bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival curves to support quality improvement in hospitals with excess 30-day mortality after acute myocardial infarction, cerebral stroke and hip fracture: a before–after study
Authors: Kristoffersen Doris Tove , Helgeland Jon , Waage Halfrid Persdatter , Thalamus Jacob , Clemens Dirk , Lindman Anja Schou , Rygh Liv Helen , Tjomsland Ole
Published: March 2015

Objectives

To evaluate survival curves (Kaplan-Meier) as a means of identifying areas in the clinical pathway amenable to quality improvement.

Design

Observational before–after study.

Setting

In Norway, annual public reporting of nationwide 30-day in-and-out-of-hospital mortality (30D) for three medical conditions started in 2011: first time acute myocardial infarction (AMI), stroke and hip fracture; reported for 2009. 12 of 61 hospitals had statistically significant lower/higher mortality compared with the hospital mean.

Participants

Three hospitals with significantly higher mortality requested detailed analyses for quality improvement purposes: Telemark Hospital Trust Skien (AMI and stroke), Østfold Hospital Trust Fredrikstad (stroke), Innlandet Hospital Trust Gjøvik (hip fracture).

Outcome measures

Survival curves, crude and risk-adjusted 30D before (2008–2009) and after (2012–2013).

Interventions

Unadjusted survival curves for the outlier hospitals were compared to curves based on pooled data from the other hospitals for the 30-day period 2008–2009. For patients admitted with AMI (Skien), stroke (Fredrikstad) and hip fracture (Gjøvik), the curves suggested increased mortality from the initial part of the clinical pathway. For stroke (Skien), increased mortality appeared after about 8 days. The curve profiles were thought to reflect suboptimal care in various phases in the clinical pathway. This informed improvement efforts.

Results

For 2008–2009, hospital-specific curves differed from other hospitals: borderline significant for AMI (p=0.064), highly significant (p≤0.005) for the remainder. After intervention, no difference was found (p>0.188). Before–after comparison of the curves within each hospital revealed a significant change for Fredrikstad (p=0.006). For the three hospitals, crude 30D declined and they were non-outliers for risk-adjusted 30D for 2013.

Conclusions

Survival curves as a supplement to 30D may be useful for identifying suboptimal care in the clinical pathway, and thus informing design of quality improvement projects.
Safer fluid prescribing at North Bristol Trust: Bringing practice in line with NICE Guidance with a redesign of the fluid prescription chart
Authors: Andersson Johanna , Bull Thomas , Paul Daniel , Reynolds Emily , Nishimura Aimi , Lloyd Jessica , Jetley Amanda , Davies Mari , Eisenhauer Helen , Maggs Daniel , Clapham Sorcha , Trivedi Kaushali , Hair Robert , Plumb Benjamin , Plumb Benjamin
Published: March 2015

The National Institute of Clinical Excellence (NICE) released new fluid guidelines following data suggesting 20% of patients receiving fluids suffer adversely (2013). This quality improvement group assessed fluid prescribing in a tertiary teaching centre and introduced a new fluid- prescribing chart to align practice with NICE recommendations.

Notes and corresponding fluid prescription charts were reviewed for evidence of (1) indication, (2) co-morbidities, and (3) further management as surrogate markers of safe prescribing in accordance with NICE. Overall, the data showed practice fell short and prompted a redesign of the Trust fluid prescription chart. Three different variations of the chart were issued consecutively using a PDSA method (plan, do, study, act) over a 6-month period. They all included indication, co-morbidities and further management plans as constant design features. Suggestions from interested parties were incorporated and an educational programme was implemented to promote awareness.

Prior to our intervention, an indication for fluids was documented in 26% of notes, it took an average of 4.6 minutes to find co-morbidities, and further management plans were rarely documented. Following the new prescription chart, an indication was recorded in 72% of cases, co-morbidities noted on 63% of charts with 93.1% accuracy, and further management documented in 100% of cases.

The new fluid prescription chart encourages prescribers to incorporate NICE recommendations when prescribing fluids. The new fluid prescription design has since been rolled out Trust wide.
Improving documentation of cardiovascular disease risk in patients with diabetes attending non communicable disease clinics at West Bay Health Center in Qatar
Authors: Salem Mohamed , Al-Ali Amal , Bashwar Zelaikha
Published: March 2015

The documentation of cardiovascular disease (CVD) in medical records of patients with type 2 diabetes attending non communicable disease (NCD) clinics at West Bay Health Center in Qatar is less than ideal. Poor documentation of CVD will lead to poor preventive and management plans, with negative consequences for patients. Our aim is to improve this documentation of cardiovascular disease risk from 13% to 70% through the use of the WHO CVD risk prediction charts, which ran from September 2014 to January 2015.

