The Promise and Failures of Children\u27s Medicaid and the Role of Medical-Legal Partnerships as Monitors and Advocates

For decades we have known that access to early and preventive diagnosis and treatment can dramatically alter the course of a child’s life. Because of this knowledge, immediately after Congress enacted Medicaid, it created the Early and Periodic Screening, Diagnostic and Treatment, or EPSDT, program. EPSDT requires broad, holistic, and preventive care to correct or ameliorate health defects identified in Medicaid-eligible children. This coverage currently extends to 2 out of 5 children in the United States, and 47 percent of children with special health care needs. Because of the broad parameters of coverage mandated by EPSDT, Medicaid-eligible children should receive more enhanced access to care than adults on Medicaid, including any and all necessary medical care indicated by their health care providers. Tragically, for children like Savannah, a Medicaideligible girl with complex medical needs in Michigan, failures in EPSDT implementation resulted in unmet needs and dire consequences. Savannah was denied access to physical therapy, occupational therapy, and speech therapy critical to maintaining her ability to walk, feed herself, and function with some independence. As states have modified their Medicaid plan guidelines and transitioned to privatized Medicaid in an effort to cut growing costs, coverage gaps for vulnerable children like Savannah have intensified, leaving parents and providers feeling helpless and unable to give their patients and children the care they need. Medical-legal partnerships—interdisciplinary collaborations between health care providers and lawyers—are well suited to monitor EPSDT compliance, engage medical providers in informed patient advocacy, facilitate exchange of information regarding failures in coverage, and hold Medicaid programs accountable to low-income children. This article will review the history of the public health insurance system, outline the current legal mandates and landscape of EPSDT, and discuss the role that medical-legal partnerships can play in ensuring that EPSDT fulfills its purpose

Building the Case for Culturally Specific P-3 Strategies in Oregon: Listening to Voices From the Field

Oregon’s early learning and K-12 systems require transformative changes to address racial disparities in school readiness and success. Prenatal-through-Grade-3 (P-3) initiatives are an innovative way to align, strengthen and expand supports for this goal. Culturally specific organizations (CSOs) are uniquely poised and expertly prepared to meet the needs of communities of color while helping Oregon achieve its goals for reducing disparities in kinder­garten readiness and other educational outcomes. The proposed Early Childhood Equity Fund, which is included in the governor’s recommended 2019 budget, would move Oregon closer to eliminating the opportunity gap in kindergarten readiness and school success by investing in culturally specific early learning and family support programs and allocating more resources to CSOs that are imple­menting school readiness strategies

Carbon, nitrogen, and sulfur elemental and isotopic variations in mouse hair and bone collagen during short-term graded calorie restriction

We would like to thank Orsolya Cze´ re and Janet Walker (University of Aberdeen) for their technical assistance, as well as Matthew Collins (University of Cambridge and University of Copenhagen), Michael Buckley (University of Manchester), Tamsin O’Connell (University of Cambridge), Linus Girdland Flink (University of Aberdeen), and Richard Aspden (University of Aberdeen) for their inputs on this work. The authors would like to thank the two anonymous reviewers whose comments improved this manuscript.Peer reviewe

EverGraze: A Partnership between Researchers, Farmers and Advisors to Deliver Effective Grassland Management

The profitable and sustainable management of livestock production from grassland systems is challenging and it can be difficult to develop a research structure that addresses farmer’s needs and has acceptable rigour and on-ground impact. This paper describes the attributes of research, development and extension (RD&E) programs that are required for a successful partnership between researchers, farmers and advisors. Insights are provided from the EverGraze program that designed, tested and implemented farming systems based on perennial pastures across southern Australia. With this project farmers and advisors were involved in setting research direction, designing experiments, providing strategic guidance over the management of the systems experiments and then the synthesis of regionally applicable key messages. This involvement ensured the relevance of the research and aided in the extension and uptake of the information. The result has been an effective partnership between researchers, farmers and advisors that had a high level of impact across the high rainfall zone (HRZ) of southern Australia, with 1950 farmers or ~8% of those in the HRZ documented as having changed practice over an area of 816,000 ha over a five year period (2009 to 2014)

Retrospective analysis of factors influencing the implementation of a program to addressunprofessional behaviour and improve culture in Australian hospitals

