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The quality of maternity care in the United States is variable, and access to care is tenuous for rural residents, low-income individuals, and people of color. Without accessible, timely, and high-quality care, certain clinical and sociodemographic characteristics of individuals may render them more vulnerable to poor birth outcomes. However, risk factors for poor birth outcomes do not occur in a vaccum; rather, health care financing, delivery, and organization as well as the policy environment shape the context in which patients seek and receive maternity care. This paper describes the relationship between access and quality in maternity care and offers a systems-level perspective on the innovations and strategies needed in research, clinical care, and policy to improve equity in maternal and infant health., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Hospitals are perpetually challenged by concurrently improving the quality of healthcare and maintaining financial solvency. Both issues are among the top concerns for hospital executives across the United States, yet some have questioned if the efforts to enhance quality are financially sustainable. Thus, the aim of this study is to examine if efforts to improve quality in the hospital setting have a corresponding association with hospital profitability. Recent and directly relevant research on this topic is very limited, leaving practitioners uncertain about the wisdom of their investments in interventions which enhance quality and patient safety. We assessed if eight different quality measures were associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Using multivariate regression, we found that improving quality was significantly associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Significant findings were reported for seven of eight quality measures tested, including the HCAHPS Summary Star Rating (p < 0.001), Hospital Compare Overall Rating (p < 0.001), All-Cause Hospital-Wide Readmission Rate (p < 0.01), Total Performance Score (p < 0.001), Safety Domain Score (p < 0.01), Person and Community Engagement Domain Score (p < 0.001), and the Efficiency and Cost Reduction Score (p < 0.001). Failing to address quality and patient safety issues is costly for US hospitals. We believe our findings support the premise that increased attention to the quality of care delivered as well as patients' perceptions of care may allow hospitals to accentuate profitability and advance a hospital's financial position. [ABSTRACT FROM AUTHOR]

The article discusses resource use and costs in acute on chronic liver failure (ACLF) transplantation, payment models that affect transplant centers' willingness to service the sickest patients, and the emerging trend of value-based payments that link costs to outcomes as of 2023.

A large body of empirical research in accounting investigates the causes and consequences of accruals quality, reaching numerous influential conclusions. Yet little work has been done to systematically evaluate the validity of the underlying measures of accruals quality. We evaluate these measures using three criteria: (1) Is the measure unaffected by the underlying economic determinants of accruals? (2) Does the measure consistently reflect errors in accruals? (3) Does the measure facilitate tests with sufficient power to detect plausible variation in accrual errors? Using a combination of theoretical modeling and numerical simulations, we show that all measures fail at least one of these criteria. Our evaluation provides new interpretations of existing research and guides the choice of measures and the interpretation of results in future research. Data Availability: Data are available from the public sources identified in the paper. JEL Classifications: M41; C12. [ABSTRACT FROM AUTHOR]

Background: State-level child care quality rating and improvement systems (QRIS) have been implemented in a majority of states in the U.S.A. One goal is to improve developmental outcomes for young children, especially from families with fewer resources. Research is needed to determine if QRIS can produce quality improvements that will support the development of children from birth to three years. Objective: Explore the association of toddlers' growth trajectories over two years with their participation in varying quality-rated levels of child care. Methods: In this two-year longitudinal study of 75 toddlers (M age = 15.5 months; SD = 2.36) children's cognitive and social-emotional growth trajectories were estimated in three assessments, 12 months apart. All toddlers were low-income Child Care and Development Fund voucher recipients, cared for by child care providers within a Midwestern state's voluntary QRIS. QRIS-rated child care quality, caregiver education level, and child–adult ratio were observed in parallel with individual cognitive and social-emotional child assessments. Growth analyses controlled for parent education, child race, ethnicity, disability status, and gender. Results: Toddlers who received care in settings rated highest by the QRIS and those with caregivers who had higher education levels progressed at significantly higher rates of development in early learning skills, compared with toddlers placed in QRIS-rated lower quality settings or with caregivers with less education. Conclusions: State-level QRIS have the potential to inform parents' and policymakers' decisions about child care quality associated developmental outcomes for children under three years of age. Especially important is the role of QRIS in incentivizing the educational preparation of toddler caregivers. [ABSTRACT FROM AUTHOR]

