Social sector expenditures and rainy-day funds

Gonzalez and Paqueo examine the effects of budget stabilization funds--often called rainy-day funds--on the volatility of social spending and, for contrast, on nonsocial sector spending. They analyze the rainy-day funds of U.S. states. The authors find that rainy-day funds are ineffective in reducing the volatility of nonsocial sector expenditures but are effective in reducing the volatility of social sector expenditures. The authors also find that states that have stringent deposit and withdrawal rules have higher rainy-day fund balances, and thus are more effective in reducing the volatility of social sector expenditures. Finally, for long-term effectiveness, stabilization funds depend obviously on sustained economic growth.Urban Governance and Management,Environmental Economics&Policies,Regional Governance,Infrastructure Finance,Public Sector Economics&Finance,National Governance,Environmental Economics&Policies,Infrastructure Finance,Infrastructure Finance,Public Sector Economics&Finance

Economic analysis of health care utilization and perceived illness ; ethnicity and other factors

Paqueo and Gonzalez look at the determinants of health-seeking behavior of the Mexican population and within this context focus on the effect of ethnicity. They address the following questions: To what extent are the indigenous people at a disadvantage health care-wise and in what particular health services are they disadvantaged? Is the health care gap due to indigenous cultures by itself as opposed to the impact of socioeconomic differences? What policy instruments can be used to reduce the gap? The authors find that contrary to expectations, the indigenouspeople in Mexico tend to have a positive behavior toward modern preventive care compared with the nonindigenous population, holding socioeconomic factors constant. Apparently, there is no cultural barrier in regard to these services. But ethnicity remains negatively associated with the use of inpatient hospital care and medical and dental consultations. Insurance has a significant and positive effect on health care use. Therefore, it appears to be an effective instrument for addressing the health care disadvantages faced by the indigenous population in regard to inpatient care and the use of outpatient services of doctors, nurses, and dentists.Early Child and Children's Health,Health Systems Development&Reform,Health Monitoring&Evaluation,Public Health Promotion,Health Economics&Finance,Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Housing&Human Habitats,Gender and Health

Latino Immigrant Parents of English Language Learner Students, School Involvement and the Participation Breach

The problem addressed in this study was the minimal school involvement by Latino immigrant parents due to the hegemonic practices, cultural misunderstandings and deficit-thinking models adopted by school personnel. The purpose of this Participatory Action Research (PAR) was to investigate the perceptions and benefits of participant and co-researcher parents who collaborated in the creation of an anti-hegemonic culturally sensitive advocacy-training program. The theoretical framework employed was Critical Race Theory because it addressed the issues of institutional racism, challenge to the status quo, social justice leadership and allowed for an interdisciplinary approach in order to utilize the parents\u27 experiential knowledge to create new epistemologies that correspond to their cultural needs. Participation included five co-researchers and five participants, all Latino immigrant parents of English language learner students. The co-researcher parents collaborated to investigate and create the components of the anti-hegemonic culturally sensitive advocacy-training program. This particular study encountered a contradiction to previous research in that Latino parents felt that there were no obstacles to their involvement. It also uncovered that before any information is provided to parents in order to increase their participation, the security and comfortableness of their children has to be addressed first. In retrospect, this study found a genuine need for the understanding of the emotional and academic connections between Latino parents and students

Sistema político y movimientos indígenas: el caso del EZLN

El presente artículo analiza la vinculación del EZLN con la situación miserable en que se encuentran millones de indígenas en México contra la ingobernabilidad neoliberal. Presentamos posibles soluciones al conflicto EZLN, y resumimos los logros alcanzados por los grupos étnicos en materia de democracia dentro del Estado mexicano

An Educational Module on the Benefits of Telehealth Assisted Preanesthetic Evaluations

