The surgeon advocate's role in shaping state and federal policy.

Malaria remains a major public health threat in Ethiopia, with more than 7.3 million confirmed cases and 1,157 deaths reported in 2024, representing the highest incidence recorded in the past seven years. Persistent regional heterogeneity in transmission, emerging insecticide resistance, and systemic health system constraints continue to undermine national malaria elimination efforts. This study assessed systemic challenges and strategic priorities in Ethiopia's malaria management across six operational domains: preparedness, detection, containment, response, recovery, and prevention. A national landscape analysis was conducted using a convergent mixed-methods approach. Peer-reviewed literature and relevant policy documents published between 2016 and 2025 were systematically searched across bibliographic databases and institutional repositories. Eligible studies were assessed using predefined inclusion criteria and synthesized descriptively across six operational domains of malaria management. In parallel, structured consultations were undertaken with malaria programme professionals at federal, regional, and facility levels to validate and contextualize findings from the evidence synthesis. These consultations were conducted as part of technical validation and did not constitute primary qualitative research. The search yielded 246 records, of which 198 unique documents were screened and 24 malaria-specific primary studies met inclusion criteria. Household surveys reported national insecticide-treated net (ITN) ownership averaging approximately 64%, with substantially lower coverage and utilization documented in several high-burden and urban-adjacent settings, particularly within Oromia and selected densely populated areas. Indoor residual spraying (IRS) was implemented in roughly half of targeted high-risk zones, with operational coverage constrained by logistical delays and reduced effectiveness in areas with documented pyrethroid resistance. Digital malaria surveillance platforms were operational in approximately 80% of health facilities; however, multiple studies reported delayed reporting, incomplete data submission, and weak feedback mechanisms, especially in remote districts. Diagnostic performance was compromised by intermittent stock-outs, expired rapid diagnostic tests (RDTs), and widespread pfhrp2/3 gene deletions affecting HRP2-based RDT sensitivity. Post-outbreak recovery capacity remained limited, with only about half of health facilities reporting timely replenishment of essential malaria commodities within three months and little evidence of routine after-action review processes. Cross-cutting constraints included delayed financing, fragmented digital systems, limited routine entomological surveillance, and insufficient community engagement in prevention activities. Ethiopia's malaria programme demonstrates foundational capacity to interrupt transmission but remains constrained by systemic, operational, and equity-related gaps. Strengthening real-time surveillance and data use, adapting vector control strategies in response to resistance patterns, institutionalizing recovery and learning mechanisms, and embedding community-centred prevention approaches are essential to support a resilient and sustainable malaria response.

High prescription drug costs are a pressing national concern and contribute to medication nonadherence and poor health outcomes. The Inflation Reduction Act (IRA) introduced sweeping reforms to improve medication affordability, but their potential impact on medication adherence is unknown. To evaluate the association of the IRA's 2024 prescription drug provisions with cost-related medication nonadherence as well as health care-related financial strain. This quasi-experimental difference-in-differences analysis used data from the 2021-2024 National Health Interview Survey. Adults aged 62 to 67 years who were enrolled in Medicare Part D (intervention) or private insurance (comparator) were included. Individuals with incomes 135% or less of the federal poverty level, dually enrolled in Medicaid, and who currently used insulin were excluded from the primary analysis because preexisting protections limited their out-of-pocket spending in Medicare. The IRA's prescription drug provisions were enacted on January 1, 2024, including (1) elimination of the 5% coinsurance requirement for catastrophic coverage that effectively capped out-of-pocket drug costs to approximately $3300 per year and (2) expansion of full low-income subsidies. The primary outcome was cost-related medication nonadherence. The secondary outcome was health care-related financial strain. The study population included 1454 Medicare beneficiaries (weighted mean [SD] age, 66.1 [0.8] years; 53.1% female) and 3797 privately insured comparators (weighted mean [SD] age, 63.3 [1.2] years; 50.7% female). Prior to the 2024 IRA reforms, trends in cost-related medication nonadherence were parallel between the 2 groups. Following implementation of the IRA's 2024 provisions, cost-related medication nonadherence declined among Medicare beneficiaries relative to comparators (adjusted difference-in-differences estimate, -4.9 percentage points [pp]; 95% CI, -8.8 to -1.0 pp). Among Medicare beneficiaries with multiple chronic conditions, the decline was more pronounced (adjusted difference-in-differences estimate, -7.8 pp; 95% CI, -12.9 to -2.8 pp). These findings were robust across multiple sensitivity analyses as well as secondary analyses using Medicare beneficiaries with incomes 135% or less of the federal poverty level and dually enrolled in Medicaid as an alternative comparator group. In contrast, there were no meaningful differential changes observed for health care-related financial strain (adjusted difference-in-differences estimate, -2.6 pp; 95% CI, -10.1 to 5.0 pp). In this difference-in-differences analysis, the IRA's 2024 prescription drug provisions were associated with a reduction in cost-related medication nonadherence among eligible Medicare beneficiaries in their first year. These early improvements may have important implications for chronic disease management and downstream clinical outcomes.