An intervention in the form of an education session was run on 13th November 2014 for nurses that run the NCD clinic, covering the new NCD format (including the location of risk documentation, the method used for calculation the CVD, and mandatory documentation of CVD scores). A group discussion was also held with a physician for revising the CVD risk that was documented by nurses. Posters were placed in the NCD nurse station and clinics to remind them about CVD calculation and documentation. The average percentage of complete CVD risk documentation for patients with diabetes was 7%, increasing to 59% after the intervention. Overall, our intervention improved the documentation of CVD by 52%.
The no-touch vein graft for coronary artery bypass surgery preserves the left ventricular ejection fraction at 16 years postoperatively: long-term data from a longitudinal randomised trial
Authors: Johansson Benny , Samano Ninos , Souza Domingos , Bodin Lennart , Filbey Derek , Mannion John D , Bojö Leif
Published: March 2015

Objectives

To assess the left ventricular heart function and the clinical outcome 16 years after coronary artery bypass surgery.

Design

In a randomised trial, the no-touch (NT) vein graft in coronary artery bypass surgery has shown a superior patency rate, a slower progression of atherosclerosis and better clinical outcome compared to the conventional (C) vein graft at 8.5 years. All patients at mean time 16 years were offered an echocardiographic and clinical examination.

Results

In the NT-group 34 patients and in the C-group 31 patients underwent an echocardiography examination. A significantly better left ventricle ejection fraction was seen in the NT-group compared to the C-group (57.9% vs 49.4%; p=0.011). The size of the left atrium in NT was 21.7 cm2compared to 23.9 cm2in C; p=0.034. No patient in NT had atrial fibrillation compared to five patients in C (p=0.021). Patients with a brain natriuretic peptide value (BNP) ≥150 was 30% in NT compared to 38% in C. Total mortality was 25% in NT vs 27% in C. Cardiac-related deaths were 8% and 12% in NT and C respectively.

Conclusions

The NT vein graft preserves the left ventricular ejection fraction after 16 years. A smaller left atrium, a lower BNP and no atrial fibrillation indicatesan improved diastolic left ventricular function in the NT-group.

Trial registration

The study is registered withclinicaltrials.gov(NCT01686100) andThe Research and Development registryin Sweden (no. 102841).
Relationship between age at gonadectomy and health problems in kittens adopted from shelters
Authors: Porters N. , Polis I. , Moons C. P. H. , Van de Maele I. , Ducatelle R. , Goethals K. , Duchateau L. , de Rooster H.
Published: March 2015

Prepubertal gonadectomy (PPG) is promoted as a way of managing overpopulation in cats, but concerns about PPG and potential health issues still exist. The objective of the present study was to evaluate short‐term and long‐term health problems in cats subjected to PPG in comparison to gonadectomy at traditional age (TAG). In a prospective clinical trial, 800 shelter kittens aged between approximately 8 weeks and 12 weeks were recruited before adoption and randomly assigned to either the PPG group (gonadectomy performed immediately) or the TAG group (gonadectomy delayed until six months to eight months of age). Short‐term health issues included mortality between when kittens arrived at the clinic and up to seven days after they returned to the shelter, as well as the occurrence of various other health issues arising in the first month following adoption. Kittens were followed‐up until 24 months of age specifically for feline lower urinary tract disease, urethral obstruction (male cats), lameness, fractures and hypersensitivity disorders with dermatological presentation. In the short term, there were no significant differences between health problems in PPG and TAG kittens. Similarly, no significant differences were observed between treatment groups in terms of the type or number of health issues in the long term. In conclusion, there are no health‐related contraindications to advocating PPG strategies in shelter cats. Ideally, PPG should be performed at the shelter facility itself as long as excellent infectious disease control and postoperative clinical observation before adoption are guaranteed.
Computational study of substituent effects on gas-phase stabilities of Meisenheimer complexes
Authors: Nakata Kazuhide , Fujio Mizue , Siehl Hans-Ullrich , Tsuno Yuho
Published: March 2015

The total stabilization energies (TSEs) and anion stabilization energies (ASEs) of ring-substituted (X-) Meisenheimer complexes featuring two NO2 groups in the ring were determined using appropriate isodesmic reactions. The structures and energies of respective species were calculated at the B3LYP/6–311+G(2d,p) level of theory. Ten series of substituent effects were examined by varying substituent Y, which is connected to the sp3 carbon of the ring. The substituent effects were successfully analyzed using an extended Yukawa–Tsuno equation, [Formula: see text]. The r− values for the TSEs were identical to those for the ASEs, whereas the s values for the TSEs were significantly different from those for the ASEs. This shows that the effect of neutral species contributes to the s values of the TSEs. The r− and s values for the ASEs of all Meisenheimer complexes were distributed in a narrow range because substituent Y was insulated from the π-conjugation system. The r− values were large and the s values were small. This shows that the r− and s values were independent of each other and that the extended three-term Yukawa–Tsuno equation was intrinsic for substituent-effect analyses of anions. Although the variation was not substantial, the change in the r− values was clearly explained by the orbital interaction between substituent Y and the π-conjugation system. The r− values exhibited a good correlation with the bond lengths between the ring and the 4-NO2 group among all Meisenheimer complexes and benzylic anions. These facts provide a physical meaning: the r− value is a parameter that reveals the degree of the additional π interactions between the electron-withdrawing substituents and the π-conjugation systems of the ring.
Source water inputs and catchment characteristics regulate limnological conditions of shallow subarctic lakes (Old Crow Flats, Yukon, Canada)
Authors: Balasubramaniam Ann M. , Hall Roland I. , Wolfe Brent B. , Sweetman Jon N. , Wang Xiaowa
Published: March 2015

