The Impact of Medicare's Prospective Payment System on Psychiatric Patients Treated in Scatterbeds

Medicare's Prospective Payment System (PPS) for hospitals was phased-in during the 1884 Federal Fiscal Year. While many providers of psychiatric inpatient care were exempted from PPS patients treated in general hospital beds outside of psychiatric units (scatterbeds) were not. This allows for an initial assessment of the impact of PPS on psychiatric patients. We use a single equation model of hospital length of stay to estimate the impact of PPS. We allow for the possibility of both anticipating behavior and slow adjustment to the new payment scheme. The results indicate a substantial response to PPS over the first year of implementation. The estimated response includes sizable anticipatory and slow adjustment components. The findings suggest that policy discussions may be weighted too heavily in the direction of concern over hospital financial status given the ability of hospitals to change their behavior.

The Kindred Bonds of Mentally Ill Homeless Persons

While the unraveling of the kinship bond has long been suspected to play a role in the epidemiology of homelessness, the connection between kinship and homelessness has been little studied. Based on a normative analysis of the role of family structure in response to adversity, this article explores the impact of the amount and quality of kinship ties on episodes of homelessness experienced by discharged psychiatric patients in Ohio. Survey data derived from personal interviews with both former patients and their kin indicate more strain in relations with kin of the homeless than the nonhomeless. The strain in the kinship bond appears to emanate from a greater prevalence of chronic disabilities that undermine independent functioning and tax the resources of relatives who choose to remain involved. Consistent with this interpretation, patients with histories of homelessness reported more psychiatric symptoms, more deficits in daily living skills, and more contact with the criminal justice system. In general, patient variables were better able than family variables to differentiate the homeless from the nonhomeless. Nonetheless, the formulation of public policies for reducing the incidence and prevalence of homelessness will surely need to take account of the kinship bond and how it can be strengthened

Assessments of community mental health support systems: A key informant approach

This article describes the development of a ‘key informant survey’ to assess the performance of local systems of care for persons with a chronic mental illness. The measure yields ratings of: (1) the extent to which clients experience service delivery problems in 11 community support system elements, (2) overall performance of the community support system, and (3) the performance of local mental health authorities. Following pre-testing, the survey was administered to 699 respondents in nine U.S. cities. Internal consistency coefficients were found to be within acceptable ranges for all of the scales across all nine cities. Analyses comparing mean values for performance ratings showed that the nine sites could be arranged into three groups representing high, medium and low system performance. These findings support observations from site visits conducted over several years and suggest that the survey is a valid instrument for assessing local systems of care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44310/1/10597_2005_Article_BF02188593.pd

Patterns of medical management of overactive bladder (OAB) and benign prostatic hyperplasia (BPH) in the United States

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142147/1/nau23276.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142147/2/nau23276_am.pd

Playing the victim? Human trafficking, African youth, and geographies of structural inequality

This article explores the role of agency in determining who is and is not considered to be a legitimate victim of human trafficking. It draws on critical human trafficking scholarship and research on the life chances of West African youth. This is complemented by qualitative data from youth embroiled in football-related human trafficking. The insights from these analyses are brought into conversation with theoretical work on the geographies of commodities. This results in the concept of ‘unveiling the football trafficking fetish’, which is used to theorise how and why the agency of mobile youthful African male bodies undermines their claims of being trafficked human beings. The findings that emerge are significant in two ways. First, they generate theoretical insights on the coexistence of agency and exploitation in young lives, and how young people’s aspirations and agency can be (mis)read and work against them. Second, they provide a unique illustration of how human trafficking is a product of capitalism yet can be presented as a form of behaviour that lies outside of capitalist social relations. To centre these social relations and foster new forms of critical dialogue within and beyond population geography, the article concludes by recommending we consider the implications of conceptualising people as susceptible to rather than vulnerable to human trafficking

Planetary Candidates Observed by Kepler, III: Analysis of the First 16 Months of Data

New transiting planet candidates are identified in sixteen months (May 2009 - September 2010) of data from the Kepler spacecraft. Nearly five thousand periodic transit-like signals are vetted against astrophysical and instrumental false positives yielding 1,091 viable new planet candidates, bringing the total count up to over 2,300. Improved vetting metrics are employed, contributing to higher catalog reliability. Most notable is the noise-weighted robust averaging of multi-quarter photo-center offsets derived from difference image analysis which identifies likely background eclipsing binaries. Twenty-two months of photometry are used for the purpose of characterizing each of the new candidates. Ephemerides (transit epoch, T_0, and orbital period, P) are tabulated as well as the products of light curve modeling: reduced radius (Rp/R*), reduced semi-major axis (d/R*), and impact parameter (b). The largest fractional increases are seen for the smallest planet candidates (197% for candidates smaller than 2Re compared to 52% for candidates larger than 2Re) and those at longer orbital periods (123% for candidates outside of 50-day orbits versus 85% for candidates inside of 50-day orbits). The gains are larger than expected from increasing the observing window from thirteen months (Quarter 1-- Quarter 5) to sixteen months (Quarter 1 -- Quarter 6). This demonstrates the benefit of continued development of pipeline analysis software. The fraction of all host stars with multiple candidates has grown from 17% to 20%, and the paucity of short-period giant planets in multiple systems is still evident. The progression toward smaller planets at longer orbital periods with each new catalog release suggests that Earth-size planets in the Habitable Zone are forthcoming if, indeed, such planets are abundant.Comment: Submitted to ApJS. Machine-readable tables are available at http://kepler.nasa.gov, http://archive.stsci.edu/kepler/results.html, and the NASA Exoplanet Archiv

Dethroning historical reputations: Universities, museums and the commemoration of benefactors

The campaigns in universities across the world to reject, rename and remove historic benefactions have brought the present into collision with the past. In Britain the attempt to remove a statue of one of Oxford’s most famous benefactors, the imperialist Cecil Rhodes, has spread to other universities and their benefactors, and now also affects civic monuments and statues in towns and cities across the country. In the United States, memorials to leaders of the Confederacy in the American Civil War and to other slaveholders have been the subject of intense dispute. Should we continue to honour benefactors and historic figures whose actions are now deemed ethically unacceptable? How can we reconcile the views held by our ancestors with those we now hold today? Should we even try, acknowledging, in the words of the novelist L. P. Hartley, that ‘the past is another country; they do things differently there’? The essays in this interdisciplinary collection are drawn from a conference at the Institute of Historical Research in the University of London. Historians, fundraisers, a sociologist and a museum director examine these current issues from different perspectives, with an introductory essay by Sir David Cannadine, president of the British Academy. Together they explore an emerging conflict between the past and present, history and ideology, and benefactors and their critics

JOINT COMMITMENT, COERCION AND FREEDOM IN SCIENCE Conceptual Analysis and Case Studies

International audienceThis paper deals with the Ethics of group life in the sciences, if not directly with the policy of science that might evolve from it, and more precisely with the issue of democracy within scientific life

One-year outcomes of the ARTISAN-SNM study with the Axonics System for the treatment of urinary urgency incontinence

Aims: Sacral neuromodulation (SNM) is a guideline-recommended treatment for voiding dysfunction including urgency, urge incontinence, and nonobstructive retention as well