COSTS AND EFFECTS OF ARKANSAS' LONG-TERM CARE DEMONSTRATION PROJECT (MEDICAID, CHANELLING, COMMUNITY ASSESSMENT)

The purpose of this study was to assess the impact of the Arkansas Long-Term Care Demonstration Project upon Arkansas' Medicaid expenditures and upon the clients it serves. A Retrospective Medicaid expenditure study component used analyses of variance techniques to test for the Project's effects upon aggregated expenditures for 28 demonstration and control counties representing 25 percent of the State's population over four years, 1979-1982.^ A second approach to the study question utilized a 1982 prospective sample of 458 demonstration and control clients from the same 28 counties. The disability level or need for care of each patient was established a priori. The extent to which an individual's variation in Medicaid utilization and costs was explained by patient need, presence or absence of the channeling project's placement decision or some other patient characteristic was examined by multiple regression analysis. Long-term and acute care Medicaid, Medicare, third party, self-pay and the grand total of all Medicaid claims were analyzed for project effects and explanatory relationships.^ The main project effect was to increase personal care costs without reducing nursing home or acute care costs (Prospective Study). Expansion of clients appeared to occur in personal care (Prospective Study) and minimum care nursing home (Retrospective Study) for the project areas. Cost-shifting between Medicaid and Medicare in the project areas and two different patterns of utilization in the North and South projects tended to offset each other such that no differences in total costs between the project areas and demonstration areas occurred. The project was significant ((beta) = .22, p < .001) only for personal care costs. The explanatory power of this personal care regression model (R('2) = .36) was comparable to other reported health services utilization models. Other variables (Medicare buy-in, level of disability, Social Security Supplemental Income (SSI), net monthly income, North/South areas and age) explained more variation in the other twelve cost regression models. ^

Strange bedfellows: The ethics and politics of medical futility in Texas

Background: Futile medical treatments are interventions that are not associated with a benefit to the patient. The definition and concept of medical futility are controversial. The Texas Advance Directives Act (TADA) was passed in 1999 to address medically inappropriate interventions by allowing providers to withdraw inappropriate interventions against a surrogate decision maker's wishes following a review, attempt to transfer the patient, and 10-day waiting period. The original legislation was a negotiated compromise by players across the political spectrum. However, in recent years there has been increasing controversy regarding TADA and attempts to alter its applicability in Texas. ^ Purpose: The purpose of this project was to apply Paul Sabatier's advocacy coalition framework (ACF) to gain understanding into the historical, ethical, and political basis of the initial compromise, and determine the sources of conflict that have led to increased opposition to TADA. ^ Methods: Using the ACF model, key actors within the medical futility policy debate in Texas were aggregated into coalitions based on shared beliefs. A narrative summary based analysis identified the core elements of the policy subsystem, as well as the constraints and resources of the subsystem actors. Externalities that promoted adjustments to coalition beliefs and tactics used by coalition participants were analyzed. Data sources included review of the published literature regarding medical futility, as well as analysis of published newspaper accounts and editorials regarding the medical futility issue in Texas, legislative testimony, and review of weblogs and online commentaries dealing with the issue. ^ Results: Primary coalition participants in developing compromise legislation in 1999 were the Providers and Vitalists, with Autonomists gaining a prominent role starting in 2006. Internal factors associated with the breakdown of consensus included changes to the makeup of the governing coalition and changes in individual case information available to the Vitalist coalition. Externalities related to the intertwining of the Sun Hudson case and the Terri Schiavo case generated negative publicity for the TADA from progressive and conservative viewpoints. Dissemination of information in various venues regarding contentious cases was associated with more polarization of viewpoints, and realignment of coalition alliances. ^ Conclusions: The ACF provided an outline for the initial compromise over the creation of the Texas Advance Directives Act as well as the eventual loss of consensus. The debate between the Provider, Vitalist, and Autonomist coalitions has been affected by internal policy evolution, changes in the governing coalition, and important externalities. The debate over medical futility in Texas has had much broader implications in the dispute over Health Care Reform.^