Medicaid is integral to public health because it insures one in five Americans and half of the nation's births. Nearly two-thirds of all Medicaid recipients are currently enrolled in a health maintenance organization (HMO). Proponents of HMOs argue that they can lower costs while maintaining access and quality. We critically reviewed 32 studies on Medicaid managed care (2011-2019). Authors reported state-specific cost savings and instances of increased access or quality with implementation or redesign of Medicaid managed-care programs. Studies on high-risk populations (e.g., disabled) found improvements in quality specific to a state or a high-risk population. A unique model of managed care (i.e., the Oregon Health Plan) was associated with reduced costs and improved access and quality, but results varied by comparison state. New trends in the literature focused on analysis of auto-assignment algorithms, provider networks, and plan quality. More analysis of costs jointly with access/quality is needed, as is research on managing long-term care among elderly and disabled Medicaid recipients. [ABSTRACT FROM AUTHOR]

Objectives: To examine metabolic monitoring rates in commercially insured children and adolescents treated with a second-generation antipsychotic (SGA) during calendar years (CYs) 2016 and 2017. Methods: In this retrospective study, data were collected from a large national commercial health plan for the period covering January 1, 2016 to December 31, 2017. Commercially insured children and adolescents, aged 8-19 years with ≥2 SGA prescription claims during the CY, were identified for the CY2016 and CY2017 cohorts. The primary outcome of interest was the percentage of subjects with any glucose or lipid metabolism parameter monitoring. Other calculated metabolic testing rates included glucose, hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), other cholesterol (including triglycerides), and combined glucose and lipid metabolism testing (≥1 test for blood glucose or HbA1c and ≥1 test for LDL-C or other cholesterol). Results: In CY2016 and CY2017, 1502 and 1239 subjects, respectively, were identified for this study. The most common psychiatric diagnoses in CY2016 and CY2017 were major depressive disorder (57.1%, 56.5%, respectively), anxiety disorders (42.9%, 47.5%), attention-deficit/hyperactivity disorder (41.6%, 45.8%), and bipolar disorder (24.1%, 25.9%). The rate of any metabolic testing was 53.5% in CY2016 and 51.3% in CY2017. Glucose testing (50.3%, 46.9%, respectively) was most common in both CYs, followed by LDL-C testing (31.2%, 28.5%). Rates of combined glucose and lipid metabolism testing were 30.7% in CY2016 and 26.9% in CY2017. Conclusions: Given the known potential for adverse cardiometabolic effects, rates of metabolic monitoring associated with SGA use in children and adolescents urgently need to be improved. There is a critical need for understanding barriers to routine monitoring, particularly of lipids, and developing interventions to enhance metabolic monitoring. [ABSTRACT FROM AUTHOR]

Context: State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. Method: This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Findings: Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. Conclusion: State regulations restricting NP SoP do not improve the quality of care. [ABSTRACT FROM AUTHOR]

