The Impact of the Hospital Value-Based Purchasing Program on Healthy Days, Health Inequity, and Hospital Community Benefit Spending

The Hospital Value-Based Purchasing Program (HVBP) is a Centers for Medicare and Medicaid Services (CMS) program implemented in 2012 to reward acute-care hospitals with incentive payments for the quality of care provided to Medicare patients in inpatient settings. Under this policy, payment adjustments are made based on a variety of factors including clinical quality, patient experience, and cost reductions. This paper uses state-level variation in the implementation of HVBP to ascertain whether the policy led to improvements in Healthy Days (a CDC-designed composite measure of individuals’ self-reported number of physically and mentally “healthy” days per month), health disparities, and community benefit spending patterns using a difference-in-differences model. Notably, this paper adds to economic literature on health equity by utilizing and comparing three measures of health disparity, including a novel measure of health inequity that includes a social justice component in the U.S. context. Results show that the HVBP led to meaningful improvements in Healthy Days, with differential effects based on income and race. It also significantly reduced health disparities and significantly increased certain types of community benefit spending, showing that hospitals can and should be invested in addressing community health. Policymakers should continue to use value-based policies to implement incentives to achieve health equity, but must be more thoughtful and intentional with these efforts by grappling with racial, political, sociological, and economic structures that contribute to inequity

Sirens of Modernity

By the 1960s, Hindi-language films from Bombay were in high demand, not only for domestic and diasporic audiences, but for sizable non-diasporic audiences across Eastern Europe, Central Asia, the Middle East, and the Indian Ocean world. Confounding critics who saw the films as noisy and nonsensical, Bombay films attracted worldwide viewers precisely for their elements of romance, music, and spectacle. In this richly documented history of 1960s Hindi cinema, Samhita Sunya historicizes the emergence of world cinema as a category of cinematic diplomacy that formed in the crucible of the Cold War. Interwoven with this history is an account of the prolific transnational circuits of popular Hindi films. By following archival leads and threads of argumentation within commercial Hindi films that seem to be odd cases—flops, remakes, low-budget comedies, and prestige productions—this book offers a novel map for excavating the historical and ethical stakes of world cinema and world-making via Bombay. “Samhita Sunya’s rich and provocative book offers a needed corrective to contemporary debates on transnational cinema, translation and co-production, and cinephilia by approaching them from a new geographic and historical vantage point. A terrific contribution to a growing body of film studies scholarship that is redefining the field as we know it.” Masha Salazkina, author of In Excess: Sergei Eisenstein’s Mexico “This elegantly written book remaps the atlas of world cinema. Its refreshingly non-Eurocentric perspective, innovative methods for tracing the intersection of material and affective histories of circulation, and transregional scope make it a valuable addition to film studies, South Asian studies, and inquiries into the global 1960s.” Manishita Dass, author of Outside the Lettered City: Cinema, Modernity, and the Public Sphere in Late Colonial Indi

Acculturation: Strategies to Overcome Stress by Migrant Families

Migration contributes to cultural change which involves acculturation, enculturation and resilience. Locational choice, cultural differences, coping mechanisms and learning specific skills help to sustain socio-economic life patterns. Seven domains are linked at the primary level (language, religion, cultural events, entertainment, food, and shopping habits); three at the secondary level (cognitive styles, behavioural patterns, and attitudes). On a temporal scale - acculturation reflects in cultural change of migrants’ psychological character and cultural-economic safety. Acculturation strategies involve processes like integration, separation, assimilation and marginalization based on individual and group identities. The paper will attempt to identify the underlying factors that shape the psychology of a person who decides to migrate. Migrants, when leaving their native place, create two layers of psychological problems and thus different coping strategies adopted by everyone related to migration. The psychological stress of immigrants shall also be explored in this paper and will also focus on the types and impact of migration due to COVID -19 on family, the relationship between work and migration and coping mechanisms. Responsibility should be attached with multiple dimensions centering on personal, familial as well as community levels. In the COVID era, the issue of responsibility becomes the most coveted notion for existence especially in the context of migration

Stretch‐Induced Increase in Cardiac Contractility Is Independent of Myocyte Ca\u3csup\u3e2+\u3c/sup\u3e While Block of Stretch Channels by Streptomycin Improves Contractility After Ischemic Stunning

