State Level Research Articles

New Estimates of US Civil War mortality from full-census records

The Civil War was the deadliest conflict in US history. However, incomplete records have made it difficult to estimate the exact death toll both nationally, and especially, at the state level. In this article, we leverage the recently released full count of individual census returns and a sample of linked records across multiple censuses to provide i) the most precise national estimate of excess mortality to date and ii) reliable state-level estimates of excess mortality among native-born white males. Our national estimate is 698,000 Civil War deaths. This is substantially higher than the conventional historical estimate of 618,000 but lower than the most recent estimate of around 750,000 deaths based on a 1% census sample. Leveraging a novel migration-adjusted census comparison method, we document the extent to which the war’s toll was much greater in the Confederate states than in the Union.

Barriers and facilitators to quality HS biologic care and outcomes for the Medicaid population across US states

Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by painful skin lesions and dermal abscesses.1 US-based patients with HS are often covered by Medicaid (21.6–31.0%)2–5 with substantial state-by-state variations in coverage. Barriers to accessing biologics for HS may delay treatment and worsen patient outcomes. Here, we report differences in Medicaid criteria to access biologic care for HS across all 50 US states. Procedure/study: A qualitative review of the Medicaid Utilization Management (UM) policies for biologic use in HS was conducted. Data were collected from the Medicaid UM policies, Medicaid websites, and Managed Medicaid UM policies of each state in February 2024. All 50 states were analyzed; barriers to access and discrepancies across state Medicaid UM policies were identified, and opportunities to address these discrepancies in the form of an HS coalition were recognized. The analysis stratified the Medicaid UM criteria for each state for treatment with a biologic (adalimumab/secukinumab) into no or low, medium, and high barrier levels. For high barrier level states, comparison with UM criteria for psoriasis was made. Results: Overall, the UM policies varied widely, and burdensome barriers to biologic care were identified in some states. In total, 40 states had no or low barrier criteria; states with low barrier criteria required an HS diagnosis and a prescription, or inadequate responses to ≥1 therapy (steroids/antibiotics). Alabama, Kentucky, Minnesota, Missouri, Ohio, Oregon, Pennsylvania, and Washington had medium barrier criteria and generally required an HS diagnosis and failure with ≥2 therapies. Here, criteria may be reduced to align with low barrier states. Iowa and Oklahoma had high barrier criteria. Both required ≥3 abscesses or inflammatory nodules, an HS diagnosis with Hurley Stage II/III, and failure with ≥2 therapies. In Iowa, eligible requests received three months treatment, with additional authorizations conditional upon ≥50% reduction in abscess and nodule count. The approval criteria of biologics for psoriasis were less stringent than HS in Iowa and Oklahoma, including fewer criteria items and therapy failures: Iowa ≥2 vs ≥3; Oklahoma ≥1 vs ≥2. Conclusion: Substantial state-by-state variations in Medicaid criteria were observed, with ten out of 50 states having medium to high barriers to accessing biologics. Large disparities in criteria for access to biologic care between psoriasis and HS were observed in two states. These barriers and discrepancies represent opportunities for an HS coalition at the state level, to improve access to care and patient outcomes.6

SARS-CoV-2 surveillance in US wastewater: Leading indicators and data variability analysis in 2023–2024

Wastewater-Based Epidemiology (WBE) has become a powerful tool for assessing disease occurrence in communities. This study investigates the coronavirus disease 2019 (COVID-19) epidemic in the United States during 2023–2024 using wastewater data from 189 wastewater treatment plants in 40 states and the District of Columbia. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pepper-mild mottle virus normalized SARS-CoV-2 RNA concentration data were compared with COVID-19 hospitalization admission data at both national and state levels. We further investigate temporal features in wastewater viral RNA abundance, with peak timing and cross-correlation lag analyses indicating that wastewater SARS-CoV-2 RNA concentrations precede hospitalization admissions by 2 to 12 days. Lastly, we demonstrate that wastewater treatment plant size has a significant effect on the variability of measured SARS-CoV-2 RNA concentrations. This study highlights the effectiveness of WBE as a non-invasive, timely and resource-efficient disease monitoring strategy, especially in the context of declining COVID-19 clinical reporting.