Climate variations exert rapid and strong control on the hydrology of shallow lake-rich subarctic landscapes, but knowledge of the associated effects on limnological conditions remains limited. Based on analysis of water isotope compositions and water chemistry at 56 lakes across Old Crow Flats (Yukon), a large thermokarst landscape, we assess if differences in source water inputs (snowmelt versus rainfall) affect limnological conditions during the ice-free season of 2007 and explore influences of catchment features. Results demonstrate that lakes with snowmelt-dominated source waters, situated in catchments that support tall shrub and woodland vegetation, possess significantly higher (p < 0.05) nutrient (N, P, SiO2) and dissolved organic carbon concentrations than lakes with rainfall-dominated source waters. Conversely, rainfall-dominated lakes, located in catchments dominated by dwarf shrubs and sparse vegetation, have significantly higher concentrations of major ions (Mg2+, Na+, SO42−) and pH. These limnological differences persisted throughout the ice-free season. We suggest that interaction of snowmelt with organic-rich detritus raises nutrient concentrations in snowmelt-dominated lakes and that evaporative-concentration, shoreline erosion and possibly rainfall runoff are processes that raise the ionic content of lakes with rainfall-dominated source waters. Knowledge of these relations improves the ability to anticipate limnological responses to ongoing and future climate and hydrological change in Arctic and subarctic regions.
Spatially segregated foraging patterns of moose (Alcesalces) and mountain hare (Lepustimidus) in a subarctic landscape: different tables in the same restaurant?
Authors: Öhmark Sara M. , Iason Glenn R. , Palo R. Thomas
Published: March 2015

Differences in body sizes of mountain hares (Lepus timidus L., 1758) and moose (Alces alces (L., 1758)) affect their ability to perceive and respond to environmental heterogeneity and plant density. Therefore, we expect these species to show niche separation at different scales in the same environment. Results showed that the numbers of mountain birches (Betula pubescens subsp. czerepanovii L.) browsed by moose per unit area was inversely related to hare browsing. Moose browsed larger birches compared with hares, and while hares targeted areas with high birch densities regardless of tree sizes, moose preferentially browsed areas with high densities of large birches. Moose browsing was clustered at spatial intervals of 1000–1500 m, while hare browsing was clustered at intervals of less than 500 m. Willows (genus Salix L.) in the study area were heavily browsed by moose, while few observations of hare browsing on willow were made. Regarding both hare and moose, numbers of birch stems with new browsing per sample plot were positively correlated with the numbers of birch stems with old browsing, indicating that hare and moose preferred the same foraging sites from year to year. These findings have implications for management of the species because they show the importance of scale and landscape perspectives in planning and actions.
Ginsenoside Rg1 Downregulates the Shear Stress Induced MCP-1 Expression by Inhibiting MAPK Signaling Pathway
Authors: He Jian , Li Yu-Lin
Published: March 2015

Ginsenoside Rg1 has been reported to possess anti-inflammatory activities, but the effects of Rg1 on the shear induced MCP-1 upregulation mechanism on endothelial cells (ECs) remain to be determined. In this study, we show that Rg1 down modulates shear induced pro-inflammatory cytokine MCP-1 gene expression and monocytes adhesion without potential cell toxicity. The negative effects on monocytes adhesion is due to a decrease in MCP-1 protein release. Furthermore, the inhibitory effect of Rg1 on the phosphorylation level of ERK, p38, and JNK mitogen-activated protein kinase (MAPK) induced by shear stress (SS) is similar with that of specific chemical inhibitors for MAPK pathways activation. These results demonstrate that ginsenoside Rg1 inhibits the shear induced inflammation by suppressing the MAPK pathway. This suggests that Rg1 may serve as a novel anti-inflammatory agent for inflammation-induced cardiovascular diseases treatment.
Ferulic Acid Reverses the Cognitive Dysfunction Caused by Amyloid β Peptide 1-40 Through Anti-Oxidant Activity and Cholinergic Activation in Rats
Authors: Tsai Fan-Shiu , Wu Lung-Yuan , Yang Shu-Er , Cheng Hao-Yuan , Tsai Chin-Chuan , Wu Chi-Rei , Lin Li-Wei
Published: March 2015