Stretching the cardiac left ventricle (LV) enhances contractility but its effect on myoplasmic [Ca2+] is controversial. We measured LV pressure (LVP) and [Ca2+] as a function of intra-LV stretch in guinea pig intact hearts before and after 15 min global stunning ± perfusion with streptomycin (STM), a stretch activated channel blocker. LV wall [Ca2+] was measured by indo-1 fluorescence and LVP by a saline-filled latex balloon inflated in 50 μL steps to stretch the LV. We implemented a mathematical model to interpret crossbridge dynamics and myofilament Ca2+ responsiveness from the instantaneous relationship between [Ca2+] and LVP ± stretching. We found that: (1) stretch enhanced LVP but not [Ca2+] before and after stunning in either control (CON) and STM groups, (2) after stunning [Ca2+] increased in both groups although higher in STM versus CON (56% vs. 39%), (3) STM-enhanced LVP after stunning compared to CON (98% vs. 76% of prestunning values), and (4) stretch-induced effects on LVP were independent of [Ca2+] before or after stunning in both groups. Mathematical modeling suggested: (1) cooperativity in cross-bridge kinetics and myofilament Ca2+ handling is reduced after stunning in the unstretched heart, (2) stunning results in depressed myofilament Ca2+ sensitivity in the presence of attached cross-bridges regardless of stretch, and (3) the initial mechanism responsible for increased contractility during stretch may be enhanced formation of cross-bridges. Thus stretch-induced enhancement of contractility is not due to increased [Ca2+], whereas enhanced contractility after stunning in STM versus CON hearts results from improved Ca2+ handling and/or enhanced actinomyosin cross-bridge cycling

Comparison of Cumulative Planimetry versus Manual Dissection to Assess Experimental Infarct Size in Isolated Hearts

Introduction Infarct size (IS) is an important variable to estimate cardiac ischemia/reperfusion injury in animal models. Triphenyltetrazolium chloride (TTC) stains viable cells red while leaving infarcted cells unstained. To quantify IS, infarcted and non-infarcted tissue is often manually dissected and weighed (IS-DW). An alternative is to measure infarcted areas by cumulative planimetry (IS-CP). Methods We prospectively compared these two methods in 141 Langendorff-prepared guinea pig hearts (1.44 ± 0.02 g) that were part of different studies on mechanisms of cardioprotection. Hearts were perfused with Krebs–Ringer\u27s and subjected to 30 min global ischemia after various cardioprotective treatments. Two hours after reperfusion hearts were cut into 6–7 transverse sections (3 mm) and stained for 5 min in 1% TTC and 0.1 M KH2PO4 buffer (pH 7.4, 38 °C). Each slice was first scanned and its infarcted area measured with Image 1.62 software (NIH). Infarctions in individual slices of each heart were averaged (IS-CP) on the basis of their weight. After scanning, IS-DW was determined by careful manual dissection of infarcted from non-infarcted tissue and measuring their respective total weight. Results We found limited tissue permeation of TTC in relation to the slice thickness leaving tissue in the center unstained, as well as significant cross-contamination of stained vs. unstained tissue after manual dissection. IS-CP and IS-DW ranged from 6.0 to 73.1% and 19.4 to 70.5%, respectively, and correlated as follows: IS-DW = (27.6 ± 1.4) + (0.518 ± 0.038) • IS-CP; r = 0.75 (Pearson), p \u3c 0.001. In addition, IS-CP correlated better with return of function after reperfusion like developed left ventricular pressure, contractility and relaxation, and myocardial oxygen consumption. Discussion Despite a good correlation between both methods, limited tissue permeation by TTC diffusion and limited precision in the ability to manually dissect stained from unstained tissue leads to an overestimation of infarct size by dissection and weighing compared to cumulative planimetry

"The Fight for Voice": Exploring Conflict and Participation in Hamilton's Neighbourhood Action Strategy

Despite the widespread popularity of participatory design, research, and planning processes, an analysis of power indicates that participation in these processes is not as inclusive as it is articulated to be. The conflation of participation with consensus models of decision-making have coerced diverse participants into agreeing – often, with the dominant voices in power. Democratic theories of “agonistic pluralism” offer an alternative. Conceptualizing conflicts as a space of diverse viewpoints interacting, agonistic pluralism sees political life as dynamic, evolving, and always moving in and out of conflict. Combining this with an understanding that 1) participatory processes must disrupt power structures in order to advance social justice, and 2) unconscious psychological factors affect individual participation in groups, I conceptualize inclusive democratic participation as a process of internal transformation, therapy, and healing. This internal process then affects external change – leading to public discourse and outcomes benefitting communities experiencing marginalization. Following this framework, I use arts-based interviews to understand how different residents, institutional partners, community developers, and researchers understand and practice participatory democracy in Hamilton’s Neighbourhood Action Strategy. These different understandings of participatory democracy interact and conflict to illustrate 1) how different forms of personal, positional, and systemic power serve to supress diverse perspectives, and 2) how important psychology and social justice are to inclusive democratic participation. Ultimately, this paper claims that a heightened self-awareness of personal, positional, and systemic power can help researchers, designers, and practitioners manage their power in a way that encourages diverse perspectives rather than suppressing them. This is important because when we manage our power in order to facilitate more inclusive democratic participation, we make strides towards a truer democracy with pluralistic public discourse and engagement

