bluuebunny/crossref_metadata_2025 huggingface dataset:
PENGARUH KONSERVATISME AKUNTANSI DAN INTENSITAS MODAL TERHADAP TAX AVOIDANCE DENGAN DEWAN KOMISARIS INDEPENDEN SEBAGAI VARIABEL MODERATING
Authors: Alfian Nurul
Published: July 2023

This study aims to provide empirical evidence that accounting conservatism and capital intensity affect tax avoidance, as well as the existence of an independent board of commissioners as a moderating variable to interact with the relationship between accounting conservatism and capital intensity on tax avoidance. This research is associative, sample selection is done by purposive sampling method. The data used are secondary data and annual reports, while the data analysis techniques used are descriptive statistical analysis and multiple regression analysis and for statistical analysis of moderating variables using the value test using SPSS 21.The results of this study indicate that accounting conservatism has a significant negative effect on tax avoidance, while capital intensity has a significant and positive effect on tax avoidance. And the independent board of commissioners is able to moderate the effect of accounting conservatism on tax avoidance, while the independent board of commissioners is not a variable that moderates the effect of capital intensity on tax avoidance.
PENGARUH EARNING PER SHARE (EPS), PRICE TO BOOK VALUE (PBV), DAN VOLUME PERDAGANGAN TERHADAP HARGA SAHAM (Studi Pada Perusahaan IDX Value 30 di Bursa Efek Indonesia)
Authors: Hutabarat Francis
Published: July 2023

ABSTRAK Tujuan penelitian ini adalah untuk menyelidiki hubungan antara laba per saham (EPS), harga terhadap nilai buku (PBV), dan volume perdagangan dalam kaitannya dengan harga saham. Perusahaan yang tergabung dalam IDX Value 30 dipilih sebagai sampel yang representatif untuk penelitian ini. Kinerja harga 30 saham yang memiliki valuasi harga rendah, likuiditas transaksi tinggi, dan kinerja keuangan yang solid diukur dengan indeks yang disebut IDX Value 30, dan indeks ini disebut IDX Value 30. Metode penelitian kuantitatif digunakan dalam hal ini. penelitian, dan data dari laporan keuangan perusahaan yang tercatat di BEI Value 30 dijadikan sebagai sumber data sekunder. Metode analisis yang digunakan adalah regresi linier berganda, selain uji asumsi tradisional dan uji hipotesis. Temuan membawa kita pada kesimpulan bahwa masing-masing variabel independen memiliki pengaruh yang signifikan secara parsial terhadap variabel dependen. Selain itu, variabel Earning Per Share (EPS), Price To Book Value (PBV), dan Volume Perdagangan masing-masing berpengaruh signifikan terhadap harga saham pada perusahaan yang tercatat di IDX Value 30. Kata kunci: EPS; PBV; Volume, SahamABSTRACTThis study's objective is to investigate the relationship between earnings per share (EPS), price to book value (PBV), and trade volume in relation to stock prices. Companies that are part of the IDX Value 30 were selected as a representative sample for this study. The price performance of 30 equities that have low price valuations, high transaction liquidity, and solid financial performance is measured by an index called the IDX Value 30, and this index is referred to as the IDX Value 30. Quantitative research methods are utilized in this study, and the data from firm financial reports that are listed on the IDX Value 30 serve as the source of secondary data. The method of analysis that is utilized is multiple linear regression, in addition to the traditional assumption test and the hypothesis test. The findings lead us to the conclusion that each independent variable has an effect that is partially significant on the dependent variable. In addition, the Earnings Per Share (EPS), Price To Book Value (PBV), and Trading Volume variables each have a significant effect on stock prices in companies that are listed on the IDX Value 30.Keywords: EPS, PBV, Volume, Stock
El impacto del independentismo en el sector empresarial Catalán
Authors: Florido-Benítez Lázaro , Barranquero-Martín Javier
Published: July 2023

Desde que el Tribunal Constitucional de España suspendió la declaración unilateral Independentista Catalana el 31 de octubre de 2017, la inestabilidad e incertidumbre ha permanecido en el cielo de los ciudadanos catalanes. Esta decisión política independentista ha afectado de una manera significativa al tejido empresarial catalán. Este trabajo de investigación analiza cómo ha incidido el “procés” en términos macroeconómicos e ipso facto al efecto de las deslocalizaciones de las empresas. Es vital escenificar esta convulsión política y social, para entender mejor las consecuencias que está teniendo en el ámbito económico-social y tomar mejores decisiones futuras en la resolución de conflictos. La metodología de este estudio combina datos cuantitativos y cualitativos para garantizar una objetividad en los resultados y sus correspondientes conclusiones. Los resultados obtenidos en este trabajo indican que el impacto del independentismo catalán tiene consecuencias considerables, ya que la inversión se reduce tanto a nivel regional como nacional. Además, en el primer trimestre de 2020, se produjo una masiva deslocalización de empresas, concretamente 6.031, desde Cataluña a otras regiones españolas y extranjeras. No podemos olvidar que un referéndum es parte de una sociedad democrática, otra cosa distinta es que este sea legal o ilegal, su contenido y su espíritu.
Hate, Identification, and Othering
Authors: Helm Bennett W.
Published: July 2023

This paper argues that hate differs from mere disliking in terms of its “depth,” which is understood via a notion of “othering,” whereby one rejects at least some aspect of the identity of the target of hate, identifying oneself as not being what they are. Fleshing this out reveals important differences between personal hate, which targets a particular individual, and impersonal hate, which targets groups of people. Moreover, impersonal hate requires focusing on the place hate has within particular sorts of communities, enabling a further important distinction between “insider” and “outsider” hate in terms of whether the hater includes members of the targeted group within a particular community or rejects them as “beneath” membership in that community.
Research on the Influence of Live Webcast on Teenagers' Consumption Behavior under the New Media Background
Authors: Wei Binge
Published: July 2023

