The Ethical Review of Health Care Quality Improvement Initiatives: Findings From the Field

Based on surveys, examines the review mechanisms of quality improvement initiatives, including frequency; type, such as use of independent review boards; and consideration for ethical issues such as minimal risk and patient privacy and confidentiality

Factor demand linkages, technology shocks, and the business cycle

This paper argues that factor demand linkages can be important for the transmission of both sectoral and aggregate shocks. We show this using a panel of highly disaggregated manufacturing sectors together with sectoral structural VARs. When sectoral interactions are explicitly accounted for, a contemporaneous technology shock to all manufacturing sectors implies a positive response in both output and hours at the aggregate level. Otherwise there is a negative correlation, as in much of the existing literature. Furthermore, we find that technology shocks are important drivers of the business cycle

Cultures of success: Recruiting and retaining new live-in residence life professionals

A qualitative inquiry designed to understand entry-level, live-in, professional staff recruitment and retention practices perceived as successful revealed a link to elements of organizational culture. Several important areas of understanding emerged: the actual recruitment and retention practices, the impact of leadership, and the role of organizational culture in the success of the department. This article addresses the impact of culture on the organization and its contribution to success in hiring and retaining entry-level staff. The discussion of findings and practical implications broadens our understanding of culture and better informs practice

A national survey of 'inactive' physicians in the United States of America: enticements to reentry

<p>Abstract</p> <p>Background</p> <p>Physicians leaving and reentering clinical practice can have significant medical workforce implications. We surveyed inactive physicians younger than typical retirement age to determine their reasons for clinical inactivity and what barriers, real or perceived, there were to reentry into the medical workforce.</p> <p>Methods</p> <p>A random sample of 4975 inactive physicians aged under 65 years was drawn from the Physician Masterfile of the American Medical Association in 2008. Physicians were mailed a survey about activity in medicine and perceived barriers to reentry. Chi-square statistics were used for significance tests of the association between categorical variables and t-tests were used to test differences between means.</p> <p>Results</p> <p>Our adjusted response rate was 36.1%. Respondents were fully retired (37.5%), not currently active in medicine (43.0%) or now active (reentered, 19.4%). Nearly half (49.5%) were in or had practiced primary care. Personal health was the top reason for leaving for fully retired physicians (37.8%) or those not currently active in medicine (37.8%) and the second highest reason for physicians who had reentered (28.8%). For reentered (47.8%) and inactive (51.5%) physicians, the primary reason for returning or considering returning to practice was the availability of part-time work or flexible scheduling. Retired and currently inactive physicians used similar strategies to explore reentry, and 83% of both groups thought it would be difficult; among those who had reentered practice, 35.9% reported it was difficult to reenter. Retraining was uncommon for this group (37.5%).</p> <p>Conclusion</p> <p>Availability of part-time work and flexible scheduling have a strong influence on decisions to leave or reenter clinical practice. Lack of retraining before reentry raises questions about patient safety and the clinical competence of reentered physicians.</p

Sudden Infant Death Syndrome and prenatal maternal smoking: rising attributed risk in the Back to Sleep era

BACKGROUND: Parental smoking and prone sleep positioning are recognized causal features of Sudden Infant Death. This study quantifies the relationship between prenatal smoking and infant death over the time period of the Back to Sleep campaign in the United States, which encouraged parents to use a supine sleeping position for infants. METHODS: This retrospective cohort study utilized the Colorado Birth Registry. All singleton, normal birth weight infants born from 1989 to 1998 were identified and linked to the Colorado Infant Death registry. Multivariable logistic regression was used to analyze the relationship between outcomes of interest and prenatal maternal cigarette use. Potential confounders analyzed included infant gender, gestational age, and birth year as well as maternal marital status, ethnicity, pregnancy interval, age, education, and alcohol use. RESULTS: We analyzed 488,918 birth records after excluding 5835 records with missing smoking status. Smokers were more likely to be single, non-Hispanic, less educated, and to report alcohol use while pregnant (p < 0.001). The study included 598 SIDS cases of which 172 occurred in smoke-exposed infants. Smoke exposed infants were 1.9 times (95% CI 1.6 to 2.3) more likely to die of SIDS. The attributed risk associating smoking and SIDS increased during the study period from approximately 50% to 80%. During the entire study period 59% (101/172) of SIDS deaths in smoke-exposed infants were attributed to maternal smoking. CONCLUSIONS: Due to a decreased overall rate of SIDS likely due to changing infant sleep position, the attributed risk associating maternal smoking and SIDS has increased following the Back to Sleep campaign. Mothers should be informed of the 2-fold increased rate of SIDS associated with maternal cigarette consumption