Carotenoid composition and sequestration in cassava (Manihot esculentum Crantz) roots

Cassava (Manihot esculentum Crantz) is a staple food source for many developing countries. Its edible roots are high in starch but lack micronutrients such as β-carotene. In the present study, analysis of pedigree breeding populations has led to the identification of cassava accessions with enhanced β-carotene contents up to 40 μg/g DW. This represents 0.2% of the Recommended Daily Allowance (RDA) for vitamin A. The β-branch of the carotenoid pathway predominates in cassava roots, with dominant levels of β-carotene followed by other minor epoxides of β-ring derived carotenoids. Metabolomic analysis revealed that steady state levels of intermediary metabolism were not altered by the formation of carotenoids, similar to starch and carbohydrate levels. Apocarotenoids appeared to be independent of their carotenoid precursors. Lipidomic analysis provided evidence of a significant positive correlation between carotenoid and lipid content, in particular plastid specific galactolipids. Proteomic analysis of isolated amyloplasts identified the majority of proteins associated with translation and carbohydrate/starch biosynthesis (e.g. glucose-1-phosphate adenylyltransferase). No carotenoid related proteins were detected even in the highest carotenoid containing lines. Carotenoids were associated with fractions typically annotated as plastoglobuli and plastid membranes (particularly the envelope). Proteomic analysis confirmed these structures apart from plastoglobuli, thus potentially amyloplast structures may not contain classical plastoglobuli structures.

РОЗВИТОК ЕМОЦІЙНОГО ІНТЕЛЕКТУ МАЙБУТНІХ ФІЛОЛОГІВ

This article is dedicated to the illumination of theoretical foundations and peculiarities of the interpretation of the concept of “emotional intelligence”. In particular, attention is focused on several models of emotional intelligence presented in classical psychological literature: the ability model of J. Mayer, P. Salovey, D. Caruso, the model of D. Goleman, the model of R. Bar-On. Within the framework of this study, an experimental investigation of the level of emotional intelligence of first-year philology students of the bachelor’s degree at Rivne State University of the Humanities was carried out based on N. Hall’s emotional intelligence test. As a result of the obtained data, it was concluded that the integrative level of emotional intelligence of first-year philology students of the bachelor’s degree is at a rather low level. This indicates the need for its development in society as a whole and in the educational environment in particular. Since the modern world dictates conditions in which the demand for a highly qualified specialist in the labor market today depends not only on his professional qualification, but also on the ability to communicate with people, make non-standard decisions, the ability to resolve conflict situations or the ability to prevent them, possession of critical thinking, the ability to adapt to new life conditions, etc. That is, a high level of development of emotional intelligence today can ensure highly competitive ability of a specialist and contributes to the building of a successful career in the chosen field. Relevant and promising in this regard is the need to introduce at the state level into the educational process (at all its levels) elements of training that would contribute to the development of emotional intelligence of education seekers and in particular the philological direction.

Early Childhood Special Education STARS: A Five-Point Model for Addressing the Teacher Shortage

There is currently a crisis-level shortage of qualified early childhood educators, including early childhood special educators. Teacher preparation programs must address the shortage through effective teacher recruiting, training, and retention strategies. We recommend a five-point STARS model that includes: (a) Supplemental funding during field placements, (b) Teacher preparation that leads to early childhood education and early childhood special education dual licensure, (c) Advocacy at the local, state, and national levels, (d) Relationships between teacher training programs and local public and private early learning centers, and (e) Supportive and ongoing mentoring for in-service early childhood special educators. This manuscript provides an overview of this STARS model with specific recommendations for teacher educators.

ABA and Melatonin: Players on the Same Field?

