The Myths of \u27Broken\u27 Government: Moving Beyond the Conventional Wisdom

The budget difficulties faced by Maine and by most other states have prompted a national search for better ways to deliver government services. In Maine, a conference entitled Rethinking Maine Government was held at the University of Maine on January 5-6, 1993 under the auspices of the Margaret Chase Smith Center for Public Policy. Maine Policy Review selected three of the presentations at that conference for this issue. Anthony Cahill challenged the 400 legislators, state government officials and business leaders attending the conference to think in terms of a revolution in rethinking Maine\u27s state government

Using Quality Improvement (QI)-Focused Evaluation to Redesign Direct Home- and Community-based Services during the COVID-19 Public Health Emergency:

Like many UCEDDs in the Developmental Disabilities (DD) network, the Center for Development and Disability at the University of New Mexico offers direct service programs in home and community settings. Before the start of the COVID-19 pandemic, services were delivered in-person to about 1,000 families across the state including clients with intellectual or developmental disabilities and/or from at-risk communities. In March 2020, due to the spread of COVID-19, a public health emergency was declared in New Mexico and home and community services were stopped throughout the state. This meant direct service programs at the Center had to turn to telehealth – the use of telecommunications and virtual technology – to deliver services. Center faculty and staff then developed a hybrid quality improvement – evaluation process to assess how this change affected services. The results of this process are reported in this article. The purpose of our evaluation was to both understand “what it takes” to deliver effective services using telehealth, and to assess the how clients and providers experiences services delivered by telehealth. This paper describes findings based on a combination of interviews, focus groups, surveys and program data, focused on four questions: How did clients rate the quality and efficacy of telehealth-based services? How did clients/families compare virtual to in-person services? What were the experiences of service providers as the switch to telehealth-based services took place? What barriers did they face related to technology and a new service delivery processes? What changes did program leaders make to support staff and service delivery? How did programs use technology to deliver services? How well equipped were Center programs to use telehealth to provide services and how were obstacles overcome? The article ends by discussing four issues that all UCEDD’s and other agencies delivering telehealth/distance-based direct services might consider moving forward

Immunization in Patients With Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease of the central nerv-ous system characterized by inflammatory demyelination and some axonal damage. An overactive or dysfunctional immune response to self-antigen is believed to be the pathogenic mechanism and therefore the treatment of MS often involves immunosuppressive therapy. Be-cause of altered immune function in patients with MS, questions arise about risk of infections in this population and the safety and efficacy of common immunizations. The risk of MS exacerbation with common infections and safety and efficacy of immunization are reviewed along with the available guidelines for use of vaccines in patients with MS

UVM Tobacco Use and Attitudes After Implementation of a Tobacco-Free Policy

Introduction: Widespread public health initiatives have led to falling smoking rates. Currently, 1,620 U.S. colleges have adopted smoke-free policies. In August 2015, the University of Vermont (UVM) adopted a tobacco-free policy that bans all forms of tobacco use on university property. The purpose of this study was to compare tobacco use and attitudes before and after policy implementation.https://scholarworks.uvm.edu/comphp_gallery/1230/thumbnail.jp

Advanced Maternal Age and the Risk of Major Congenital Anomalies

Objective This study aims to determine if advanced maternal age (AMA) is a risk factor for major congenital anomalies, in the absence of aneuploidy. Study Design Retrospective cohort study of all patients with a singleton gestation presenting for second trimester anatomic survey over a 19-year study period. Aneuploid fetuses were excluded. Study groups were defined by maternal age ≤ 34 and ≥ 35 years. The primary outcome was the presence of one or more major anomalies diagnosed at the second trimester ultrasound. Univariable and multivariable logistic regression analyses were used to estimate the risk of major anomalies in AMA patients. Results Of 76,156 euploid fetuses, 2.4% (n = 1,804) were diagnosed with a major anomaly. There was a significant decrease in the incidence of major fetal anomalies with increasing maternal age until the threshold of age 35 (p < 0.001). Being AMA was significantly associated with an overall decreased risk for major fetal anomalies (adjusted odds ratio: 0.59, 95% confidence interval: 0.52–0.66). The subgroup analysis demonstrated similar results for women ≥ 40 years of age. Conclusion AMA is associated with an overall decreased risk for major anomalies. These findings may suggest that the “all or nothing” phenomenon plays a more robust role in embryonic development with advancing oocyte age, with anatomically normal fetuses being more likely to survive