With the continuous development of the Internet economy, short video on the Internet has an increasing influence on the consumption behavior of teenagers. How to help teenagers correctly grasp consumption behavior has become a hot issue in society. Live marketing is a new network marketing mode, which combines the characteristics of previous video marketing, community marketing and event marketing, and can make brand, marketing, users, transactions and communities coherent. As a new product of Internet technology, live webcast is also one of the external factors that influence the youth's consumption values, and it also exerts a subtle influence on the formation of the youth's correct consumption values. This paper takes Tiktok short video platform as an example to study the comprehensiveness, interest, interactivity and quality of Tiktok short video content, explore whether consumers' purchase intention will be affected by these four dimensions, and introduce the perceived value as an intermediary variable for further research. Use the user behavior decision analysis model to analyze the influencing factors of live broadcast marketing on consumers' purchase intention, and finally propose measures for the problems of live broadcast marketing, so as to provide reference for Tiktok to improve marketing efficiency.
SUDIJSKA (NE)PRISTRASNOST I VEŠTAČKA INTELIGENCIJA
Authors: Avramović Dragutin S. , Jovanov Ilija D.
Published: July 2023

Neprestani napredak u razvoju informacionih tehnologija i veštačke inteligencije otvorio je neslućene mogućnosti njihove upotrebe i u sferi prava. Uticaj veštačke inteligencije je danas naročito vidljiv u pokušajima „zauzdavanja” diskrecije sudske vlasti, koja se nalazi na najklizavijem terenu između stvaraoca i primenjivača prava. Na prvi pogled deluje da veštačka inteligencija može pružiti mnogo, jer ima veliki potencijal u prevazilaženju ljudskih slabosti u sudijskom odlučivanju, naročito u pogledu jednakosti u postupanju i nepostojanju predrasuda i predubeđenja. U radu se kritički analizira ovakav pristup, kojim se, prema mišljenju autora, ne može prevazići osnovni, „ljudski deficit” i ograničenja prilikom sudijskog odlučivanja. Autori ukazuju na slabosti i probleme upotrebe veštačke inteligencije sa stanovišta nepristrasnog odlučivanja. S obzirom na velika očekivanja i mogućnosti koje otvara upotreba veštačke inteligencije, često se gubi iz vida činjenica da je i veštačka inteligencija tvorevina lјudskog bića. Autori smatraju da ona ne može biti od prevelike pomoći što se tiče nepristrasnosti u sudijskom odlučivanju, odnosno da nije baš „razum bez strasti”, pošto je njen tvorac, čovek, uneo u nju svoje subjektivne stavove, predubeđenja i specifične poglede na svet. Nesumnjivo, veštačka inteligencija može doprineti povećanju nepristrasnosti i jednakosti u sudijskom odlučivanju, ali kao pomoćno sredstvo, a ne i kao garant potpune nepristrasnosti. Veštačka inteligencija nas ne može odvesti dalјe od onoga što je još Holms podrazumevao pod pravom – predviđanje onoga kako će sud postupiti i ništa više od toga. Realno očekivanje od ovog novuma je povećanje predvidivosti postupanja, ali nikako uspostavlјanje potpune pravne sigurnosti.
Knowledge Management: A Tool and Technology for Organizational Success
Authors: CHATTERJEE Sidharta , MOUSUMI Samanta
Published: July 2023

Knowledge is a productive resource having successful applications in almost every field and domain of human activities. With unprecedented growth in knowledge resources and explosion in data, such informative resources need effective organization for storage and efficient retrieval for future uses. The entire process involving organization, storage, and dissemination of knowledge falls under the auspices of knowledge management. Thus, Knowledge Management is an organizational practice. In this research paper, we provide a general outline of some of the tools and technologies deployed in managing knowledge across organizations. We believe that the practice of knowledge management - though considered to be a process - it is also a "method" by which organizations are able to management their knowledge and human resources. On this regard, this paper contributes to our further understanding of what organizational knowledge is, and how they should be proficiently managed that would contribute to organizational success.© 2023 The Author(s). Published by RITHA Publishing. This article is distributed under the terms of the license CC-BY 4.0., which permits any further distribution in any medium, provided the original work is properly cited.
The Impact of Investments on Economic Growth: Evidence from Tajikistan
Authors: ABDUVALIEV Mubinzhon
Published: July 2023

The aim of this paper is to assess the effect of foreign direct investment on economic growth in Tajikistan. Using annual time series data for 2005 to 2021, the study reveals a relationship between foreign direct investment and per capita GDP growth in Tajikistan. Based on the analysis of the Vector Error Correction Model (VECM), it has been found that these variables have a long-term relationship. The residuals of the regressions showed no autocorrelation in the post-estimation diagnostic tests performed to determine the validity of the VECM model. Furthermore, our findings suggest that improving the institutional quality of the country complements the improvement of the investment climate and results in significant increases in foreign direct investment inflows.© 2023 The Author(s). Published by RITHA Publishing. This article is distributed under the terms of the license CC-BY 4.0., which permits any further distribution in any medium, provided the original work is properly cited.
About Governance of Agricultural Knowledge and Innovation System. The Case of Bulgaria. Part III
Authors: BACHEV Hrabrin
Published: July 2023

