Decentralization and Health: Case Studies of Kenya, Pakistan, and the Philippines

Decentralization, defined by the World Bank (2001) as, “the transfer of authority and responsibility for public functions from the central government to intermediate and local governments or quasi-­‐independent government organizations and/or the private sector,” is a movement that has gained much traction in recent history. For many countries undergoing decentralization, a major driver has been a desire to increase the role and participation of local governments in the decision-­‐making space. In doing this, it is hoped to create governance structures that are more accountable and responsive to the people. For health, decentralization has been touted as a potential way to improve responsiveness to local needs, improve service delivery, and improve equitability. In light of these goals, many countries as part of their political decentralization have also opted to decentralize healthcare.https://jdc.jefferson.edu/cwicposters/1020/thumbnail.jp

Hold All Arbitrations: Public Policy Invalidations Are on the Loose - Town of Groton v. United Steelworkers of America

The United States Supreme Court has held that arbitration awards derived from collective bargaining agreements may be invalidated based on public policy. However, an arbitration award should only be invalidated if the public policy is explicit, well-defined, and dominant.\u27 This article will examine how the Connecticut Supreme Court applied the public policy test and whether the court adequately justified its decision

Class Action vs. Arbitration: Does TILA Support Class Actions in Arbitration Where Statutory Rights are Concerned - Johnson v. West Suburban Bank

Johnson v. West Suburban Bank is an important case in American jurisprudence because it combines several United States Supreme Court cases to establish a test for whether arbitration provisions relating to statutory rights should be upheld when they essentially preclude class actions. This Casenote will examine the progression the courts have taken and Johnson\u27s subsequent test. Finally, an evaluation of this test will follow

Wraparound Case Management for Children with Serious Emotional Disturbance: A Qualitative Look at Caregivers\u27 Experiences

Wraparound treatment has been described as a unique set of community services and natural supports for a child/adolescent with serious emotional disturbance (SED) based on a definable planning process, individualized for the child and family to achieve a positive set of outcomes. Research has focused on many components of wraparound interventions, but little attention has been paid to experiences of the caregivers of children receiving services. One of the few studies addressing this issue found higher levels of caregiver satisfaction with wraparound services than with treatment-as-usual. The critical role of caretakers in the wraparound process suggests many important research questions including: What is it about wraparound services that meet caregivers\u27 needs? What aspects of wraparound do caregivers feel work best for their child and family? Are there components of wraparound that could be improved? Findings could suggest strategies for informing and potentially improving services to children with SED and their families

The Influence of Exercise Empowerment on Life Stress

Background: Psychological stress – when an individual perceives that the environment exceeds their ability to meet the demands placed on them - is common in college students and exercise, and specifically instructional physical activity courses, is frequently cited as a one method of stress reduction. Objective: Determine any relationship between exercise empowerment and perceived life stress for those participating in instructional physical activity courses (IPAC). Methods: All undergraduate students (n = 3388) enrolled in IPAC in 15-week IPAC at a large university were surveyed on perceived life stress (PSS), empowerment in exercise (EES), and specific demographic variables. Results: 944 of 3388 enrolled students (Nov. 2015, April 2016) completed the survey. The data revealed GPA (p \u3c 0.002), sex (p \u3c 0.000), and EES (p \u3c 0.001) showed differences for PSS. It was determined that EES, sex, and GPA predicted PSS differently for students according to their year in college. Conclusions: For freshman and seniors, sex and lower GPA were a stronger predictor of PSS with no mitigating effect of exercise empowerment. For sophomores and juniors the level of life stress was lower at higher levels of exercise empowerment. These findings support a complex relationship between exercise empowerment and life stress. While exercise is cited as a method for stress reduction the relationship between exercise empowerment and life stress for college-aged students is not as straightforward as it may seem

Internet Service Providers (ISP) Markets of Australia and New Zealand

This paper compares the Australian and New Zealand Internet market. It draws heavily on Enright (2000) which reports the short history of Internet Service Providers (ISPs) in New Zealand since the inception of the Internet in 1994. It also provides a review of the prices and market shares and strategic motivations for entry to this market. The Internet phenomenon is worldwide. Thus although the New Zealand market has experienced rapid price declines and growing market penetration its performance in delivering benefits to consumers should be judged relative to that of ISP markets elsewhere. International comparisons are fraught with difficulties that make for very cautious interpretation of cross-country price studies. Nevertheless some consideration of the Australian ISP market does help place the New Zealand market in perspective. The purpose of this paper is to build on the evidence of Enright op cit and place it in a wider context by comparing the Australian and New Zealand ISP markets in 1999. The comparison suggests that Internet service provision in New Zealand was cheaper in 1999 than in Australia and that penetration and usage in New Zealand was at least that of Australia

Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study

Background/aim: Shoulder pain is a major musculoskeletal problem. We aimed to identify which baseline patient and clinical characteristics are associated with a better outcome, 6 weeks and 6 months after starting a course of physiotherapy for shoulder pain. Methods: 1030 patients aged ≥18 years referred to physiotherapy for the management of musculoskeletal shoulder pain were recruited and provided baseline data. 840 (82%) provided outcome data at 6 weeks and 811 (79%) at 6 months. 71 putative prognostic factors were collected at baseline. Outcomes were the Shoulder Pain and Disability Index (SPADI) and Quick Disability of the Arm, Shoulder and Hand Questionnaire. Multivariable linear regression was used to analyse prognostic factors associated with outcome. Results: Parameter estimates (β) are presented for the untransformed SPADI at 6 months, a negative value indicating less pain and disability. 4 factors were associated with better outcomes for both measures and time points: lower baseline disability (β=−0.32, 95% CI −0.23 to −0.40), patient expectation of ‘complete recovery’ compared to ‘slight improvement’ as ‘a result of physiotherapy’ (β=−12.43, 95% CI −8.20 to −16.67), higher pain self-efficacy (β=−0.36, 95% CI −0.50 to −0.22) and lower pain severity at rest (β=−1.89, 95% CI −1.26 to −2.51). Conclusions: Psychological factors were consistently associated with patient-rated outcome, whereas clinical examination findings associated with a specific structural diagnosis were not. When assessing people with musculoskeletal shoulder pain and considering referral to physiotherapy services, psychosocial and medical information should be considered. Study registration Protocol published at http://www.biomedcentral.com/1471-2474/14/192

Protein Identification Using Bayesian Stochastic Search

Current methods for protein identification in tandem mass spectrometry (MS/MS) involve database searches or de novo peptide sequencing, with database searches being the standard method. With database searches, issues arise when the species is not in the database. Shortcomings of de novo peptide sequencing and database searches include chemical noise, overly complex fragments, and incomplete b and y ion sequences. Here we present a Bayesian approach to identifying peptides. Our model uses prior information about the average relative abundances of bond cleavages and the prior probability of any particular amino acid sequence. The proposed likelihood function is composed of two overall distance measures, which measure how close an observed spectrum is to a theoretical scan for a peptide. A Markov chain Monte Carlo (MCMC) algorithm is employed to simulate candidate choices from the posterior distribution of the peptide sequence. The true peptide is estimated as the peptide with the largest posterior density. In addition, our method is designed to rank top candidate peptides according to their approximate posterior densities, which allows one to see the relative uncertainty in the best\u27\u27 choice. A simulation study was carried out to ensure our algorithm is performing accurately. Two different noise structures were explored: a Laplace noise structure and a Poisson noise structure. Simulation studies showed our methods are promising. Our motivating data come from the Pacific Northwest National Laboratory (PNNL) and the dataset is from the salmonella typhimurium species. The dataset is a set of doubly charged tryptic peptides. When our method was applied to peptides from this dataset, the true peptide was captured among the list of the top estimated peptides

Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis

Objectives: To (i) identify predictors of outcome for the physiotherapy management of shoulder pain and (ii) enable clinicians to subgroup people into risk groups for persistent shoulder pain and disability. Methods: 1030 people aged ≥18 years, referred to physiotherapy for the management of musculoskeletal shoulder pain were recruited. 810 provided data at 6 months for 4 outcomes: Shoulder Pain and Disability Index (SPADI) (total score, pain sub-scale, disability sub-scale) and Quick Disability of the Arm, Shoulder and Hand (QuickDASH). 34 potential prognostic factors were used in this analysis. Results: Four classification trees (prognostic pathways or decision trees) were created, one for each outcome. The most important predictor was baseline pain and/or disability: higher or lower baseline levels were associated with higher or lower levels at follow up for all outcomes. One additional baseline factor split participants into four subgroups. For the SPADI trees, high pain self-efficacy reduced the likelihood of continued pain and disability. Notably, participants with low baseline pain but concomitant low pain self-efficacy had similar outcomes to patients with high baseline pain and high pain self-efficacy. Cut points for defining high and low pain self-efficacy differed according to baseline pain and disability. In the QuickDASH tree, the association between moderate baseline pain and disability with outcome was influenced by patient expectation: participants who expected to recover because of physiotherapy did better than those who expected no benefit. Conclusions: Patient expectation and pain self-efficacy are associated with clinical outcome. These clinical elements should be included at the first assessment and a low pain self-efficacy response considered as a target for treatment intervention