Practical Implications of Current Intimate Partner Violence Research for Victim Advocates and Service Providers

This guide uses a question-and-answer format to inform victim advocates and service providers of the findings of published research on intimate partner violence (IPV) and their relevance for practice. The first of 13 sections of the guide poses and answers 11 questions pertinent to the issue, “What is intimate partner violence?” The issues addressed include the various behaviors and circumstances that constitute IPV, whether men and women are equally likely to be victims or perpetrators of IPV, and whether women’s use of IPV is different from men’s.The second major section poses and answers 12 questions related to IPV victimization rates, addressing issues of populations at increased risk for IPV, with special attention to women who are separated or divorced, pregnant, disabled, elderly, LGBT, live in rural areas. The guide’s third section poses and answers 19 questions related to the impact of IPV on victims. The fourth section poses and answers 20 questions related to the characteristics of persons who perpetrate IPV. Other sections of the guide pose and answer questions related to victim characteristics that predict IPV victimization; whether IPV victims seek assistance and services; protective factors and coping skills that mitigate the adverse impact of IPV; the services that are typically available to IPV victims; whether victim services work; health-care providers’ role in responding to IPV; what victim advocates and service providers need to know about the legal system; the features of IPV victim advocacy; and the performance measures advocates should adopt in evaluating the criminal justice response to IPV. The implications drawn from the research are offered as guidance, not rules of practice. 884 references are provided

Integrated Care for Older Adults in Rural Communities

Recognizing that traditional models of health care delivery and payment often produce fragmented and costly care and poor outcomes for those with the highest needs, many reforms under the Affordable Care Act (ACA) focus on realigning payment incentives and integrating care. These reforms presuppose the existence of supporting infrastructure and capacity, including dedicated care management staffing and health information technology and exchange. With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), this brief reviews the opportunities and challenges these reform initiatives present for rural communities: How easily can current models for integrating care be adapted to a rural context and culture? How well do they account for gaps and variations in local delivery systems, capacity, and infrastructure? Which strategies offer the greatest promise for addressing the needs of rural residents? Because Medicaid is a primary source of funding for LTSS, we focus this inquiry on models serving Medicaid-eligible individuals; in some cases these programs may also serve individuals who are also eligible for Medicare

Engaging Patients in Health System Transformation: The experience of the Maine Health Access Foundation\u27s (MeHAF) Advancing Payment Reform Initiative

In 2001, the Institute of Medicine (IOM) identified patient centeredness as one of six essential aims of “a new health care system for the 21st century”.1 Since that time, we have begun a gradual shift from a professionally driven system toward one that is more “patient centered” or “consumer centered,” recognizing and incorporating patients’ perspectives in decisions in clinical care, delivery system, and policies. As the health care system responds to new payment approaches and positions itself to achieve the Triple Aim (i.e. better care, lower cost, enhanced patient experience), it is important to assess how organizations that are moving to advance health care service delivery and payment reform are integrating patient engagement into the health system transformation process. Since 2011, the Maine Health Access Foundation’s Advancing Payment Reform initiative has funded 13 health system transformation projects. Diverse in their approach, each has undertaken efforts to achieve greater patient engagement ranging from involving patients and families as informed and active participants in their own health care (e.g. shared decision making, self-management) to involving patients at the organizational or policy-level through consumer advisory boards and other means to provide guidance for health system transformation. This brief summarizes the experience of these grantees in developing and implementing strategies to engage patients in payment reform and delivery system redesign.2 The purpose is to identify common themes and lessons within and across these initiatives to inform future patient engagement efforts

Large entropy production inside black holes: a simple model

Particles dropped into a rotating black hole can collide near the inner horizon with enormous energies. The entropy produced by these collisions can be several times larger than the increase in the horizon entropy due to the addition of the particles. In this paper entropy is produced by releasing large numbers of neutrons near the outer horizon of a rotating black hole such that they collide near the inner horizon at energies similar to those achieved at the Relativistic Heavy Ion Collider. The increase in horizon entropy is approximately 80 per dropped neutron pair, while the entropy produced in the collisions is 160 per neutron pair. The collision entropy is produced inside the horizon, so this excess entropy production does not violate Bousso's bound limiting the entropy that can go through the black hole's horizon. The generalized laws of black hole thermodynamics are obeyed. No individual observer inside the black hole sees a violation of the second law of thermodynamicsComment: 10 page

The Role of Organizational Change in Health System and Payment Reform

The Maine Health Access Foundation (MeHAF) has awarded grants to 14 Maine health organizations to date to mitigate the increasing cost of health care in Maine through innovative delivery system and payment reform strategies that preserve access, improve quality, and offer better value. As part of the evaluation of this initiative, the University of Southern Maine Muskie School of Public Service (Muskie School) is producing a series of issue briefs that capture common themes and challenges across grantees in achieving payment reform and health system delivery change to assess lessons learned. This is the first issue brief which describes our evaluation approach and presents an analysis of the role of organizational change among grantees engaged in delivery system and payment reform

Automated Textural Classification of Osteoarthritis Magnetic Resonance Images

Osteoarthritis (OA) is the most common cause of disability in the United Kingdom and United States. Identifying the rate of OA progression remains an important clinical and research challenge for early disease monitoring. Texture analysis of tibial subchondral bone using magnetic resonance imaging (MRI) has demonstrated the ability to discriminate between different stages of OA. This work combines texture analysis with machine learning methods (Lasso, Decision Tree, and Neural Network) to predict radiographic disease progression over 3 years, trained using data from the Osteoarthritis Initiative. We achieved high sensitivity (86%), specificity (64%) and accuracy (74%) for predictions of OA progression.The authors acknowledge research support from the National Institute of Health Research Cambridge Biomedical Research Centre. RT acknowledges the support of the UK Engineering and Physical Sciences Research Council (EPSRC) grant EP/L016516/1 for the University of Cambridge Centre for Doctoral Training, the Cambridge Centre for Analysis. JK and JM acknowledge support by GlaxoSmithKline. AM acknowledges research support from Arthritis Research UK; Tissue Engineering Centre award. FG acknowledges research support from Cancer Research UK

Health Data and Financing and Delivery System Reform: Is the Glass Half Full or Half Empty?

In 2011, the Maine Health Access Foundation (MeHAF) launched its Advancing Payment Reform initiative to stimulate innovative payment and delivery system reform strategies in Maine. This policy paper reports on the health data experience of the 14 program grantees, using interviews conducted in 2013-14 and other information garnered from the evaluation of the initiative. The paper focuses on the role and impact of health data in supporting implementation and monitoring of specific components of the projects’ reform strategies; the data infrastructure challenges the projects have faced and how those have been addressed; and the generalizable lessons learned so far for improving data usefulness, access, analysis, and integration to support payment and delivery system reform. Support for this policy paper was provided by the Maine Health Access Foundation