Hospital selective contracting without consumer choice: What can we learn from Medi‐Cal?

In the selective contracting era, consumer choice has generally been absent in most state Medicaid programs, including California's (called Medi-Cal). In a setting where beneficiary exit is not a threat, a large payer may have both the incentives and the ability to exercise undue market power, potentially exposing an already vulnerable population to further harm. The analyses presented here of Medi-Cal contracting data, however, do not yield compelling evidence in favor of the undue market power hypothesis. Instead, hospital competition appears to explain with greater consistency why certain hospitals choose to contract with Medi-Cal while others do not, the trends in inpatient prices paid by Medi-Cal over time, and the effect of price competition on service cutbacks, such as emergency room closures. Copyright 2003 by the Association for Public Policy Analysis and Management.     

Identifying Fatal Head Injuries on Postmortem Computed Tomography Using Convolutional Neural Network/Deep Learning: A Feasibility Study

Postmortem computed tomography (PMCT) is a relatively recent advancement in forensic pathology practice that has been increasingly used as an ancillary investigation and screening tool. One area of clinical CT imaging that has garnered a lot of research interest recently is the area of “artificial intelligence” (AI), such as in screening and computer-assisted diagnostics. This feasibility study investigated the application of convolutional neural network, a form of deep learning AI, to PMCT head imaging in differentiating fatal head injury from controls. PMCT images of a transverse section of the head at the level of the frontal sinus from 25 cases of fatal head injury were combined with 25 nonhead-injury controls and divided into training and testing datasets. A convolutional neural network was constructed using Keras and was trained against the training data before being assessed against the testing dataset. The results of this study demonstrated an accuracy of between 70% and 92.5%, with difficulties in recognizing subarachnoid hemorrhage and in distinguishing congested vessels and prominent falx from head injury. These results are promising for potential applications as a screening tool or in computer-assisted diagnostics in the future.     

Examining Youth and Program Predictors of Engagement in Out-of-School Time Programs

Prior research suggests that youths’ engagement in out-of-school time programs may be a crucial factor linking program participation to positive outcomes during adolescence. Guided by the theoretical concept of flow and by stage-environment fit theory, the present study explored correlates of engagement in youth programs. Engagement was conceptualized as the extent to which youth found the program activities enjoyable, interesting, and challenging. The current study examined how program content, monetary incentives, and youth demographic characteristics were linked to youth engagement among a sample of primarily low-income middle and high school youth attending 30 out-of-school programs (n = 435, 51 % female). Results from multilevel models suggested that program content and staff quality were strongly associated with youth engagement. Youth who reported learning new skills, learning about college, and learning about jobs through activities in the program were more engaged, as were youth who found the staff caring and competent. Results demonstrated that the link between learning content for the future and engagement was stronger for older youth than younger youth. In addition, there was a trend suggesting that providing a monetary incentive was associated negatively with youth engagement. Taken as a whole, these findings have important implications for researchers, practitioners, and policymakers interested in understanding the characteristics of out-of-school time programs that engage older youth.     

Small states and the ‘throughput’ legitimacy of international organizations

Abstract

The unequal participation of member states in international organizations (IOs) undermines IOs’ legitimacy as global actors. Existing scholarship typically makes this assessment by referencing a combination of input—the interests IOs serve—and output—the decisions they take. This scholarship does not, however, pay enough attention to how IOs have responded to these concerns. We argue that IOs have used the participation of small states—whose membership most studies typically ignore—as an important means of generating what Vivian Schmidt calls ‘throughput’ legitimacy for their operations. We organize our analysis of ‘throughput’ legitimacy in IOs around four institutional mechanisms—(1) agenda setting; (2) leadership (s)election; (3) management and operation; and (4) service delivery—in which all states seek to exert influence. What emerges is an account of IOs seeking to balance ‘inputs’ and ‘outputs’ by way of ‘throughputs’. We conclude by arguing for an expanded focus on the means by which IOs generate ‘throughput’ legitimacy in future research.     

Immigration and the Imagined Community in Europe and the United States

Both Europe and the United States are confronting the challenges of economic and cultural integration posed by immigration. This article uses the ESS and CID surveys to compare transatlantic public opinion about immigrants and immigration. We find more tolerance for cultural diversity in the United States, but we also find that Americans, like Europeans, tend to overestimate the number of immigrants in their countries and tend to favor lower levels of immigration. The underpinnings of individual attitudes are similar in all countries and immigration attitudes are surprisingly unrelated to country-level differences in GDP, unemployment and the number and composition of the foreign born. An implication of these findings is that acceptance of higher levels of immigration, deemed by many to be an economic need, will require both more selective immigration policies and an emphasis on the cultural assimilation of newcomers.     

Dominant Party Strategy and Democratization

How do incumbent parties strategize against challengers when a new partisan cleavage cuts across the incumbent's electoral coalition? This article argues that a two‐dimensional extension of Riker's anticoordination thesis conflicts with Downsian extensions. It shows that when voters coordinate on a single challenger based on their shared preference on a cross‐cutting cleavage, a vote‐maximizing incumbent party should move away from the challenger on the primary dimension of competition, even at the risk of abandoning the center. The article develops this hypothesis with reference to dominant parties in competitive authoritarian regimes where challenger parties constantly attempt “heresthetical” moves by mobilizing regime issues into the partisan debate, and it tests the predictions with an original sample survey of national leaders of Mexico's Revolutionary Institutional Party (PRI). It also spells out the implications of the findings for dominant party survivability in democratic transitions and, more broadly, for incumbents' spatial strategies in the face of new partisan cleavages.     

A Global Model for Forecasting Political Instability

Examining onsets of political instability in countries worldwide from 1955 to 2003, we develop a model that distinguishes countries that experienced instability from those that remained stable with a two-year lead time and over 80% accuracy. Intriguingly, the model uses few variables and a simple specification. The model is accurate in forecasting the onsets of both violent civil wars and nonviolent democratic reversals, suggesting common factors in both types of change. Whereas regime type is typically measured using linear or binary indicators of democracy/autocracy derived from the 21-point Polity scale, the model uses a nonlinear five-category measure of regime type based on the Polity components. This new measure of regime type emerges as the most powerful predictor of instability onsets, leading us to conclude that political institutions, properly specified, and not economic conditions, demography, or geography, are the most important predictors of the onset of political instability.     

美国流域治理与公益诉讼司法实践及其启示

为应对水体污染,促进河流、湖泊和湿地健康,美国自上个世纪70以来逐步发展出一套由行政机关、检察官和公民社会主导的多元治理机制,在流域保护立法与司法实践中所积累的成功经验与失败教训能为我国提供借鉴。我国在面对"两化叠加"治理难题时,应确立融合平衡理念,进一步创新环境治理手段,拓展司法保护机制,同时完善协商和解途径,充分发挥社会各方面力量。