Idaho: Round 1 - State-Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.Idaho is by some accounts one of the most conservative states in the country, yet it is the only state led by a Republican governor and a Republican legislature that chose to create a health insurance exchange as part of the Affordable Care Act's (ACA) implementation. The state has decided not to expand Medicaid for the time being, though they may revisit this decision in the future

Michigan: Baseline Report - State Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.Michigan has taken a mixed approach to implementing the Patient Protection and Affordable Care Act (ACA). It very nearly became the first state led entirely by Republicans to create a health insurance exchange as part of the ACA. Instead, Michigan was one of the more than thirty states to default to a federally run exchange. The state decided to adopt the Medicaid expansion, but with a delayed start date of April 2014

Developing a survey instrument to evaluate tertiary chemistry students' attitudes and learning experiences

New Zealand tertiary institutions, like others worldwide, have experienced a decline in science and chemistry enrolments in recent times as students seek other career paths that they perceive to be more lucrative. In a previous article we described a qualitative study of the learning experiences of students enrolled in a first year chemistry course at a New Zealand tertiary institution. Researchers in education and science education have two choices of methodology, a qualitative or a quantitative approach, and each possesses advantages and disadvantages. Qualitative studies typically use resource intensive data gathering techniques such as interviews. These studies are useful in that they allow researchers to study issues of interest in great depth and, for example, allow investigators to probe for underlying reasons about students' views for abstract scientific concepts. However, because qualitative studies are more labour intensive, they typically involve only small numbers of participants, which in the minds of many researchers and teachers results in a lack of generalisability. In other words, it is not necessarily clear what implications the findings hold in other contexts. In contrast, quantitative studies involve larger numbers of participants. By the judicious use of statistical analysis, researchers can investigate changes and trends, and extrapolate their findings to a large (or target) population. However, whilst the results from quantitative studies are more generalisable, they are often less detailed. Hence researchers are confronted with a trade-off situation in which they must choose between the depth of understanding provided from qualitative studies, versus the generalisability of a quantitative approach: because of this dilemma, increasingly researchers employ a mixed methodology approach. In this paper we describe a quantitative study that complements previous qualitative work. We report on the development of a questionnaire that investigates tertiary level learning experiences of chemistry students, along with their attitude toward chemistry and chemistry self-efficacy

Computational modelling of combined storm surge and wave overtopping of embankments

The primary function of seawalls and embankments is to protect against damage and injury caused by flooding. Coastal flooding is caused by combinations of high tides, waves, wind set-up and storm surges driven by low-pressure systems. However with global warming causing sea levels to rise and with increased storminess causing more extreme waves and storm surges, the likelihood of overtopping of seawalls with zero or negative freeboard may well be expected to increase. Researchers using physical and numerical models to develop design formulae have widely investigated wave overtopping of seawalls with positive freeboard. However the design of seawalls with zero or negative freeboard has attracted much less attention, and some variation exists between overtopping discharge calculated with current design formulae. The focus of this thesis is the extreme situation when overtopping caused by storm waves is combined with surge levels above the embankment crest. The local highly accelerative flow over the embankment crest caused by the high surge level will significantly alter the flow at the crest. This is likely to have a highly non-linear effect upon the overtopping waves. In this thesis, the flow is investigated with a 2DV numerical model based on the Reynolds averaged Navier-Stokes (RANS) equations developed by Lin and Liu (1998a). The model describes the flow characteristics of a breaking wave such as the velocities within the wave as well as the turbulence at the seabed boundary layer. As an example of the model’s ability to describe complex hydrodynamic flows, this study investigates its ability to represent the second order mass transport under progressive and standing waves. The model results are compared with available theory and experimental results. This shows that mass transport is successfully predicted, although there is some variation in the magnitude compared to the experimental and theoretical results. To consider the model’s ability to simulate storm surge wave overtopping of embankments, the RANS model has been used to simulate an experimental study conducted by Hughes and Nadal (2009). To examine the success of the model at reproducing the wave generation, transformation and overtopping processes the model results have been compared with the experimental laboratory data. This makes possible a wave-by-wave comparison of overtopping parameters such as discharge, depth and velocity for a storm surge event. Additionally the overtopping discharge predicted by the model is compared with design formulae and the differences in the overtopping discharge calculated with current design formulae are investigated and explained. Finally, the RANS model is used to determine the effect of embankment crest width on the magnitude of the overtopping discharge. Results from RANS model tests are used to provide design guidance in the form of an equation that allows the effect of crest width to be included when evaluating combined discharge at embankments.Britannia Royal Naval Colleg

