An O’Neill Institute Briefing Paper: The Supreme Court’s Landmark Decision on the Affordable Care Act: Healthcare Reform’s Ultimate Fate Remains Uncertain

The Supreme Court’s decision on the constitutionality of the Patient Protection and Affordable Care Act (ACA) is a landmark on the path toward ensuring universal access to health care in the United States. In a 5-4 decision written by Chief Justice Roberts, the Court upheld the law in its entirety with the sole exception that Congress may not revoke existing state Medicaid funding to penalize states that decline to participate in the Medicaid expansion under the ACA. In this O’Neill Institute Briefing, we explain and analyze the Court’s decision, focusing on the individual purchase mandate and the Medicaid expansion, while also explaining the fundamental shifts in constitutional interpretations that may affect public health, safety and environmental protection in the future. The precise significance of the individual mandate to the proper functioning of the ACA remains to be seen, primarily because the penalties are small relative to the cost of insurance. The IRS also has little enforcement authority if individuals elect not to purchase insurance. The mandate remains the only mechanism for the ACA’s financial sustainability. The importance of the Medicaid expansion cannot be overstated, as it is the sole means by which poor Americans will gain coverage. If states decline to participate there may be a social justice disaster in which disparities in access to health insurance in some states actually widen under the ACA as middle-class and well-off Americans gain access to insurance while the poor are left behind. Justice Roberts sided with the Court’s conservative wing to espouse a narrow view of Congress’ ability to regulate under the Commerce Clause, which could create challenges as future Congresses seek to address national public health problems. Even so, we conclude that the Court’s decision leaves the United States immensely better off in that future debates will likely center around how to ensure access to health care for all, not whether to do so–that debate is over, and the nation should push forward on the path toward universal coverage

The President’s Global Health Initiative

The U.S. Global Health Initiative (GHI) represents the Obama administration’s new strategy for international development assistance in health. With a pledge of $63 billion over six years, GHI aims to fund PEPFAR and a set of broader global health issues (e.g., maternal and child health, nutrition, and neglected tropical diseases). GHI is also being framed as “smart power” whereby health would serve as a critical tool for U.S. foreign policy. However, as the U.S. enters a period of severe budgetary restraint and as domestic crises rise to the fore, the promise of global health reform could become illusory. The lack of coordination and coherence in the U.S. global health architecture, as well as the broader U.S. foreign assistance system, require fundamental changes in the U.S. approach to global health going forward. This article analyzes current weaknesses in the GHI strategy and makes four key suggestions for the transformation of the U.S. global health enterprise under GHI. These suggestions include: (1) the devotion of resources that are predictable, sustainable, and scalable to needs; (2) the development of a true “whole of government” approach; (3) greater collaboration with international partners for success; and (4) the encouragement of host country ownership

The Zika Virus Threat: How Concerns About Scientists May Undermine Efforts to Combat the Pandemic

Using data from the University of New Hampshire’s October 2016 Granite State Poll, authors Thomas Safford, Lawrence Hamilton, and Emily Whitmore investigate how New Hampshire residents view the Zika crisis. They report that most New Hampshire residents believe Zika is only a minor threat to public health in the United States, and they generally trust the CDC as a source of information about the virus. The data also show that, while there is doubt about the government’s ability to control the spread of the virus, the public feels that emergency federal funding to combat Zika should be a priority. They discuss that many Granite Staters have real concerns about the practice of science, believing scientists change their findings to get the answers they want. More importantly, individuals who questioned the integrity of scientists are less likely to believe Zika is a threat, have confidence in the government’s ability to combat the virus, trust the CDC, and to prioritize emergency funding. They conclude that these results suggest that health officials working to engage the public in efforts to control the spread of Zika must not only discuss risks associated with the virus and mechanisms of transmission, but also confront science skepticism and potential concerns about the integrity of the scientists gathering data related to Zika and other infectious diseases

Axonal amyloid precursor protein and its fragments undergo somatodendritic endocytosis and processing.