Using data from a subsample of 913 study children and their friends who participated in the NICHD Study of Early Child Care and Youth Development, the interactive contributions of child-reported attribution biases and teacher-reported child emotional intensity (EI) at Grade 4 (M = 9.9 years) to observed child-friend interaction at Grade 6 (M = 11.9 years) were examined. Study children's hostile attribution bias, combined with high EI, predicted more negative child-friend interaction. In contrast, benign attribution bias, combined with high EI, predicted more positive child-friend interaction. The findings are discussed in light of the "fuel" interpretation of EI, in which high-intensity emotions may motivate children to act on their cognitive biases for better or for worse. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of alternative methods of aggregating individual quality measures on Accountable Care Organization (ACO) overall scores.Data Source: 2014 quality scores for Medicare ACOs.Study Design: We compare ACO overall scores derived using CMS' aggregation approach to those derived using alternative approaches to grouping and weighting measures.Principal Findings: Alternative grouping and weighting methods based on statistical criteria produced overall quality scores similar to those produced using CMS' approach (κ = 0.80 to 0.95). Scores derived from giving specific domains greater weight were less similar (κ = 0.51 to 0.93).Conclusions: How measures are grouped into domains and how these domains are weighted to generate overall scores can have important implications for ACO's shared savings payments. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC).Data Sources/study Setting: Secondary claims data from fiscal years 2008-2010. The sample included nonelderly Medicaid beneficiaries with at least two of eight target conditions (asthma, chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, seizure disorder, major depressive disorder, and schizophrenia).Study Design: We used linear probability models with person- and year-level fixed effects to examine the association between patient-centered medical home (PCMH) enrollment and nine disease-specific quality-of-care metrics, controlling for selection bias and time-invariant differences between enrollees.Data Collection Methods: This study uses a dataset that links Medicaid claims with other administrative data sources.Principal Findings: Patient-centered medical home enrollment was associated with an increased likelihood of receiving eight recommended mental and physical health services, including A1C testing for persons with diabetes, lipid profiles for persons with diabetes and/or hyperlipidemia, and psychotherapy for persons with major depression and persons with schizophrenia. PCMH enrollment was associated with overuse of short-acting β-agonists among beneficiaries with asthma.Conclusions: The PCMH model can improve quality of care for patients with multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Objective: To compare the quality of care following admission to a nursing home (NH) with and without a dementia special care unit (SCU) for residents with dementia.Data Sources/study Setting: National resident-level minimum dataset assessments (MDS) 2005-2010 merged with Medicare claims and provider-level data from the Online Survey, Certification, and Reporting database.Study Design: We employ an instrumental variable approach to address the endogeneity of selection into an SCU facility controlling for a range of individual-level covariates. We use "differential distance" to a nursing home with and without an SCU as our instrument.Data Collection/extraction Methods: Minimum dataset assessments performed at NH admission and every quarter thereafter.Principal Findings: Admission to a facility with an SCU led to a reduction in inappropriate antipsychotics (-9.7 percent), physical restraints (-9.6 percent), pressure ulcers (-3.3 percent), feeding tubes (-8.3 percent), and hospitalizations (-14.7 percent). We found no impact on the use of indwelling urinary catheters. Results held in sensitivity analyses that accounted for the share of SCU beds and the facilities' overall quality.Conclusions: Facilities with an SCU provide better quality of care as measured by several validated quality indicators. Given the aging population, policies to promote the expansion and use of dementia SCUs may be warranted. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of the 2014 Medicaid expansion on Medicaid managed care plan quality.Data Sources: Three composite measures of plan-level quality constructed from the Health Care Effectiveness Data and Information Set.Study Setting: One hundred and sixty-three plans in 27 Medicaid expansion states and 100 plans in 14 nonexpansion states.Study Design: Quasi-experimental difference-in-differences (DID) analysis, comparing quality before (2011-13) and after (2014-15) Medicaid expansion in states that elected to expand Medicaid eligibility and those that did not.Principal Findings: Mean plan enrollment increased from 130,533 to 274,259 in expansion states and from 105,449 to 148,194 in nonexpansion states. The proportion of enrollees receiving recommended preventive care increased from 62.6 to 65.2 percent in expansion states and from 59.3 to 62.5 percent in nonexpansion states (adjusted DID: -0.7 percentage points [95% CI -2.2, 0.7]). The proportion of enrollees receiving recommended chronic disease care management increased from 65.4 to 66.0 percent in expansion states and from 62.5 to 63.1 percent in nonexpansion states (adjusted DID: 1.1 percentage points [95% CI -0.5, 2.6]). We observed similar patterns for the receipt of recommended maternity care.Conclusions: Medicaid expansion increased enrollment in managed care plans, but it did not result in erosion of quality. [ABSTRACT FROM AUTHOR]

Objective: To find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics.Data Sources/study Setting: Twenty-nine thousand five hundred and sixty-two adult patients with diabetes seen at eight Midwestern U.S. health systems during 2010-2011.Study Design: We retrospectively evaluated the relationship between six diabetes quality metrics and patients' combinations of chronic conditions. We analyzed 12 conditions that were concordant with diabetes care to define five mutually exclusive combinations of conditions ("classes") based on condition co-occurrence. We used logistic regression to quantify the relationship between condition classes and quality metrics, adjusted for patient demographics and utilization.Data Collection: We extracted electronic health record data using a standardized algorithm.Principal Findings: We found the following condition classes: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. Adjusted odds ratios and 95 percent confidence intervals for glycemic control were, respectively, 1.95 (1.7-2.2), 1.6 (1.4-1.9), 1.3 (1.2-1.5), and 1.3 (1.2-1.4) compared to the class with no comorbidities. Results showed similar patterns for other metrics.Conclusions: Patients had distinct quality metric achievement by condition class, and those in less severe classes were less likely to achieve diabetes metrics. [ABSTRACT FROM AUTHOR]

