The Patient Protection and Affordable Care Act (ACA) 1 laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. 2 During the first openenrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, federal and state funding was used to develop navigator programs in each state. The design of these programs differed by location, 3 and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource.4 This is somewhat surprising, given that LHDs serve as trusted entities in communities, can reach the most-vulnerable populations, and have access to data and resources that might facilitate ACA outreach and enrollment. This is one in a series of reports designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Potential roles include serving as a coordinator for community activities, being a trusted source of health care information for consumers, and leveraging community partners to increase capacity for outreach and enrollment. These reports identify compelling models for how LHDs can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage. Each case study
La falta de gestión y educación ambiental dentro de las centrales de abastos de frutas y verduras en ciudades intermedias de Colombia, está generando volúmenes de residuos innecesarios que terminan dispuestos en rellenos sanitarios, desaprovechando su potencial de recuperación y reciclaje. El propósito de esta investigación fue determinar los factores que ocasionan los problemas en la separación y disposición de residuos, a partir de un estudio de caso dentro del establecimiento comercial de expendio de frutas y verduras más grande de la ciudad de Neiva – Colombia con un área de 80.049 m2. Para su desarrollo se determinó la periodicidad y frecuencia de recolección y transporte de los residuos a diario, se realizó una caracterización de estos y se aplicó una herramienta de recolección a 107 establecimientos. Se encontró un problema cultural, un 72% de la comunidad comerciante envejecida, un 54% de residuos orgánicos desaprovechados, 42% de otros residuos recuperables.
The Patient Protection and Affordable Care Act (ACA) 1 laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. 2 During the first openenrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, federal and state funding was used to develop navigator programs in each state. The design of these programs differed by location, 3 and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource. 4 This is somewhat surprising, given that LHDs serve as trusted entities in communities, can reach the most-vulnerable populations, and have access to data and resources that might facilitate ACA outreach and enrollment. This is one in a series of reports designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Potential roles include serving as a coordinator for community activities, being a trusted source of health care information for consumers, and leveraging community partners to increase capacity for outreach and enrollment. These reports identify compelling models for how LHDs can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage. Each case study • The department established a network of in-person assisters (IPAs) and IPA organizations that were instrumental in outreach and enrollment efforts. It also created a forum for information-sharing around challenges and provided support and technical assistance to the group.• Challenges to outreach and enrollment efforts included the Washington Medicaid renewal policy, the poor relationship between the IPAs and the Washington Health Benefit Exchange, and lack of support to address IPAs' concerns. In addition, some raised concerns about having a public health department serve as a lead agency.• Boosts to those efforts included grant support from the Washington Health Benefit Exchange, formal collaboration with the health sector through a steering committee, the exchange grant, and the collaborative culture among organizations in Tacoma.
El alto impacto ambiental de los desechos sólidos y líquidos que contienen elementos tóxicos y metales está teniendo un impacto negativo en diversos ecosistemas, este trabajo tiene como objetivo realizar una revisión sistemática y análisis bibliométrico de la producción científica, con la esperanza de comprender la capacidad de retención y absorción de biocarbón, análisis Capacidad de diferentes biochars para ciertos elementos contaminantes incluyendo metales pesados; el análisis bibliométrico se realizó a través de una revisión de las bases de datos web of science (WoS) y Scopus. Los registros obtenidos se analizan utilizando teoría de grafos y herramientas como bibliometrix, Sci2 Tool, Gephi, se dividen en tres categorías: clásica, estructural y reciente, donde se obtienen tres perspectivas: captación de metales pesados, biodisponibilidad y contaminantes; De igual manera, se identificó que el campo de estudio es nuevo. El principal autor es Yang Yi, autores importantes como Geng Yong y Liang Dong cuentan con un H-index bastante alto. Adicionalmente, los países con mayor producción en el tema son: CHINA que ocupa el primer lugar, USA con el segundo lugar y KOREA con el tercer puesto.
The Patient Protection and Affordable Care Act (ACA) 1 laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. 2 During the first openenrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, federal and state funding was used to develop navigator programs in each state. The design of these programs differed by location, 3 and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource.4 This is somewhat surprising, given that LHDs serve as trusted entities in communities, can reach the most-vulnerable populations, and have access to data and resources that might facilitate ACA outreach and enrollment. This is one in a series of reports designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Potential roles include serving as a coordinator for community activities, being a trusted source of health care information for consumers, and leveraging community partners to increase capacity for outreach and enrollment. These reports identify compelling models for how LHDs can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage. Each case study • Outreach and enrollment efforts face challenges, such as inconsistencies between national and state enrollment processes, the fact that a major grant was not actually awarded until just before open enrollment began, underestimations of the time required to complete enrollments, and high insurance costs.• Some factors-such as a long history of partnership, trust, and strong communication; complementary, not competing, interests; strong community presence; the ability to influence policy; and shared decisionmaking across the alliance-help local health departments' efforts.
