The Cost of Caring for Young Children

This study examines the "cost burden" of child care, defined as day care expenses divided by after-tax income. Data are from the wave 10 core and child care topical modules to the 1996 Survey of Income and Program Participation. We estimate that the average child under six years of age lives in a family that spends 4.9 percent of after-tax income on day care. However, this conceals wide variation: 63 percent of such children reside in families with no child care expenses and 10 percent are in families where the cost burden exceeds 16 percent. The burden is typically greater in single-parent than married-couple families but is not systematically related to a measure of socioeconomic status that we construct. One reason for this is that disadvantaged families use lower cost modes and pay less per hour for given types of care. The cost burden would be much less equal without low cost (presumably subsidized) formal care focused on needy families, as well as government tax and transfer policies that redistribute income towards them.

AN OBSERVATIONAL STUDY OF THE METHODS AND PROGRESS IN ENTERPRISE LEAN TRANSFORMATION AT A LEARNING HEALTH CARE ORGANIZATION

The health care industry in the United States is increasingly pressured to improve safety and quality performance and increase revenue. In response, many health care institutions are moving to redesign their processes and practices in an effort to decrease costs and provide safer, higher quality, and more efficient care. The purpose of this paper is to document the Lean implementation strategy and progress in implementation at a large teaching health care organization undergoing Lean transformation in order to understand enterprise transformation strategies and the impact of leadership involvement on culture development and Lean implementation. Through direct observations and involvement and transformation activities, the methodology for Lean transformation and progress in implementation were documented and analyzed. The organization employed an outside consultant to assist with transformation activities, and underwent a three-pronged approach to implementation, which included model area development, team member problem solving training, and management-led problem solving activities. It was found that leadership involvement was lacking, especially at the highest levels, and the organization struggled to build the culture necessary to support transformation and develop an operational model area, though successes were realized in efforts to train employees in Toyota’s 8-Step Problem Solving method and in management-led problem solving activities

Herbal Marijuana Alternatives Investigation: K2 and Spice: A Masters Thesis

Background Herbal marijuana alternatives (HMA), legal plant products adulterated with synthetic cannabinoid receptor agonists, represent a growing public health concern. Only a few case reports describe HMA and synthetic cannabinoid’s clinical toxicity. We describe an outbreak of HMA abuse primarily in the Midwest, the clinical presentation of HMA toxicity, and clinical and forensic testing. Methods During the course of ongoing surveillance for emerging drugs of abuse between November 2009 and August 2010, we retrospectively and prospectively identified a convenience sample comprising 81 cases of abuse of HMA products. Subject demographics, vital signs, lab results and urine were obtained (when available) and tested via gas chromatography mass spectrometry (GCMS) analysis. Samples of HMAs and synthetic cannabinoids were also analyzed via GCMS. Results HMA users were predominantly young males who inhaled HMAs. Analysis of their urine detected synthetic cannabinoid parent compound in one subject. GCMS analysis of synthetic cannabinoids established a reference library that confirmed the presence of synthetic cannabinoids in sampled HMA products. Conclusion HMA products were available in head shops, gas stations, and via the Internet. We have confirmed the presence of synthetic cannabinoids in these HMA products. The tachycardia, hypertension, agitation, anxiety, vomiting and hallucinations observed in this convenience sample are not readily explained by the presence of synthetic cannabinoids acting on CB1 and CB2 receptors. Further research must be done on HMA products and their abusers

International Foot and Ankle Biomechanics Community (i-FAB): past, present and beyond

The International Foot and Ankle Biomechanics Community (i-FAB) is an international collaborative activity which will have an important impact on the foot and ankle biomechanics community. It was launched on July 2nd 2007 at the foot and ankle session of the International Society of Biomechanics (ISB) meeting in Taipei, Taiwan. i-FAB is driven by the desire to improve our understanding of foot and ankle biomechanics as it applies to health, disease, and the design,development and evaluation of foot and ankle surgery, and interventions such as footwear, insoles and surfaces

Public Philosophy and Philosophical Publics: Performative Publishing and the Cultivation of Community

The emergence of new platforms for public communication, public deliberation, and public action presents new possibilities for forming, organizing, and mobilizing public bodies, which invite philosophical reflection concerning the standards we currently look to for coordinating public movements and for evaluating their effects. Developing a broad understanding of public philosophy, this article begins with the view of philosophy and intellectual freedom articulated in Kant’s publicly oriented writings. We then focus on the power of philosophical discourse to form and further articulate public bodies. Drawing on Dewey’s work, we discuss the role of philosophical discourse in the articulation of publics into self-regulated, sovereign entities. We conclude with an account of how publishing itself might come to play an important role in the practice of public philosophy in a digital age

