bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the Value of Care for Veterans: Impacts of VA Payment Reform for Community‐Based Dialysis
Authors: Wang V. , Swaminathan S. , Corneau E. , Maciejewski M. , Trivedi A. , O'Hare A. , Mor V. 
Published: August 2020

End‐stage kidney disease (ESKD) is common among Veterans. VA’s limited capacity to deliver dialysis treatment means that VA relies heavily on community providers, making chronic dialysis the single largest VA expenditure for outpatient community care. In the past, VA paid for non‐VA dialysis on a local, ad hoc basis, with some payments greatly exceeding Medicare’s reimbursement rates. In 2009‐2011, the VA began implementing payment policies to standardize the process of pricing non‐VA dialysis care, beginning with the use of the Medicare fee schedule and national dialysis contracts with non‐VA dialysis facilities. This study examined the effect of VA’s standardized pricing policies on VA costs, access to non‐VA dialysis care, and patient outcomes.We used an interrupted time series design and 2006‐2016 data from VA, Medicare, and the US Renal Data System to identify Veterans receiving VA‐financed dialysis in the community from non‐VA providers. Changes over time in prices for non‐VA dialysis treatments and associated ancillary services were ascertained from >7 million VA‐paid community dialysis claims. We performed multivariable regression analyses using differential trend/intercept shift models to examine the effects of VA national contract pricing on (a) VA treatment prices for non‐VA dialysis, (b) access to non‐VA dialysis care defined as the number of non‐VA dialysis providers, and non‐VA dialysis providers’ publicly reported quality hospitalization and mortality rates, patient distance to non‐VA dialysis care, and (c) Veterans’ one‐year mortality, controlling for patient and facility fixed effects.National cohort of 24,130 VA‐enrolled Veterans who received ≥1 community‐based chronic dialysis treatment financed by VA in 2006‐2016.Before implementation of national contracts, treatment prices for non‐VA dialysis care varied widely across VA facilities from as little as $61 to as much as $1,575 per treatment. After implementation of national contracts, there was significantly reduced variation in the cost of treatment across individuals ($73.40 to $663.37) and the average price per dialysis session dropped by 40% (P < .001). Over the same time period, the average number of non‐VA dialysis facilities providing VA‐paid dialysis care increased from 19 to 37 and there were no changes in community dialysis facility quality (P ≥ .44) or 1‐year mortality (12% vs. 11%, P = .98).VA’s policy to standardize national dialysis contracts resulted in a substantial increase in the value of VA‐financed community dialysis care by reducing spending with no adverse effect on Veterans’ access to care nor on mortality.Our findings suggest it is possible to simultaneously lower costs while improving VA partnerships with community providers. National price setting may be a feasible approach for VA to improve the value of other community care services.Department of Veterans Affairs.
Progress of California's Effort to Improve Outcomes of Care for Homeless Medicaid Patients Under a Section 1115 Medicaid Waiver Program
Authors: Pourat N. , Yue D. , Chen X. , O'Masta B. , Huynh M. , Chau B. 
Published: August 2020

