Healthcare Affordability in the US

Healthcare Affordability in the US Advanced Nurse Practitioner Scope of Practice Issues Marina Bukhrashvili New York State needed an additional 1,200 physicians to address the shortage by 2012, according to a 2012 Haney’s survey by the Healthcare Association of New York State (Verdon, Ritchie, Marbury Mazzolini, 2014). The scope of Certified Nurse Practitioner (CNP) practice is currently debated in some states. In New York State, the Nurse Practitioners Modernization Act will allow those nurses who have more than 3,600 hours of experience to treat patients without the supervising physician’s signed practice agreement (Farmer, 2014).This act will become law on January 1, 2015. This act may fill that void; however, various New York physician advocate groups continue to argue that patient safety will be compromised because of the gap in training of CNPs (Verdon et al., 2014). The United States (U.S.) health care system faces many challenges due to demographical, economic and political shifts. There are existing gaps in quality and accessibility of care and patient safety. U.S. population is aging rapidly and it is estimated that about 18 percent of the U.S. population will be 65 years old or older by 2025 (U.S. Census Bureau, 2012). With growing number of Medicare beneficiaries, there will be more demand for primary care providers. It is estimated that by 2020, the U.S. nation will require 40 percent more primary care providers (Hauer et al., 2008). U.S people 65 and older will have more than one chronic disease and physicians’ shortages will not meet the demands that are expected (Centers for Disease Control and Prevention, 2012). The National Governors Association (NGA) reviewed of the literature and summarized that CNPs can reduce disparities in access to care, promote cost effectiveness through policy advancement, patient advocacy and the development of innovative models of care to improve patient care (NGA, 2013). The push for giving CNPs more autonomy continues with the shortage of primary care physicians on the rise. The American Academy of Family Physicians (AAFP) is not supporting the idea of allowing CNPs the full scope of practice without working under the physician’s supervision. One of the reasons cited is that family physicians have extensive training and education, which would ensure patients’ safety and provide the best quality of care (American Academy of Family Physicians, 2012). The scope of CNPs’ practice is currently debated in some states. Researchers studied care provided by both nurse practitioners and physicians and showed that while quality of care was similar for both providers, patients’ results were same or better for NPs as compared to physicians (Bauer, J. 2010). In addition, it was found that nurse practitioners provide care at a lower cost as well as more disease prevention counseling, health education, and health promotion activities than physicians (Mehrota et al., 2009). Another study which used data from the Association of American Medical Colleges’ Consumer Survey showed that consumers are open to the idea of obtaining medical care from NPs (Dill, Pankow, Erikson Shippman, 2013). Compared to physicians, CNPs traditionally are reimbursed at a lower Medicare rate for delivery of the same services. Yet, while our healthcare desperately needs to reduce cost, it is estimated that a cost savings would remain, even if CNPs were to receive equivalent reimbursement, because they utilize fewer resources than physicians (Health Policy Brief, 2012). In 2009, on average, it cost 20% less to visit a nurse practitioner than to visit a physician (Eibner, Hussey, Ridgely Glynn, 2009). In Massachusetts, after the insurance reform was implemented, it was shown that the state could save from $4.2 to $8.4 billion over a 10-year period when nurse practitioners use was increased (Eibner et al., 2009). Accountable care organizations (ACA), community and nurse-managed health centers, patient-centered medical homes success will require that CNPs have full scope of practice to have the ability to practice independently without restrictions (Fairman, Rowe, Hassmiller, Shalala, 2011). Organizational barriers exist for reimbursements of care provided by CNPs. Notwithstanding that the quality and standards of preventing care established in the ACA are met by these providers, their current rate of reimbursement for Medicare services to residents in long term care (LTC) facilities is only 85 percent of the rate that physicians charge for the same services (American Association of Nurse Practitioners, 2013). The unlimited contribution of CPNs will be even more important considering that with the implementation of the ACA, millions of newly insured Americans will seek the access to healthcare. Expanding the scope of practice of advanced practice nurses can possibly translate to an increased access to healthcare for many current and future patients, especially in underserved areas (National Governors Association, 2012). There is a need for the uniform standards for practice and to eliminate the difference in the level of practice among CNPs from one state to another (NGA, 2012). The scope of practice will establish which activities are reimbursed by third party payers and will have direct impact on the independent practice of CNPs (NGA, 2012). When CNPs are required to collaborate or to be supervised by the physician, they are less likely to be selected by insurers and are unable to directly bill for the services they render (NGA, 2012). Instead, the bill for their services is coded under the physician’s provider number. If the requirement for physician involvement is dropped, CNPs would be allowed to be credentialed as providers and directly reimbursed for their services. This is also important if a physician moves or does not want to collaborate with a CNP. Another issue related to scope of practice is the lack of universal, federal recommendations for mobility across states for practitioners involved in telemedicine. The significant discrepancy in CNP scopes of practice across states limits the ability of expert CNPs to work as consultants in a different state, which may limit the access of individuals to specialty consultations that may not be available locally. In their study of nurse migration, it was reported that nurses, including CNPs, move to states with less restrictive scopes of practice. Migration of CNPs may contribute to the shortage of primary care providers, especially in disadvantaged areas (Kalist, Spurr, Wada, 2010). Nurses are restricted to certify in some state to do health care visits or stay in skilled nursing facilities, admit patients to hospitals or prescribe medications without physician’s supervision and because of that nurses move to less restrictive states, and from primary to specialist care, a resu lting loss of access to care a lot of patients (Eibner et al., 2009). With millions of people signing up for health care under the Affordable Care Act, the aging population and number of chronic illnesses growing, the demand for primary care services is projected to grow. NPs will play a significant part in expansion and shaping of health care delivery. The looming shortage of primary care practitioners can be alleviating by integrating into health care delivery primary care nurse practitioners and physicians assistants. Medical profession should have an active interest in advancing the role of NPs and making sure that the high standards of the profession are intact. While NPs should not be a replacement for doctors they should be allowed to practice to the full extent of their training. Relaxing the scope of practice laws that prevent nurse practitioners from playing the important role in providing basic primary health care services is the first step that should be undertaken. References American Association of Nurse Practitioners (2013). Issues at-a-glance: Full practice authority.  Retrieved from: http://www.aanp.org Association of Advanced Nursing Practice Educators. (2009).Universities and advanced practice  programmes. Retrieved from  http://www.aanpe.org/AANPEHEIsMembers/AANPEMemberUniversitiesCoursesProgrammes/tabid/469/language/en-US/Default.aspx Bauer, J. (2010). Nurse practitioners as an underutilized resource for health reform: Evidence-based demonstrations of cost-effectiveness. Journal of the American Academy of Nurse  Practitioners 22 (2010), 228-231. Centers for Disease Control and Prevention (2012). Chronic diseases and health promotion.  Retrieved from: http://www.cdc.gov/chronicdisease/overview/index.htm Dill, M., Pankow, S., Erikson, C., Shipman, S. (2013). Health Affairs. Retrieved from  http://content.healthaffairs.org/content/32/6/1135.abstract The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care. (2012)  Retrieved from  http://www.nga.org/cms/home/nga-center-for-best-practices/center-publications/page-health-publications/col2-content/main-content-list/the-role-of-nurse-practitioners.html The, O. C., Pr, N. (2012). Education and Training: Family Physicians and Nurse Practitioners.  