The Effects of Cardiac Specialty Hospitals on the Cost and Quality of Medical Care

The recent rise of specialty hospitals -- typically for-profit firms that are at least partially owned by physicians -- has led to substantial debate about their effects on the cost and quality of care. Advocates of specialty hospitals claim they improve quality and lower cost; critics contend they concentrate on providing profitable procedures and attracting relatively healthy patients, leaving (predominantly nonprofit) general hospitals with a less-remunerative, sicker patient population. We find support for both sides of this debate. Markets experiencing entry by a cardiac specialty hospital have lower spending for cardiac care without significantly worse clinical outcomes. In markets with a specialty hospital, however, specialty hospitals tend to attract healthier patients and provide higher levels of intensive procedures than general hospitals.

Interventional Systems Ethnography and Intersecting Injustices: A New Approach for Fostering Reciprocal Community Engagement

Effectively addressing wicked problems requires collaborative, embedded action. But, in many cases, scholarly commitments, social justice, privilege, and precarity collide in ways that make it difficult for community-engaged scholars to ethically navigate competing duties. This article presents our efforts to support reciprocal community engagement in addressing cancer- obesity comorbidity and risk coincidence in underserved communities. Partnering with community healthcare professionals, we conducted an adapted Systems Ethnography/Qualitative Modeling (SEQM) study. SEQM offers an alternative ethical framework for community-engaged research, one that supports reciprocity through enabling participant-centered community self-definition, goal setting, and solution identification

Prevalence of the EH1 Groucho interaction motif in the metazoan Fox family of transcriptional regulators

<p>Abstract</p> <p>Background</p> <p>The Fox gene family comprises a large and functionally diverse group of <it>forkhead</it>-related transcriptional regulators, many of which are essential for metazoan embryogenesis and physiology. Defining conserved functional domains that mediate the transcriptional activity of Fox proteins will contribute to a comprehensive understanding of the biological function of Fox family genes.</p> <p>Results</p> <p>Systematic analysis of 458 protein sequences of the metazoan Fox family was performed to identify the presence of the engrailed homology-1 motif (eh1), a motif known to mediate physical interaction with transcriptional corepressors of the TLE/Groucho family. Greater than 50% of Fox proteins contain sequences with high similarity to the eh1 motif, including ten of the nineteen Fox subclasses (A, B, C, D, E, G, H, I, L, and Q) and Fox proteins of early divergent species such as marine sponge. The eh1 motif is not detected in Fox proteins of the F, J, K, M, N, O, P, R and S subclasses, or in yeast Fox proteins. The eh1-like motifs are positioned C-terminal to the winged helix DNA-binding domain in all subclasses except for FoxG proteins, which have an N-terminal motif. Two similar eh1-like motifs are found in the zebrafish FoxQ1 and in FoxG proteins of sea urchin and amphioxus. The identification of eh1-like motifs by manual sequence alignment was validated by statistical analyses of the Swiss protein database, confirming a high frequency of occurrence of eh1-like sequences in Fox family proteins. Structural predictions suggest that the majority of identified eh1-like motifs are short α-helices, and wheel modeling revealed an amphipathicity that supports this secondary structure prediction.</p> <p>Conclusion</p> <p>A search for eh1 Groucho interaction motifs in the Fox gene family has identified eh1-like sequences in greater than 50% of Fox proteins. The results predict a physical and functional interaction of TLE/Groucho corepressors with many members of the Fox family of transcriptional regulators. Given the functional importance of the eh1 motif in transcriptional regulation, our annotation of this motif in the Fox gene family will facilitate further study of the diverse transcriptional and regulatory roles of Fox family proteins.</p

A Compendium of Far-Infrared Line and Continuum Emission for 227 Galaxies Observed by the Infrared Space Observatory

