Статті в журналах з теми "United States. Office of Personnel Management. Office of Inspector General"

Health care organizations must continuously improve their productivity to sustain long-term growth and profitability. Sustainable productivity performance is mostly assumed to be a natural outcome of successful health care management. Data envelopment analysis (DEA) is a popular mathematical programming method for comparing the inputs and outputs of a set of homogenous decision making units (DMUs) by evaluating their relative efficiency. The Malmquist productivity index (MPI) is widely used for productivity analysis by relying on constructing a best practice frontier and calculating the relative performance of a DMU for different time periods. The conventional DEA requires accurate and crisp data to calculate the MPI. However, the real-world data are often imprecise and vague. In this study, the authors propose a novel productivity measurement approach in fuzzy environments with MPI. An application of the proposed approach in health care is presented to demonstrate the simplicity and efficacy of the procedures and algorithms in a hospital efficiency study conducted for a State Office of Inspector General in the United States.

The prevalence, costs, and disability associated with chronic pain continue to escalate. So too, the numerous modalities of treatments applied in managing these patients continue to increase as well. In the period from 2000 to 2011 interventional techniques increased 228%. In addition, analysis of utilization trends and expenditures for spinal interventional techniques alone from 2000 to 2008 illustrated an increase in Medicare fee-for-service expenditures of 240% in terms of dollars spent in the United States. The Office of Inspector General (OIG) of the Department of Health and Human Services showed an increase in facet joint and transforaminal epidural injections, with a significant proportion of these services did not meet the medical necessity criteria. The increasing utilization of interventional techniques is also associated with significant variations among specialty groups and regional variations among states. Overall procedures have increased by 173%, with rate of 130% per 100,000 Medicare beneficiaries for epidural injections; 383%, with a rate of 308% for facet joint interventions; and overall 410%, or a rate of 331% for sacroiliac joint interventions. Certain high volume interventions such as lumbar transforaminal epidural injections and lumbar facet joint neurolysis have actually increased a staggering 806% and 662%. Coverage policies across ambulatory settings and by multiple payers are highly variable. Apart from variability in the development of coverage policies, payments also substantially vary by site of service. In general, amongst the various ambulatory settings the highest payments are made to hospital outpatient departments (HOPDs) the lowest to in-office procedures, and payment to ambulatory surgery centers (ASCs) falling somewhere in the middle. This manuscript describes the many differences that exist between the various settings, and includes suggestions for accountable interventional pain management with coverage for techniques with evidence, addressing excessive use of specific techniques, and equalizing payments across multiple ambulatory settings. Key words: Accountable interventional pain management, Medicare, Medicare Evidence Development & Coverage Advisory Committee, epidural injections, facet joint interventions, sacroiliac joint injections, payment policies

256 Background: In 2000, Office of Inspector General (OIG) provided guidance for physician practices in the adoption of corporate compliance program (CCP). The notice provided a basic outline that would allow organizations to detect, prevent and possibly report potential fraud and abuse as it relates to federal health care payers. Insurance payers, e.g., United, Healthcare, and Humana, are also requiring organizations to institute CCP for reimbursement. As health care reform evolves there is will be a greater need for an alliance between providers and payers as each are increasingly held accountable for their actions related to ethical behavior in documentation, billing and coding, HIPAA, improper inducements, kickbacks, financial conflicts of interest, in addition to other areas. Methods: The Illinois CancerCare (ILCC) is one of the largest private oncology practice in Midwest. We implemented the components outlined by OIG by completing the following tasks: identifying and empowering a compliance officer; identifying high-risk areas; developing policies and standards for major processes that might lead to fraud, waste, or abuse; developing a training program for all physicians, NPs, and employees; creating and implementing an auditing and monitoring program; developing investigation and remediation standards; and establishing committees for oversight. Results: The entire process took 18 months to be fully functional. We have developed a plan that is completely complaint and meets all the criteria as required and our personnel have been trained. Conclusions: In future most large practices in the United States will likely be required to have a CCP. It is complicated and includes multistep processes. In the end, implementing a CCP allows organizations to show their desire to be a quality organization with internal monitors to ensure they are participating in federal health care programs using ethical standards.

Background: Reports from the United States Government Accountability Office (GAO), the Institute of Medicine (IOM), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) continue to express significant concern with the overall fiscal sustainability of Medicare and the exponential increase in costs for chronic pain management. Study Design: The study is an analysis of the growth of interventional techniques in managing chronic pain in Medicare beneficiaries from 2000 to 2011. Objective: To evaluate the use of all interventional techniques in chronic pain management. Methods: The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master Data from 2000 to 2011. Results: Interventional techniques for chronic pain have increased dramatically from 2000 to 2011. Overall, the increase of interventional pain management (IPM) procedures from 2000 to 2011 went up 228%, with 177% per 100,000 Medicare beneficiaries. The increases were highest for facet joint interventions and sacroiliac joint blocks with a total increase of 386% and 310% per 100,000 Medicare beneficiaries, followed by 168% and 127% for epidural and adhesiolysis procedures, 150% and 111% for other types of nerve blocks and finally, 28% and 8% increases for percutaneous disc procedures. The geometric average of annual increases was 9.7% overall with 13.7% for facet joint interventions and sacroiliac joint blocks and 7.7% for epidural and adhesiolysis procedures. Limitations: The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, as well as potential documentation, coding, and billing errors. Conclusion: Interventional techniques increased significantly in Medicare beneficiaries from 2000 to 2011. Overall, there was an increase of 177% in the utilization of IPM services per 100,000 Medicare beneficiaries, with an annual geometric average increase of 9.7%. The study also showed an exponential increase in facet joint interventions and sacroiliac joint blocks. Key words: Interventional techniques, interventional pain management, facet joint injections, epidural steroid injections, sacroiliac joint injections, chronic pain, chronic spinal pain

OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9–2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine–Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services.