Effects of a Large Fishing Closure on Benthic Communitites in the Western Gulf of Maine: Recovery from the Effects of Gillnets and Otter Trawls

The recovery of benthic communities inside the western Gulf of Maine fishing closure area was evaluated by comparing invertebrate assemblages at sites inside and outside of the closure four to six years after the closure was established. The major restriction imposed by the closure was a year-round prohibition of bottom gillnets and otter trawls. A total of 163 seafloor sites (~half inside and half outside the closure) within a 515-km2 study area were sampled with some combination of Shipek grab, Wildco box corer, or underwater video. Bottom types ranged from mud (silt and clay) to boulders, and the effects of the closure on univariate measures (total density, biomass, taxonomic richness) of benthos varied widely among sediment types. For sites with predominantly mud sediments, there were mixed effects on inside and outside infauna and no effect on epifauna. For sites with mainly sand sediments, there were higher density, biomass, and taxonomic richness for infauna inside the closure, but no significant effects on epifauna. For sites dominated by gravel (which included boulders in some areas), there were no effects on infauna but strong effects on epifaunal density and taxonomic richness. For fishing gear, the data indicated that infauna recovered in sand from the impacts of otter trawls operated inside the closure but that they did not recover in mud, and that epifauna recovered on gravel bottoms from the impact of gillnets used inside the closure. The magnitudes of impact and recovery, however, cannot be inferred directly from our data because of a confounding factor of different fishing intensities outside the closure for a direct comparison of preclosure and postclosure data. The overall negative impact of trawls is likely underestimated by our data, whereas the negative impact of gillnets is likely overestimated

The Effect of CodY on stationary phase mutagenesis in Bacillus subtilis

We examine the notion that cells in conditions of stress accumulate mutation is in genes under selection via transcription processes. CodY is a global transcriptional regulator in many Gram positives, including soil and pathogenic microbes. In conditions of exponential growth and when branch chain amino acids and GTP are in abundance CodY acts as a transcriptional repressor of many metabolic operons. This transitional repression saves the cell energy and allows efficient use of resources. In conditions of starvation, CodY relieves repression of genes involved in acquisition of nutrients and degradation of carbon sources (genes under selection). Here, we compare the accumulation of mutations in genes under selection in wild type and CodY

Bottom habitat mapping using towed underwater videography: subtidal oyster reefs as an example application

Towed underwater video has become a widely used method for bottom habitat mapping in coastal waters, but very little has been published on this relatively new and effective approach. We use a case study on two oyster reefs to illustrate the pros and cons of towed video, visualization techniques, and future research topics. Towed video is deployed in similar fashion to single-beam sonars, yielding narrow swaths of video imagery that are recorded concurrently with global positioning system (GPS) data for georeferencing. The major advantages over acoustic (sonar) methods are that image processing and interpretation are relatively simple, and there is little or no need for subsequent ground-truthing. The system used in the present study consists of an underwater black and white camera mounted on a steel frame, differential GPS unit, and digital video camera for recording. It was assembled from off-the-shelf items, and total cost was approximately $3500 (2006 US$). The imagery from both study reefs was of sufficient quality to allow classification of the surveyed bottom into three categories: nonreef, low-density shell, and high-density shell. Some reef characteristics such as the amount of vertical relief were easily discernable and showed substantial differences between the two reefs. Reef bottom areal coverages determined from the video imagery compared well with recent previous studies on the two reefs using other methods. Water clarity limitations represent the major obstacle to widespread use of video for routine mapping of oyster reefs. Turbidity–image quality relations remain to be quantified