Cost-Effectiveness and Health Equity Improvements From Excluding Sugar-Sweetened Beverages From the Supplemental Nutrition Assistance Program.

While interest in the therapeutic and recreational use of hallucinogens has increased, national surveillance often reports use in aggregate, potentially masking shifting trends among pharmacologically distinct substances. This study assessed trends in specific hallucinogens from 2021 to 2023 and identified correlates of use, with particular attention to subgroup patterns in populations commonly prioritized for prevention and access-focused interventions. Using nationally representative NSDUH data (2021-2023; ages ≥12), we estimated annual past-year prevalence of LSD, PCP, ecstasy (MDMA), ketamine, Salvia divinorum, and tryptamines (including DMT). We fit survey-weighted logistic regression models with year (continuous) to assess trends and pooled multivariable models to examine demographic correlates. Although overall past-year hallucinogen use was stable (2.83 % [95 % CI: 2.52-3.14] in 2021; 2.82 % [2.52-3.12] in 2023), substance-specific trends diverged. LSD declined (aOR per year=0.83, 95 % CI: 0.75-0.93), from 0.88 % (0.72-1.04) in 2021-0.58 % (0.47-0.68) in 2023. Ketamine increased (aOR=1.11, 95 % CI: 1.02-1.21), from 1.61 % (1.42-1.80) to 1.91 % (1.67-2.16). Ecstasy/MDMA and tryptamines were stable, and PCP and Salvia remained rare. Use concentrated among young adults and males; adjusted models indicated higher odds among uninsured respondents and those below the federal poverty level. Despite stable overall hallucinogen prevalence, significant increases were observed for ketamine alongside declines for LSD, suggesting a shifting landscape of hallucinogen use. Substance-specific monitoring may better inform screening, prevention, and harm-reduction efforts than aggregate hallucinogen indicators, especially as ketamine's medical availability expands and disparities in access to mental health treatment persist.

