Integrating Indian Health Programs Into Medicaid Managed Care Systems

The Indian Health Service (IHS), recognizing that state Medicaid programs are rapidly purchasing managed care plans for their beneficiaries and that managed care enrollment has significant implications for both Indians and Indian health facilities, convened this Roundtable to discuss options for participation in such care. The purpose of this roundtable was to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by IHS, programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act.By design, Roundtable participants were a group with diverse backgrounds in Indian health programs, safety-net providers, (e.g. federally qualified health centers, public hospital), state Medicaid and health departments, and the managed care industry. The overall goal of the Roundtable was to determine how to increase participation in Medicaid managed care among Indian health programs while maintaining their mission and capacity to provide a comprehensive and culturally sensitive health care system for all American Indians and Alaska Natives.Some of the issues raised during the Roundtable are applicable to any health care provider who desires to participate in Medicaid managed care, while others relate generally to safety-net providers. Other issues are important to Indian health programs, as well as to Indians and tribes as consumers of health services. The group\u27s consensus was that all issues must be addressed if Indian programs are to be successful participants. The 21 issues the Roundtable identified can be clustered into five areas: 1) Indian Health Program Mission and Roles; 2) Indian Medicaid Managed Care Populations; 3) Indian Health Program Participation; 4) Legal Issues; and 5) Other Areas Needing Assistance/Training

Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960

BACKGROUND: Typically, lifetime risk is calculated by the period method using current risks at different ages. Here, we estimate the probability of being diagnosed with cancer for individuals born in a given year, by estimating future risks as the cohort ages. METHODS: We estimated the lifetime risk of cancer in Britain separately for men and women born in each year from 1930 to 1960. We projected rates of all cancers (excluding non-melanoma skin cancer) and of all cancer deaths forwards using a flexible age-period-cohort model and backwards using age-specific extrapolation. The sensitivity of the estimated lifetime risk to the method of projection was explored. RESULTS: The lifetime risk of cancer increased from 38.5% for men born in 1930 to 53.5% for men born in 1960. For women it increased from 36.7 to 47.5%. Results are robust to different models for projections of cancer rates. CONCLUSIONS: The lifetime risk of cancer for people born since 1960 is >50%. Over half of people who are currently adults under the age of 65 years will be diagnosed with cancer at some point in their lifetime

Investigation of mechanical losses of thin silicon flexures at low temperatures

The investigation of the mechanical loss of different silicon flexures in a temperature region from 5 to 300 K is presented. The flexures have been prepared by different fabrication techniques. A lowest mechanical loss of $3\times10^{-8}$ was observed for a 130 $\mu$m thick flexure at around 10 K. While the mechanical loss follows the thermoelastic predictions down to 50 K a difference can be observed at lower temperatures for different surface treatments. This surface loss will be limiting for all applications using silicon based oscillators at low temperatures. The extraction of a surface loss parameter using different results from our measurements and other references is presented. We focused on structures that are relevant for gravitational wave detectors. The surface loss parameter $\alpha_s$ = 0.5 pm was obtained. This reveals that the surface loss of silicon is significantly lower than the surface loss of fused silica.Comment: 16 pages, 7 figure

Dynamic validation of the Planck/LFI thermal model

The Low Frequency Instrument (LFI) is an array of cryogenically cooled radiometers on board the Planck satellite, designed to measure the temperature and polarization anisotropies of the cosmic microwave backgrond (CMB) at 30, 44 and 70 GHz. The thermal requirements of the LFI, and in particular the stringent limits to acceptable thermal fluctuations in the 20 K focal plane, are a critical element to achieve the instrument scientific performance. Thermal tests were carried out as part of the on-ground calibration campaign at various stages of instrument integration. In this paper we describe the results and analysis of the tests on the LFI flight model (FM) performed at Thales Laboratories in Milan (Italy) during 2006, with the purpose of experimentally sampling the thermal transfer functions and consequently validating the numerical thermal model describing the dynamic response of the LFI focal plane. This model has been used extensively to assess the ability of LFI to achieve its scientific goals: its validation is therefore extremely important in the context of the Planck mission. Our analysis shows that the measured thermal properties of the instrument show a thermal damping level better than predicted, therefore further reducing the expected systematic effect induced in the LFI maps. We then propose an explanation of the increased damping in terms of non-ideal thermal contacts.Comment: Planck LFI technical papers published by JINST: http://www.iop.org/EJ/journal/-page=extra.proc5/1748-022

