Community benefit activities of private, nonprofit hospitals

The definition of hospital community benefits has been intensely debated for many years. Recently, consensus has developed about one group of activities being central to community benefits because of its focus on care for the poor and on needed community services for which any payments received are low relative to costs. Disagreements continue, however, about the treatment of bad debt expense and Medicare shortfalls. A recent revision of the Internal Revenue Service's Form 990 Schedule H, which is required of all nonprofit hospitals, highlights the agreed-on set of activities but does not dismiss the disputed items. Our study is the first to apply definitions used in the new IRS form to assess how conclusions about the adequacy of nonprofit hospital community benefits could be affected if bad debt expenses and Medicare shortfalls are included or excluded. Specifically, we examine 2005 financial data for California and Florida hospitals. Overall, we find that conclusions about community benefit adequacy are very different depending on which definition of community benefits is used. We provide thoughts on new directions for the current policy debate about the treatment of bad debts and Medicare shortfalls in light of these findings.     

Evaluation and classification of fentanyl-related compounds using EC-SERS and machine learning

Multiple analytical techniques for the screening of fentanyl-related compounds exist. High discriminatory methods such as GC–MS and LC–MS are expensive, time-consuming, and less amenable to onsite analysis. Raman spectroscopy provides a rapid, inexpensive alternative. Raman variants such as electrochemical surface-enhanced Raman scattering (EC-SERS) can provide signal enhancements with 10¹⁰ magnitudes, allowing for the detection of low-concentration analytes, otherwise undetected using conventional Raman. Library search algorithms embedded in instruments utilizing SERS may suffer from accuracy when multicomponent mixtures involving fentanyl derivatives are analyzed. The complexing of machine learning techniques to Raman spectra demonstrates an improvement in the discrimination of drugs even when present in multicomponent mixtures of various ratios. Additionally, these algorithms are capable of identifying spectral features difficult to detect by manual comparisons. Therefore, the goal of this study was to evaluate fentanyl-related compounds and other drugs of abuse using EC-SERS and to process the acquired data using machine learning—convolutional neural networks (CNN). The CNN was created using Keras v 2.4.0 with Tensorflow v 2.9.1 backend. In-house binary mixtures and authentic adjudicated case samples were used to evaluate the created machine-learning models. The overall accuracy of the model was 98.4 ± 0.1% after 10-fold cross-validation. The correct identification for the in-house binary mixtures was 92%, while the authentic case samples were 85%. The high accuracies achieved in this study demonstrate the advantage of using machine learning to process spectral data when screening seized drug materials comprised of multiple components.     

Adaptive Programming Improves Outcomes in Drug Court: An Experimental Trial

Prior studies in Drug Courts reported improved outcomes when participants were matched to schedules of judicial status hearings based on their criminological risk level. The current experiment determined whether incremental efficacy could be gained by periodically adjusting the schedule of status hearings and clinical case-management sessions in response to participants' ensuing performance in the program. The adjustments were made pursuant to a priori criteria specified in an adaptive algorithm. Results confirmed that participants in the full adaptive condition (n = 62) were more than twice as likely as those assigned to baseline-matching only (n = 63) to be drug-abstinent during the first 18 weeks of the program; however, graduation rates and the average time to case resolution were not significantly different. The positive effects of the adaptive program appear to have stemmed from holding noncompliant participants more accountable for meeting their attendance obligations in the program. Directions for future research and practice implications are discussed.     

The fundamental right of data protection in the European Union: in search of an uncharted right

The entry into force of the EU Charter of Fundamental Rights and the ensuing introduction of the right to data protection as a new fundamental right in the legal order of the EU has raised some challenges. This article is an attempt to bring clarity on some of these questions. We will therefore try to address the issue of the place of the right to the protection of personal data within the global architecture of the Charter, but also the relationship between this new fundamental right and the already existing instruments. In doing so, we will analyse the most pertinent case law of the Court of Luxembourg, only to find out that it creates more confusion than clarity. The lesson we draw from this overview is that the reasoning of the Court is permeated by a ‘privacy thinking’, which consists not only in overly linking the rights to privacy and data protection, but also in applying the modus operandi of the former to the latter (which are different we contend). The same flawed reasoning seems to be at work in the EU Charter of Fundamental Rights. Therefore, it is crucial that the different modi operandi be acknowledged, and that any upcoming data protection instrument is accurately framed in relation with Article 8 of the Charter.     

Childhood Sibling Aggression and Emotional Difficulties and Aggressive Behavior in Adulthood

Preliminary evidence indicates that childhood sibling aggression, the most common form of family violence, might be associated with aggression and emotional difficulties in adulthood. Three hundred twenty-two adult participants, recruited from various sources, completed an online survey retrospectively examining this relationship further. Levels of childhood sibling aggression perpetration and victimization were highly correlated, precluding separate analyses. Significant associations between childhood sibling aggression and adult emotional difficulties and aggression were found, even after controlling for exposure to other forms of family violence and other demographic variables. Neither gender nor reported sibling relationship moderated the childhood sibling aggression and adult difficulties effects. These findings, while mostly exploratory, suggest that greater attention should be paid to childhood sibling aggression.