Research ObjectiveThe current Section 1115 Medicaid Waiver in California includes the Whole Person Care (WPC) pilot program, designed to improve care coordination for high‐cost, high‐utilizing populations, with special emphasis on the homeless. Pilots link homeless and other patients to housing, food, benefits, and similar services with the goals of improving health outcomes. We examined the impact of WPC in the first two years of the program on health care utilization of homeless enrollees.Study DesignWe conducted difference‐in‐difference (DD) analyses using a generalized mixed‐effect model to compare the 2‐year change in the pre‐ and postperiod among key outcome measures using an intervention‐control methodology. We developed a model for identifying homeless Medicaid patients in a control sample that matched the characteristics of WPC enrollees. We examined the (1) likelihood of hospitalization, (2) likelihood of emergency department (ED) visits, (3) number of ED visits, outpatient follow‐up after hospitalization for mental illness in (4) 7 days and (5) 30 days, and (6) initiation and (7) engagement of alcohol and other drug dependence treatment.Population StudiedThe DD model included 133 998 person‐years among the WPC homeless enrollees and 201 523 person‐years among the control group.Principal FindingsThe analyses (table below) showed that the predicted probability of hospitalization and ED visits and predicted number of ED visits declined for WPC homeless enrollees from before to after WPC enrollment, with a greater reduction for WPC enrollees than the control group in the same time period. Changes in other outcomes were not significant.ConclusionsEarly analyses indicated reductions in ED visits and hospitalizations among homeless WPC enrollees compared to the control group but not the other outcomes examined. Improvements in outcomes were likely due to pilot's effort to assess homeless patients' needs and linkages to housing and other needed social services.Implications for Policy or PracticeReductions in ED visits and hospitalizations are likely indicators of better outcomes and have significant implications for cost reduction under the Medicaid program. Our findings provide the needed evidence that provision of housing support and other social services may improve health outcomes among homelessness patients who frequently have higher level of need for care.Primary Funding SourceCalifornia Department of Health Care Services.
Trainee surgeons and patient outcomes in carotid endarterectomy: a retrospective cohort study
Authors: Johnson Nicholas W. , Smoll Nicholas R. , Tan Christianne , Brooks Christopher E. 
Published: August 2020

AbstractBackgroundIn Australia and New Zealand, more than 2000 carotid endarterectomies are performed annually. The major morbidities arising from this procedure are post‐operative stroke, cranial nerve injury and death. Carotid endarterectomy surgery is a key component of the vascular surgical training programme. We assessed the impact of having a surgical trainee perform a major component of this procedure on the post‐operative rates of stroke, cranial nerve injury and mortality.MethodsWe performed a retrospective cohort study of vascular surgical patients undergoing carotid endarterectomy, with data obtained from the Australasian Vascular Audit database between January 2010 and December 2014. The dataset comprised of 6528 carotid endarterectomies performed during this time. The collected data were stratified into two categories – consultant‐led cases, and those in which trainee surgeons performed at least a major component of the surgery under consultant supervision. The results were analysed for differences in post‐operative stroke, cranial nerve injury and inpatient mortality. Differences between groups were assessed using multivariate analysis, adjusting for potentially confounding covariables.ResultsOn multivariate analysis, there was no statistically significant difference in the rates of post‐operative stroke (odds ratio (OR) 0.88, 95% confidence interval (CI) 0.57–1.36, P = 0.55), cranial nerve injury (OR 0.68, 95% CI 0.39–1.21, P = 0.19) or inpatient mortality (OR 0.78, 95% CI 0.29–2.13, P = 0.63) between the two cohorts.ConclusionHaving surgical trainees perform components of carotid endarterectomies under supervision is not associated with an increased rate of post‐operative stroke, cranial nerve injury or mortality.
Central venous catheters are an important factor in paediatric thrombosis
Authors: Biswas Mouri , Ryan Paul M. , Nakrani Rima , Bhatt Mihir , Chan Anthony K. C. , Mondal Tapas 
Published: August 2020

