Targeting Poverty in the Courts: Improving the Measurement of Ability to Pay

Ability-to-pay determinations are essential when governments use money-based alternative sanctions, like fines, to enforce laws. One longstanding difficulty in the U.S. has been the extreme lack of guidance on how courts are to determine a litigant’s ability to pay. The result has been a seat-of-the-pants approach that is inefficient and inaccurate, and, as a consequence, very socially costly. Fortunately, online platform technology presents a promising avenue for reform. In particular, platform technology offers the potential to increase litigant access, reduce costs, and ensure consistent and fair treatment—all of which should lead to more accurate sanctions. We use interviews, surveys, and case-level data to evaluate and discuss the experiences of six courts that recently adopted an online ability-to-pay assessment tool that streamlines and standardizes ability-to-pay determinations. Our findings suggest that the online tool improves accuracy and therefore the effectiveness of fines as punishments, and so it may make the use of fines as sanctions more socially attractive

Receipt, 23 March 1871

https://egrove.olemiss.edu/aldrichdocs/1270/thumbnail.jp

Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis.

OBJECTIVES: A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure temporal trends in sepsis survivorship and hospital-based acute care use in sepsis survivors. In addition, because readmissions after pneumonia are subject to penalty under the national readmission reduction program, we examined whether readmission rates declined after sepsis hospitalizations related to pneumonia. DESIGN AND SETTING: Retrospective, observational cohort study conducted within an academic healthcare system from 2010 to 2015. PATIENTS: We used three validated, claims-based approaches to identify 17,256 sepsis or severe sepsis hospitalizations to examine trends in hospital-based acute care after sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased from 3.9% to 9.4%, whereas in-hospital mortality rate for sepsis hospitalizations declined from 24.1% to 14.8%. As a result, the proportion of medical and surgical discharges at-risk for hospital readmission after sepsis increased from 2.7% to 7.8%. Over 6 years, 30-day hospital readmission rates declined modestly, from 26.4% in 2010 to 23.1% in 2015, driven largely by a decline in readmission rates among survivors of nonsevere sepsis, and nonpneumonia sepsis specifically, as the readmission rate of severe sepsis survivors was stable. The modest decline in 30-day readmission rates was offset by an increase in emergency department treat-and-release visits, from 2.8% in 2010 to a peak of 5.4% in 2014. CONCLUSIONS: Owing to increasing incidence and declining mortality, the number of sepsis survivors at risk for hospital readmission rose significantly between 2010 and 2015. The 30-day hospital readmission rates for sepsis declined modestly but were offset by a rise in emergency department treat-and-release visits

The production, purification and crystallization of a pocilloporin pigment from a reef-forming coral

Reef-building corals contain fluorescent pigments termed pocilloporins that function by regulating the light environment of coral and acting as a photoprotectant in excessive sunlight. These pocilloporins are related to the monomeric green fluorescent protein and the tetrameric DsRed fluorescent proteins, which have widespread use as biotechnological tools. An intensely blue-coloured pocilloporin, termed Rtms5, was expressed in Escherichia coli, purified and crystallized. Rtms5 was shown to be tetrameric, with deep blue crystals that diffract to 2.2 Angstrom resolution and belong to space group I4(1)22. The colour of this pocilloporin was observed to be sensitive to pH and a yellow (pH 3.5) and a red form (pH 4.5) of Rtms5 were also crystallized. These crystals belong to space group P4(2)22 and diffract to 2.4 Angstrom resolution or better

Effects of Yoga on Arm Volume among Women with Breast Cancer Related Lymphedema: A Pilot Study

Lymphedema affects 3–58% of survivors of breast cancer and can result in upper extremity impairments. Exercise can be beneficial in managing lymphedema. Yoga practice has been minimally studied for its effects on breast cancer related lymphedema (BCRL). The purpose of this study was to determine the effect of yoga on arm volume, quality of life (QOL), self-reported arm function, and hand grip strength in women with BCRL. Six women with BCRL participated in modified Hatha yoga 3×/week for 8 weeks. Compression sleeves were worn during yoga sessions. Arm volume, QOL, self-reported arm function, and hand grip strength were measured at baseline, half-way, and at the conclusion of yoga practice. Arm volume significantly decreased from baseline (2423.3 ml ± 597.2) to final measures (2370.8 ml ± 577.2) (p = .02). No significant changes in QOL (p = .12), self-reported arm function (p = .34), or hand grip strength (p = .26) were found. Yoga may be beneficial in the management of lymphedema