This paper is the third part of our attempt to examine the governance, efficiency, and development of the Agricultural Knowledge and Innovation System (AKIS) in Bulgaria based on a project related to mechanisms and the modes of agrarian governance in Bulgaria. The research continues with the expert assessment on governance of AKIS in Bulgaria and the SWOT analysis regarding development strategy and intervention needs providing recommendations and actionable steps to address the identified weaknesses and enhance the effectiveness, efficiency, and inclusiveness of the AKIS governance. It is emphasising the approaches of comparative data and institutional analysis, gap analysis, SWOT, strategic orientation, experts’ assessments to identify actors and relations, state and trends in development, assess strengths, weaknesses, opportunities, and threats, formulate adequate strategy, and specify overall and public intervention needs of AKIS in the country.© 2023 The Author(s). Published by RITHA Publishing. This article is distributed under the terms of the license CC-BY 4.0., which permits any further distribution in any medium, provided the original work is properly cited.
HUMIC ACID APPLICATION IMPROVES THE GROWTH, FLORET AND BULB INDICES OF GLADIOLUS (Gladiolus grandiflorus L.)
Authors: M. Bashir
Published: July 2023

Humic acid is an organic acid having positive effect on plant growth. The presentstudy was carried out to see the effect of humic acid in combination with NPK on soil for growth,flower production and vase life of gladiolus flowers. Five treatments i.e. nitrogen, phosphorous, potash(NPK) (17:17:17) (10 g), 8% humic acid (1.0 mL) + NPK (17:17:17) (10 g), 8% humic acid (2.0 mL)+ NPK (17:17:17) (10 g), 8% humic acid (3.0 mL) + NPK (17:17:17) (10g) were studied, whereastreatment without exogenous feeding of NPK and humic acid served as control. All the treatments were applied at plating and 3rd leaf stage through soil. All the treatments were arranged in randomized complete block design (RCBD) in triplicate. Results depicted that humic acid (3.0 mL) in combinationwith NPK (17:17:17) produced higher sprouting, plant height, number of leaves per plant, leaf area,spike length, spike diameter, stem length, flower characteristics, vase life, number of cormels plant-1diameter of cormels and weight of cormels per plant than all other treatments. However, plants grownwithout application of humic acid (only NPK) showed relatively less and least growth characteristicsand poor floral and bulb indices as compared to other treatments. It could be concluded that humic acidapplication can increase the vase life by increasing growth indices such as leaf area, fresh and dryweight of floret.
EFFECT OF MALATHION ON BLOOD BIOCHEMICAL PARAMETERS (UREA AND CREATININE) IN NILE TILAPIA (OREOCHROMIS NILOTICUS)
Authors: A. Zulfiqar
Published: July 2023

The present study was conducted to evaluate the serological changes (urea and creatinine) in the kidneys of Nile tilapia (Oreochromis niloticus) after acute exposure to Malathion. Four groups of 15 fish were made each and categorized as; Group A: (control group) and Groups B, C and D (experimental groups). The LC50 of Malathion was 2µg/L at 96 hours of exposure in Nile tilapia. The fish were exposed to sub-lethal concentrations of 0.5, 1.0 and 1.5 µg/L to group B, C and D respectively. Blood samples were collected after 48, 72 and 96 hours of exposure to Malathion. Serum was separated and analyzed for levels of urea and creatinine that was significantly enhanced after acute exposure to Malathion at 48, 72 and 96 hours. Moreover, morphological and behavioral changes and mortality rates were also recorded. The results revealed that the pesticide (Malathion) has an adverse effect on kidneys. High levels of Malathion result in kidney damage and serological alterations in Nile tilapia.
AKUNTABILITAS KEUANGAN DALAM ORGANISASI KEAGAMAAN STUDI KASUS PADA GEREJA KRISTEN INJILI ONOMI FLAVAUW SENTANI
Authors: Puspita Gratiana Deodata , S K Miraclin Yuliana
Published: July 2023

Gereja merupakan salah satu bentuk organisasi nonprofit, yaitu organisasi yang tidak bertujuan mencari keuntungan melainkan untuk kesejahteraan masyarakat karena dana yang digunakan untuk operasional gereja tidak berasal dari kegiatan operasional gereja melainkan dari masyarakat. Oleh sebab itu maka penting bagi gereja untuk bertanggung jawab atas penggunaan dana tersebut. Penelitian ini bertujuan untuk mengetahui dan menggambarkan bagaimana akuntabilitas keuangan yang diterapkan pada Gereja Kristen Injili Onomi Flavauw Sentani. Penelitian ini menggunakan metode kualitatif. Penelitian ini melihat pertanggungjawaban keuangan dari pengelola Gereja. Data dalam penelitian ini yaitu data primer yang diperoleh secara langsung dari Gereja Kristen Injili Onomi Flavauw Sentani. Teknik pengumpulan data dilakukan dengan observasi (Pengamatan), Wawancara, dan Dokumentasi, dan Teknik analisis data engan mengunakan Teknik analisis data kualitatif yang terdiri dari reduksi data, penyajian data dan penarikan kesimpulan. Berdasarkan hasil penelitian dapat diketahui bahwa kepercayaan dan wujud nyata dari penginaan keuangan menjadi hal utama dalam praktik akuntabilitas serta pertanggungjawaban keuangan gereja dimana sumber keuangan gereja berasal dari para jemaaat. Berdasarkan hasil penelitian pengurus Gereja telah 90% memahami pentingnya akuntabilitas keuangan dan sudah menerapkan praktek akuntasi dalam laporan keuangan walaupun masih menggunakan metode pembukuan yang sederhana serta telah menerapkannya sesuai acuan pokok – pokok ajaran di Gereja.
Karakterisasi Ice Cream Sinbiotik Rendah Lemak Dengan Perbedaan Konsentrasi Ekstrak Pisang dan Edamame
Authors: Prawintasari Meidina Nurma , Jayus Jayus , Nafi’ Ahmad
Published: July 2023

