Hospital Merger and Acquisition Effects on Healthcare Quality and Cost

Healthcare is as much a business subject to market dynamics as it is a public service, with enormous sums of money and resources devoted to it. Since a person’s health is one of his or her most valuable assets, healthcare will always be in high demand, regardless of the price of medical goods and services. Considering healthcare’s nature as a necessary good and the irreplaceable importance of a medical facility to its service area, any changes in capacity or method of healthcare delivery may have profound effects on the dependent population. Situations in which a hospital merges with a healthcare system or another hospital exemplify such a change, for mergers entail potentially large-scale alterations to the local healthcare market and to the manner in which care is provided. The number of hospital mergers and acquisitions has been steadily increasing since 2003, with the number of deals growing over 40 percent from 2010 to 2015. A concern is that larger institutions or systems wield greater market power and may gain the ability to control the majority of healthcare delivery in the local area; this decrease in competition can lead to rising costs without comparable improvements in quality. On the other hand, consolidations can also present the opportunity for better integration and efficiency of care, more abundant and valuable technological resources, elimination of duplicate services, collaboration among more adept healthcare providers, and overall cost savings from economies of scale. This study explores the effects of hospital consolidation and resultant operational changes on patient outcomes and the costs associated with their care. Furthermore, the effect of hospital ownership status on quality and cost measures will also be assessed. This thesis differs from existing literature because it is the first known study to use hospital-level data from 2010 to 2014 to analyze whether hospital mergers significantly affect healthcare quality and cost

Does Money Buy Enough Happiness: Investigating the Relationship Between Income and Suicide Rates

The number of suicides documented across the United States has been steadily increasing for several decades, despite there being a decrease globally. Our research explores the effect that household income may have on this counterintuitive relationship by using data from the U.S. Census Bureau and the Centers for Disease Control and Prevention’s National Center for Health Statistics from 2010 - 2019. Our Fixed Effects regression model will identify causal relationships within our panel data set and illustrate how suicide rates fluctuate with household income and demographics. We predict that median household income will have a negative association with the average number of suicides across United States counties. This analysis prompts further questions of how policymakers and activists can address the causes of the increasing number of suicides within the United States

The Interplay between Branching and Pruning on Neuronal Target Search during Developmental Growth: Functional Role and Implications

Regenerative strategies that facilitate the regrowth and reconnection of neurons are some of the most promising methods in spinal cord injury research. An essential part of these strategies is an increased understanding of the mechanisms by which growing neurites seek out and synapse with viable targets. In this paper, we use computational and theoretical tools to examine the targeting efficiency of growing neurites subject to limited resources, such as maximum total neural tree length. We find that in order to efficiently reach a particular target, growing neurites must achieve balance between pruning and branching: rapidly growing neurites that do not prune will exhaust their resources, and frequently pruning neurites will fail to explore space effectively. We also find that the optimal branching/pruning balance must shift as the target distance changes: different strategies are called for to reach nearby vs. distant targets. This suggests the existence of a currently unidentified higher-level regulatory factor to control arborization dynamics. We propose that these findings may be useful in future therapies seeking to improve targeting rates through manipulation of arborization behaviors

Evaluation of Target Search Efficiency for Neurons During Developmental Growth

In this work we investigated how branching and pruning influence the probability of successfully connecting to neurons located at different locations away from the initiation point, under the assumption that the neuron has finite growth resources. We find out that balanced branching and pruning, and the distance to target are essential in determining the optimal growth parameters

Endocide-Induced Abnormal Growth Forms of Invasive Giant Salvinia (Salvinia molesta)

Giant salvinia (Salvinia molesta) is one of the most noxious invasive species in the world. The fern is known to have primary, secondary, and tertiary growth forms, which are also commonly hypothesized as growth stages. The identification of these forms is primarily based on the size and folding status of the floating leaves. However, we identified 12 forms in the greenhouse and the field. Our experiments showed that the folding of floating leaves is a reversible trait dependent on water access. The floating leaves quickly fold in response to water shortage, reducing water loss and needs, decreasing growth, and avoiding trichome damage. The leaves re-open to allow trichomes repel water and enhance growth when having adequate water supply. Larger secondary or tertiary forms do not produce small-leaf primary forms without high intensity stress. These results do not support the hypothesis that three growth forms represent sequential growth stages. The abnormal small-leaf forms are the result of endocide-induced autotoxicity and some of them never grow into other forms. The development of abnormal forms and reversible leaf folding strategy in response to high stress along with rapid asexual reproduction are major adaptive traits contributing to the invasiveness of S. molesta

