Expanding Impact through Evaluation: Insights from the Packard Foundation's Work on Children's Health Insurance

This report explores the Packard Foundation's experience with program evaluation as a strategic intervention in its work on children's health insurance and presents some of the principal lessons learned from that experience. The report also highlights the value of being opportunistic and adaptive to changing circumstances. The Packard Foundation experience suggests that to have a major impact on the issues that it cares about, a foundation has to be on the lookout for windows of opportunity to advance its agenda, and must be highly strategic in leveraging those opportunities if and when they occur

The Potential for Using Excise Taxes to Reduce Smoking

We examine the potential for reducing cigarette smoking through increases in cigarette excise taxes by estimating the price elasticity of demand for cigarettes. Using information on individual smoking behavior for a sample of adults in the 1976 Health Interview Survey, we estimate the adult price elasticity of demand for cigarettes to be -.45. Moreover, we find that price has its greatest effect on the smoking behavior of young males and that it operates primarily on the decision to begin smoking regularly rather than via adjustments in the quantity of cigarettes smoked by smokers. It follows that, if future reductions in cigarette smoking are desired, Federal excise tax policy can be a potent tool to accomplish this goal, but only in the long run. An excise tax increase, if maintained in real terms, would discourage smoking participation by successive cohorts of young adults and those reduced smoking levels would be reflected in aggregate smoking as these cohorts mature. In the short run however, the impact of an excise tax increase on aggregate cigarette consumption would be relatively small.

Time-Utilization of a Population of General Practitioners in a Prepaid Group Practice

A population of seven general surgeons in a prepaid group practice previously shown to have a mean operative work load of 9.2 HE per week were found to have a mean standardized seven day working week of 56.2 hours exclusive of evening activities. The surgeons also devoted a mean of 6.7 evening hours to professional activities for a total working week of 62.9 hours. Comparisons of the time utilization of this population of general surgeons with a population of previously studied community surgeons revealed that the prepaid group surgeons were able to maintain a surgical output more than double that of the community surgeons without having to devote twice as much time to professional activities. Economies in the utilization of surgical manpower in the prepaid group appear to stem from geographic and specialty restrictions on the scope of work of the surgeons, from a reduction of waiting time in the office, and from the utilization of paraprofessional personnel for operative assisting.

The effect of cigarette price increase on the cigarette consumption in Taiwan: evidence from the National Health Interview Surveys on cigarette consumption

BACKGROUND: This study uses cigarette price elasticity to evaluate the effect of a new excise tax increase on cigarette consumption and to investigate responses from various types of smokers. METHODS: Our sample consisted of current smokers between 17 and 69 years old interviewed during an annual face-to-face survey conducted by Taiwan National Health Research Institutes between 2000 to 2003. We used Ordinary Least Squares (OLS) procedure to estimate double logarithmic function of cigarette demand and cigarette price elasticity. RESULTS: In 2002, after Taiwan had enacted the new tax scheme, cigarette price elasticity in Taiwan was found to be -0.5274. The new tax scheme brought about an average annual 13.27 packs/person (10.5%) reduction in cigarette consumption. Using the cigarette price elasticity estimate from -0.309 in 2003, we calculated that if the Health and Welfare Tax were increased by another NT$ 3 per pack and cigarette producers shifted this increase to the consumers, cigarette consumption would be reduced by 2.47 packs/person (2.2%). The value of the estimated cigarette price elasticity is smaller than one, meaning that the tax will not only reduce cigarette consumption but it will also generate additional tax revenues. Male smokers who had no income or who smoked light cigarettes were found to be more responsive to changes in cigarette price. CONCLUSIONS: An additional tax added to the cost of cigarettes would bring about a reduction in cigarette consumption and increased tax revenues. It would also help reduce incidents smoking-related illnesses. The additional tax revenues generated by the tax increase could be used to offset the current financial deficiency of Taiwan's National Health Insurance program and provide better public services

The use of high halide-ion concentrations and automated phasing procedures for the structural analysis of BclA, the major component of the exosporium of Bacillus anthracis spores.

International audienceThe structure determination of the recombinant form of BclA, the major protein component of Bacillus anthracis exosporium, involved soaking in a high concentration of potassium iodide as the means of obtaining a good-quality heavy-atom derivative. The data to 2 angstroms resolution collected on a laboratory source were of sufficient quality to allow successful phasing and chain tracing by automated methods

Experience with Pregnancy, the Demand for Prenatal Care and the Production of Surviving Infants

