Health care policy analysis of Medicaid's early and periodic screening, diagnosis, and treatment (EPSDT) benefit in Colorado

The purpose of this thesis is to identify "best practice" recommendations for successful implementation of the EPSDT outreach program at Memorial Health System's Hospital for Children in Colorado Springs through a policy analysis of Medicaid EPSDT services in Colorado. A successful program at Memorial will increase education and awareness of EPSDT services, enrollment, and access to and utilization of health care services for eligible children. Methodology utilized in this study included questionnaires designed for the EPSDT contract administrator and outreach coordinators/workers; analysis of current federal and state policies; and studies conducted at the federal and state level, and by various advocacy groups. The need for this analysis of EPSDT came about in part through an awareness of increasingly high numbers of children in poverty and who are uninsured. Though the percentage of children living in poverty in Colorado is slightly below the national average (see Table 2), according to data analyzed by The Annie E. Casey Foundation, the percentage of children (0-18) living in poverty in Colorado increased from 10% in 2000 to 16% in 2006, a dramatic increase of 60% surpassed by only one other state in the nation (The Annie E. Casey Foundation, 2008). By comparison, the U.S. percentage of children in poverty during the same time frame rose from 17% to 18% (The Annie E. Casey Foundation, 2008). What kind of health care services are available to this vulnerable and growing group of Coloradans, and what are the barriers that affect their enrollment in, access to and utilization of these health care services? Barriers identified included difficulty with the application process; system and process issues; a lack of providers; and a lack of awareness and knowledge of EPSDT. Fiscal restraints and legislation at the federal and state level are also barriers to increasing enrollment and access to services. Outreach services are a critical component of providing EPSDT services, and there were several recommendations regarding outreach and case management that will benefit the program in the future. Through this analysis and identification of a broad range of barriers, a clearer picture emerged of current challenges within the EPSDT program as well as a broad range of strategies and recommendations to address these challenges. Through increased education and advocacy for EPSDT and the services it encompasses; stronger collaboration and cooperation between all groups involved, including providing a Medical Home for all eligible children; and new legislation putting more money and focus on comprehensive health care for low-income uninsured children; enrollment, access to and utilization of developmentally appropriate and quality health care services can be achieved. ^

Retrospective analysis of Methicillin-Resistant Staphylococcus Aureus (MRSA) skin and Soft-Tissue Infections (SSTI) in a university hospital emergency department (ED)

Study Objective: Identify the most frequent risk factors of Community Acquired-MRSA (CA-MRSA) Skin and Soft-tissue Infections (SSTIs) using a case series of patients and characterize them by age, race/ethnicity, gender, abscess location, druguse and intravenous drug-user (IVDU), underlying medical conditions, homelessness, treatment resistance, sepsis, those whose last healthcare visit was within the last 12 months, and describe the susceptibility pattern from this central Texas population that have come into the University Medical Center Brackenridge (UMCB) Emergency Department (ED). ^ Methods: This study was a retrospective case-series medical record review involving a convenience sample of patients in 2007 from an urban public hospital's ED in Texas that had a SSTI that tested positive for MRSA. All positive MRSA cultures underwent susceptibility testing to determine antibiotic resistance. The demographic and clinical variables that were independently associated with MRSA were determined by univariate and multivariate analysis using logistic regression to calculate odds ratios (OR), 95% confidence intervals, and significance (p≤ 0.05). ^ Results: In 2007, there were 857 positive MRSA cultures. The demographics were: males 60% and females 40%, with the average age of 36.2 (std. dev. =13) the study population consisted of non-Hispanic white (42%), Hispanics (38%), and non-Hispanic black (18.8%). Possible risk factors addressed included using recreational drugs (not including IVDU) (27%) homelessness (13%), diabetes status (12.6%) or having an infectious disease, and IVDU (10%). The most frequent abscess location was the leg (26.6%), followed by the arm and torso (both 13.7%). Eighty-three percent of patients had one prominent susceptibility pattern that had a susceptibility rate for the following antibiotics: trimethoprim/sulfamethoxazole (TMP-SMX) and vancomycin had 100%, gentamicin 99%, clindamycin 96%, tetracycline 96%, and erythromycin 56%. ^ Conclusion: The ED is becoming an important area for disease transmission between the sterile hospital environment and the outside environment. As always, it is important to further research in the ED in an effort to better understand MRSA transmission and antibiotic resistance, as well as to keep surveillance for the introduction of new opportunistic pathogens into the population. ^

Analysis and visualization of the dynamics of research groups in terms of projects and co-authored publications : A case study of library and information science in Argentina

Objective: The present study offers a novel methodological contribution to the study of the configuration and dynamics of research groups, through a comparative perspective of the projects funded (inputs) and publication co-authorships (output). Method: A combination of bibliometric techniques and social network analysis was applied to a case study: the Departmento de Bibliotecología (DHUBI), Universidad Nacional de La Plata, Argentina, for the period 2000-2009. The results were interpreted statistically and staff members of the department, were interviewed. Results: The method makes it possible to distinguish groups, identify their members and reflect group make-up through an analytical strategy that involves the categorization of actors and the interdisciplinary and national or international projection of the networks that they configure. The integration of these two aspects (input and output) at different points in time over the analyzed period leads to inferences about group profiles and the roles of actors. Conclusions: The methodology presented is conducive to micro-level interpretations in a given area of study, regarding individual researchers or research groups. Because the comparative input-output analysis broadens the base of information and makes it possible to follow up, over time, individual and group trends, it may prove very useful for the management, promotion and evaluation of science