In plants, abscisic acid (ABA) and melatonin (MT) are conventionally treated as molecules mitigating stress responses. To understand the mechanisms of ABA–MT interplay, we examined the effects of ABA and MT treatment in ABA and MT loss-of-function mutants of Arabidopsis thaliana exposed to high light (HL) stress. ABA constantly suppressed ASMT encoding N-acetylserotonin methyltransferase in the context of differential responses of other MT biosynthesis genes in both the wild type (WT) and mutants. However, this response was absent in the mutant with the disrupted ABI4. Given that the ASMT promoter region contains several potential ABI4-binding elements, these data suggest that ASMT can be a potential target gene for ABI4. A role for ABI4 in the interactions between ABA and MT is supported by the finding that ABI4 is constitutively derepressed in the MT signaling mutants cand2 and gpa1, which exhibited elevated steady state levels of ABI4 transcripts and were not regulated by either stress or melatonin. In addition, the abi4 mutant showed increased modulations in the expression of the MT catabolic genes M2H and M3H in response to ABA treatment, inferring that this transcription factor is a negative regulator of ABA-dependent changes in MT content. Furthermore, all tested mutants with impaired ABA synthesis or signaling displayed elevated steady state MT levels compared to WT, while MT treatment contributed to the downregulation of key ABA synthesis and signaling genes. Collectively, our results suggest that ABA and melatonin act antagonistically, modulating the expression of ABA and MT signaling and metabolism genes. To understand the mechanisms of ABA–MT interactions, we studied the effects of ABA and MT treatment in ABA and MT loss-of-function mutants of Arabidopsis thaliana exposed to severe light stress (SLS).

The Role of Media Diplomacy in Shaping the State’s International Image

The article attempts to determine the role of media diplomacy in shaping the state's image in the international arena. Media diplomacy under the conditions of globalization transformed geopolitical relations and changed the hierarchical system of foreign policy decision-making, highlighting the competition among states for the opportunity to influence public opinion. The information policy of the state involves not only the dissemination of positive information about it in the international information space, but also the integration of politicians, state government structures, non-state actors, famous personalities, and opinion leaders into the brand management system of the state's national policy. At the same time, the use of social media platforms in the implementation of diplomatic activities has led to the fact that any user of a social network today is not only a consumer of information, but also a direct supplier and distributor of it, meaning they have the opportunity to influence the adoption of certain decisions at the state level and shape in this way the image of the state. The article analyzes the use of media diplomacy mechanisms in the formation of Ukraine's image, identifies positive and negative aspects, and discusses prospects for its development.

Do transition to practice hour requirements make a difference in adverse action and medical malpractice payment reports: An analysis from the National Practitioner Data Bank

ABSTRACT Background: The transition to practice (TTP) hour requirement presents a barrier to full practice authority (FPA) for nurse practitioners (NPs). Since 2015, the predominant method of granting FPA entails a TTP hour requirement. Purpose: Adverse action reports (AARs) and medical malpractice payment reports (MMPRs) of NPs were compared in states with FPA on initial licensure and states with FPA requiring a TTP hour period using data from the National Practitioner Data Bank (NPDB). The relationship of TTP hours to AARs and MMPRs was also evaluated. Methodology: A secondary analysis was obtained from a review of retrospective data in the NPDB. States examined were those that grant FPA on initial advanced practice registered nurse licensure and states that require a TTP hour requirement as part of their criteria for granting FPA. Results: In a 5-year period, postimplementation of FPA or 5-year postexpiration of the TTP requirement in 23 states, plus the District of Columbia, revealed that states with FPA granted on initial licensure demonstrated a lower incidence of AARs and MMPRs at the 5-year period compared with states that require a TTP hour period. No relationship existed between the amount of TTP hours and the incidence of AARs and MMPRs. Conclusion: Transition to practice hours remains a barrier to NPs achieving FPA. It is important for nursing to continue to build the body of evidence that refutes or supports the need for TTP hours. Implications: These data can be used when lobbying at the state level in the remaining states seeking FPA.

