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There is variation in care of secundum atrial septal defects. Defects <3 mm and patent foramen ovale are not clinically significant. Defects >3 mm are often followed clinically and may require closure. Variation in how these lesions are monitored may result in over-utilisation of routine studies and higher than necessary patient charges.
To determine utilisation patterns for patients with secundum atrial septal defects diagnosed within the first year of life and compare to locally developed optimal utilisation standard to assess charge savings.
This was a retrospective chart review of patients with secundum atrial septal defects diagnosed within the first year of life. Patients with co-existing cardiac lesions were excluded. Total number of clinic visits, electrocardiograms, and echocardiograms were recorded. Total charge was calculated based on our standard institutional charges. Patients were stratified based on lesion and provider type and then compared to “optimal utilisation” using analysis of variance statistical analysis.
Ninety-seven patients were included, 40 had patent foramen ovale (or atrial septal defect <3 mm), 43 had atrial septal defects not requiring intervention and 14 had atrial septal defects requiring intervention. There was a statistically significant difference in mean charge above optimal for these lesions of $1033, $2885, and $5722 (p < 0.02), respectively. There was statistically significant variation of charge among types of provider as well. Average charge savings per patient would be $2530 with total charge savings of $242,472 if the optimal utilisation pathway was followed.
Using optimal utilisation and decreasing variation could save the patient significant unnecessary charges.
Chinese privet (Ligustrum sinense Lour.) is a deciduous to evergreen shrub with an expansive nonnative global range. Control costs are often high, so land managers must carefully consider whether the plant’s potential negative effects warrant active management. To help facilitate this decision-making process, we reviewed and synthesized the literature on the potential ecological effects of L. sinense invasion. We also identified research gaps in need of further study. We found ample evidence of negative relationships between L. sinense invasion and native plant communities. While observational studies are not able to confirm whether L. sinense is driving these relationships, experimental evidence suggests that there is a cause–effect relationship. Of particular concern is the possibility that L. sinense could suppress forest regeneration and cause areas to transition from forest to L. sinense–dominated shrublands. Although this outcome would obviously impact a wide variety of wildlife species, empirical evidence of negative effects of L. sinense on wildlife are limited, and some species may actually benefit from the additional cover and foraging opportunities that L. sinense can provide. Further research on the potential effects of L. sinense invasion on large-scale forest structure and wildlife populations is needed. In areas where L. sinense invasion is a concern, evidence suggests early detection and management can mitigate control costs.
Data mining is a process of finding correlations and collecting and analysing a huge amount of data in a database to discover patterns or relationships. Flight delay creates significant problems in the present aviation system. Data mining techniques are desired for analysing the performance in which micro-level causes propagate to make system-level patterns of delay. Analysing flight delays is very difficult – both when looking from a historical view as well as when estimating delays with forecast demand. This paper proposes using Decision Tree (DT), Support Vector Machine (SVM), Naive Bayesian (NB), K-nearest neighbour (KNN) and Artificial Neural Network (ANN) to study and analyse delays among aircrafts. The performance of different data mining methods is found in the different regions of the updated datasets on these classifiers. Finally, the result shows a significant variation in the performance of different data mining methods and feature selection for this problem. This paper aims to deal with how data mining techniques can be used to understand difficult aircraft system delays in aviation. Our aim is to develop a classification model for studying and reducing delay using different data mining methods and, in this manner, to show that DT has a greater classification accuracy. The different feature selectors are used in this study in order to reduce the number of initial attributes. Our results clearly demonstrate the value of DT for analysing and visualising how system-level effects happen from subsystem-level causes.
It is widely assumed that celebrities are imbued with political capital and the power to move opinion. To understand the sources of that capital in the specific domain of sports celebrity, we investigate the popularity of global soccer superstars. Specifically, we examine players’ success in the Ballon d’Or—the most high-profile contest to select the world’s best player. Based on historical election results as well as an original survey of soccer fans, we find that certain kinds of players are significantly more likely to win the Ballon d’Or. Moreover, we detect an increasing concentration of votes on these kinds of players over time, suggesting a clear and growing hierarchy in the competition for soccer celebrity. Further analyses of support for the world’s two best players in 2016 (Lionel Messi and Cristiano Ronaldo) show that, if properly adapted, political science concepts like partisanship have conceptual and empirical leverage in ostensibly non-political contests.
Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.