Es krim sinbiotik yang menggunakan susu sapi mengandung lemak jenuh yang cukup tinggi sehingga dapat menurunkan nilai fungsional produk. Oleh karena itu diperlukan bahan alternatif lain untuk menggantikan penggunaan susu sapi, salah satunya berupa ekstrak edamame. Tujuan penelitian ini adalah untuk: 1) menentukan efek dari rasio ekstrak pisang dan edamame terhadap karakteristik es krim sinbiotik rendah lemak; 2) menentukan rasio terbaik dari ekstrak pisang dan edamame yang menghasilkan es krim sinbiotik rendah lemak dengan karakteristik terbaik. Penelitian ini menggunakan desain Rancangan Acak Lengkap (RAL)  faktor tunggal berupa perbedaan konsentrasi dari ekstrak pisang dan ekstrak edamame (0%:0%; 20%:80%; 40%:60%; 50%:50%; 60%:40%; 80%:20%). Konsentrasi yang berbeda dari ekstrak pisang dan edamame tidak mempengaruhi secara signifikan hasil dari jumlah total bakteri asam laktat dan viabilitas bakteri asam laktat, tetapi secara signifikan mempengaruhi nilai overrun, waktu kecepatan meleleh, dan kandungan lemak dari sampel es krim sinbiotik rendah lemak. Perlakuan terbaik dari sampel es krim sinbiotik rendah lemak yaitu pada sampel dengan rasio ekstrak pisang dan ekstrak edamame 60%:40% dengan hasil dari tes efektivitas yang diperoleh nilai 0.73.
Plantas popularmente antihipertensivas en Jipijapa, Manabí. Mito y realidad
Authors: Herrera Velazquez Maria del Rosario , Rodriguez Palmero Orelvis , Torregrosa Cortiñas Lorena
Published: July 2023

La fitoterapia es la forma más antigua de atención médica y se refiere al uso médico de las plantas o sus componentes. Siguiendo la línea de investigación del Ministerio de Salud Pública de Ecuador sobre Medicamentos, Suministros, Conocimiento y Uso de Plantas Medicinales, se realizaron 614 entrevistas a hipertensos adultos sobre uso de plantas medicinales e hipertensión arterial. La edad promedio de los entrevistados fue de 58 años, predominando mujeres (60,09%), con nivel básico de escolaridad (29,47%) y un promedio de 7,2 años de padecimiento de la enfermedad. El 58% de la población entrevistada utiliza plantas medicinales para tratar la hipertensión, siendo las más utilizadas Matricaria recutita (manzanilla), Plectranthus amboinicus (oreganón), Cymbopogon citratus (hierba luisa) y Valeriana officinalis (valeriana), la hierba luisa es la única con eficacia comprobada como anti-hipertensiva. El 34,03% de las plantas usadas se compran en el mercado, la parte más utilizada fue la hoja y la infusión el modo de preparación. En cuanto a la composición química de las especies citadas, el orégano francés contiene compuestos aromáticos y oxigenados como principales constituyentes. La manzanilla contiene, fundamentalmente: flavonoides, taninos y terpenoides, la hierba luisa compuestos fenólicos y la valeriana se caracteriza por contener flavonoides y terpenoides. El uso popular de tres de las plantas estudiadas se atribuye a sus efectos sedante y relajante, por lo que sus efectos antihipertensivos son un mito y no una  realidad.
PROSES PEMBELAJARAN ALAT MUSIK PIANO PADA ANAK USIA DINI DI AMABILE MUSIK STUDIO
Authors: Anggraini Raden Roro Anggita , Ardini Ni Wayan , Sumerjana Ketut
Published: July 2023

Penelitian ini membahas tentang observasi pembelajaran alat musik piano pada anak usia dini di Amabile Music Studio. Penelitian ini bertujuan untuk menggambarkan perencanaan, pelakasanaan serta pembelajaran melalui musik dalam proses pembelajaran antara pengajar dan murid di Amabile Music Studio. Dampak penelitian yang dilaksanakan di Amabile Music Studio adalah meningkatnya kualitas pembelajaran yang lebih memotivasi, inspirasi, dan meningkatkan minat dan bakat di bidang seni, khususnya di bidang musik.
ANALISIS PENYUSUNAN SILABUS PEMBELAJARAN GITAR KLASIK YANG BERORIENTASI PADA PESERTA DIDIK DI AMABILE MUSIC STUDIO, DENPASAR, BALI
Authors: Lee Yngwie McCuaren , Ardini Ni Wayan , Prasetyo Guntur Eko
Published: July 2023