Territory and Infrastructure : Strategic Identification and Project Pondering

El Territorio hoy es visto como una totalidad organizada que no puede ser pensada separando cada uno de los elementos que la componen; cada uno de ellos es definido por su relación con los otros elementos. Así, un pensamiento que integra diferentes disciplinas y saberes comienza a manejar una realidad que lejos está de definir certezas inamovibles, y comienza a vislumbrar horizontes estratégicos. La adaptación a la no linealidad de las relaciones que se dan sobre el territorio, y la diferencia de velocidades en las que actúan los distintos actores, nos exige hacer de la flexibilidad una característica esencial de la metodología de planificación estratégica. La multi-causalidad de los fenómenos que estructuran el territorio nos obliga a construir criterios cualitativos, entendiendo que nos es imposible la medición de estas cadenas causales y su reconstrucción completa en el tiempo; sin dejar por ello de edificar un marco profundo de acción y transformación que responda a una realidad cierta y veraz. Los fenómenos producidos sobre el territorio nunca actúan de manera aislada, lo que implica una responsabilidad a la hora de comprender las sinergias y la restricción que afectan los resultados de los procesos desatados. La presente ponencia corresponde a la Segunda Fase del proceso de identificación estratégica de los proyectos Plan Estratégico Territorial (PET) que se inició en el año 2005; dicho Plan es llevada a cabo por la Subsecretaría de Planificación Territorial del Ministerio de Planificación Federal y fue abordado sobre la base de tres pretensiones: institucionalizar el ejercicio del pensamiento estratégico, fortalecer la metodología de trabajo transdisciplinaria y multisectorial, y diseñar un sistema de ponderación de proyectos estratégicos de infraestructura, tanto a nivel provincial como nacional, con una fuerte base cualitativa. Este proceso dio como resultado una cartera ponderada de proyectos de infraestructura conjuntamente con una metodología que permitió consolidar los equipos provinciales de planificación, tanto en su relación con los decisores políticos como con los actores de los múltiples sectores del gobierno, y en estos resultados consolidar y reforzar una cultura del pensamiento estratégico sobre el territorio

Territory and Infrastructure : Strategic Identification and Project Pondering

El Territorio hoy es visto como una totalidad organizada que no puede ser pensada separando cada uno de los elementos que la componen; cada uno de ellos es definido por su relación con los otros elementos. Así, un pensamiento que integra diferentes disciplinas y saberes comienza a manejar una realidad que lejos está de definir certezas inamovibles, y comienza a vislumbrar horizontes estratégicos. La adaptación a la no linealidad de las relaciones que se dan sobre el territorio, y la diferencia de velocidades en las que actúan los distintos actores, nos exige hacer de la flexibilidad una característica esencial de la metodología de planificación estratégica. La multi-causalidad de los fenómenos que estructuran el territorio nos obliga a construir criterios cualitativos, entendiendo que nos es imposible la medición de estas cadenas causales y su reconstrucción completa en el tiempo; sin dejar por ello de edificar un marco profundo de acción y transformación que responda a una realidad cierta y veraz. Los fenómenos producidos sobre el territorio nunca actúan de manera aislada, lo que implica una responsabilidad a la hora de comprender las sinergias y la restricción que afectan los resultados de los procesos desatados. La presente ponencia corresponde a la Segunda Fase del proceso de identificación estratégica de los proyectos Plan Estratégico Territorial (PET) que se inició en el año 2005; dicho Plan es llevada a cabo por la Subsecretaría de Planificación Territorial del Ministerio de Planificación Federal y fue abordado sobre la base de tres pretensiones: institucionalizar el ejercicio del pensamiento estratégico, fortalecer la metodología de trabajo transdisciplinaria y multisectorial, y diseñar un sistema de ponderación de proyectos estratégicos de infraestructura, tanto a nivel provincial como nacional, con una fuerte base cualitativa. Este proceso dio como resultado una cartera ponderada de proyectos de infraestructura conjuntamente con una metodología que permitió consolidar los equipos provinciales de planificación, tanto en su relación con los decisores políticos como con los actores de los múltiples sectores del gobierno, y en estos resultados consolidar y reforzar una cultura del pensamiento estratégico sobre el territorio

