Impact of Provider Incentives on Quality and Value of Health Care

The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value- Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success. Expected final online publication date for the Annual Review of Public Health Volume 38 is March 20, 2017. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates

North Pacific-wide spreading of isotopically heavy nitrogen during the last deglaciation: Evidence from the western Pacific

Sedimentary delta(15) N records in two IMAGES cores (MD012404 and MD012403) retrieved from the Okinawa Trough (OT) in the western North Pacific reveal deglacial increases with two peaks occurring during the Bolling/Allerod and the Preboreal/early Holocene periods. These peaks are synchronous with previously reported delta(15) N peaks in the Eastern Tropical North Pacific, although the amplitudes (from 3.8 to 5.8%) are much smaller in the OT. Similar delta(15) N values for the last glacial maximum and the late-Holocene observed by us at a site far from the present-day zones of water-column denitrification (WCD) indicate that the mean N-15/N-14 of nitrate in the upper ocean did not differ much between the two climate states. The accumulation rate of organic carbon and total sulfur content are used as indices of the local WCD potential. The results suggest that enhancement of global WCD rather than local denitrification should be responsible for the deglacial maxima of sedimentary delta(15) N in the Okinawa Trough. Our data could provide additional constraints to better understand changes in nitrogen budget during the glacial to interglacial transition.National Science Council of Taiwan [NSC 96-2611-M-001-005]; State Key Laboratory of Marine Environmental Science, ; Xiamen University, Xiame

Expansion of Nature Conservation Areas: Problems with Natura 2000 Implementation in Poland?

In spite of widespread support from most member countries’ societies for European Union policy, including support for the sustainable development idea, in many EU countries the levels of acceptance of new environmental protection programmes have been and, in particular in new member states, still are considerably low. The experience of the countries which were the first to implement union directives show that they cannot be effectively applied without widespread public participation. The goal of this study was, using the example of Poland, to assess public acceptance of the expansion of nature conservation in the context of sustainable development principles and to discover whether existing nature governance should be modified when establishing new protected areas. The increase in protected areas in Poland has become a hotbed of numerous conflicts. In spite of the generally favourable attitudes to nature which Polish people generally have, Natura 2000 is perceived as an unnecessary additional conservation tool. Both local authorities and communities residing in the Natura areas think that the programme is a hindrance, rather than a help in the economic development of municipalities or regions, as was initially supposed. This lack of acceptance results from many factors, mainly social, historic and economic. The implications of these findings for current approach to the nature governance in Poland are discussed

Visible and Invisible Trends in Black Men's Health: Pitfalls and Promises for Addressing Racial, Ethnic, and Gender Inequities in Health

Over the past two decades, there has been growing interest in improving black men's health and the health disparities affecting them. Yet, the health of black men consistently ranks lowest across nearly all groups in the United States. Evidence on the health and social causes of morbidity and mortality among black men has been narrowly concentrated on public health problems (e.g., violence, prostate cancer, and HIV/AIDS) and determinants of health (e.g., education and male gender socialization). This limited focus omits age-specific leading causes of death and other social determinants of health, such as discrimination, segregation, access to health care, employment, and income. This review discusses the leading causes of death for black men and the associated risk factors, as well as identifies gaps in the literature and presents a racialized and gendered framework to guide efforts to address the persistent inequities in health affecting black men

Role of carbon cycle observations and knowledge in carbon management

Author Posting. © Annual Reviews, 2003. This article is posted here by permission of Annual Reviews for personal use, not for redistribution. The definitive version was published in Annual Review of Environment and Resources 28 (2003): 521-558, doi:10.1146/annurev.energy.28.011503.163443.Agriculture and industrial development have led to inadvertent changes in the natural carbon cycle. As a consequence, concentrations of carbon dioxide and other greenhouse gases have increased in the atmosphere and may lead to changes in climate. The current challenge facing society is to develop options for future management of the carbon cycle. A variety of approaches has been suggested: direct reduction of emissions, deliberate manipulation of the natural carbon cycle to enhance sequestration, and capture and isolation of carbon from fossil fuel use. Policy development to date has laid out some of the general principles to which carbon management should adhere. These are summarized as: how much carbon is stored, by what means, and for how long. To successfully manage carbon for climate purposes requires increased understanding of carbon cycle dynamics and improvement in the scientific capabilities available for measurement as well as for policy needs. The specific needs for scientific information to underpin carbon cycle management decisions are not yet broadly known. A stronger dialogue between decision makers and scientists must be developed to foster improved application of scientific knowledge to decisions. This review focuses on the current knowledge of the carbon cycle, carbon measurement capabilities (with an emphasis on the continental scale) and the relevance of carbon cycle science to carbon sequestration goals.The National Center for Atmospheric Research is supported by the National Science Foundation

Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) conference

In 2012, Kidney Disease: Improving Global Outcomes (KDIGO) published a guideline on the classification and management of acute kidney injury (AKI). The guideline was derived from evidence available through February 2011. Since then, new evidence has emerged that has important implications for clinical practice in diagnosing and managing AKI. In April of 2019, KDIGO held a controversies conference entitled Acute Kidney Injury with the following goals: determine best practices and areas of uncertainty in treating AKI; review key relevant literature published since the 2012 KDIGO AKI guideline; address ongoing controversial issues; identify new topics or issues to be revisited for the next iteration of the KDIGO AKI guideline; and outline research needed to improve AKI management. Here, we present the findings of this conference and describe key areas that future guidelines may address