Deposition of potentially neurotoxic Aβ fragments derived from amyloid precursor protein (APP) at synapses may be a key contributor to Alzheimer's disease. However, the location(s) of proteolytic processing and subsequent secretion of APP fragments from highly compartmentalized, euploid neurons that express APP and processing enzymes at normal levels is not well understood. To probe the behavior of endogenous APP, particularly in human neurons, we developed a system using neurons differentiated from human embryonic stem cells, cultured in microfluidic devices, to enable direct biochemical measurements from axons. Using human or mouse neurons in these devices, we measured levels of Aβ, sAPPα, and sAPPβ secreted solely from axons. We found that a majority of the fragments secreted from axons were processed in the soma, and many were dependent on somatic endocytosis for axonal secretion. We also observed that APP and the β-site APP cleaving enzyme were, for the most part, not dependent on endocytosis for axonal entry. These data establish that axonal entry and secretion of APP and its proteolytic processing products traverse different pathways in the somatodendritic compartment before axonal entry

Beginning the Journey: Disability Inclusion Pledge Survey Findings and Recommendations

The Disability & Philanthropy Forum is an emerging philanthropy-serving organization created by the Presidents' Council on Disability Inclusion in Philanthropy. Central to the Forum's mission is expanding philanthropic commitment to disability rights and justice by centering the leadership of the disability community.To help funders and philanthropy-serving organizations as they engage in their disability inclusion journeys, the Forum created the Disability Inclusion Pledge. The Pledge identifies concrete ways for funders and others in the sector to actively shift away from policies and practices that perpetuate ableism — the systemic stigmatization of and discrimination against people with disabilities — and uplift disability as an essential component of advancing equity.Beginning the Journey: Disability Inclusion Pledge Survey Findings and Recommendations provides a baseline measurement of how current practices and plans of responding Pledge signatories align with each of the eight action agendas included in the Pledge

Implementing Public Health Regulations in Developing Countries: Lessons from the OECD Countries

The enforcement of public health standards is a common problem in many developing countries. Public health agencies lack sufficient resources and, too often, enforcement mechanisms rely on slow and erratic judicial systems. These limitations can make traditional public health regulations difficult to implement. In this article, we examine innovative approaches to the implementation of public health regulations that have emerged in recent years within OECD countries. These approaches aim to improve compliance with health standards, while reducing dependence on both the legal system and the administrative resources of public health agencies. This article begins by discussing some traditional forms of public health regulations; these regulations include administrative searches and inspections as well as licensing measures. Within these traditional forms of public health regulation, there are several ways of improving compliance without substantially increasing administrative costs. These measures include public disclosure and several types of sanctions, which may escalate in severity as an actor continues to flout the public health regulation. In addition to such traditional measures, we discuss more creative approaches to reducing dependence on the judiciary and reducing administrative costs. Dependence on the judiciary can be reduced through increased reliance on alternative dispute resolution methods, such as mediation and arbitrations, as well as through the use of a public health Ombudsman. Administrative costs could also potentially be reduced through the creative use of public-private cooperation measures, such as negotiated rulemaking and self-regulating codes of conduct. Developing countries may find some useful lessons in the innovative approaches described; however, these approaches will likely need to be adapted to fit each country’s particular institutional setting

Content Blocking and the Patron as Situated Knower: What Would It Take for an Internet Filter to Work?

Librarians often object to Internet filters on the grounds that filters are prone to overblocking and underblocking. This argument implies that a significant problem with contemporary filters is that they are insufficiently fine-grained. In this article, we posit that present-day filters will always be conceptually capable of failure, regardless of how granular their content analysis becomes. This is because, we argue, objections to content are best understood as objections to problematic inter- actions between content and particular knowers. We import the concept of the situated knower from feminist epistemology to capture the heterogeneous, socially embedded nature of patrons, about whom we cannot make blunt generalizations for filtering purposes. A successful filter would need information about these differently situated patrons, the content they seek, and the inter- actions between the two. We conclude that a genuinely successful Internet filter would therefore need to be both mind reading and fortune-telling

A survey of teacher feeling in selected areas concerned with evaluation of teacher service to children

Thesis (Ed.M.)--Boston Universit

Spatio-Temporal Low Count Processes with Application to Violent Crime Events

There is significant interest in being able to predict where crimes will happen, for example to aid in the efficient tasking of police and other protective measures. We aim to model both the temporal and spatial dependencies often exhibited by violent crimes in order to make such predictions. The temporal variation of crimes typically follows patterns familiar in time series analysis, but the spatial patterns are irregular and do not vary smoothly across the area. Instead we find that spatially disjoint regions exhibit correlated crime patterns. It is this indeterminate inter-region correlation structure along with the low-count, discrete nature of counts of serious crimes that motivates our proposed forecasting tool. In particular, we propose to model the crime counts in each region using an integer-valued first order autoregressive process. We take a Bayesian nonparametric approach to flexibly discover a clustering of these region-specific time series. We then describe how to account for covariates within this framework. Both approaches adjust for seasonality. We demonstrate our approach through an analysis of weekly reported violent crimes in Washington, D.C. between 2001-2008. Our forecasts outperform standard methods while additionally providing useful tools such as prediction intervals