Territory and Infrastructure : Strategic Identification and Project Pondering

El Territorio hoy es visto como una totalidad organizada que no puede ser pensada separando cada uno de los elementos que la componen; cada uno de ellos es definido por su relación con los otros elementos. Así, un pensamiento que integra diferentes disciplinas y saberes comienza a manejar una realidad que lejos está de definir certezas inamovibles, y comienza a vislumbrar horizontes estratégicos. La adaptación a la no linealidad de las relaciones que se dan sobre el territorio, y la diferencia de velocidades en las que actúan los distintos actores, nos exige hacer de la flexibilidad una característica esencial de la metodología de planificación estratégica. La multi-causalidad de los fenómenos que estructuran el territorio nos obliga a construir criterios cualitativos, entendiendo que nos es imposible la medición de estas cadenas causales y su reconstrucción completa en el tiempo; sin dejar por ello de edificar un marco profundo de acción y transformación que responda a una realidad cierta y veraz. Los fenómenos producidos sobre el territorio nunca actúan de manera aislada, lo que implica una responsabilidad a la hora de comprender las sinergias y la restricción que afectan los resultados de los procesos desatados. La presente ponencia corresponde a la Segunda Fase del proceso de identificación estratégica de los proyectos Plan Estratégico Territorial (PET) que se inició en el año 2005; dicho Plan es llevada a cabo por la Subsecretaría de Planificación Territorial del Ministerio de Planificación Federal y fue abordado sobre la base de tres pretensiones: institucionalizar el ejercicio del pensamiento estratégico, fortalecer la metodología de trabajo transdisciplinaria y multisectorial, y diseñar un sistema de ponderación de proyectos estratégicos de infraestructura, tanto a nivel provincial como nacional, con una fuerte base cualitativa. Este proceso dio como resultado una cartera ponderada de proyectos de infraestructura conjuntamente con una metodología que permitió consolidar los equipos provinciales de planificación, tanto en su relación con los decisores políticos como con los actores de los múltiples sectores del gobierno, y en estos resultados consolidar y reforzar una cultura del pensamiento estratégico sobre el territorio

Agricultural trade and prosperity

In an environment where there is no communication between different social levels and which is suffering an increasing demand in agricultural production, agribusiness and quality, trade, as a regulator of the supply and demand, has a strong impact on the economic and environmental areas as well as on the farmers quality of life. This entails the need to find a sustainable and fair balance between the different parties (farmers and traders). This paper seeks to find this balance through the integration of trade with prosperity, understood not from a purely economic point of view, but as an improvement in life quality. This proposal is framed within Working With People (WWP) as the main conceptual base for achieving concrete actions that will promote a rapprochement between the parties that will lead to the sector?s sustainable resilience. This will be achieved through a exhaustive review of scientific literature in order to analyze and develop the state of the art of the concepts involved. The result is a conceptual proposal presented from the three dimensions of the WWP model: technical-entrepeneurial, ethical-social, political-contextual"

Resilence, rural development and suistainable management: a working with people model approach

Nowadays, it has become evident the need to seek sustainable development models that address challenges arising in a variety of contexts. The resilience concept appears connected to the ability of people to cope with adversities that inevitably arise due to context dynamics, at different spatial and temporal scales. This concept is related to the model known as Working With People (WWP), focused on rural development projects planning, management and evaluation, from the integration of three dimensions: technical-entrepreneurial, ethical-social and political-contextual. The research reported is part of the RETHINK European Project, whose overall aim is farm modernization and rural resilience. The resilience concept has been analyzed, in the scope of rural development projects management, and a relationship with the WWP model has been established. To this end, a thorough review of the scientific literature concerning this topic has been addressed, in order to develop the state of the art of the different concepts and models involved. A conceptual proposal for the integration of resilience in rural development projects sustainable management, through the three-dimensional WWP model is presented.

Technology transfer of renewable energy for rural development: historical evolution and lessons of experience from the model WWP

Technology transfer (TT) in the area of renewable energy (RE) throughout history has been an important tool for rural development (RD). Initially, the TT has been conceptualized as the purchase or donation of machinery from first world countries - without any consideration of staff training and contextual conditions for the adaptation of technology to the needs of the country. Various researches have revealed the existence of different approaches to planning the TT of RE, demonstrating the high complexity of projects from the social and contextual dimension. This paper addresses the conceptual evolution of the TT of RE for RD, examining its different periods considered for three criteria: historical events occurred, the role of stakeholders and changing objectives for the TT of RE for RD. For the conceptual analysis of changes the model Working With People (WWP) is used for planning and project management of high social complexity in RD. The analysis defines the existence of four historical periods in the TT of RE and synthesizes the lessons of experience from the three dimensions (ethical-social, technical-entrepreneurial, and political-contextual) of the WWP model.