Penelitian ini bertujuan untuk mengetahui penerapan silabus pembelajaran gitar klasik yang berorientasi pada peserta didik di Amabile Music Studio, Denpasar, Bali. Sampel Penelitian ini adalah peserta didik pembelajaran gitar klasik di Amabile Music Studio, Denpasar, Bali. Teknik pengambilan sampel menggunakan teknik Purposive Sampling dan Quota Sampling yang menghasilkan sebanyak 4 orang peserta didik yang memenuhi kriteria sebagai responden. Pengumpulan data dilakukan melalui wawancara kepada Komang Wisnu sebagai tenaga didik, Justina Tjandra selaku pemilik Amabile Music Studio dan observasi terhadap peserta didik di kelas pembelajaran gitar klasik, serta studi literatur terhadap berbagai sumber bacaan dan media daring. Hasil penelitian terhadap peserta didik menunjukkan bahwa setiap peserta didik memiliki silabus yang berbeda sesuai dengan kemauan, kemampuan, kebutuhan dan keinginan masing-masing peserta didik. Adapun kriteria dari penyusunan silabus pembelajaran gitar klasik ialah a) mengandung kaidah, aturan dan unsur-unsur yang terdapat dalam teori musik klasik barat, baik pada penerapan permainan maupun materi pembelajarannya, b) memiliki tingkat kesulitan yang menyerupai tingkat kesulitan setiap grade pada silabus pembelajaran gitar klasik ABRSM dan c) memaksimalkan karya-karya instrumental gitar klasik, baik klasik tradisional maupun klasik modern. Capaian dari pembelajaran gitar klasik ialah peserta didik mampu mengikuti dan memahami materi yang disampaikan oleh tenaga didik. Amabile Music Studio mengacu pada kurikulum ABRSM untuk pembelajarannya, namun bersifat fleksibel dalam penyusunan dan penerapan silabus pembelajaran gitar klasik kepada peserta didik. Selain silabus, peran tenaga didik juga berpengaruh sebagai orang yang membentuk peserta didik melalui pemberian silabus yang telah disusun.
Use and Costs of Supplemental Benefits in Medicare Advantage, 2017-2021
Authors: Cai Christopher L. , Iyengar Sonia , Woolhandler Steffie , Himmelstein David U. , Kannan Kavya , Simon Lisa
Published: January 2025

Importance

Nearly all Medicare Advantage (MA) plans offer dental, vision, and hearing benefits not covered by traditional Medicare (TM). However, little is known about MA enrollees’ use of those benefits or how much they cost MA insurers or enrollees.

Objective

To estimate use, out-of-pocket (OOP) spending, and insurer payments for dental, hearing, and vision services among Medicare beneficiaries.

Design, Setting, and Participants

This cross-sectional analysis used pooled 2017-2021 Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey (MCBS) data for MA and TM beneficiaries (excluding those also covered by Medicaid). The analysis was performed from September 10, 2023, to June 30, 2024.

Exposures

MA compared with TM coverage.

Main Outcomes and Measures

The main outcome was receipt of eye examinations, corrective lenses, hearing aids, optometry and dental visits, and MA and TM enrollees’ and insurers’ spending for such services. MEPS and MCBS data were weighted to be nationally representative.

Results

We included 76 557 non–dually eligible Medicare beneficiaries, including 23 404 from the MEPS and 53 153 from the MCBS. Weighted demographic characteristics of MA and TM beneficiaries were similar (54.7% and 51.9% female; 39.8% and 35.2% older than 75 years, respectively). Only 54.2% (95% CI, 52.4%-55.9%) and 54.3% (95% CI 52.2%-56.3%) of MA beneficiaries were aware of having MA dental and vision coverage, respectively. MA enrollees were no more likely to receive eye examinations, hearing aids, or eyeglasses than TM enrollees. After adjustment for demographic differences, MA and TM enrollees paid OOP $205.86 (95% CI, $192.44-$219.27) and $226.12 (95% CI, $212.02-$240.23), respectively, for eyeglasses (MA − TM difference, −$20.27 [95% CI, −$33.77 to −$6.77] or −9.0% [95% CI, −14.9% to −3.0%]); $226.82 (95% CI, $202.24-$251.40) and $249.98 (95% CI, $226.22-$273.74) for dental visits, respectively (MA − TM difference, −$23.16 [95% CI, −$43.15 to −$3.17] or −9.3% [95% CI, −17.3% to −1.3%]); and no less for optometry visits or durable medical equipment (a proxy for hearing aids). Nationwide, MA plans’ annual spending on vision, dental services, and durable medical equipment totaled $3.9 billion (95% CI, $3.3-$4.4 billion), while enrollees spent OOP $9.2 billion (95% CI, $8.2-$10.2 billion) annually for these services and other private insurers covered $2.8 billion (95% CI, $2.7-$3.0 billion).

Conclusions and Relevance

In this cross-sectional study of 2 nationally representative surveys, MA beneficiaries did not receive more supplemental services than TM beneficiaries, possibly because of cost-sharing and limited awareness of benefit coverage.
Procedure Coding, Reimbursement, and Billing Compliance
Authors: Baselski Vickie S. , Weissfeld Alice S.
Published: January 2025

Correct procedure coding is the foundation for accurate documentation of services for workload productivity determination in addition to accurate billing and reimbursement for services and is a critical element of a laboratory compliance program. This chapter discusses factors to be considered in code selection. Several code types are used for microbiology services. These include: CPT codes, HCPCS codes, and other procedure coding systems. Microbiology coding is based on methodological approaches in the laboratory and falls into several categories. Billing for laboratory test procedures occurs via several different mechanisms. The primary billing mechanisms include the following: retrospective payment, prospective payment, new technology add‐on payments, and value‐based payments. The primary role for the laboratory in reimbursement is to ensure that correct coding has been applied to services rendered so that appropriate billing and workload documentation occurs.
Collection, Transport, and Manipulation of Clinical Specimens and Other Preanalytical Concerns
Authors: Linscott Andrea J. , Wang Huanyu
Published: January 2025

