Factors associated with needle sharing among Black male injection drug users in Harris County, Texas

Background. Injection drug users (IDUs) are at increased risk for HIV transmission due to unique risk behaviors, such as sharing needles. In Houston, IDUs account for 18% of all HIV/AIDS cases among Black males. ^ Objectives. This analysis compared demographic, behavioral, and psychosocial characteristics of needle sharing and non-sharing IDUs in a population of Black males in Harris County, Texas. ^ Methods. Data used for this analysis were from the second IDU cycle of the National HIV Behavioral Surveillance System. This dataset included a sample of 288 Black male IDUs. Univariate and multivariate statistical analysis were performed to determine statistically significant associations of needle sharing in this population and to create a functional model to inform local HIV prevention programs. ^ Results. Half of the participants in this analysis shared needles in the past 12 months. Compared to non-sharers, sharers were more likely to be homeless (OR=3.70, p<0.01) or arrested in the past year (OR=2.31, p<0.01), inject cocaine (OR=2.07, p<0.01), report male-to-male sex in the past year (OR=6.97, p<0.01), and to exchange sex for money or drugs. Sharers were less likely than non-sharers to graduate high school (OR=0.36, p<0.01), earn $5,000 or more a year (OR=1.15, p=0.05), get needles from a medical source (OR=0.59, p=0.03), and ever test for HIV (OR=0.17, p<0.01). Sharers were more likely to report depressive symptoms (OR=3.49, p<0.01), lower scores on the family support scale (mean difference 0.41, p=0.01) and decision-making confidence scale (mean difference 0.38, p<0.01), and greater risk-taking (mean difference -0.49, p<0.01) than non-sharers. In a multivariable logistic regression, sharers were less likely to have graduated high school (OR=0.33, p<0.01) and have been tested for HIV (OR=0.12, p<0.01) and were more likely to have been arrested in the past year (OR=2.3, p<0.01), get needles from a street source (OR=3.87, p<0.01), report male-to-male sex (OR=7.01, p<0.01), and have depressive symptoms (OR=2.36, p=0.02) and increased risk-taking (OR=1.78, p=0.01). ^ Conclusions. IDUs that shared needles are different from those that did not, reporting lower socioeconomic status, increased sexual and risk behaviors, increased depressive symptoms and increased risk-taking. These findings suggest that intervention programs that also address these demographic, behavioral, and psychosocial factors may be more successful in decreasing needle sharing among this population.^

THE EFFECTS OF COST-SHARING ON USE OF SERVICES AND CONSUMER CHARACTERISTICS IN A STATE'S CRIPPLED CHILDREN'S DIVISION

The present study analyzed some of the effects of imposing a cost-sharing requirement on users of a state's health service program. The study population consisted of people who were in diagnosed medical need and included, but was not limited to, people in financial need.^ The purpose of the study was to determine if the cost-sharing requirement had any detrimental effects on the service population. Changes in the characteristics of service consumers and in utilization patterns were analyzed using time-series techniques and pre-post policy comparisons.^ The study hypotheses stated that the distribution of service provided, diagnoses serviced, and consumer income levels would change following the cost-sharing policy.^ Analysis of data revealed that neither the characteristics of service users (income, race, sex, etc.) nor services provided by the program changed significantly following the policy. The results were explainable in part by the fact that all of the program participants were in diagnosed medical need. Therefore, their use of "discretionary" or "less necessary" services was limited.^ The study's findings supported the work of Joseph Newhouse, Charles Phelps, and others who have contended that necessary service use would not be detrimentally affected by reasonable cost-sharing provisions. These contentions raise the prospect of incorporating cost-sharing into programs such as Medicaid, which, at this writing, do not demand any consumer payment for services.^ The study concluded with a discussion of the cost-containment problem in health services. The efficacy of cost-sharing was considered relative to other financing and reimbursement strategies such as HMO's, self-funding, and reimbursement for less costly services and places of service. ^

A practice-based culminating experience: Writing a HRSA grant application with Texas Organ Sharing Alliance for public education efforts to increase solid organ donation

In November 2010, nearly 110,000 people in the United States were waiting for organs for transplantation. Despite the fact that the organ donor registration rate has doubled in the last year, Texas has the lowest registration rate in the nation. Due to the need for improved registration rates in Texas, this practice-based culminating experience was to write an application for federal funding for the central Texas organ procurement organization, Texas Organ Sharing Alliance. The culminating experience has two levels of significance for public health – (1) to engage in an activity to promote organ donation registration, and (2) to provide professional experience in grant writing. ^ The process began with a literature review. The review was to identify successful intervention activities in motivating organ donation registration that could be used in intervention design for the grant application. Conclusions derived from the literature review included (1) the need to specifically encourage family discussions, (2) religious and community leaders can be leveraged to facilitate organ donation conversations in families, (3) communication content must be culturally sensitive and (4) ethnic disparities in transplantation must be acknowledged and discussed.^ Post the literature review; the experience followed a five step process of developing the grant application. The steps included securing permission to proceed, assembling a project team, creation of a project plan and timeline, writing each element of the grant application including the design of proposed intervention activities, and completion of the federal grant application. ^ After the grant application was written, an evaluation of the grant writing process was conducted. Opportunities for improvement were identified. The first opportunity was the need for better timeline management to allow for review of the application by an independent party, iterative development of the budget proposal, and development of collaborative partnerships. Another improvement opportunity was the management of conflict regarding the design of the intervention that stemmed from marketing versus evidence-based approaches. The most important improvement opportunity was the need to develop a more exhaustive evaluation plan.^ Eight supplementary files are attached to appendices: Feasibility Discussion in Appendix 1, Grant Guidance and Workshop Notes in Appendix 2, Presentation to Texas Organ Sharing Alliance in Appendix 3, Team Recruitment Presentation in Appendix 5, Grant Project Narrative in Appendix 7, Federal Application Form in Appendix 8, and Budget Workbook with Budget Narrative in Appendix 9.^