An Overview of Medicaid Managed Care Litigation

This Issue Brief is intended as one of several in the Managed Behavioral Health Care Issue Brief Series that deals with managed behavioral health care from a purely legal point of view. Since the enactment of Medicaid in 1965, states have had the option of offering beneficiaries enrollment in managed care arrangements. With the advent of mandatory managed care reaching millions of beneficiaries (including a growing proportion of disabled recipients), the amount and scope of litigation involving Medicaid managed care plans can be expected to grow. A review of the current litigation regarding Medicaid managed care reveals two basic types of lawsuits: (1) those that challenge the practices of managed care companies under various federal and state laws that safeguard consumer rights, protect health care quality, and prohibit discrimination; and (2) suits that assert claims arising directly under the Medicaid statute and implementing regulations, as well as claims related to Constitutional safeguards that undergird the program

Screening, intervention and outcome in autism and other developmental disorders: the role of randomized controlled trials

We draw attention to a number of important considerations in the arguments about screening and outcome of intervention in children with autism and other developmental disorders. Autism screening in itself never provides a final clinical diagnosis, but may well identify developmental deviations indicative of autism—or of other developmental disorders—that should lead to referral for further clinical assessment. Decisions regarding population or clinic screening cannot be allowed to be based on the fact that prospective longitudinal RCT designs over decades could never be performed in complex developmental disorders. We propose an alternative approach. Early screening for autism and other developmental disorders is likely to be of high societal importance and should be promoted and rigorously evaluated

Sociosexuality, testosterone, and life history status: Prospective associations and longitudinal changes among men in Cebu, Philippines

Sociosexuality is defined as an individual\u27s interest in uncommitted sexual activity and can be measured in terms of both psychological orientations and behavioral expression. In socio-ecological contexts in which adults monogamously partner and cooperate to raise children, individuals with unrestricted sociosexuality are likely to prioritize mating/competition over committed partnering and parenting. Given the importance of mother-father cooperation in the evolutionary past, humans may have the capacity to facultatively and opportunistically downregulate sociosexuality to focus on priorities related to invested partnering and parenting. To date, no prior studies have used longitudinal data to track within-individuals changes in sociosexuality as it relates to such life history transitions. Given the lack of prior longitudinal research in this area, it is likewise unknown what physiological mechanisms might mediate within-individual changes in sociosexuality through time but testosterone is a plausible candidate. To explore these questions, we drew on a large, long-running study of Filipino men (n=288), who were single non-fathers at 25.9 years of age and were followed up 4–5 years later. We found that men with more unrestricted sociosexuality at baseline were more likely to experience relationship dissolution by follow-up, consistent with past work. Compared to men who remained single non-fathers at follow-up, men who became married residential fathers showed shifts towards more restricted global sociosexuality as well as sociosexual behavior. Relative to their own baseline values, married residential fathers also had more restricted sociosexuality in all domains at follow-up. They were the only group for whom this was found. We found theoretically-consistent but modest support for positive correlations between men\u27s testosterone and their sociosexuality, but no evidence that the two change in tandem together through time. Our results suggest that some amount of between-individual differences in sociosexuality are not stable and can facultatively shift alongside other aspects of male reproductive effort

Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies

Treating chronic pain in the context of opioid misuse can be very challenging. This paper explores the epidemiology and potential treatments for chronic pain and opioid misuse and identifies educational and regulation changes that may reduce diversion of opioid analgesics. We cover the epidemiology of chronic pain and aberrant opioid behaviors, psychosocial influences on pain, pharmacological treatments, psychological treatments, and social treatments, as well as educational and regulatory efforts being made to reduce the diversion of prescription opioids. There are a number of ongoing challenges in treating chronic pain and opioid misuse, and more research is needed to provide strong, integrated, and empirically validated treatments to reduce opioid misuse in the context of chronic pain

TNM staging with FDG-PET/CT in patients with primary head and neck cancer

Purpose: PET/CT, PET+CT, and CT were compared concerning accuracies in TNM staging and malignancy detection in head and neck cancer. The impact of PET/CT compared to the other imaging modalities on therapy management was assessed. Materials and methods: Fifty-five patients with suspected head and neck primary cancer underwent whole-body FDG-PET/CT. PET/CT and PET+CT were evaluated by a nuclear medicine physician and a radiologist; CT was evaluated by two radiologists, PET by two nuclear physicians. Histopathology served as the standard of reference. Differences between the staging modalities were tested for statistical significance by McNemar's test. Results: Overall TNM-staging and T-staging with PET/CT were more accurate than PET+CT and CT alone (p < 0.05). PET/CT was marginally more accurate than CT alone in N-staging (p = 0.04); no statistically significant difference was found when compared to PET+CT for N-staging. PET/CT altered further treatment in 13 patients compared to CT only and in 7 patients compared to PET+CT. Conclusion: Combined PET/CT proved to be partly more accurate in assessing the overall TNM-stage than CT and PET+CT. These results were based on a higher accuracy concerning the T-stage, mainly in patients with metallic implants and marginally the N-stage. Therapy decisions have been influenced in a substantial number of patients. PET/CT might be considered as a first line diagnostic tool in patients with suspected primary head and neck cance