Retrieved from  http://www.aafp.org/dam/AAFP/documents/news/NP-Kit-FP-NP-UPDATED.pdf Eibner, C.E., Hussey, P.S., Ridgely, M,S., McGlynn, E,A. (2009). Controlling health care  spending in Massachusetts: an analysis of options. Retrieved from  http://www.rand.org/pubs/technical_reports/2009/RAND_TR733.pdf Fairman, J., Rowe, J., Hassmiller, S., Shalala, D. (2011). Broadening the scope of nursing  practice. New England Journal of Medicine 364(3), 193-196.  doi:10.1056/NEJMp1012121 Farmer, R., (2014) Milestone New York legislation eases practice restrictions on NPs.  Retrieved from  http://news.nurse.com/article/20140505/NY02/305050020#.VGAJdMnsoh0 Hauer, K.E., Durning, S.J., Kernan, W.N., Fagan, M.J., Mintz, M., O’Sullivan, P.S†¦.Schwartz,  M.D. (2008). Factors associated with medical students career choices regarding internal  medicine. JAMA, 300(10), 1154-1164. Kalist, D., Spurr, S., Wada, T. (2010). Immigration of Nurses. Industrial Relations: A Journal  of Economy and Society, 49(3), 406-428. Mehrota, A. et al. (2009). Comparing Costs and Quality of Care at Retail Clinics with that of  Other Medical Settings for 3 Common Illnesses. Annals of Internal Medicine, 151, 321-323. Nurse Practitioners and Primary Care. (2013). Retrieved from  http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79 Sealey, G. (2014). U.S. Elderly to Double in 25 Years. Retrieved from  http://abcnews.go.com/US/story?id=91943page=1 U.S. Census Bureau, Statistical Abstract of the United States: 2012 (131st Edition) Washington,  DC, 2011. Retrieved from: http://www.census.gov/compendia/statab/. Verdon, D., Ritchie, A., Marbury, D., Mazzolini, C. (2014). (Slideshow) Scope of practice  debate in primary care spreads to 8 states. Retrieved from  http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/midlevel-providers/slideshow-scope-practice-debate-primary-care-sprea?page=full

Yersinia pestis :: Biology Biological Health Medical Essays

Yersinia pestis Life History Yersinia pestis is the causative agent of the systemic invasive infectious disease often referred to as the plague. The Y. pestis is an extremely virulent pathogen that is likely to cause severe illness and death upon infection unless antibiotics are administered. In the past, Y. pestis has caused devastating epidemics during three periods of modern history; the Justinian Plague spread from the Middle East to the Mediterranean during the 6th-8th centuries AD and killed approximately 25% of the population below the Alps region. Perhaps the most famous incidence of any disease was the devastating Black Plague of 8th-14th century Europe that eradicated 25 million people (nearly 25% of the population) and marked the end of the Dark Ages. The third endemic began in 1855 in China and was responsible for millions of deaths. Microbiological Characteristics Yersinia pestis is a Gram-negative, bipolar-staining coccobacillus member of the Enterobacteriaceae family, and is an obligate intracellular pathogen that must be contained within the blood to survive. It is also a fermentative, motile organism that produces a thick anti-phagocytic slime layer in its path. Transmission Y. pestis has the ability to cause disease in rodents, insects and humans. The primary carriers of the pathogen are the Oriental rat flea, Xenopsylla cheopis, and infected rodents. The path of transmission to humans usually involves a flea feeding on an infected rodent and becoming a carrier of infection. Once internalized, the bacteria will continue to reproduce until a large blockage is formed in the midgut of the flea, causing digestion and other gastrointestinal functions to cease. When the flea attempts to feed on humans, the blockage inhibits any blood from entering the stomach cavity; instead, portions of the blockage, often containing 11,000-24,000 bacilli, are regurgitated into the mammalian host. Virulence Factors Yersinia pestis encodes two antigenic molecules: Fraction 1 (F1) capsular antigen, and VW antigen. Both of these molecules are needed for pathogenicity, and are not expressed at temperatures lower than 37Â °C. This requirement is the main reason why Yersinia is not virulent in fleas, since their body temperature normally levels around 25Â °C. Yersinia is a model for studying Type III Secretion Systems (TTSS) that inject bacterial proteins into a host cell. In Y. pestis, it is the translocation of Yersinia outer proteins (Yop’s) that blocks the host cell’s ability to communicate with immune system cells and down-regulates the response of phagocytic host cells to infection.

