bluuebunny/crossref_metadata_2025 huggingface dataset:
Public private partnerships for hospitals
Authors: Alonso José M , Clifton Judith , Díaz-Fuentes Daniel
Published: June 2017

Despite the growing prevalence of Public–Private Partnerships in healthcare, scholars have paid little attention to their consequences for the workforce. Public–Private Partnerships may have important consequences in labour-intensive services such as healthcare, since staff reductions and higher working loads may lead to a decrease in service quality and patient safety. In this paper, we analyse the extent to which Public–Private Partnership schemes have influenced employment in Madrid, one of the most enthusiastic adopters of Public–Private Partnership models in Spain. To do so, we compare clinical staff employment levels across three types of hospital management models, including two types of Public–Private Partnerships. Our findings illustrate that clinical staff employment levels seem to be substantially lower in Public–Private Partnership hospitals than in directly managed public hospitals, particularly as regards nursing staff, and in those types of hospitals where the private sector manages both clinical and non-clinical staff.
Breaking the path in national development? The politics of public–private partnerships in Ghana
Authors: Zaato Joshua Jebuntie , Ohemeng Frank Louis Kwaku
Published: June 2017

Public–private partnerships (PPPs), it is argued, generate greater value for money than traditional procurement methods. Governments overwhelmed by budget deficits and public debts see them as a way to overcome the challenges of providing critical public infrastructure. However, many PPP projects are not on cost and on time, igniting criticisms and debate as to their merits. The Ghanaian Government has developed a PPP policy framework with the view of engaging the private sector to build needed infrastructure. Incorporating insights from path dependency, we are interested in finding out if, compared to traditional procurement, the policy represents a new path for national development.
The Double Stigma of Limited Literacy and Mental Illness: Examining Barriers to Recovery and Participation among Public Mental Health Service Users
Authors: Lincoln Alisa K. , Adams Wallis , Eyllon Mara , Garverich Suzanne , Prener Christopher G. , Griffith John , Paasche-Orlow Michael K. , Hopper Kim
Published: June 2017

The disadvantaged social position of public mental health service users reflects synergistic relationships among tangible disadvantage and stigma and its consequences. Limited literacy, an important factor in social disadvantage and an additional source of stigma, is virtually absent from the discussion. Employing a mixed-methods, service user–informed design, we explore the meaning and impact of limited literacy in the lives of public mental health service users in the United States. Of 267 participants, 184 (69 percent) read at or below an eighth-grade level. Next, we demonstrate levels of and explore relationships among both literacy and mental illness concealment stigma and stigma consciousness (for mental illness). Finally, informed by our qualitative data, we describe how people encounter and manage this double burden of stigma with respect to: contexts of concealment, dilemmas of disclosure, and reduction and exclusion. Limited literacy and its associated stigma are important and underexamined barriers to mental health, well-being, recovery, and social inclusion for public mental health service users. Future work should include further examination of the multiple and layered stigmas in the lives of people with serious mental illness.
Anniversaries, Trajectories, and the Challenges for the Communication of Sport
Authors: Wenner Lawrence A.
Published: June 2017

This editorial essay by Communication and Sport Editor-in-Chief Lawrence Wenner is drawn from his March 31, 2017, keynote address honoring the 10th meeting of the Communication and Sport Summit convened by the International Association for Communication and Sport (IACS) in Scottsdale, AZ. The first section focuses on anniversaries, noting recent anniversaries of key works, the “coming of age” of the disciplinary area and the publication changes ahead for Communication and Sport as the journal enters its fifth year. The second section considers questions about disciplinary coherence for the study of communication and sport and points to key role that IACS can play in reconciling three distinct dispositions at play in scholarship: (1) media, sports, and society disposition; (2) sport communication as profession disposition; and (3) communication studies and sport disposition. The third section considers key challenges ahead for the study of communication and sport, calling attention to the need for the field to think globally, to avoid ethnocentrism, to grow and embrace an international scholarly agenda that reaches beyond the confines of the west, and to work to diversify and become an inclusive and interdisciplinary community of scholars.
Efficiency of Family Bargaining Models with Renegotiation: The Role of Transferable Utility across Periods
Authors: Gugl Elisabeth , Welling Linda
Published: June 2017

In dynamic family bargaining models, it is often assumed, for simplicity, that spouses have transferable utility as well as identical and constant marginal rates of intertemporal substitution. It has been argued that as long as spouses are at an interior solution, renegotiation does not hinder efficiency. We show that identical and constant marginal rates of intertemporal substitution (i.e., transferable utility across periods) are the source of this efficiency result. Even at an interior solution, renegotiation can cause inefficiency if marginal rates of intertemporal substitution are not constant. Our model is the first to both identify this source of inefficiency in a bargaining model in which the threatpoints of later periods are determined endogenously and demonstrate that there is no one-size-fits-all policy regulating divorce that can restore efficiency when couples are allowed to differ in their initial wage rates and/or preferences.
Psychiatric Symptoms and Barriers to Care in HIV-Infected Individuals Who Are Lost to Care
Authors: McLean Carmen P. , Gay Natalie G. , Metzger David A. , Foa Edna B. ,   Penn Mental Health AIDS Research Center
Published: June 2017

