Feasibility and validity of International Classification of Diseases based case mix indices

BACKGROUND: Severity of illness is an omnipresent confounder in health services research. Resource consumption can be applied as a proxy of severity. The most commonly cited hospital resource consumption measure is the case mix index (CMI) and the best-known illustration of the CMI is the Diagnosis Related Group (DRG) CMI used by Medicare in the U.S. For countries that do not have DRG type CMIs, the adjustment for severity has been troublesome for either reimbursement or research purposes. The research objective of this study is to ascertain the construct validity of CMIs derived from International Classification of Diseases (ICD) in comparison with DRG CMI. METHODS: The study population included 551 acute care hospitals in Taiwan and 2,462,006 inpatient reimbursement claims. The 18(th )version of GROUPER, the Medicare DRG classification software, was applied to Taiwan's 1998 National Health Insurance (NHI) inpatient claim data to derive the Medicare DRG CMI. The same weighting principles were then applied to determine the ICD principal diagnoses and procedures based costliness and length of stay (LOS) CMIs. Further analyses were conducted based on stratifications according to teaching status, accreditation levels, and ownership categories. RESULTS: The best ICD-based substitute for the DRG costliness CMI (DRGCMI) is the ICD principal diagnosis costliness CMI (ICDCMI-DC) in general and in most categories with Spearman's correlation coefficients ranging from 0.938-0.462. The highest correlation appeared in the non-profit sector. ICD procedure costliness CMI (ICDCMI-PC) outperformed ICDCMI-DC only at the medical center level, which consists of tertiary care hospitals and is more procedure intensive. CONCLUSION: The results of our study indicate that an ICD-based CMI can quite fairly approximate the DRGCMI, especially ICDCMI-DC. Therefore, substituting ICDs for DRGs in computing the CMI ought to be feasible and valid in countries that have not implemented DRGs

Pathway-based predictive approaches for non-animal assessment of acute inhalation toxicity

New approaches are needed to assess the effects of inhaled substances on human health. These approaches will be based on mechanisms of toxicity, an understanding of dosimetry, and the use of in silico modeling and in vitro test methods. In order to accelerate wider implementation of such approaches, development of adverse outcome pathways (AOPs) can help identify and address gaps in our understanding of relevant parameters for model input and mechanisms, and optimize non-animal approaches that can be used to investigate key events of toxicity. This paper describes the AOPs and the toolbox of in vitro and in silico models that can be used to assess the key events leading to toxicity following inhalation exposure. Because the optimal testing strategy will vary depending on the substance of interest, here we present a decision tree approach to identify an appropriate non-animal integrated testing strategy that incorporates consideration of a substance's physicochemical properties, relevant mechanisms of toxicity, and available in silico models and in vitro test methods. This decision tree can facilitate standardization of the testing approaches. Case study examples are presented to provide a basis for proof-of-concept testing to illustrate the utility of non-animal approaches to inform hazard identification and risk assessment of humans exposed to inhaled substances

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Surviving the Velvet Hammer: Analyzing the Criminalization of Working-Class Mothers in a Neoliberal Context

Criminalization refers to the labeling and stigmatization of certain people, acts, or communities as criminal agents, and continues to play a significant role in shaping the social world of the United States. However, the study of criminalization and its effects begs to be interrogated from an intersectional perspective. Intersectionality should be employed to understand these growing trends, in an effort to create a more nuanced understanding of how criminalization operates as a force in the lives of people with varying identities. This paper will interrogate criminalization through multiple areas of critical inquiry, including those of public policy, media, and gender studies, as well as critical and feminist theory. Using recent case studies as evidence, I argue that women of color and working class women are uniquely criminalized as a result of their insersectional identities. The cases, as well as their media reception, reveal motherhood, as an aspect of identity, is yet another crucial vehicle by which criminalization occurs. By supplementing policy studies with the work of feminist and media scholars, I hope to further illuminate the intersections of social class, racial privilege, and gender in the context of criminalization discourses

Social Reproduction as Political Resistance: Case Studies from US Politics in an Age of Extraction

Thesis (Ph.D.)--University of Washington, 2022This dissertation advances a novel theoretical framework that puts feminist theories of social reproductioninto conversation with research on contemporary political economy and political resistance. I expand and universalize the logics of social reproduction so as to bring their political commitments out of the home and into the realm of deliberative public acts. Part I contains two central theoretical contributions. First I assert that distinctly public political actions take up the logic and commitments of social reproduction theory when they are (1) future-oriented (2) community-motivated, and (3) aimed at collective over individualized benefits for a given political community. While most of the existing literature on social reproduction takes the actions associated with biological or private reproduction as the central site for the enacting an ethics of care, I theorize a social reproductive politics that looks instead to the realm of formal political acts. Under this expanded schematic, actions that take place in the presence of others, outside the private realm of the household, and which are driven by motivations and processes not necessarily tied directly to human reproduction or regeneration, can just as easily advance a politics of care that seeks to improve or maintain the shared world of a political community. Second, I consider the ways in which extraction as a governing logic, not just a material practice, has increasingly driven developments in US political economy, presenting new threats to communities living under increasingly extractive regimes. Extraction, in addition to describing a material practice, here represents a political ethos that prioritizes the accumulation of private profit and corporate interests over the needs of an existing community. Using this conception, I show how extraction can take as its object not just natural or material resources, but social resources as well. Thus things like tax bases and community spaces become extractable, as states allow and even sanction the siphoning of collective resources back into the reserves of private or corporate interests through policy and regulatory regimes. When registering and working collectively to resist or object to increasing extractive threats, I argue, communities often embody the tenets of social reproduction in order to maintain their collective resources and ways of life. In Part II I present empirical evidence in support of this two-part theory in the form of two in-depth case studies explored using qualitative, quantitative, historical, and ethnographic methods. The first considers historical methods of extraction by taxation in South Louisiana, and traces local movements to register objections to long-running tax exemptions that funnel resources away from local governing bodies and back into private reserves of corporate wealth. These movements, I argue, embody the futureoriented and collectivized ethos of social reproductive politics. The second traces the expansion of the cryptocurrency industry in two Central Washington counties and considers how the industry’s extractive tendencies have increasingly shaped life for local residents. After residents and their local governing boards registered crypto mining firms’ massive consumption of power as an extractive threat, public utilities managers instituted new higher rates aimed at reining in these new industries. I consider this political process under my expended schematic of social reproduction, pointing to the future-oriented and collective concerns that animated it. I conclude by drawing some comparisons and distinctions between these two case studies to investigate the constraints inherent in a politics of social reproduction that seeks to enact meaningful checks on contemporary extractive regimes

Case Studies in Politics, Femininities, and Masculinities

Please click the links below to view more information about each presentation. “Honey Badgers, Tigers, and Grizzlies, Oh My: Toward an Intersectional Analysis of Ferocious Femininity” Ashley A. Mattheis, University of North Carolina at Chapel Hill “How to be a Good American: Lessons in Citizenship from the First Ladies of the United States” Jonathan Foland, University of North Carolina at Chapel Hill “Surviving the Velvet Hammer: Analyzing the Criminalization of Working-Class Mothers in a Neoliberal Context” Grace E. Reinke, Louisiana State University and Agricultural & Mechanical College “Re-enforcing Traditional Models of Masculinities in Selected Nigerian Adverts” Adebisi Adetutu Ogungbesan, University of Ibada