Background: Recent reports of the United States Government Accountability Office (GAO), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) expressed significant concern with overall fiscal sustainability of Medicare and exponential increase in costs for interventional pain management techniques. Interventional pain management (IPM) is an evolving specialty amenable to multiple influences. Evaluation and isolation of appropriate factors for increasing growth patterns have not been performed. Study Design: Analysis of the growth of interventional techniques in managing chronic pain in Medicare beneficiaries from 1997 to 2006. Objective: To evaluate the use of all interventional techniques. Methods: The standard 5% national sample of the CMS carrier claim record data for 1997, 2002, and 2006 was utilized. This data set provides information on Medicare enrollees in the feefor-service Medicare program. Current procedural technology (CPT) codes for 1997, 2002, and 2006 were used to identify the number of procedures performed each year, and trends in expenditures. Results: Interventional techniques increased significantly in Medicare beneficiaries from 1997 to 2006. Overall, there was an increase of 137% in patients utilizing IPM services with an increase of 197% in IPM services, per 100,000 Medicare beneficiaries. The majority of the increases were attributed to exponential growth in the performance of facet joint interventions. There was a 13.9-fold difference in the increase between the state with the lowest rate and the state with the highest rate in utilization patterns of interventional techniques (California 37% vs. Connecticut 514%), with an 11.6-fold difference between Florida and California (431% vs. 37% increase). In 2006, Florida showed a 12.7-fold difference compared to Hawaii with the lowest utilization rate. Hospital outpatient department (HOPD) expenses constituted the highest increase with fewer patients treated either in an ambulatory surgery center (ASC) or in-office setting. Overall HOPD payments constituted 5% of total 2006 Medicare payments, in contrast to 57% of total IPM payments, an 11.4-fold difference. Limitations: The limitations of this study include a lack of inclusion of Medicare participants in Medicare Advantage plans and potential documentation, coding, and billing errors. Conclusion: This study shows an overall increase of IPM services of 197% compared to an increase of 137% in patients utilizing IPM services from 1997 to 2006. Key words: Interventional techniques, interventional pain management, facet joint injections, epidural steroid injections, sacroiliac joint injections, chronic pain, chronic spinal pain, ambulatory surgery center (ASC), hospital outpatient department (HOPD)

Background: Both the Office of Inspector General (OIG) and reports from studies of the utilization of facet joint interventions have expressed that explosive increases in facet joint interventions provided to spinal pain patients are a major concern. Study Design: The study is designed to assess the growth of facet joint interventions in managing spinal chronic pain in Medicare beneficiaries from 2000 to 2011. Objective: To assess the use of facet joint interventions in chronic pain management. Methods: The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) physician supplier procedure summary master data from 2000 to 2011. Results: The utilization of all types of facet joint interventions increased enormously from 2000 to 2011, with an overall increase of 308% per 100,000 Medicare beneficiaries and a 13.6% average annual increase. In addition, the highest increases were seen for cervical/ thoracic radiofrequency neurotomy with 836%, followed by an increase of 662% for lumbar/ sacral radiofrequency neurotomy, a 359% increase in cervical/thoracic facet joint injections, and 228% increase in lumbosacral facet joint injections. In reference to the number of procedures performed, however, the highest numbers were in the lumbosacral region with 990,449 total procedures of lumbar facet joint blocks and 406,378 lumbosacral radiofreqency neurotomies in 2011. Cervical and thoracic facet joint nerve blocks were 317,220, whereas cervical and thoracic radiofrequency neurotomies were 97,526 in 2011. The data also showed that there were enormous increases in the proportion of procedures performed by the specialty of physical medicine and rehabilitation, with an increase of 781% and an annual increase of 21.9% excluding physicians of physical medicine and rehabilitation enrolled as interventional pain management or pain management. Even though the numbers were very low for nurse anesthetists, nurse practitioners, and physician assistants, the increases were from 143 in 2000 to 21,263 in 2011, providing an annual increase of 55.2%, an overall increase of 12,460%. Limitations: The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, as well as potential documentation, coding, and billing errors. Furthermore, the data provided for state utilizations is based on claims data for that state which also may include patients from contiguous or other states receiving services in those states. Conclusions: The explosive increase in the number of lumbar facet joint interventions performed began to wane in 2008. From 2008 to 2010, the utilization of facet joint interventions declined by 6%. Key Words: Chronic spinal pain, interventional pain management, interventional techniques, facet joint injections, medial branch blocks, radiofrequency neurotomy

