scholarly journals Governing Migration through Multi‐Level Governance? City Networks in Europe and the United States *

2021 ◽  
Author(s):  
Tiziana Caponio
Keyword(s):  
United States ◽  
The United States ◽  
Multi Level

scholarly journals Gender disparities in opioid treatment progress in methadone versus counseling

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Erick Guerrero ◽  
Hortensia Amaro ◽  
Yinfei Kong ◽  
Tenie Khachikian ◽  
Jeanne C. Marsh
Keyword(s):  
United States ◽  
Treatment Outcomes ◽  
Treatment Plan ◽  
Dropout Rate ◽  
The United States ◽  
Gender Disparities ◽  
Opioid Use ◽  
Lower Odds ◽  
Male Clients ◽  
Multi Level

Abstract Background In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States. Methods Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs. Results We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients. Conclusions Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.

Multi-level drivers of tobacco use and purchasing behaviors during COVID-19 “lockdown”: A qualitative study in the United States

2021 ◽  
Vol 94 ◽  
pp. 103175
Author(s):  
Daniel P. Giovenco ◽  
Torra E. Spillane ◽  
Rachel M. Maggi ◽  
Esther Y. Lee ◽  
Morgan M. Philbin
Keyword(s):  
United States ◽  
Qualitative Study ◽  
Tobacco Use ◽  
The United States ◽  
Multi Level

scholarly journals Multi-level water governance without integrated water resources management (IWRM): cooperation in the Columbia River Basin

2020 ◽  
Vol 23 ◽  
Author(s):  
Armando Gallo Yahn Filho
Keyword(s):  
United States ◽  
Water Resources ◽  
River Basin ◽  
Water Resources Management ◽  
Columbia River ◽  
Integrated Water Resources Management ◽  
The United States ◽  
Columbia River Basin ◽  
Resources Management ◽  
Multi Level

Abstract International basins are divided into sub-basins that can be managed at the international, national and local levels, separately or together. Regarding the international level, many actors, beyond the States, participate in water management. This work is a case study on the Columbia River Basin (CRB), which is shared by the United States and Canada and its waters drain off into the Pacific Ocean. There are two theoretical foundations: multi-level governance and integrated water resources management (IWRM). Then, this work will demonstrate the impossibility of implementing IWRM in the CRB, even though there is multi-level governance within it, which allows cooperation between the United States and Canada, avoiding the risk of conflict in this basin.

A multi-level modeling approach to understanding residential segregation in the United States

2018 ◽  
Vol 45 (6) ◽  
pp. 1090-1105 ◽  
Author(s):  
Mariana C Arcaya ◽  
Gabriel Schwartz ◽  
SV Subramanian
Keyword(s):  
United States ◽  
Census Data ◽  
Multiple Scales ◽  
The United States ◽  
Residential Patterns ◽  
Geographic Concentration ◽  
Modeling Approach ◽  
Relative Contribution ◽  
Multi Level ◽  
Block Groups

A well-known limitation of commonly used segregation measures is their inability to describe patterns at multiple scales. Multi-level modeling approaches can describe how different levels of geography contribute to segregation, but may be difficult to interpret for non-technical audiences and have rarely been applied in the US context. This paper provides a readily interpretable description of multi-scale Black–non-Black segregation in the United States using a multi-level modeling approach and the most recent Census data available. We fit a three-level random intercept multi-level logistic regression model predicting the proportion of the population that is Black (Hispanic and non-Hispanic) at the block group level, with block groups nested in tracts and tracts nested in Metropolitan Statistical Areas (MSAs). For the 102 largest MSAs in the United States, we then estimated the extent to which micro- versus meso-level variability drives overall racial residential patterning within the MSA. Finally, we created a typology of racial residential patterning within MSAs based on the total proportion of the MSA population that is Black and the relative contribution of block groups (micro) versus tracts (meso) in driving variation. We find that nearly 80% of the national variation in the geographic concentration of Black residents is driven by within-MSA, tract-level processes. However, the relative contribution of small versus larger scales to within-MSA segregation varies substantially across metropolitan areas. We detect five meaningfully different types of metropolitan segregation across the largest MSAs. Multi-level descriptions of segregation may help planners and policymakers understand how and why segregated residential patterns are evolving in different places and could provide important insights into interventions that could improve integration at multiple scales.

Cervical Laminoplasty Construct Stability: A Finite Element Study

2008 ◽  
Author(s):  
Srinivas C. Tadepalli ◽  
Nicole A. Kallemeyn ◽  
Kiran H. Shivanna ◽  
Joseph Smucker ◽  
Douglas C. Fredericks ◽  
...  
Keyword(s):  
United States ◽  
Finite Element ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
The United States ◽  
Cervical Laminoplasty ◽  
Finite Element Study ◽  
Multi Level ◽  
Laminectomy And Fusion ◽  
Element Study

Cervical laminoplasty is one of many modern techniques utilized in the management of cervical myelopathy. In the United States cervical spondylotic myelopathy (CSM) has been classically treated with multilevel decompression and fusion. Furthermore, multi-level anterior cervical decompression and fusion (ACDF), via disectomies or corpectomies, and multi-level cervical laminectomy and fusion have been well described [1]. In the last decade cervical laminoplasty has grown in popularity as a non-fusion alternative that allows multi-level cervical decompression.

Sign in / Sign up

Export Citation Format

Share Document