Efficiency from pharmacy inventory technology: A means to improving quality in non-profit hospitals

Hospitals, like all organizations, have both a mission and a finite supply of resources with which to accomplish that mission. Because the inventory of therapeutic drugs is among the more expensive resources needed by a hospital to achieve its mission, a conceptual model of structure plus process equals outcome posits that adequate emphasis should be placed on optimization of the organization's investment in this important structural resource to provide highest quality outcomes. Therefore emphasis should be placed on the optimization of pharmacy inventory because lowering the financial investment in drug inventory and associated costs increases productive efficiency, a key element of quality. ^ In this study, a post-intervention analysis of a hospital pharmacy inventory management technology implementation at The University of Texas M.D. Anderson Cancer Center was conducted to determine if an intervention which reduced a hospital's financial investment in pharmaceutical inventory provided an opportunity to incrementally optimize the organization's mix of structural resources thereby improving quality of care. The results suggest that hospital pharmacies currently lacking technology to support automated purchasing logistics and perpetual, real-time inventory management for drugs may achieve measurable benefits from the careful implementation of such technology, enabling the hospital to lower its investment in on-hand inventory and, potentially, to reduce overall purchasing expenditures. ^ The importance of these savings to the hospital and potentially to the patient should not be underestimated for their ability to generate funding for previously unfunded public health programs or in their ability to provide financial relief to patients in the form of lower drug costs given the current climate of escalating healthcare costs and tightening reimbursements.^

Sharing scholastic life : What do children think about it?

In this article we present the results found in a descriptive- exploratory study, in which we investigated a group of scholar's (9 and 10 years old) conceptions of their classmates with psychological disorders at school. The answers of 90 students who belong to low and average socio- cultural level groups were analyzed. These groups were identified in relation to the parent's occupational category and educational level. The instrument elaborated to such aim was a semi- structured interview which included different aspects related to: which the most frequent problems are, how these problems are expressed at school, which their determinants are and the consequences for the children, as well as the their self referred knowledge of these problems.

Sharing scholastic life : What do children think about it?

In this article we present the results found in a descriptive- exploratory study, in which we investigated a group of scholar's (9 and 10 years old) conceptions of their classmates with psychological disorders at school. The answers of 90 students who belong to low and average socio- cultural level groups were analyzed. These groups were identified in relation to the parent's occupational category and educational level. The instrument elaborated to such aim was a semi- structured interview which included different aspects related to: which the most frequent problems are, how these problems are expressed at school, which their determinants are and the consequences for the children, as well as the their self referred knowledge of these problems.

Sharing scholastic life : What do children think about it?

In this article we present the results found in a descriptive- exploratory study, in which we investigated a group of scholar's (9 and 10 years old) conceptions of their classmates with psychological disorders at school. The answers of 90 students who belong to low and average socio- cultural level groups were analyzed. These groups were identified in relation to the parent's occupational category and educational level. The instrument elaborated to such aim was a semi- structured interview which included different aspects related to: which the most frequent problems are, how these problems are expressed at school, which their determinants are and the consequences for the children, as well as the their self referred knowledge of these problems.

Formation of supply chain collaboration and firm performance in the Thai automotive and electronics industries

This paper examines factors that encourage firms to go into supply chain collaborations (SCC) and relationships between SCC and supply chain performances (SCP), using a questionnaire survey on Thai automotive and electronics industries in 2012. OLS regression results show firms established supplier evaluation and audit system, system of rewards for high-performance supplier and long-term transactions with their supply chain partners under a competitive pressure are more closely cooperate with these partners on information sharing and decision synchronization. Instrumental variables regression indicates SCC arisen from competitive pressure, supplier evaluation and audit, a system of rewards for high-performance supplier and long-term relationship causally influence SCP such as on-time delivery, responsiveness to fast procurement, flexibility to customer need, and profit.

