A world away and here at home: a prioritisation framework for US international patient programmes

2021 ◽  
pp. medethics-2020-106772
Author(s):  
Emily Berkman ◽  
Jonna Clark ◽  
Douglas Diekema ◽  
Nancy S Jecker
Keyword(s):  
Catchment Area ◽  
Home Country ◽  
Geographical Area ◽  
Healthcare Services ◽  
Clinical Expertise ◽  
Geographic Population ◽  
General Duty ◽  
Healthcare Needs ◽  
The Us ◽  
The Usa

Programmes serving international patients are increasingly common throughout the USA. These programmes aim to expand access to resources and clinical expertise not readily available in the requesting patients’ home country. However, they exist within the US healthcare system where domestic healthcare needs are unmet for many children. Focusing our analysis on US children’s hospitals that have a societal mandate to provide medical care to a defined geographic population while simultaneously offering highly specialised healthcare services for the general population, we assume that, given their mandate, priority will be given to patients within their catchment area over other patients. We argue that beyond prioritising patients within their region and addressing inequities within US healthcare, US institutions should also provide care to children from countries where access to vital medical services is unavailable or deficient. In the paper, we raise and attempt to answer the following: (1) Do paediatric healthcare institutions have a duty to care for all children in need irrespective of their place of residence, including international patients? (2) If there is such a duty, how should this general duty be balanced against the special duty to serve children within a defined geographical area to which an institution is committed, when resources are strained? (3) Finally, how are institutional obligations manifest in paradigm cases involving international patients? We start with cases, evaluating clinical and contextual features as they inform the strength of ethical claim and priority for access. We then proceed to develop a general prioritisation framework based on them.

Cigarette and cigar sales in Hawaii before and after implementation of a Tobacco 21 Law

2020 ◽  
Vol 30 (1) ◽  
pp. 98-102 ◽  
Author(s):  
Rebecca Glover-Kudon ◽  
Doris G Gammon ◽  
Todd Rogers ◽  
Ellen M Coats ◽  
Brett Loomis ◽  
...  
Keyword(s):  
Large Scale ◽  
Geographical Area ◽  
Upward Trend ◽  
Food Stores ◽  
The Us ◽  
Before And After ◽  
Youth And Young Adults ◽  
The Usa ◽  
Product Sales ◽  
The Impact

IntroductionOn 1 January 2016, Hawaii raised the minimum legal age for tobacco access from 18 to 21 years (‘Tobacco 21 (T21)’) statewide, with no special population exemptions. We assessed the impact of Hawaii’s T21 policy on sales of cigarettes and large cigars/cigarillos in civilian food stores, including menthol/flavoured product sales share.MethodsCigarette and large cigar/cigarillo sales and menthol/flavoured sales share were assessed in Hawaii, California (implemented T21 in June 2016 with a military exemption), and the US mainland using the only Nielsen data consistently available for each geographical area. Approximate monthly sales data from large-scale food stores with sales greater than US$2 million/year covered June 2012 to February 2017. Segmented regression analyses estimated changes in sales from prepolicy to postpolicy implementation periods.ResultsFollowing T21 in Hawaii, average monthly cigarette unit sales dropped significantly (−4.4%, p<0.01) coupled with a significant decrease in menthol market share (−0.8, p<0.01). This combination of effects was not observed in comparison areas. Unit sales of large cigars/cigarillos decreased significantly in each region following T21 implementation. T21 policies in Hawaii and California showed no association with flavoured/menthol cigar sales share, but there was a significant increase in flavoured/menthol cigar sales share in the USA (7.1%, p<0.01) relative to Hawaii’s implementation date, suggesting T21 may have attenuated an otherwise upward trend.ConclusionsAs part of a comprehensive approach to prevent or delay tobacco use initiation, T21 laws may help to reduce sales of cigarette and large cigar products most preferred by US youth and young adults.

scholarly journals A transboundary dilemma: dichotomous designations of Atlantic halibut status in the Northwest Atlantic

