Duration of Public Assistance Receipt: Is Welfare a Trap?

This paper uses data from the National Longitudinal Survey of Youth to answer two questions about the effects of the Aid to Families with Dependent Children (AFDC) program: (1) Does the length of time that one receives AFDC affect the likelihood of permanently leaving AFDC? (2) What personal and family characteristics are associated with the long-term receipt of AFDC? The answer to the first question is that the likelihood of permanently leaving AFDC decreases with the length of time that individuals receive benefits, after adjustments for other measured and unmeasured attributes of individuals and their families. The answer to the second question is that not having a high school diploma, never having married, having more than two children, and having little work experience are associated with long-term receipt. Many of the recipients who will reach the five-year limit imposed by the new federal legislation are in situations that make it difficult for them to support themselves and their families without public assistance.

Perioperative Medication Teaching Protocol: An Evidence-Based Project in a Perioperative Surgical Home

At the outpatient surgery center, there is a need for a perioperative medication guideline to improve appropriate medication teaching and compliance in the days and weeks leading up to a surgical intervention. It is critical that protocols and evidence-based guidelines are used throughout the management of all patients taking oral anticoagulants during the perioperative window. Currently, there is no standardized teaching protocol for patients preparing for surgery who are on anticoagulants. This lack of standardization could lead to increased surgical complications. Patient education is essential to preoperative optimization and can lead to improved patient compliance. This can be done by streamlining the education given to patients regarding their perioperative anticoagulant management, which increases effectiveness of the education and decrease adverse reactions. One solution, and the focus of this project, will be implementing a standardized medication teaching protocol, via the perioperative surgical home, to improve appropriate adherence in patients taking anticoagulants. The aim of the proposed project is that by May 30, 2021, 100% of perioperative nursing staff will receive the preoperative medication guideline, participate in the educational training, and demonstrate competency in knowledge of the guideline and patient education

A variational approach to strongly damped wave equations

We discuss a Hilbert space method that allows to prove analytical well-posedness of a class of linear strongly damped wave equations. The main technical tool is a perturbation lemma for sesquilinear forms, which seems to be new. In most common linear cases we can furthermore apply a recent result due to Crouzeix--Haase, thus extending several known results and obtaining optimal analyticity angle.Comment: This is an extended version of an article appeared in \emph{Functional Analysis and Evolution Equations -- The G\"unter Lumer Volume}, edited by H. Amann et al., Birkh\"auser, Basel, 2008. In the latest submission to arXiv only some typos have been fixe

Minutes of a Special Joint Telephonic Meeting of the Boards of Directors of Countrywide Financial Corporation and Countrywide Bank, FSB

Individuals present during this meeting were all of the members of the Board of Directors for Countrywide Financial Corporation (CFC) and Countrywide Bank, FSB with the exception of Director Henry G. Cisneros. Countrywide Financial Corporation\u27s senior management (listed as authors below) were also in attendance

Identification of publicly available data sources to inform the conduct of Health Technology Assessment in India

Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole

A voice for change? Trust relationships between ombudsmen, individuals and public service providers

There has been a debate for years about what the role of the ombudsman is. This article examines a key component of the role, to promote trust in public services and government. To be able to do this, however, an ombudsman needs to be perceived as legitimate and be trusted by a range of stakeholders, including the user. This article argues that three key relationships in a person’s complaint journey can build trust in an institution, and must therefore be understood as a system. The restorative justice framework is adapted to conceptualize this trust model as a novel approach to understanding the institution from the perspective of its users. Taking two public sector ombudsmen as examples, the article finds that voice and trust need to be reinforced through the relationships in a consumer journey to manage individual expectations, prevent disengagement, and thereby promote trust in the institution, in public service providers, and in government

Entry, Exit, and the Determinants of Market Structure

This paper estimates a dynamic, structural model of entry and exit in an oligopolistic industry and uses it to quantify the determinants of market structure and long-run firm values for two U.S. service industries, dentists and chiropractors. Entry costs faced by potential entrants, fixed costs faced by incumbent producers, and the toughness of short-run price competition are all found to be important determinants of long-run firm values, firm turnover, and market structure. Estimates for the dentist industry allow the entry cost to differ for geographic markets that were designated as Health Professional Shortage Areas and in which entry was subsidized. The estimated mean entry cost is 11 percent lower in these markets. Using simulations, we compare entry-cost versus fixed-cost subsidies and find that entry-cost subsidies are less expensive per additional firm

Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence

<p>Abstract</p> <p>Background</p> <p>People with diabetes can suffer from diverse complications that seriously erode quality of life. Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years. Accurate projections of diabetes burden are essential to policymakers planning for future health care needs and costs.</p> <p>Methods</p> <p>Using data on prediabetes and diabetes prevalence in the United States, forecasted incidence, and current US Census projections of mortality and migration, the authors constructed a series of dynamic models employing systems of difference equations to project the future burden of diabetes among US adults. A three-state model partitions the US population into no diabetes, undiagnosed diabetes, and diagnosed diabetes. A four-state model divides the state of "no diabetes" into high-risk (prediabetes) and low-risk (normal glucose) states. A five-state model incorporates an intervention designed to prevent or delay diabetes in adults at high risk.</p> <p>Results</p> <p>The authors project that annual diagnosed diabetes incidence (new cases) will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050. Assuming low incidence and relatively high diabetes mortality, total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the US adult population by 2050. However, if recent increases in diabetes incidence continue and diabetes mortality is relatively low, prevalence will increase to 33% by 2050. A middle-ground scenario projects a prevalence of 25% to 28% by 2050. Intervention can reduce, but not eliminate, increases in diabetes prevalence.</p> <p>Conclusions</p> <p>These projected increases are largely attributable to the aging of the US population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer. Effective strategies will need to be undertaken to moderate the impact of these factors on national diabetes burden. Our analysis suggests that widespread implementation of reasonably effective preventive interventions focused on high-risk subgroups of the population can considerably reduce, but not eliminate, future increases in diabetes prevalence.</p

Immunoelectron Microscopic Evidence for Tetherin/BST2 as the Physical Bridge between HIV-1 Virions and the Plasma Membrane

Tetherin/BST2 was identified in 2008 as the cellular factor responsible for restricting HIV-1 replication at a very late stage in the lifecycle. Tetherin acts to retain virion particles on the plasma membrane after budding has been completed. Infected cells that express large amounts of tetherin display large strings of HIV virions that remain attached to the plasma membrane. Vpu is an HIV-1 accessory protein that specifically counteracts the restriction to virus release contributed by tetherin. Tetherin is an unusual Type II transmembrane protein that contains a GPI anchor at its C-terminus and is found in lipid rafts. The leading model for the mechanism of action of tetherin is that it functions as a direct physical tether bridging virions and the plasma membrane. However, evidence that tetherin functions as a physical tether has thus far been indirect. Here we demonstrate by biochemical and immunoelectron microscopic methods that endogenous tetherin is present on the viral particle and forms a bridge between virion particles and the plasma membrane. Endogenous tetherin was found on HIV particles that were released by partial proteolytic digestion. Immunoelectron microscopy performed on HIV-infected T cells demonstrated that tetherin forms an apparent physical link between virions and connects patches of virions to the plasma membrane. Linear filamentous strands that were highly enriched in tetherin bridged the space between some virions. We conclude that tetherin is the physical tether linking HIV-1 virions and the plasma membrane. The presence of filaments with which multiple molecules of tetherin interact in connecting virion particles is strongly suggested by the morphologic evidence