The professional teacher in classroom, school, and society

Introduction:By the 1970s, large authoritiess were criticized about interfering the function of markets and the ability of the persons to run their ain personal businesss. Managerialism and marketization of the public services was the chief impression of ‘new public direction ‘ . In order to better the efficiency and effectivity in the populace sector, different schemes such as internal audit and quality confidence have been introduced. ( Aucoin, 1990 ) As instruction is one of the cardinal public services in Hong Kong, it can non hedge from the tidal force of marketization. The reform is related to the transportation of duty from the authorities to the school. In other words, there is a alteration in the nature of the authorities engagement with a position to going more competitory and providing for the demands in the market, and the ever-changing universe. Efficiency, answerability, quality and efficient usage of resources have become the ‘yardstick ‘ in mea suring the public presentation by society, authorities and schools. Those standards have made a great impact on instruction at all degrees. Policy of Decentralization in Schools: In an effort to advance ‘quality instruction ‘ in schools, Hong Kong authorities introduced the thought of a school-based direction theoretical account with a position to conveying about decentalisation. This policy based on an premise: when a market mechanism is in topographic point in the instruction system, s chools will go antiphonal and accountable to the populace, and therefore will choose for better-quality public presentation. ( Brown, 1995 ) Decentralization allows schools flexibleness to apportion resources. Marketization enhances the power of parents as they provide the demands. Diversity of school was decreased and hence the competition between schools is violent. The functions of instructors and pupils have to alter harmonizing to the above-named factors. Fig. 1 Marketization theoretical account ( Modified from Ball )Parental pick:Parental pick is one of the cardinal influences of the educational market. Restructuring instruction by the authorization of parents and pupils through picks in instruction is the cardinal thought under acceptance of a market-oriented attack. In Hong Kong, most of the parents are fond of English Medium Secondary Schools because they believe in the myths of better educational services inside them. ( Band1c†Ya ®Ã‚ ¶e†¢Ã‚ ·a„†ºa‚?c µÃ‚ ±e†¹Ã‚ ±a? ­ , 2010 ) Presently, instruction is considered as a sort of commercial merchandise instead than larning to larn. The whole schooling system can be regarded as a trade good market controlled by civilization of quality. Furthermore, schools are the mills for â€Å" value-addedness † while the pupils ‘ acquisition results are the trade goods within the market. Parents are the goaded force and exert great force per unit areas to school in order to bring forth better reactivity and academic effectivity. ( e ¶Sa ¤se†¹Ã‚ ±?-†¡c? ­ e ¶Sa?-a ®Ã‚ ¶e†¢Ã‚ ·e § , 2008 )Diverseness:In the aftermath of the economic restructuring of Hong Kong into a service economic system, there was a great alteration of the prevocational and secondary proficient schools in 2000. Education and Manpower Bureau revamped and enriched the proficient course of study by stressing more on concern and technological facets every bit good as linguistic communications. ( Education Department, 1997 ) The differences between secondary proficient schools and mainstream secondary schools became bleary. Furthermore, inclusive instruction is introduced and implemented. Students with particular educational demands ( SEN pupil ) are encouraged to have instruction in ordinary schools every bit far as possible. This policy increases the learning diverseness of pupils inside chief watercourse schools. This follows with increasing of demands of resources and teacher re-training. In world, nevertheless, there is unequal support and resources. Under inclusive instruction system, schools can merely have $ 10,000 subsidies for every SEN pupil. Compared with the original system, schools can enroll one instructor and learning aid for every 15 SEN pupils. ( ez?a†¢Ã¢â€ž ¢e‚?eaS?a? §a ¤sca °Ã¢â‚¬Ëœ , 2005 ) Merely 6 % of instructors agree with adequate support under the bing system. ( Education Convergence, 2002 ) In the past 15 old ages, the diverseness of school is reduced due to revamping secondary proficient schools and inclusive instruction. More and more schools became mainstream schools. Normally, those schools focus on academic facets instead than developing pupil ‘s possible since academic accomplishment of pupils is an of import public presentation index under cognition base society. Students ‘ endowments are ever buried.Competition:Under marketization, competition becomes much more serious than earlier. From the fact that the figure of pupils entry to secondary one lessening dramatically ( a? ­a ­?aae ·?a?†¦e ©sa , 2010 ) , schools which did non get adequate figure of pupils might be closed by the authorities. In order to hedge from this procedure, different schools principals utilizing different schemes to pull pupils to analyze their school. The schemes including give different subsidy or even hard currency to the new pupils. Harmonizing to the research ( e ¦Ã¢â€ž ¢Ã¢â‚¬ ¢Ã¢â€ž ¢e‚?a °Ã‚ ­aaâ€Å"?a?