The collection, transport, and processing of clinical specimens are preanalytical steps that are key to organism recovery. Quality specimens must be collected in order to provide the most clinically relevant microbiology results for the patients. Collection of a specimen is dependent on the anatomic site of infection or suspected disease. Certain specimens—such as blood specimens for blood cultures; skin, hair, and nails for fungal culture; and CSF samples, unless for viral cultures—for bacterial cultures should never be refrigerated. Common collection devices used for microbiologic specimens include sterile urine cups or urine transport tubes with preservatives, sterile wide‐mouth containers, agar plates that have been directly inoculated, sterile screw‐cap tubes, blood culture bottles or lysis centrifugation tubes, and swabs submitted in a transport medium. Triaging specimens for processing may become necessary when large volumes of specimens are received at the same time.
Cerebrospinal Fluid Cultures
Authors: Selvarangan Rangaraj
Published: January 2025

Bacterial meningitis is the result of infection of the meninges. Identification of the infecting agents is one of the most important functions of the diagnostic microbiology laboratory because acute meningitis is life‐threatening. Cerebrospinal fluid (CSF) from a patient suspected of having meningitis is an emergency specimen that requires immediate processing to determine the etiologic agent. CSF is obtained by transcutaneous aspiration, and therefore, all organisms recovered from the culture are potential pathogens and must be reported to the physician immediately. Aerobic bacteria commonly cause bacterial meningitis, but anaerobes may be present in CSF when a meningeal abscess or a similar infectious process is adjacent to the meninges. These include traumatic head injury or prostheses, such as metal cranial plates and shunt drains. The chapter focuses on specimen collection, transport, and handling, quality control, procedure, interpretation and limitations of the procedure.
Genital Cultures
Authors: Filkins Laura M. , Garner Omai B.
Published: January 2025

Routine genital cultures enable detection of nonfastidious aerobic bacteria and are only indicated for some clinical presentations of genital infections. When a routine genital culture is ordered, potentially clinically significant bacteria should be evaluated using an indication specific approach but often include
Enterobacterales
,
Pseudomonas aeruginosa
,
S. aureus
, and
Streptococcus pyogenes
. For certain pathogens, such as
Chlamydia trachomatis
,
N. gonorrhoeae
,
Haemophilus ducreyi
, or
S. agalactiae
(group B
streptococcus
(GBS) for prenatal screening), cultures are ordered specifically for those pathogens, with proper collection and selection media or cell culture. For diagnosis of GBS disease in nonpregnant adults and in neonates, routine culture of the symptomatic body site and routine cultures collected based on clinical risk assessment will detect this pathogen, along with the other potential pathogens that can be isolated from those cultures.
Taxonomy Updates for Anaerobes
Authors: Shannon Samantha K. , Pence Morgan A.
Published: January 2025

The International Committee on Systematics of Prokaryotes (ICSP) and the International Code of Nomenclature of Bacteria (ICNB) are responsible for the naming of prokaryotes, including anaerobes. ICSP and ICNB maintain a strict set of rules for naming and renaming bacteria. Not all proposed taxonomic changes that are published are in compliance with the ICNB. Thus, it is imperative to consult reliable sources to prevent adoption of invalid taxonomy. Taxonomic changes are frequently proposed by evolutionary microbiologists, and new taxonomic name proposals may have detrimental effects for clinical laboratories and hospitals. The Clinical and Laboratory Standards Institute is currently developing a document to address taxonomy changes and guidance for updating organism names for laboratory reporting. Microbiology laboratory leadership should discuss taxonomy changes with infectious diseases and other key clinician groups to determine if changes should be incorporated into laboratory reporting.
Introduction
Authors: McElvania Erin
Published: January 2025

There has been a revolution in the way clinical microbiology laboratories identify microorganisms with the advent of matrix‐assisted laser desorption ionization–time of flight mass spectrometry (MALDI‐TOFMS). MALDI‐TOFMS identifies microorganisms based on their protein profile rather than traditional methods of phenotypic identification such as biochemical testing. MALDI‐TOFMS identification begins with colonies growing on solid agar or growing in liquid media. Cellular extracts of microorganism or direct application of a thin layer of organism from a colony are applied to the MALDI‐TOFMS target, followed by the application of matrix. Initial use of MALDI‐TOF in the clinical microbiology laboratory focused on bacterial identification from colonies growing on solid agar. Due to the ease of use, cost savings, and high accuracy, many laboratories had interest in using MALDI‐TOFMS for identification of other organism groups.
MALDI‐TOF MS for Identification of Bacteria and Yeast from Positive Blood Culture Broth
Authors: McElvania Erin
Published: January 2025

Identification of bacteria and yeast from blood culture is one of the most important functions of the microbiology laboratory due to the morbidity and mortality bloodstream infections inflict among patients. Matrix‐assisted laser desorption ionization–time of flight mass spectrometry (MALDI‐TOF MS) provides identification of bacteria and yeast in under an hour. MALDI‐TOF MS performed directly from other patient specimens has not been implemented for routine use in clinical microbiology laboratories because the method does not perform well on polymicrobial specimens or those with a low burden of organisms. Blood culture broth is a complex specimen type due to the presence of RBCs and other blood components which must be separated from the bacteria or yeast to achieve high‐quality MALDI‐TOF MS spectra for accurate organism identification.
Oxacillin Salt Agar Test to Detect Methicillin (Oxacillin)‐Resistant
Staphylococcus aureus
Authors: Simner Patricia J.
Published: January 2025

The oxacillin salt agar test is an optional test for detecting
mec
A‐mediated methicillin (oxacillin) resistance in
Staphylococcus aureus
. A standard number of bacteria are inoculated onto Mueller‐Hinton agar containing 6 µg of oxacillin per ml and 4% NaCl. Following overnight incubation, the appearance of growth indicates that the
S. aureus
isolate is resistant to oxacillin, all other penicillins, carbapenems, beta‐lactam–beta‐lactamase inhibitor combinations, and cephems with the exception of ceftaroline. The chapter covers proper quality control principles for analytical tests. With postanalytical considerations, it provides attention to common test limitations, interpretive challenges, and results reporting.
Screen Tests to Detect High‐Level Aminoglycoside Resistance in
Enterococcus
spp.
Authors: Maris Alexander S. , Tao Lili
Published: January 2025