The article is dedicated to Heorhiy H. Shevel, Minister for Foreign Affairs of Soviet Ukraine from August of 1970 to November of 1980.The authors presented sincere recollections about this well known person, under whose leadership they began their diplomatic service that lasted for several decades. The decision to share those memories with readers of Diplomatic Ukraine was prompted by the fact that on May 9 this year was Mr. Shevel`s 100 anniversary. Unfortunately, neither the researchers of the history of Ukrainian diplomacy, nor those in charge of the Ministry of Foreign Affairs and the Diplomatic Academy paid the necessary tribute to this event. The authors of the article focus on the fact that with no previous experience in foreign policy matters Mr. Shevel managed in the conditions of a totalitarian Soviet system to realize important ideas in the interests of the Ukrainian diplomatic service and its development. From the very start of his duties as Minister of Foreign Affairs he undertook many practical steps to promote and improve the professional skills of his subordinates, to ensure their perfect command of foreign languages and to provide the Ministry`s staff and Ukraine`s permanent missions at the United Nations in New York, UNESCO in Paris and at other international organizations with a skilled personnel. Moreover, despite essential dependence on the policy of the USSR Ministry of Foreign Affairs, Mr. Shevel also succeeded in ensuring more visible results of participation of the Ukrainian SSR in the activities of the United Nations Economic Commission for Europe and in the International Labour Organization. During his term as Minister for Foreign Affairs, representatives of the Ukrainian SSR were elected 37 times to the governing bodies of various international organizations, their sessions and conferences. As an evidence of substantial resurgence of Ukrainian diplomacy of the said period is the fact that the Ukrainian SSR also signed and ratified 64 multilateral international documents. Minister Shevel also paid particular attention to establishing Ukraine`s image abroad as one of the original members of the United Nations, by promoting its achievements in scientific, cultural and humanitarian fields, as well as to strengthening ties with Ukrainian communities in various foreign countries. This very important component of its work the Ministry of Foreign Affairs accomplished in close cooperation with two public organizations – the Society for ties with Ukrainians abroad (Society Ukraina) and the Ukrainian Society for friendship and cultural relations with foreign countries. Minister H. Shevel was also the initiator of the construction in Kyiv of several buildings to locate Consulates–General of Eastern-European states. Nowadays, these buildings are used by diplomatic missions of respective foreign states accredited in independent Ukraine. The authors of the reviewed article are confident that despite various fabricated and often unfounded conclusions about the Ukrainian diplomacy of the Soviet period the irrefutable fact is that during Minister Shevel`s years it acquired and strengthened the necessary practical experience and professional diplomatic skills. Therefore, they support as indisputable the conclusion made several years ago by one of the researchers of the history of National diplomacy that “it would be incorrect to consider the 1970s of the past century as such that passed off in vain for the Ukrainian foreign-policy office”.30 years have passed since the untimely death of Heorhiy H. Shevel on July 17, 1989. Being a man of his times and performing highly responsible duties of the Minister of Foreign Affairs, in actually limited framework, he was at the same time a peculiar and extraordinary personality. And as such a figure he will always remain in the memory of all who knew him well and had the opportunity to work under his management. Because memory, emphasize the authors of the noted article, means first and foremost the ability not to forget the past. And this, they remark, is what the present generation of Ukrainian diplomats must keep in view and never forget. Keywords: Ministry of Foreign Affairs, Ukrainian diplomacy, foreign policy, international organizations, diplomatic service, memory.