Cholinergic dysfunction and oxidation stress are the dominant mechanisms of memory deficit in Alzheimer's disease (AD). This study describes how ferulic acid (FA) ameliorates cognitive deficits induced by mecamylamine (MECA), scopolamine (SCOP), central acetylcholinergic neurotoxin ethylcholine mustard aziridinium ion (AF64A) and amyloid β peptide (Aβ1-40). This study also elucidates the role of anti-oxidant enzymes and cholinergic marker acetylcholinesterase (AChE) in the reversal of FA from Aβ1-40-induced cognitive deficits in rats. At 100 mg/kg, FA attenuated impairment induced by MECA and SCOP plus MECA; however, this improvement was not blocked by the peripheral muscarinic receptor antagonist scopolamine methylbromide (M-SCOP). At 100 and 300 mg/kg, FA also attenuated the impairment of inhibitory passive avoidance induced by AF64A. Further, FA attenuated the performance impairment and memory deficit induced by Aβ1-40in rats, as did vitamin E/C. FA reversed the deterioration of superoxide dismutase (SOD) and AChE activities, and the glutathione disulfide (GSSG) and glutathione (GSH) levels in the cortex and hippocampus. Vitamin E/C only selectively reversed deterioration in the hippocampus. We suggest that FA reduced the progression of cognitive deficits by activating central muscarinic and nicotinic receptors and anti-oxidant enzymes.
On Clifford-algebraic dimensional extension and SUSY holography
Authors: Gates S. J. , Hübsch T. , Stiffler K.
Published: March 2015

We analyze the group of maximal automorphisms of the N-extended worldline supersymmetry algebra, and its action on off-shell supermultiplets. This defines a concept of "holoraumy" that extends the notions of holonomy and curvature in a novel way and provides information about the geometry of the supermultiplet field-space. In turn, the "holoraumy" transformations of 0-brane dimensionally reduced supermultiplets provide information about Lorentz transformations in the higher-dimensional space–time from which the 0-brane supermultiplets are descended. Specifically, Spin(3) generators are encoded within 0-brane "holoraumy" tensors. Worldline supermultiplets are thus able to holographically encrypt information about higher-dimensional space–time geometry.
Deformed shell model results for neutrinoless double beta decay of nuclei in A = 60 - 90 region
Authors: Sahu R. , Kota V. K. B.
Published: March 2015

Nuclear transition matrix elements (NTME) for the neutrinoless double beta decay (Oνββ or OνDBD) of 70 Zn , 80 Se and 82 Se nuclei are calculated within the framework of the deformed shell model (DSM) based on Hartree–Fock (HF) states. For 70 Zn , jj44b interaction in 2p3/2, 1f5/2, 2p1/2 and 1g9/2 space with 56 Ni as the core is employed. However, for 80 Se and 82 Se nuclei, a modified Kuo interaction with the above core and model space are employed. Most of our calculations in this region were performed with this effective interaction. However, jj44b interaction has been found to be better for 70 Zn . The above model space was used in many recent shell model (SM) and interacting boson model (IBM) calculations for nuclei in this region. After ensuring that DSM gives good description of the spectroscopic properties of low-lying levels in these three nuclei considered, the NTME are calculated. The deduced half-lives with these NTME, assuming neutrino mass is 1 eV, are 1.1 × 1026, 2.3 × 1027 and 2.2 × 1024 yr for 70 Zn , 80 Se and 82 Se , respectively.
Monitoring the Sky with the Prototype All-Sky Imager on the LWA1
Authors: Obenberger K. S. , Taylor G. B. , Hartman J. M. , Clarke T. E. , Dowell J. , Dubois A. , Dubois D. , Henning P. A. , Lazio J. , Michalak S. , Schinzel F. K.
Published: March 2015

We present a description of the Prototype All-Sky Imager (PASI), a backend correlator and imager of the first station of the Long Wavelength Array (LWA1). PASI cross-correlates a live stream of 260 dual-polarization dipole antennas of the LWA1, creates all-sky images, and uploads them to the LWA-TV website in near real time. PASI has recorded over 13,000[Formula: see text]hr of all-sky images at frequencies between 10 and 88[Formula: see text]MHz creating opportunities for new research and discoveries. We also report rate density and pulse energy density limits on transients at 38, 52, and 74[Formula: see text]MHz, for pulse widths of 5[Formula: see text]s. We limit transients at those frequencies with pulse energy densities of [Formula: see text][Formula: see text][Formula: see text], [Formula: see text][Formula: see text][Formula: see text], and [Formula: see text][Formula: see text][Formula: see text][Formula: see text]J[Formula: see text]m[Formula: see text][Formula: see text]Hz[Formula: see text] to have rate densities [Formula: see text][Formula: see text][Formula: see text], [Formula: see text][Formula: see text][Formula: see text], and [Formula: see text][Formula: see text][Formula: see text] year[Formula: see text].
Farmers' Willingness to Pay for Improved Irrigation Water — A Case Study of Malaprabha Irrigation Project in Karnataka, India
Authors: Biswas Durba , Venkatachalam L.
Published: March 2015