A point-prevalence study of antimicrobial use among inpatients at 5 public hospitals in Sri Lanka revealed that 54.6% were receiving antimicrobials: 43.1% in medical wards, 68.0% in surgical wards, and 97.6% in intensive care wards. Amoxicillin-clavulanate was most commonly used for major indications. Among patients receiving antimicrobials, 31.0% received potentially inappropriate therapy.
Hospital environmental surfaces are frequently contaminated by microorganisms. However, the causal mechanism of bacterial contamination of the environment as a source of transmission is still debated. This prospective study was performed to characterize the nature of multidrug-resistant organism (MDRO) transmission between the environment and patients using standard microbiological and molecular techniques.
Prospective cohort study at 2 academic medical centers.
A prospective multicenter study to characterize the nature of bacterial transfer events between patients and environmental surfaces in rooms that previously housed patients with 1 of 4 ‘marker’ MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, and MDR Acinetobacter baumannii. Environmental and patient microbiological samples were obtained on admission into a freshly disinfected inpatient room. Repeat samples from room surfaces and patients were taken on days 3 and 7 and each week the patient stayed in the same room. The bacterial identity, antibiotic susceptibility, and molecular sequences were compared between organisms found in the environment samples and patient sources.
We enrolled 80 patient–room admissions; 9 of these patients (11.3%) were asymptomatically colonized with MDROs at study entry. Hospital room surfaces were contaminated with MDROs despite terminal disinfection in 44 cases (55%). Microbiological Bacterial Transfer events either to the patient, the environment, or both occurred in 12 patient encounters (18.5%) from the microbiologically evaluable cohort.
Microbiological Bacterial Transfer events between patients and the environment were observed in 18.5% of patient encounters and occurred early in the admission. This study suggests that research on prevention methods beyond the standard practice of room disinfection at the end of a patient’s stay is needed to better prevent acquisition of MDROs through the environment.
What explains citizens’ willingness to fight for their country in times of war? Using six waves of the World Values Survey, this study finds that individual willingness to fight is negatively related with country-level income inequality. When income inequality is high, the rich are less willing to fight than the poor. When inequality is low, the poor and rich differ little in their willingness to fight. This change in the willingness to fight between low and high inequality countries is greater among the rich than among the poor. This article explores several explanations for these findings. The data are consistent with the argument that high inequality makes it more attractive for the rich to buy themselves out of military service.
To determine the feasibility and value of developing a regional antibiogram for community hospitals.
Multicenter retrospective analysis of antibiograms.
SETTING AND PARTICIPANTS
A total of 20 community hospitals in central and eastern North Carolina and south central Virginia participated in this study.
We combined antibiogram data from participating hospitals for 13 clinically relevant gram-negative pathogen–antibiotic combinations. From this combined antibiogram, we developed a regional antibiogram based on the mean susceptibilities of the combined data.
We combined a total of 69,778 bacterial isolates across 13 clinically relevant gram-negative pathogen–antibiotic combinations (median for each combination, 1100; range, 174–27,428). Across all pathogen–antibiotic combinations, 69% of local susceptibility rates fell within 1 SD of the regional mean susceptibility rate, and 97% of local susceptibilities fell within 2 SD of the regional mean susceptibility rate. No individual hospital had >1 pathogen–antibiotic combination with a local susceptibility rate >2 SD of the regional mean susceptibility rate. All hospitals’ local susceptibility rates were within 2 SD of the regional mean susceptibility rate for low-prevalence pathogens (<500 isolates cumulative for the region).
Small community hospitals frequently cannot develop an accurate antibiogram due to a paucity of local data. A regional antibiogram is likely to provide clinically useful information to community hospitals for low-prevalence pathogens.
Do welfare states make people happy? In this chapter, we argue that the answer depends critically on how we conceptualize welfare states and the logics that underpin their presumed connection with well-being. In particular, we contend that understanding the relationship between welfare states and happiness requires that we distinguish between the “how much” protection welfare states offer and “what kind” of labor market opportunities they provide to go along with that protection. Welfare states are about more versus less protection, but they also are about whom they protect and in what way. This matters for happiness; more protection produces more happiness for those at risk, but having more flexible labor markets produces more happiness, too, even if a country's overall levels of protection are lower.
To make our argument and organize the empirical analysis, we rely critically on two concepts. The first is that of decommodification, taken from Gøsta Esping-Andersen's (1985) work. Decommodification means that people's access to basic resources needed to sustain their lives is protected from market risks to which they would be exposed if illness, old age, and unemployment would disrupt market-based resource flows. Decommodification supplies life satisfaction by granting peace of mind. The second concept is that of human capacities to choose one's own life and competently cope with challenges, which we take from Armatya Sen's (2011) The Idea of Justice. People's happiness depends on their capabilities and ability to make choices. This requires freedoms but also investments in their capabilities, skills, and competences.