Past studies of barriers to HIV care have not comprehensively assessed psychiatric symptoms, and few have assessed barriers to care among people living with HIV (PLWH) who are lost to care (LTC). We examined psychiatric symptoms, barriers to HIV care, and immune functioning in PLWH who were retained in care (RIC; n = 21) or LTC (n = 21). Participants completed diagnostic interviews for posttraumatic stress disorder (PTSD) and other psychiatric disorders, self-report measures of HIV risk behaviors and psychiatric symptoms, and a blood draw to assess viral load. Compared to RIC participants, LTC participants met criteria for a greater number of psychiatric disorders and reported greater depressive symptoms and more barriers to HIV care. There were no group differences in PTSD severity, risk behaviors, or viral load, suggesting that LTC individuals experience greater psychiatric problems and perceive more barriers to care than RIC participants, but are not less likely to have achieved viral suppression.
Associations Between Emotional Engagement With School and Behavioral and Psychological Outcomes Across Adolescence
Authors: Markowitz Anna J.
Published: June 2017

Although a small body of research suggests that emotional engagement with school is related to youth behavioral and psychological outcomes, it remains unclear whether these associations represent causal relationships and at what age engagement matters most for student outcomes. Using data from two large, national surveys, this study uses three analytic strategies to reduce threats to causal inference and assess whether the central relationship changes as youth age. Results across both data sets are consistent with a causal relationship between emotional engagement with school and youth behavioral and psychological outcomes that decreases somewhat as youth age. Given the importance of emotional engagement for these outcomes, and the importance of avoiding problem behaviors and maintaining healthy psychological functioning for students’ long-run outcomes, research should continue to explore the ways in which schools and educational policy can influence students’ engagement.
Prevalence and Predictors of Herbal Medicine Use Among Adults in the United States
Authors: Rashrash Mohamed , Schommer Jon C , Brown Lawrence M
Published: June 2017

Objective:

To describe the prevalence of herbal medicine use among US adults and to assess factors associated with and predictors of herbal use.

Design:

The data for herbal products use were collected from the 2015 National Consumer Survey on the Medication Experience and Pharmacists’ Roles. Chi-square test was used to analyz factors associated with herbal use, and predictors of herbal use were assessed with logistic regression analysis.

Results:

Factors associated with herbal supplement use include age older than 70, having a higher than high school education, using prescription medications or over-the-counter (OTC) medications, and using a mail-order pharmacy.” All Disease state associated significantly with herbal use. Approximately thirty-eight percent of those who used herbals used prescription medications and 42% of those who used herbals also used an OTC medication. The most frequent conditions associated with herbal supplement use were a stroke (48.7%), cancer (43.1%), and arthritis (43.0%). Among herbal product users, factors that predicted use included having higher than school education, using OTC medications, using mail-order pharmacy, stroke, obesity, arthritis, and breathing problems.

Conclusions:

More than one-third of respondents reported using herbal supplements. Older age and higher education were associated with a higher use of herbal supplements. People with chronic diseases are more likely to use herbal medicines than others. OTC drug users and patients with stroke are more likely to use herbal medicines than others.
Nurse-Led Phone Call Follow-Up Clinics Are Effective for Patients With Prostate Cancer
Authors: Casey RG , Powell L , Braithwaite M , Booth CM , Sizer B , Corr JG
Published: June 2017

Introduction:

The rising cost of healthcare requires rethinking in terms of resource utilisation care delivery. Nurse-led PSA phone follow-up clinics may provide a suitable option.

Materials and methods:

815 patients were recruited for the nurse-led stable prostate cancer telephone follow-up service. A convenience sample was selected for postal questionnaire assessment of their satisfaction.

Results:

815 patients had 3683 phone-call follow ups over 10 years. Patients’ own understanding of condition varied from average (76.3%) and good (9.2%) in the majority. 87.2% found the service convenient and 75.6% informative. 95.3% found the telephone assessment preferable to attending the outpatient department. 87.2% were keen on savings on transport/travel. 53.5% found it more reassuring. 91.9% of patients felt that everything they wanted to talk about was covered.

Discussion:

This service can be delivered in a high volume nurse-led service, with high levels of patient satisfaction, as an innovative service development.
Good Visual Outcome Following Vitrectomy for Epiretinal Membrane With Foveal Tissue Herniation
Authors: Oellers Patrick , Eliott Dean
Published: June 2017

Epiretinal membrane with foveal herniation is a rare presentation of a common disease. Only 1 case without follow-up has been reported in the literature so far, and there are no reports on visual outcome following membrane peel. We present a patient with epiretinal membrane causing significant macular edema and foveal herniation through a round central hole within the epiretinal membrane. The patient underwent vitrectomy with epiretinal membrane peel and indocyanine green assisted wide internal limiting membrane peel, which resulted in substantial visual acuity gain and restoration of macular anatomy. The presence of severe foveal herniation does not preclude good visual and anatomic outcome.
Obinutuzumab: what is there to learn from clinical trials?
Authors: Cartron Guillaume , Watier Hervé
Published: June 2017

