Perceptions of the healthcare system among stakeholders

The U.S. healthcare system is rife with complexities and is consistently a source of political debate. One’s interaction with the system may directly impact the understanding of the system. The objective of this research is to examine the perceptions of the United States healthcare system from the viewpoint of healthcare providers, insurers, and consumers. Using a grounded theory approach, theoretical sampling was used to explore similarities and differences between the three groups of actors in the healthcare system. Data were collected through interviews with thirty-one participants using a semi-structured interview schedule. Themes of cost, access, and inefficiency emerged from the data. The theme of cost included the ability to pay, innovative care delivery, and relation to access. Access included the need for guidance, geographical proximity to healthcare, and socioeconomic status. The theme of inefficiency included how insurance dictates care, and the unwieldy system. Similarities among groups were the high cost of care, ability to pay, and complexity. Differences discovered were the insurers’ dual role as professional and consumer, providers’ informal access to care, and differing views on who is to blame for the high cost of healthcare. This research unveils perspectives of three stakeholders of actors in the healthcare system, providing a foundation for further research to better understand these perspectives in improving equity and access in healthcare. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Parliamentary roll-call voting as a complex dynamical system:The case of Chile

A method is proposed to study the temporal variability of legislative roll-call votes in a parliament from the perspective of complex dynamical systems. We studied the Chilean Chamber of Deputies’ by analyzing the agreement ratio and the voting outcome of each vote over the last 19 years with a Recurrence Quantification Analysis and an entropy analysis (Sample Entropy). Two significant changes in the temporal variability were found: one in 2014, where the voting outcome became more recurrent and with less entropy, and another in 2018, where the agreement ratio became less recurrent and with higher entropy. These changes may be directly related to major changes in the Chilean electoral system and the composition of the Chamber of Deputies, given that these changes occurred just after the first parliamentary elections with non-compulsory voting (2013 elections) and the first elections with a proportional system in conjunction with an increase in the number of deputies (2017 elections) were held.</p

Reducing model bias in a deep learning classifier using domain adversarial neural networks in the MINERvA experiment

We present a simulation-based study using deep convolutional neural networks (DCNNs) to identify neutrino interaction vertices in the MINERvA passive targets region, and illustrate the application of domain adversarial neural networks (DANNs) in this context. DANNs are designed to be trained in one domain (simulated data) but tested in a second domain (physics data) and utilize unlabeled data from the second domain so that during training only features which are unable to discriminate between the domains are promoted. MINERvA is a neutrino-nucleus scattering experiment using the NuMI beamline at Fermilab. $A$-dependent cross sections are an important part of the physics program, and these measurements require vertex finding in complicated events. To illustrate the impact of the DANN we used a modified set of simulation in place of physics data during the training of the DANN and then used the label of the modified simulation during the evaluation of the DANN. We find that deep learning based methods offer significant advantages over our prior track-based reconstruction for the task of vertex finding, and that DANNs are able to improve the performance of deep networks by leveraging available unlabeled data and by mitigating network performance degradation rooted in biases in the physics models used for training.Comment: 41 page

Evaluation of the Performance of Routine Information System Management (PRISM) framework: evidence from Uganda

<p>Abstract</p> <p>Background</p> <p>Sound policy, resource allocation and day-to-day management decisions in the health sector require timely information from routine health information systems (RHIS). In most low- and middle-income countries, the RHIS is viewed as being inadequate in providing quality data and continuous information that can be used to help improve health system performance. In addition, there is limited evidence on the effectiveness of RHIS strengthening interventions in improving data quality and use. The purpose of this study is to evaluate the usefulness of the newly developed Performance of Routine Information System Management (PRISM) framework, which consists of a conceptual framework and associated data collection and analysis tools to assess, design, strengthen and evaluate RHIS. The specific objectives of the study are: a) to assess the reliability and validity of the PRISM instruments and b) to assess the validity of the PRISM conceptual framework.</p> <p>Methods</p> <p>Facility- and worker-level data were collected from 110 health care facilities in twelve districts in Uganda in 2004 and 2007 using records reviews, structured interviews and self-administered questionnaires. The analysis procedures include Cronbach's alpha to assess internal consistency of selected instruments, test-retest analysis to assess the reliability and sensitivity of the instruments, and bivariate and multivariate statistical techniques to assess validity of the PRISM instruments and conceptual framework.</p> <p>Results</p> <p>Cronbach's alpha analysis suggests high reliability (0.7 or greater) for the indices measuring a promotion of a culture of information, RHIS tasks self-efficacy and motivation. The study results also suggest that a promotion of a culture of information influences RHIS tasks self-efficacy, RHIS tasks competence and motivation, and that self-efficacy and the presence of RHIS staff have a direct influence on the use of RHIS information, a key aspect of RHIS performance.</p> <p>Conclusions</p> <p>The study results provide some empirical support for the reliability and validity of the PRISM instruments and the validity of the PRISM conceptual framework, suggesting that the PRISM approach can be effectively used by RHIS policy makers and practitioners to assess the RHIS and evaluate RHIS strengthening interventions. However, additional studies with larger sample sizes are needed to further investigate the value of the PRISM instruments in exploring the linkages between RHIS data quality and use, and health systems performance.</p

Diversification and Specialization of Plant RBR Ubiquitin Ligases

Background: RBR ubiquitin ligases are components of the ubiquitin-proteasome system present in all eukaryotes. They are characterized by having the RBR (RING – IBR – RING) supradomain. In this study, the patterns of emergence of RBR genes in plants are described. Methodology/Principal Findings: Phylogenetic and structural data confirm that just four RBR subfamilies (Ariadne, ARA54, Plant I/Helicase and Plant II) exist in viridiplantae. All of them originated before the split that separated green algae from the rest of plants. Multiple genes of two of these subfamilies (Ariadne and Plant II) appeared in early plant evolution. It is deduced that the common ancestor of all plants contained at least five RBR genes and the available data suggest that this number has been increasing slowly along streptophyta evolution, although losses, especially of Helicase RBR genes, have also occurred in several lineages. Some higher plants (e. g. Arabidopsis thaliana, Oryza sativa) contain a very large number of RBR genes and many of them were recently generated by tandem duplications. Microarray data indicate that most of these new genes have low-level and sometimes specific expression patterns. On the contrary, and as occurs in animals, a small set of older genes are broadly expressed at higher levels. Conclusions/Significance: The available data suggests that the dynamics of appearance and conservation of RBR genes is quite different in plants from what has been described in animals. In animals, an abrupt emergence of many structurall