State-based Policy Research Articles

Explicit inference: A meta-replication of SEER cancer registry research evaluating the Affordable Care Act's Medicaid expansion.

Among the provisions within the Affordable Care Act (ACA), expanding Medicaid was arguably the greatest contributor to increasing access to care. For over a decade, researchers have investigated how Medicaid expansion impacted cancer outcomes. Over this same decade, statistical theory illuminated how state-based policy research could be compromised by invalid inference. After reviewing the literature to identify the inference strategies of state-based cancer registry Medicaid expansion research, this study aimed to assess how inference decisions could change the interpretation of Medicaid expansion's impact on staging, treatment, and mortality in cancer patients. Cancer case data (2000-2019) was obtained from the Surveillance, Epidemiology, End Results (SEER) programme. Cases included all cancer sites combined, top 10 cancer sites combined, and three screening amenable cancers (colorectal, female breast, female cervical). A Difference-in-Differences design estimated the association between Medicaid expansion and four binary outcomes: distant stage, initiating treatment >1 month after diagnosis, no surgery recommendation, and death. Three inference techniques were compared: (1) traditional, (2) cluster, and (3) Wild Cluster Bootstrap. Data was accessed via SEER*Stat. Estimating standard errors via traditional inference would suggest that Medicaid expansion was associated with delayed treatment initiation and surgery recommendations. Traditional and clustered inference also suggested that Medicaid expansion reduced mortality. Inference using Wild Cluster Bootstrap techniques never rejected the null hypotheses. This study reiterates the importance of explicit inference. Future state-based, cancer policy research can be improved by incorporating emerging techniques. These findings warrant caution when interpreting prior SEER research reporting significant effects of Medicaid expansion on cancer outcomes, especially studies that did not explicitly define their inference strategy.

On heartbreak, livelihoods and art: affect and crip desire in art making assemblages

ABSTRACT This article explores the affective dimensions of disabled, D/deaf, mad, and neurodiverse artists’ work through a livelihoods framework informed by the social and tacit dimensions of heartbreak. Heartbreak emerged during interviews with twenty artists in Canada in 2020, during a time of significant state-based policy changes that impacted disabled people’s livelihoods in the province of Ontario. Taken together, the artists’ stories form a rhizomatic cartography that takes crip wisdom and desire as significant elements of artmaking amid wider relational assemblages of affect. Drawing on Deleuzian and Guattarian concepts of desire and Puar’s difference-in/as-assemblage, researchers assert that although crip artmaking is not without joy, heartbreak is embedded in the politically aesthetic work of cultural production.

Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective.

Safety-net hospitals (SNHs) and facilities are the cornerstone of healthcare services for the medically underserved. The burden of chronic liver disease-including end-stage manifestations of cirrhosis and liver cancer-is high and rising among populations living in poverty who primarily seek and receive care in safety-net settings. For many reasons related to social determinants of health, these individuals often present with delayed diagnoses and disease presentations, resulting in higher liver-related mortality. With recent state-based policy changes such as Medicaid expansion that impact access to insurance and critical health services, an overview of the body of literature on SNH care for chronic liver disease is timely and informative for the liver disease community. In this narrative review, we discuss controversies in the definition of a SNH and summarize the known disparities in the cascade of the care and management of common liver-related conditions: (1) steatotic liver disease, (2) liver cancer, (3) chronic viral hepatitis, and (4) cirrhosis and liver transplantation. In addition, we review the specific impact of Medicaid expansion on safety-net systems and liver disease outcomes and highlight effective provider- and system-level interventions. Lastly, we address remaining gaps and challenges to optimizing care for vulnerable populations with chronic liver disease in safety-net settings.

Assisted Living: New Initiatives, Brighter Future

Assisted Living: New Initiatives, Brighter Future

State-Based Policy Supports for Refugee, Asylee, and TPS-Background Students in US Higher Education

Higher education for displaced students is rarely the focus of academic literature in the context of the United States, despite 79.5 million people displaced worldwide as of December 2019 and 3 million refugees resettled in the United States since the 1970s (UNHCR, 2020). An estimated 95,000 Afghans will be resettled in the US by September 2022, and the executive branch has requested $6.4 billion in funds from Congress to support this resettlement process (Young, 2021). This represents the most concentrated resettlement in the US since the end of the Vietnam War. It is therefore clear that policy supports for displaced students represent a pressing educational equity issue. This paper applies critical policy analysis to state-level policies supporting displaced students and argues that both data gaps and policy silence characterize the current state of play.