An assessment of supervisory well-being in a statewide guardian ad litem program

Guardian ad Litem programs recruit, train, and supervise volunteers who are court-appointed to represent and advocate for the best interests of children in family court proceedings involving allegations of abuse or neglect. This manuscript presents the results of an assessment of supervisory well-being. We assessed 81 supervisors on four measures of well-being and presented a staff development workshop to discuss the findings. The assessment found that Guardian ad Litem supervisors had less social support, lower self-esteem, stronger caregiving identities, and more distress than a comparison group of social workers. We discuss the salience of leadership and supervisory support in promoting employee well-being

No Good Options: Picking Up the Pieces After King v. Burwell

If the Supreme Court rules against the government in King v. Burwell, insurance subsidies available under the Affordable Care Act (ACA) will evaporate in the thirty-four states that have refused to establish their own health-care exchanges. The pain could be felt within weeks. Without subsidies, an estimated eight or nine million people stand to lose their health coverage. Because sicker people will retain coverage at a much higher rate than healthier people, insurance premiums in the individual market will surge by as much as fifty percent. Policymakers will come under intense pressure to mitigate the fallout from a government loss in King. But the Republican-controlled Congress has already ruled out a surgical fix, and recent reporting suggests that Congress will be hard-pressed to develop an alternative reform proposal that could meet with the White House’s approval. Even a temporary extension will meet with fierce resistance from legislators who will see an extension as a tacit concession that the subsidies, in some form, are here to stay. All eyes will turn to the Obama administration and to the states. Yet public debate about their post-King options has been limited. Part of the reason is strategic: the government’s supporters fear that discussing fixes might signal to the Supreme Court that eliminating the subsidies would not do much damage. The Obama administration, for example, has declined to tell Congress whether it even has a contingency plan. And while the ACA’s opponents suggest that the King aftermath might not be so bad, they have generally declined to endorse specific fallback plans. In this Essay, we take a hard look at some potential options available both to the administration and to the states to mitigate the fallout of a government defeat in King. Some are straightforward and noncontroversial; others will face intense political resistance and press up against legal boundaries. Taken together, we believe these options might enable policymakers to moderate, at least somewhat, the consequences of a government loss in King

Feasibility of Manual Teach-and-Replay and Continuous Impedance Shaping for Robotic Locomotor Training Following Spinal Cord Injury

Robotic gait training is an emerging technique for retraining walking ability following spinal cord injury (SCI). A key challenge in this training is determining an appropriate stepping trajectory and level of assistance for each patient, since patients have a wide range of sizes and impairment levels. Here, we demonstrate how a lightweight yet powerful robot can record subject-specific, trainer-induced leg trajectories during manually assisted stepping, then immediately replay those trajectories. Replay of the subject-specific trajectories reduced the effort required by the trainer during manual assistance, yet still generated similar patterns of muscle activation for six subjects with a chronic SCI. We also demonstrate how the impedance of the robot can be adjusted on a step-by-step basis with an error-based, learning law. This impedance-shaping algorithm adapted the robot's impedance so that the robot assisted only in the regions of the step trajectory where the subject consistently exhibited errors. The result was that the subjects stepped with greater variability, while still maintaining a physiologic gait pattern. These results are further steps toward tailoring robotic gait training to the needs of individual patients

Population Pharmacokinetic and Pharmacodynamic Analysis of Buprenorphine for the Treatment of Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a condition affecting newborns exposed to an opioid in utero. Symptoms of NAS include excessive crying, poor feeding, and disordered autonomic control. Up to 2/3 of infants will require pharmacologic therapies to reach symptom control. Opioids including morphine and methadone are the current first-line treatments. Buprenorphine is being investigated as a treatment of NAS. The purpose of this analysis was to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) of BUP in infants with NAS. Poster presented at American Society for Clinical Pharmacology and Therapeutics (ASCPT) 2017 Annual Meeting, March 15-18, 2017 in Washington DC.https://jdc.jefferson.edu/petposters/1004/thumbnail.jp