Background: State-owned enterprises (SOEs) occupy a unique and critical position within the American economic landscape, operating at federal, state, and municipal levels while balancing multiple and often conflicting objectives including commercial sustainability, public service delivery, social responsibility, and political accountability ((Shleifer &Vishny, 1997). Unlike private corporations driven primarily by shareholder wealth maximization, U.S. SOEs function within a complex regulatory and political framework that demands governance structures capable of reconciling profitability with service equity, efficiency with accessibility, and financial sustainability with social benefit(OECD Guidelines on Corporate Governance of State-Owned Enterprises, 2015). The United States operates a decentralized system of SOEs that differs fundamentally from centralized national SOE systems found in many countries, with diverse governance arrangements established through federal legislation, state statutes, local ordinances, and individual organizational charters. This fragmented governance landscape creates both substantial challenges and significant opportunities for governance effectiveness, yet limited research exists examining the specific governance-performance relationship in U.S. SOEs compared to international enterprises or private corporations. Aims: To examine the relationship between corporate governance and financial performance in U.S. state-owned enterprises, identify best practices across diverse SOE contexts, and provide practical recommendations for improving governance and performance. This study addresses a key gap in the literature by analyzing governance mechanisms and offering actionable strategies for enhancing governance in the U.S. SOE context. Study Design: This research employs a systematic literature review and synthesis of corporate governance frameworks applied to U.S. SOEs, supplemented by comparative analysis of governance structures across federal, state, and municipal enterprises operating in diverse sectors including transportation, utilities, pension systems, and development finance. The analysis examines SOE governance practices across U.S. federal and state-level enterprises. Results: Strong empirical evidence indicates that effective governance structures characterized by board independence, functional diversity, robust oversight committees, and appropriate stakeholder engagement correlate positively with improved financial performance in U.S. SOEs (Publication: Effects of Corporate Governance on the Performance of State-Owned Enterprises, n.d.). Key findings show that SOEs with strong governance achieve greater operational efficiency, lower fraud incidence, and higher stakeholder confidence. Independent audit committees reduce financial misstatements, while boards with strong independence detect fraud faster than management-dominated boards. Despite these gains, challenges remain, including political influence, conflicting objectives, and resource constraints that limit governance investment. Political influence on SOE decision-making reduces financial performance, while organizations experiencing frequent board turnover due to political cycles show higher operational costs (Kuzman et al., 2018). Conclusion: Although U.S. SOE governance has strengthened since the 2008 financial crisis, continued focus on board independence, transparency, and accountability is essential to sustain and improve financial performance. Implementing best practices such as formal governance frameworks, regular board evaluations, performance-based compensation, comprehensive risk management, and ongoing training can significantly enhance SOE effectiveness and public value creation across diverse contexts. The transition to Audit 5.0 within governance frameworks emphasizes human-technology collaboration, continuous assurance, and ethical oversight as core pillars of modern assurance practices in SOE governance (Tavares et al., 2025).

This essay contends that the current crisis in US public administration is the continuation of long term trends that have permanently altered the practice of public administration. Three trends are identified: (1) the breakdown of the symbiotic relationship between politics and administration with the resulting politicization of the administrative process, (2) the disruption of the budget cycle, and (3) the eroding of bureaucratic capacity to implement effective programs. The result is the creation of permanent crises affecting large areas of public service delivery at federal, state, and local levels. The essay then outlines a set of topics that academic public administration needs to address and links these topics to changes in public administration curriculum in three areas: politics and administration (or democratic governance), adapting to the new budgeting uncertainty, and management of low capacity organizations in continual crises.

Background/Objectives: Increasing popularity, convenience, and access to processed foods are shifting the composition of dietary intake from whole to ultra-processed foods (UPF). This study aimed to assess the association between periconceptional UPF consumption and the incidence of adverse pregnancy outcomes (APOs). Methods: This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). Patients were excluded if they were missing periconceptional diet data or if their pregnancy ended before 20 weeks. Food Frequency Questionnaire items were categorized using the NOVA Scale to calculate the proportion of total energy intake comprised of UPF (% kcal/day). Bivariate and multivariate analyses examined the relationships between UPF intake and preterm birth, hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), small-for-gestational-age (SGA) infants, large-for-gestational-age (LGA) infants, and fetal or neonatal demise. Results: A total of 6693 participants were included in the analysis. The sample was predominantly White (78%) and not Hispanic (84%), and a majority of participants had commercial insurance (76%). UPF accounted for an average of 51.3 ± 12.7% of participants' daily total energy intake. Mean UPF intake was higher among patients who identified as Black or non-Hispanic, patients with public insurance, less than a high school education, a household income below the federal poverty level (all p-values < 0.001), patients with chronic hypertension (p = 0.02), and patients who delivered vaginally (p = 0.002). Patients with preterm birth, HDP, SGA infants, and fetal or neonatal demise all had significantly higher proportions of daily UPF intake compared to patients without these adverse outcomes. After adjusting for potential confounders, higher UPF intake remained significantly associated with preterm birth (AOR 1.11, 95% CI 1.02-1.21) and HDP (AOR 1.05, 95% CI 1.001-1.11). Conclusions: On average, more than half of participants' daily energy intake was from UPF, and higher UPF intake correlated with several adverse pregnancy outcomes. Future efforts should focus on improving nutritional literacy regarding UPF consumption in pregnancy.

