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Impact of the Affordable Care Act on Presentation, Treatment, and Outcomes of Intrahepatic Cholangiocarcinoma
No full textBackground: The Affordable Care Act (ACA) transformed the US healthcare system, expanding healthcare insurance coverage. However, its impact on rare malignancies that lack an established screening strategy such as intrahepatic cholangiocarcinoma (ICC) remains ill-defined. Methods: Patients diagnosed with ICC were identified from the National Cancer Database and divided relative to ACA implementation. Multivariate logistic regression analyses were performed to evaluate association with stage at diagnosis, receipt of surgical and multimodal treatments, and survival. Results: Among the 9095 patients, 5636 (62.0%) were diagnosed before and 3459 (38.0%) after the implementation of the ACA. Across US regions, rates of early-stage diagnosis increased in the post-ACA era (Northeast, 62.9% vs. 85.2%; South, 63.7% vs. 78.5%; Midwest, 62.1% vs. 83.4%; West, 55.5% vs. 75.4%; p \u3c 0.001). On multivariate analyses, the post-ACA era was associated with increased early-stage diagnosis (OR = 2.19; 95% CI 1.79–2.69), and receipt of surgical treatment (OR = 1.19, 95% CI 1.03–1.38) (both p \u3c 0.01). Furthermore, the ACA’s Medicaid expansion (ME) was also associated with improved overall survival (HR = 0.89, 95% CI 0.80–0.99, p = 0.038). Of note, although the odds of receiving surgical treatment increased after ACA for non-Hispanic White patients (OR = 1.34; 95% CI 1.20–1.49; p \u3c 0.001), no such effect was observed in non-Hispanic Black (OR = 1.01, 95% CI 0.71–1.45), Hispanic (OR = 1.44, 95% CI 0.99–2.09), or others (OR = 1.43, 95% CI 0.98–2.10) (all p \u3e 0.05). Conclusions: The implementation of the ACA increased rates of early diagnosis and receipt of surgical treatment. Additionally, ME improved short- and long-term outcomes. However, racial and socioeconomic disparities persist, resulting in inequitable access to care and outcomes for patients with ICC
(R2051) Analysis of MAP/PH1, PH2/2 Queueing Model with Working Breakdown, Repairs, Optional Service, and Balking
Get PDFIn this paper, a classical queueing system with two types of heterogeneous servers has been considered. The Markovian Arrival Process (MAP) is used for the customer arrival, while phase type distribution (PH) is applicable for the offering of service to customers as well as the repair time of servers. Optional service are provided by the servers to the unsatisfied customers. The server-2 may get breakdown during the busy period of any type of service. Though the server- 2 got breakdown, server-2 has a capacity to provide the service at a slower rate to the current customer who is receiving service when the moment of server-2 struck with breakdown. In the period of vacation/closedown of server-1 and the server-2 is in working breakdown or under repair process, the arrival of customers may balk the system due to the impatient. Stability conditions has derived for our system and the stationary probability vector was evaluated by using the matrix analytical method. This model also examined at the analysis of busy period,waiting time distribution and system performance measures. The numerical illustrations are provided with the aid of two dimensional and three dimensional graphs
An Assessment Of The Global Pattern Of Trafficking Of Minors And Young Adults
Get PDFHuman trafficking is a global menace. Millions of young girls, boys, women, and men have been victims of various forms of trafficking. The crime has no geographical boundaries, and the victims often experience physical, psychological, and sexual abuse, creating a global health and security threat. The current study incorporated multiple secondary quantitative sources with an exclusive focus on children/minors (ages 0–8), adolescents (9–17 years), and young adults (ages 18–20) from 2002–2017. The study utilized multiple data sources, each measuring various aspects of human trafficking—the victimization profile of trafficking victims (CTDC data), the country’s response to trafficking (HTI data), and country-level influencing factors of trafficking (corruption, human development, unemployment). Under five research questions, 10 hypotheses were framed and tested using Binary Logistic Regression, Chi-Square Test of Independence, Multinomial Logistic Regression, and Linear Regression. The results showed that the victims’ age and gender had a stronger association with the types of exploitation, the means of control used by traffickers, and the recruiter’s relationship with the victim.
Regarding countries’ responses to trafficking flows, based on whether a country was a source, transit, destination spot, or had internal trafficking, at least one anti-trafficking measure (prosecution, protection, and prevention), showed a significant positive effect. Lastly, the country-level influencing factors like human development and democracy showed a stronger association with anti-trafficking responses implying that countries with higher human development and democracy have better trafficking policies. Similarly, the unemployment rate showed a stronger association with the anti-trafficking policies indicating that countries with higher unemployment rates affect the policies negatively. Hence, the findings of this study provided a comprehensive picture of trafficking from a global perspective.
Keywords: human trafficking, minor victims, young adult victims, CTDC data, HTI datase
Fiscal Years Legislative Appropriations- September 1987
No full texthttps://digitalcommons.pvamu.edu/fiscal-and-data-processing-report/1020/thumbnail.jp
Che fare senza Euridice? from Orfeo and Euridice
No full texthttps://digitalcommons.pvamu.edu/voice-soprano/1010/thumbnail.jp
