Seven Steps Toward State Success in Covering Children Continuously

Summarizes recommendations from symposium discussions on state efforts to increase health coverage for children, including simplifying procedures, emphasizing community-based outreach, changing agency culture, and partnering with local organizations

Supporting State Policymakers' Implementation of Federal Health Reform

Outlines the capacities states will need to implement federal healthcare reform in the areas of information and analysis, strategic implementation and planning, topic-specific technical assistance, communications, and coordination and integration

States' Roles in Shaping High Performance Health Systems

Analyzes results from the State Health Policies Aimed at Promoting Excellent Systems survey and a review of current research on efforts to improve state healthcare systems, with a focus on coverage; quality, safety, and value; and infrastructure

A State Policymakers' Guide to Federal Health Reform: Part I: Anticipating How Federal Health Reform Will Affect State Roles

Examines how federal healthcare reform will affect states' tools and roles in connecting people to services, promoting coordination and integration, improving care for those with complex needs, being results-oriented, and increasing efficiencies

State Health Policies Aimed at Promoting Excellent Systems: A Report on States’ Roles in Health Systems Performance

States shape the health system in many ways: as purchasers, regulators, and conveners. Despite these various roles, there is little systematic effort to monitor state choices, learn from the choices states make, and purposefully spread one state’s innovations to other states. Coordination between states and the federal government on approaches to improving the health care system is often lacking, limiting our nation’s ability to address critical problems. In an effort to improve health system performance and increase the spread of innovation, the National Academy for State Health Policy (NASHP), with support from the Commonwealth Fund, prepared this report on a broad array of state health policies and practices. This report describes a tremendous amount of activity at the state level and which has implications for how well the health care system performs

Addressing obstacles to the inclusion of palliative care in humanitarian health projects: a qualitative study of humanitarian health professionals’ and policy makers’ perceptions

© 2020, The Author(s). Background: Humanitarian non-governmental organizations provide assistance to communities affected by war, disaster and epidemic. A primary focus of healthcare provision by these organizations is saving lives; however, curative care will not be sufficient, appropriate, or available for some patients. In these instances, palliative care approaches to ease suffering and promote dignity are needed. Though several recent initiatives have increased the probability of palliative care being included in humanitarian healthcare response, palliative care remains minimally integrated in humanitarian health projects. Methods: We conducted a qualitative study using interpretive description methodology to investigate humanitarian policy-makers’ and health care professionals’ experiences and perceptions of palliative care during humanitarian crises. In this article, we report on the analysis of in-depth interviews with 24 participants related to their perceptions of obstacles to providing palliative care in humanitarian crises, and opportunities for overcoming these obstacles. Among the participants, 23 had experience as humanitarian health professionals, and 12 had experience with policy development and organizational decision-making. Results: Participants discussed various obstacles to the provision of palliative care in humanitarian crises. More prominent obstacles were linked to the life-saving ethos of humanitarian organizations, priority setting of scarce resources, institutional and donor funding, availability of guidance and expertise in palliative care, access to medication, and cultural specificity around death and dying. Less prominent obstacles related to continuity of care after project closure, equity, security concerns, and terminology. Conclusion: Opportunities exist for overcoming the obstacles to providing palliative care in humanitarian crises. Doing so is necessary to ensure that humanitarian healthcare can fulfill its objectives not only of saving lives, but also of alleviating suffering and promoting dignity of individuals who are ill or injured during a humanitarian crises, including persons who are dying or likely to die

Regional brain response to visual food cues is a marker of satiety that predicts food choice