Reading Recovery

Reading Recovery is an early, short-term intervention literacy program. It helps the lowest achieving first grade children develop effective and efficient problem solving processes and strategies used by successful children in the classroom. The goal of the program is to bring those children who are having most difficulty developing literacy skills to a level of achievement at or beyond their peers. This way, they can participate in and benefit from regular classroom literacy instruction

Characterization of Swelling Ratio and Water Content of Hydrogels for Cartilage Engineering Applications

Due to the high prevalence of arthritis and cartilage-related injuries, tissue engineers are studying ways to grow cartilage tissue replacements. Resilin, an elastomeric protein found in insect cuticles, is known for its extraordinary resilience and elasticity. In previous studies, recombinant resilin-based hydrogels, or cross-linked protein networks, exhibited potential for use in cartilage tissue scaffolds. Our lab successfully developed resilin-based proteins with a sequence based on the mosquito gene and showed that resilin-based hydrogels possess mechanical properties of the same order of magnitude as native articular cartilage. In addition, these mechanical properties can be controlled by changing the protein concentration. To understand how these resilin-based hydrogels will behave in physiological environments, it is necessary to characterize their physical properties, such as swelling ratio and water content. In this study, we developed a protocol to fabricate hydrogels and characterize their swelling ratio and water content using bovine serum albumin (BSA) as a model protein and a cross-linker, tri(hydroxymethyl)phosphine (THP). Hydrogels of varying diameters (4mm and 6mm) and protein concentrations (8 – 14 wt%) were fabricated at 37oC in silicone molds. To mimic a physiological environment, hydrogels were stored in phosphate buffered saline (PBS). Each hydrogel was weighed until fully swollen, indicated by a constant weight for 3 time points. Freeze-drying was performed to obtain dry hydrogels. The swelling ratio and water content were calculated using the final swollen weight and the dry weight. Results showed that size did not significantly affect swelling ratio or water content of 8, 12, and 14 wt% BSA gels but did affect 10 wt% hydrogels. Furthermore, an increase in protein concentration resulted in a decrease in swelling ratio and water content. Because this procedure allowed successful characterization of BSA hydrogels, this protocol will be adapted to characterize our own resilin-based protein hydrogels in future studies

An evaluation of the Writing Assessment Measure (WAM) for children's narrative writing

AbstractThe study evaluated the reliability and validity of the Writing Assessment Measure (WAM), developed to reflect the skills which children of different abilities are expected to achieve in written expression, as part of the National Curriculum guidelines in England and Wales. The focus was on its potential use in investigations of children's written narrative in order to inform and target related interventions. The study involved 97 children aged 7–11 from one urban primary school in England. Prompt 1 was administered to all the children in their classrooms together with a standardised written expression test. After three weeks, the same procedure was followed and Prompt 2 was administered. Statistical analyses of the reliability and validity of the instrument showed that it is consistent over time and can be scored reliably by different raters. Content validity of the instrument was demonstrated through inspection of item total correlations which were all significant. Analyses for concurrent validity showed that the instrument correlates significantly with the Wechsler Written Expressive Language sub-test. Significant differences between children of different age and writing skill were also found. The findings indicate that the instrument has potential utility to professionals assessing children's writing

Using small-angle scattering and contrast matching to understand molecular packing in low molecular weight gels

It is difficult to determine exactly the molecular packing in the aggregates in low molecular weight gels. Attempts to understand the packing have been made using X-ray diffraction, but there are complications with drying and questions as to whether the crystal structures represent the packing in the gel phase. Here, we exploit contrast matching in small-angle neutron scattering experiments. By preparing selectively deuterated analogs of the same molecule, the scattering from that section of the molecule decreases compared with the hydrogenated molecule. We examine packing in the pre-gelled solutions at high pH and in the gels at low pH. The data from the final gels show a lack of specific order in the aggregates that form the gel matrix. The packing in these systems is not well ordered in the gel state and so implies that it is likely that current models and cartoons are not correct

The Archives at the Tip of Their Fingers: Exploring User Reactions to Large-Scale Digitization

Advances in digital image capture technology and the adoption of More Product, Less Process methods have resulted in special collections and archives large- scale digitization that creates a new kind of digital surrogate. Mirroring and reusing aggregate archival arrangement and description, these digital surrogates represent multiple items and are minimally described as a whole. The authors conducted interviews to explore user reactions to this digitization method at the University of Nevada, Las Vegas. This study found that large-scale digitization does have a positive impact for users, although additional strategies may be required to maximize the usefulness of the resulting digital objects