Purpose Nurse practitioner (NP) regulation and physician oversight (PO) of NP practice are inextricably intertwined. A flexible, well-prepared workforce is needed to meet consumer healthcare needs. All outcome studies have revealed that NPs provide safe, effective, quality care with outcomes equal to or better than that of physicians or physician assistants. Variability in state regulation of NP practice limits the full deployment of these proven healthcare providers, threatens the quality and safety of NP-delivered care, and limits consumer choice in healthcare access. The purpose of this study was to document NP perceptions of the impact of PO on the safety and quality of NP practice. Data sources A total of 1139 NP respondents completed an exploratory survey, Impact of Regulatory Requirements for Physician Oversight on Nurse Practitioner Practice. Participants were asked their perceptions of the impact of PO on patient care and NP practice. Descriptive statistics on the state of residence regulatory requirements and personal demographics were also collected. Conclusions NP perceptions of the impact of PO on the safety and quality of NP practice were predicted by NP experience and state regulatory environment ranking. Implications for practice The results of this study have implications for educators, policy makers, and nursing advocacy groups seeking to increase access to care in U.S. populations. Study participants perceived that requirements for PO impacted their practice and may jeopardize patient safety. An understanding of the impact of influences on regulatory processes is critical to ensuring full deployment of NPs as interprofessional leaders to meet current and future healthcare access. [ABSTRACT FROM AUTHOR]

Background: As the population ages, the prevalence of myelodysplastic syndromes (MDS) will increase, and many patients with MDS will require end-of-life (EOL) care. Little is known about the intensity of EOL care received by patients with these malignancies.Methods: Using the Surveillance, Epidemiology, and End Results-Medicare database and standard EOL quality measures, we assessed the prevalence and predictors of intensive care unit (ICU) admission in the last 30 days of life, chemotherapy in the last 14 days of life, and hospice enrollment among MDS patients who were 65 years old or older and died between 2006 and 2011.Results: Of 6,955 patients, 28% were admitted to the ICU and 7% received chemotherapy near the EOL, while 49% enrolled in hospice. In multivariable models, patients dependent on red blood cell or platelet transfusions at the EOL were less likely to enroll in hospice (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.61-0.78). Nonwhite patients were less likely to enroll in hospice (OR, 0.77; 95% CI, 0.67-0.89) and more likely to be admitted to the ICU near the EOL (OR, 1.19; 95% CI, 1.03-1.38). Finally, the prevalence of hospice enrollment increased in later years (P < .001).Conclusions: The intensity of EOL care for patients with MDS varies but is potentially suboptimal with respect to the traditional measure of hospice use. The lower odds of enrollment for transfusion-dependent patients suggest that the current hospice model, which largely disallows transfusions, may not be meeting the palliative needs of this population. [ABSTRACT FROM AUTHOR]