Far-infrared line and continuum fluxes are presented for a sample of 227 galaxies observed with the Long Wavelength Spectrometer on the Infrared Space Observatory. The galaxy sample includes normal star-forming systems, starbursts, and active galactic nuclei covering a wide range of colors and morphologies. The dataset spans some 1300 line fluxes, 600 line upper limits, and 800 continuum fluxes. Several fine structure emission lines are detected that arise in either photodissociation or HII regions: [OIII]52um, [NIII]57um, [OI]63um, [OIII]88um, [NII]122um, [OI]145um, and [CII]158um. Molecular lines such as OH at 53um, 79um, 84um, 119um, and 163um, and H2O at 58um, 66um, 75um, 101um, and 108um are also detected in some galaxies. In addition to those lines emitted by the target galaxies, serendipitous detections of Milky Way [CII]158um and an unidentified line near 74um in NGC1068 are also reported. Finally, continuum fluxes at 52um, 57um, 63um, 88um, 122um, 145um, 158um, and 170um are derived for a subset of galaxies in which the far-infrared emission is contained within the ~75" ISO LWS beam. The statistics of this large database of continuum and line fluxes, including trends in line ratios with the far-infrared color and infrared-to-optical ratio, are explored.Comment: Accepted for publication in the Astrophysical Journal Supplement Serie

Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework

Pediatric feeding disorders (PFDs) lack a universally accepted definition. Feeding disorders require comprehensive assessment and treatment of 4 closely related, complementary domains (medical, psychosocial, and feeding skill-based systems and associated nutritional complications). Previous diagnostic paradigms have, however, typically defined feeding disorders using the lens of a single professional discipline and fail to characterize associated functional limitations that are critical to plan appropriate interventions and improve quality of life. Using the framework of the World Health Organization International Classification of Functioning, Disability, and Health, a unifying diagnostic term is proposed: “Pediatric Feeding Disorder” (PFD), defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. By incorporating associated functional limitations, the proposed diagnostic criteria for PFD should enable practitioners and researchers to better characterize the needs of heterogeneous patient populations, facilitate inclusion of all relevant disciplines in treatment planning, and promote the use of common, precise, terminology necessary to advance clinical practice, research, and health-care policy

Contrast media kinetics in multiparametric magnetic resonance imaging before radical prostatectomy predicts the probability of postoperative incontinence.

PURPOSE To evaluate the role of preoperative multiparametric magnetic resonance imaging (MRI) as predictor of post-prostatectomy incontinence (PPI). METHODS We analyzed patients who underwent robot-assisted radical prostatectomy for localized prostate cancer at our institution between July 2015 and April 2017. In these patients, we measured the perfusion quality of the pelvic floor with contrast media kinetics in the preoperative MRI of the prostate and compared the levator ani muscle (region of interest) to the surrounding pelvic muscle structures (reference). Prospectively collected questionnaires regarding urinary incontinence were then evaluated 1 year postoperatively. Outcomes were dichotomized into "continent" (ICIQ-Score = 0-5) and "incontinent" (ICIQ-Score ≥ 6). In each patient, we determined the perfusion ratio of the levator ani muscle divided by the surrounding pelvic muscle structures and compared them among the groups. RESULTS Forty-two patients were included in the study (n = 22 in "continent", n = 20 in "incontinent" group). The median perfusion ratio from the continent group was significantly higher compared to the incontinent group (1.61 vs. 1.15; 95% CI 0.09-0.81, p = 0.015). The median perfusion ratio in "excellent" (ICIQ-Score = 0) was significantly higher than in "poor" (ICIQ-Score ≥ 11) outcomes (1.48 vs. 0.94; 95% CI 0.04-1.03, p = 0.036). Further, a higher perfusion ratio was negatively correlated with ICIQ-Score (r = - 0.33; 95% CI - 0.58 to 0.03; p = 0.031). CONCLUSIONS Our data demonstrate a promising new strategy to predict PPI through the perfusion quality of pelvic muscle structures with contrast media kinetics. This may facilitate preoperative patient consulting and decision-making