Policy analysis of Texas Senate Bill 532 and the regulation of nurse practitioners in the convenience care model

Background. Retail clinics, also called convenience care clinics, have become a rapidly growing trend since their initial development in 2000. These clinics are coupled within a larger retail operation and are generally located in "big-box" discount stores such as Wal-mart or Target, grocery stores such as Publix or H-E-B, or in retail pharmacies such as CVS or Walgreen's (Deloitte Center for Health Solutions, 2008). Care is typically provided by nurse practitioners. Research indicates that this new health care delivery system reduces cost, raises quality, and provides a means of access to the uninsured population (e.g., Deloitte Center for Health Solutions, 2008; Convenient Care Association, 2008a, 2008b, 2008c; Hansen-Turton, Miller, Nash, Ryan, Counts, 2007; Salinsky, 2009; Scott, 2006; Ahmed & Fincham, 2010). Some healthcare analysts even suggest that retail clinics offer a feasible solution to the shortage of primary care physicians facing the nation (AHRQ Health Care Innovations Exchange, 2010). ^ The development and performance of retail clinics is heavily dependent upon individual state policies regulating NPs. Texas currently has one of the most highly regulated practice environments for NPs (Stout & Elton, 2007; Hammonds, 2008). In September 2009, Texas passed Senate Bill 532 addressing the scope of practice of nurse practitioners in the convenience care model. In comparison to other states, this law still heavily regulates nurse practitioners. However, little research has been conducted to evaluate the impact of state laws regulating nurse practitioners on the development and performance of retail clinics. ^ Objectives. (1). To describe the potential impact that SB 532 has on retail clinic performance. (2). To discuss the effectiveness, efficiency, and equity of the convenience care model. (3). To describe possible alternatives to Texas' nurse practitioner scope of practice guidelines as delineated in Texas Senate Bill 532. (4). To describe the type of nurse practitioner state regulation (i.e. independent, light, moderate, or heavy) that best promotes the convenience care model. ^ Methods. State regulations governing nurse practitioners can be characterized as independent, light, moderate, and heavy. Four state NP regulatory types and retail clinic performance were compared and contrasted to that of Texas regulations using Dunn and Aday's theoretical models for conducting policy analysis and evaluating healthcare systems. Criteria for measurement included effectiveness, efficiency, and equity. Comparison states were Arizona (Independent), Minnesota (Light), Massachusetts (Moderate), and Florida (Heavy). ^ Results. A comparative states analysis of Texas SB 532 and alternative NP scope of practice guidelines among the four states: Arizona, Florida, Massachusetts, and Minnesota, indicated that SB 532 has minimal potential to affect the shortage of primary care providers in the state. Although SB 532 may increase the number of NPs a physician may supervise, NPs are still heavily restricted in their scope of practice and limited in their ability to act as primary care providers. Arizona's example of independent NP practice provided the best alternative to affect the shortage of PCPs in Texas as evidenced by a lower uninsured rate and less ED visits per 1,000 population. A survey of comparison states suggests that retail clinics thrive in states that more heavily restrict NP scope of practice as opposed to those that are more permissive, with the exception of Arizona. An analysis of effectiveness, efficiency, and equity of the convenience care model indicates that retail clinics perform well in the areas of effectiveness and efficiency; but, fall short in the area of equity. ^ Conclusion. Texas Senate 532 represents an incremental step towards addressing the problem of a shortage of PCPs in the state. A comparative policy analysis of the other four states with varying degrees of NP scope of practice indicate that a more aggressive policy allowing for independent NP practice will be needed to achieve positive changes in health outcomes. Retail clinics pose a temporary solution to the shortage of PCPs and will need to expand their locations to poorer regions and incorporate some chronic care to obtain measurable health outcomes. ^

Returning Texas Senate Bill 530 back to 1100 Congress Avenue: The need for effective surveillance reporting of student fitness levels to Texas house representatives