It is a great pleasure to introduce the second volume second issue of our journal into the global community yearning for high-quality, impactful papers. IPJAF continues to seek and provide readers throughout the world with technology supported peer-reviewed scholarly articles on a broad range of established and emergent areas of accounting, finance, business, economics, and social sciences. I am resolute to maintain the high-quality standard of research and publication which is anchored on the exemplary service and dedication of our editorial board, editorial review and the editorial office. This volume 2, issue 2 comprises five manuscripts dealing with financial accounting, taxation, and auditing. The first article entitled “Examining the independent audit committee, managerial ownership, independent board member and audit quality in listed banks” by Dr. Hisar Pangaribuana (Adventist University of Indonesia, Bandung, Indonesia), Dr. Jenny Sihombinga (Adventist University of Indonesia, Bandung, Indonesia), and Dr. Oluwatoyin Muse Johnson Popoola (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia) examines the effects of the independent audit committee on the relationship between managerial ownership and independent board member on audit quality in the Indonesian listed banks. The unit of analysis is companies carrying on the banking business and listed on the Indonesian stock exchange (IDX) between the period of 2010 to 2015. This study is explanatory (i.e., causal predictive), and uses the second generation structural equation modelling statistical analysis tools, PLS-SEM and PROCESS Partial Least Square for hypotheses testing. The results show that the independent board member has a significant impact on the independent audit committee and the audit quality. The study reveals that managerial ownership does not influence audit quality. The adoption of the independent audit committee with a long tenure of years can be potentially risky and less creative. As a result, their oversight functions may be in jeopardy, impaired or reduced performances. The research findings reveal no significant indirect effects of the independent audit committee on the relationship between managerial ownership, independent board member and audit quality in the banks listed in IDX. Independent board members need to renew the appointment of the independent audit committee members to improve the quality of the oversight functions undertaken by the audit committee, and hence, enhance audit quality. The authors suggest further research on the ideal level of managerial ownership and number of an independent board member to produce a good audit quality in the Indonesian listed banks. The second article titled “Salaried taxpayers’ internal states and assessment performance under self-assessment system: a quasi-experimental evaluation” by Dr. Noraza Mat Udin (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia) takes a look at the first reform that impacts taxpayers, that is, the implementation of self-assessment system (SAS) to replace the old assessment system in 2004. The perception is that SAS had entirely changed the taxpayers’ responsibilities from being assessed by the tax authority to a person who is responsible for assessing own income tax liability. Her study explores the public fora debates on whether taxpayers can perform their responsibilities that were previously handled by trained tax personnel in Malaysia. Her paper reports the findings of a quasi-experimental evaluation of salaried individual taxpayers’ in the early stage of SAS implementation. She argues that a lot needs to be done, notwithstanding SAS had been implemented for more than a decade, the problem of taxpayer performance is continuing due to the dynamic nature of taxation in reality. The data were collected using a quasi-experimental method known as posttest-only no-treatment control group design. The sample comprised post-graduate students, who were actual taxpayers. Among the elements of the taxpayer’s internal states considered in this study, tax knowledge was found to have a significant relationship with assessment performance. Further analysis was conducted which showed that the majority of tax knowledge dimensions had a significant relationship with taxpayer assessment performance. The findings of this study have contributed to the body of knowledge because there is a general dearth of published research, particularly in Malaysia that investigates taxpayer assessment performance especially using an experimental approach. The third article with a caption, “Working capital management and firm performance: lessons learnt during and after the financial crisis of 2007-2008 in Nigeria” by Mr. Sunday Simon (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), Dr. Norfaiezah Sawandi (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), and Prof. Dr. Mohamad Ali Abdul-Hamid (Department of Accounting, College of Business Administration, University of Sharjah, United Arab Emirate) examines the relationship between working capital management (WCM) and firm performance during and after the financial crisis of 2007-2008 in Nigeria. The authors argue that the financial crisis could be attributable to the deterioration and ultimate failure of WCM performance that affected many Nigerian firms. During the crisis, lending conditions were deeply affected, and financing operations became challenging for firms. Although research findings on the causes and effects of the crisis on the economy are known, what remains unknown is whether the financial crisis had a significant impact on WCM performance. The differences between the two periods, the crisis period and then after the crisis period, is operationalised through two analyses. The findings indicate that WCM variables have more explanatory power (R2) in the period after the crisis than during the crisis. Also, the results of the Cramer Z-statistic, which examined between sample comparisons of the R2, revealed that the Z-scores are significant, implying that a significant difference existed between the two periods. It suffices to say that WCM was affected during the financial crisis and led to low profitability, whereas, during the after-crisis period, WCM associates with higher profitability. These findings have implications for managers and policymakers because access to financing has become a global problem and adequate WCM management increases a company’s resilience to financial and external shocks. The fourth article entitled “The Influence of Technology Readiness on Information Technology Competencies and Civil Conflict Environment” by Prof. Dr. Kamil Md. Idris (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), Associate Prof. Dr. Akilah Abdullah (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), Haetham H. Kasem Alkhaffaf (OYA Graduate School of Business, College of Business, Universiti Utara Malaysia), and Al-Hasan Al-Aidaros (Islamic Business School, Universiti Utara Malaysia, Malaysia). Their study confirms prior findings that the Technology Readiness scale can capture the association among technology readiness and technology usage behaviours. The study also expands earlier research by investigating the impact of technology readiness on individual competency among accountants to using IT in a workplace under the intensity of civil conflict in Iraqi environment. The result shows that there is a positive significant relationship between technology readiness and the IT competencies of Iraqi accountants. It implies that the technology readiness regarding willingness, enthusiasm, and motivation of accountants using IT has an impact on their IT competencies. In other words, the higher the readiness of the accountants in making use of technology, the higher their competence in the use of IT. This study contributes to the body of knowledge in terms of theory, method and practice in Iraq especially and developing countries in general. The fifth article titled “Mediating effect of Quality-differentiated Auditor on the relationship between Managerial ownership and Monitoring mechanisms” and authored by Dr. Rachael Oluyemisi Arowolo (Chrisland University, Nigeria), Prof. Dr. Ayoib Che-Ahmad (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), Dr. Oluwatoyin Muse Johnson Popoola (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia) and Dr. Hisar Pangaribuana (Adventist University of Indonesia, Bandung, Indonesia) examines the relationship between Managerial Ownership (MO) and MMs with quality-differentiated auditors (QDA) as the channel for the relationship. Over the past decade, most studies in corporate governance and audit market emphasised the importance of monitoring mechanisms (MM), especially after the global economic meltdown resulting from the Enron saga. The literature on MM continues growing as many countries especially the Sub-Saharan Africa are still struggling to come out of the effect of the economic meltdown and businesses continues to fail or merge. The study used data from non-financial listed companies in Nigeria providing empirical supports that MO significantly associates with MMs in the right direction. Likewise, QDA also influences the MMs in the right direction suggesting that QDA is necessarily required to enhance adequate MMs. The findings of this study provide support for the association of MO and MMs with the intervention of QDA for solutions to agency problems. Companies should, therefore, motivate the management to own shares within the reasonable range that aligns the interest of the management with that of the shareholders. This paper adds to knowledge especially in Nigeria and Sub-Saharan Africa by examining a mediating effect to depict the relationship between MO and MM, which are not evident in prior studies It is my conviction that in the coming year, the vision of IPJAF to publish high-quality manuscripts in the established and emergent areas of accounting and finance from academic and professional researchers will be sustained and appreciated. As you read throughout this volume 2, issue 2 of IPJAF, I would like to remind you that the success of our journal depends on you, your friends and colleagues as stakeholder through the submission of high-quality articles for review and publication. Once again, I acknowledge with gratitude your continued support as we strive to make IPJAF the most authoritative journal on accounting and finance for the community of academic, professional, industry, society and government. Oluwatoyin Muse Johnson Popoola, PhD Editor-in-Chief popoola@omjpalpha.com

