Medi-Cal Expansion under the Affordable Care Act: Significant Increase in Coverage with Minimal Cost to the State

Since 2011, California has been taking steps towards expanding Medicaid under the Afordable Care Act (ACA) by implementing Low Income Health Programs (LIHPs) in most California counties. Under the "Bridge to Reform" Medicaid §1115 waiver, just over 500,000 California adults are currently enrolled in coverage in advance of ACA implementation using federal and county funds. he vast majority of these LIHP enrollees can become eligible for Medi-Cal coverage under the ACA beginning January 1, 2014, and the remainder will be eligible for subsidies through Covered California (the California Health Benefit Exchange).In early 2013, California legislators will consider bills to implement a key provision of the ACA that would expand Medi-Cal to low-income adults under age 65, including those without children living at home. Lawfully-present childless adults with income up to 138 percent of the Federal Poverty Level and parents with income between 106 percent and 138 percent of the Federal Poverty Level will be newly eligible. Some unenrolled children and parents who are already income-eligible for the program under existing eligibility rules could also enroll due to the minimum coverage requirement to obtain insurance created by the ACA, improved eligibility, enrollment and redetermination processes, and enhanced awareness of coverage options.In this report, we estimate the growth in Medi-Cal enrollment among both the newly and already eligible using the UC Berkeley-UCLA California Simulation of Insurance Markets (CalSIM) model. We discuss the broader impact of the Medi-Cal Expansion in terms of health outcomes, providers and the economy. We estimate the federal and state spending on increased Medi-Cal enrollment, along with the state tax revenues generated by new federal Medi-Cal spending and potential savings in other areas of the budget

Pre-trial detention in the Netherlands:Absolutely low, relatively high

In this chapter, we outline Dutch legislation and practice of pre-trial detention. We also elaborate on the findings we collected in the DETOUR project that is introduced in Chapter 1. The findings are still very much relevant today and are complemented by more recent research findings in the area of pre-trial detention in the Netherlands and case law from the European Court of Human Rights (ECtHR). Although the absolute number of pre-trial detainees in the Netherlands is low compared to most other European countries, the relative part has remained rather high (between 41% and 49%) in the last ten years. We demonstrate that decision-making in pre-trial detention cases in the Netherlands is driven by a couple of important factors among which legal culture is probably the most important. A preventive approach is leading, based on assumptions about the societal impact of the release of the suspect. Government policy is aimed at an “on-the-spot” approach and the mantra is being “tough on crime”. This causes a climate in which the provisional release of suspects of so-called high impact crimes or repeat offenders is an exception. This legal culture, that is manifest in the policy on the expedited proceedings as well, seems to be deeply institutionalised and has led to a very extensive interpretation of the statutory grounds for pre-trial detention.</p

Massachusetts Health Passport Project Evaluation Final Report

Adapted from the Executive Summary: The Massachusetts Health Passport Project (MHPP) began in April 2004, as a pilot program of the Juvenile Rights Advocacy Project at Boston College Law School under the direction of Francine Sherman, Esq. The program was originally called the Girls’ Health Passport Project (GHPP) and was designed to address the unmet health needs and gaps in health care services for girls committed to the Massachusetts Department of Youth Services (DYS) and re-entering their communities from DYS assessment and treatment facilities. An advisory board of health, juvenile justice, philanthropy, and evaluation professionals assisted the program in its early development

Management of trypanosomiasis and leishmaniasis

&lt;p&gt;Background: The current treatments for human African trypanosomiasis (HAT), Chagas disease and leishmaniasis (collectively referred to as the kinetoplastid diseases) are far from ideal but, for some, there has been significant recent progress. For HAT the only advances in treatment over the past two decades have been the introduction of an eflornithine/nifurtimox co-administration and a shorter regime of the old standard melarsoprol.&lt;/p&gt; &lt;p&gt;Sources of data: PubMed.&lt;/p&gt; &lt;p&gt;Areas of Agreement: There is a need for new safe, oral drugs for cost-effective treatment of patients and use in control programmes for all the trypanosomatid diseases.&lt;/p&gt; &lt;p&gt;Areas of controversy: Cutaneous leishmaniasis is not on the agenda and treatments are lagging behind.&lt;/p&gt; &lt;p&gt;Growing points: There are three compounds in development for the treatment of the CNS stage of HAT: fexinidazole, currently due to entry into phase II clinical studies, a benzoxaborole (SCYX-7158) in phase I trials and a diamidine derivative (CPD-0802), in advanced pre-clinical development. For Chagas disease, two anti-fungal triazoles are now in clinical trial. In addition, clinical studies with benznidazole, a drug previously recommended only for acute stage treatment, are close to completion to determine the effectiveness in the treatment of early chronic and indeterminate Chagas disease. For visceral leishmaniasis new formulations, therapeutic switching, in particular AmBisome, and the potential for combinations of established drugs have significantly improved the opportunities for the treatment in the Indian subcontinent, but not in East Africa.&lt;/p&gt; &lt;p&gt;Areas timely for developing research: Improved diagnostic tools are needed to support treatment, for test of cure in clinical trials and for monitoring/surveillance of populations in control programmes.&lt;/p&gt

Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study

<p>Abstract</p> <p>Background</p> <p>Quality improvement collaboratives (QICs) bring together groups of healthcare professionals to work in a structured manner to improve the quality of healthcare delivery within particular domains. We explored which characteristics of the composition, participation, functioning, and organization of these collaboratives related to changes in the healthcare for patients with anxiety disorders, dual diagnosis, or schizophrenia.</p> <p>Methods</p> <p>We studied three QICs involving 29 quality improvement (QI) teams representing a number of mental healthcare organizations in the Netherlands. The aims of the three QICs were the implementation of multidisciplinary practice guidelines in the domains of anxiety disorders, dual diagnosis, and schizophrenia, respectively. We used eight performance indicators to assess the impact of the QI teams on self-reported patient outcomes and process of care outcomes for 1,346 patients. The QI team members completed a questionnaire on the characteristics of the composition, participation in a national program, functioning, and organizational context for their teams. It was expected that an association would be found between these team characteristics and the quality of care for patients with anxiety disorders, dual diagnosis, and schizophrenia.</p> <p>Results</p> <p>No consistent patterns of association emerged. Theory-based factors did not perform better than practice-based factors. However, QI teams that received support from their management and both active and inspirational team leadership showed better results. Rather surprisingly, a lower average level of education among the team members was associated with better results, although less consistently than the management and leadership characteristics. Team views with regard to the QI goals of the team and attitudes towards multidisciplinary practice guidelines did not correlate with team success.</p> <p>Conclusions</p> <p>No general conclusions about the impact of the characteristics of QI teams on the quality of healthcare can be drawn, but support of the management and active, inspirational team leadership appear to be important. Not only patient outcomes but also the performance indicators of monitoring and screening/assessment showed improvement in many but not all of the QI teams with such characteristics. More studies are needed to identify factors associated with the impact of multidisciplinary practice guidelines in mental healthcare.</p

RISO e LÁGRIMAS: interioridade como controle corporal das emoções

Tradução do Capítulo 5 do livro Performing Emotions: Gender, bodies, spaces, in Chekhov's drama and Stanislavski's theatre, de Peta Tait. Este texto aborda questões sobre a representação das emoções e os problemas de gênero na relação criativa entre a atriz Olga Knipper e o ator e diretor Constantin Stanislavski nas montagens do Teatro de Arte de Moscou das peças de Anton Chekhov

The implications of American chestnut reintroduction on landscape dynamics and carbon storage

In the eastern United States, American chestnut (Castanea dentata) was historically a major component of forest communities, but was functionally extirpated in the early 20th century by an introduced pathogen, chestnut blight (Cryphonectria parasitica). Because chestnut is fast-growing, long-lived, and resistant to decay, restoration of American chestnut using blight-resistant stock could have the potential to increase carbon sequestration or storage in forested landscapes. However, carbon dynamics are also affected by interspecific competition, succession, natural disturbance, and forest management activities, and it is unknown how chestnut restoration might interact with these other processes. We used the PnET-Succession extension of the LANDIS-II forest landscape model to study the implications of chestnut restoration on forest composition and carbon storage in the context of other disturbances, including timber harvest and insect pest outbreaks. Our results imply that it could take a millennium or more for chestnut to fully occupy landscapes without aggressive restoration efforts. When successful, chestnut restoration activities displaced other species approximately in proportion to their abundance on the landscape, rather than replacing a single species or genus (e.g., Quercus). Insect pests increased the rate of chestnut colonization by reducing the abundance of competitors, and also had a dominant effect on carbon dynamics. Although chestnut is fast-growing, moderately shade-tolerant, and decomposes very slowly, our results suggest that it can only modestly increase the carbon storage potential of eastern forests. However, our results also demonstrate that compositional changes in forest communities can have noticeable effects on biomass accumulation, even with the large uncertainties introduced by invasive pests

Long-Distance and Trans-Generational Stomatal Patterning by CO2 Across Arabidopsis Organs

Stomata control water loss and carbon dioxide uptake by both altering pore aperture and developmental patterning. Stomatal patterning is regulated by environmental factors including atmospheric carbon dioxide (p[CO2]), which is increasing globally at an unprecedented rate. Mature leaves are known to convey developmental cues to immature leaves in response to p[CO2], but the developmental mechanisms are unknown. To characterize changes in stomatal patterning resulting from signals moving from mature to developing leaves, we constructed a dual-chamber growth system in which rosette and cauline leaves of Arabidopsis thaliana were subjected to differing p[CO2]. Young rosette tissue was found to adjust stomatal index (SI, the proportion of stomata to total cell number) in response to both the current environment and the environment experienced by mature rosette tissue, whereas cauline leaves appear to be insensitive to p[CO2] treatment. It is likely that cauline leaves and cotyledons deploy mechanisms for controlling stomatal development that share common but also deploy distinctive mechanisms to that operating in rosette leaves. The effect of p[CO2] on stomatal development is retained in cotyledons of the next generation, however, this effect does not occur in pre-germination stomatal lineage cells but only after germination. Finally, these data suggest that p[CO2] affects regulation of stomatal development specifically through the development of satellite stomata (stomata induced by signals from a neighboring stomate) during spacing divisions and not the basal pathway. To our knowledge, this is the first report identifying developmental steps responsible for altered stomatal patterning to p[CO2] and its trans-generational inheritance

Editorial

Informações sobre o conteúdo da Urdimento v.1, n.28, 2017