Every Texas student is required to complete the FITNESSGRAM fitness assessment under legislation outlined in Senate Bill 530. This study described cardiovascular, body mass index (BMI), and overall fitness levels of students (grades 3–12) in the state of Texas during the 2009–2010 school year, and provides examples of how to effectively present results to Texas House Representatives using three unique health communication strategies. Given the Texas legislature mandates FITNESSGRAM collection yet did not require reporting according to their election district, the data were aggregated to 150 Texas House Representative Districts by sex and grade category to facilitate effective fitness data dissemination. Fitness data were also analyzed with results from the Texas Assessment of Knowledge and Skills (TAKS) to provide insight into potential relationships between fitness and academic achievement. ^ The majority of students in Texas need improvement on at least 1 fitness assessment. In general, female students have superior fitness in elementary and middle school but the fitness edge is erased by high school. Female cardiovascular fitness deteriorates faster from elementary to high school compared to male students. Female BMI deteriorates and male BMI improves from elementary to high school. Cardiovascular fitness and overall fitness decreases from elementary to high school for both male and female students. ^ Student fitness was significantly and strongly independently correlated with academic achievement. Further analysis showed that House Representatives with TAKS scores in the top quartile consistently showed superior fitness. Small significant partial correlations remain between fitness and TAKS assessment after controlling for socioeconomic status. In general, correlations were stronger between female BMI and TAKS assessment compared to male students. Cardiovascular fitness was significantly correlated with TAKS assessment for both genders. This paper supports student fitness as a confounder in the relationship between socioeconomic status and academic achievement. Plus, student fitness has a strong correlation with academic that deserves further exploration. ^ Senate Bill 530 fails to organize and implement a health communication strategy that effectively disseminates the health data collected to stakeholders of interest. The lack of a vital health communication strategy results in an incomplete student health surveillance system. This paper outlines three unique strategies tailored to legislators. It is important to disseminate health information using a variety of methods tailored to your targeted audience. The use of interactive mapping technology presented (GIS) uses new technology that has the potential to effectively reach a large audience.^

Científicos y políticas públicas : la incidencia de una red en el tratamiento de una Ley de Ordenamiento Territorial

Nuestro trabajo tiene como objetivo aplicar conceptos de la teoría de los sistemas complejos y herramientas del análisis de redes sociales para describir y analizar el surgimiento y la evolución de una red social conformada por científicos, docentes, graduados y funcionarios públicos de diferentes organismos científicos y académicos, que crearon y participaron de un equipo multidisciplinario que elaboró un informe sobre un proyecto de ley de Ordenamiento Territorial y Usos del Suelo de la provincia de Mendoza en el año 2006. Para la compresión de la evolución del proceso de elaboración del proyecto de ley de ordenamiento territorial y de usos del suelo, organizaremos la estructura del trabajo de la siguiente manera: - Primero aplicaremos aspectos teóricos y metodológicos, basados en la sistematización realizada por Rolando García en su libro “Sistemas Complejos. Conceptos, método y fundamentación epistemológica de la investigación interdisciplinaria", para realizar el recorte del sistema objeto de estudio. - En segundo lugar utilizaremos la Teoría de Análisis de Redes Sociales para describir la composición y estructura del sistema (nodos y vínculos) en cada momento. La estructura del sistema en cada momento significativo será graficada por medio el Software Ucinet 6 y NetDraw. - Por último, haremos referencia a las dificultades que tuvo el proceso desde el punto de vista de las condicionalidades que generaban los modelos mentales que portaban los participantes.

¿El de gaucho o el de Buffalo Bill? Los horizontes de identidades prestadas a partir de los disfraces y las personificaciones lúdicas en la provincia de Buenos Aires durante los carnavales de la época fresquista [1936-1940]

Fil: Bisso, Andrés. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.

¿El de gaucho o el de Buffalo Bill? Los horizontes de identidades prestadas a partir de los disfraces y las personificaciones lúdicas en la provincia de Buenos Aires durante los carnavales de la época fresquista [1936-1940]

Fil: Bisso, Andrés. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.

¿El de gaucho o el de Buffalo Bill? Los horizontes de identidades prestadas a partir de los disfraces y las personificaciones lúdicas en la provincia de Buenos Aires durante los carnavales de la época fresquista [1936-1940]

Fil: Bisso, Andrés. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.