Analysis and visualization of the dynamics of research groups in terms of projects and co-authored publications : A case study of library and information science in Argentina

Objective: The present study offers a novel methodological contribution to the study of the configuration and dynamics of research groups, through a comparative perspective of the projects funded (inputs) and publication co-authorships (output). Method: A combination of bibliometric techniques and social network analysis was applied to a case study: the Departmento de Bibliotecología (DHUBI), Universidad Nacional de La Plata, Argentina, for the period 2000-2009. The results were interpreted statistically and staff members of the department, were interviewed. Results: The method makes it possible to distinguish groups, identify their members and reflect group make-up through an analytical strategy that involves the categorization of actors and the interdisciplinary and national or international projection of the networks that they configure. The integration of these two aspects (input and output) at different points in time over the analyzed period leads to inferences about group profiles and the roles of actors. Conclusions: The methodology presented is conducive to micro-level interpretations in a given area of study, regarding individual researchers or research groups. Because the comparative input-output analysis broadens the base of information and makes it possible to follow up, over time, individual and group trends, it may prove very useful for the management, promotion and evaluation of science

Analysis and visualization of the dynamics of research groups in terms of projects and co-authored publications : A case study of library and information science in Argentina

Objective: The present study offers a novel methodological contribution to the study of the configuration and dynamics of research groups, through a comparative perspective of the projects funded (inputs) and publication co-authorships (output). Method: A combination of bibliometric techniques and social network analysis was applied to a case study: the Departmento de Bibliotecología (DHUBI), Universidad Nacional de La Plata, Argentina, for the period 2000-2009. The results were interpreted statistically and staff members of the department, were interviewed. Results: The method makes it possible to distinguish groups, identify their members and reflect group make-up through an analytical strategy that involves the categorization of actors and the interdisciplinary and national or international projection of the networks that they configure. The integration of these two aspects (input and output) at different points in time over the analyzed period leads to inferences about group profiles and the roles of actors. Conclusions: The methodology presented is conducive to micro-level interpretations in a given area of study, regarding individual researchers or research groups. Because the comparative input-output analysis broadens the base of information and makes it possible to follow up, over time, individual and group trends, it may prove very useful for the management, promotion and evaluation of science

Growth of the Firm and Economic Backwardness: A Case Study and Analysis of China's Mobile Handset Industry

Economic backwardness often influences the growth of firms in developing countries. In this paper, we investigate the growth conditions and paths available for latecomers competing with first movers. Employing the concepts of boundaries of the firm and the disadvantage of backwardness, we present a case study of China's mobile handset industry and proceed to develop a simple model. We find that although significant disadvantage does not allow latecomers to grow, there are possibilities for changing the conditions of growth if latecomers can utilize outside resources and/or indigenous advantages.

Agricultural efficiency of rice farmers in Myanmar : a case study in selected areas

This paper try to analyze unique data set for rice producing agricultural households in some selected areas of Bago and Yangon divisions to examine the households' profit efficiency and the relationship between farm and household attributes and profit inefficiency using a Cobb-Douglas production frontier function. The frequency distribution reveals that the mean technical inefficiency is 0.1627 with a minimum of 3 percent and maximum of 73 percent which indicates that, on average, about 16% of potential maximum output is lost owing to technical inefficiency in both studied areas. While 85% of the sample farms exhibit profit inefficiency of 20% or less, about 40% of the sample farms is found to exhibit technical inefficiency of 20% or less, indicating that among the sample farms technical inefficiency is much lower than profit inefficiency.

Gender-preferential intergenerational patterns in primary education attainment : a quantitative analysis of a case of rural Mindanao, the Philippines

The Philippines has achieved a relatively high standard of education. Previous researches, most of which deal with Luzon Island, have indicated that rural poverty alleviation began partly due to the increased investment in education. However, the suburban areas beyond Luzon Island have rarely been studied. This study examines a case from rural Mindanao, and investigates the determinants and factors associated with children's education, with a special focus on delays in schooling, which may be a cause of dropout and holdover incidences, as well as exploring gender-specific differential patterns. The result shows that after controlling other socioeconomic attributes, (1) delays in schooling, as well as years completed, are more favorable for girls than boys; (2) the level of maternal education is equally associated with the child(ren)’s education level regardless of their gender; and (3) paternal education is preferentially and favorably influential to the same-gender child(ren), i.e., son(s). To reduce the boy-unfriendly gender bias in primary education, this study suggests two future tasks, i.e., providing boy-specific interventions to enhance the magnitude of the father-son educational virtuous circle, and comparing the magnitude of gender-equal maternal education influence and boy-preferential paternal education influence to specify which effect is larger.