†Ã¢â‚¬ ¢Ã¢â€ž ¢a? «a ·?aeY? , 2010 ) , some instructors were forced to advance the school. The promotional activities including be aftering different activities, some even serve as salesmen on the street to advance the school. We believed that these should non be the responsibilities of instructors. The direct result is teacher can non pass equal clip on the lesson planning or fixing resource for pupils. This implies that learning quality in footings of pupil larning result may deteriorate due to the deficit of readying. Second consider competition between pupils. Hong Kong is a cognition based society. Under the construct of marketization, educational success implies competiveness, which farther elaborates to money and high socio-economical degree. We argued that the ultimate end of instruction should non be served as a tool to mount up to higher socio-economical degree. If marketization continues, the purposes of instruction would go training pupils to accomplish academic success merely and in uniformity. We argued there would be two possible result of this uniformity. The first result is we would lose out value instruction. Previously school non merely concentrate on academic country, but besides the whole individual development of pupils. Teacher can hold flexibleness to learn different country of cognition, but non constrained to the examinational stuffs. But under marketization, we focus on the acquisition result and competiveness between pupils instead than value. It seems that the value instr uction is no longer of import in the modern society. Therefore we argued this may be one of the accounts of the happening of different societal issues. The 2nd possible result of uniformity is the changing of features of pupils. After marketization, we focus more on competition every bit good as public scrutiny. Therefore different accomplishments such as communicating or coaction may be omitted in the course of study. From the illustration of the maestro alumnus in Chinese university, this indicated that our current educational system maintain preparation pupils in this mode. ( a? ­a ¤Ã‚ §c? ©a? «200? ¬?e ¦Ã¢â‚¬ ¹a ·?a ¤Ã‚ ±?†¢- , 2011 ) This in bend pupils can merely execute good in the test merely, but can non use the cognition in the existent state of affairs or utilizing different accomplishments to work out jobs.The effects of the reform of educational system on instructors:In fact, the work load of instructors was really high before the reform of educational system. Teachers have more than 30 periods per hebdomad and it was one of the highest Numberss around the universe ( Cheng, 2004 ) . Furthermore, the figure of pupils per category normally is really high and it is about 40 per category. It may to a great extent increase the work load of instructors. Under the reform of the educational system, the work load of instructors is farther increased. In the yesteryear, the instructors could still manage their work. It was because of the standardised course of study, lower in-class diverseness of pupils and the comparatively teacher-centered instruction manner. However, under the reform of the educational system, the stria of pupils was changed from 5-band system to 3-band system. In other words, the intra-school diverseness of pupils became much higher. This may ensue in the dramatic addition in the trouble and cost of learning and direction of schools. Ultimately, instructors have to pay more attempt to cover with the jobs in learning, conselling and resources allotment. As the diverseness of pupil additions, the original high quality schools and pupils become second-rate since the resources have to be shifted to cover with the jobs of less able pupils. As mentioned antecedently, inclusive instruction is one of the of import policies under the reform of the educational system. It aims to include some SEN pupils into the normal categories so that SEN pupils can accept the legitimate instruction. This may increase the intra-school diverseness of pupils and the operating cost of schools. Besides, excess back uping resources should be needed. However, a batch of schools do n't run into the standards to suit the SEN pupils and are forced to make so. Under the state of affairs of high work load and ‘big category ‘ , instructors really have non adequate clip and energy to take attention of the SEN pupils. As a consequence, the SEN pupils finally get no benefit. The reform of educational system involves the alteration in the instruction schemes and the usage of the instruction tools. In order to do the instruction more effectual, instructors have to take a batch of preparation classs about the alteration of the course of study, the application of information engineering and etc. Besides, some instructors have to complete the graduate student sheepskin of instruction. Teachers have to pay excess clip and energy on their surveies. In add-on to the work load and day-to-day responsibilities in school, instructors may experience collapsed. As a consequence, the success of the reform of educational system may be hard to be achieved since instructors really have no clip and energy to take attention of the diverseness of the ability of pupils and aid pupils ‘ growing.Decision:In decision, marketization have its ain advantages such as bettering efficiency of acquisition and instruction in footings of larning result. Nevertheless, the purposes o f instruction and value instruction are neglected in the current marketized educational system. We believed that the disadvantages overwhelm the advantages and this is non a good pattern to our following coevals. Entire words: 1675