Objectives To identify the risks of the combination of normal body mass index ( BMI) and central obesity (normal weight and central obesity ( NWCO)) on physical activity and function. Design Longitudinal Osteoarthritis Initiative Study. Setting Community based. Participants Adults aged 60 and older at risk of osteoarthritis (N = 2,210; mean age 68, range 67.1-69.0) were grouped according to BMI (normal 18.5-24.9 kg/m2, overweight 25.0-29.9 kg/m2, obese ≥30.0 kg/m2). High waist circumference ( WC) was defined as greater than 88 cm for women and greater than 102 cm for men. Subjects were subcategorized according to WC (five categories). Subjects with normal BMI and a large WC were considered to have NWCO (n = 280, 12.7%). Measurements Six-year changes in the Physical Component Summary of the Medical Outcomes Study 12-item Short Form Survey ( PCS), Physical Activity Scale for the Elderly ( PASE), and Late-Life Function and Disability Index ( LL- FDI) were examined. The association between BMI and WC over 6 years was assessed (reference normal BMI, normal WC). Stratified analyses were performed according to age (60-69; ≥70). Results Physical component scores, PASE, and LL- FDI declined with time. Mean PASE scores at 6 years differed between the NWCO group and the group with normal BMI and WC (117.7 vs 141.5), but rate of change from baseline to 6 years was not significantly different ( P = .35). In adjusted models, those with NWCO had greater decline in PCS over time, particularly those aged 70 and older than those with normal BMI and WC (time interaction β = −0.37, 95% confidence interval = −0.68 to −0.06). Conclusion Normal weight and central obesity in older adults at risk of osteoarthritis may be a risk factor for declining function and physical activity, particularly in those aged 70 and older, suggesting the value of targeting those with NWCO who would otherwise be labeled as low risk. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to describe the culture of medical groups and determine the factors which influence such cultures. It notes that a qualitative study of the organizational cultures of eight multispecialty medical groups has been conducted, utilizing data gathered during site visits and thorough interviews with clinical and administrative staff. It reveals that a multiplicity and diversity in cultures occur such as patient-centered, physician-centered, rational cultures.

Background: Public reporting of provider performance can assist consumers in their choice of providers and stimulate providers to improve quality. Reporting of quality measures is supported by advocates of health care reform across the political spectrum.Objective: To assess the availability, credibility and applicability of existing public reports of hospital and physician quality, with comparisons across geographic areas.Approach: Information pertaining to 263 public reports in 21 geographic areas was collected through reviews of websites and telephone and in-person interviews, and used to construct indicators of public reporting status. Interview data collected in 14 of these areas were used to assess recent changes in reporting and their implications.Participants: Interviewees included staff of state and local associations, health plan representatives and leaders of local health care alliances.Results: There were more reports of hospital performance (161) than of physician performance (103) in the study areas. More reports included measures derived from claims data (mean, 7.2 hospital reports and 3.3 physician reports per area) than from medical records data. Typically, reports on physician performance contained measures of chronic illness treatment constructed at the medical group level, with diabetes measures the most common (mean number per non-health plan report, 2.3). Patient experience measures were available in more hospital reports (mean number of reports, 1.2) than physician reports (mean, 0.7). Despite the availability of national hospital reports and reports sponsored by national health plans, from a consumer standpoint the status of public reporting depended greatly on where one lived and health plan membership.Conclusions: Current public reports, and especially reports of physician quality of care, have significant limitations from both consumer and provider perspectives. The present approach to reporting is being challenged by the development of new information sources for consumers, and consumer and provider demands for more current information. [ABSTRACT FROM AUTHOR]

Aim. To examine the association between nurses’ reports of unmet nursing care needs and their reports of patients’ receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals. Background. Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes. Design. Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US. Methods. Multivariate linear regression models estimated the effect of unmet nursing care needs on adverse events given the influence of patient factors and the care environment. Results. The proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. However, nurses who reported that these adverse events occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event. Conclusion. The findings suggest that attention to optimising patient care delivery could result in a reduction in the occurrence of adverse events in hospitals. Relevance to clinical practice. The occurrence of adverse events may be mitigated when nurses complete care activities that require them to spend time with their patients. Hospitals should engage staff nurses in the creation of policies that influence human resources management to enhance their awareness of the care environment and patient care delivery. [ABSTRACT FROM AUTHOR]

Background: The frequency of early repeat and follow-up tests (RAFTs) occurring after colonoscopy has not been previously examined in the literature. RAFTs incur cost, discomfort, and inconvenience to patients who have undergone colonoscopic examination; therefore, it is important to identify factors associated with their use.Methods: We identified elderly Medicare recipients who had colonoscopy performed in 1999 from the 5% Medicare administrative files (N = 69,282). We determined the number of early RAFTs (repeat colonoscopy, barium enema, flexible sigmoidoscopy) occurring within the year of initial colonoscopy.Results: Of the study sample, 8.3% required at least one RAFT during the year. Using multivariable analysis, we found that RAFTs varied significantly with age, race, sex, income, comorbidity, provider type, and place of service. RAFTs were 22% higher in African Americans compared to whites. Gastroenterologists used 20-35% fewer RAFTs than the other provider types performing colonoscopy.Conclusions: The frequency of early RAFTs after colonoscopy occurs in 8.3% of the Medicare population. Important differences exist in the frequency of RAFTs by race and provider type. [ABSTRACT FROM AUTHOR]

The article presents abstracts of articles about planning including those focusing on settlement house work and social reform, the development of heating and cooking technology in the U.S. in the 19th century and emergence of historic sites as tourist destinations in the U.S. in the late 19th century.