Towards a praxis of difference: Reimagining intercultural understanding in Australian schools as a challenge of practice

ABSTRACT Intercultural education in Australia has been positioned in State-based official curriculum and education policy as developing understanding between diverse cultural groups. However, cultivating such understanding far more complex in practice than policy and curriculum directives can capture. In Australia, eruptions of intercultural tensions has an ongoing and complex history. This paper examines the challenges for teachers’ intercultural practice in one Australian public school setting. Reporting on a single-site ethnography drawing on Lefebvre’s production of space. I conceptualise teachers’ intercultural work as a praxis of difference, this paper problematises the way intercultural education is often taken up in tokenistic ways and advocates for reimagining intercultural education as a challenge of practice. I argue that an examination of the conditions that produce complex relations between diverse cultural groups in particular spaces is a productive starting point for developing intercultural understanding as a rational praxis of difference .

Predictive Maintenance Decision Making Based on Reinforcement Learning in Multistage Production Systems

Predictive maintenance has become increasingly prevalent in modern production systems that are challenged by high-mix low-volume production and short production life cycle. It is very helpful to prevent costly equipment failures, and reduce significant production loss caused by unscheduled machine breakdown. Although important, decision models for joint predictive maintenance and production in manufacturing systems have not been fully explored. Therefore, we propose a reinforcement learning based decision model, that brings together production system modeling and approximate dynamic programming. We start from the development of a state-based model by analyzing the dynamics of a multistage production system with predictive maintenance. It provides an approach to quantitatively evaluate the various disruptions as well as the maintenance decision’s impact on production. Then a reinforcement learning method is proposed to explore optimal maintenance policies, that optimize the production and maintenance cost. To further improve the performance of the production system, machine stoppage bottlenecks are defined. An event-based indicator is proved to identify bottlenecks with production data. We test the proposed models in simulation case studies. The proposed predictive maintenance decision model is compared with three policies, which are state-based policy (SBP), time-based policy (TBP) and greedy policy (GP). The numerical studies show that the proposed decision model outperforms the policies, and it has the lowest system cost that is 9.68%, 39.07%, and 39.56% lower than SBP, TBP, and GP, respectively. In addition, the research shows that bottleneck identification and mitigation could help manufacturing systems to achieve more than 9.00% throughput improvement.

Women Empowerment in Punjab: Dimensions, Determinants, and Implications for Access to Healthcare

In developing countries like Pakistan, because of the complex cultural and socio-demographic milieu women empowerment always remained the contested issue. Overall major indicators of human development of women have been considered lower rather than men. In Pakistan, some considerable measures have focused on women's empowerment however, their status is still miserable specifically in rural areas. This study was aimed to find out, the extent of rural women empowerment and the effect of women empowerment regarding access to healthcare in the Vehari district of Southern Punjab, Pakistan. The study used data of 240 married women respondents and employed Cronbach’s alpha and OLS approaches for various analyses of the study components. Scores of various components regarding women's empowerment were regressed over the scores of women's access to healthcare in the final analysis of the study. The finding of the study indicated that the power of decision-making (0.87), self-esteem (0.79), and mobility (0.89) has positive and significant effects on access to health care whereas control over the resource (0.73) estimates indicated positive while the insignificant impact on health access. Education access, adequate job opportunities, and media information approach considered more appropriate and feasible measures for adequate women empowerment and health care access. Emergency-based State-based policy measures need to be applied such as women schooling at doorstep, increasing females' priority-based job opportunities, and proper access to media for increasing awareness regarding their rights and significant role in society.