The Future of Early Education Importance of Preschool

Did you know that  Forbes.com reports that the Department of Education has awarded almost $250 million in an effort to ensure that development of early education programs, preschool, continue to best serve children from low- and moderate-income families? This is one example of the Presidents long-standing plan to offer free, universal pre-school for these families. However, President Trumps latest budget for 2019 education appears to be reducing funding   for schools. As we know, in President Obamas 2013 State of the Union address he unveiled his plan for universal Pre-K or pre-kindergarten education for four-year-olds. His plan would guarantee kids whose household income is at or below 200% of the poverty line a free pre-K education with local schools and local partners, and their teachers would have the same training as K-12 teachers. In addition, the programs would offer many of the benefits of private school pre-kindergarten programs, including small class sizes, high adult-to-child ratios, and assessment of the programs provided. The program would also expand the number of full-day kindergarten programs available. Unease in Regards to the Future of Early Childhood Education However, despite these advancements, there is unease as a result of the new leadership of our nation coming; many people are unsure about the future of early childhood programs. Betsy DeVos has been chosen by President Donald Trump to take on the role of Education Secretary, and her position on pre-school funding is not clear; the same can be said for the President. As a result, there are some who are uncomfortable with the uncertainty, and the latest budget developments are not alieviating fears.   Why Pre-Kindergarten is So Important While many private schools offer high-quality pre-kindergarten programs and full-day kindergartens, providing enriching educational opportunities for children under age 6, many children who attend public schools, particularly children living in poverty, do not have access to these programs. According to the National Institute for Early Education Research (NIEER) in New Brunswick, New Jersey, 28% of 4-year-olds were enrolled in a pre-kindergarten program in the 2011-2012 school year, which represents an increase over the 14% of four-year-olds who did so in 2002. Yet, pre-kindergarten programs are critical to children’s long-term success, and experts at NIEER have documented that children who have been enrolled in high-quality pre-kindergarten programs enter kindergarten with better vocabularies and more advanced pre-reading and math skills than children who don’t have access to these programs. Kids enrolled in pre-k programs aren’t just learning how to recognize letters and numbers; they are also learning critical social skills and the importance of working independently in the classroom. Through high-quality pre-k programs, they develop the confidence to take on more advanced classroom work. Many children struggle with social skills and behavioral problems in kindergarten, and many children are even kicked out of kindergarten. Pre-kindergarten programs are essential in teaching kids the social skills they need for later grades, not just the academic skills. Pre-K Benefits Last a Lifetime The benefits of pre-kindergarten education last well beyond kindergarten. According to research conducted by NIEER, there are amazing long-term economic benefits from early childhood education for children in poverty. For example, life-time earnings of some children increase by hundreds of thousands of dollars, and the economics benefits of these programs outweigh the costs by a factor of up to 16 (in some programs). In addition, such programs show that participants have lower crime rates and decreased rates of welfare dependence as adults, so the benefits of early childhood education can last a lifetime. According to the White House Fact Sheet on Obama’s educational plan, children from low-income families are less likely to have access to pre-kindergarten programs, and middle-class families also struggle to afford private pre-school programs, yet these programs are critical to children’s long-term school success. Children from low-income families who are not reading at grade level by third grade are six times less likely to graduate from high school. According to the Fact Sheet from the White House, only 60% of American children have access to full-day kindergarten programs, yet these programs are also essential to teaching children skills critical skills for later academic success. Pre-kindergarten programs are a promising way to reduce adult poverty in this country and to provide the essential skills workers need as adults. Working with at-risk children in the primary or middle school years may be too late, and while private schools offer high-quality pre-school and early education programs, research studies have documented the need to expand these programs to state-funded programs across the country. Article updated by Stacy Jagodowski