ABSTRACT The high incidence of healthcare fraud in the United States resulted in the creation of multiple outlets to report fraud, such as the Medicare Hotline, the Office of the Inspector General, and the filing of False Claim Act lawsuits associated with whistleblower rewards. Despite the high incidence, examinations of whistleblowing factors in this industry, such as whistleblowers’ professional roles and fraud types, are scarce, and the interaction effects of these factors are unknown. In this study, participants from two different professional roles disclose their likelihood of reporting Medicare fraud through the aforementioned three reporting outlets conditional on two different billing fraud types. The results indicate that although workers in both professional roles show similar likelihoods to report fraud regardless of the reporting outlet, fraud type and its interaction with the professional role influence some but not all the reporting likelihoods.

Objective: Health practitioners are potentially subject to malpractice claims against them and previous research has indicated that legal proceedings against dentists are becoming a larger proportion of all malpractice payments against healthcare professionals in the United States. The objective of this study is to describe trends in the number of malpractice payments and adverse actions made against dentists in the state of Texas over a fifteen-year period from 2006 to 2020. Methods: Data regarding the adverse actions and malpractice payments against dentists was retrieved from the National Practice Data Bank for the years 2006-2020. The data set included adverse actions such as loss of clinical licensure, loss of clinical privileges or panel memberships, drug enforcement administration license and Department of Health and Human Services-Office of the Inspector General exclusion (i.e., exclusion from federally funded health programs). We exported all data into data visualization tools which we used to study and report trends. The University of Michigan Medical School Committee on Human Studies determined our study was not regulated and exempt (HUM00116742). Results: The number of adverse actions against dentists in Texas rose from 2006 (75 actions) to 2015 (164 actions) followed by a downward trend until 2020 (70 actions). The number of malpractice payments against dentists had an inverse relationship with adverse actions between 2006 – 2014 and again 2017 – 2020. However, during 2014 – 2016 there was a concurrent increase in malpractice payments and adverse actions. Loss of clinical licensure was the most common (91.23%) adverse action, followed by Drug Enforcement Administration (DEA) action (3.77%), Health and human services – exclusions by the Office of the Inspector General (HHS OIG) exclusion (1.68%) with the least common being cancellation of clinical privileges/panel memberships (1.33%). Conclusion: The number of malpractice payments against dentists followed a loosely inverse relationship with adverse actions.

Americans have grown accustomed to the drumbeat of data breaches, particularly because most have involved credit card data where individuals are protected from harm and almost never suffer out-of-pocket losses. But the more recent data breaches — Equifax, Yahoo! and the United States Office of Personnel Management — raise new concerns because of the amount of highly sensitive data that has been compromised. These compromises have caught the attention of the Federal Trade Commission (FTC), state attorneys general and Congress, and, as a result, the approaches to privacy-related harms are changing. This paper explores the circuit courts of appeals‘ approaches to privacy harms in data breach cases, specifically with regard to Article III standing, and the FTC‘s approach in its privacy and cyber security enforcement actions. After examining both approaches, this paper concludes with insights into best practices on dealing with the shifting legislative, judicial and regulatory climate surrounding breaches.

The pandemic has enhanced the social function of digital technologies and services. It is solely through digital technology that a massive shift to remote work has been possible during the most difficult period of the pandemic. All over the world, the philosophy of office work is changing, and there is a transition to permanent and conditional-permanent remote work. For example, Transport Canada is planning to move to telecommuting as a key employment model for its employees. In the near future, telecommuting will continue for most of the 6,000 employees in the agency. In China, widespread use of WeChat, Tencent, and Ding digital working applications began in late January 2020, when isolation measures were introduced. In Switzerland, COOVID-19 Remote Work and Study Resources provides free resources for remote operation and distance learning. Zoom and Google Meet videoconferencing, remote workplaces, and new social platforms run remote work almost immediately, and this trend is likely to continue after the lifting of the quarantine. Trends in staff employment worldwide are rather mixed. According to LinkedIn, it is possible to track changes in the employment rates of seven key economies – Australia, China, France, Italy, Singapore, Great Britain and United States. In France and Italy, the decline was more pronounced at -70% and -64.5% respectively by mid-April 2020. Since then, employment has been gradually recovering, and most of the seven key economies for which these figures have been analysed tend to change by 0 per cent year on year. By July 1, 2020, China, France, and the United States had seen the largest rebound in relative recruitment – -6% or -7%. At the end of September 2020, the countries with a high recovery in employment were China (22 per cent), Brazil (13 per cent), Singapore (8 per cent) and France (5 per cent). In these economies, hiring so far seems to compensate for months in which no new personnel have been recruited, indicating some stabilization of the labor market.