The object of this research is to develop a model of household demand for prenatal care and attempt to measure the productive value of prenatal care per se on infant health as measured by survival. Traditionally, infant mortality rates have been used as indices of a nation\u27s health status. Since the U.S. has lagged significantly behind other developed nations in reducing infant mortality since the mid-1950\u27s, there have been charges of a malfunction in the U.S. health delivery system. Particularly in the area of infant health, critics have charged that more prenatal care Inputs are needed and that they should be directed specifically towards so-called high risk mothers. Others have questioned the value of input intensive prenatal care, claiming its marginal product is low, cost high and efficacy unproven. An economic model is developed in which the demand for healthy children is viewed as being derived from the demand for children per se. In a world where families cannot substantially effect the outcome of Individual pregnancies by varying inputs, it is demonstrated that measured infant mortality rates will be not only a function of health status but also fertility decisions, in a world where families can vary inputs, it is argued that prenatal care, as the most pregnancy relevant related input, should be a good index of the total demand for pregnancy related inputs. It is argued that the level of inputs will be positively correlated with income, tend to increase in families who have experienced pregnancy losses and decrease as family size increases, particularly if marginal children are less wanted as family size increases. Demand and production relationships are estimated using data from the 1970 New York City birth cohort. The data set consists primarily of birth and linked death certificates for the period January to June, 1970 and contains 54,000 observations after editing. Several different dependent variables are utilized to estimate the demand for care. They Include a dichotomous care/no care variable, the interval to the first visit and the number of visits. Significant empirical findings include: (1 ) the decision whether or not to seek care Is most strongly influenced by legitimacy status; (2) the demand for care is effected by past experience as predicted by the model in that families with more live children demand less care and those with a history of losses demand more care; (3) substantially less care is demanded by blacks, foreign born and Puerto Rican born mothers even when other variables are accounted for; (4) less care, other things equal, is obtained in specially designated Maternal and Infant Care Project areas, despite the presence of these special projects to encourage the use of care by high risk mothers of low socio-economic status; (5) the amount of care a mother receives is substantially determined by obstetrical protocol and does not seem to reflect her previous pregnancy experience. Outcome measures Include birth weight, infant death, neonatal and postneonatal death. Regarding birth weight significant findings include; (1 ) birth weight differentials atrributable to race, ethnicity, nativity or legitimacy characteristics are substantially reduced by taking account of differentials in the level of care received; (2 ) the net gain in birth weight attributable to a full complement of prenatal care (303 grams) as compared with no care is substantial when comapred with the birth weights of high risk infants; (3) previous experience of pregnancy successes and losses are reflected by increments or decrements in birth weight. In comparing results of outcome regressions for neonatal and postneonatal mortality, it is found that other things equal, prenatal care has a positive effect on survival during the neonatal period but no effect during the postneonatal period. Hence, it is argued that care per se has real value in improving pregnancy outcomes and is not primarily acting as a proxy variable for wantedness or other unmeasured inputs. The results of using FIML logit estimators on the dichotomous dependent variables biased on a subsample of observations do not agree with the OLS estimates based on the entire sample. It is suggested that econometricians need to more fully explore the relationship between the value of these two techniques, particularly in very large data sets

Experimental Playing and Issues in Music History

Written for MUSC 360 Music History I: From Chant to Bac

Arrangement of Annexin A2 tetramer and its impact on the structure and diffusivity of supported lipid bilayers

Annexins are a family of proteins that bind to anionic phospholipid membranes in a Ca2+-dependent manner. Annexin A2 forms heterotetramers (Anx A2t) with the S100A10 (p11) protein dimer. The tetramer is capable of bridging phospholipid membranes and it has been suggested to play a role in Ca2+-dependent exocytosis and cell-cell adhesion of metastatic cells. Here, we employ x-ray reflectivity measurements to resolve the conformation of Anx A2t upon Ca2+-dependent binding to single supported lipid bilayers (SLBs) composed of different mixtures of anionic (POPS) and neutral (POPC) phospholipids. Based on our results we propose that Anx A2t binds in a side-by-side configuration, i.e., both Anx A2 monomers bind to the bilayer with the p11 dimer positioned on top. Furthermore, we observe a strong decrease of lipid mobility upon binding of Anx A2t to SLBs with varying POPS content. X-ray reflectivity measurements indicate that binding of Anx A2t also increases the density of the SLB. Interestingly, in the protein-facing leaflet of the SLB the lipid density is higher than in the substrate-facing leaflet. This asymmetric densification of the lipid bilayer by Anx A2t and Ca2+ might have important implications for the biochemical mechanism of Anx A2t-induced endo- and exocytosis.Comment: 27 pages, 7 figures; supplementary material available upon request from the author

Atmospheric model development in support of SEASAT. Volume 4: Forecast model sensitivity study

Atmospheric analysis and prediction models of varying (grid) resolution were developed. The models were tested using real observational data for the purpose of assessing the impact of grid resolution on short range numerical weather prediction. The work statement was amended to include the performance of sensitivity tests using a coarse mesh (63 x 63 x 5 level) prediction model in order to identify and order factors which might mask or impair the utility of SEASAT data on short range weather prediction. Such factors included: initial conditions; topography; surface friction; latent heating; diffusion of momentum and temperature; and computational devices such as tendency truncators, pressure smoothers, and temporal filters