Hamersma S.,University of Florida |
Kim M.,Thomas University
Journal of Health Economics | Year: 2013
In this paper, we examine the effects of recent parental Medicaid eligibility expansions on Medicaid participation and private insurance coverage. We present a new approach for estimating these policy effects that explicitly models the particular policy instrument over which legislators have control-income eligibility thresholds. Our approach circumvents estimation problems stemming from misclassification or measurement error. Moreover, it allows us to assess how the policy effects may vary at different initial threshold levels. Using data from the Survey of Income and Program Participation, we find three main results. First, the eligibility expansions result in significant increases in Medicaid participation; a " typical" expansion increases Medicaid participation by about four percent of baseline coverage rates. Second, the participation effect is larger for lower initial thresholds and the effect decreases as Medicaid thresholds increase. Third, we find no statistically significant evidence of crowd out regardless of initial threshold level. © 2012 Elsevier B.V.
Wright J.L.,Thomas University
International Journal of Law and Psychiatry | Year: 2010
Adult guardianship is a coercive exercise of the state's power over an innocent individual, justified only by: 1) the ward's incapacity; and 2) the need to protect the ward's well-being. The raison d'être of guardianship is to improve the well-being of the incapacitated ward. Studies of actual guardianship proceedings have long indicated serious ongoing concerns with the process. Repeated revisions of statutes have attempted to improve guardianship procedures, with some success. However, relatively little attention has been paid to the actual effect of guardianship on the well-being of respondents and wards, when the system functions as intended. The presumption that guardianship, when not abused, is in the best interests of an incapacitated adult is called into serious question by empirical research into the role of internal locus of control and autonomy on human well-being. Indeed, a wide range of data indicates that guardianship itself can have significant negative effects on the physical and mental well-being of respondents and wards. The guardianship system must be reformed to maximize the therapeutic effects of guardianship and to minimize the unnecessarily anti-therapeutic effects. I examine the effects of guardianship from a therapeutic jurisprudence perspective and propose and analyze modifications that could enhance the therapeutic effects of guardianship. © 2010.
Kumar S.,Thomas University
Expert Systems with Applications | Year: 2014
Purpose Managing processed food products' safety and recall is a challenge for industry and governments. Contaminated food items can create a significant public health hazard with potential for acute and chronic food borne illnesses. This industry study examines the challenges companies face while managing a processed food recall situation and devise a responsive and reliable knowledge management framework for product safety and recall supply chain for the focal global manufacturing and distribution enterprise. Method Drawing upon the knowledge management and product safety and recall literature and reliability engineering theory, this study uses a holistic single case based approach to develop a knowledge management framework with Failure Mode Effects and Criticality Analysis (FMECA) decision model. This knowledge management decision framework facilitates analysis of the root causes for each potential major recall issue and assesses the reliability of the product safety and recall supply chain system and its critical components. Results The main reasons highlighted for a recall and associated failure modes in a knowledge management framework are to devise appropriate deployment of resources, technology and procedures to recall supply chain. This study underscores specific information described by managers of a global processed food manufacturer and their perspectives about the product safety and recall process, and its complexities. Full scale implementation of product safety and recall supply chain in the proposed knowledge management framework after the current pilot study will be carried out eventually through expert systems. This operational system when fully implemented will capture the essence of decision making environments comprising goals and objectives, courses of action, resources, constraints, technology and procedures. Implications The study recognizes the significance of communication, integration, failsafe knowledge management process design framework, leveraging technology such as Radio Frequency Identification (RFID) within all levels of supply chain for product traceability and the proactive steps to help companies successfully manage a recall process and also reestablish trust among the consumers. The proposed knowledge management framework can also preempt product recall by acting as an early warning system. A formal knowledge management framework will enable a company's knowledge be cumulative for product safety and recall and serve as an important integrating and coordinating role for the organization. © 2014 Elsevier Ltd. All rights reserved.
Scibora L.M.,Thomas University
Diabetes, Obesity and Metabolism | Year: 2014
Bariatric surgery is the most effective therapeutic approach to morbid obesity, resulting in substantial weight loss and improved cardiometabolic profiles; however, a growing body of evidence suggests that bariatric procedures increase both skeletal fragility and the risk of related future fracture secondary to excessive bone loss. Prospective evidence shows that areal bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DXA) declines by as much as 14% in the proximal femoral regions, including the femoral neck and total hip, 12 months postoperatively. Lumbar spine areal BMD outcomes show greater 12-month postoperative variability across surgical procedures (-8 to +6%) and contrast with no change in volumetric BMD outcomes measured by quantitative computed tomography. Diminished mechanical loading, micronutrient deficiency and malabsorption, along with neurohormonal alterations, offer plausible underlying mechanisms to explain these observed post-bariatric bone changes, but most remain largely unsubstantiated in this population. Importantly, DXA-based skeletal imaging may have limited utility in accurately detecting bone change in people undergoing bariatric surgery; partly because excessive tissue overlying bone increases the variability of areal BMD outcomes. Moreover, a paucity of fracture and osteoporosis incidence data raises questions about whether marked post-bariatric surgery bone loss is clinically relevant or a functional adaptation to skeletal unloading. Future studies that use technology which is able to accurately capture the site-specific volumetric BMD and bone architectural changes that underpin bone strength in people undergoing bariatric surgery, that consider mechanical load, and that better quantify long-term fracture and osteoporosis incidence are necessary to understand the actual skeletal effects of bariatric surgery. © 2014 John Wiley & Sons Ltd.
White S.W.,Thomas University
International Journal of Production Economics | Year: 2013
The way in which service firms transform inputs into outputs is typically uncertain or unknown. Consequently decision makers, at best, can only make estimates of the underlying production function. The purpose of this study is to offer policy recommendations to service providers and to examine experimentally the sensitivity of estimates of production functions. The primary result of this study is a foundation for modeling manpower planning decisions for co-produced services when production functions are mis-estimated and/or mis-specified. © 2011 Elsevier B.V.