Obinutuzumab (OBZ) is a recombinant type II anti-CD20 and immunoglobulin G1 Fc-optimized monoclonal antibody (mAb), recently approved in chronic lymphocytic leukemia (CLL; B-cell CLL) and follicular lymphoma (FL). Rituximab (RTX) is frequently considered as its “ancestor” and OBZ clinical development was justified by the importance of FcγRIIIA-mediated mechanisms in RTX clinical activity. However, RTX differs from OBZ in 2 critical independent properties: being a type I anti-CD20 mAb and not being Fc-optimized. Moreover, the use of a different dosing regimen for RTX and OBZ further complicates any interpretation of clinical results. The results obtained for OBZ in CLL provide new arguments for FcγRIIIA-mediated mechanisms when the target antigen is expressed at a low density. Results of OBZ in FL confirm the interest for FcγRIIIA-mediated mechanisms, with some limitations, some of them being possibly due to lack of OBZ-induced complement activation. The situation in diffuse large B-cell lymphoma is deceiving, as the possible gains of activity of OBZ appear to be annihilated by the lack of complement activation. Although RTX was by chance an anti-CD20 mAb with equilibrated pharmacodynamic properties, the reinforcement of some of these properties, which has been done at the expense of complement activation, has conferred an advantage in some B-cell disorders while restricting OBZ indications. The OBZ story nicely demonstrates that the future of naked mAbs is to design agents with optimized and tailored properties, and that this must be done step by step, with a full clinical validation.
Effects of hemin and hemodialysis in a patient with acute intermittent porphyria and renal failure
Authors: Attarian Shirin , Yu Chunli , Anderson Karl E. , Friedman Ellen W.
Published: June 2017

Key Points

Hemin and hemodialysis had an additive effect in decreasing ALA and PBG in our patient with acute intermittent porphyria and renal failure. The time course of ALA and PBG reaccumulation after hemodialysis is not known.
On hazard ratio estimators by proportional hazards models in matched-pair cohort studies
Authors: Shinozaki Tomohiro , Mansournia Mohammad Ali , Matsuyama Yutaka
Published: June 2017

Background

In matched-pair cohort studies with censored events, the hazard ratio (HR) may be of main interest. However, it is lesser known in epidemiologic literature that the partial maximum likelihood estimator of a common HR conditional on matched pairs is written in a simple form, namely, the ratio of the numbers of two pair-types. Moreover, because HR is a noncollapsible measure and its constancy across matched pairs is a restrictive assumption, marginal HR as “average” HR may be targeted more than conditional HR in analysis.

Methods

Based on its simple expression, we provided an alternative interpretation of the common HR estimator as the odds of the matched-pair analog of C-statistic for censored time-to-event data. Through simulations assuming proportional hazards within matched pairs, the influence of various censoring patterns on the marginal and common HR estimators of unstratified and stratified proportional hazards models, respectively, was evaluated. The methods were applied to a real propensity-score matched dataset from the Rotterdam tumor bank of primary breast cancer.

Results

We showed that stratified models unbiasedly estimated a common HR under the proportional hazards within matched pairs. However, the marginal HR estimator with robust variance estimator lacks interpretation as an “average” marginal HR even if censoring is unconditionally independent to event, unless no censoring occurs or no exposure effect is present. Furthermore, the exposure-dependent censoring biased the marginal HR estimator away from both conditional HR and an “average” marginal HR irrespective of whether exposure effect is present. From the matched Rotterdam dataset, we estimated HR for relapse-free survival of absence versus presence of chemotherapy; estimates (95% confidence interval) were 1.47 (1.18–1.83) for common HR and 1.33 (1.13–1.57) for marginal HR.

Conclusion

The simple expression of the common HR estimator would be a useful summary of exposure effect, which is less sensitive to censoring patterns than the marginal HR estimator. The common and the marginal HR estimators, both relying on distinct assumptions and interpretations, are complementary alternatives for each other.
RETRACTED ARTICLE: Existence of weak solutions for two point boundary value problems of Schrödingerean predator-prey system and their applications
Authors: Lü Fengjiao , Ülker Tanriver
Published: June 2017

By means of a variational analysis and the theory of variable exponent Sobolev spaces, the existence of weak solutions for two point boundary value problems of Schrödingerean predator-prey system with latent period is investigated either analytically or numerically. More precisely, the local stability of the Schrödingerean equilibrium and endemic equilibrium of the model are discussed in detail. And we specially analyzed the existence and stability of the Schrödingerean Hopf bifurcation by using the center manifold theorem and the bifurcation theory. As applications, theoretic analysis and numerical simulation show that the Schrödingerean predator-prey system with latent period has very rich dynamic characteristics.
Some applications via fixed point results in partially ordered $S_{b}$-metric spaces
Authors: Kishore GNV , Rao KPR , Panthi D , Srinuvasa Rao B , Satyanaraya S
Published: June 2017

In this paper we give some applications to integral equations as well as homotopy theory via fixed point theorems in partially ordered complete $S_{b}$

S
b

-metric spaces by using generalized contractive conditions. We also furnish an example which supports our main result.
Draft genome sequence of Desulfoplanes formicivorans Pf12BT, a sulfate-reducing bacterium of the family Desulfomicrobiaceae
Authors: Watanabe Miho , Kojima Hisaya , Fukui Manabu
Published: June 2017