RELIGIÃO PROFÉTICA E CRISE POLÍTICA: Um estudo da sociedade norte-israelita à luz de Oséias 9,1-9.

Com o desenvolvimento deste projeto de pesquisa Religião profética e crise política: estudo da sociedade norte-israelita à luz de Oséias 9,1-9 queremos identificar que momento de crise foi essa pelo qual passou a sociedade norte-israelita no século VIII a.C., e qual seria o background oseânico que teria funcionado como um verdadeiro leitmotiv em sua vida profética. Ao invés de partirmos de uma regressão, i.é., de um estudo dedutivo (método descendente), devido à falta de material e também pela complexidade do trabalho, farei o inverso, partirei da teoria que hoje é plenamente aceita no meio acadêmico. Fundado numa metodologia que privilegia os resultados obtidos a partir dos mais rigorosos dados historiográficos métodos históricos críticos e pesquisas arqueológicas este projeto de pesquisa utilizará o método indutivo, i.é., partiremos de um processo ascendente. O desafio está em delinear a trajetória autonômica da monarquia norte-israelita, procurando estabelecer quais foram os momentos mais marcantes desta caminhada histórica, suscetíveis de forjar a manifestação de profetas como Amós, Oséias, Miquéias e tantos outros. Como objeto principal de nossa pesquisa, o foco estará sobre o profeta Oséias que soube como nenhum outro antes dele, fazer uma síntese entre religião e vida, i.é., soube desenvolver critérios éticos que serviram como parâmetro avaliativo de pureza da religião javista

RELIGIÃO PROFÉTICA E CRISE POLÍTICA: Um estudo da sociedade norte-israelita à luz de Oséias 9,1-9.

Com o desenvolvimento deste projeto de pesquisa Religião profética e crise política: estudo da sociedade norte-israelita à luz de Oséias 9,1-9 queremos identificar que momento de crise foi essa pelo qual passou a sociedade norte-israelita no século VIII a.C., e qual seria o background oseânico que teria funcionado como um verdadeiro leitmotiv em sua vida profética. Ao invés de partirmos de uma regressão, i.é., de um estudo dedutivo (método descendente), devido à falta de material e também pela complexidade do trabalho, farei o inverso, partirei da teoria que hoje é plenamente aceita no meio acadêmico. Fundado numa metodologia que privilegia os resultados obtidos a partir dos mais rigorosos dados historiográficos métodos históricos críticos e pesquisas arqueológicas este projeto de pesquisa utilizará o método indutivo, i.é., partiremos de um processo ascendente. O desafio está em delinear a trajetória autonômica da monarquia norte-israelita, procurando estabelecer quais foram os momentos mais marcantes desta caminhada histórica, suscetíveis de forjar a manifestação de profetas como Amós, Oséias, Miquéias e tantos outros. Como objeto principal de nossa pesquisa, o foco estará sobre o profeta Oséias que soube como nenhum outro antes dele, fazer uma síntese entre religião e vida, i.é., soube desenvolver critérios éticos que serviram como parâmetro avaliativo de pureza da religião javista