Моделювання впливу інтенсифікації міграційних процесів на соціально-економічну стабільність в Україні

The article is aimed at elaborating an adequate mathematical instrumentarium for the formation of migration flows to assess their impact on the socio-economic stability together with unshadowing the Ukrainian economy, as well as to identify efficient measures of the State-based policy directed towards regulating these flows to prevent risks of socio-economic destabilization. The article carries out an empirical analysis of the peculiarities of the development of migration processes in Ukraine and their impact on the socio-economic state in both the medium and the long term perspective. A system of complementary dynamic macromodels of the Ukrainian economy is developed, which includes a vector autoregression model and a separate complex of simulated submodels of systemic dynamics aimed at researching migration processes and their impact on the indicators of socio-economic stability. At this, the developed models of system dynamics can be combined into a single original simulation macromodel of Ukraine, and be used independently subject to the research goals. This allows to adequately describe complex nonlinear processes, systemically identify and examine the mechanisms of supply and demand formation in the labor market, taking into account the shadow component and assess their impact on the formation of the size of migration flows, as well as to research the consequences of increasing the intensity of migration processes on the socio-economic stability in Ukraine. The implementation of the developed complex of dynamic models has allowed, in particular, to calculate the annual value of the net migration flow in Ukraine through the aging chain of the population; to empirically confirm that migration flows in Ukraine are underestimated; to detect the dynamic structure of the net migration balance and a noticeable fading of the amplitude of migration processes over time, which indicates the presence of a balancing structure for the formation of migration flows.

Emergency-Only Hemodialysis Policies: Ethical Critique and Avenues for Reform.

An estimated 6,500 undocumented immigrants in the United States have been diagnosed with end-stage renal disease (ESRD). These individuals are ineligible for the federal insurance program that covers dialysis and/or transplantation for citizens, and consequently are subject to local or state policies regarding the provision of healthcare. In 76% of states, undocumented immigrants are ineligible to receive scheduled outpatient dialysis treatments, and typically receive dialysis only when presenting to the emergency center with severe life-threatening symptoms. 'Emergency-only hemodialysis' (EOHD) is associated with higher healthcare costs, higher mortality, and longer hospitalizations. In this paper, we present an ethical critique of existing federal policy. We argue that EOHD represents a failure of fiduciary and professional obligations, contributes to moral distress, and undermines physician obligations to be good stewards of medical resources. We then explore potential avenues for reform based upon policies introduced at the state level. We argue that, while reform at the federal level would ultimately be a more sustainable long-term solution, state-based policy reforms can help mitigate the ethical shortcomings of EOHD.

Childhood abuse or trauma: A racial perspective

AbstractRacial trauma describes the emotional trauma and associated psychiatric reactions, such as distress and compromised well-being, which arise from perceived incidences of racism. It is an emerging psychological paradigm that is intimately linked to state-based policy measures such as child removal. Racial trauma is also deeply institutionalised in Australia’s education system as a consequence of the focus on dominant (white Standard Australian English speaking) culture, language, literacy and numeracy standards. Despite receiving little recognition in mental health work or the education sector, the effects of such trauma are profound and can account for the high rates of suicide and social dysfunction that we see in remote Indigenous communities as well as the low academic achievement and English language acquisition rates in Aboriginal students. This paper presents a literature review related to publications that scrutinise the relationship between racism in policy and schools and racial trauma, drawing on some research findings by one of the authors. It suggests alternative Indigenous pedagogies that can both mitigate and remove racial trauma from the school environment and lead to successful academic outcomes and well-being for Aboriginal students.

Economic Liberalisation and Farmers’ Suicides in Andhra Pradesh (1995–2014)

Adversely affected by globalisation and state-based policy changes, India’s agricultural sector has recently experienced a marked increase in farmer suicides, most prominently in Andhra Pradesh (AP). This article examines the various policy changes leading to such agrarian distress and seeks to explore how the troubling phenomenon of farmers’ suicides may be curbed.