Desulfoplanes formicivorans strain Pf12BT is the type strain of the type species in the genus Desulfoplanes, which is the one of the genera in the family Desulfomicrobiaceae within the order Desulfovibrionales. This deltaproteobacterium was isolated from a blackish meromictic lake sediment. D. formicivorans strain Pf12BT is a Gram-negative, motile and sulfate-reducing bacterium. Cells of strain Pf12BT are characterized by possession of vibroid morphology and red fluorescent pigment. Here we describe the features, draft genome sequence and annotation of this organism, the sole species of the genus Desulfoplanes. The genome comprised 3,000,979 bp, 2,657 protein-coding genes and 58 RNA genes.
Genomics insights into production of 2-methylisoborneol and a putative cyanobactin by Planktothricoides sp. SR001
Authors: Te Shu Harn , Tan Boon Fei , Boo Chek Yin , Thompson Janelle Renee , Gin Karina Yew-Hoong
Published: June 2017

Planktothricoides is a free-living filamentous cyanobacterium belonging to the order Oscillatoriales and the family Phormidiaceae, capable of forming bloom in fresh and brackish waters. A unicyanobacterial non-axenic culture dominated by Planktothricoides sp. SR001 was obtained from a freshwater reservoir in Singapore. The draft genome presented here is the first tropical freshwater Planktothricoides sp. ever sequenced. The genome of 7.0Mbp contains 5,776 genes predicted using the JGI IMG pipeline. The whole genome sequence allows identification of genes encoding for nitrogen-fixation, accessory photosynthetic pigments and biosynthesis of an off-flavor compound, 2-methylisoborneol, which has been experimentally verified here based on metabolite detection. In addition, strain SR001 genome contains an operon putatively involved in the production of a linear tripeptide cyanobactin related to viridisamide A and aeruginosamide, with the later known to possess anti-microbial or cytotoxic effect.
Natural graft tissues and synthetic biomaterials for periodontal and alveolar bone reconstructive applications: a review
Authors: Sheikh Zeeshan , Hamdan Nader , Ikeda Yuichi , Grynpas Marc , Ganss Bernhard , Glogauer Michael
Published: June 2017

Periodontal disease is categorized by the destruction of periodontal tissues. Over the years, there have been several clinical techniques and material options that been investigated for periodontal defect repair/regeneration. The development of improved biomaterials for periodontal tissue engineering has significantly improved the available treatment options and their clinical results. Bone replacement graft materials, barrier membranes, various growth factors and combination of these have been used. The available bone tissue replacement materials commonly used include autografts, allografts, xenografts and alloplasts. These graft materials mostly function as osteogenic, osteoinductive and/or osteoconductive scaffolds. Polymers (natural and synthetic) are more widely used as a barrier material in guided tissue regeneration (GTR) and guided bone regeneration (GBR) applications. They work on the principle of epithelial cell exclusion to allow periodontal ligament and alveolar bone cells to repopulate the defect before the normally faster epithelial cells. However, in an attempt to overcome complications related to the epithelial down-growth and/or collapse of the non-rigid barrier membrane and to maintain space, clinicians commonly use a combination of membranes with hard tissue grafts. This article aims to review various available natural tissues and biomaterial based bone replacement graft and membrane options used in periodontal regeneration applications.
Is Harmonic Averaging of Shear Wave Velocity or the Simplified Rayleigh Method Appropriate to Estimate the Period of a Soil Profile?
Authors: Urzúa Alfredo , Dobry Ricardo , Christian John T.
Published: June 2017

For soil sites with well-defined soil-rock interfaces and high impedance contrast, the maximum amplification of earthquake ground motion tends to occur at the fundamental period in shear of the soil profile, T. Analytical results are presented for the calculation of T for several idealized soil profiles as well as more realistic layered profiles using three simplified procedures. The first is the use of harmonic averaging of V S to estimate the value of the equivalent shear wave velocity of the profile, V eq, needed to calculate the correct value of T. Harmonic averaging tends to overestimate T for profiles where V S increases with depth, and to underestimate T in profiles where V S decreases with depth. The second is the Simplified Rayleigh Method proposed by the authors, which is easily implemented in a spreadsheet and gives values of T and effective shear wave velocity that are accurate within a few percent. The third method is the Simplified Gómez Method, which accounts for differences in density and has been incorporated into the Mexico City Code; it generally gives results superior to harmonic averaging but underestimates T for some profiles where V S increases with depth.
“It Was Their Business to Know”: British Merchants and Mercantile Epistemology in the Eighteenth Century
Authors: Deringer William
Published: June 2017

This article explores the history of commercial epistemology during the first half of the eighteenth century in Britain. During that period, questions about the character of commerce as a field of knowledge—whether it was a simple or complex, how it related to commercial “interest,” and especially who possessed it—lay at the heart of political-economic debate. This article looks specifically at one set of attitudes about commercial epistemology, what I call mercantile epistemology, which came to dominate economic thinking from 1714 to roughly 1750. Mercantile epistemology was based on two pillars. The first was that commerce was a straight-forward, “common sense” field of knowledge; the second was that, though commerce was not an abstruse field, it was businesspeople who understood it best. At the heart of this mercantile epistemology was the sense that the nation had one coherent business community who shared common goals and agreed upon a set of commercial “maxims.” This mercantile epistemology first attained its position of authority in British economic thinking following the heated debate over the Anglo-French Commerce Treaty in 1713–14. This mercantile epistemology maintained a strong hold on British economic thinking until roughly 1750, when its keys pillars began to be challenged from various directions. Focusing on epistemology offers a powerful way to rethink the history of what Adam Smith dubbed the “Mercantile System.”
Capitalist Threads: Engels the Businessman and Marx's Capital
Authors: Mata Tiago , Van Horn Robert
Published: June 2017