ABSTRACT Introduction Obstetric fistulae are a leading scourge for women in developing countries resulting, in severe individual suffering and devastating socio-economic repercussions for her family and community. The underlying causes of obstetric fistula stem from multiple factors to include poor nutrition, early marriage, insufficient education and inferior social status of women as well as substandard medical care. The US Agency for International Development (USAID) has invested more than $100 million globally since 2004 to address these factors as well as support women suffering with fistulae. The ultimate goal is to eradicate obstetric fistula in Bangladesh in the next 20 years. Despite these efforts, nearly 20,000 women in Bangladesh, still suffer with this malady. Methods To close this gap, USAID and the Department of Defense (DOD) developed a novel Interagency Agreement (IAA) leveraging the surgical skills of military health professionals to scale-up the ongoing fistula care program. The agreement outlined three lines of effort: (1) treat existing fistulae by bolstering surgical capacity of the existing USAID fistula care program; (2) promote fistula mitigation with lectures and hands-on teaching of obstetric care as well as safe gynecologic surgery; and (3) assist with advocacy at higher levels of the Bangladesh government. A Bangladesh Fistula Mission Partnership working group was formed to design and implement this IAA. Critical partners from the US Embassy in Dhaka included USAID (Health, Legal, Contracting), the DOD (Office of Defense Cooperation), and Department of State (Regional Security Officer). Partners from the US Army included United States Army-Pacific Command (Surgeon, Legal, Finance, Security Cooperation, Contracting), Regional Health Command-Pacific (Operations, Legal, Public Affairs), and Tripler Army Medical Center (Department of OBGYN, Operations, Public Affairs). Institutional Review Board approval was not required as the treatments offered were standard of care. Results The Tripler Army Medical Center (TAMC) health professionals executed the IAA with one pre-deployment site survey and two surgical missions in 2016–2017. The military team supported the surgical repair of 40 pelvic fistulae and perineal tears and provided operative management for an additional 25 patients with pelvic organ prolapse. Furthermore, the team conducted 19 professional lectures and multiple educational forums at hospitals in Kumudini, Khulna and the premier medical university in Dhaka for over 800 attendees including physicians, nurses and students to help prevent obstetric and surgical fistulae. Importantly, the team assisted USAID as subject matter experts in its advocacy to the Bangladesh Ministry of Health for improved maternity care and regulatory oversight. During the missions, the team enhanced their readiness by exercising individual and collective tasks while exposing personnel to the cultural context of the region. Conclusion This IAA was the first USAID funded and DoD-executed health mission in the US Indo-Pacific Command Area of Responsibility. Direct participation in the IAA enabled TAMC to support the US Indo-Pacific Command Theater Campaign Plan, the Department of Defense Instruction 2000.30 on Global Health Engagements, the USAID Country Development Cooperation Strategy, and the US Ambassadors Integrated Country Strategy Objectives in Bangladesh. This effort can serve as a model for future cooperation between USAID and the DoD.

Introduction I have this somewhat diffuse concern that at some point, I am in an appointment procedure ... and people say: ‘He has to ... be on social media, [and] have followers ..., because otherwise he can’t say anything about the field of research, otherwise he won’t identify with it … and we need a direct connection to legitimise our discipline in the population!’ And this is where I think: ‘For God’s sake! No, I really don’t want that.’ (Postdoc) Social media such as Facebook or Twitter have become an integral part of many people’s everyday lives and have introduced severe changes to the ways we communicate with each other and about ourselves. Presenting ourselves on social media and creating different online personas has become a normal practice (Vorderer et al. 270). While social media such as Facebook were at first mostly used to communicate with friends and family, they were soon also used for work-related communication (Cardon and Marshall). Later, professional networks such as LinkedIn, which focus on working relations and career management and special interest networks, such as the academic social networking sites (ASNS) Academia.edu and ResearchGate, catering specifically to academic needs, emerged. Even though social media have been around for more than 15 years now, academics in general and German academics in particular are rather reluctant users of these tools in a work-related context (König and Nentwich 175; Lo 155; Pscheida et al. 1). This is surprising as studies indicate that the presence and positive self-portrayal of researchers in social media as well as the distribution of articles via social networks such as Academia.edu or ResearchGate have a positive effect on the visibility of academics as well as the likelihood of their articles being read and cited (Eysenbach; Lo 192; Terras). Gruzd, Staves, and Wilk even assume that the presence in online media could become a relevant criterion in the allocation of scientific jobs. Science is a field where competition for long-term positions is high. In 2017, only about 17% of all scientific personnel in Germany had permanent positions, and of these 10% were professors (Federal Statistical Office 32). Having a professorship is therefore the best shot at obtaining a permanent position in the scientific field. However, the average vocational age is 40 (Zimmer et al. 40), which leads to a long phase of career-related uncertainty. Directing attention to yourself by acquiring knowledge in the use of social media for professional self-representation might offer a career advantage when trying to obtain a professorship. At the same time, social media, which have been praised for giving a voice to the unheard, become a tool for the exclusion of scholars who might not want or be able to use these tools as part of their work and career-related communication, and might remain unseen and unheard. The author obtained current data on this topic while working on a project on Mediated Scholarly Communication in Post-Normal and Traditional Science under the project lead of Corinna Lüthje. The project was funded by the German Research Foundation (DFG). In the project, German-speaking scholars were interviewed about their work-related media usage in qualitative interviews. Among them were users and non-users of social media. For this article, 16 interviews with communication scholars (three PhD students, six postdocs, seven professors) were chosen for a closer analysis, because of all the interviewees they described the (dis)advantages of career-related social media use in the most detail, giving the deepest insights into whether social media contribute to a social exclusion of academics or not. How to Define Social Exclusion (in Academia)? The term social exclusion describes a separation of individuals or groups from mainstream society (Walsh et al.). Exclusion is a practice which implies agency. It can be the result of the actions of others, but individuals can also exclude themselves by choosing not to be part of something, for example of social media and the communication taking part there (Atkinson 14). Exclusion is an everyday social practice, because wherever there is an in-group there will always be an out-group. This is what Bourdieu calls distinction. Symbols and behaviours of distinction both function as signs of demarcation and belonging (Bourdieu, Distinction). Those are not always explicitly communicated, but part of people’s behaviour. They act on a social sense by telling them how to behave appropriately in a certain situation. According to Bourdieu, the practical sense is part of the habitus (Bourdieu, The Logic of Practice). The habitus generates patterns of action that come naturally and do not have to be reflected by the actor, due to an implicit knowledge that is acquired during the course of (group-specific) socialisation. For scholars, the process of socialisation in an area of research involves the acquisition of a so-called disciplinary self-image, which is crucial to building a disciplinary identity. In every discipline it contains a dominant disciplinary self-image which defines the scientific perspectives, practices, and even media that are typically used and therefore belong to the mainstream of a discipline (Huber 24). Yet, there is a societal mainstream outside of science which scholars are a part of. Furthermore, they have been socialised into other groups as well. Therefore, the disciplinary mainstream and the habitus of its members can be impacted upon by the societal mainstream and other fields of society. For example, societally mainstream social media, such as Twitter or Facebook, focussing on establishing and sustaining social connections, might be used for scholarly communication just as well as ASNS. The latter cater to the needs of scholars to not just network with colleagues, but to upload academic articles, share and track them, and consume scholarly information (Meishar-Tal and Pieterse 17). Both can become part of the disciplinary mainstream of media usage. In order to define whether and how social media contribute to forms of social exclusion among communication scholars, it is helpful to first identify in how far their usage is part of the disciplinary mainstream, and what their including features are. In contrast to this, forms of exclusion will be analysed and discussed on the basis of qualitative interviews with communication scholars. Including Features of Social Media for Communication Scholars The interviews for this essay were first conducted in 2016. At that time all of the 16 communication scholars interviewed used at least one social medium such as ResearchGate (8), Academia.edu (8), Twitter (10), or Facebook (11) as part of their scientific workflow. By 2019, all of them had a ResearchGate and 11 an Academia.edu account, 13 were on Twitter and 13 on Facebook. This supports the notion of one of the professors, who said that he registered with ResearchGate in 2016 because "everyone’s doing that now!” It also indicates that the work-related presence especially on ResearchGate, but also on other social media, is part of the disciplinary mainstream of communication science. The interviewees figured that the social media they used helped them to increase their visibility in their own community through promoting their work and networking. They also mentioned that they were helpful to keep up to date on the newest articles and on what was happening in communication science in general. The usage of ResearchGate and Academia.edu focussed on publications. Here the scholars could, as one professor put it, access articles that were not available via their university libraries, as well as “previously unpublished articles”. They also liked that they could see "what other scientists are working on" (professor) and were informed via e-mail "when someone publishes a new publication" (PhD student). The interviewees saw clear advantages to their registration with the ASNS, because they felt that they became "much more visible and present" (postdoc) in the scientific community. Seven of the communication scholars (two PhD students, three postdocs, two professors) shared their publications on ResearchGate and Academia.edu. Two described doing cross-network promotion, where they would write a post about their publications on Twitter or Facebook that linked to the full article on Academia.edu or ResearchGate. The usage of Twitter and especially Facebook focussed a lot more on accessing discipline-related information and social networking. The communication scholars mentioned that various sections and working groups of professional organisations in their research field had accounts on Facebook, where they would post news. A postdoc said that she was on Facebook "because I get a lot of information from certain scientists that I wouldn’t have gotten otherwise". Several interviewees pointed out that Twitter is "a place where you can find professional networks, become a part of them or create them yourself" (professor). On Twitter the interviewees explained that they were rather making new connections. Facebook was used to maintain and intensify existing professional relationships. They applied it to communicate with their local networks at their institute, just as well as for international communication. A postdoc and a professor both mentioned that they perceived that Scandinavian or US-American colleagues were easier to contact via Facebook than via any other medium. One professor described how he used Facebook at international conferences to arrange meetings with people he knew and wanted to meet. But to him Facebook also catered to accessing more personal information about his colleagues, thus creating a new "mixture of professional respect for the work of other scientists and personal relationships", which resulted in a "new kind of friendship". Excluding Features of Social Media for Communication Scholars While everyone may create an Academia.edu, Facebook, or Twitter account, ResearchGate is already an exclusive network in itself, as only people working in a scientific field are allowed to join. In 2016, eight of the interviewees and in 2019 all of them had signed up to ResearchGate. So at least among the communication scholars, this did not seem to be an excluding factor. More of an issue was for one of the postdocs that she did not have the copyright to upload her published articles on the ASNS and therefore refrained from uploading them. Interestingly enough, this did not seem to worry any of the other interviewees, and concerns were mostly voiced in relation to the societal mainstream social media. Although all of the interviewees had an account with at least one social medium, three of them described that they did not use or had withdrawn from using Facebook and Twitter. For one professor and one PhD student this had to do with the privacy and data security issues of these networks. The PhD student said that she did not want to be reminded of what she “tweeted maybe 10 years ago somewhere”, and also considered tweeting to be irrelevant in her community. To her, important scientific findings would rather be presented in front of a professional audience and not so much to the “general public”, which she felt was mostly addressed on social media. The professor mentioned that she had been on Facebook since she was a postdoc, but decided to stop using the service when it introduced new rules on data security. On one hand she saw the “benefits” of the network to “stay informed about what is happening in the community”, and especially “in regards to the promotion of young researchers, since some of the junior research groups are very active there”. On the other she found it problematic for her own time management and said that she received a lot of the posted information via e-mail as well. A postdoc mentioned that he had a Facebook account to stay in contact with young scholars he met at a networking event, but never used it. He would rather connect with his colleagues in person at conferences. He felt people would just use social media to “show off what they do and how awesome it is”, which he did not understand. He mentioned that if this “is how you do it now … I don't think this is for me.” Another professor described that Facebook "is the channel for German-speaking science to generate social traffic”, but that he did not like to use it, because “there is so much nonsense ... . It’s just not fun. Twitter is more fun, but the effect is much smaller", as bigger target groups could be reached via Facebook. The majority of the interviewees did not use mainstream social media because they were intrinsically motivated. They rather did it because they felt that it was expected of them to be there, and that it was important for their career to be visible there. Many were worried that they would miss out on opportunities to promote themselves, network, and receive information if they did not use Twitter or Facebook. One of the postdocs mentioned, for example, that she was not a fan of Twitter and would often not know what to write, but that the professor she worked for had told her she needed to tweet regularly. But she did see the benefits as she said that she had underestimated the effect of this at first: “I think, if you want to keep up, then you have to do that, because people don’t notice you.” This also indicates a disciplinary mainstream of social media usage. Conclusion The interviews indicate that the usage of ResearchGate in particular, but also of Academia.edu and of the societal mainstream social media platforms Twitter and Facebook has become part of the disciplinary mainstream of communication science and the habitus of many of its members. ResearchGate mainly targets people working in the scientific field, while excluding everyone else. Its focus on publication sharing makes the network very attractive among its main target group, and serves at the same time as a symbol of distinction from other groups (Bourdieu, Distinction). Yet it also raises copyright issues, which led at least one of the participants to refrain from using this option. The societal mainstream social media Twitter and Facebook, on the other hand, have a broader reach and were more often used by the interviewees for social networking purposes than the ASNS. The interviewees emphasised the benefits of Twitter and Facebook for exchanging information and connecting with others. Factors that led the communication scholars to refrain from using the networks, and thus were excluding factors, were data security and privacy concerns; disliking that the networks were used to “show off”; as well as considering Twitter and Facebook as unfit for addressing the scholarly target group properly. The last statement on the target group, which was made by a PhD student, does not seem to represent the mainstream of the communication scholars interviewed, however. Many of them were using Twitter and Facebook for scholarly communication and rather seemed to find them advantageous. Still, this perception of the disciplinary mainstream led to her not using them for work-related purposes, and excluding her from their advantages. Even though, as one professor described it, a lot of information shared via Facebook is often spread through other communication channels as well, some can only be received via the networks. Although social media are mostly just a substitute for face-to-face communication, by not using them scholars will miss out on the possibilities of creating the “new kind of friendship” another professor mentioned, where professional and personal relations mix. The results of this study show that social media use is advantageous for academics as they offer possibilities to access exclusive information, form new kinds of relations, as well as promote oneself and one’s publications. At the same time, those not using these social media are excluded and might experience career-related disadvantages. As described in the introduction, academia is a competitive environment where many people try to obtain a few permanent positions. By default, this leads to processes of exclusion rather than integration. Any means to stand out from competitors are welcome to emerging scholars, and a career-related advantage will be used. If the growth in the number of communication scholars in the sample signing up to social networks between 2016 to 2019 is any indication, it is likely that the networks have not yet reached their full potential as tools for career advancement among scientific communities, and will become more important in the future. Now one could argue that the communication scholars who were interviewed for this essay are a special case, because they might use social media more actively than other scholars due to their area of research. Though this might be true, studies of other scholarly fields show that social media are being applied just the same (though maybe less extensively), and that they are used to establish cooperations and increase the amount of people reading and citing their publications (Eysenbach; Lo 192; Terras). The question is whether researchers will be able to avoid using social media when striving for a career in science in the future, which can only be answered by further research on the topic. References Atkinson, A.B. “Social Exclusion, Poverty and Unemployment.” Exclusion, Employment and Opportunity. Eds. A.B. Atkinson and John Hills. London: London School of Economics and Political Science, 1998. 1–20. Bourdieu, Pierre. Distinction: A Social Critique of the Judgement of Taste. Cambridge, Massachusetts: Harvard UP, 1984. ———. The Logic of Practice. Stanford, California: Stanford UP, 1990. 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