In principle, the approach toward irrigation management in India has gradually shifted from a government-dominated, supply-side paradigm toward a user-preferred, demand-side paradigm. Yet, decisions regarding water allocation and irrigation charges do not adequately incorporate farmers' preferences and their willingness-to-pay (WTP) for improved irrigation. Since public investment on irrigation projects is sizeable and the opportunity cost of irrigation water is increasing, there exists a need to estimate the economic value of irrigation water in order to utilize it in an efficient manner. This paper presents results of a contingent valuation (CV) study conducted in a semi-arid region, namely, the Malaprabha Irrigation Project in Karnataka, India, which elicited farmers' preferences and their WTP value for improved irrigation. The results suggest that farmers predict a significant increase in agricultural benefits due to additional irrigation and they are willing to pay significantly higher than what they are currently paying to secure these benefits. It implies that improved irrigation increases not only the farmers' benefits but could potentially increase the government's revenue, resulting in a win–win outcome.
GIS-based variability of building materials towards the Île-de-France cuesta (Paris Basin, France): inventory, distribution, uses and relationship with the environment
Authors: Turmel A. , Fronteau G. , Chalumeau L. , Deroin J.-P. , Eyssautier-Chuine S. , Thomachot-Schneider C. , De Kock T. , Cnudde V. , Barbin V.
Published: March 2015

The
Pays rémois
in the eastern Paris Basin is an administrative area of 1394 km
2
; in the surroundings of Reims (France). Two main geological substrata are separated by the Île-de-France cuesta: the Tertiary substratum in the western part is composed of various types of geomaterials (clay, sandstone, limestone, burrstone), whereas the substratum in the eastern part is composed only of Cretaceous Chalk. A field survey in each
commune
of the
Pays rémois
identified 26 building materials documented in a Geographic Information System database (GIS-database) that includes information about them (lithology, petrographical and petrophysical data, weathering) and the corresponding buildings (e.g. town, georeferenced data, building type, position on the façade). The spatial analysis of the building materials’ distribution (Standard Deviational Ellipse) with GIS identifies their uses and the criteria established for the selection of the materials: availability, efficiency, workability and durability. Some lithologies were preferred for particular buildings or selected for their efficiency in specific positions. The study also defines the relation between the stones’ origin (local and non-local stones) and their application. This database is useful to establish stone replacement strategies in the
Pays rémois
.
The Double Disparity Facing Rural Local Health Departments
Authors: Harris Jenine K. , Beatty Kate , Leider J.P. , Knudson Alana , Anderson Britta L. , Meit Michael
Published: March 2015

Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
Using Electronic Health Records for Population Health Research: A Review of Methods and Applications
Authors: Casey Joan A. , Schwartz Brian S. , Stewart Walter F. , Adler Nancy E.
Published: March 2015

The use and functionality of electronic health records (EHRs) have increased rapidly in the past decade. Although the primary purpose of EHRs is clinical, researchers have used them to conduct epidemiologic investigations, ranging from cross-sectional studies within a given hospital to longitudinal studies on geographically distributed patients. Herein, we describe EHRs, examine their use in population health research, and compare them with traditional epidemiologic methods. We describe diverse research applications that benefit from the large sample sizes and generalizable patient populations afforded by EHRs. These have included reevaluation of prior findings, a range of diseases and subgroups, environmental and social epidemiology, stigmatized conditions, predictive modeling, and evaluation of natural experiments. Although studies using primary data collection methods may have more reliable data and better population retention, EHR-based studies are less expensive and require less time to complete. Future EHR epidemiology with enhanced collection of social/behavior measures, linkage with vital records, and integration of emerging technologies such as personal sensing could improve clinical care and population health.
A Review of Opportunities to Improve the Health of People Involved in the Criminal Justice System in the United States
Authors: Freudenberg Nicholas , Heller Daliah
Published: March 2015

In the past decade, many constituencies have questioned the efficacy, cost, and unintended consequences of mass incarceration in the United States. Although substantial evidence now demonstrates that US incarceration policies have had unintended adverse health consequences, we know less about the strategies and policies that can prevent or reduce these problems for justice-involved individuals and how the criminal justice system (CJS) can contribute to the Healthy People 2020 national goal of eliminating inequities in health. This review examines strategies that have been used to improve the health of people at various stages of CJS involvement, including diversion from jail and prison stays into community settings, improvements to the social and physical environments within correctional facilities, provision of health and other services to inmates, assistance for people leaving correctional facilities to make the transition back to the community, and systems coordination and integration.
Racial and Ethnic Disparities in the Quality of Health Care
Authors: Fiscella Kevin , Sanders Mechelle R.
Published: March 2015