This essay illuminates a neglected aspect of Friedrich Engels's life: his work at his family's textile firm, Ermen & Engels, in Manchester, the hub of the cotton industry in the mid-nineteenth century. We argue that Engels was a merchant and an intelligencer with a detailed, comprehensive understanding of products and the movements of goods, orders, and prices in the global cotton trade. The statistical insights Engels gleaned on matters such as machinery depreciation and reinvestment, his contextualization of capitalism within a unified world market, and his recognition of the tendencies toward overproduction that threatened economic crisis, all contributed to shaping key ideas and themes of Karl Marx's Capital Volumes I and II, leaving a lasting imprint on Marxist political economy.
Sometimes Sex Is Just a Pain in the Ass; Or, the Paradox of Sexual Politics
Authors: Cohen Ed
Published: June 2017

In the wake of the US Supreme Court decision in Obergefell et al. v. Hodges, US citizens can now claim a right to marriage without regard to their genital anatomy. No doubt this genital indiscrimination has much to recommend it. Yet we might wonder why this achievement represents the culmination of almost fifty years of sexual politics. To answer this question, the essay returns Guy Hocquenghem’s seminal 1972 text Homosexual Desire to consider the latent friction between sexual and politics that Hocquenghem identifies and that continues to characterize our contemporary moment. It then situates Hocquenghem’s text in relation to Michel Foucault’s reflections about origins of politics in ancient Greek in his first lecture course at the Collège de France, which took place the year before Hocquenghem’s book appeared, to suggest that the relation between the sexual and the political may inevitably entail paradox.
Immunosurveillance by human γδ T lymphocytes: the emerging role of butyrophilins
Authors: Kabelitz Dieter , Lettau Marcus , Janssen Ottmar
Published: June 2017

In contrast to conventional T lymphocytes, which carry an αβ T-cell receptor and recognize antigens as peptides presented by major histocompatibility complex class I or class II molecules, human γδ T cells recognize different metabolites such as non-peptidic pyrophosphate molecules that are secreted by microbes or overproduced by tumor cells. Hence, γδ T cells play a role in immunosurveillance of infection and cellular transformation. Until recently, it has been unknown how the γδ T-cell receptor senses such pyrophosphates in the absence of known antigen-presenting molecules. Recent studies from several groups have identified a unique role of butyrophilin (BTN) protein family members in this process, notably of BTN3A1. BTNs are a large family of transmembrane proteins with diverse functions in lipid secretion and innate and adaptive immunity. Here we discuss current models of how BTN molecules regulate γδ T-cell activation. We also address the implications of these recent findings on the design of novel immunotherapeutic strategies based on the activation of γδ T cells.
Inhibition of IRE1α-mediated XBP1 mRNA cleavage by XBP1 reveals a novel regulatory process during the unfolded protein response
Authors: Chalmers Fiona , Sweeney Bernadette , Cain Katharine , Bulleid Neil J.
Published: June 2017

Background: The mammalian endoplasmic reticulum (ER) continuously adapts to the cellular secretory load by the activation of an unfolded protein response (UPR).  This stress response results in expansion of the ER, upregulation of proteins involved in protein folding and degradation, and attenuation of protein synthesis.  The response is orchestrated by three signalling pathways each activated by a specific signal transducer, either inositol requiring enzyme α (IRE1α), double-stranded RNA-activated protein kinase-like ER kinase (PERK) or activating transcription factor 6 (ATF6).  Activation of IRE1α results in its oligomerisation, autophosphorylation and stimulation of its ribonuclease activity.  The ribonuclease initiates the splicing of an intron from mRNA encoding the transcription factor, X-box binding protein 1 (XBP1), as well as degradation of specific mRNAs and microRNAs. Methods: To investigate the consequence of expression of exogenous XBP1, we generated a stable cell-line expressing spliced XBP1 mRNA under the control of an inducible promotor.  Results: Following induction of expression, high levels of XBP1 protein were detected, which allowed upregulation of target genes in the absence of induction of the UPR.  Remarkably under stress conditions, the expression of exogenous XBP1 repressed splicing of endogenous XBP1 mRNA without repressing the activation of PERK.  Conclusions: These results illustrate that a feedback mechanism exists to attenuate activation of the Ire1α ribonuclease activity in the presence of XBP1.
Quality of Care of Hospitalized Infective Endocarditis Patients: Report from a Tertiary Medical Center
Authors: Kashef Mohammad Amin , Friderici Jennifer , Hernandez‐Montfort Jaime , Atreya Auras R. , Lindenauer Peter , Lagu Tara
Published: June 2017

OBJECTIVE

There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE).