2016 ◽  
Vol 73 (7) ◽  
pp. 1798-1805 ◽  
Author(s):  
Nancy L. Shackell ◽  
Kenneth T. Frank ◽  
Janet A. Nye ◽  
Cornelia E. den Heyer
Keyword(s):  
Geographical Area ◽  
Suitable Habitat ◽  
Atlantic Halibut ◽  
Stock Structure ◽  
Marine Stewardship Council ◽  
Stock Assessments ◽  
The Us ◽  
The Usa ◽  
Us Endangered Species Act ◽  
Trawl Surveys

Abstract We investigated conflicting perspectives over a transboundary species (Atlantic Halibut-Hippoglossus hippoglossus L.) assumed to be one population spanning the border separating the USA and Canada. In Canada, the fishery is certified as sustainable by the international Marine Stewardship Council (2013). In the USA, that same population is listed as a “Species of Concern” under the US Endangered Species Act (1973). There are fishery-independent trawl surveys conducted by both USA and Canada on juvenile halibut abundance across the border. The data are sorted and both nations use their own jurisdictional boundaries to define the geographical area of their separate stock assessments. Here, we undertake a spatially unified, in-depth comparison of juvenile halibut distribution and abundance, and quantify the amount of suitable habitat for halibut across both sides of the border from 1965 to 2014. Juvenile halibut abundance was, on average, five times greater in Canada than in USA waters. The median per cent of occupied sets in Canada was about four times greater than in the US (2.5%). These differences could not be explained by the availability of “suitable” habitat. The lack of halibut in US waters, in contrast to Canada, suggests a finer-scale stock structure exists and that halibut have not re-established in the USA due to historical serial overfishing. A gradient from high occupancy of halibut in Canada to lower occupancy in the USA is evident, suggestive of connectivity between the two areas and supported by a lag correlation analysis of temporal abundance trends. The USA may now be a sink to Canada's source of halibut. While both countries have been correct in their individual assessments, a bilateral assessment of halibut would benefit both nations, and could include analyses of how fishing patterns in Canada will influence the magnitude and speed of halibut re-colonization in the USA.

Measurement Invariance of a Universal Behavioral Screener Across Samples From the USA and Germany

2018 ◽  
Vol 34 (2) ◽  
pp. 87-100 ◽  
Author(s):  
Gino Casale ◽  
Robert J. Volpe ◽  
Brian Daniels ◽  
Thomas Hennemann ◽  
Amy M. Briesch ◽  
...  
Keyword(s):  
Measurement Invariance ◽  
Student Behavior ◽  
Cross Cultural ◽  
Cross Cultural Comparison ◽  
School Based ◽  
Cultural Research ◽  
Universal Screener ◽  
Confirmatory Factor ◽  
The Us ◽  
The Usa

Abstract. The current study examines the item and scalar equivalence of an abbreviated school-based universal screener that was cross-culturally translated and adapted from English into German. The instrument was designed to assess student behavior problems that impact classroom learning. Participants were 1,346 K-6 grade students from the US (n = 390, Mage = 9.23, 38.5% female) and Germany (n = 956, Mage = 8.04, 40.1% female). Measurement invariance was tested by multigroup confirmatory factor analysis (CFA) across students from the US and Germany. Results support full scalar invariance between students from the US and Germany (df = 266, χ2 = 790.141, Δχ2 = 6.9, p < .001, CFI = 0.976, ΔCFI = 0.000, RMSEA = 0.052, ΔRMSEA = −0.003) indicating that the factor structure, the factor loadings, and the item thresholds are comparable across samples. This finding implies that a full cross-cultural comparison including latent factor means and structural coefficients between the US and the German version of the abbreviated screener is possible. Therefore, the tool can be used in German schools as well as for cross-cultural research purposes between the US and Germany.