Background: Unprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos, implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers. Method: Data relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers. Results: Four enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool (‘Design quality and packaging’), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos (‘Goals and Feedback’, ‘Access to Knowledge and Information’). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers. Conclusion: Aspects of the inner setting (e.g., ‘Leadership Engagement’, ‘Tension for Change’) had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them

Why are we misdiagnosing urinary tract infection in older patients? A qualitative inquiry and roadmap for staff behaviour change in the emergency department

Purpose - The aim of this study was to identify the psychological and behavioural factors influencing clinicians managing older people with possible UTI in urgent care settings, and to develop an improvement roadmap. Methods - Michie’s behaviour change wheel and COM-B (Capability, Opportunity, Motivation, Behaviour Change) models were used as the theoretical basis for this study. Semi-structured interviews were undertaken with 21 purposively selected medical and nursing staff in a large urban emergency department in the East Midlands, United Kingdom. Analysis was informed by the framework approach. A participatory design approach was used to develop an improvement roadmap. Results - Key themes emerging from the semi-structured interviews included lack of knowledge on the role of urine dipstick testing, bias towards older people, automatic testing, time and resource constraints, pressures from peers and patients, and fear of the legal consequences of inaction. A thematic networks map indicated complex interactions between psychological and behavioural factors. Among more than 50 different intervention ideas identified by the workshop participants, two interventions were prioritised for implementation: i) controlling the use of dip stick urine tests; ii) providing individualised feedback to staff regarding the outcomes of patients diagnosed and treated for UTI. Conclusions - Psychological and behavioural factors play a significant role in the misdiagnosis of UTI in older people. Systematic approaches incorporating these factors might improve patient outcomes. Future studies should focus on implementation and evaluating their effectiveness and sustainability

The Lantern Vol. 41, No. 1, Fall 1974

• The Fable • Landscape - Clear Weather in the Valley • Josephine Palooka • Don\u27t Bark Twice - It\u27s All Right • Masks • Suicide Note From a Lemming • The Death of Dame Sexton • Come September • Leaves • Spruce Grove • The Class of \u2775 • The Promise • Images • Sixth Station • Borealis • To Gemhttps://digitalcommons.ursinus.edu/lantern/1105/thumbnail.jp

Impact of a (poly)phenol-rich extract from the brown algae Ascophyllum nodosum on DNA damage and antioxidant activity in an overweight or obese population: a randomized controlled trial

Background Epidemiologic evidence suggests that a diet rich in (poly)phenols has beneficial effects on many chronic diseases. Brown seaweed is a rich source of (poly)phenols. Objective The aim of this study was to investigate the bioavailability and effect of a brown seaweed (Ascophyllum nodosum) (poly)phenol extract on DNA damage, oxidative stress, and inflammation in vivo. Design A randomized, double-blind, placebo-controlled crossover trial was conducted in 80 participants aged 30–65 y with a body mass index (in kg/m2) ≥25. The participants consumed either a 400-mg capsule containing 100 mg seaweed (poly)phenol and 300 mg maltodextrin or a 400-mg maltodextrin placebo control capsule daily for an 8-wk period. Bioactivity was assessed with a panel of blood-based markers including lymphocyte DNA damage, plasma oxidant capacity, C-reactive protein (CRP), and inflammatory cytokines. To explore the bioavailability of seaweed phenolics, an untargeted metabolomics analysis of urine and plasma samples after seaweed consumption was determined by ultra-high-performance liquid chromatography–high-resolution mass spectrometry. Results Consumption of the seaweed (poly)phenols resulted in a modest decrease in DNA damage but only in a subset of the total population who were obese. There were no significant changes in CRP, antioxidant status, or inflammatory cytokines. We identified phlorotannin metabolites that are considered potential biomarkers of seaweed consumption including pyrogallol/phloroglucinol-sulfate, hydroxytrifurahol A-glucuronide, dioxinodehydroeckol-glucuronide, diphlorethol sulfates, C-O-C dimer of phloroglucinol sulfate, and C-O-C dimer of phloroglucinol. Conclusions To the best of our knowledge, this work represents the first comprehensive study investigating the bioactivity and bioavailability of seaweed (poly)phenolics in human participants. We identified several potential biomarkers of seaweed consumption. Intriguingly, the modest improvements in DNA damage were observed only in the obese subset of the total population. The subgroup analysis should be considered exploratory because it was not preplanned; therefore, it was not powered adequately. Elucidation of the biology underpinning this observation will require participant stratification according to weight in future studies. This trial was registered at clinicaltrials.gov as NCT02295878