ABSTRACT Background: Neuronal processes that underlie the subjective experience of satiety after a meal are not well defined. Objective: We investigated how satiety alters the perception of and neural response to visual food cues. Design: Normal-weight participants (10 men, 13 women) underwent 2 fMRI scans while viewing images of high-calorie food that was previously rated as incompatible with weight loss and "fattening" and low-calorie, "nonfattening" food. After a fasting fMRI scan, participants ate a standardized breakfast and underwent reimaging at a randomly assigned time 15-300 min after breakfast to vary the degree of satiety. Measures of subjective appetite, food appeal, and ad libitum food intake (measured after the second fMRI scan) were correlated with activation by "fattening" (compared with "nonfattening") food cues in a priori regions of interest. Results: Greater hunger correlated with higher appeal ratings of "fattening" (r = 0.46, P = 0.03) but not "nonfattening" (r = 20.20, P = 0.37) foods. Fasting amygdalar activation was negatively associated with fullness (left: r = 20.52; right: r = 20.58; both P # 0.01), whereas postbreakfast fullness was positively correlated with activation in the dorsal striatum (right: r = 0.44; left: r = 0.45; both P , 0.05). After breakfast, participants with greater activation in 4 regions-medial orbital frontal cortex (r = 0.49, P , 0.05), left amygdala (r = 0.49, P , 0.05), left insula (r = 0.47, P , 0.05), and nucleus accumbens (right: r = 0.57, P , 0.01; left: r = 0.43, P , 0.05)-chose buffet foods with higher fat content. Conclusions: Postmeal satiety is shown in regional brain activation by images of high-calorie foods. Regions including the amygdala, nucleus accumbens, and dorsal striatum may alter perception of, and reduce motivation to consume, energy-rich foods, ultimately driving food choice. This trial was registered at clinicaltrials.gov as NCT01631045. Am J Clin Nutr 2012;96:989-99

A case analysis of partnered research on palliative care for refugees in Jordan and Rwanda

© 2021, The Author(s). Background: This case analysis describes dilemmas and challenges of ethical partnering encountered in the process of conducting a research study that explored moral and practical dimensions of palliative care in humanitarian crisis settings. Two contexts are the focus of this case analysis: Jordan, an acute conflict-induced refugee situation, and Rwanda, a protracted conflict-induced refugee setting. The study’s main goal was to better understand ways humanitarian organizations and health care providers might best support ethically and contextually appropriate palliative care in humanitarian contexts. An unintended outcome of the research was learning lessons about ethical dimensions of transnational research partnerships, which is the focus of this case analysis. Discussion: There exist ongoing challenges for international collaborative research in humanitarian conflict-induced settings. Research partnerships were crucial for connecting with key stakeholders associated with the full study (e.g., refugees with life limiting illness, local healthcare providers, aid organization representatives). While important relationships were established, obstacles limited our abilities to fully attain the type of mutual partnership we aimed for. Unique challenges faced during the research included: (a) building, nurturing and sustaining respectful and equitable research partnerships between collaborators in contexts of cultural difference and global inequality; (b) appropriate ethics review and challenges of responding to local decision-maker’s research needs; and (c) equity and fairness towards vulnerable populations. Research strategies were adapted and applied to respond to these challenges with a specific focus on (d) research rewards and restitution. Conclusions: This case analysis sheds light on the importance of understanding cultural norms in all research roles, building relationships with decision makers, and developing teams that include researchers from within humanitarian crisis settings to ensure that mutually beneficial research outcomes are ethical as well as culturally and contextually relevant

Computational modelling of salamander retinal ganglion cells using machine learning approaches

Artificial vision using computational models that can mimic biological vision is an area of ongoing research. One of the main themes within this research is the study of the retina and in particular, retinal ganglion cells which are responsible for encoding the visual stimuli. A common approach to modelling the internal processes of retinal ganglion cells is the use of a linear - non-linear cascade model, which models the cell's response using a linear filter followed by a static non-linearity. However, the resulting model is generally restrictive as it is often a poor estimator of the neuron's response. In this paper we present an alternative to the linear - non-linear model by modelling retinal ganglion cells using a number of machine learning techniques which have a proven track record for learning complex non-linearities in many different domains. A comparison of the model predicted spike rate shows that the machine learning models perform better than the standard linear - non-linear approach in the case of temporal white noise stimuli