Production sharing, demand spillovers and CO2 emissions : the case of Chinese regions in GVCs

This study adopts the perspective of demand spillovers to provide new insights regarding Chinese domestic-regions' production position in global value chains and their associated CO2 emissions. To this end, we constructed a new type of World Input-Output Database in which China's domestic interregional input-output table for 2007 is endogenously embedded. Then, the pattern of China's regional demand spillovers across both domestic regions and countries are revealed by employing this new database. These results were further connected to endowments theory, which help to make sense of the empirical results. It is found that China's regions locate relatively upstream in GVCs, and had CO2 emissions in net exports, which were entirely predicted by the environmental extended HOV model. Our study points to micro policy instruments to combat climate change, for example, the tax reform for energy inputs that helps to change the production pattern thus has impact on trade pattern and so forth.

Heterogeneous firms and cost sharing in China's marketplaces

This study extends Melitz's model with heterogeneous firms by introducing shared fixed costs in a marketplace. It aims to explain heterogeneous firms' choice between traditional marketplaces and modern distribution channels on the basis of their productivities. The results reveal that the co-existence of a traditional marketplace and modern distribution channels improves social welfare. In addition, a deregulation policy for firm entry outside a marketplace and accumulation of human capital are factors that contribute to improve the social welfare.

Sharing Human-Generated Observations by Integrating HMI and the Semantic Sensor Web

Current “Internet of Things” concepts point to a future where connected objects gather meaningful information about their environment and share it with other objects and people. In particular, objects embedding Human Machine Interaction (HMI), such as mobile devices and, increasingly, connected vehicles, home appliances, urban interactive infrastructures, etc., may not only be conceived as sources of sensor information, but, through interaction with their users, they can also produce highly valuable context-aware human-generated observations. We believe that the great promise offered by combining and sharing all of the different sources of information available can be realized through the integration of HMI and Semantic Sensor Web technologies. This paper presents a technological framework that harmonizes two of the most influential HMI and Sensor Web initiatives: the W3C’s Multimodal Architecture and Interfaces (MMI) and the Open Geospatial Consortium (OGC) Sensor Web Enablement (SWE) with its semantic extension, respectively. Although the proposed framework is general enough to be applied in a variety of connected objects integrating HMI, a particular development is presented for a connected car scenario where drivers’ observations about the traffic or their environment are shared across the Semantic Sensor Web. For implementation and evaluation purposes an on-board OSGi (Open Services Gateway Initiative) architecture was built, integrating several available HMI, Sensor Web and Semantic Web technologies. A technical performance test and a conceptual validation of the scenario with potential users are reported, with results suggesting the approach is sound

Automated attribute inference in complex service workflows based on sharing analysis

The properties of data and activities in business processes can be used to greatly facilítate several relevant tasks performed at design- and run-time, such as fragmentation, compliance checking, or top-down design. Business processes are often described using workflows. We present an approach for mechanically inferring business domain-specific attributes of workflow components (including data Ítems, activities, and elements of sub-workflows), taking as starting point known attributes of workflow inputs and the structure of the workflow. We achieve this by modeling these components as concepts and applying sharing analysis to a Horn clause-based representation of the workflow. The analysis is applicable to workflows featuring complex control and data dependencies, embedded control constructs, such as loops and branches, and embedded component services.

Negative ternary set-sharing

The Set-Sharing domain has been widely used to infer at compiletime interesting properties of logic programs such as occurs-check reduction, automatic parallelization, and flnite-tree analysis. However, performing abstract uniflcation in this domain requires a closure operation that increases the number of sharing groups exponentially. Much attention has been given to mitigating this key inefflciency in this otherwise very useful domain. In this paper we present a novel approach to Set-Sharing: we define a new representation that leverages the complement (or negative) sharing relationships of the original sharing set, without loss of accuracy. Intuitively, given an abstract state sh\> over the finite set of variables of interest V, its negative representation is p(V) \ shy. Using this encoding during analysis dramatically reduces the number of elements that need to be represented in the abstract states and during abstract uniflcation as the cardinality of the original set grows toward 2 . To further compress the number of elements, we express the set-sharing relationships through a set of ternary strings that compacts the representation by eliminating redundancies among the sharing sets. Our experiments show that our approach can compress the number of relationships, reducing signiflcantly the memory usage and running time of all abstract operations, including abstract uniflcation.

Sharing analysis of arrays, collections, and recursive structures

Precise modeling of the program heap is fundamental for understanding the behavior of a program, and is thus of signiflcant interest for many optimization applications. One of the fundamental properties of the heap that can be used in a range of optimization techniques is the sharing relationships between the elements in an array or collection. If an analysis can determine that the memory locations pointed to by different entries of an array (or collection) are disjoint, then in many cases loops that traverse the array can be vectorized or transformed into a thread-parallel versión. This paper introduces several novel sharing properties over the concrete heap and corresponding abstractions to represent them. In conjunction with an existing shape analysis technique, these abstractions allow us to precisely resolve the sharing relations in a wide range of heap structures (arrays, collections, recursive data structures, composite heap structures) in a computationally efflcient manner. The effectiveness of the approach is evaluated on a set of challenge problems from the JOlden and SPECjvm98 suites. Sharing information obtained from the analysis is used to achieve substantial thread-level parallel speedups.