The experience of freedom and choice, particularly in labor markets, provides fulfillment that translates into life satisfaction. In this vein, a highly regulatory welfare state, conferring little freedom of choice on people, for example, in labor markets, may generate less life satisfaction than a freedom-inducing welfare state, even if decommodification is equally high. So instead of more decommodifying welfare states simply making all or most citizens a bit happier than less decommodifying ones, different kinds of welfare states also create distinct sets of more or less happy citizens across countries.
Describe the epidemiology of healthcare-related (ie, healthcare-associated and hospital-acquired) pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA) among hospitalized patients in community hospitals.
Retrospective cohort study.
Twenty-four community hospitals in the southeastern United States affiliated with the Duke Infection Control Outreach Network (median size, 211 beds; range, 103–658 beds).
Adult patients with healthcare-related MRSA pneumonia admitted to study hospitals from January 1, 2008, to December 31, 2012, were identified using surveillance data. Seasonal and annual incidence rates (cases per 100,000 patient-days) were estimated using generalized estimating equation models. Characteristics of community-onset and hospital-onset cases were compared.
A total of 1,048 cases of healthcare-related pneumonia due to MRSA were observed during 5,863,941 patient-days. The annual incidence rate of healthcare-related MRSA pneumonia increased from 11.3 cases per 100,000 patient-days (95% confidence interval [CI], 6.8–18.7) in 2008 to 15.5 cases per 100,000 patient-days (95% CI, 8.4–28.5) in 2012 (P = .055). The incidence rate was highest in winter months and lowest in summer months (15.4 vs 11.1 cases per 100,000 patient-days; incidence rate ratio, 1.39 [95% CI, 1.06–1.82]; P = .016). A total of 814 cases (77.7%) were community-onset healthcare-associated pneumonia cases; only 49 cases (4.7%) were ventilator-associated cases. Of 811 patients whose disposition was known, 240 (29.6%) died during hospitalization or were discharged to hospice.
From 2008 through 2012, the incidence of healthcare-related MRSA pneumonia among patients who were admitted to a large network of community hospitals increased, despite the decreasing incidence of invasive MRSA infections nationwide. Additional study is warranted to evaluate trends in this important and potentially modifiable public health problem.
Infect Control Hosp Epidemiol 2014;35(12):1452–1457
While several reports discuss controversies regarding ambulance diversion from acute care hospitals and the mortality, financial, and resource effects, there is scant literature related to the effect of hospital characteristics.
The objective of this study was to describe specific paramedic receiving center characteristics that are associated with ambulance diversion rates in an Emergency Medical Services system.
A retrospective observational study design was used. The study was performed in a suburban EMS system with 27 paramedic receiving centers studied; one additional hospital present at the beginning of the study period (2000-2008) was excluded due to lack of recent data. Hospital-level and population-level characteristics were gathered, including diversion rate (hours on diversion/total hours open), for-profit status, number of specialty services (including trauma, burn, cardiovascular surgery, renal transplant services, cardiac catheterization capability [both interventional and diagnostic], and burn surgery), average inpatient bed occupancy rate (total patient days/licensed bed days), annual emergency department (ED) volume (patients per year), ED admission rate (percent of ED patients admitted), and percent of patients leaving without being seen. Demographic characteristics included percent of persons in each hospital's immediate census tract below the 100% and 200% poverty lines (each considered separately), and population density within the census tract. Bivariate and regression analyses were performed.
Diversion rates for the 27 centers ranged from 0.3%-14.5% (median 4.5%). Average inpatient bed occupancy rate and presence of specialty services were correlated with an increase in diversion rate; occupancy rate showed a 0.08% increase in diversion hours per 1% increase in occupancy rate (95% CI, 0.01%-0.16%), and hospitals with specialty services had, on average, a 4.1% higher diversion rate than other hospitals (95% CI, 1.6%-6.7%). Other characteristics did not show a statistically significant effect. When a regression was performed, only the presence of specialty services was related to the ambulance diversion rate.
Hospitals in this study providing specialty services were more likely to have higher diversion rates. This may result in increased difficulty getting patients requiring specialty care to centers able to provide the needed level of service. Major limitations include the retrospective nature of the study, as well as reliance on multiple data systems.
KahnC, StrattonS, AndersonC. Characteristics of Hospitals Diverting Ambulances in a California EMS System. Prehosp Disaster Med. 2014;29(1):1-5.