The Medicare Prescription Drug, Improvement, & Modernization Act of 2003: Are We Playing the Lottery With Healthcare Reform?

With millions of Americans unable to cope with the rising costs of prescription drugs, and many even forced to go without health insurance, the mounting pressure on Congress to enact major healthcare reform culminated in the Medicare Prescription Drug, Improvement, & Modernization Act of 2003. This iBrief examines this legislation, and concludes that it provides elusive benefits for seniors and merely creates a windfall for the pharmaceutical and insurance industries

When Business Gets Involved: A case study of business community involvement in Illinois' early childhood education policy

As the first state to offer universal preschool to three?year?olds, Illinois' experience with early childhood education (ECE) policy reform efforts offers valuable lessons about how such change takes shape. The confluence of factors includes well?organized advocacy groups, the endurance to continue efforts over decades, a supportive governor, and an engaged business community. The description below details Illinois' ECE activities from 1992 to the present, with a particular focus on the business role in ECE policy. Chicago Metropolis 2020 was the main business group involved in ECE efforts, but, significantly, advocates and politicians also continuously cast the issues in language that would motivate economic and business interests

Using Shock Index as a Predictor of ICU Readmission: A Quality Iimprovement Project

Background: Adverse events will occur in one-third of patients discharged from the intensivecare unit (ICU) and evidence shows that ICU readmissions increase a patient’s length of stay,mortality, hospital costs, and nosocomial infections, as well as decrease long-term survival.Specific predictive factors that will accurately predict which patients are at risk of adverseevents requiring readmission are needed.Aim: The specific aim of this project was to identify if shock index (SI) values higher than 0.7at the time of transfer from the ICU are a useful predictor of ICU readmission.Methods: Using the Plan, Do, Study, Act (PDSA) framework, a retrospective chart review wasperformed using a matched cohort of 34 patients readmitted with 72 hours of discharge from theICU and 34 controls to obtain SI values at admission, transfer from and readmission to the ICU.A second PDSA cycle looked for SI trends within 24 hours prior to discharge from the ICU.Results: An odds ratio calculating the risk of readmission of patients with an elevated SI was2.96 (Confidence Interval (CI) 1.1 to 7.94, p-value=0.03). The odds ratio for an 80% SIelevation over 24 hours prior to discharge was 1.56 (CI 0.36 to 6.76, p-value=0.55).Conclusion and Implications for CNL Practice: Patients with elevated SIs at the time oftransfer are three times more likely to be readmitted to the ICU. Patients with elevations in atleast 80% of the 24 hour pre-discharge SIs showed no significant differences between thecontrol and readmitted cohorts. Implications of these results for the clinical nurse leader will bediscussed

Giving voice to jazz singers’ experiences of flow in improvisation

Jazz instrumentalists’ experiences of improvisation have informed psychological research on a range of topics including flow in improvisation, yet there is scant evidence of jazz singers’ improvising experiences. Using Interpretative Phenomenological Analysis (IPA), this study investigated the experiences of three professional Australian jazz singers who improvise extensively in their performance practice: How do these singers experience improvisation? IPA of semi-structured interviews with the singers resulted in two superordinate themes which both related to the flow state: 1) singers experienced flow when improvisation “went well”; 2) singers experienced flow as meaningful—flow provided singers with both the freedom to express the self and the opportunity to contribute to something beyond the self. These findings reveal a new context for flow experiences. Implications for vocal jazz education and practice are discussed

Institutional Independence: Lawyers and the Administrative State

The institutional structure where federal government lawyers practice is fraught with political and economic pressures that undermine the ability of lawyers to exercise independent professional judgment. A lack of candid legal advice in this space not only removes a pivotal fail-safe between legal and illegal state action but also precariously imbalances the powerful administrative state, exposing it to undue political influence. For these reasons, this Article argues that structural changes to administrative institutions must be made to support and nurture lawyers’ ability to independently determine the bounds of legality. Previous scholarship has examined the role of professional independence for lawyers generally; however, the legal academy has yet to explore the centrality of professional independence to administrative law or the structural pressures influencing its exercise. This Article joins a body of work that adopts a new institutionalist approach to professional misconduct. In doing so, this Article makes three principal contributions: (1) it outlines why institutionally sustained professional independence is essential to the federal administrative state; (2) it identifies institutional failings that impede government lawyers’ exercise of professional independent judgment; and (3) it proposes institution-based solutions to facilitate professionally independent conduct by government lawyers. By insulating government lawyers from excessive interference on core professional judgment calls, civil society may rely on these lawyers to help protect the basic structure of the rule of law

Loving’s Legacy: Decriminalization and the Regulation of Sex and Sexuality

2017 marked the fiftieth anniversary of Loving v. Virginia, the landmark Supreme Court decision that invalidated bans on miscegenation and interracial marriages. In the years since Loving was decided, it remains a subject of intense scholarly debate and attention. The conventional wisdom suggests that the Court’s decision in Loving was hugely transformative— decriminalizing interracial marriages and relationships and removing the most pernicious legal barriers to such couplings. But other developments suggest otherwise. If we shift our lens from marriages to other areas of the law—child custody cases, for example—Loving’s legacy seems less rosy. In the years preceding and following Loving, white women routinely lost custody of their white children when they remarried or began dating black men. That this should happen in the years before Loving is perhaps unsurprising. But one might expect a shift after Loving, when interracial marriages and dating were decriminalized and made lawful. This was not the case. Even after Loving, white women routinely lost custody when they remarried or dated black men. These underexplored child-custody cases illuminate an important aspect of Loving—and indeed, any civil rights effort that is predicated on decriminalization. Despite the turn toward decriminalization and subsequent legalization, the impulse to punish and stigmatize certain conduct does not dissipate entirely. Instead, it may simply be rerouted into other legal avenues where disapprobation of the challenged conduct may continue to be expressed and felt. Recognizing and understanding this “regulatory displacement” phenomenon is critical as we assess the progress of other decriminalization efforts, including the recent struggle to legalize same-sex marriages

Between the Lines: Writing Center Classes in Pedagogical Perspective

The CFP for this spring 2007 issue of Praxis invites us to consider the writing center and the classroom as separate entities with complementary, but ultimately distinct, practices, methods, and goals. This perspective is by no means new. When the first writing labs emerged in the 1940s, they imagined themselves as a counterpoint to the traditional classroom; indeed, many initial explorations of what writing centers could become began with an assertion of what they were not.[1] From those earliest years until now, however, a third entity has existed alongside these seemingly dichotomous forms. The writing center class (or “workshop,” as it’s sometimes called) does represent an alternative to the traditional classroom.[2] It typically meets a handful of times at most; students earn neither credits nor grades for attending, and they sign up voluntarily. At the same time, the material and pedagogical conditions of the writing center class–a group of students, an “expert” instructor, handouts, desks, a chalkboard–can appear quite conventional. In short, by combining elements of the traditional classroom and the writing center, the writing center class is a hybrid form. Those who want to offer this kind of instruction–and there are many reasons to do so–must carefully negotiate that hybridity if they want to succeed.University Writing Cente