Title An Educational Module on the Benefits of Telehealth Assisted Preanesthetic Evaluations Impact Statement Healthcare systems are always seeking new ways to increase efficiency, save on costs, and provide quality care for their patients. The use of telehealth in the preanesthesia setting is a tool that can help to further improve a healthcare system’s ability to achieve these goals. This project will be a step towards determining the support for and viability of telehealth utilization in the preanesthesia setting. Background/Purpose/Question Surgery cancellations are a significant problem with the potential for far-reaching consequences. Unexpected day-of-surgery cancellations can be costly to both the patient and the health care team. Telemedicine and telehealth are readily available tools for overcoming obstacles to accessing health care. Their use can improve patient outcomes, primarily by reducing the transportation time and costs and increasing the access to physicians. However, there is relatively little data on provider attitudes on the use of telemedicine to reduce cancellations and surgical delays. This project aims to answer: Among anesthesia providers (P), is an educational module designed to improve knowledge of the effectiveness of telehealth-assisted PAE (I), when compared to face-to-face preoperative assessment (C), effective in increasing provider knowledge (O) that leads to an improvement in the quality of patient care, the experience of the patient, its effect on staff, productivity, and cost-savings potential? Methods/Evidence Search Using the keywords listed under “Eligibility Criteria,” a search was conducted on CINAHL. Non-English, non-peer-reviewed articles were eliminated from the search, as well as articles older than 10 years. The same steps were taken with PubMed and Google Scholar. A total of 152 articles were found as potential evidence sources. Sources meeting criteria based on title were 44. Sources meeting criteria based on abstract were 13. Finally, sources meeting criteria based on full text were 8: a systematic literature review, a prospective randomized trial, a case-controlled study, a quasi-experimental study, a retrospective study, 2 descriptive studies, and a mixed methods approach. A total of 7 of the studies were performed in the United Sates while 1 was done in Australia. Synthesis of Literature/Results/Discussion A systematic literature review was conducted by Schoen and Prater. The results of their systematic review found that PAE can be successfully performed using telehealth and that patients also reported satisfaction with utilization of telehealth when performing PAE. For this project, the pre-test and post-test assessed if the educational module enhanced the participants attitude and perception of the use of telehealth during the PAE. The results show that after an educational module was shown, perception of the technology improved. Future research should focus on creating experiments with larger sample sizes and implementing the technology to see what real-world benefits the technology can offer. Conclusions/Recommendations for Practice 4 Telehealth is an increasingly relevant topic in the healthcare industry. It can provide many benefits to both the provider and the consumer. The project shows that presenting the topic and educating providers about the topic can make them more open to using the technology in their practice. Information gained from this project can be used to determine the feasibility of implementing this technology at health care facility where anesthesia providers practice

Resilience and Environmental Justice: Potential Linkages

AbstractIn May 2008, the remote city of Chaiten in Chile was evacuated due to the risk of a volcano eruption. Few days later, severe floods drove to the destruction of the almost entire city. In the months following the disaster, the Government developed projects that failed to relocate the city to a safer location as well as strategies to support the affected population aimed to improve community resilience. Contradictory institutional policies as well as the unforeseen effects of implemented bond schemes have resulted in a highly segregated and environmentally unjust city where public policies. outputs are unevenly distributed. Thus, this paper addresses how some related processes of increasing resilience may impact negatively upon environmental justice, hence exploring a potential inverse relationship between resilience and environmental justice. Five years on, nearly half of the population have returned to Chaiten despite the refusal of the authorities. While northern Chaiten concentrates most of the population and investment, 160 families living in the southern Chaiten bear the lack of potable water and other basic services, and are more vulnerable to future disaster impacts. Split in two due to both geography and policies, Chaiten faces now two realities

Preoperative and Intraoperative Opioid-Sparing Analgesic Techniques to Reduce Postoperative Opioid Consumption in Patients Undergoing Open, Non-Emergent Abdominal Surgeries: An Educational Module

