Alien Registration- Morton, Laura (Knox, Waldo County)

https://digitalmaine.com/alien_docs/5175/thumbnail.jp

Measuring Poverty at the State Level

Outlines a model for using the National Academy of Sciences poverty measure, which accounts for all income, non-discretionary work and out-of-pocket health expenses, and geographic cost variations, to estimate the effects of poverty reduction policies

Complementary logics of target-setting : hierarchist and experimentalist governance in the Scottish National Health Service

Where policy ends are contested and means for change are ambiguous, imposing central targets on local organisations – what we call hierarchist governance – is problematic. The concept of experimentalist governance suggests that target-setting should rather be a learning process between central regulators and local organisations. However, the relationship between experimentalist and hierarchist governance remains unclear. Existing literature suggests that the learning-oriented experimentalist logic is hard to reconcile with a hierarchist logic focussed on accountability for results. We examine whether complementary use of hierarchist and experimentalist ideas is possible. Drawing on experiences from Scotland, we find that experimentalist and hierarchist logics can co-exist in the same performance management system. Each logic served distinct roles with respect to target-setting, implementation and accountability. The emphasis on experimentalism was stronger where ends and means were contested (the case of shifting the balance of care for older people) than where both ends and means seemed obvious initially (the case of healthcare-associated infections, where target-setting followed a more hierarchist logic). However, governance drifted towards experimentalism when rising rates of community-acquired infections decreased clarity about effective interventions. The nature of policy issues and changes therein over time appear to be important conditions for synergies between governance logics

Efficiency measurement for management

The previous chapter has discussed the use of efficiency analysis tools to guide policy development and formulation. While few readers will doubt that clear, consistent policy direction is necessary for the delivery of productivity improvements, it is not sufficient. To lead to action on the ground, policy interventions have to influence the behaviour of the staff who see and treat patients, and deliver public health and social care programmes. In this chapter, we discuss the challenges facing management as it seeks to use the analytic tools discussed elsewhere in this volume to secure efficiency improvements

Executive decision-making in the domestic sheep.

Two new large animal models of Huntington's disease (HD) have been developed recently, an old world monkey (macaque) and a sheep. Macaques, with their large brains and complex repertoire of behaviors are the 'gold-standard' laboratory animals for testing cognitive function, but there are many practical and ethical issues that must be resolved before HD macaques can be used for pre-clinical research. By contrast, despite their comparable brain size, sheep do not enjoy a reputation for intelligence, and are not used for pre-clinical cognitive testing. Given that cognitive decline is a major therapeutic target in HD, the feasibility of testing cognitive function in sheep must be explored if they are to be considered seriously as models of HD. Here we tested the ability of sheep to perform tests of executive function (discrimination learning, reversal learning and attentional set-shifting). Significantly, we found that not only could sheep perform discrimination learning and reversals, but they could also perform the intradimensional (ID) and extradimensional (ED) set-shifting tasks that are sensitive tests of cognitive dysfunction in humans. Their performance on the ID/ED shifts mirrored that seen in humans and macaques, with significantly more errors to reach criterion in the ED than the ID shift. Thus, sheep can perform 'executive' cognitive tasks that are an important part of the primate behavioral repertoire, but which have never been shown previously to exist in any other large animal. Sheep have great potential, not only for use as a large animal model of HD, but also for studying cognitive function and the evolution of complex behaviours in normal animals

The Scottish NHS : meeting the financial challenge ahead

The Scottish NHS faces a crisis of affordability in the next couple of decades as the population ages and demands on services intensify. This presents two challenges: the first is how to redesign services to achieve greater efficiencies, and the second is how to engage the public so that there is a realistic public view about what is affordable, against which a mature discussion about the hard choices about funding and provision can take place. We refer to these as the innovation and openness challenges. In the paper we outline the current state of the system and discuss possible policy options. We conclude with some recommendations for next steps

Developing robust composite measures of healthcare quality – ranking intervals and dominance relations for Scottish Health Boards

Although composite indicators are widely used to inform health system performance comparisons, such measures typically embed contentious assumptions, for instance about the weights assigned to constituent indicators. Moreover, although many comparative measures are constructed as ratios, the choice of denominator is not always straightforward. The conventional approach is to determine a single set of weights and to choose a single denominator, even though this involves considerable methodological difficulties. This study proposes an alternative approach to handle incomplete information about an appropriate set of weights and about a defensible denominator in composite indicators which considers all feasible weights and can incorporate multiple denominators. We illustrate this approach for comparative quality assessments of Scottish Health Boards. The results (displayed as ranking intervals and dominance relations) help identify Boards which cannot be ranked, say, worse than 4th or better than 7th. Such rankings give policy-makers a sense of the uncertainty around ranks, indicating the extent to which action is warranted. By identifying the full range of rankings that the organizations under comparison may attain, the approach proposed here acknowledges imperfect information about the “correct” set of weights and the appropriate denominator and may thus help to increase transparency of and confidence in health system performance comparisons

Community based low threshold substance use services: practitioner approaches and challenges.

Low threshold services are typically provided within community or city settings, either by statutory or community organisations. Services may be staffed by counsellors, key workers or support workers who would normally seek to engage informally with clients and deliver brief, harm reduction focused interventions. In addition, low threshold services often depend on volunteers for staffing and provide new drugs workers who may require high levels of supervision with an entry point into drugs work. A range of issues have emerged in relation to low threshold service provision including high volumes of clients accessing a service, variation in approach and aims of low threshold services and health and safety implications for workers and clients in regard to service users being severely intoxicated, using substances on the premises or overdosing