Islamic Political Thought: Reviving a Rationalist Tradition

This work develops the foundations of an Islamic argument for secular, liberal democracy from within the Islamic discursive tradition. First, it challenges the presentation of contemporary Islamic political thought as a unified, continuous development of the classical canon by showing the influence of the now marginalized medieval rationalists in the development of Islamic political thought. The classical rationalist concern with divine justice forced the founders of Sunni orthodoxy to state their epistemologies and their positions on ethical ontology. The orthodox positions, and their related methods of legal-juristic reasoning, are shown to be incapable of accommodating the modern Islamic positions on political representation, slavery, and just war. This leads to the second argument of the work, that the modern Islamic discourse is better understood as a reflection of the central concern with justice and its rationalist epistemology and ethical ontology we find in the writings of classical rationalists. This argument is made by examining the works of three classical rationalists, a theologian, a philosopher, and a historian. Their political positions, shaped by their rationalism and concern with justice, challenged their orthodox contemporaries, and provide substantive critiques of the classical political accommodations, methods of politico-legal reasoning, and hence, of modern Islamist political projects. The final chapter reveals how far the mainstream of Islamic political thought has deviated from the classical discourses, since the 19th century, by adopting the language and ideals of the European Enlightenment. This shift is presented as a triumph of classical rationalism over literalism, whose epistemological foundations and ontological implications have yet to be acknowledged and appreciated.

Transcending Cultural and Language Differences: Ethical Codes of Conduct for Translators and Interpreters in Afghanistan

This project examines what an ethical code of conduct would look like in Afghanistan through analysis of historical, cultural and linguistic aspects found within its regions, as well as an examination of ethical codes of conduct for translators and interpreters in other countries. While numerous ethical guidelines and codes of conduct for translators and interpreters exist throughout global communities, it seems that creating a successful standardized ethical code of conduct in Afghanistan may be difficult to achieve given cultural and linguistic complexities. An ethical code of conduct for translators and interpreters in Afghanistan should include particular focus on: cultural sensitivity and courtesy, impartiality, conflict of interest, options for withdrawal, as well as reflect the importance of Pashtunwali.

Legal, Ethical and Cultural Issues U.S. companies face when moving operations to China.

Beyond free trade agreements governing cross-border commerce, the source of most global economic growth is attributed to business across interconnecting markets. Among the most attractive and complex markets, China stands out. Despite its appeal, American businesses are more likely to fail in China due to an overwhelming desire for an immediate return on investment while neglecting to consider or completely disregarding China's unique legal, ethical and cultural environment. This capstone project will give recommendations to help businesses succeed when entering China and avoid legal, ethical and cultural issues such as the ones that Google, Apple, and Yahoo experienced.

Associative Behaviours and Political Participation of EU migrants

Civic culture is structured on a network of interpersonal associations with different degrees of formalization. According to theories on civic and political action, certain agents, such as associations, play a key role in setting targets, socializing or coordinating sociopolitical actions, among other functions. Associations strengthen the political and civic system of societies. Likewise, they are a vehicle for individuals’ integration, which is particularly important in the case of immigrants. For these, associations are both a vehicle for integration and an instrument for political participation. This article explores the use and purpose of associations according to immigrants from Romania, Poland, the United Kingdom and Germany living in Spain.

Stigmatisation of EU mobile citizens: a ticking time bomb for the European project. EPC Commentary, 24 January 2014

The 2013 European Year of Citizens was profoundly marked by escalating attacks against one of the EU’s major achievement for EU citizens: freedom of movement. In April 2013, Home Affairs Ministers from Austria, Germany, the Netherlands and the UK were party to a letter claiming that “a significant number of new immigrants draw social assistance in the host countries, frequently without genuine entitlement, burdening host societies’ social welfare systems”. This letter laid the groundwork for a “battle plan”, presented by David Cameron in November, which aimed to make the free movement of persons “less free” and put forward the idea of capping “EU migration”. Furthermore, in December, the German conservative Christian Social Union (CSU) took up a similar petty political discourse. After the end of the transitional period for Romania and Bulgaria on 1 January 2014, the debate continues with Chuka Umunna (British Labour Party) proposing to restrict the freedom of movement to highly skilled EU citizens and to citizens in possession of a firm job offer. Alongside this, the German Chancellor, Angela Merkel announced the formation of a committee to investigate “poverty migration” in Germany. This wave of resentment has been more recently followed by the UK Prime Minister David Cameron, expressing his intention to re-negotiate EU law in order to be able to withdraw child benefits from EU citizens working in the UK, citing Polish citizens working in the UK as an example. Seeing this as a stigmatisation of the Polish population, the Polish foreign minister, Radosław Sikorski, qualified Cameron’s discourse as “unacceptable”. The debate over limiting freedom of movement has continuously escalated and reached a worrying level. With the EP elections approaching in May 2014, this debate is likely to become worse.