Background: Opioids have long been considered the “gold standard” of pain management; however, the significant side effects associated with opioid use make opioid-sparing analgesic methods appealing for various reasons. Reducing postoperative opioid consumption without compromising pain management is an area requiring further exploration. Objective: This study seeks to assess healthcare providers’ knowledge and confidence regarding the use of various preoperative and perioperative interventions aimed at reducing postoperative opioid consumption following non-emergent open abdominal surgeries. Based on the systematic review performed, Certified Registered Nurse Anesthetists were presented with a pre-assessment test, an educational video presentation, and a post-assessment test. Data Sources: Investigator used Pubmed, CINAHL, and EMBASE databases to answer the PICO (i.e., population, intervention, comparison, outcome) question: In patients undergoing open, nonemergent abdominal surgeries, does the use of multimodal, opioid-sparing pain management techniques during the preoperative and perioperative period reduce postoperative opioid consumption versus non-multimodal pain management? This question became the basis for the educational module by the same name. Pre-assessment and post-assessment testing were used to measure the effects of the intervention. Statistical analysis was applied to assess the effectiveness of the educational intervention. Study Selection: Nine articles were included in the systematic review and the findings were incorporated into the educational presentation. All found that their respective non-opioid interventions reduced postoperative opioid consumption to some degree. A majority reported secondary outcomes of reduced opioid-related side effects such as nausea and vomiting, decreased time to first meal, first ambulation, and foley removal, and increased patient satisfaction. Results: There were nine participants in the study and survey. The pre- and post-test gauged participants’ knowledge and confidence in non-opioid analgesic methods and implementing them in practice. The average number of correct answers in the pre-test was 4.22, compared to 7.44 in the post-test. Confidence for preoperative and intra-operative interventions improved from 44.44% and 33.33% to 88.89% and 100%, respectively. With education, participants were more likely to advocate for opioid-sparing analgesic interventions to improve postoperative outcomes for patients undergoing non-emergent abdominal surgery. All participants selected more correct answers in the post-test than pre-test. Conclusions: The evidence shows that several non-opioid analgesic interventions can reduce postoperative opioid consumption. The implementation of an educational module based on these findings led to a significant increase in providers’ knowledge and confidence of opioid-sparing analgesic methods in patients undergoing non-emergent open abdominal surgery and the benefits associated with non-opioid interventions

Nestinþ cells direct inflammatory cell migration in atherosclerosis

Atherosclerosis is a leading death cause. Endothelial and smooth muscle cells participate in atherogenesis, but it is unclear whether other mesenchymal cells contribute to this process. Bone marrow (BM) nestinþ cells cooperate with endothelial cells in directing monocyte egress to bloodstream in response to infections. However, it remains unknown whether nestinþ cells regulate inflammatory cells in chronic inflammatory diseases, such as atherosclerosis. Here, we show that nestinþ cells direct inflammatory cell migration during chronic inflammation. In Apolipoprotein E (ApoE) knockout mice fed with high-fat diet, BM nestinþ cells regulate the egress of inflammatory monocytes and neutrophils. In the aorta, nestinþ stromal cells increase B30 times and contribute to the atheroma plaque. Mcp1 deletion in nestinþ cells—but not in endothelial cells only— increases circulating inflammatory cells, but decreases their aortic infiltration, delaying atheroma plaque formation and aortic valve calcification. Therefore, nestin expression marks cells that regulate inflammatory cell migration during atherosclerosis.Pro-CNIC FoundationSevero Ochoa Center of Excellence award SEV-2015-0505 to CNICWellcome Trust and MRC to the Cambridge Stem Cell InstituteMinisterio de Economía y Competitividad (RETIC Grant RD12/0042/0028 to V.A.; SAF2012-40127 to J.M-G.; Plan Nacional Grant SAF-2011-30308, Ramón y Cajal Program Grant RYC-2009-04703 and Spanish Cell Therapy Network TerCel to S.M-F.)Marie Curie Career Integration Program Grant (FP7-PEOPLE-2011-294096)ConSEPOC-Comunidad de Madrid Grant (S2010/BMD-2542)National Health Institute Blood and Transplant (United Kingdom)Horizon2020 (ERC-2014-CoG-64765)Horizon2020 (ERC-2014-CoG-64765