The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.
Impact of Provider Incentives on Quality and Value of Health Care
Authors: Doran Tim , Maurer Kristin A. , Ryan Andrew M.
Published: March 2015

The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.
Sugar-Sweetened Beverages and Children's Health
Authors: Scharf Rebecca J. , DeBoer Mark D.
Published: March 2015

Temporal trends in the epidemic of childhood obesity have been paralleled by increases in the consumption of sugar-sweetened beverages (SSB) during childhood. Consumption has increased dramatically over the past several decades in all age ranges, with some moderation over the past 10 years. Evidence from cross-sectional, longitudinal, and interventional studies supports links between SSB consumption in childhood and unhealthy weight gain, as well as other untoward health outcomes. These data have stimulated public health efforts to curtail consumption as a means of improving childhood weight status and related health outcomes. Reducing ready access to SSBs, changing the message environment to which children are exposed, and replacing SSBs with healthier beverages have had moderate success in decreasing SSB consumption and curbing unhealthy weight gain.
Making Healthy Choices Easier: Regulation versus Nudging
Authors: Hansen Pelle Guldborg , Skov Laurits Rohden , Skov Katrine Lund
Published: March 2015

In recent years, the nudge approach to behavior change has emerged from the behavioral sciences to challenge the traditional use of regulation in public health strategies to address modifiable individual-level behaviors related to the rise of noncommunicable diseases and their treatment. However, integration and testing of the nudge approach as part of more comprehensive public health strategies aimed at making healthy choices easier are being threatened by inadequate understandings of its scientific character, its relationship with regulation, and its ethical implications. This article reviews this character and its ethical implication with a special emphasis on the compatibility of nudging with traditional regulation, special domains of experience, and the need for a more nuanced approach to the ethical debate. The aim is to advance readers' understanding and give guidance to those who have considered working with or incorporating the nudge approach into programs or policies aimed at making healthful choices easier.
The Health Effects of Income Inequality: Averages and Disparities
Authors: Truesdale Beth C. , Jencks Christopher
Published: March 2015

Much research has investigated the association of income inequality with average life expectancy, usually finding negative correlations that are not very robust. A smaller body of work has investigated socioeconomic disparities in life expectancy, which have widened in many countries since 1980. These two lines of work should be seen as complementary because changes in average life expectancy are unlikely to affect all socioeconomic groups equally. Although most theories imply long and variable lags between changes in income inequality and changes in health, empirical evidence is confined largely to short-term effects. Rising income inequality can affect individuals in two ways. Direct effects change individuals' own income. Indirect effects change other people's income, which can then change a society's politics, customs, and ideals, altering the behavior even of those whose own income remains unchanged. Indirect effects can thus change both average health and the slope of the relationship between individual income and health.
Bias Analysis for Uncontrolled Confounding in the Health Sciences
Authors: Arah Onyebuchi A.
Published: March 2015

Uncontrolled confounding due to unmeasured confounders biases causal inference in health science studies using observational and imperfect experimental designs. The adoption of methods for analysis of bias due to uncontrolled confounding has been slow, despite the increasing availability of such methods. Bias analysis for such uncontrolled confounding is most useful in big data studies and systematic reviews to gauge the extent to which extraneous preexposure variables that affect the exposure and the outcome can explain some or all of the reported exposure-outcome associations. We review methods that can be applied during or after data analysis to adjust for uncontrolled confounding for different outcomes, confounders, and study settings. We discuss relevant bias formulas and how to obtain the required information for applying them. Finally, we develop a new intuitive generalized bias analysis framework for simulating and adjusting for the amount of uncontrolled confounding due to not measuring and adjusting for one or more confounders.
Cumulative Environmental Impacts: Science and Policy to Protect Communities
Authors: Solomon Gina M. , Morello-Frosch Rachel , Zeise Lauren , Faust John B.
Published: March 2015

Many communities are located near multiple sources of pollution, including current and former industrial sites, major roadways, and agricultural operations. Populations in such locations are predominantly low-income, with a large percentage of minorities and non-English speakers. These communities face challenges that can affect the health of their residents, including limited access to health care, a shortage of grocery stores, poor housing quality, and a lack of parks and open spaces. Environmental exposures may interact with social stressors, thereby worsening health outcomes. Age, genetic characteristics, and preexisting health conditions increase the risk of adverse health effects from exposure to pollutants. There are existing approaches for characterizing cumulative exposures, cumulative risks, and cumulative health impacts. Although such approaches have merit, they also have significant constraints. New developments in exposure monitoring, mapping, toxicology, and epidemiology, especially when informed by community participation, have the potential to advance the science on cumulative impacts and to improve decision making.
A Transdisciplinary Approach to Public Health Law: The Emerging Practice of Legal Epidemiology
Authors: Burris Scott , Ashe Marice , Levin Donna , Penn Matthew , Larkin Michelle
Published: March 2015