In the last decade, UN bodies and the WHO call for the abolition of coercion in psychiatry. Studies provide some evidence for interventions to reduce the use of coercion, but it is unclear whether the use of coercion is decreasing in real-world practice. The aim of this study was to gather longitudinal ecologic data on the use of coercive interventions in European countries and to depict trends over time. For each country, inclusion required access to ecologic datasets spanning a minimum of four years, pertain to a defined population (country or federal state level), and allowing the necessary elements to calculate both the proportion of psychiatric admissions affected by involuntary admissions (IAs) and coercive measures (CMs) and the rate per 100,000 inhabitants. Country experts were accessed via a European network of experts (FOSTREN group). Data were obtained from Austria, England, Germany, Norway, Sweden, and Switzerland, and covered periods between 4 and 10 years. In no country, an absolute decrease in IA and the use of CM could be observed. Rates of IA per 100,000 inhabitants changed between -5.4% (Sweden) and +37% (Germany). Rates of admissions exposed to any kind of CM changed between +11% (Austria) and +86% (Norway). The findings suggest a persistence or rise in coercive practices despite national and international policy commitments. An increase in involuntary admissions suggests reasons outside psychiatric hospitals, whereas a disproportionate increase in coercive measures may indicate a change of practice in in-patient psychiatry. Further research is needed to explore the reasons from clinical and societal perspectives.

ABSTRACT Tribal Colleges and Universities (TCUs) play a critical role in Indigenous nation‐building and postsecondary access, yet faculty development within these institutions remains chronically under‐resourced and inconsistently supported. This critical literature review examines faculty development across TCUs that function primarily within the community college sector, with attention to the structural and policy conditions shaping professional growth. Drawing on peer‐reviewed scholarship, institutional data, and cross‐institutional examples, the analysis identifies persistent challenges related to chronic underfunding, faculty workload, limited professional infrastructure, and misalignment between prevailing faculty development models and the missions of Indigenous‐serving institutions. The review synthesizes evidence from 37 TCUs serving approximately 28,000 students annually and examines how faculty development is supported at institutional, consortial, and federal levels. Although TCUs receive substantially less federal funding per student than other public community colleges, the literature documents meaningful innovation in faculty development when culturally grounded approaches and sustained resources are available. Building on this synthesis, the article advances a three‐tiered framework for faculty development that distinguishes near‐term institutional strategies from mid‐ and long‐term consortial and federal actions. The framework offers practical guidance for institutional leaders, policymakers, and intermediary organizations seeking to strengthen faculty capacity while honoring tribal sovereignty, community accountability, and the teaching‐centered missions of community college‐functioning TCUs.

This study examines the multifaceted impact of migrants and asylum seekers on United States public finance through comprehensive analysis of fiscal contributions, economic participation, and policy implications during the Trump (2017-2021) and Biden (2021-2024) administrations. Employing a mixed-methods approach combining policy analysis, econometric modeling, and case study examination, we analyze migration trends, labor market integration, and budgetary impacts across federal, state, and local government levels. Using border encounters and immigration court backlogs as proxy measures for unauthorized migration, we document a 19.5% increase in foreign-born population from 41 million (2020) to 49 million (March 2024), with corresponding rise in border encounters from 0.8 million (2017) to 3.2 million (2023). Our findings reveal that migrants fill critical labor market gaps in agriculture, construction, and hospitality sectors, contributing to wage stabilization during tight labor market conditions (job-to-unemployed ratio declining from 2.03 to 1.5). However, this influx generates substantial fiscal pressures on local governments, with New York City projecting $6.98 billion expenditure (FY2023-2025) against only $156 million federal funding. Regression analysis examining sectoral stock price responses to migration patterns (2019-2024) demonstrates positive correlations in agriculture (R² = 0.99, p &lt; 0.001) but mixed results in hospitality and construction sectors. These findings contribute to immigration economics literature by demonstrating the asymmetric distribution of migration benefits (labor market) versus costs (local public services), with implications for federal-state fiscal federalism and immigration policy design.