Purpose. An overview of the emerging field of comparative effectiveness research (CER) and its relevance to pharmacists and pharmacy-based decision-makers is provided. Summary. The U.S. government is investing over $1 billion on CER over the next two years. This investment is in part driven by the recognition that, despite having the highest per capita health care expenditures in the world, the United States does not always perform well on measures of health compared with other countries. There also is increased awareness of the limited information provided by results of traditional randomized clinical trials to inform decisions about therapeutic alternatives as applied in actual practice. Comparative effectiveness studies have two important principal components: (1) the comparison of two or more agents or interventions that are considered true therapeutic alternatives and (2) the examination of effects (outcomes) in actual practice. Comparative effectiveness studies differ from traditional efficacy studies in several ways, including the research question addressed, comparison groups, patient population, setting, outcomes measured, and validity. Studies that are within the scope of CER can be categorized as primary comparative effectiveness studies or secondary comparative effectiveness studies. CER also can be used to compare medical devices, procedures, health services, or any competing intervention. Conclusion. Comparative effectiveness is an emerging area of research relevant to many areas of health care, especially pharmacotherapy. The knowledge gained from CER is important to pharmacists when applying drug information and making decisions related to drug therapy. [ABSTRACT FROM AUTHOR]

The article presents abstracts on city planning-related topics, including visions of waterfront development in postindustrial Philadelphia, the construction of a town planning perception of Colombo, and city planning and the U.S. census.

Scores of talented and dedicated people serve the forensic science community, performing vitally important work. However, they are often constrained by lack of adequate resources, sound policies, and national support. It is clear that change and advancements, both systematic and scientific, are needed in a number of forensic science disciplines to ensure the reliability of work, establish enforceable standards, and promote best practices with consistent application. Strengthening Forensic Science in the United States: A Path Forward provides a detailed plan for addressing these needs and suggests the creation of a new government entity, the National Institute of Forensic Science, to establish and enforce standards within the forensic science community. The benefits of improving and regulating the forensic science disciplines are clear: assisting law enforcement officials, enhancing homeland security, and reducing the risk of wrongful conviction and exoneration. Strengthening Forensic Science in the United States gives a full account of what is needed to advance the forensic science disciplines, including upgrading of systems and organizational structures, better training, widespread adoption of uniform and enforceable best practices, and mandatory certification and accreditation programs. While this book provides an essential call-to-action for congress and policy makers, it also serves as a vital tool for law enforcement agencies, criminal prosecutors and attorneys, and forensic science educators. This article is the Executive Summary of Strengthening Forensic Science in the United States and permission was graciously provided by the National Academies of Science to reprint it here. [ABSTRACT FROM AUTHOR]

Scientific-funding bodies are increasingly under pressure to use journal rankings to measure research quality. Hiring and promotion committees routinely hear an equivalent argument: ‘this is important work because it is to be published in prestigious journal X’. But how persuasive is such an argument? This paper examines data on citations to articles published 25 years ago. It finds that it is better to write the best article published in an issue of a medium-quality journal such as the OBES than all four of the worst four articles published in an issue of an elite journal like the AER. Decision-makers need to understand this. [ABSTRACT FROM AUTHOR]

Building on research that has studied cultural differences between South Korea and the USA, the authors' conceptualization suggests that products associated with fixed and discounted price formats would be evaluated differently in these two countries. The differences in product evaluations were expected to lead to differences in perceptions of quality monetary sacrifice and value of offers between the two pricing formats. These predictions were tested using laboratory experiments conducted in South Korea and the USA. Results showed that Korean subjects' evaluated a product that was discounted in price to be superior in quality and value and lower in monetary sacrifice than when it was the full price. The US subjects however, reacted in an opposite manner and evaluated products with discounted prices as inferior in quality and value in comparison to a fixed price. These findings were robust across two discount conditions (15 percent and 20 percent off). [ABSTRACT FROM AUTHOR]

