Alien Registration- Dionne, Francois (Lewiston, Androscoggin County)

https://digitalmaine.com/alien_docs/29207/thumbnail.jp

Alien Registration- Dionne, Francois (Lewiston, Androscoggin County)

https://digitalmaine.com/alien_docs/29207/thumbnail.jp

Navigating stormy waters in times of fiscal uncertainty: mitigating the challenges

New approaches to resource allocation are providing healthcare managers with ways to meet budget pressures while maximizing benefit to patients and populations. But putting these approaches in place often involves significant organizational change to which some degree of resistance must be expected. The authors have seen seven common objections raised time and again. Here, we offer our best advice on how healthcare leaders can anticipate and respond proactively to these challenges. </jats:p

Road safety for fleets of vehicles

Road safety for fleets of vehicles has been neglected in the insurance literature, mainly because appropriate data and methodology were not available. This article makes a threefold contribution: 1) Produce statistics on current fleets’ road safety offences and accidents using a panel of 20 years of data on truck fleets; 2) relate fleets’ offences to accidents; and 3) identify and classify the riskiest fleets for insurance ratemaking based on past experience in managing road safety. Our main technical innovation to the insurance literature is in the estimation of fleets’ distributions of accidents. For each fleet size (or group of sizes), we estimate the parameters of the negative binomial (NB) distribution of the annual number of accidents according to the characteristics of the fleets, the years, and the number of driver (DRV) and carrier (CAR) road safety violations accumulated in the previous year. When the NB model does not accurately predict the mathematical expectation of the number of accidents of larger fleets, we proceed in two steps. First, we estimate the probability of having zero accidents in a year, and then estimate the negative binomial distribution using the estimated probability of having zero accidents, to weight the zeros of each fleet. To achieve our third objective, we construct risk classes for the vehicle fleets using the predicted accident probabilities obtained from the estimated models. Our results show a substantial heterogeneity between fleets in terms of road safety. This information should be very useful for optimal insurance pricing and better incentives for road safety

FORCES RESULTING FROM BAT IMPACT ON THE CHEST OF

Th effect of inertia was Investigated by impacting a Hybrid II mannequin in constrained and unconstrained configurations with a baseball bat swung at an angular velocity representative of a typical blow. The forces induced by the blow from a bat to the chest of the mannequin were found to be equivalent for both configurations. An analytical model of blunt Impact used to validate the findings and provide insight into the physical phenomenon, suggests that the effect of inertia only becomes prevalent when the mass of the impactor is substantial as compared to that of the mannequin

Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining ‘success’ and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members

Spin Hall magnetoresistance in a canted ferrimagnet

We study the spin Hall magnetoresistance effect in ferrimagnet/normal metal bilayers, comparing the response in collinear and canted magnetic phases. In the collinear magnetic phase, in which the sublattice magnetic moments are all aligned along the same axis, we observe the conventional spin Hall magnetoresistance. In contrast, in the canted phase, the magnetoresistance changes sign. Using atomistic spin simulations and x-ray absorption experiments, we can understand these observations in terms of the magnetic field and temperature dependent orientation of magnetic moments on different magnetic sublattices. This enables a magnetotransport based investigation of noncollinear magnetic textures

Identifying disinvestment options to increase the impact of priority setting in health care organizations

Choices about what to fund and what not to fund are necessary in health care because claims on resources always exceed those available. Moreover, the choices faced by decision-makers are often between or amongst a wide range of difficult to compare programs or interventions. It is no surprise, then, that processes that inform those choices are of considerable interest. Yet, we know that existing priority setting processes have found limited practical use and when used, are rarely used to their full potential. The objective of the current research was to produce new knowledge that would facilitate the use of formal priority setting processes in decision-making on resource allocation in health care. Based on a detailed review of the literature, a decision was made to focus on one particular aspect of priority setting in health care that has long been recognized as a significant barrier to the successful implementation of priority setting processes: the identification of disinvestment options. Building on initial exploratory research, a proposed procedural change to the Program Budgeting and Marginal Analysis (PBMA) priority setting process was designed to address challenges in identifying disinvestment options. The proposed procedural change was then evaluated in a case study as part of a real-world priority setting exercise. The key finding of this research project was that adding a step -- that focused on the determination and communication of acceptable service reductions, at the outset of process implementation -- to the standard PBMA process, has the potential to assist in ‘disarming’ organizational incentives that have been found to work against the identification of disinvestment options. This key finding is of critical importance because without practical disinvestment options, priority setting processes are likely to have limited impact on decision-making and therefore limited practical appeal. Further, without formal, structured priority setting processes that actually work in practice, resource allocation decisions will continue to follow historical patterns, leading to incremental growth without explicit consideration of return on investment. As such, this study makes a novel contribution to the literature in an area that is highly relevant to the everyday challenges faced by health care decision-makers.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat