¿QUÉ INHIBE LA PARTICIPACIÓN EN ACTIVIDADES DE MOVILIDAD?: Un acercamiento a la percepción de los estudiantes de educación superior en Guanajuato

La movilidad estudiantil, como parte de los esfuerzos de internacionalización, es una de las actividades que ha tenido efectos positivos tanto en estudiantes como en las instituciones de educación superior. Sin embargo, el análisis sobre la gestión de este tipo de programas en México es todavía limitado, particularmente el que se basa en la perspectiva de los estudiantes. Con base en resultados obtenidos de una encuesta con representatividad estatal, aplicada a estudiantes de Guanajuato, se presentan diversos hallazgos con respecto a factores que inhiben la movilidad estudiantil, entre los que destacan las restricciones derivadas del contexto socioeconómico de alumnos y sus familias. Esto resalta la necesidad de diseñar políticas de promoción de movilidad académica que consideren dichos factores, a efecto de reducir la posibilidad de generar nuevas brechas de desigualdad.Alternate :Student mobility, as part of the efforts of internationalization, is an activity that has had positive effects on both the students and institutions of higher education. The analysis of program implementation in Mexico, however, is still limited, and particularly in terms of student perspectives. Based on results obtained from a state survey of students in Guanajuato, this article points to factors that inhibit student mobility, underlining restrictions derived from the socioeconomic context of students and their families. The findings emphasize the need to design policies that consider such factors in promoting student mobility, in order to reduce the possibility of generating new inequality gaps.

A Qualitative Examination of California WIC Participants' and Local Agency Directors' Experiences during the Coronavirus Disease 2019 Pandemic

Background The US Department of Agriculture granted waivers to allow flexibility in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) operations during the coronavirus disease 2019 (COVID-19) pandemic;however, research examining the associations between waiver introduction and changes in perceptions, practices, and challenges of WIC participants' and agency directors' experiences is limited. Objective The objective of this study was to assess California WIC participants' and agency directors' perceptions and practices of remote WIC services during the COVID-19 pandemic. A secondary aim was to understand other COVID-19 challenges related to maintaining access to healthy foods by WIC participants. Design A qualitative study that included semistructured interviews was conducted between June 2020 and March 2021. Participants and setting One hundred eighty-two WIC participants with a child aged 0 to 5 years from three regions of California (Southern, Central, and Northern) and 22 local WIC agency directors across the state were interviewed. Main outcome measures WIC participants' and agency directors' perceptions, practices, and other challenges during COVID-19. Statistical analyses performed Interviews were recorded, transcribed, and analyzed using a grounded theory approach. Results Participants shared that they valued the information received from WIC and were very satisfied with remote WIC services. Participants reported that enrolling in WIC remotely was easier than coming in person. All waivers and changes to WIC operations, namely the physical presence, remote benefit issuance, and separation of duties waivers, and remote work and remote delivery of nutrition education, were largely viewed by WIC agency directors as options that should be continued post-pandemic. Further, a majority (63%) of households reported experiencing food insecurity, and half of respondents received food from a food bank or pantry during the pandemic. Conclusions Findings suggest WIC will attract and retain the most families by offering a hybrid model of services, incorporating both onsite services and remote options to work more efficiently and effectively.

Compulsory licensing: an effective tool for securing access to Covid-19 vaccines for developing states?

A significant issue in combatting the Covid-19 pandemic is the need to enhance developing states' access to Covid-19 vaccines. The present paper considers the request for a temporary waiver of intellectual property rights in relation to Covid-19 technologies and treatments submitted to the World Trade Organization and analyses a key argument against the proposed waiver: that the compulsory licensing provisions set out in the TRIPS Agreement are sufficiently flexible to help states get access to vaccines. The compulsory licensing flexibilities set out in TRIPS, including the amendment to TRIPS in Article 31bis, are evaluated, to explore whether compulsory licensing could be an effective tool in helping developing states to access Covid-19 vaccines. Key issues are explored from a human rights perspective to examine whether a rights-based approach to the compulsory licensing provisions could offer further insights as to how the provisions could be more workable, to enhance access to medicines and vaccines for developing states.

A Needle in a Haystack? Human Rights Framing at the World Trade Organization for Access to COVID-19 Vaccines

How and why is implicit and explicit human rights language used by World Trade Organization (WTO) negotiators in debates about intellectual property, know-how, and technology needed to manufacture COVID-19 vaccines, and how do these findings compare with negotiators' human rights framing in 2001? Sampling 26 WTO members and two groups of members, this study uses document analysis and six key informant interviews with WTO negotiators, a representative of the WTO Secretariat, and a nonstate actor. In WTO debates about COVID-19 medicines, negotiators scarcely used human rights frames (e.g., "human rights" or "right to health"). Supporters used both human rights frames and implicit language (e.g., "equity," "affordability," and "solidarity") to garner support for the TRIPS waiver proposal, while opponents and WTO members with undetermined positions on the waiver used only implicit language to advocate for alternative proposals. WTO negotiators use human rights frames to appeal to previously agreed language about state obligations;for coherence between their domestic values and policy on one hand, and their global policy positions on the other;and to catalyze public support for the waiver proposal beyond the WTO. This mixed-methods design yields a rich contextual understanding of the modern role of human rights language in trade negotiations relevant for public health.

Charity or empowerment? The role of COVAX for low and middle-income countries.

What has the past reaction to the COVID-19 pandemic taught us? We have seen that many low and middle-income countries (LMICs) still lack access to vaccines, and it seems little progress has been made in the last few months and year. This article discusses whether the current strategies, most notably, vaccine donations by the international community and the COVID-19 global access facility COVAX, offer meaningful solutions to tackle the problem. At the centre of our analysis, we compare the concepts of "donations" and "charity" with "vaccine equity" and the "empowerment" of poorer countries. We suggest that the achievement of fair global vaccine production requires that our global approach is supportive of the idea of empowerment. We, therefore, need structural reforms, which would most importantly include capacity building, to positively impact this goal and to take the interests of the global poor seriously.

The State of Advanced Practice Registered Nursing in Alabama

Scope of practice for advanced practice registered nurses (APRNs) varies according to U.S. jurisdiction licensure requirements. Nineteen U.S. jurisdictions currently allow independent practice in all four APRN roles: certified nurse midwife (CNM), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). Twenty-six U.S. jurisdictions allow full practice authority for CNPs. APRNs practicing in the remaining U.S. jurisdictions have varying practice restrictions, which are dictated by their state licensure laws. Alabama's scope and standards of practice restrict all APRN roles. During the initial months of the COVID-19 pandemic, Alabama was one of many U.S. jurisdictions that implemented emergency waivers, thereby expanding the scope of APRN practice and granting increased autonomy to APRNs while caring for more complex patients. Once the pandemic threat lessened, many U.S. jurisdictions, including Alabama, returned to pre-pandemic restrictive scope of practice regulations. Through empirical evidence, we conducted a review of APRN practice before, during, and after the pandemic. The literature included anecdotal reports of safe delivery of healthcare provided by APRNs working under the emergency waivers. The literature revealed that APRNs are prepared to practice to the full extent of their scope of practice and provide high-quality healthcare services to improve access to care. Alabama and other U.S. jurisdictions where APRN practice is restricted should advocate for legislative changes supporting APRN full practice authority commensurate with their educational training and certification. © 2023 National Council of State Boards of Nursing

Compulsory Licensing of Trade Secrets: Illegality Under International and Domestic Laws

Hundreds of partnerships and collaborations, among manufacturers around the world, are expected to result in the delivery of eleven billion doses of COVID-19 vaccines by the end of 2021.2 In the years leading up to the Doha Declaration on the TRIPS Agreement and Public Health (Doha Declaration) and the amendment to the TRIPS Agreement (i.e., Article 31bis)-when global health concerns were primarily focused on HIV/AIDS, tuberculosis, and malaria (as highlighted by the Doha Declaration itself)-the IP rights subject to greatest debate and discussion were patent rights.3 During discussions over COVID-19-related IP rights, however, trade secret protection gained prominence for those who advocated for eliminating, or reducing, IP protection in an attempt to increase the production and distribution of vaccines and therapeutics.4 Yet as detailed herein, although there may be some overlap in the type of subject matter that patents and trade secrets protect, the nature of these two distinct forms of IP protection is very different, such that the protection accorded, and permissible limitations on, such protection are likewise necessarily quite different. "5 These flexibilities and associated conditions, as expanded through Article 31 bis, are the subject of a pending proposal by the European Union (EU) that the WTO General Council adopt a "Declaration on the TRIPS Agreement and Public Health in the Circumstances of a Pandemic," clarifying certain aspects of permissible compulsory licensing of patents.6 Despite these built-in flexibilities and efforts to further clarify the scope of the TRIPS Agreement, several WTO members have proposed a so-called "TRIPS Waiver," which would, as initially proposed, provide discretion for WTO members to opt not to protect multiple types of IP rights covering COVID-19-related products and technologies.7 Among the types of protection, specifically listed in the proposed TRIPS Waiver is trade secret protection, as identified through reference to Part II, Section 7 of the TRIPS Agreement.8 If the TRIPS Waiver currently being debated at the WTO is approved, it would have harmful implications for generations to come, limiting the ability of the biopharmaceutical industry to respond to future pandemics with vaccines and therapeutics as quickly as was possible in response to the COVID-19 pandemic.9 Several commentators, including academics, argue that trade secrets- including those related to technologies and processes relevant to COVID-19 vaccines, treatments, and diagnostics-are currently subject to certain flexibilities, including the possibility of requiring the right holder to license, or otherwise share, a trade secret against their will. [...]we conclude by examining the costs and risks that would arise from failing to respect trade secret protection, including through an action as aggressive as compulsory licensing (Section V). Traditionally, trade secret protection was understood to be based in principles of property rights.20 For example, in Ruckelshaus v. Monsanto Co., the U.S. Supreme Court held that trade secrets were a form of property, reasoning that they "have many of the characteristics of more tangible forms of property" because they are "assignable[,]" "can form the res of a trust[,]" and pass "to a trustee in bankruptcy.

Patient Cost Share for Emergency Physician Servcies During the COVID-19 Pandemic.

BACKGROUND: As a result of the Coronavirus disease 2019 (COVID-19) pandemic, health plans were required to implement, or voluntarily implemented, patient cost-share waivers for COVID-19-related emergency care. The impact of the cost waivers on patients for emergency physician services has not been previously reported. OBJECTIVE: To measure the impact of COVID-19 cost-sharing waivers on patients for emergency physician services. METHODS: A multicenter retrospective review of emergency physician commercial claims was conducted to determine the impact of the patient cost share waivers on COVID-19-related emergency physician services. Seventy-seven emergency departments (EDs) representing about a quarter of all EDs in California were included in the study. Emergency physician claims during a 9-month prepandemic period in 2019 were compared with claims during a 9-month pandemic period in 2020 to determine if there were any changes in the patient cost share between the two study periods and between COVID vs. non-COVID-related care. RESULTS: The average patient cost share was $19 for COVID-19-related emergency physician professional care and $52 for visits unrelated to COVID-19. Compared with non-COVID-19 care visits, the patient cost share was 63% less for COVID-19-related care. There was a small increase (< $2) in the patient cost share for non-COVID-19 emergency professional care during the pandemic compared with the prepandemic period. CONCLUSION: Payment policies implemented by California health plans were effective at reducing the patient cost share for patients that required COVID-19-related emergency physician care.

Summary of NCTRC Response to COVID-19 Related to Certification Standards, Interpretive Guidelines, and Financial Assistance Programs

To provide a measured, data-driven response to the changes COVID-19 brought about that also reflects the organizational mission of protecting the public, NC-TRC used feedback and guidance from the profession, legal counsel, and accreditation bodies within the credentialing industry to increase access to certification and support for applicants and certificants. The NCTRC financial assistance programs were heavily promoted, and changes were made to certification standards and interpretive guidelines related to internships, access to the CTRS exam, and options to regain certification for those outside the re-entry period.

A Qualitative Examination of California WIC Participants' and Local Agency Directors' Experiences during the Coronavirus Disease 2019 Pandemic.

BACKGROUND: The US Department of Agriculture granted waivers to allow flexibility in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) operations during the coronavirus disease 2019 (COVID-19) pandemic; however, research examining the associations between waiver introduction and changes in perceptions, practices, and challenges of WIC participants' and agency directors' experiences is limited. OBJECTIVE: The objective of this study was to assess California WIC participants' and agency directors' perceptions and practices of remote WIC services during the COVID-19 pandemic. A secondary aim was to understand other COVID-19 challenges related to maintaining access to healthy foods by WIC participants. DESIGN: A qualitative study that included semistructured interviews was conducted between June 2020 and March 2021. PARTICIPANTS AND SETTING: One hundred eighty-two WIC participants with a child aged 0 to 5 years from three regions of California (Southern, Central, and Northern) and 22 local WIC agency directors across the state were interviewed. MAIN OUTCOME MEASURES: WIC participants' and agency directors' perceptions, practices, and other challenges during COVID-19. STATISTICAL ANALYSES PERFORMED: Interviews were recorded, transcribed, and analyzed using a grounded theory approach. RESULTS: Participants shared that they valued the information received from WIC and were very satisfied with remote WIC services. Participants reported that enrolling in WIC remotely was easier than coming in person. All waivers and changes to WIC operations, namely the physical presence, remote benefit issuance, and separation of duties waivers, and remote work and remote delivery of nutrition education, were largely viewed by WIC agency directors as options that should be continued postpandemic. Further, a majority (63%) of households reported experiencing food insecurity, and half of respondents received food from a food bank or pantry during the pandemic. CONCLUSIONS: Findings suggest WIC will attract and retain the most families by offering a hybrid model of services, incorporating both onsite services and remote options to work more efficiently and effectively.

INTELLECTUAL PROPERTY AND GLOBAL INEQUALITY IN THE COVID-19 PANDEMIC

The Covid-19 pandemic has increased the inequality of rights around the world. The intellectual property system contributes to this asymmetry by limiting access to vaccines and other health technologies to only a few producers. This article addresses the impacts of this system, presents and analyses alternatives for broadening the supply of these health goods - such as compulsory licensing - and demonstrates the importance of defending the TRIPS Waiver mechanism in the fight against the coronavirus.

CAPITALISM AND THE SYSTEM OF PATENT MONOPOLIES WERE THE BIGGEST CHALLENGE TO THE TRIPS WAIVER

An interview with Fatima Hassan, a South-African human rights lawyer and founder of the Health Justice Initiative, is presented. Among other things, Hassan discusses how the African continent has positioned itself in the fight for access to vaccines, considering a context of global inequality highlighted by the COVID-19 pandemic, the main challenges to the proposal led by South Africa and India for a temporary patent waiver for COVID technologies such as vaccines and drugs to address health emergencies such as the current COVID-19 pandemic, and the need to highlight the systemic problem of inequality that the pandemic and the protectionism surrounding vaccines have exposed.

The Stark law, from inception to COVID-19 blanket waivers: a review.

The concept of physicians referring patients to their own healthcare entities is considered a "self-referral". A discerning factor of a self-referral is when the physician has a financial interest in the entity of patient referral. Prospects of healthcare overutilization and costs, thereby, rise. Self-referral laws, therefore, are important to regulate overutilization and contain costs. In the 1980s, Congressman Fortney Stark initiated an act that was one of the precursors to one such self-referral law, known as the Stark Law. The Stark Law, in its initial phase, known as Stark I, addressed self-referrals selectively from laboratory services. Stark I, thereafter, in a series of subsequent amendments and enactments, burgeoned to include multiple services, referred as Designated Health Services (DHS), for self-referrals. The expanded law, inclusive of those DHS, is now known as Stark II. The passage of the 2010 Affordable Care Act as well as the prevailing 2019 Coronavirus Disease (COVID-19) pandemic further modified the Stark Law. Given the legislative history of the said law, the present review curates the legal initiatives of this law from its nascent formative stages to the present form. The purpose of the above curation is to present a bird's eye view of its evolution and present analysts of any future research segments. This review, furthermore, describes the waivers of this law specific to COVID-19, or COVID-19 blanket waivers, which are instruments to assuage any barriers and further placate any hurdles arising from this law prevalent in this pandemic.

TRIPS Pluralism

The article explains that the interpretation of the TRIPS Agreement by WTO dispute-settlement panels and the Appellate Body has palpably shifted since the establishment of the WTO in 1995. Some of this shift is also arguably present in disputes concerning other WTO instruments. This progressive shift comes at a time when key debates about TRIPS waivers are taking place on the rue de Lausanne, namely a first for the COVID-19 pandemic and a second possible one for environmental protection measures related to climate change. According to the proposed pluralist analysis of TRIPS, it was less likely as of 2020 that the WTO dispute-settlement system would find unjustifiable inconsistencies between WTO commitments, on the one hand, and measures to protect public health or mitigate climate change, on the other hand. Whether future Appellate Body will follow that jurisprudence is an open question. Though the analysis contained in the article may make the COVID-related TRIPS waivers doctrinally unnecessary and allow Members to take measures now, its main aim is to inform the debates about the waivers and the future interpretation of the TRIPS Agreement, including the three-step test.

Serving Summer Meals During the COVID-19 Pandemic: A Case Study of 2 Summer Food Service Program Sponsors in Maryland.

BACKGROUND: The Summer Food Service Program (SFSP) provides free and nutritious meals to children under age 18 during out-of-school times. During the COVID-19 pandemic, Maryland sponsors served over 9.5 million meals to children through an expanded version of the SFSP. This study aimed to explore and compare the factors that enabled 2 SFSP sponsors in Maryland to dramatically increase meals distribution during the pandemic. METHODS: Sponsors were selected based on their responses in the larger study and demographic characteristics of the area in which they served. Semi-structured in-depth interviews were conducted over Zoom-4 interviews with Sponsor A (3 interviews with the sponsor, 1 interview with their vendor) and 1 interview with Sponsor B. Qualitative data were analyzed inductively and deductively. Participation data from 2019 and 2020 were obtained from the Maryland State Department of Education and analyzed. RESULTS: Despite their differences in organization type and geographic region, they identified similar facilitators to their success-communication with the community and utilization of the United States Department of Agriculture-issued waivers. CONCLUSIONS: Strengthening community communication networks and permanently integrating more flexibility into regulation of the SFSP may increase meals participation during future out-of-school times.

Emergency Flexibility for States to Increase and Maintain Medicaid Eligibility for LTSS under COVID-19.

Medicaid provides essential coverage for health care and long-term services and supports (LTSS) to low-income older adults and disabled individuals but eligibility is complicated and restrictive. In light of the current public health emergency, states have been given new authority to streamline and increase the flexibility of Medicaid LTSS eligibility, helping them enroll eligible individuals and ensure that current beneficiaries are not inadvertently disenrolled. Though state budgets are under increased pressure during the economic crisis created by the coronavirus, we caution states against cutting Medicaid LTSS eligibility or services to balance their budgets. These services are critical to an especially vulnerable population during a global pandemic.

COVID-19 in the Long-Term Care Setting: The CMS Perspective.

Safeguarding the health and promoting the well-being and quality of life of the most vulnerable and fragile citizens is a top priority for the Centers for Medicare & Medicaid Services (CMS). In response to the Coronavirus Disease 2019 (COVID-19) pandemic, numerous regulatory policies and 1,135 waivers of federal requirements have been implemented by CMS to give long-term care providers and professionals flexibility to meet the demands of resident and patient care needs during this public health emergency. Goals for these policies and waivers are increasing capacity, enhancing workforce and capability, improving oversight and transparency, preventing COVID-19 transmission, and reducing provider burden. J Am Geriatr Soc 68:1366-1369, 2020.