A model for inter-module analysis and optimizing compilation

Recent research into the implementation of logic programming languages has demonstrated that global program analysis can be used to speed up execution by an order of magnitude. However, currently such global program analysis requires the program to be analysed as a whole: sepárate compilation of modules is not supported. We describe and empirically evalúate a simple model for extending global program analysis to support sepárate compilation of modules. Importantly, our model supports context-sensitive program analysis and multi-variant specialization of procedures in the modules.

Modelling seed germination in forest tree species through survival analysis. The Pinus pinea L. case study

The direct application of existing models for seed germination may often be inadequate in the context of ecology and forestry germination experiments. This is because basic model assumptions are violated and variables available to forest managers are rarely used. In this paper, we present a method which addresses the aforementioned shortcomings. The approach is illustrated through a case study of Pinus pinea L. Our findings will also shed light on the role of germination in the general failure of natural regeneration in managed forests of this species. The presented technique consists of a mixed regression model based on survival analysis. Climate and stand covariates were tested. Data for fitting the model were gathered from a 5-year germination experiment in a mature, managed P. pinea stand in the Northern Plateau of Spain in which two different stand densities can be found. The model predictions proved to be unbiased and highly accurate when compared with the training data. Germination in P. pinea was controlled through thermal variables at stand level. At microsite level, low densities negatively affected the probability of germination. A time-lag in the response was also detected. Overall, the proposed technique provides a reliable alternative to germination modelling in ecology/forestry studies by using accessible/ suitable variables. The P. pinea case study highlights the importance of producing unbiased predictions. In this species, the occurrence and timing of germination suggest a very different regeneration strategy from that understood by forest managers until now, which may explain the high failure rate of natural regeneration in managed stands. In addition, these findings provide valuable information for the management of P. pinea under climate-change conditions.

Analysis of behavior directed towards changing the innovation agents. Case study of the Canary Islands

In 2005 the Directorate General for Industrial Development and Technological Innovation of the Canary Islands proceeded to carry out a project to measure the behavioral skills of various government agencies and companies in the Canary Islands in order to prepare a White Paper to assess the most effective measures for the stimulation of innovation in this autonomous community and to facilitate the objectives of public subsidies. This paper shows a portion of the work performed comparing the activity oriented towards innovation and the one aimed at sustaining the status quo of the organizations in the sample.

Relationship between objective and subjective indicators in urban soundscape analysis. The case of Cordoba - Argentina

This paper presents the main results of a comparative evaluation of some acoustical parameters with the user´s perception of urban sounds. The study was carried out in three open spaces integrated with different environmental characteristics but similar objective conditions of urban noise. The subjective evaluation was done by means of a survey simultaneously with the objective measurements. The results of the crossed analysis confirmed that in environments with similar noise levels not always exists direct correlation between the objetive indicators and the acoustic comfort of the people. To predict the acustical quality of the soundscape it is necessary to consider aspects such as the background noise and the perception of natural or technological sounds as complements of the general sound level.

The influence of economic incentives linked to road safety indicators on accidents: The case of toll concessions in Spain

The goal of this paper is to evaluate whether the incentives incorporated in toll highway concession contracts in order to encourage private operators to adopt measures to reduce accidents are actually effective at improving safety. To this end, we implemented negative binomial regression models using information about highway characteristics and accident data from toll highway concessions in Spain from 2007 to 2009. Our results show that even though road safety is highly influenced by variables that are not managed by the contractor, such as the annual average daily traffic (AADT), the percentage of heavy vehicles on the highway, number of lanes, number of intersections and average speed; the implementation of these incentives has a positive influence on the reduction of accidents and injuries. Consequently, this measure seems to be an effective way of improving safety performance in road networks.

Does high speed rail compete fairly with other transportation modes? Madrid-Barcelona case study

Transportation modes produce many external costs such as congestion, accidents, and environmental impacts (pollution, noise and so on). From the microeconomic theory it is well known that in order to maximize social welfare, transportation modes should internalize the marginal costs they produce. Allocative efficiency is achieved when all transportation modes are priced at their social marginal cost. The objective of this research is to evaluate to what extent different passenger transport modes internalize their social marginal costs. This analysis is important since it affects the competitiveness of the different transport modes for a given OD pair. The case study analyzed is the corridor Madrid-Barcelona in Spain and the different transport modes have been considered (cars, buses, high-speed train and air). The research calculates the marginal social cost per user for each transportation mode, and it compares it with the average fare—allowing for the effect of discriminatory taxes—currently paid by the users. The external costs are calculated according to the guidelines established by the European Union. The gap between the marginal social cost and the price paid by users will provide the extra cost per passenger that each transport mode should have to pay for internalizing the external cost it produces. The research shows that external costs already produced by road and air transport modes are much higher than those produced by rail. However, the results show that road transport already internalizes every external costs it produces because users pay high fuel taxes. In other words, although rail transportation produces lower external costs, road transportation pays more than it should on the basis of the social marginal costs. The results of this work might be of help for Europ ean policy actions to be undertaken in the future.