The Epidemiology of U.S. Immunization Law: Translating CDC Immunization Guidelines into Practice: State Laws Related to the Use of Standing Orders Covering Immunization Practice

This pilot study examines how five states -- Georgia, Massachusetts, New York, Oregon, and Texas – approach the legal question of delegation of medical practice powers in an immunization practice context

The Epidemiology of U.S. Immunization Law: A National Study for the National Immunizations Program, Centers for Disease Control and Prevention: Medicaid Coverage of Immunizations for Non-Institutionalized Adults

As a health policy matter, coverage of immunizations and their administration for all ages at levels recommended by the Advisory Committee on Immunization Practices (ACIP) has grown in importance for several reasons: 1) the growing attention to both manmade and naturally occurring public health threats; 2) recognition of the value of immunization to society; and 3) the relatively high cost of at least certain immunization services in relation to personal income. No population stands to benefit more from immunization coverage than low income persons. Studies suggest that adult immunization status is particularly low, and that financial barriers play a role, especially for low income persons. Medicaid is the nation-s single largest source of health insurance for children and adults. Eligibility for adults is linked to both membership in a recognized categorical status and low income, including individuals age 65 and over, adults (mostly women) in families with children, individuals with disabilities, pregnant women, and certain other categorical groups. This review is the second in a series of studies which describes the different health insurance coverage options available to individuals and families in the United States for acquiring medically appropriate immunizations. This report analyses the provision of immunization services to adult beneficiaries of Medicaid. Coverage and payment information was reviewed from every state, while data from the District of Columbia was unobtainable

The Epidemiology of U.S. Immunization Law: Mandated Coverage of Immunizations Under State Health Insurance Laws

Immunizations represent both basic clinical care as well as an essential public health activity with population-wide health implications, and for a number of reasons, the focus on national immunization policy has intensified in recent years. Insurers and employee health plans may cover immunization services as a matter of benefit design choice. Federal and state insurance laws also may mandate coverage of one or more classes of immunization services. For approximately 100 million persons who are members of state-regulated health insurance plans, state law plays a primary role in determining coverage. Thus the extent of state immunization health insurance mandates is essential in examining the overall adequacy of health insurance financing for immunization services. This analysis is part of a comprehensive study of the epidemiology of U.S. immunization law. It provides a detailed assessment of state immunization statutes in force as of winter 2003

How Medical Claims Simplification Can Impede Delivery of Child Developmental Services

This report examines HIPAA administrative standardization and the process of modifying the standardized codes. It assesses the implications of HIPAA standardization for payment of Medicaid-covered early childhood preventive and developmental services, drawing on findings from a 50-state, point-in-time review of readily available state HIPAA compliance documents conducted in December 2004

Reasonable Modification or Fundamental Alteration? Recent Developments in ADA Caselaw and Implications for Behavioral Health Policy

This issue brief examines the concept of fundamental alteration under the Americans with Disabilities Act (ADA); specifically it considers when proposed modifications of public programs under Title II of the ADA will be considered to amount to the type of fundamental alteration that lies beyond judicial power to compel. The issue of when a program change constitutes a fundamental alteration is important in state community integration planning efforts, since these types of changes will require legislative action

The Affordable Care Act: U.S. Vaccine Policy and Practice

When fully implemented, the Patient Protection and Affordable Care Act, amended by the Health and Education Reconciliation Act will extend health insurance coverage to 94 percent of Americans while establishing a comprehensive set of strategies to improve care and contain costs. The central provisions of the Act – guaranteed affordable and accessible coverage – take effect January 1, 2014. Important insurance reforms aimed at improving coverage become effective before that date, as do a series of investments aimed at improving the accessibility and quality of health care. This report has several aims: 1) to examine how the laws address vaccine policy and practice; 2) to assess how access to vaccines and immunization services will be affected; and 3) to assess the extent to which health reform addresses recommendations of the National Vaccine Advisory Committee\u27s (NVAC) Vaccine Finance Working Group (VFWG) 2008

Dose volume histogram analysis of normal structures associated with accelerated partial breast irradiation delivered by high dose rate brachytherapy and comparison with whole breast external beam radiotherapy fields