PATIENTS AND METHODS

We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations. Outcomes included embolic events, inhospital and 1‐year mortality, length of stay (LOS) and cardiac surgery. We used descriptive statistics to describe the cohort and Fisher exact and unpaired t tests to compare native valve endocarditis (NVE) with prosthetic valve endocarditis (PVE).

RESULTS

Of 170 patients, definite IE was present in 135 (79.4%) and possible IE in 35 (20.6%); 74.7% had NVE, and 25.3% had PVE. Mean ± standard deviation age was 60.0 ± 17.9 years. Comparing PVE to NVE, patients with PVE were less likely to have embolic events (14.0% vs. 32.3%; P = 0.03), had shorter LOS (median 12.0 days vs. 14.0 days; P = 0.047), but they did not show a statistically significant difference in inhospital mortality (20.9% vs. 12.6%; P = 0.21). Of 170, patients 27.6% (n = 47) underwent valve surgery. Most patients received timely blood cultures and antibiotics. Guideline‐recommended consults were underused, with 86.5%, 54.1%, and 47.1% of patients receiving infectious disease, cardiac surgery, and cardiology consultation, respectively. As the number of consultations increased (from 0 to 3), we observed a nonsignificant trend toward reduction in 6‐month readmission and 12‐month mortality.

CONCLUSION

IE remains a disease with significant morbidity and mortality. There are gaps in the care of IE patients, most notably underuse of specialty consultation.
Rates, Predictors and Variability of Interhospital Transfers: A National Evaluation
Authors: Mueller Stephanie K. , Zheng Jie , Orav E. John , Schnipper Jeffrey L.
Published: June 2017

IMPORTANCE

Interhospital transfer (IHT) remains a largely unstudied process of care.

OBJECTIVE

To determine the nationwide frequency of, patient and hospital‐level predictors of, and hospital variability in IHT.

DESIGN

Cross‐sectional study.

SETTING

Centers for Medicare and Medicaid 2013 100% Master Beneficiary Summary and Inpatient claims files merged with 2013 American Hospital Association data.

PATIENTS

Beneficiaries ≥65 years and older enrolled in Medicare A and B, with an acute care hospitalization claim in 2013.

EXPOSURES

Patient and hospital characteristics of transferred and nontransferred patients.

MEASUREMENTS

Frequency of interhospital transfers (IHT); adjusted odds of transfer of each patient and each hospital characteristic; and variability in hospital transfer rates.

RESULTS

Of 6.6 million eligible beneficiaries with an acute care hospitalization, 101,507 (1.5%) underwent IHT. Selected characteristics associated with greater adjusted odds of transfer included: patient age 74‐85 years (odds ratio [OR], 2.38 compared with 65‐74 years; 95% confidence intervals [CI], 2.33‐2.43); nonblack race (OR, 1.17; 95% CI, 1.13‐1.20); higher comorbidity (OR, 1.37; 95% CI, 1.36‐1.37); lower diagnosis‐related group–weight (OR, 2.02; 95% CI, 1.95‐2.09); fewer recent hospitalizations (OR, 1.87; 95% CI, 1.79‐1.95); and hospitalization in the Northeast (OR, 1.40; 95% CI, 1.27‐1.55). Higher case mix index of the hospital was associated with a lower adjusted odds of transfer (OR, 0.36; 95% CI, 0.30‐0.45). Variability in hospital transfer rates remained significant after adjustment for patient and hospital characteristics (variance 0.28, P = 0.01).

CONCLUSIONS

In this nationally representative evaluation, we found that a sizable number of patients undergo IHT. We identified both expected and unexpected patient and hospital‐level predictors of IHT, as well as unexplained variability in hospital transfer rates, suggesting lack of standardization of this complex care transition. Our study highlights further investigative avenues to help guide best practices in IHT.
Postdischarge Clinics and Hospitalists: A Review of the Evidence and Existing Models
Authors: Doctoroff Lauren
Published: June 2017

Over the past 10 years, postdischarge clinics have been introduced in response to various health system pressures, including the focus on rehospitalizations and the challenges of primary care access. Often ignored in the discussion are questions of the effect of postdischarge physician visits on readmissions. In addition, little attention has been given to other clinical outcomes, such as reducing preventable harm and mortality. A review of dedicated, hospitalist‐led postdischarge clinics, of the data supporting postdischarge physician visits, and of the role of hospitalists in these clinics may be instructive for hospitalists and health systems considering the postdischarge clinic environment.
The Shifting Landscape in Utilization of Inpatient, Observation, and Emergency Department Services Across Payers
Authors: Nuckols Teryl K. , Fingar Kathryn R. , Barrett Marguerite , Steiner Claudia A. , Stocks Carol , Owens Pamela L.
Published: June 2017

Recent policies by public and private payers have increased incentives to reduce hospital admissions. Using data from four states from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, this study compared the payer‐specific population‐based rates of adults using inpatient, observation, and emergency department (ED) services for 10 common medical conditions in 2009 and in 2013. Patients had an expected primary payer of private insurance, Medicare, Medicaid, or no insurance. Across all four payer populations, inpatient admissions declined, and care shifted toward treat‐and‐release observation stays and ED visits. The percentage of hospitalizations that began with an observation stay increased. Implications for quality of care and costs to patients warrant further examination.
Telemetry Monitor Watchers Reduce Bedside Nurses' Exposure to Alarms by Intercepting a High Number of Nonactionable Alarms
Authors: Palchaudhuri Sonali , Chen Stephanie , Clayton Elaine , Accurso Anthony , Zakaria Sammy
Published: June 2017