Analysis of the Intrinsically Disordered N-Terminus of the DNA Junction-Resolving Enzyme T7 Endonuclease I:Identification of Structure Formed upon DNA Binding

This work was supported by grants from The Engineering and Physical Sciences Research Council (EPSRC), Basic Technology EP/F039034/1, The Wellcome Trust, 099149/Z/12/Z, and Cancer Research UK (CRUK), C28/A18604.The four-way (Holliday) DNA junction of homologous recombination is processed by the symmetrical cleavage of two strands by a nuclease. These junction-resolving enzymes bind to four-way junctions in dimeric form, distorting the structure of the junction in the process. Crystal structures of T7 endonuclease I have been determined as free protein, and the complex with a DNA junction. In neither crystal structure was the N-terminal 16-amino acid peptide visible, yet deletion of this peptide has a marked effect on the resolution process. Here we have investigated the N-terminal peptide by inclusion of spin-label probes at unique sites within this region, studied by electron paramagnetic resonance. Continuous wave experiments show that these labels are mobile in the free protein but become constrained on binding a DNA junction, with the main interaction occurring for residues 7-10 and 12. Distance measurements between equivalent positions within the two peptides of a dimer using PELDOR showed that the intermonomeric distances for residues 2-12 are long and broadly distributed in the free protein but are significantly shortened and become more defined on binding to DNA. These results suggest that the N-terminal peptides become more organized on binding to the DNA junction and nestle into the minor grooves at the branchpoint, consistent with the biochemical data indicating an important role in the resolution process. This study demonstrates the presence of structure within a protein region that cannot be viewed by crystallography.Publisher PDFPeer reviewe

An Analysis of Private School Closings

We add to the small literature on private school supply by exploring exits of K-12 private schools. We find that the closure of private schools is not an infrequent event, and use national survey data from the National Center for Education Statistics to study closures of private schools. We assume that the probability of an exit is a function of excess supply of private schools over the demand, as well as the school's characteristics such as age, size, and religious affiliation. Our empirical results generally support the implications of the model. Working Paper 07-0

Environmental risk assessment of GE plants under low-exposure conditions

The requirement for environmental risk assessment (ERA) of genetically engineered (GE) plants prior to large scale or commercial introduction into the environment is well established in national laws and regulations, as well as in international agreements. Since the first introductions of GE plants in commercial agriculture in the 1990s, a nearly universal paradigm has emerged for conducting these assessments based on a few guiding principles. These include the concept of case-by-case assessment, the use of comparative assessments, and a focus of the ERA on characteristics of the plant, the introduced trait, and the receiving environment as well as the intended use. In practice, however, ERAs for GE plants have frequently focused on achieving highly detailed characterizations of potential hazards at the expense of consideration of the relevant levels of exposure. This emphasis on exhaustive hazard characterization can lead to great difficulties when applied to ERA for GE plants under low-exposure conditions. This paper presents some relevant considerations for conducting an ERA for a GE plant in a low-exposure scenario in the context of the generalized ERA paradigm, building on discussions and case studies presented during a session at ISBGMO 12

Nonprofit governance: Improving performance in troubled economic times

Nonprofit management is currently pressured to perform effectively in a weak economy. Yet, nonprofit governance continues to suffer from unclear conceptions of the division of labor between board of directors and executive directors. This online survey of 114 executive directors aims to provide clarification and recommendations for social administration