Supervision of offenders in the community remains a critical component of the correctional processes in the United States. With almost six million offenders under correctional supervision in the community, there has been relatively little attention and few resources devoted to the style and quality of supervision received by these offenders. As a result of the lack of research regarding the style of probation and parole supervision, there is a need to identify and quantify styles of casework and surveillance supervision. This article describes a research project that identifies the key functions of parole and probation officers, reports self- and peer-rating on a casework to surveillance continuum, and establishes an instrument that can be used to create baseline information regarding how probation and parole officers spend their time, and whether the functions officers perform are casework, surveillance, or a balance of the two. [ABSTRACT FROM AUTHOR]

The study objective was to examine quality oversight efforts by Medicaid managed care organizations (MCOs) for children in a sample of ambulatory care institutions and private practices in New York City. This was a cross-sectional study of quality assurance priorities and strategies of MCOs and their impact date in institutions in New York City. Data were from structured interviews administered in 1997 to medical directors in the eight largest MCOs; and medical directors, heads of ambulatory pediatrics, and institutional pediatricians in a random sample of 15 institutions and 20 private office-based providers. Medical directors in MCOs reported that their main priority areas were the preventive care measures (e.g., immunization and lead screening) that they must report to the state. Knowledge of these MCO priority areas and monitoring activities was high for medical directors in the random sample, but decreased from these medical directors to heads of ambulatory pediatrics to institutional pediatricians, with the differences between the medical directors and institutional pediatricians significant (P < .05). However, 96% of the institutional pediatricians reported knowing their own institution's priorities and monitoring activities. In contrast, most private pediatricians reported they knew MCO priorities and monitoring activities (80%). Less than 33% of any group reported activities as "very effective" or felt any incentive to improve performance. There was a high level of overlap in provider networks, with institutions and private providers having children in many MCOs, and MCOs having children in many sites. Conclusions. The current model of quality oversight is producing reports for the state, but is not translating into effective strategies at the provider level. The need to work through the leadership in institutions to influence quality is highlighted. The level of overlap in provider networks suggests the need for collaboration among MCOs in quality monitoring. [ABSTRACT FROM AUTHOR]

The Census of Agriculture is an important source of data for persons interested in studying the structure of agriculture. The census has been used to study agriculture and quality of life in Kansas recently and aggregated state level data was used to describe the relationship between farm size, agriculture and energy consumption. As sociological interest in agriculture, grows, it is likely that the Census of Agriculture will become the source of many more studies. Unfortunately, the units of analysis reported in the Census of Agriculture like-aggregate national, state and county statistics-create problems for those who use them for sociological purposes. This short article will illustrate some of the problems inherent in the use of census materials by reexamining some of the data used on recent papers on energy and agriculture. A serious difficulty posed by the use of census material for sociological research stems from the fact that census data are aggregated on the bases of political units like states and counties.

The article focuses on the quality of reading research in the U.S. Research studies that was submitted gives the editors some perspective on the state of reading research both in terms of the quality of the research and the quality of research writing. This state of reading research is not something that has gone unrecognized. Many of the doctoral programs in reading in universities throughout the country emphasize the development of reading specialists who are being educated to be teacher trainers rather than training reading researchers.

The article discusses the importance for international nurses to establish rapport in providing care and treatment to patients in the U.S. It stresses the need to build positive relationship with clients to develop trust, credibility, and competence among nurses. International nurses are encouraged to learn the country's customs, norms and regional cultural differences, as well as to use a variety of resources and strategies to learn how to establish rapport with clients and patients and to eliminate their unfavorable perception of quality of care. The tips in building relationships with patients are presented.

The idea of a nationwide survey to examine the quality of undergraduate education has arisen in several venues in the U.S. One of the first times was eight years ago, when the notion of such a survey was mooted as a way to obtain a proxy measure of collegiate attainment as part of the National Education Goals process. The argument then, as now, was that much is known through research about the factors responsible for high gains in collegiate learning, embodied in such documents is the well-known Wingspread Seven Principles of Good Practice. Since that time, several states (most notably North Carolina) have instituted regular surveys that include good-practice items, but the idea of a national survey has remained just that-an idea.