Cardiac telemetry, designed to monitor hospitalized patients with active cardiac conditions, is highly utilized outside the intensive care unit but is also resource‐intensive and produces many nonactionable alarms. In a hospital setting in which dedicated monitor watchers are set up to be the first responders to system‐generated alerts, we conducted a retrospective study of the alerts produced over a continuous 2‐month period to evaluate how many were intercepted before nurse notification for being nonactionable, and how many resulted in code team activations. Over the 2‐month period, the system generated 20,775 alerts (5.1/patient‐day, on average), of which 87% were intercepted by monitor watchers. None of the alerts for asystole, ventricular fibrillation, or ventricular tachycardia resulted in a code team activation. Our results highlight the high burden of alerts, the large majority of which are nonactionable, as well as the role of monitor watchers in decreasing the alarm burden on nurses. Measures are needed to decrease telemetry‐related alerts in order to reduce alarm‐related harms, such as alarm fatigue.
Perceptions of Hospital‐Dependent Patients on Their Needs for Hospitalization
Authors: Liu Tao , Kiwak Eliza , Tinetti Mary E.
Published: June 2017

In the United States, older adults account for a significant proportion of hospitalizations, and a subset become hospital‐dependent, for reasons that are unclear. We conducted a qualitative study to explore these individuals' perspectives on their need for hospitalizations. Twenty patients hospitalized at an academic medical center underwent semistructured qualitative interviews. Criteria for selection included age 65 and older, at least three hospitalizations over six months, admission to the medical service at the time of the study, did not meet criteria for chronic critical illness, was not comfort measures only, and did not have a conservator. Interviews were audiotaped, transcribed, and inductively analyzed. The major themes derived were the necessity and inevitability of hospitalizations (“You have to bring me in here”), feeling safe in the hospital (“It makes me feel more secure”), patients hospitalized despite having outside medical and social support (“I have everything”), and inadequate goals‐of‐care discussions (“It just doesn't occur to me”). Results suggested that candid discussions about health trajectories are needed to ensure hospitalization is consistent with the patient's realistic health priorities.
Incidental Pulmonary Nodules Reported on CT Abdominal Imaging: Frequency and Factors Affecting Inclusion in the Hospital Discharge Summary
Authors: Bates Ruth , Plooster Corbin , Croghan Ivana , Schroeder Darrell , McCoy Christopher
Published: June 2017

Incidental imaging findings require an assessment of risk and clinical relevance, as well as consideration of further evaluation. Incidental findings are common on imaging obtained in the hospital, with pulmonary nodules being among the most frequent findings that may require additional evaluation. We conducted a retrospective study to determine the factors associated with documentation of incidental findings in the hospital discharge summary, using pulmonary nodules reported on abdominal computed tomography (CT) as an example of incidental findings with well‐defined follow‐up guidelines. Between January 1, 2012 and December 31, 2014, 7173 patients underwent in‐patient abdominal CT without concurrent chest CT; of these patients, 62.2% were ≥60 years old, 50.6% were men, and 45.5% were current or former smokers. Incidental pulmonary nodules were reported in 402 patients (5.6%; 95% confidence interval [CI], 5.1%‐6.2%). Based on nodule size, reported size stability, and patients' smoking status, 208 patients (2.9%; 95% CI, 2.5%‐3.3%) required follow‐up surveillance, per the 2005 Fleischner Society guidelines. Of these 208 patients, 48 (23%) received discharge summaries that included documentation of the incidental findings, with 34 summaries including a recommendation for nodule follow‐up and 19 summaries including a time frame for repeat CT. Three factors were positively associated with the inclusion of the pulmonary nodule in the discharge summary: mention of the pulmonary nodule in the summary headings of the radiology report (P ≤ 0.001), radiologist recommendations for further surveillance (P ≤ 0.001), and medical discharging service (P = 0.016). These findings highlight the need for a multidisciplinary systems‐based approach to incidental pulmonary nodule documentation and surveillance.
Roles de género y salud en mujeres desplazadas por la violencia en Medellín, 2013-2014
Authors: Posada Zapata Isabel Cristina , Mendoza Ríos Abraham , Orozco Giraldo Isabel Cristina , Restrepo Correa Carolina , Cano Bedoya Sara María
Published: June 2017