Financial Security for Future Retirees

A new analysis indicates that Americans in nearly every state will fall far short in meeting their economic needs in retirement. The State Financial Security Scorecards research project gauges the retirement readiness of future retirees in each of the fifty states and the District of Columbia in three key areas: anticipated retirement income; major retirement costs like housing and healthcare; and labor market conditions for older workers.The research finds that the lowest ranking states include:1. California due to low potential retirement income, low workplace retirement plan access and high retiree costs.2. Florida due to high retiree costs, low wages for older workers and low workplace retirement plan access.3. South Carolina due to low potential retirement income and low labor market scores. The highest-ranking states include Wyoming, Alaska, Minnesota and North Dakota due to their relatively strong labor markets and lower retiree costs. However, each of these states with a favorable outlook is weak in terms of potential retirement income for retirees. For example, North Dakotans have an average defined contribution retirement account balance of only $27,700 – nowhere near the level of accumulated savings required to ensure self-sufficiency through retirement. These state scorecards are designed to serve as a tool for policymakers to identify areas of focus for state-based policy interventions that will strengthen Americans’ ability to financially prepare for retirement. The State Financial Security Scorecard project provides a two-page summary of the economic outlook for retirement security in every state. It considers trends in retirement plan participation rates in each state, evaluates average savings levels in individual retirement accounts in relation to median income and considers current poverty levels in each state.

Multi-period marketing-mix optimization with response spike forecasting

Optimizing the marketing budget and its distribution across various channels and target segments, along with the timing of each marketing action for maximum profit, are among the essential problems in marketing. A crucial requirement for effective decision making in direct marketing is an efficient optimization algorithm, coupled with reliable predictions on how the various marketing actions will impact consumers' purchase decisions. For maximizing mid-term revenues, while properly incorporating the temporal dynamics of individual consumers' mental states, we introduce a comprehensive optimization framework for obtaining a state-based marketing-mix policy, with a novel combination of machine learning, optimization, and simulation. Each consumer's purchase decision is modeled with a marked point process whose discrete-state approximation enables efficient optimization of high-dimensional decision variables, and whose discrete event simulation supplies accurate forecasts of the revenues and risks of the optimized policy. The key idea for ensuring the practicality of the proposed approach to marketing planning is a linear programming formulation that allows both handling of temporal dynamics and complex budget constraints across many periods, segments, and channels required in real marketing operations. A real-world case study based on an online retailing dataset implies high revenue gains when the simulation model can be relied on.

Financial Security Scorecard: A State-by-State Analysis of Economic Pressures Facing Future Retirees

The Financial Security Scorecard: A State-by-State Analysis of Economic Pressures Facing Future Retirees finds states fall short in key areas measuring retirement readiness.This new analysis gauges the relative performance of the fifty states and the District of Columbia in three key areas: anticipated retirement income; major retirement costs like housing and healthcare; and labor market conditions for older workers.The study is designed to serve as a tool for policymakers to help identify potential areas of focus for state-based policy interventions to improve Americans’ retirement prospects.

The Collective Mind

The spring 2009 issue of the newsletter of the Sociology of Education Section of the American Sociological Association featured a brief (about 4,000 words) essay by sociologist Steven Brint. In ‘‘The ‘Collective Mind’ at Work: A Decade in the Life of U.S. Sociology of Education,’’ Brint offered al ucid and empirically informed appraisal of American sociology of education as reflected in its primary journal, Sociology of Education .B rint’s essay is reprinted here as it appeared in the newsletter. 1 Brint based his essay on a content analysis of all of the articles that appeared in Sociology of Education between 1999 and 2008. By carefully coding each of the 168 articles that were published during this period into a variety of categories (as explained in his article), Brint reached several conclusions about the collective mind of the sociology of education research community. American sociology of education, according to Brint, focused on ‘‘studies of educational achievement and educational attainment as conditioned by social inequality, family and student behaviors, and school organization.’’ It did so in a way that Brint characterized as not exactly ‘‘abstract empiricism,’’ but certainly only mildly interested in the development and testing of sociological theory. Finally, Brint saw the collective mind of American sociology of education as generally indifferent to ‘‘most of the rest of the world, the U.S. capitalist market economy, or state-based policy coalitions struggling over the forms and functions of schooling.’’ Since its publication, Brint’s provocative but evenhanded criticisms of sociology of education have given members of the research community much to think about and talk about. His observations on where we succeed and where we fail as a subdiscipline are frequent topics of conversation at professional meetings, and (admittedly without looking at the data) the piece has been cited an unusual number of times for a non-peer-reviewed publication. Brint’s essay was much on the minds of the current editorial team when we assumed responsibility for the journal four years ago. We have been struck over the years how many of our colleagues have read Brint’s piece and were eager to discuss it. The transition from one editorial team to the next provides an opportunity to revisit Brint’s assessment of our shared enterprise as sociologists of education. We asked the incoming editorial team of Rob Warren, Amy Binder, Eric Grodsky, and Hyunjoon Park to prepare brief responses to Brint’s essay, 2 and the current team of David Bills, Steve Morgan, and Stefanie DeLuca jointly prepared its own response. Steven Brint, graciously and on very short notice, has written a response to the responses. We thank everyone for their participation in this exchange.