High‐level aminoglycoside resistance (HLAR) in enterococci is most commonly detected by assessing growth at high concentrations of gentamicin and sometimes streptomycin. Strains that show HLAR to gentamicin will not be synergistically killed with combinations of cell wall‐active drugs plus gentamicin. HLAR to gentamicin also means HLAR to tobramycin, netilmicin, amikacin, and kanamycin. This chapter describes the agar screen test in detail, and presents the reference to use of standard disk diffusion and broth microdilution MIC test procedures for detecting HLAR. It covers proper quality control principles for analytical tests. With postanalytical considerations, the chapter provides attention to common test limitations, interpretive challenges, and results reporting.
Serum Inhibitory and Bactericidal Titers
Authors: Alby Kevin
Published: January 2025

Schlichter and MacLean first used serum inhibitory titers (SIT) to assess the effectiveness of penicillin in the treatment of subacute bacterial endocarditis. Other recognized clinical indications for obtaining serum bactericidal titers (SBT) to monitor effective therapy are osteomyelitis, closed‐space infections such as meningitis or joint infection, and the use of oral antimicrobial agents after intravenous therapy. The SIT and SBT tests are designed to determine the activities of an antimicrobial agent(s) in a patient's serum against the patient's own infecting organism. The test integrates the pharmacokinetic and pharmacodynamic properties of the antimicrobial agent(s) that the patient is receiving. Doubling dilutions of the patient's serum are made, and a standard inoculum of the patient's organism is added to each tube or well and then incubated for 24 h at 35°C.
Quality Assurance Measures for Antimicrobial Susceptibility Testing
Authors: Cullen Sharon K.
Published: January 2025

Quality control (QC) is performed to ensure proper performance of antimicrobial susceptibility tests (AST) in order to provide accurate, reproducible, and timely results. The basic QC procedure used in clinical laboratories involves testing reference strains that have defined characteristics of susceptibility to the antimicrobial agent(s) tested. These strains must be properly maintained in order to ensure their reliable performance. Testing the QC strains controls many parameters of the AST; however, testing the QC strains alone does not always ensure reliable results when testing patients' isolates. Inclusion of supplemental control strains (particularly if recommended in the manufacturer's instructions when using a commercial test system), evaluation of susceptibility profiles on patients' isolates, verification of technologist competency, and review of cumulative susceptibility statistics are some of the additional measures that can be taken to further ensure quality of AST results.
Creation of an Antibiogram and Verification of Data
Authors: Johnson J. Kristie , Cullen Sharon K.
Published: January 2025

The antimicrobial susceptibility data that are generated by clinical microbiology laboratories from testing individual patient isolates can be utilized by different health care disciplines. These individual patient isolate data can be combined into a cumulative antimicrobial susceptibility test database, also referred to as an antibiogram, and utilized to determine empiric antibiotics at the local level, to observe increase in resistance, or to compare against local or national data. This chapter gives an overview on how to gather, validate, create, and distribute data based on the Clinical and Laboratory Standards Institute guidelines found in M39‐A5. These guidelines were designed to gather data for the selection of the most appropriate agents for initial empiric antimicrobial therapy. The quality of the data extracted in antibiogram reports is highly dependent on the accuracy and completeness of data entry into the lab information system.
Preparation of Broth Microdilution MIC Trays
Authors: Lonsway David R.
Published: January 2025

Broth microdilution MIC trays may be prepared in‐house for performance of quantitative antimicrobial susceptibility studies. The medium preparation would be similar to what is used for conventional MICs, but there are a few differences in the MIC plate preparation. These include using higher drug stock concentrations for the instrument to automatically create the serial doubling dilution concentrations and the addition of a dispersal or wetting agent to the antimicrobial agent stock solution(s) to enhance accurate release of the antimicrobial agent from the HP D300e's disposable dispense head cassette into the 96‐well tray. This system is usually reserved for producing small numbers of MIC trays and experimental checkerboard drug combinations. If large numbers of trays are required, dilutions of the antimicrobial agents are made in large volumes and generally dispensed in 0.1‐ml amounts into microdilution trays by using a commercial dispensing apparatus.
Examination and Evaluation of Primary Cultures
Authors: Zhang Sean X. , Memon Warda
Published: January 2025

Several key characteristics of a fungus may be discerned from primary cultures. For the yeasts, these include the presence of a capsule, budding characteristics, size, morphology, and colony color. If CHROMagar or another chromogenic medium was used in the primary setup, presumptive identification of a yeast may be possible. For molds, helpful features include colony characteristics, sporulation characteristics, the presence of septa, and hyphal or conidial color. CHROMagar contains enzymatic substrates that are linked to chromogenic compounds. Blood cultures or fluid cultures incubated in broth that have fungal elements upon Gram staining should be subcultured onto appropriate mycology media. One of the more controversial issues regarding primary cultures is quantitation. While for yeasts, quantitation is generally reported using criteria similar to those used in bacteriology for deciding clinical significance, the situation is different for molds, because they grow as contiguous cells that may break off into fragments.
Presumptive Identification Tests for Yeasts Isolated on Primary Culture
Authors: Leal Sixto M. , Azar Marwan M.
Published: January 2025