Reimagining early childhood education and school readiness through the perspectives of historically marginalized families living in a rural community

Given opportunities for early childhood education (ECE) expansion in the US, we seek to explore and elevate the perspectives of historically marginalized families, from an understudied rural community, to inform future local and state action involving public pre-kindergarten (pre-K) and kindergarten (K) provision. In partnership with a state Department of Education (DOE) and local district, we conducted two culturally responsive focus groups to investigate how such caregivers conceptualize ECE and school readiness, identify barriers with the current system, and pinpoint potential solutions to improve public pre-K and K. Participants included eight female caregivers, three of whom identified as Black, two as Hispanic, and three as White. All families met the DOE's eligibility requirements to attend public preschool. Through two 90-minute focus groups, we found families conceptualized ECE as a time for humanizing and hands-on classroom practices. They questioned the concept of school readiness, instead advocating for ways that schools can be ready for their children. Furthermore, families identified accountability culture (testing, standardization of curricula, narrow focus on core academic content, etc.), as a problem, particularly upon kindergarten entry. Solutions to improve pre-K and K included representative curricula, more equitable funding, and opportunities for collaboration across education interest-holders (e.g., teachers, families, administration, etc.) at school, district, and state levels.

THE ROLE AND SIGNIFICANCE OF INTERNATIONAL TRANSFER OF TECHNOLOGY IN THE CONDITIONS OF DEVELOPING THE NATIONAL ECONOMY OF THE COUNTRY

The purpose of the article is to study the theoretical and practical aspects of the development of international technology transfer. It has been established that today the latest technologies and innovations affect all spheres of the national economy. Participation in the international transfer of technologies becomes a necessary and imperative condition for the existence of any production, not only at the state level, but also at the global level. That is why state support for innovative activities, namely the promotion of research and development, affects the socio-economic development of modern society. The functioning and development of the world economic system takes place under the influence of the processes of integration and globalization, which leads to the acceleration of the movement of capital, financial and labor resources, goods and the growth of the intensity of information exchange. Due to the accumulation of scientific and technical potential in a number of economically developed countries, it is knowledge, intelligence and innovation that become the main driving force behind the success of individual companies in these countries in the global economy. Today, modern companies enter into a competitive struggle not so much for the level of development of the production structure and its volumes, as for the level of available innovations on the global technology market. Today, domestic science is on the brink of disaster, this state is explained by the economic crisis that occurred against the background of the military aggression of our northeastern "neighbor". In Ukraine until 2022, there were negative processes associated with the development of scientific and technological developments, as evidenced by numerous studies of the dynamics of the share of R&D expenditures in GDP, it is obvious that in today's conditions this is an unacceptable trend and the state should make maximum efforts for practical and rapid accumulation of such a sector of the national economy as science. It has been proven that Ukraine should focus on the specifics of the development of international legal regulation and guarantees in the field of technology transfer, from the point of view of international obligations. Since even those norms of international regulations implemented in domestic legislation do not provide full guarantees for the formation and development of a transparent and fair international technology transfer.

Nonlinear time series analysis of state-wise COVID-19 in Malaysia using wavelet and persistent homology.

The nonlinear progression of COVID-19 positive cases, their fluctuations, the correlations in amplitudes and phases across different regions, along with seasonality or periodicity, pose challenges to thoroughly examining the data for revealing similarities or detecting anomalous trajectories. To address this, we conducted a nonlinear time series analysis combining wavelet and persistent homology to detect the qualitative properties underlying COVID-19 daily infection numbers at the state level from the pandemic's onset to June 2024 in Malaysia. The first phase involved investigating the evolution of daily confirmed cases by state in the time-frequency domain using wavelets. Subsequently, a topological feature-based time series clustering is performed by reconstructing a higher-dimensional phase space through a delay embedding method. Our findings reveal a prominent 7-day periodicity in case numbers from mid-2021 to the end of 2022. The state-wise daily cases are moderately correlated in both amplitudes and phases during the Delta and Omicron waves. Biweekly averaged data significantly enhances the detection of topological loops associated with these waves. Selangor demonstrates unique case trajectories, while Pahang shows the highest similarity with other states. This methodological framework provides a more detailed understanding of epidemiological time series data, offering valuable insights for preparing for future public health crises.

