Connecting the Dots: A Healthy Community Leader's Guide to Understanding the Nonprofit Hospital Community Benefit Requirements

Imagine a healthy community as a connect-the-dots landscape painting. Each "dot" has its place and purpose: affordable housing, a vibrant economy, safe streets and public transportation, a high quality public education system, easy access to fresh food and safe recreation, and a healthcare system that provides both preventative and responsive services.The revised nonprofit hospital community benefit requirements in the federal Affordable Care Act (ACA) are an opportunity for us to help connect the dots, which are often referred to as "determinants of health." They are an impetus for healthy community design leaders and nonprofit hospitals to form partnerships that define, design and implement plans for healthy communities. "Connecting the Dots: A Healthy Community Leader's Guide to Understanding Nonprofit Hospital Community Benefit Requirements" is a brand new Policy Primer from St. Luke's Health Initiatives that's been developed to increase understanding and create opportunities to connect Community Development with Community Benefit. It provides a guide for how Community Development leaders can begin to connect with nonprofit hospitals, building on a brief tracing of community benefit history and examination of current Community Health Needs Assessment work and hospital funding priorities

The Tax Advantage of Big Business: How the Structure of Corporate Taxation Fuels Concentration and Inequality

Corporate concentration in the United States has been on the rise in recent years, sparking a heated debate about its causes, consequences, and potential remedies. In this study, we examine a facet of public policy that has been largely neglected in current debates about concentration: corporate taxation. As part of our analysis we develop the first empirical mapping of the effective tax rates (ETRs) of nonfinancial corporations disaggregated by size and broken down by jurisdiction. Our findings reveal a striking and persistent tax advantage for big business. Since the mid-1980s, large corporations have faced lower worldwide ETRs relative to their smaller counterparts. The regressive worldwide ETR is driven by persistent regressivity in the domestic ETR and a marked drop in the progressivity of the foreign ETR over the past decade. We go on to show how persistent regressivity in the worldwide tax structure is bound up with the increasing relative power of large corporations within the corporate universe, as well as a shift in firm-level power relations. As large corporations become less disposed to investments that may indirectly benefit ordinary workers, they become more disposed to shareholder value enhancement that directly benefits the asset-rich. What this means is that the corporate tax structure is connected not only to rising corporate concentration, but also to widening household inequality

Dropped? Latino Education and Arizona's Economic Future

Describes persistent barriers to educational opportunities and the achievement gap Latinos face; implications for incomes, health insurance coverage, and the economy; and strategies for improving the educational system and Latino educational attainment

A critical assessment of viscous models of trench topography and corner flow

Stresses for Newtonian viscous flow in a simple geometry (e.g., corner flow, bending flow) are obtained in order to study the effect of imposed velocity boundary conditions. Stress for a delta function velocity boundary condition decays as 1/R(2); for a step function velocity, stress goes as 1/R; for a discontinuity in curvature, the stress singularity is logarithmic. For corner flow, which has a discontinuity of velocity at a certain point, the corresponding stress has a 1/R singularity. However, for a more realistic circular-slab model, the stress singularity becomes logarithmic. Thus the stress distribution is very sensitive to the boundary conditions, and in evaluating the applicability of viscous models of trench topography it is essential to use realistic geometries. Topography and seismicity data from northern Hoshu, Japan, were used to construct a finite element model, with flow assumed tangent to the top of the grid, for both Newtonian and non-Newtonian flow (power law 3 rheology). Normal stresses at the top of the grid are compared to the observed trench topography and gravity anomalies. There is poor agreement. Purely viscous models of subducting slables with specified velocity boundary conditions do not predict normal stress patterns compatible with observed topography and gravity. Elasticity and plasticity appear to be important for the subduction process

An Interview with Colonel Lawrence Machabee, USMC: A Retrospective View of Humanitarian Demining at the Department of State

Despite the growing attention that humanitarian demining receives now worldwide, in 1994, when Col. Lawrence Machabee began his three-year stint as a Department of Defense (DoD)/Department of State Exchange Officer within the Department of State, humanitarian demining was on no one\u27s radar screen, at least politically in the U.S. In FY 93, the U.S. government started demining programs in six countries and had allocated a total of $9 million to its demining efforts around the world. All this changed in January 1994 with the Department of State publication Hidden Killers. Col. Machabee was a central figure in the development of that document, which was, in effect, a follow-on report to one solicited from the Department of State by the U.S. Congress the year before. Hidden Killers served as an authoritative document that people could reference in terms of demining problems worldwide and sparked national and international interest in scope of the demining problem. In 1997 the U.S. government is involved in demining programs in 15 countries and is allocating more than$44 million to those projects

