Balancing Coordinated Care with Tribal Sovereignty: Lesson’s from Oregon’s Medicaid Reform

The purpose of this case study is to examine the efforts made by the legislature and the Oregon Health Authority (OHA) to involve Oregon’s nine federally recognized tribes in the implementation of the revised Oregon Health Plan. We identified eight key informants, consisting of four tribal representatives and four state representatives, for interviews. Additionally, we identified the contact person from each newly-established Medicaid delivery network to determine if they had included the tribe(s) or planned to include the tribe(s) in their network. The OHA made some steps to ensure the inclusion of tribes in the planning and implementation process, but were challenged with the rapid implementation timeframe. Formal linkages between the tribes and Medicaid delivery networks were not developed. The federally recognized tribes of Oregon and their respective members had legitimate concerns about the revised Oregon Health Plan and how they might affect access to health care services and provider reimbursements. As other states expand Medicaid based on changes resulting from the Patient Protection and Affordable Care Act, the needs of American Indians and Alaska Natives must be included in the planning process

Effect of Defoliation Management on Expression of the ‘High Sugar’ Cultivar Trait in Tasmania

The proposed benefits of perennial ryegrass (Lolium perenne L.) cultivars with a high concentration of water soluble carbohydrates (WSC) for the dairy industry in Australia include enhanced rumen protein metabolism, and potential improvements in milk components (Stewart et al. 2009). Perennial ryegrass cultivars have been developed to express higher levels of WSC, and extensive trials have shown consistent trait expression in Europe (reviewed by Edwards et al. 2007a). In New Zealand and Australia, there has been less consistent expression of the high sugar trait (Smith et al. 1998; Parsons et al. 2004; Francis et al. 2006), possibly reflecting a genotype by environmental interaction (Parsons et al. 2007). The current study was developed to investigate whether the high sugar trait of cultivars Aber-Magic (developed in Aberystwyth) and SF Joule AR1 (developed in Australia), is consistently expressed in cool temperate Tasmania, Australia, and to quantify the effect of contrasting defoliation management on trait expression. It is also important to confirm that any elevation in WSC concentration does not occur at the expense of dry matter (DM) yield, and to consider the relationship between WSC and crude protein (CP) concentrations - thought to be an important contributor to more efficient nitrogen (N) partitioning (Edwards et al. 2007b)

Effect of Nitrogen Fertiliser Applications on Botanical Composition

The diminishing returns associated with nitrogen (N) fertiliser use over time are well recognised, as are the detrimental effect to the environment of excess N fertiliser use (Eckard 1998). However, many Tasmanian dairy farmers apply continually high rates of N fertiliser (e.g. in excess of 500 kg/ha annually) to minimise risk associated with variable pasture dry matter (DM) yields, and this often occurs at the expense of white clover populations within the pasture (Frame 1990; Frame et al. 1998). The responses of botanical composition and perennial ryegrass DM yields to N fertiliser application rate were investigated in the current field plot study, to provide further information for farmers about the production-related effects of their N use

The Iowa Homemaker vol.6, no.2 Extra

Table of Contents An Invitation to Attend the Dedication of Home Economics Hall by Anna E. Richardson, page 1 In Our New Home at Last by Marcia E. Turner, page 2 Household Equipment by Eloise Davison, page 2 A Walk Around Campus by Vivian Jordan Brashear, page 3 Textiles and Clothing by Frances Sims, page 4 Child Care and Parent Training by Lydia Swanson, page 4 Applied Art by Joanna M. Hansen, page 5 Foods and Nutrition Department by Alma M. Riemenschneider, page 6 Institutional Management by Linda Spence Brown, page 7 Physical Education by Winifred R. Tilden, page 7 Home Economics Vocational Education by Marica E. Turner, page 8 The Department of Hygiene by Grace Magee, page 8 The Household Administration Department by Ruth M. Lindquist, page 9 Homemakers Department by Elizabeth M. Rivers, page

Incorporating prior knowledge improves detection of differences in bacterial growth rate

BACKGROUND: Robust statistical detection of differences in the bacterial growth rate can be challenging, particularly when dealing with small differences or noisy data. The Bayesian approach provides a consistent framework for inferring model parameters and comparing hypotheses. The method captures the full uncertainty of parameter values, whilst making effective use of prior knowledge about a given system to improve estimation. RESULTS: We demonstrated the application of Bayesian analysis to bacterial growth curve comparison. Following extensive testing of the method, the analysis was applied to the large dataset of bacterial responses which are freely available at the web-resource, ComBase. Detection was found to be improved by using prior knowledge from clusters of previously analysed experimental results at similar environmental conditions. A comparison was also made to a more traditional statistical testing method, the F-test, and Bayesian analysis was found to perform more conclusively and to be capable of attributing significance to more subtle differences in growth rate. CONCLUSIONS: We have demonstrated that by making use of existing experimental knowledge, it is possible to significantly improve detection of differences in bacterial growth rate

INvestigational Vertebroplasty Efficacy and Safety Trial (INVEST): a randomized controlled trial of percutaneous vertebroplasty

Background: The treatment of painful osteoporotic vertebral compression fractures has historically been limited to several weeks of bed rest, anti-inflammatory and analgesic medications, calcitonin injections, or external bracing. Percutaneous vertebroplasty (the injection of bone cement into the fractured vertebral body) is a relatively new procedure used to treat these fractures. There is increasing interest to examine the efficacy and safety of percutaneous vertebroplasty and to study the possibility of a placebo effect or whether the pain relief is from local anesthetics placed directly on the bone during the vertebroplasty procedure. Methods/Designs: Our goal is to test the hypothesis that patients with painful osteoporotic vertebral compression fractures who undergo vertebroplasty have less disability and pain at 1 month than patients who undergo a control intervention. The control intervention is placement of local anesthesia near the fracture, without placement of cement. One hundred sixty-six patients with painful osteoporotic vertebral compression fractures will be recruited over 5 years from US and foreign sites performing the vertebroplasty procedure. We will exclude patients with malignant tumor deposit (multiple myeloma), tumor mass or tumor extension into the epidural space at the level of the fracture. We will randomly assign participants to receive either vertebroplasty or the control intervention. Subjects will complete a battery of validated, standardized measures of pain, functional disability, and health related quality of life at baseline and at post-randomization time points (days 1, 2, 3, and 14, and months 1, 3, 6, and 12). Both subjects and research interviewers performing the follow-up assessments will be blinded to the randomization assignment. Subjects will have a clinic visit at months 1 and 12. Spine X-rays will be obtained at the end of the study (month 12) to determine subsequent fracture rates. Our co-primary outcomes are the modified Roland score and pain numerical rating scale at 1 month. Discussion: Although extensively utilized throughout North America for palliation of pain, vertebroplasty still has not undergone rigorous study. The study outlined above represents the first randomized, controlled study that can account for a placebo effect in the setting of vertebroplasty. Trial Registration: Current Controlled Trials ISRCTN81871888.The source of funding for the study and all authors for this publication was National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)