Telehealth Research Strategies in a Post COVID-19 Era: A Roadmap for the Coming Decade.

An Agency for Healthcare Research and Quality-funded Think Tank, held at Michigan State University, brought together a wide range of subject matter experts in telemedicine, telehealth, digital health, digital access, and health care. The authors of this article represented a group focused on the research needs, constructs, and strategies in the post-COVID era. While telemedicine and telehealth grew exponentially during the pandemic, the challenges that have been with us for decades, while ameliorated to some extent, remain. To showcase the State of Michigan as a model, the authors reviewed challenges and opportunities related to telehealth and telemedicine usage and categorized them into seven areas of highest priority. Based on a review of the literature and consultation in the fields of telehealth, telemedicine, and digital access, we identified seven key categories where research would be most effective going forward. These categories include research into the impact of telehealth on clinical services, telehealth's use in administrative activities, education and training for health care providers and patients, telehealth policy implications at state and federal levels, the impact of future technology and innovation on telehealth services, patient characteristics and their experiences, and the ethical aspects of telehealth in the future. We have formulated this overview of our findings to act as a roadmap for future telehealth research. We recommend that ongoing studies should explore each of the seven categories identified above. The search for solutions to overcome the challenges within these topics must not be constrained to research that has been conducted recently; many of these challenges have faced telehealth researchers for decades, and numerous solutions have been proposed over the years. Some of these proposals should be explored once again in light of technological and societal advances. The findings from these studies should be shared in ways and through venues that can make them accessible outside the spheres of academic research, but also by practitioners, policymakers, and patients. Third, research into telehealth in all its incarnations must be prioritized, and leadership is needed to ensure these areas of study are continued to be spotlighted after the noise of the COVID-19 pandemic grows quiet.

Хлібозаготівельні кампанії у південно-східних областях України як форма терору проти селянства регіону

The topic of the Famine of 1932–1933 was and remains sensitive for Ukrainian society. The 90th anniversary of this tragedy coincided with no less tragic events caused by Russia’s full-scale war against Ukraine. In both cases, we are dealing with an attempt to destroy the Ukrainian people, destroy their state, reshape culture, annex memory. Each of these efforts of the totalitarian regime can be considered both individually and comprehensively, through the prism of the use of special mechanisms of terror. The Soviet Union was the state that, from the first days of its existence, turned terror into a tool for “working” with society. It was he who was used by the Bolshevik regime to “solve” the national question. In parallel with the promotion of the idea of internationalism, the Soviet government embodied, initiated and intensified the class struggle. Its scale was fully felt by the Ukrainians, who in the 1930s became hostages of an artificially created famine. However, the proposed article offers an analysis not of famine as such, but of the preconditions that led to it through total bread harvesting campaigns. The focus is on highlighting their scale in the region, the population of which, a priori, could not become hostage to hunger, due to the agrarian potential of the southeastern regions of the Ukrainian SSR. Based on statistical data obtained from a large number of archival documents, the article demonstrates the evolution of state policy in relation to the implementation of grain procurement campaigns. On the example of government decisions, the expansion of the scale of bread procurement and their forcing at the highest state level is demonstrated. Therefore, the author draws attention to the occurrence of a food collapse among the million population of the region, for which the actions of the state authorities were a priori incomprehensible. Along with this, the formation of the personnel policy in the Ukrainian SSR to ensure and support the grain procurement terror is not left out of the author’s attention. Thus, according to the article, specific persons delegated by the state government were behind the bread procurement terror in the South-Eastern regions of Ukraine. And this is only once again confirming that mass grain procurement campaigns in the Ukrainian SSR were clearly directed, coordinated and were a manifestation of the concentrated rejection of the Ukrainian factor by the Soviet Bolshevik system. Keywords: bread procurement campaigns, South-Eastern regions of Ukraine, soviet terror, Ukrainian SSR, the Holodomor of 1932–1933, Ukrainian peasantry.