Public health law has roots in both law and science. For more than a century, lawyers have helped develop and implement health laws; over the past 50 years, scientific evaluation of the health effects of laws and legal practices has achieved high levels of rigor and influence. We describe an emerging model of public health law that unites these two traditions. This transdisciplinary model adds scientific practices to the lawyerly functions of normative and doctrinal research, counseling, and representation. These practices include policy surveillance and empirical public health law research on the efficacy of legal interventions and the impact of laws and legal practices on health and health system operation. A transdisciplinary model of public health law, melding its legal and scientific facets, can help break down enduring cultural, disciplinary, and resource barriers that have prevented the full recognition and optimal role of law in public health.
One Hundred Years in the Making: The Global Tobacco Epidemic
Authors: Wipfli Heather , Samet Jonathan M.
Published: March 2015

Today's global tobacco epidemic may represent one of the first instances of the globalization of a noninfectious cause of disease. This article focuses on the first century of the global tobacco epidemic and its current status, reviewing the current and projected future of the global tobacco epidemic and the steps that are in progress to end it. In the United States and many countries of Western Europe, tobacco consumption peaked during the 1960s and 1970s and declined as tobacco control programs were initiated, motivated by the evidence indicting smoking as a leading cause of disease. Despite this policy advancement and the subsequent reductions in tobacco consumption, the global tobacco epidemic continued to grow exponentially in the later years of the twentieth century, as the multinational companies sought new markets to replace those shrinking in high-income countries. In response, between 2000 and 2004, the World Health Organization developed its first public health treaty, the Framework Convention on Tobacco Control, which entered into force in 2005. An accompanying package of interventions has been implemented. New approaches to tobacco control, including plain packaging and single representation of brands, have been implemented by Australia and Uruguay, respectively, but have been challenged by the tobacco industry.
Preventing Obesity Across Generations: Evidence for Early Life Intervention
Authors: Haire-Joshu Debra , Tabak Rachel
Published: March 2015

To prevent the intergenerational transfer of obesity and end the current epidemic, interventions are needed across the early life stages, from preconception to prenatal to infancy through the age of 2 years. The foundation for obesity is laid in early life by actions and interactions passed from parent to child that have long-lasting biologic and behavioral consequences. The purpose of this paper is to examine the best evidence about (a) factors in parents and offspring that promote obesity during the early life stages, (b) the social determinants and dimensions of obesity in early life, (c) promising and effective interventions for preventing obesity in early life, and (d) opportunities for future research into strategies to disrupt the intergenerational cycle of obesity that begins early in life. The pathway for halting the intergenerational obesity epidemic requires the discovery and development of evidence-based interventions that can act across multiple dimensions of influence on early life.
Documenting the Effects of Armed Conflict on Population Health
Authors: Levy Barry S. , Sidel Victor W.
Published: March 2015

War and other forms of armed conflict have profound adverse effects on population health. It is important to document these effects to inform the general public and policy makers about the consequences of armed conflict, provide services to meet the needs of affected populations, protect human rights and document violations of international humanitarian law, and help to prevent future armed conflict. Documentation can be accomplished with surveillance, epidemiological surveys, and rapid assessment. Challenges include inadequate or absent data systems, social breakdown, forced migration, reporting biases, and the fog of war. The adverse effects of the Iraq War on population health demonstrate how the effects of armed conflict on population health can be documented. We recommend the establishment of an independent mechanism, operated by the United Nations or a multilateral organization, to investigate and document the effects of armed conflict on population health.
Civil Rights Laws as Tools to Advance Health in the Twenty-First Century
Authors: McGowan Angela K. , Lee Mary M. , Meneses Cristina M. , Perkins Jane , Youdelman Mara
Published: March 2015

To improve health in the twenty-first century, to promote both access to and quality of health care services and delivery, and to address significant health disparities, legal and policy approaches, specifically those focused on civil rights, could be used more intentionally and strategically. This review describes how civil rights laws, and their implementation and enforcement, help to encourage health in the United States, and it provides examples for peers around the world. The review uses a broad lens to define health for both classes of individuals and their communities—places where people live, learn, work, and play. Suggestions are offered for improving health and equity broadly, especially within societal groups and marginalized populations. These recommendations include multisectorial approaches that focus on the social determinants of health.
Chronic disuse and skeletal muscle structure in older adults: sex-specific differences and relationships to contractile function
Authors: Callahan Damien M. , Tourville Timothy W. , Miller Mark S. , Hackett Sarah B. , Sharma Himani , Cruickshank Nicholas C. , Slauterbeck James R. , Savage Patrick D. , Ades Philip A. , Maughan David W. , Beynnon Bruce D. , Toth Michael J.
Published: March 2015