Pre-laboratory videos enhance student preparation and confidence

BACKGROUND: Laboratory classes are an integral component of Biochemistry and Molecular Cell Biology undergraduate degrees designed to develop proficiency in technical skills, provide theory in context and promote inquiry-oriented learning. There is increasing body of evidence to suggest that pre-laboratory preparation is beneficial to student learning because students who are well prepared for their laboratory classes are reported to derive maximum benefit from their laboratory experience. AIM: Our aim was to introduce short videos on specific laboratory skills to assist with the pre-laboratory preparation of second and third year Biochemistry and Molecular Biology undergraduates. INTERVENTION: Despite the essential nature of laboratory skills optimal learning in classes is impeded by increasing student numbers and lack of engagement of students. In an effort to engage and better prepare students for their laboratory classes we used brief videos on specific laboratory techniques as pre-laboratory exercises prior to introducing new skills in the practical class. The exemplar used in the current study was a video on SDS-polyacrylamide gel electrophoresis (SDS-PAGE). DESIGN AND METHOD: Teaching staff developed short videos on several laboratory techniques (SDS-PAGE, pipetting, Clarke’s oxygen electrode) using domestic quality equipment (webcam/video camera) and commercially available editing software. The videos were short (no more than 8-10 minutes), concise, could be employed across different units and year levels, featured the exact settings and instruments that were used in class and could be downloaded on to any mobile device and therefore available as a flexible learning tool. Students enrolled in second and third year Biochemistry units were required to view the video on SDS-PAGE prior to attending class, and complete a quiz related to the video content, both of which were accessible on Moodle. The quiz was a formative assessment only. At the completion of the laboratory class students were invited to participate in a questionnaire which explored student feedback on a number of aspects that included functionality of the video, skills development, attitude, learning effectiveness and learning styles. The responses and numerical data were collated and analysed. RESULTS: In both 2nd and 3rd year levels greater than 70% of students reported that the videos reinforced the concepts of the technique while more than 60% found that the content helped integrate the theory with the practice. Data showed that > 50% of reported increased confidence in carrying out specific tasks while more than 50% of students felt they were overall more confident to carry out the class activities. Written comments from students support the numerical survey data that viewing videos prior to attending class made them confident and better prepared for the laboratory class. CONCLUSION: Both survey and qualitative data show that the pre-laboratory videos had a positive impact on student preparation for their practical classes

USE OF PERIPHERAL VASOPRESSORS IN EARLY SEPSIS-INDUCED HYPOTENSION ACROSS MICHIGAN HOSPITALS

INTRODUCTION: Recent data suggest it may be safe to administer vasopressors via peripheral IV (PIV), challenging convention that vasopressors must be delivered centrally. Surviving Sepsis Campaign 2021 guidelines suggest using peripheral vasopressors as a bridge to central access. However, little is known about vasopressor initiation in practice. METHODS: Cohort study of patients hospitalized with community-onset sepsis at 12 hospitals in the Hospital Medicine Safety Consortium (HMS) sepsis initiative. HMS is a Collaborative Quality Initiative sponsored by Blue Cross Blue Shield of Michigan. A random sample of adult sepsis hospitalizations between 11/2020-1/2022 were included. Data were abstracted by trained abstractors. We sought to determine how commonly vasopressors were initiated via PIV vs central access across hospitals. HMS-Sepsis is expanding to 69 hospitals. Here we present pilot data; full cohort analysis is in process. RESULTS: of 1,901 patients in the HMS-Sepsis registry at the time of pilot data analysis, 440 (23.1%) had hypotension (defined by mean arterial pressure\u3c 65mmHg, systolic blood pressure\u3c 90mmHg, and/or vasopressor initiation) within 3 hours of hospital arrival. of these, 160 (36.4%) received vasopressors within 6 hours of hospital arrival. Route of initial vasopressor was PIV in 122 (76.3%), central access in 30 (18.8%), midline catheter in 1 (0.6%), oral (ie, midodrine) in 5 (3.1%), and unknown in 2 (1.3%). Across all hospitals, 50.0% to 91.7% of vasopressor initiation was via PIV (median 83.3%). Among 122 patients with vasopressor initiation via PIV, 66 (54.1%) received a 2nd vasopressor, after a median of 2.8 hrs [IQR 1, 8] from 1st vasopressor. Route of 2nd vasopressor was PIV in 27 (40.9%) and central access in 30 (45.4%). Time from hypotension to vasopressor initiation did not differ between patients receiving initial vasopressor via PIV vs central access (median 1.9 vs 2.1 hrs, p=0.79). Likewise, IV fluids within 6 hrs (median 2.0 vs 2.1L, p=0.78), hospitalization length (median 7 vs 6 days, p=0.31), and inhospital mortality (33.6% vs 40.0%, p=0.51) were similar. CONCLUSIONS: In this 12-hospital cohort, vasopressors were most frequently initiated peripherally. Outcomes were similar between patients in whom vasopressors were initiated via peripheral vs central access