Avances y retos del plurilingüismo en los poderes públicos del estado españolProgress and challenges of multilingualism in the public powers of the Spanish state

Abstract More than four decades after the promulgation of the Spanish Constitution of 1978, its provisions on linguistic matters have been defined, through a dynamic and constructive process, by the state and regional legislators, and by the jurisprudence of the Constitutional Court, to the point of allowing a significant advance of minority languages that had been neglected for decades. Over time, this dynamic, not exempt from controversy, as corresponds to an open and plural society, has revealed some imbalances due to the asymmetry of the constitutional linguistic model, for example the scarce presence and promotion of linguistic diversity at the state level.

The implementation process of decentralization of health services: a qualitative perspective from Sudan

BackgroundHealth system reform initiatives have increasingly embraced decentralization as a key trend. The implementation process and its outcomes are influenced by a myriad of factors, including economic forces, political dynamics, and ideological factors. Comprehending and carefully examining the implementation phase of decentralization and its consequences to achieve desired outcomes is crucial. Notably, this phase is often considered the weakest aspect of policy reforms, especially in developing countries. Therefore, this study aimed to explore and analyze the implementation phase of decentralization and its implications as essentials for achieving intended goals. The study objectives evolved around examining the entire decentralization as a multifaceted social and political process in Khartoum State, Sudan, from its early stages of decision-making, policy formulation, and implementation process and the influencing contextual factors.MethodsThis study was an exploratory qualitative study that employed in-depth interviews to gather perspectives of healthcare providers and policymakers, semi-structured observations, and thematic analysis. The study utilized Grindle’s framework for analysis.FindingsThis study revealed a political nature of decision-making, with a top–down approach to the implementation, which also lacked stakeholder involvement. It showed a lack of transparency, official documentation, and proper handover procedures from the Ministry of Health to the devolved hospitals during the implementation process. A conflict of interest between the federal and the state level was also reported. It is important to note that this process occurred within the context of structural adjustment program (SAP) schemes, which had already empowered the private sector in Sudan.ConclusionThis study documented the implementation process of decentralization of health services and its influencing factors. The study recommended reforming the decentralization policy through consultative stakeholder involvement and by implementing a concurrent responsibility paradigm that divides authority between the federal and state levels.

Relations among the trifurcated narcissism domains at trait and state level: Two of a kind?

This study explored narcissistic states using a hierarchical, trifurcated structure, examining state variability and trait-state associations of agentic extraversion, self-centered antagonism, and narcissistic neuroticism. The primary objective was to investigate whether the structural composition of narcissism, well-established in trait data, could be replicated in state data. We examined this structure at both between- and within-person levels in state data, including situation-specific structures of narcissism. The study used data from an experimental study where participants ( N = 189) met in groups of up to four people weekly over six weeks. Multilevel confirmatory factor analyses revealed that the narcissism structure was largely the same at both levels. However, within-person compositions of narcissism differed across affiliative versus controversial situations. In affiliative contexts, grandiosity manifested exclusively through agentic extraversion, with no expression through self-centered antagonism. In controversial settings, agentic extraversion and narcissistic neuroticism exhibited a slight negative association, contrasting the positive association observed across all group meetings. Our results show that narcissistic states exhibited less variability compared to the Big Five and rarely varied above their corresponding trait levels. This research contributes to a refined understanding of narcissism, highlighting the interplay between trait tendencies and situational factors in shaping narcissistic state expressions.