<p>Abstract</p> <p>Purpose</p> <p>To assess the radiation dose delivered to the heart and ipsilateral lung during accelerated partial breast brachytherapy using a MammoSite™ applicator and compare to those produced by whole breast external beam radiotherapy (WBRT).</p> <p>Materials and methods</p> <p>Dosimetric analysis was conducted on patients receiving MammoSite breast brachytherapy following conservative surgery for invasive ductal carcinoma. Cardiac dose was evaluated for patients with left breast tumors with a CT scan encompassing the entire heart. Lung dose was evaluated for patients in whom the entire lung was scanned. The prescription dose of 3400 cGy was 1 cm from the balloon surface. MammoSite dosimetry was compared to simulated WBRT fields with and without radiobiological correction for the effects of dose and fractionation. Dose parameters such as the volume of the structure receiving 10 Gy or more (V10) and the dose received by 20 cc of the structure (D20), were calculated as well as the maximum and mean doses received.</p> <p>Results</p> <p>Fifteen patients were studied, five had complete lung data and six had left-sided tumors with complete cardiac data. Ipsilateral lung volumes ranged from 925–1380 cc. Cardiac volumes ranged from 337–551 cc. MammoSite resulted in a significantly lower percentage lung V30 and lung and cardiac V20 than the WBRT fields, with and without radiobiological correction.</p> <p>Conclusion</p> <p>This study gives low values for incidental radiation received by the heart and ipsilateral lung using the MammoSite applicator. The volume of heart and lung irradiated to clinically significant levels was significantly lower with the MammoSite applicator than using simulated WBRT fields of the same CT data sets.</p> <p>Trial registration</p> <p>Dana Farber Trial Registry number 03-179</p

A coupled terrestrial and aquatic biogeophysical model of the Upper Merrimack River watershed, New Hampshire, to inform ecosystem services evaluation and management under climate and land-cover change

Accurate quantification of ecosystem services (ES) at regional scales is increasingly important for making informed decisions in the face of environmental change. We linked terrestrial and aquatic ecosystem process models to simulate the spatial and temporal distribution of hydrological and water quality characteristics related to ecosystem services. The linked model integrates two existing models (a forest ecosystem model and a river network model) to establish consistent responses to changing drivers across climate, terrestrial, and aquatic domains. The linked model is spatially distributed, accounts for terrestrial–aquatic and upstream–downstream linkages, and operates on a daily time-step, all characteristics needed to understand regional responses. The model was applied to the diverse landscapes of the Upper Merrimack River watershed, New Hampshire, USA. Potential changes in future environmental functions were evaluated using statistically downscaled global climate model simulations (both a high and low emission scenario) coupled with scenarios of changing land cover (centralized vs. dispersed land development) for the time period of 1980–2099. Projections of climate, land cover, and water quality were translated into a suite of environmental indicators that represent conditions relevant to important ecosystem services and were designed to be readily understood by the public. Model projections show that climate will have a greater influence on future aquatic ecosystem services (flooding, drinking water, fish habitat, and nitrogen export) than plausible changes in land cover. Minimal changes in aquatic environmental indicators are predicted through 2050, after which the high emissions scenarios show intensifying impacts. The spatially distributed modeling approach indicates that heavily populated portions of the watershed will show the strongest responses. Management of land cover could attenuate some of the changes associated with climate change and should be considered in future planning for the region

The challenge of predicting groundwater quality impacts in a CO2 leakage scenario: Results from field, laboratory, and modeling studies at a natural analog site in New Mexico, USA

AbstractA vital aspect to public and regulatory acceptance of carbon sequestration is assurance that groundwater resources will be protected. Theoretical and laboratory studies can, to some extent, be used to predict the consequences of leakage. However, direct observations of CO2 flowing through shallow drinking water aquifers are invaluable for informing credible risk assessments. To this end, we have sampled shallow wells in a natural analog site in New Mexico, USA, where CO2 from natural sources is upwelling from depth. We collected major ion, trace element, and isotopic (3H, 18O, and Sr) data and, coupled with laboratory experiments and reactive transport modeling, have concluded that the major control on groundwater quality at this site is not chemical reaction of CO2 with the aquifer but intrusion of saline waters upwelling with the CO2.Using reactive transport modeling based on field data, we show the difference in reactivity of the CO2 and CO2/saline water source terms, particularly with respect to carbonate mineralogy. Sr isotopes were used to investigate whether aquifer waters were affected by carbonate mineral reaction with CO2 or by saline water intrusion. Preliminary data suggest that Sr isotopes can successfully be used to discriminate between the two types of source terms at Chimayó; this technique shows promise for monitoring CCS sites.In developing predictive capabilities for future sites, it is critical to identify the solid phases and specific reactions controlling dissolved trace metal concentrations in both the presence and absence of CO2. We have conducted laboratory experiments to identify these phases and have found that some elements (e.g., U, Ca) are largely controlled by ion exchange and/or carbonate minerals. In the experiments, the concentration of some metals increases after exposure to CO2 (although concentrations remain below the U.S. EPA primary drinking water standards); we are currently extending these experiments to determine if the reactions causing the increase are reversible and, if so, on what time scales. Metal scavenging by secondary mineral precipitation, as observed at other natural analog sites, may be important at certain temporal scales.We are using the information gained from this field and laboratory study to develop predictive models for application to risk assessment at future CCS sites. The models will be particularly useful in identifying the temporal and spatial scales of water quality changes and in developing possible mitigation strategies in the case of leaks at engineered CCS sites