Given the global threat of increasing antibiotic resistance, risk factor detection of multi-resistant pathogens is particularly important. This is complicated by different definitions, using the international extended spectrum beta-lactamases (ESBL) definition and the German definition of multidrug-resistant Gram-negative pathogens (MRGN). Although the MRGN definition was primarily introduced for hospital hygiene measures, it is often used in outpatient or semi-inpatient areas. Due to the increasing numbers of outpatient treatments of the healthcare system, corresponding data is necessary for specific hygiene regulations. This study provides MRGN and ESBL data based on a stool examination and a questionnaire evaluation in the period 07/2021-03/2022 of 231 outpatients of Saarland University Medical Center before traveling abroad. There was a 3MRGN prevalence of 2.6% with five Escherichia coli and one Klebsiella pneumoniae and an ESBL prevalence of 5.6% with 13 ESBL Escherichia coli, four of which could also be classified as 3MRGN. These prevalences were compared with MRGN/ESBL prevalences in PubMed and Google Scholar in different areas of the German healthcare system in the period 2013-2024 at the federal state level. The selective literature search revealed geographical differences and missing prevalence data depending on the healthcare sector (outpatient/inpatient) and federal state. Resistance data is often evaluated according to international standards, i.e. according to the ESBL definition. Outpatient MRGN prevalences are hardly known despite the increasing numbers of outpatients of the healthcare system. Due to the scarcity of outpatient data, our study from a travel medicine clinic provides interesting epidemiological data that should be considered in the context of the COVID-19 pandemic.

ABSTRACT Climate adaptation exhibits epistemic and operational ambiguity due to its close association with development policies. While this challenges adaptation finance tracking, it may potentially reduce its exposure to political opposition. This article analysis the volume, distribution and evolution of public adaptation finance in Brazil during the first implementation cycle of its National Adaptation Plan (2016–2020), a period characterized by political instability and rise of climate denialist discourses at the federal level – especially from 2019 onwards, when President Jair Bolsonaro took office. Using an original dataset combining domestic federal budget and international bilateral and multilateral financial flows, the study finds that public adaptation finance totalled US$ 992.8 million over the period, of which 81% came from domestic sources. Total adaptation finance was more than 40 times lower than disaster-related monetary losses, and corresponded to only 0.008% of Brazil’s GDP. During Bolsonaro’s climate denialist government, NAP-related budget expenditures decreased, while international adaptation finance increased. The largest decrease in NAP-related expenditures occurred between 2019 and 2020 (−43.7%), when Bolsonaro’s government was effectively in charge of budget execution. In contrast, domestic adaptation finance remained relatively stable under the Rousseff and Temer administrations (2016–2018), despite fiscal and political constraints. Findings suggest that NAP expenditures which were intertwined within development budgets were preserved from larger reductions under climate denialism. Results contribute to emerging understandings of how public adaptation finance behaves in the face of denialist discourses and disputes on adaptation framing, and address a gap in the literature regarding data availability on the role of domestic adaptation finance. Key policy insights Domestic adaptation finance is closely embedded within development-aimed national budgets, which may contribute to sustaining some adaptation-related expenditures during periods of climate denialism. Domestic public budgets are central to adaptation finance resilience: with 81% of public adaptation finance in Brazil originating from domestic sources between 2016 and 2020, national budgets constitute a primary pillar of adaptation finance. Denialist discourses affect domestic and international adaptation finance differently. In Brazil, domestic adaptation finance declined during the Bolsonaro administration (2019–2020), while international adaptation finance increased, suggesting a rebalancing of funding sources rather than a uniform suppression of adaptation finance.