El fenómeno del desplazamiento afecta a toda la población colombiana, especialmente a aquella que tiene mayor vulnerabilidad, como las mujeres, que ven afectada su salud por el cambio de roles que deben asumir. Objetivo: analizar cómo los roles que desempeñan las mujeres en situación de desplazamiento influyen en sus condiciones de vulnerabilidad psicológica y social. Materiales y métodos: se realizó una investigación cualitativa utilizando la teoría fundada; se tuvieron en cuenta fuentes primarias, constituidas por los discursos recogidos en entrevistas aplicadas personalmente a mujeres que hubieran sido desplazadas, residentes en tres asentamientos de la ciudad de Medellín y cuyas características se definieron por la diversidad cultural, étnica e idiosincrásica, y fuentes secundarias, compuestas por la revisión de documentos oficiales, literatura, otras investigaciones y demás material que tratara acerca de este tema. Se realizaron quince entrevistas semiestructuradas, se organizaron seis grupos focales y se realizaron seis entrevistas a profundidad. Para el análisis se utilizó la codificación, categorización e interpretación. Resultados: las mujeres desplazadas se ven sometidas a cambios significativos en sus roles luego de la llegada a la ciudad, los cuales agudizan sus condiciones de vulnerabilidad e influyen en su percepción de salud. La relación entre los múltiples roles y su efecto sobre las condiciones de vulnerabilidad no puede estudiarse analizando cada rol independientemente y sin considerar diferentes dimensiones de funcionamiento y adaptación de la mujer. Conclusión: la experiencia del desplazamiento afecta los roles asumidos por las mujeres, y estos a su vez las condiciones de vulnerabilidad y su percepción de salud.
Provisión pública y oferta privada de medicamentos contra las enfermedades venéreas. Argentina 1930-1945
Authors: Biernat Carolina , Simonetto Patricio
Published: June 2017

Objetivos: contribuir a la investigación sobre la vinculación entre la política sanitaria de profilaxis venérea y el proceso de producción, importación y circulación de medicamentos para el tratamiento de los “males secretos” durante el siglo xx en Argentina. Desarrollo: desde 1936 el Estado desplegó una política de profilaxis venérea que otorgó prerrogativas a los grupos privados para la producción e importación de fármacos. Mientras el Departamento Nacional de Higiene promovió un tratamiento estandarizado de las dolencias, los laboratorios privados usaron publicidades para construir, ampliar y segmentar el mercado consumidor. En este artículo destacamos cómo el mensaje de las propagandas de medicamentos contra las dolencias de transmisión sexual en las revistas médicas tenía como fin transformar a los galenos en agentes de recomendación de dichos productos. Conclusiones: el tratamiento estandarizado impuesto por la burocracia sanitaria estimuló la producción, importación y oferta de fármacos de laboratorios nacionales y extranjeros. Los anuncios publicitarios apelaron al galeno como portador de un criterio legítimo para el consumo de medicamentos. Los laboratorios  nanciaron revistas de grupos de galenos con el fin de ampliar el consumo de sus productos entre los pacientes de estos.
Managing Posterior Price Matching: The Role of Customer Boundedly Rational Expectations
Authors: Huang Tingliang , Yin Zhe , Chen Ying-Ju
Published: June 2017

The posterior price-matching policy, whereby a firm promises to reimburse the price difference to a customer who purchases a product before the firm marks it down, has been used in practice. The extensive literature has offered the following explanations for why posterior price matching is adopted: to reduce inventory, to soften competition, to price discriminate consumers, and to eliminate consumer strategic waiting incentives. In this paper, we provide a novel explanation and investigate the role of consumer bounded rationality in the sense of anecdotal reasoning. We adopt a simple model that allows us to isolate the role of customer bounded rationality on using posterior price matching. We demonstrate that while it is never optimal to adopt posterior price matching when consumers have rational expectations, it can be optimal when they have boundedly rational expectations. We show when and how a seller can intentionally mark down with some probability and adopt price matching to make a profit. Ignoring customer bounded rationality can result in a significant profit loss. Then, we build a dynamic programming model to investigate how the firm should dynamically manage its markdowns over the long run. We show that a cyclic policy switching between a high and low markdown probability is typically optimal for exploiting customer bounded rationality. We characterize the nature of the cyclic policy and the range in which it is optimal. Our findings underscore the importance of consumer bounded rationality and provide managerial and practical guidelines on how to manage price matching when customers are boundedly rational.

The online supplement is available at https://doi.org/10.1287/msom.2016.0612 .
Prospects of Wood-Based Energy Alternatives in Revitalizing the Economy Impacted by Decline in the Pulp and Paper Industry
Authors: Poudyal Neelam C. , Joshi Omkar , Taylor Adam M. , Hodges Donald G.
Published: June 2017

Recently, the US forest product industry has seen remarkable shifts in market demand for traditional forest products. The displacement of paper demand by new electronic media and communication technology has led to the closure of several pulp and paper–based manufacturing facilities across the nation. The closure of such facilities can have devastating impacts on forest communities in the mills' fiber shed area, particularly forest landowners, loggers, truckers, and others involved in the supply chain. Sustaining forest-dependent communities need viable economic alternatives. Development agencies at the local and regional levels need to fully understand the feasibility of new forest-based alternatives. With a case of 24 counties that made up the hardwood fiber shed for a recently closed pulp mill, this study analyzed the feasibility of three alternatives in revitalizing the affected economy through utilizing the surplus fiber and creating new opportunities for the displaced workforce. Although investment in each business alternative is likely to yield positive return on investment for the region, expected impacts on jobs and industrial output varied considerably. Compared with wood pellet and bioelectricity, the bio-oil industry is likely to generate jobs that will not only offset the current job deficit but also create additional opportunities. Results from a multiregional input–output analysis revealed spillover economic opportunities beyond the impacted areas. Findings will be useful in guiding sustainable business and investment decisions as well as understanding the anticipated community benefits of energy-based industries in revitalizing economies affected by the declining market demand for traditional forest products.