AbstractAimTo establish the incidence and characteristics of paediatric thrombosis (PT) in a Canadian tertiary care centre during the era of low molecular weight heparin (LMWH).MethodsA retrospective observational case study of all patients <18 years of age evaluated for arterial and venous thrombosis from May 2008 to July 2018 at McMaster Children’s Hospital was conducted through the electronic medical record.ResultsThe incidence of PT was 52.2 per 10 000 hospital admissions (n = 477/91 462). Provoked thrombosis was more prevalent (88.9%, n = 424/477) than unprovoked (2.9%, n = 14/477) or idiopathic thrombosis (4%, n = 19/477). Half of PT were in children <2 years (51.2%, n = 244/477). Central vascular catheterisation was a contributory factor in more than half of thrombotic events (56.2%, n = 268/477), while trauma (1.1%, n = 5/477), oral contraceptives (4%, n = 19/477), infection (4%, n = 19/477), surgery (6.9%, n = 33/477) and malignancy (8.4%, n = 40/477) were also risk factors. Arterial ischaemic stroke was diagnosed in 11.1% of cases (n = 53/477), while pulmonary embolism was identified in 7.1% (n = 34/477) and 1.7% of cases were fatal (n = 8/477). LMWH was the first‐line therapeutic of choice (47.8%, n = 228/477), with 28.1% (n = 134/477) requiring no intervention.ConclusionThese data reiterate the elevated thrombosis risk to which infants and children with central vascular access are exposed.
PSMB8 inhibition decreases tumor angiogenesis in glioblastoma through vascular endothelial growth factor A reduction
Authors: Chang Hsin‐Han , Cheng Yu‐Chen , Tsai Wen‐Chiuan , Chen Ying 
Published: August 2020

AbstractGlioblastoma, also known as glioblastoma multiforme (GBM), is a fast‐growing tumor and the most aggressive brain malignancy. Proteasome subunit beta type‐8 (PSMB8) is one of the 17 essential subunits for the complete assembly of the 20S proteasome complex. The aim of the present study was to evaluate the role of PSMB8 expression in GBM progression and angiogenesis. PSMB8 expression in glioblastoma LN229 and U87MG was knocked down by siRNA or inducible shRNA both in vitro and in vivo. After PSMB8 reduction, cell survival, migration, invasion, angiogenesis, and the related signaling cascades were evaluated. An orthotopic mouse tumor model was also provided to examine the angiogenesis within tumors. A GEO profile analysis indicated that high expression of PSMB8 mRNA in GBM patients was correlated with a low survival rate. In immunohistochemistry analysis, PSMB8 expression was higher in high‐grade than in low‐grade brain tumors. The proliferation, migration, and angiogenesis of human GBM cells were decreased by PSMB8 knockdown in vitro. Furthermore, phosphorylated focal adhesion kinase (p‐FAK), p‐paxillin, MMP2, MMP9, and cathepsin B were significantly reduced in LN229 cells. Integrin β1 and β3 were reduced in HUVEC after incubation with LN229‐conditioned medium. In an orthotopic mouse tumor model, inducible knockdown of PSMB8 reduced the expression of vascular endothelial growth factor (VEGF), VEGF receptor, and CD31 as well as the progression of human glioblastoma. In this article, we demonstrated the role of PSMB8 in glioblastoma progression, especially neovascularization in vitro and in vivo. These results may provide a target for the anti–angiogenic effect of PSMB8 in glioblastoma therapy in the future.
Patterns of niche contraction identify vital refuge areas for declining mammals
Authors: von Takach Brenton , Scheele Ben C. , Moore Harry , Murphy Brett P. , Banks Sam C. 
Published: August 2020

AbstractAimInvestigation of realized niche contraction in declining species can help us understand how and where threats are being either mediated or tolerated across landscapes. It also provides insights into species' sensitivity to environmental change that are unable to be identified through analysis of declines in range size or abundance alone. Here, we apply the recently proposed "niche reduction hypothesis" to investigate relationships between trends in niche breadth and geographic distribution of declining species.LocationNorthern Australia.MethodsWe compare and contrast contemporary and historical data sets to examine the relationship between extent of occurrence (EOO) and realized niche hypervolume, and investigate changes in species' utilization of environmental space through time via generalized linear modelling and bootstrapping of historical values. We also use the "Maxent" algorithm to create and stack contemporary and historical ecological niche models (ENMs) and identify regions where resilience to threatening processes is maximized.ResultsWe found larger mean reductions in niche hypervolume (39%) than EOO (30.5%), with little correlation (r = 0.07) between the two measures, suggesting that contraction of realized niche breadth can be largely independent of reduction in EOO. We also identified a general set of environmental conditions towards which species' realized niches contracted. Comparison of stacked ENMs allowed us to identify regions of natural refuge where environmental conditions are associated with increased species resilience to threats, and conversely, regions where habitat suitability has declined.Main conclusionsExamining species declines from an ecological niche perspective provides a powerful tool for understanding how environmental conditions, biotic interactions and species traits shape responses to local and global environmental changes. Quantifying reductions in niche breadth is crucial as contraction to a narrower subset of environmental space can reduce a species' ability to tolerate other threats and potentially lower adaptive capacity and genetic diversity, increasing extinction risk.
Carbon benefits from Forest Transitions promoting biomass expansions and thickening
Authors: Kauppi Pekka E. , Ciais Philippe , Högberg Peter , Nordin Annika , Lappi Juha , Lundmark Tomas , Wernick Iddo K. 
Published: August 2020