Evaluation of Spatial and Temporal Distribution of Carbon Emissions in Power Grid Based on Cloud Theory

In order to clearly determine the carbon emission distribution of regions, lines or nodes in the power grid, this paper applies cloud theory to the evaluation of the distribution of carbon emissions in the power grid. Based on the theory of carbon emission flow in the whole life cycle, five indicators that can reflect the spatial and temporal distribution of carbon emissions are constructed from the two dimensions of space and time. Cloud theory is used to establish the standard cloud of the carbon emission distribution level to quantify the randomness and fuzziness of the data to be evaluated. The bilateral constraint cloud theory and data-driven cloud transformation are combined to construct five comprehensive standard clouds of excellent, good, medium, poor and inferior, which are used as the evaluation interval of the evaluation index of carbon emission distribution. The reverse cloud is used to convert multiple sets of data into cloud droplets. Through the similarity measurement algorithm based on cloud model overlap, the comprehensive evaluation level of carbon emission distribution state in the time dimension is determined. Taking the IEEE 39 system as the research object, the spatial and temporal distribution of carbon emissions is evaluated, and the rationality and effectiveness of the proposed model are verified. Finally, the influence of the new energy penetration rate and power supply structure on the carbon emission distribution of the power grid is discussed by using cloud computing. Based on this, the targeted carbon reduction strategies for different types of nodes and the method of measuring the optimal new energy penetration rate are proposed and can provide a decision-making reference for optimizing the carbon emissions of the power grid.

Der Medizinische Dienst Eine sozialmedizinische Institution der Qualitätssicherung im Gesundheitssystem

As a corporation under public law, the federally established Medical Service (MD) is an organizationally and substantively independent socio-medical expert organization. It uses its expertise to support the health and nursing care insurance companies as well as their associations and other clients from the healthcare system nationwide in ensuring medical and nursing care within the social law solidarity community consisting of statutory health and social care insurance. In relation to the 12.000 employees, the specialist tasks are carried out by doctors (20.1 %), nursing staff (40.4 %) and members of other suitable professions in the healthcare sector (5.5 %). With a total of over 2.955.000 GKV assessments, 13.200 structural audits in hospitals, significantly more than 1.600 on-site quality controls in hospitals, almost 3.000.000 nursing assessments, almost 21.900 quality inspections in nursing facilities as well as committee work at state and federal level, the MD assumes a comprehensive constitutive-constitutional and quality-assuring expert care mandate. The social-medical service provided, which is committed to the general social law principles of quality, humanity and cost-effectiveness and is regulated by guidelines issued by the MD Bund and approved by the Federal Ministry of Health, is subject to standardized, nationwide quality assurance.

Bridging Public Health Research and State-Level Policy: The Texas Research-to-Policy Collaboration Project.

Significant barriers to the implementation of evidence-based policy exist. Establishing an infrastructure and resources to support this process at the state level can accelerate the translation of research into practice. This study describes the adaptation and initial evaluation of the Texas Research-to-Policy Collaboration (TX RPC) Project, focusing on the adaptation process, legislative public health policy priorities, and baseline researcher policy knowledge and self-efficacy. The federal Research-to-Policy Collaboration (RPC) method was adapted to the Texas legislative process in 2020. Policymakers and public health researchers were recruited using direct outreach and referrals. Legislators or their aides were interviewed to determine health policy needs, which directed the development of legislator resources, webinars, and recruitment of additional public health researchers with specific expertise. Researchers were trained to facilitate communication with policymakers, and TX RPC Project staff facilitated legislator and researcher meetings to provide data and policy input. Baseline surveys were completed with legislators to assess the use of health researchers in policy. Surveys were also administered before training to researchers assessing self-efficacy, knowledge, and training needs. Qualitative data from the legislator interviews were analyzed using inductive and deductive approaches. Quantitative survey data were analyzed using descriptive statistics for scales and individual survey items. Legislative offices (n = 21) identified health care access, mental health, and health disparities as key health issues. Legislators reported that health data were important but did not actively involve researchers in legislation. Researchers (n = 73) reported that policy informed their work but had low engagement with legislators. Researcher training surveys indicated lower policy self-efficacy and knowledge and the need for additional training. Adaptation of the RPC model for state-level health policy is feasible but necessitates logistical changes based on the unique legislative body. Researchers need training and resources to engage with policymakers.