El desarrollo urbano no controlado está generando un desequilibrio en los ecosistemas urbanos y los servicios ecosistémicos que estos proveen. Este trabajo es una revisión sistemática y un análisis bibliométrico de los resultados de investigaciones científicas en agroforestería urbana, con el propósito de identificar tendencias mundiales en esta área del conocimiento. El análisis bibliométrico se realizó con base en una revisión de las bases de datos Scopus y Web of Science (WoS). Todos los registros obtenidos fueron analizados mediante la teoría de grafos y algunas herramientas como bibliometrix, Sci2 Tool y Gephi, las cuales se dividen en tres categorías: clásica, estructural y reciente. Este ejercicio identificó cuatro perspectivas: agrosilvicultura e infraestructuras verdes urbanas, agroforestería urbana como servicio de aprovisionamiento, valoración de los servicios ecosistémicos urbanos e impactos de la agroforestería en los territorios.
Limited Print and Electronic Distribution RightsThis document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.html.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org For more information on this publication, visit www.rand.org/t/rr1392Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2016 RAND CorporationR® is a registered trademark.iii Preface This report summarizes findings from a project designed to highlight innovative models and best practices that leverage local health department (LHD) involvement in outreach and health insurance enrollment activities conducted as a result of the Patient Protection and Affordable Care Act (ACA). From June through October 2014, RAND and National Association of County and City Health Officials staff visited LHDs and their partners engaged in outreach and enrollment in Eagle, Pitkin, and Garfield Counties in Colorado; Tacoma-Pierce, Washington; New Orleans, Louisiana; Boston, Massachusetts; West Virginia; Houston, Texas; and Illinois. Each of these case studies was designed to capture nuanced differences in how LHDs support outreach and enrollment efforts in their communities, identify facilitators and barriers to these approaches, and develop lessons learned from these activities. In this report, we observed and identified compelling models for how local and state health departments can implement similar activities in their own communities. Given the varied approaches that public health can take and the myriad contextual differences, we sought to choose case study sites that reflect differences in expansion statues, urbanicity, use of public health data, partnerships, leadership by the LHD, and involvement of public health at the state, compared to local level. This report provides guidance and insight into the role LHDs can play now, and may help redefine that role in the future, as states continue to enroll residents in health insurance coverage. We summarize the methods used in each case study and present results from each of the case studies-first providing important context for health care reform in that state, followed by a justification for selection of the...
A retrospective analysis of data concerned with the regulation of the transport of animals for caged animal feeding operations (feedlots) and the availability and use of antibiotics was accomplished from data available from an aggregation of domestic and global agencies. Agency data sources included are the United States Department of Agriculture‐Animal Plant Health Inspection System (USDA‐APHIS), the Environmental Protection Agency (EPA), the United States Geological Survey (USGS), Center for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Customs and Border Protection‐Eagle Pass Sector (CBP), Drug Enforcement Administration (DEA), Texas Water Development Board‐Laredo, Texas, (TWDB), Texas Commission on Environmental Quality‐Laredo, Texas, (TCEQ), Organization for Economic Cooperation and Development (OECD), Asia Pacific Economic Cooperation (APEC), European Centre for Disease Prevention and Control (ECDC), European Medicines Agency (EMEA), Food and Agriculture Organization (FAO), World Organization for Animal Health (OIE), Transatlantic Taskforce on Antimicrobial Resistance (TATFAR), World Health Organization (WHO), and Central Drugs Standard Control Organization (CDSCO). Based on the analysis, an action plan is proposed for the Global Union for Antibiotics Research and Development[1][2][3](GUARD) to mitigate AR pandemic (ARP). The primary suggestion is the immediate establishment of a centralized database that will serve as an open‐ended system for reporting, monitoring and control, education, and information sharing in the following processes: i. Antibiotics prescription details by name of disease and dosage, ii. Amount of antibiotics produced per country and per capita, including utilization of antibiotics per country and per capita. Implementation of antibiotics time out (ATO), iii. Detection of active pharmaceutical ingredients (API) in soil and water, iv. Streamlining of the disposal of antibiotics by universal and global disposal standards (Best Available Techniques), v. Maintain a global monitoring system for emergence of AR pathogen induced infectious diseases on twenty‐four‐hour and seven day cycles, vi. Mandatory cyclic reporting (quarterly, semiannual, and annual) regarding morbidity and mortality rates due to AR pathogens, vii. Mandatory annual summit to address threats of emergence and spread of AR infectious diseases, viii. Generate global trust fund to create resources for mitigation of the AR, ix. Global implementation‐success rate of Antibiotics Timeout (ATO), x. Creation of a Pharmaco‐Ecotoxicology data sheet for “Bioaccumulation potential of antibiotics, its active pharmaceutical ingredients (API) in the non‐target organisms (aquatic, terrestrial, avian species) and Environmental risk assessment for biological response using multi‐biomarker approach. Taken together, a collective effort addressing the aforesaid suggestions on a global scale would plausibly mitigate ARP. Data analysis and adequate literature sources will be presented at EB 2017.Support or Funding InformationProfessional development funds to Subburaj Kannan
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