Sanctions of the USA and the Policy of Bank of Russia:double Blow to the National Economy

2014 ◽  
pp. 13-29 ◽  
Author(s):  
S. Glazyev
Keyword(s):  
National Security ◽  
Economic Sanctions ◽  
Capital Flight ◽  
Practical Advice ◽  
The Us ◽  
Monetary Authorities ◽  
The Usa ◽  
Simultaneous Adoption ◽  
The Eu

This article examines fundamental questions of monetary policy in the context of challenges to the national security of Russia in connection with the imposition of economic sanctions by the US and the EU. It is proved that the policy of the Russian monetary authorities, particularly the Central Bank, artificially limiting the money supply in the domestic market and pandering to the export of capital, compounds the effects of economic sanctions and plunges the economy into depression. The article presents practical advice on the transition from external to domestic sources of long-term credit with the simultaneous adoption of measures to prevent capital flight.

Possibility of Using in Russia the Experience of LED Lighting Application at the USA Airfields

2019 ◽  
pp. 71-77
Author(s):  
Vladimir V. Vorozhikhin ◽  
Eugenia L. Moreva ◽  
Vladimir G. Starovoytov ◽  
Igor G. Tyutyunnik
Keyword(s):  
Air Transportation ◽  
Improve Quality ◽  
Led Lighting ◽  
The Us ◽  
The Usa ◽  
Quality And Reliability ◽  
Lighting Application

The purpose of this paper is an investigation of LEDs illumination experience at US-based aerodromes with an assessment of its feasibility and its necessity in Russia. The following methods were used: the analysis of aerodrome lighting requirements; the review and the analysis of development features in aerodrome LEDs illumination; the experience analysis of LEDs illumination of US-based aerodromes; the deductive analysis and the assessment synthesis of feasibility and necessity of US experience in LEDs illumination at Russian-based aerodromes. The following results were achieved: – The analysis of issues and opportunities was conducted for development of LEDs illumination at US-based aerodromes and of American experts’ recommendations for its use; – The cases were taken for use and assessment of development in LEDs illumination at US-based aerodromes; – The review and the analysis were conducted in relation to a developing market of LEDs illumination at Russian-based aerodromes. The main conclusion is that the US experience will improve quality and reliability of service provided in air transportation, comfort, and safety of Russian flights, as well as competitiveness of Russian- based airports and airlines (indirectly).

Interaction of Ukrainian Diaspora and the USA Government Regarding Celebration of Ukrainian Independence Day on January 22

2018 ◽  
Vol 1 (47) ◽  
pp. 136-145
Author(s):  
Halyna Shchyhelska
Keyword(s):  
United States ◽  
House Of Representatives ◽  
The United States ◽  
100Th Anniversary ◽  
Totalitarian Regime ◽  
The Public ◽  
Us Congress ◽  
The Us ◽  
Public Consciousness ◽  
The Usa

2018 marks the 100th anniversary of the proclamation of Ukrainian independence. OnJanuary 22, 1918, the Ukrainian People’s Republic proclaimed its independence by adopting the IV Universal of the Ukrainian Central Rada, although this significant event was «wiped out» from the public consciousness on the territory of Ukraine during the years of the Soviet totalitarian regime. At the same time, January 22 was a crucial event for the Ukrainian diaspora in the USA. This article examines how American Ukrainians interacted with the USA Government institutions regarding the celebration and recognition of the Ukrainian Independence day on January 22. The attention is focused on the activities of ethnic Ukrainians in the United States, directed at the organization of the special celebration of the Ukrainian Independence anniversaries in the US Congress and cities. Drawing from the diaspora press and Congressional Records, this article argues that many members of Congress participated in the observed celebration and expressed kind feelings to the Ukrainian people, recognised their fight for freedom, during the House of Representatives and Senate sessions. Several Congressmen submitted the resolutions in the US Congress urging the President of United States to designate January 22 as «Ukrainian lndependence Day». January 22 was proclaimed Ukrainian Day by the governors of fifteen States and mayors of many cities. Keywords: January 22, Ukrainian independence day, Ukrainian diaspora, USA, interaction, Congress

scholarly journals Trends in educational mobility: How does China compare to Europe and the United States?

