Medicaid Policies for Alcohol SBI Reimbursement

The purpose of this report was to review existing reimbursement policies by state Medicaid agency, including the District of Columbia (D.C.), in order to understand similarities and differences associated with financial compensation for alcohol screening and brief intervention (SBI) services. Alcohol SBI is an evidence-based practice known to help reduce atrisk alcohol consumption among patients who drink too much. 1 Although alcohol SBI was designed to be a population-based approach to address unhealthy alcohol consumption, its current utilization is limited. 2 Implementation of the practice into routine clinical care remains a challenge at the health system level even with support from federal resources (e.g., SBIRT: Screening, Brief Intervention, and Referral to Treatment). One way to encourage the uptake of alcohol SBI/SBIRT among providers is to ensure that the service is reimbursable by third-party payers. However, reimbursement opportunities vary by state and payer, and in some locations are non-existent. Information about the current status of policies will assist in the development of policies and incentives to encourage healthcare providers and systems to submit claims for alcohol SBI/SBIRT and potentially increase the routine uptake of the service in clinical careCenters for Disease Control and Prevention Cooperative Agreement Number DD00114

Design and analysis for a decision making matrix for sustainability at the local level

A matrix for achieving the goal of sustainability at the local level through the decision making process of project development is developed in this study. Presently, many decisions as to the desirability of development are based on economic impact to the local area.Using the matrix could change this by using sustainability as the standard. The model used was designed by European planners for planning at any level. A baseline of sustainability for the local area is first determined, then the development project is assessed using the matrix to determine the impact on a given condition. The matrix is constructed using local trends and principles (or goals) of sustainability. Trend Impact Analysis is used to quantify the data. It was found that the matrix does generate information that could be useful in the decision making process and that the information may be used to further the goals of sustainability at the local level. It was discovered that the relationship among the trends and between the trends and objectives is an important part of the analysis that requires detailed attention. The model chosen serves as a proxy standard for sustainability, with the goals designed to be comprehensive. However, the objectives chosen to achieve sustainabilitycannot be standardized and will need to be determined by the local community

Academic attainment and special educational needs in extremely preterm children at 11 years of age : the EPICure Study

Aim: To assess academic attainment and special educational needs (SEN) in extremely preterm (EP) children in middle childhood. Methods: Of 307 EP (=25 weeks) survivors born in the UK and Ireland in 1995, 219 (71%) were re-assessed at 11 years, with a comparison group of 153 classmates born at term, using standardised tests of cognitive ability and academic attainment and teacher reports of school performance and special educational needs (SEN). Multiple imputation was used to correct for selective dropout. Results: EP children had significantly lower scores than classmates for cognitive ability (-20 points; 95%CI: -23,-17), reading (-18 points; -22,-15) and mathematics (-27 points; -31,-23). Twenty-nine (13%) EP children attended special school. In mainstream schools, 105 (57%) EP children had SEN (OR: 10; 6, 18) and 103 (55%) required SEN resource provision (OR: 10; 5, 18). Teachers rated 50% of EP children with attainment below the average range compared with 5% of classmates (OR: 18; CI: 8, 41). EP children who are entered for mainstream education an academic year early due to preterm birth had similar academic attainment but required more SEN support (OR: 2; 1.1,3.8). Conclusions: EP survivors remain at high risk for learning impairments and poor academic attainment in middle childhood. A significant proportion require full-time specialist education and over half of those attending mainstream schools require additional health or educational resources in order to access the national curriculum. The prevalence and impact of SEN is likely to increase as these children approach the transition to secondary school. -------------------------------------------------------------------------------

Examination of Regional Transit Service Under Contracting: A Case Study in the Greater New Orleans Region, Research Report 10-09

Many local governments and transit agencies in the United States face financial difficulties in providing adequate public transit service in individual systems, and in providing sufficient regional coordination to accommodate transit trips involving at least one transfer between systems. These difficulties can be attributed to the recent economic downturn, continuing withdrawal of the state and federal funds that help support local transit service, a decline in local funding for transit service in inner cities due to ongoing suburbanization, and a distribution of resources that responds to geographic equity without addressing service needs. This study examines two main research questions: (1) the effect of a “delegated management” contract on efficiency and effectiveness within a single transit system, and (2) the effects of a single private firm—contracted separately by more than one agency in the same region—on regional coordination, exploring the case in Greater New Orleans. The current situation in New Orleans exhibits two unique transit service conditions. First, New Orleans Regional Transit Authority (RTA) executed a “delegated management” contract with a multinational private firm, outsourcing more functions (e.g., management, planning, funding) to the contractor than has been typical in the U.S. Second, as the same contractor has also been contracted by another transit agency in an adjacent jurisdiction—Jefferson Transit (JeT), this firm may potentially have economic incentives to improve regional coordination, in order to increase the productivity and effectiveness of its own transit service provision. Although the limited amount of available operation and financial data has prevented us from drawing more definitive conclusions, the findings of this multifaceted study should provide valuable information on a transit service contracting approach new to the U.S.: delegated management. This study also identified a coherent set of indices with which to evaluate the regional coordination of transit service, the present status of coordination among U.S. transit agencies, and barriers that need to be resolved for regional transit coordination to be successful

