Mental Health Carve-Outs: Effects and Implications

To control the rise in expenditures and to increase access to mental health and substance abuse (MH/SA) services, a growing number of employers and states are implementing a “carve-out.” Under this arrangement, the sponsor separates insurance benefits by disease or condition, service category, or population and contracts separately for the management of care and/or associated risks. A carve-out allows a unique set of managed care techniques to be applied to a subset of particularly costly or complex benefits. This article describes various carve-out models, discusses the potential advantages and disadvantages of a full carve-out, and summarizes recent public and private sector research regarding the strategy’s effects on access and use, cost savings and shifting, and quality of care. It concludes by discussing approaches to the assessment and monitoring of the processes and outcomes associated with a MH/SA carve-out.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68797/2/10.1177_107755879905600203.pd

AI-based diagnosis in mandibulofacial dysostosis with microcephaly using external ear shapes

IntroductionMandibulo-Facial Dysostosis with Microcephaly (MFDM) is a rare disease with a broad spectrum of symptoms, characterized by zygomatic and mandibular hypoplasia, microcephaly, and ear abnormalities. Here, we aimed at describing the external ear phenotype of MFDM patients, and train an Artificial Intelligence (AI)-based model to differentiate MFDM ears from non-syndromic control ears (binary classification), and from ears of the main differential diagnoses of this condition (multi-class classification): Treacher Collins (TC), Nager (NAFD) and CHARGE syndromes.MethodsThe training set contained 1,592 ear photographs, corresponding to 550 patients. We extracted 48 patients completely independent of the training set, with only one photograph per ear per patient. After a CNN-(Convolutional Neural Network) based ear detection, the images were automatically landmarked. Generalized Procrustes Analysis was then performed, along with a dimension reduction using PCA (Principal Component Analysis). The principal components were used as inputs in an eXtreme Gradient Boosting (XGBoost) model, optimized using a 5-fold cross-validation. Finally, the model was tested on an independent validation set.ResultsWe trained the model on 1,592 ear photographs, corresponding to 1,296 control ears, 105 MFDM, 33 NAFD, 70 TC and 88 CHARGE syndrome ears. The model detected MFDM with an accuracy of 0.969 [0.838–0.999] (p < 0.001) and an AUC (Area Under the Curve) of 0.975 within controls (binary classification). Balanced accuracies were 0.811 [0.648–0.920] (p = 0.002) in a first multiclass design (MFDM vs. controls and differential diagnoses) and 0.813 [0.544–0.960] (p = 0.003) in a second multiclass design (MFDM vs. differential diagnoses).ConclusionThis is the first AI-based syndrome detection model in dysmorphology based on the external ear, opening promising clinical applications both for local care and referral, and for expert centers

2016 United Kingdom national guideline on the sexual health care of men who have sex with men.

This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022

Industry influences on organizational slack.

The purpose of this study is to identify and examine differences in organizational slack across multiple industries. Using a sample of 353 US publicly traded firms, eight measures of organizational slack were examined across six 2-digit SIC industry groupings. The author’s analyses revealed significant differences across industries in each of the slack measures examined. Implications and areas for future research are discussed

The composition of corporate boards of directors: Does industry matter?

The purpose of this study is to identify and examine differences in corporate board characteristics across four industries. Using a sample of 2592 US publicly traded firms, eleven board characteristics were identified and then examined across manufacturing, retail trade, finance/insurance, and services industries. Our analyses revealed significant differences in each of the eleven board characteristics examined. Implications and areas for future research are discussed

The organizational slack and performance relationship: A configurational approach.

Purpose – The purpose of this paper is to contribute to the organizational literature and improve the understanding of the slack and performance link by: examining the slack and performance relationship using a configurational approach and by considering equifinality and its possible effects on this relationship. Design/methodology/approach – Using cluster analysis, ANCOVA, and means comparisons this study identifies different configurations of slack and their associated performance implications. Findings – The results show that configurations with higher levels of slack outperform those with lower levels of slack suggesting a positive relationship between slack and firm performance. The findings also demonstrate that alternative configurations of slack can result in similar levels of performance suggesting the existence of equifinality in this relationship. Research limitations/implications – This study contributes to prior research by moving beyond traditional linear and contingency views of slack and considering a configurational approach. An important contribution of this study is that while level of slack may be important it appears that how the various types of slack are bundled also serves as an important factor in firm outcomes and should be examined by future researchers. Practical implications – The results indicate that managerial attention should be paid to not only identifying appropriate levels and types of slack for the organization but also to appropriate ways to bundle theses resources. Originality/value – This study provides an important contribution to the literature by determining if certain slack bundles result in higher levels of performance and if there are multiple ways of bundling slack resources that result in similar performance outcomes

A reexamination of the organizational slack and innovation relationship.

In this study a configurational approach was used to examine the organizational slack and innovation relationship. Utilizing a sample of 437 manufacturing firms and multiple measures of firm innovation we identified distinct configurations of slack and found significant innovation differences between them. The results from our analyses demonstrate that configurations with moderately high combined levels of internal slack (available and recoverable slack) and moderately high levels of potential slack produced higher levels of innovation. Conversely, configurations with low to moderately low levels of each type of slack produced the lowest levels of innovation. Our findings also indicate that alternative configurations of slack can result in similar levels of innovation suggesting the existence of equifinality in this relationship. Overall, our findings suggest that the slack and innovation relationship is more complex than has been accounted for in previous research. The implications of these findings are discussed