2019 ◽  
Vol 5 (2) ◽  
pp. 214-240
Author(s):  
Rob J Gruijters ◽  
Tak Wing Chan ◽  
John Ermisch
Keyword(s):  
Educational Opportunity ◽  
The United States ◽  
International Standards ◽  
Educational Mobility ◽  
The Us ◽  
The Usa ◽  
Economic Boom ◽  
The Uk ◽  
Large Decline ◽  
Inequality Of Educational Opportunity

Despite an impressive rise in school enrolment rates over the past few decades, there are concerns about growing inequality of educational opportunity in China. In this article, we examine the level and trend of educational mobility in China, and compare them to the situation in Germany, the Netherlands, the UK and the USA. Educational mobility is defined as the association between parents’ and children’s educational attainment. We show that China’s economic boom has been accompanied by a large decline in relative educational mobility chances, as measured by odds ratios. To elaborate, relative rates of educational mobility in China were, by international standards, quite high for those who grew up under state socialism. For the most recent cohorts, however, educational mobility rates have dropped to levels that are comparable to those of European countries, although they are still higher than the US level.

scholarly journals Sweet Corn Research around the World 2015–2020

Agronomy ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 534
Author(s):  
Pedro Revilla ◽  
Calli M. Anibas ◽  
William F. Tracy
Keyword(s):  
Sweet Corn ◽  
Starch Content ◽  
Starch Synthesis ◽  
Environmental Care ◽  
Research Activities ◽  
The Us ◽  
The World ◽  
The Usa ◽  
Basic Biology ◽  
Endosperm Starch

Modern sweet corn is distinguished from other vegetable corns by the presence of one or more recessive alleles within the maize endosperm starch synthesis pathway. This results in reduced starch content and increased sugar concentration when consumed fresh. Fresh sweet corn originated in the USA and has since been introduced in countries around the World with increasing popularity as a favored vegetable choice. Several reviews have been published recently on endosperm genetics, breeding, and physiology that focus on the basic biology and uses in the US. However, new questions concerning sustainability, environmental care, and climate change, along with the introduction of sweet corn in other countries have produced a variety of new uses and research activities. This review is a summary of the sweet corn research published during the five years preceding 2021.

scholarly journals Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study

Neurosurgery ◽  
2021 ◽  
Author(s):  
Priyank Khandelwal ◽  
Fawaz Al-Mufti ◽  
Ambooj Tiwari ◽  
Amit Singla ◽  
Adam A Dmytriw ◽  
...  
Keyword(s):  
African Americans ◽  
Multicenter Study ◽  
Large Vessel ◽  
Vessel Occlusion ◽  
Cross Sectional ◽  
Younger Age ◽  
The Us ◽  
The Usa ◽  
Rehabilitation Facilities ◽  
International Multicenter Study

Abstract BACKGROUND While there are reports of acute ischemic stroke (AIS) in coronavirus disease 2019 (COVID-19) patients, the overall incidence of AIS and clinical characteristics of large vessel occlusion (LVO) remain unclear. OBJECTIVE To attempt to establish incidence of AIS in COVID-19 patients in an international cohort. METHODS A cross-sectional retrospective, multicenter study of consecutive patients admitted with AIS and COVID-19 was undertaken from March 1 to May 1, 2020 at 12 stroke centers from 4 countries. Out of those 12 centers, 9 centers admitted all types of strokes and data from those were used to calculate the incidence rate of AIS. Three centers exclusively transferred LVO stroke (LVOs) patients and were excluded only for the purposes of calculating the incidence of AIS. Detailed data were collected on consecutive LVOs in hospitalized patients who underwent mechanical thrombectomy (MT) across all 12 centers. RESULTS Out of 6698 COVID-19 patients admitted to 9 stroke centers, the incidence of stroke was found to be 1.3% (interquartile range [IQR] 0.75%-1.7%). The median age of LVOs patients was 51 yr (IQR 50-75 yr), and in the US centers, African Americans comprised 28% of patients. Out of 66 LVOs, 10 patients (16%) were less than 50 yr of age. Among the LVOs eligible for MT, the average time from symptom onset to presentation was 558 min (IQR 82-695 min). A total of 21 (50%) patients were either discharged to home or discharged to acute rehabilitation facilities. CONCLUSION LVO was predominant in patients with AIS and COVID-19 across 2 continents, occurring at a significantly younger age and affecting African Americans disproportionately in the USA.

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