The presumptive tests assume that yeast inocula are from pure cultures or from single colonies. Tests such as the
Candida albicans
screen require multiple colonies to prepare the inoculum. Sabouraud dextrose agar is the best medium to isolate yeasts for germ tube production; sheep blood agar is an acceptable substitute. Some
Candida tropicalis
isolates produce pseudohyphae, and some also produce germ tubes that require careful observation to discriminate them from those of
C. albicans
. Frequently, isolates of
C. albicans
produce colonies described as “yeasts with feet” in recognition of a peripheral fringe. If a single presumptive test is used for preliminary reporting purposes, then the report should indicate that the identification is presumptive; for example, “yeast, presumptive
Cryptococcus neoformans
”. This chapter covers proper quality control principles for analytical tests. With postanalytical considerations, it provides attention to common test limitations, interpretive challenges, and results reporting.
Identification of Molds on Primary Culture
Authors: Azar Marwan M. , Leal Sixto M.
Published: January 2025

Molds may be polymorphic, and therefore any visible structures present must be demonstrated to be produced by a single fungus. Contaminating bacteria and yeasts may interfere with the development of key characteristics of a mold, so a pure culture is optimal for identification. Most medically relevant molds cultured in nutritive media and appropriate conditions in the clinical laboratory will undergo asexual reproduction in culture. Pathogenic molds and contaminants may demonstrate only vegetative/nonreproductive hyphae requiring subculture on nutrient‐poor media to induce sporulation. Matrix‐assisted laser desorption ionization‐time of flight mass spectrometry may also enable mold identification. Filamentous fungi isolated in the laboratory must be accurately identified, and their significance must be assessed, before being reported to the clinician. The rate of growth of a mold may not be reliable on initial culture, but after subculture onto standardized medium, it may be a useful characteristic.
Molecular Identification of Yeasts and Molds
Authors: Cañete‐Gibas Connie F. , Wiederhold Nathan P.
Published: January 2025

Identification of fungi to the species level is becoming increasingly reliant upon molecular methods, such as DNA sequence analysis. Historically, species identification was performed by phenotypic characteristics, including assessment of the colony and microscopic morphologies, biochemical assays, temperature studies, and growth characteristics on different types of medium. Correct identification to the species level can have clinical implications. It may influence interpretations of antifungal susceptibility testing results, which are species specific, as are epidemiologic cutoff values. The nature of the fungal cell walls can prevent efficient lysis, thereby reducing recovery of nucleic acids. The results of DNA sequence analysis for fungal species identification should be in agreement with the phenotypic/morphologic characteristics that are observed.
Detection of Blood Parasites
Authors: Davis Richard E. , Garcia Lynne S.
Published: January 2025

Identification of blood parasites most often utilizes either or both of two types of stained blood films, also known as smears: a thin film and a thick film. With some key differences in practice, the principles of preparing and handling the combination film derive from the thin and thick film procedures. The traditional stain used to detect parasites on blood films is a Giemsa stain, which if used at a pH of 7.0 to 7.2 is optimal for visualizing characteristic parasite features. Delafield's hematoxylin stain particularly improves the visibility of the microfilaria sheath if present. Wright's stain can be used to stain blood films for detecting parasites, but it is generally considered to be inferior to Giemsa. It is important to report the level of parasitemia when blood films are examined and found to be positive for malaria parasites.
Appendixes
Authors: Pritt Bobbi S. , Garcia Lynne S.
Published: January 2025

This chapter provides illustrations and color images that show the differences among different organisms and human cells. However, unlike the ova‐and‐parasite examination, which facilitates the recovery of many different parasites, the fecal immunoassays are limited to one or two organisms only. The selection of any particular immunoassay format will often depend on the workflow options within the laboratory; different laboratories may select different formats for the rapid tests available. The composition of a quality control manual should allow for flexibility; the content should include a description of the laboratory's goals, policies, procedures, roles, responsibilities, and monitoring process for each of the quality system components. OSHA also requires each laboratory to develop a comprehensive, written chemical hygiene plan. OSHA requires monitoring for formaldehyde vapor wherever formaldehyde is used in the workplace.
Selection, Collection, Transport, and Processing of Specimens for Viral Diagnosis
Authors: Graf Erin H.
Published: January 2025

Optimal use of all diagnostic testing for viral infections, but especially recovery of viruses in culture, requires careful consideration of preanalytical factors, including selection, collection, transport, assessment, and processing of patient specimens. Specimen selection relates to more than just the specimen type or source; it also includes the appropriate clinical indications for which virus culture may be warranted. The laboratory must provide written guidelines to collection sites detailing which viruses can and should be tested by the laboratory, including specific information on the limitations of virus culture‐based methods compared to molecular and/or immunologic testing, as well as instructions for submitting specimens. It is important to ensure that the collection facility has access to all required transport media and has processes in place to store the media under required conditions, with appropriate quality assurance mechanisms in place.
Biosafety in the Clinical Virology Laboratory
Authors: Cárdenas Ana María
Published: January 2025

Laboratory biosafety is fundamental to protecting medical and public health laboratory workers and preventing unintentional exposures and acute infectious disease threats. Performing diagnostic testing and research‐related activities in the clinical virology laboratory requires special emphasis in defined areas. These areas include: general safety rules; biohazard signs and warning labels; specimen transportation, receipt, and storage; work area safety; personal protective equipment; laboratory equipment; biosafety related to virus cell cultures; biosafety considerations for virus antigen detection assays; biosafety related to molecular virology work areas; and so on. This procedure enables implementation of sustainable laboratory biosafety practices that are relevant to diagnostic virology laboratory circumstances and priorities. Facilities handling biological agents have an obligation to perform a risk assessment and implement appropriate risk control measures as well as putting into practice personnel competence and training plans to ensure continuous safe laboratory practices.