Access to stroke care units in Australian public hospitals: facts and temporal progress

There is level I evidence that management of stroke patients in stroke units (SU) improves outcomes (death and institutionalization) by approximately 20%. In Australia, there is uncertainty as to the proportion of incident cases that have access to SU. Recent national and State-based policy initiatives to increase access to SU have been taken. However, objective evidence related to SU implementation progress is lacking. The aims of the study were (i) to determine the number of SU in Australian acute public hospitals in 2004, (ii) to describe hospitals according to national SU policy criteria and (iii) to compare results to the 1999 survey to track progress. The method used in the study was a cross-sectional, postal survey technique. The participants were clinical representatives considered appropriate to describe stroke care within survey hospitals. The outcome of the study was presence of a SU according to an accepted definition. Response rate was 261/301 (87%). Sixty-one sites (23%) had either a SU and/or a dedicated stroke team. Fifty sites claimed to have a SU (19%). New South Wales with 23 had the most number of SU. Based on policy criteria, up to 64 sites could have a SU. In 1999, there were 35 public hospitals with a SU. Access to SU in Australian public hospitals remains low compared with other countries (Sweden, 70%). Implementation strategies supported by appropriate health policy to improve access are needed.

Crises as Opportunities to Consolidate Reforms: The 1997 Financial Crisis and Banking Policy Reform in Malaysia and the Philippines

Looking at crisis responses in the Philippines and Malaysia, this paper will analyse how state-based banking policy elites in both states used the 1997–2000 crisis to radically accelerate pre-crisis policy directions that were opposed by local banking institutions and their peak associations. Drawing on empirical evidence and policy reform theory, the paper will detail how these elites used both their ability to define the nature of the 1997–2000 crisis and the appropriate responses, and their control of the executive to accelerate these directions and minimize the voice of local banking players. In the case of Malaysia, the banking policy direction to be analyzed will be banking sector consolidation, while for the Philippines it will be foreign entry and equity participation in the local banking sector. Moving away from the singular domestic focus of much policy reform literature, this paper will attempt to develop a two-level model for these crisis-driven policy accelerations. To do this, it will look at the use by these state elites of their relationships with the IMF and their banking policy obligations of the GATS as the rationale for acceleration and as the rationale for their overriding of local banking interests. This incorporation of external actors and changes to the international political economy should allow for a more nuanced and well-rounded understanding of these specific elements of the 1997–2000 crisis response, as well as the political economy of policy reform in general for both Malaysia and the Philippines.

El nuevo orden económico internacional y la encrucijada de la política científico-tecnológica brasileña

<p>El autor caracteriza las nuevas trayectorias tecnológicas emergentes determinadas por su base microelectrónica, para lo cual analiza en particular los nuevos fundamentos competitivos en los países centrales expresados en la redefinición de las relaciones inter e intra-firma y del papel del Estado; asimismo, evalúa las posibilidades de catching-up que se abren a los NIC's en este nuevo periodo de desarrollo capitalista, tomando como ejemplo a Corea del Sur. Finalmente, reflexiona sobre los caminos de la inserción internacional brasileña, subrayando que las especificidades de su estructura económica y social exigen un diseño de política estatal -particularmente industrial y científico-tecnológico- distinto del elaborado en los países centrales.</p>