CASE REPORT: Liver Failure in a 4-month-old male with SMA type 2 after gene therapy/Onasemnogene abeparvovec (Zolgensma)

Introduction: Spinal muscular atrophy (SMA) is characterized by muscle weakness and atrophy resulting from progressive degeneration of the anterior horn cells in the spinal cord and the brain stem nuclei. The onset of weakness ranges from before birth to adulthood. The weakness is symmetric, proximal \u3e distal, and progressive. Onasemnogene abeparvovec (ZOLGENSMA) is a viral vector-based gene therapy designed to deliver a functional copy of the human survival motor neuron (SMN) gene to the motor neuron cells of patients with spinal muscular atrophy (SMA). It was approved in May 2019 in the USA for the treatment of pediatric patients aged \u3c 2 years with SMA and bi-allelic mutations in the SMN1 gene. There has been significant motor function gain from the patients in and out of the clinical trials However, it can cause an immune response that could lead to an increase in enzymes produced by the liver. In one paper that studies over 100 SMA patients treated with Onasemnogene abeparvovec, 34% had a least one adverse event within the hepatotoxicity category. All adverse events associated with increased serum aminotransferases concentrations resolved completely with the majority receiving prednisolone from 60–120 days. Our case study discusses another SMA type 2 male, treated with Onasemnogene abeparvovec IV infusion therapy that presented 23 days later with liver failure. Objective: The purpose is to present an adverse reaction to the gene therapy/ZOLGENSMA given to a SMA 2 patient, there is not a lot of literature out there on adverse events to this drug that was recently approved in 2019 here is the case presentation: 4 month, 21 day old male with a past medical history of Spinal Muscular Atrophy (SMA) type two was administer an IV infusion of the gene therapy, Zolgensma. His diagnosis was achieved before he was symptomatic because of his older sisters diagnosis of SMA type II. After reviewing the diagnosis with mom and the benefits and risks to all of the three treatments that are approved by the FDA for SMA type 2 (onasemnogene, nusinersen, and risdiplam), the mother chose gene therapy, Zolgensma (onasemnogene). The patient was referred to occupational, physical, and speech therapy. He was also referred to a local pediatric cardiologist and a pediatric pulmonologist for disease related restrictive lung disease. Per the pulmonologist’s recommendations, he was doing cough assist about 3-5 times per day and was also started on Synagis intramuscular for RSV prevention because of his neuromuscular disease process and inability to clear secretions. Antibodies to the adeno-associated viral vector were measured in his serum before the treatment, his titer showed 1:25 which cleared him for treatment, anti-AAV9 antibody titer of Twenty two days after the infusion and following the prednisone taper, his labs showed elevated liver enzymes, troponin, and platelets.. His prednisone dose was increased to increase to 12 ml daily + Ranitidine and he was followed in the clinic a few days later. In the clinic, he is noted to have mild jaundice of the sclera and skin, and he was alert and active. As per mom, she noticed that he began having a yellow tint to the skin and of the eyes 26 days after the infusion. He had been eating well, however, she noticed that his stools are now more pale than previously. She also notes that he was sleeping more and has decreased activity levels. Stat labs were ordered to assess liver function including: ammonia, PT/PTT, INR, total/direct bilirubin, albumin, troponin, CMP, and CBC. He was found to have decreased liver function and admitted to the ICU. (PATIENT IS STILL IN THE ICU- NEED TO UPDATE LAB VALUES next week) Methods: This is a case report so I will just be explaining the history and physical findings and lab results Results: This is a case study on an adverse event to the gene therapy Zolgensma. My methods will include lab values, and the history and physical findings, MOA of the gene therapy, treatment of the liver failure that resulted from the gene therapy. (PATIENT IS STILL IN THE ICU- NEED TO UPDATE LAB VALUES next week) Discussion: Due to how rare SMA is and the novel new treatment of onasemnogene abeparvovec, a treatment protocol for the adverse reaction of liver failure has not been standardized. Conclusions: Next steps include reporting the adverse effects of this treatment, continue gathering data on treated patients, and developing a standardized treatment for patients who develop severe liver failure to onasemnogene abeparvovec gene therapy