AbstractThe growth of the global terrestrial sink of carbon dioxide has puzzled scientists for decades. We propose that the role of land management practices—from intensive forestry to allowing passive afforestation of abandoned lands—have played a major role in the growth of the terrestrial carbon sink in the decades since the mid twentieth century. The Forest Transition, a historic transition from shrinking to expanding forests, and from sparser to denser forests, has seen an increase of biomass and carbon across large regions of the globe. We propose that the contribution of Forest Transitions to the terrestrial carbon sink has been underestimated. Because forest growth is slow and incremental, changes in the carbon density in forest biomass and soils often elude detection. Measurement technologies that rely on changes in two‐dimensional ground cover can miss changes in forest density. In contrast, changes from abrupt and total losses of biomass in land clearing, forest fires and clear cuts are easy to measure. Land management improves over time providing important present contributions and future potential to climate change mitigation. Appreciating the contributions of Forest Transitions to the sequestering of atmospheric carbon will enable its potential to aid in climate change mitigation.
Bridging the geospatial gap: Data about space and indigenous knowledge of place
Authors: Briggs Carolyn , Burfurd Ingrid , Duckham Matt , Guntarik Olivia , Kerr Di , McMillan Mark , San Martin Saldias Daisy 
Published: August 2020

AbstractIndigenous knowledge of place is not well‐served by today's digital geospatial technologies, such as spatial data, maps, spatial databases, and GIS. This paper aims to identify and explore new connections between Indigenous knowledge of place and digital geospatial technologies. Our analysis is structured around three key gaps in past work: (a) the overrepresentation of digital data about space, rather than knowledge of place; (b) a lack of facility to differentiate access to knowledge and enable Indigenous data sovereignty; (c) a lack of facility to support and sustain relationships between Indigenous and non‐Indigenous peoples. The paper further identifies and explores recent research topics in the field of geographic information science (GI science) with relevance to addressing these gaps. This includes identifying new serendipitous synergies with previously unconnected research areas, such as research into location privacy, uncertainty, qualitative spatial reasoning, or distributed spatial computing. The conclusions acknowledge that our retrospective approach is unlikely to lead to radical reformulation of geospatial technologies. Nevertheless, we argue that identifying technological opportunities could offer a pragmatic pathway to more rapidly bootstrap new approaches, beyond simply technological “fixes.”
Arbuscular mycorrhizal fungi promote plant growth of Leymus chinensis (Trin.) Tzvelev by increasing the metabolomics activity under nitrogen addition
Authors: Khan Yaseen , Yang Xue , Zhang Xinlei , Yaseen Tabassum , Shi Lianxuan , Zhang Tao 
Published: August 2020