Climate change exhibits substantial variability across both space and time, requiring mitigation and adaptation strategies that effectively address challenges at global and local scales. Accurately capturing this variability is essential for assessing climate impacts, attributing underlying causes, and formulating effective policies. This study introduces simple yet robust quantitative methods to detect local warming, distinguish among different types of warming, and compare warming trends across contiguous U.S. states using the concept of warming dominance. In contrast to traditional approaches that focus solely on average temperatures, our analysis rigorously and systematically examines the entire distribution of daily temperatures for the contiguous United States from 1950 to 2021. The results reveal that, while 44% of states show no statistically significant warming based on average temperature trends, a much larger proportion—84%—exhibit warming when assessing various quantiles of the distribution. Statistical significance is evaluated using HAC-robust t -tests at the 5% significance level (95% confidence), ensuring that detected warming reflects genuine shifts rather than random variability. These findings underscore the substantial heterogeneity in warming patterns: some states, such as those located in the so-called “Warming Hole,” display no evidence of warming at any quantile; others experience more pronounced warming in either the lower or upper tails of the temperature distribution; and a few states show consistent warming across all quantiles. The study concludes by identifying which states exhibit warming dominance over others and which appear comparatively less affected. These insights are particularly important in the United States, where climate policy is formulated and implemented at both federal and state levels.

Parents with a mental illness or substance use disorder: Parent and adolescent differences by parent treatment receipt.

Federal and State Gaps in Regulation of Hemp-Derived Delta-9-Tetrahydrocannabinol Beverages.

Coalition building for regional violence prevention advocacy: Unique perspectives from the Southeast.

Improvements in stress and sleep following 24-months of Guaranteed Income, results from a randomized trial among Black women in Georgia.

Parent-reported need for subspecialty care has the potential to be influenced by factors such as access to primary care, supplier-induced demand, and parent health literacy. We sought to model predicted likelihood of need for subspecialty care based on objective clinical factors, and to compare this "predicted need" to parent-reported need and actual receipt of subspecialty care across sociodemographic groups. The 2022-23 National Survey of Children's Health captures parent-reported need for subspecialty care. We modeled the association between parent-reported need for subspecialty care and clinical factors (child age, health status, presence and severity of specific conditions) and used this model to generate "predicted need." We compared weighted percentages of predicted need, parent-reported need, and actual receipt by family poverty level, child race, payer, and family language. Of 90,620 unweighted children included, predicted need for subspecialty care was highest for those with lowest family income (<100% federal poverty level, FPL) at 17.2% (95% CI: 16.6-17.7%) and lowest for those with highest family income (≥400% FPL) at 15.1% (95% CI: 14.8-15.3%). In contrast, parent-reported need for subspecialty care was lowest for those with lowest family income (12.8%, 95% CI: 11.6-14.0%) and highest for those with the highest family income (17.1%, 95% CI: 16.5-17.8%). Variation in these measures was also observed by payer, family language, and child race and ethnicity. Gaps between predicted need and parent-reported need for subspecialty care were larger for populations underserved by the US health care system. Predicted need for subspecialty care may serve as an alternative means of estimating underlying population need for subspecialty care.

Medicaid adult dental coverage is an optional benefit that states often add or remove in response to budgetary pressures. The effect of these fluctuations on access to dental services is unclear. Using 2010-21 Health and Retirement Study data and a dynamic difference-in-differences event study, we examined the effects of removing versus adding Medicaid adult dental benefits among adults ages 50-64 with income up to 100percent of the federal poverty level. Eliminating benefits was associated with increased dental uninsurance (60.1percentage points) and any out-of-pocket spending in the past two years (20.2percentage points), as well as decreased dental visits in the past two years (-37.4percentage points) and edentulism (complete loss of all natural teeth; -13.4percentage points). Expanding benefits was associated with decreased dental uninsurance (-40.7percentage points) and any out-of-pocket spending (-36.5percentage points), as well as increased dental visits (22.1percentage points) and edentulism (16.9percentage points). Both changes were associated with increased unawareness of dental coverage (11.7 and 33.0percentage points, respectively). Several effects persisted up to eight years, indicating that Medicaid dental policy shifts have lasting implications. These findings underscore the importance of stable Medicaid dental coverage, particularly as Congress and states weigh large-scale Medicaid cuts.