Playing in the sandbox: state building in the space of non-recognition

For unrecognised states in the international system recognition of sovereign statehood is the ultimate goal. Not being ‘a state’ means being excluded from global networks. However, even in the most basic definitions and criteria for unrecognised states there is a period of relative autonomy accorded due to non-recognition. This is a period when political actors can use isolation to establish the state’s narrative, identity and structure. It is this period that provides the foundations for external interaction. It is in this period that the state is born. This article examines another side to the politics of recognition: the politics of non-recognition. Drawing on the contemporary examples of Somaliland and Kurdistan, the article assesses the benefits as well as the costs of non-recognition

Growth rates for subclasses of Av(321)

Pattern classes which avoid 321 and other patterns are shown to have the same growth rates as similar (but strictly larger) classes obtained by adding articulation points to any or all of the other patterns. The method of proof is to show that the elements of the latter classes can be represented as bounded merges of elements of the original class, and that the bounded merge construction does not change growth rates

A Hierarchical Method Based on Active Shape Models and Directed Hough Transform for Segmentation of Noisy Biomedical Images; Application in Segmentation of Pelvic X-ray Images

Background Traumatic pelvic injuries are often associated with severe, life-threatening hemorrhage, and immediate medical treatment is therefore vital. However, patient prognosis depends heavily on the type, location and severity of the bone fracture, and the complexity of the pelvic structure presents diagnostic challenges. Automated fracture detection from initial patient X-ray images can assist physicians in rapid diagnosis and treatment, and a first and crucial step of such a method is to segment key bone structures within the pelvis; these structures can then be analyzed for specific fracture characteristics. Active Shape Model has been applied for this task in other bone structures but requires manual initialization by the user. This paper describes a algorithm for automatic initialization and segmentation of key pelvic structures - the iliac crests, pelvic ring, left and right pubis and femurs - using a hierarchical approach that combines directed Hough transform and Active Shape Models. Results Performance of the automated algorithm is compared with results obtained via manual initialization. An error measures is calculated based on the shapes detected with each method and the gold standard shapes. ANOVA results on these error measures show that the automated algorithm performs at least as well as the manual method. Visual inspection by two radiologists and one trauma surgeon also indicates generally accurate performance. Conclusion The hierarchical algorithm described in this paper automatically detects and segments key structures from pelvic X-rays. Unlike various other x-ray segmentation methods, it does not require manual initialization or input. Moreover, it handles the inconsistencies between x-ray images in a clinical environment and performs successfully in the presence of fracture. This method and the segmentation results provide a valuable base for future work in fracture detection

Elucidating novel dysfunctional pathways in Alzheimer's disease by integrating loci identified in genetic and epigenetic studies

AbstractAlzheimer's disease is a complex neurodegenerative disorder. A large number of genome-wide association studies have been performed, which have been supplemented more recently by the first epigenome-wide association studies, leading to the identification of a number of novel loci altered in disease. Twin studies have shown monozygotic twin discordance for Alzheimer's disease (Gatz et al., 2006), leading to the conclusion that a combination of genetic and epigenetic mechanisms is likely to be involved in disease etiology (Lunnon & Mill, 2013). This review focuses on identifying overlapping pathways between published genome-wide association studies and epigenome-wide association studies, highlighting dysfunctional synaptic, lipid metabolism, plasma membrane/cytoskeleton, mitochondrial, and immune cell activation pathways. Identifying common pathways altered in genetic and epigenetic studies will aid our understanding of disease mechanisms and identify potential novel targets for pharmacological intervention

Waterbird use of coastal impoundments and management implications in east-central Florida

Monthly surveys were conducted on Kennedy Space Center for one year to determine densities of waterbirds within impounded salt marshes that were predominantly open water with little emergent vegetation. The objective was to assess the importance of these impoundments to waterbirds, particularly wading birds, which are species of special conservation concern. Water-level management for mosquito control and waterfowl provided habitat for an abundance of ducks, shorebirds, coots, and wading birds. Average densities throughout the year for these groups were 5.26, 412, 2.80, and 2.20 birds/ha, respectively. The majority of waterfowl were present during the winter. Shorebirds were most common during spring migration. Wading bird densities increased with declining water level. Due to the extensive alteration and development of coastal wetlands in central Florida, properly managed impoundments may provide important feeding areas for maintaining certain waterbird populations