AbstractNitrogen (N) deposition has been influencing ecological process, for instance N addition can affect plant growth and then alter plant community composition. Arbuscular mycorrhizal fungi (AMF) is one of the important soil microbiota, which play a key role in plant growth, especially under harsh environmental conditions. However, the effects of AMF on plant growth under N addition are still not well understood. To investigate the mechanism how AMF affect plant growth under N addition, a microcosm experiment was conducted with four N addition levels. The results showed that AMF increased aboveground biomass of Leymus chinensis by 21.5% and 4.8% under with and without N addition, respectively. AMF expressively improved the net photosynthetic rate by 44% and 29%, soluble protein by 65% and 40% under with and without N additions, respectively. The chlorophyll a, chlorophyll b, chlorophyll a + b and carotenoids content in leaves treated by AMF were greater than those without AMF treatment. AMF also significantly increased the metabolomics enzymes glutamate dehydrogenase, glutamine oxoglutarate aminotransferase, alanine transaminase and nitrogen reductase activity under N addition. However, the level of glutamine synthetase and soluble carbohydrates increased significantly under N addition in non‐inoculated AMF plants. The result showed that the response of AMF to L. chinensis was stronger than nitrogen deposition, which indicates that AMF could increase plant growth by improving photosynthetic characters and affecting metabolomics enzymes of L. chinensis under N addition.
Experiences of intensive home treatment for a mental health crisis during the perinatal period: A UK qualitative study
Authors: Rubio Luisa , Lever Taylor Billie , Morant Nicola , Johnson Sonia 
Published: August 2020

AbstractSome women with severe perinatal mental health difficulties in England are cared for by acute home treatment services, known as Crisis Resolution Teams (CRTs), which provide short‐term home‐based treatment for adults experiencing a mental health crisis. Intensive home treatment has been trialed in a number of countries, but it is not known how well suited it is to the needs of perinatal women. This qualitative study aimed to explore how women and practitioners experience the provision of intensive home treatment for perinatal mental health problems. Semi‐structured interviews were conducted with women who had received intensive home treatment in the perinatal period (n = 15), and focus groups were held with practitioners working in CRTs or in specialist perinatal mental health services (3 groups, n = 25). Data were analysed thematically. Women commonly found intensive home treatment problematic, experiencing it as intrusive and heavily risk‐focused, with poor staff continuity and little tailoring to the perinatal context. However, women valued emotional support when provided, particularly when it had a perinatal focus, sometimes based on practitioners sharing their own experiences. Some women also appreciated avoiding hospital admission, but choice was often limited. Practitioners reported a lack of perinatal training among CRT staff and described difficulties tailoring treatment to perinatal women’s needs. Currently, intensive home treatment, as offered by CRTs, may not be well suited to women with perinatal mental health difficulties. Findings suggest a need to develop community crisis responses that are better tailored to the needs of this population.
A Tale of Leadership in Value Creation
Authors: Milano Greg 
Published: August 2020

In this prologue to his new book, Curing Corporate Short‐Termism, the founder and CEO of Fortuna Advisors presents a fictional account of a corporate turnaround—a “composite” reflection of the author's many years of consulting experience that dramatizes the pressure to meet near‐term earnings targets and other kinds of “agency” problems facing a public company called Blue Dynamics Corp. The tale begins with the puzzlement of the incoming CEO, Betty Manning, at finding the company's highest‐return business unit starved for investment, even as the low‐return units continue to receive and spend capital with little success. At the core of the company's capital allocation and “underinvestment” problems, she finds a corporate‐wide performance measurement and reward system focused on setting and beating budgets and growth in EPS and ROE.Manning's solution is to divorce the performance and reward system entirely from the budgeting process and implement new annual incentives and target‐setting practices that result in both more reliable budgeting and forecasting and a longer‐term view of value creation. The new measure of economic profit, called BDVA (short for Blue Dynamics Value Added), is based on a customized measure of EBITDA less a capital charge. The adoption of the new measure has the effect of encouraging her team to take a number of decisive steps: make an objective, “fact‐based” case for a strategic acquisition whose price appears to be too high (at least using conventional measures like EPS accretion); pull the trigger on a divestment that appears to have been adding value, but is more valuable outside the firm; and, more generally and most important, guide operating managers toward an ideal balance of overall growth and return on capital.