In older adults, we examined the effect of chronic muscle disuse on skeletal muscle structure at the tissue, cellular, organellar, and molecular levels and its relationship to muscle function. Volunteers with advanced-stage knee osteoarthritis (OA, n = 16) were recruited to reflect the effects of chronic lower extremity muscle disuse and compared with recreationally active controls ( n = 15) without knee OA but similar in age, sex, and health status. In the OA group, quadriceps muscle and single-fiber cross-sectional area were reduced, with the largest reduction in myosin heavy chain IIA fibers. Myosin heavy chain IIAX fibers were more prevalent in the OA group, and their atrophy was sex-specific: men showed a reduction in cross-sectional area, and women showed no differences. Myofibrillar ultrastructure, myonuclear content, and mitochondrial content and morphology generally did not differ between groups, with the exception of sex-specific adaptations in subsarcolemmal (SS) mitochondria, which were driven by lower values in OA women. SS mitochondrial content was also differently related to cellular and molecular functional parameters by sex: greater SS mitochondrial content was associated with improved contractility in women but reduced function in men. Collectively, these results demonstrate sex-specific structural phenotypes at the cellular and organellar levels with chronic disuse in older adults, with novel associations between energetic and contractile systems.
Creatine kinase B is necessary to limit myoblast fusion during myogenesis
Authors: Simionescu-Bankston Adriana , Pichavant Christophe , Canner James P. , Apponi Luciano H. , Wang Yanru , Steeds Craig , Olthoff John T. , Belanto Joseph J. , Ervasti James M. , Pavlath Grace K.
Published: March 2015

Myoblast fusion is critical for proper muscle growth and regeneration. During myoblast fusion, the localization of some molecules is spatially restricted; however, the exact reason for such localization is unknown. Creatine kinase B (CKB), which replenishes local ATP pools, localizes near the ends of cultured primary mouse myotubes. To gain insights into the function of CKB, we performed a yeast two-hybrid screen to identify CKB-interacting proteins. We identified molecules with a broad diversity of roles, including actin polymerization, intracellular protein trafficking, and alternative splicing, as well as sarcomeric components. In-depth studies of α-skeletal actin and α-cardiac actin, two predominant muscle actin isoforms, demonstrated their biochemical interaction and partial colocalization with CKB near the ends of myotubes in vitro. In contrast to other cell types, specific knockdown of CKB did not grossly affect actin polymerization in myotubes, suggesting other muscle-specific roles for CKB. Interestingly, knockdown of CKB resulted in significantly increased myoblast fusion and myotube size in vitro, whereas knockdown of creatine kinase M had no effect on these myogenic parameters. Our results suggest that localized CKB plays a key role in myotube formation by limiting myoblast fusion during myogenesis.
Cellular redox status determines sensitivity to BNIP3-mediated cell death in cardiac myocytes
Authors: Lee Youngil , Kubli Dieter A. , Hanna Rita A. , Cortez Melissa Q. , Lee Hwa-Youn , Miyamoto Shigeki , Gustafsson Åsa B.
Published: March 2015

The atypical BH3-only protein Bcl-2/adenovirus E1B 19-kDa interacting protein 3 (BNIP3) is an important regulator of hypoxia-mediated cell death. Interestingly, the susceptibility to BNIP3-mediated cell death differs between cells. In this study we examined whether there are mechanistic differences in BNIP3-mediated cell death between neonatal and adult cardiac myocytes. We discovered that BNIP3 is a potent inducer of cell death in neonatal myocytes, whereas adult myocytes are remarkably resistant to BNIP3. When exploring the potential underlying basis for the resistance, we discovered that adult myocytes express significantly higher levels of the mitochondrial antioxidant manganese superoxide dismutase (MnSOD) than neonatal myocytes. Overexpression of MnSOD confers resistance to BNIP3-mediated cell death in neonatal myocytes. In contrast, the presence of a pharmacological MnSOD inhibitor, 2-methoxyestradiol, results in increased sensitivity to BNIP3-mediated cell death in adult myocytes. Cotreatment with the mitochondria-targeted antioxidant MitoTEMPO or the MnSOD mimetic manganese (III) tetrakis (4-benzoic acid) porphyrin chloride abrogates the increased cell death by 2-methoxyestradiol. Moreover, increased oxidative stress also restores the ability of BNIP3 to induce cell death in adult myocytes. Taken together, these data indicate that redox status determines cell susceptibility to BNIP3-mediated cell death. These findings are clinically relevant, given that pediatric hearts are known to be more vulnerable than the adult heart to ischemic injury. Our studies provide important insight into why pediatric hearts are more sensitive to ischemic injury and may help in the clinical management of childhood heart disease.