A cross-sectional study to find out the prevalence, pattern, risk factors, comorbidities and severity of vascular depression in patients attending psychiatric outpatient department in a tertiary care centre

Background: Depression was declared as the second major cause of disability adjusted life years (DALY) in 2020 and the economic burden experienced by those with depression is next to coronary artery disease. Vascular depression has late age at onset 60 years or older, nonpsychotic subtype, with no family history of mental disorders, presenting with loss of pleasure and functional disability. Depression is accompanied by cerebrovascular lesions as determined by MRI and not accompanied by neurological signs. This has a spiral correlation with various comorbidities leading to diagnostic enigma at one hand and worsened prognosis on the other. This emphasized the early diagnosis and treatment to improve the quality of life.Methods: Patients with age more than 60 years, of either sex, with a mini GDS score ≥5, having the first episode of depression and who gave consent were included.Results: Hypertension thus emerged as a significant risk factor and was positively associated with increased severity of depression. Conclusions: Subclinical cognitive impairment and mild cognitive impairment (MCI) may precede years before the onset of vascular depression. Prompt detection and management of these entities and associated risk factors could prevent or postpone impending vascular depression

Osmotic Energy-Based Micro Hydroelectric Power System

A hydroelectric system has been designed for a distributed generator in the range of 10 to 100 kW. The turbine of this system is run by osmotic power, which is generated from the concentration difference between sea water and fresh water. The concentration difference creates a pressure and a flow rate. This pressure and the flow rate are the power inputs to the turbine. As the system has a high head and a low flow rate, a Pelton turbine is selected, which is the most suitable device or equipment for this power system. Turbine wheel diameter and jet velocity are estimated based on the turbine power and a nominal rotor speed of 1800 rpm, which produces 60 Hz power frequency. Torque and speed are the outputs from the Pelton turbine. By considering ideal conditions the maximum speed and torque outputs are calculated. A permanent magnet synchronous generator (PMSG) is used to generate the electric power. The whole system is divided into four parts. They are osmotic, hydro, mechanical and electrical. The power in each of these types is calculated and found to be the same. Calculations of higher power levels are also done, (100 kW and 250 kW). In the load side, capacitor, inductor, and resistors are connected. The whole system is first implemented in the Matlab/Simulink and the output values have been achieved. Then, the system is implemented in PSIM software. The PMSG model is used in both Matlab/Simulink and PSIM software packages and the same parameters values of PMSG are considered for both models. The PMSG outputs are electrical current and voltage. The voltage and current outputs from Matlab and PSIM have been compared and found same. The system is also implemented experimentally. An emulation has been done from this setup. In the experimental setup, all the parameter values are taken same those in Matlab model. The voltage, current, and frequency have been measured from the experimental setup and these results are compared with the Matlab outputs. Model is validated using experimental results

FAKTOR-FAKTOR YANG MEMPENGARUHI ONLINE SHOPPING DECISION ZALORA ONLINE STORE INDONESIA

Tujuan penelitian ini adalah mengetahui faktor-faktor apa sajakah yang mempengaruhi Online Shopping Decision Zalora Online Store Indonesia. Pengambilan sampel menggunakan kuesioner yang disebar melalui Google forms terhadap 200 orang responden di Indonesia dengan populasi pengguna internet di Indonesia. Data yang didapat dari berbagai literatur, artikel serta jurnal, didapatkan bahwa ada lima variabel yang mempengaruhi Online Shopping Decision, yaitu: Behavioral Control Perception (HV), Convenience Perception (NT), Subjective Standard (CQ), Price Expectation (MD) dan Website Impact (WS). Penelitian ini menguji statistik kelima variabel tersebut dan memperoleh informasi bahwa kelima variabel tersebut berpengaruh secara signifikan terhadap Online Shopping Decision Zalora Online Store Indonesia. Serta melalui Stepwise Method didapatkanlah suatu kombinasi terbaik yang paling berpengaruh dari semua kemungkinan yaitu antara dua variabel: Price Expectation (MD) dan Subjective Standard (CQ). Disarankan agar Zalora memberi rekomendasi produk dengan penawaran menarik, memperlihatkan komentar pembeli sebelumnya, memberi keterangan hemat dan promosi kemudahan berbelanja online di Zalora yang gratis ongkos pengiriman untuk meningkatkan Price Expectation. Juga memberi after sales service yang baik, memastikan barang sampai tepat waktu, meningkatkan brand image di masyarakat melalui promosi dan membuat program kode promo untuk meningkatkan Subjective Standard