = 0:57, CI [0.33, 0.96]) and education (high School or less; OR = 0:45, CI [0.25, 0.83]). Higher odds of reporting telehealth utilization included having more than one provider (OR = 2:33, CI [1.30, 4.18]), more physical (OR = 1:12, CI [1.00, 1.25]) and mental (OR 1.53, CI [1.24, 1.88]) health conditions, and changes in healthcare delivery during the pandemic (OR = 3:49, CI [2.78, 4.38]). Conclusions. The results illustrate that disparities exist in Arkansans’ utilization of telehealth services during the pandemic. Future research should explore the disparities in telehealth utilization and how telehealth may be used to address disparities in care for Black Arkansans and those with low socioeconomic status

On the Exponentials of Some Structured Matrices

In this note explicit algorithms for calculating the exponentials of important structured 4 x 4 matrices are provided. These lead to closed form formulae for these exponentials. The techniques rely on one particular Clifford Algebra isomorphism and basic Lie theory. When used in conjunction with structure preserving similarities, such as Givens rotations, these techniques extend to dimensions bigger than four.Comment: 19 page