Max Bill: variaciones sobre la búsqueda de la belleza

Max Bill es un artista lógico. Quince variaciones sobre el mismo tema 1938, podría ser el epítome de la lógica de Bill: la obra como resultado de la aplicación de leyes distintas sobre una estructura de orden. La gran diversidad formal de la obra de Max Bill –entre sus diseños de objetos, su tipografía, su pintura, su escultura o su arquitectura no parece haber líneas formales evidentes- se debe a que, para él, cada tarea es diferente y depende de medios y leyes propios. Una diversidad que podría ser erróneamente interpretada como un tipo de eclecticismo. Su conferencia en el Werkbund suizo de 1948 “belleza de la función, belleza como función”, se aleja del discurso funcionalista al proponer la belleza como una igual al resto de funciones. Cada obra ha de satisfacer la finalidad para la que ha sido construida y cumplir todas las funciones que en ella intervienen pero, además, ha de ser bella. La particularidad de Bill estriba en que, reconociéndose a sí mismo como un artista lógico, incluye la belleza como una más de las funciones a cumplir por cualquier objeto. Su famoso aforismo en relación a la configuración del entorno, desde la cuchara a la ciudad, incluiría la arquitectura en el ámbito de los objetos que han de cumplir esta nueva función. La búsqueda de la belleza será una constante en su obra. No una belleza generalizable y determinada a priori, sino una belleza entendida como predicado singular, individualizada para cada tarea. De este modo, podemos analizar, alternativamente, la belleza lógica de sus construcciones geométricas y la belleza simbólica de sus monumentos; la belleza del espacio sin fin en las superficies de una sola cara y la belleza prefabricada en sus más austeras realizaciones; la belleza elemental de sus esculturas y la belleza corriente con que sus arquitecturas se integran en la ciudad. Podemos plantearnos la posibilidad de una belleza de la estructura y entender simultáneamente la belleza cruda de su obra maestra, los edificios de la Escuela de Ulm. La búsqueda de la belleza nos ayudará a entender que, en la obra de Bill, la razón intuitiva -como modo de conocimiento- toma mayor importancia de la que parece. La forma como suma de todas las funciones en unidad armónica, será el resultado de un adecuado equilibrio entre razón lógica y razón intuitiva. ABSTRACT Max Bill is a logical artist. We could consider “Fitfteen variations on the same theme”, 1938, as the Bill’s logic epitome: the work as a result of the application of different tectonic laws on the order structure. The variety of the form in Bill’s work –his designed objects, his typography, his painting, his sculpture, or his architecture do not seem to have, between them, a direct line connecting the form- is due to the fact that, for him, each task is different and it depends on the own means and tectonic laws. A kind of diversity that could be misinterpreted like certain type of eclecticism. His lecture at the Suisse Werkbund (1948) “beauty from function and as function” is far from the functionalist speech, when proposing beauty as an equal to the rest of functions. In his own words, each work has to satisfy the purpose it was built for and fulfill all functions, and furthermore it has to be beautiful. Seeing himself as a logical artist, Bill however introduces beauty as one more of the functions that any object has to fulfill. His famous aphorism related to the environment management, from the spoon to the city, would include architecture as one more of the objects that have to satisfy this new function. The pursuit of beauty is a constant in his work. It won’t be a general beauty determined in advance, but a singular predicate, individualized for each task. That way, we can analyze, alternatively, the logical beauty of his geometric constructions and the symbolical beauty of his monuments; the beauty of the endless space in the single-sided surfaces and the prefabricated beauty in his most stricts constructions; the elemental beauty of his sculptures and the ordinary beauty with which some of his architectures are integrated in the city. We can also try the possibility of a beauty from the structure and understand, at the same time, the raw beauty of his architectural masterpiece, the buildings of the Ulm School of Design. The pursuit of beauty in Bill’s work will help us to understand that intuitive reason, as a way of knowledge, takes more importance than it seems. Form, as the harmonious expression of the sum of all functions, will be the result of an appropriate balance between logical and intuitive reason.

Bill Gates. El constructor de un mundo digital: de Microsoft a la filantropía

Creo haber leído alguna vez que Bill Gates es la persona más rica del mundo, lo que me indica que hay alguien, que no es el fisco, que dedica su tiempo a contar la riqueza de los ricos. Menos mal que también hay quien, como la Fundación Príncipe de Asturias,hace algo más útil, como es ocuparse de valorar y ensalzar la parte de su riqueza que algunos ricos destinan a resolver los problemas de los pobres del mundo. Así es como ha decidido premiar a la Fundación Bill y Melinda Gates por su labor benéfica en pro de la salud mundial y de la educación, de la erradicación de la hambruna y de reducir desigualdades que afectan a lo que llamamos tercer mundo.