Theoretical and Applied Perspectives on Power: Recognizing Processes That Undermine Effective Community-University Partnerships

Interrelational power dynamics are intimately connected to the success of any relationship and are especially critical in developing and sustaining mutually beneficial, reciprocally engaged partnerships. This work analyzes how elements of power impact the negotiation of engagement in community-university partnerships. Although this piece is a general theoretical account of power, it indicates very specific implications for community partners. A hypothetical example is used to contextualize distinct power challenges that confront community partners and faculty members during the engagement process. Specific attention is given to how organizational structure, the academic calendar, and the creation of knowledge influence produced understandings of differentials in power and differentials in need. The paper concludes with a discussion of three applied strategies that can be used to neutralize differentials in power and recognize differentials in need associated with the development of community-university partnerships. The theoretical language of differentials in power and differentials in need will arm practitioners with analytical tools to shape more meaningful partnerships

Reconstruction for Renal Artery Aneurysm and its Effect on Hypertension

AbstractObjectives: many renal artery aneurysms (RAA) are diagnosed incidentally in the course of investigations for hypertension and their management is controversial. Aim: to review the results of renal artery reconstruction for RAA. Methods: between January 1978 and December 1998 111 RAR were performed in 81 kidneys in 71 patients. Results: fifty-nine patients were hypertensive, three had a creatinine >2.0 mg/dl and one was on dialysis. The principal underlying pathology was fibromuscular dysplasia (39) and atherosclerosis (17). The mean RAA diameter was 2.2 (range 1–15) cm overall and 3.5 (range 2–10) cm in four patients who presented with rupture. Fifty-one patients had renal artery stenosis. Autogenous material was used in 105 RAR. There was no 30-day mortality and the morbidity rate was 16%. The 5-year cumulative patency rate was 69%. Hypertension was cured in 25% and improved in 39%.Conclusions: RAR tested for RAA treats hypertension and reduces the risk of rupture and distal embolisation

On the numerical solution of Kronecker-based infinite level-dependent QBD processes

Cataloged from PDF version of article.Infinite level-dependent quasi-birth-and-death (LDQBD) processes can be used to model Markovian systems with countably infinite multidimensional state spaces. Recently it has been shown that sums of Kronecker products can be used to represent the nonzero blocks of the transition rate matrix underlying an LDQBD process for models from stochastic chemical kinetics. This paper extends the form of the transition rates used recently so that a larger class of models including those of call centers can be analyzed for their steady-state. The challenge in the matrix analytic solution then is to compute conditional expected sojourn time matrices of the LDQBD model under low memory and time requirements after truncating its countably infinite state space judiciously. Results of numerical experiments are presented using a Kronecker-based matrix-analytic solution on models with two or more countably infinite dimensions and rules of thumb regarding better implementations are derived. In doing this, a more recent approach that reduces memory requirements further by enabling the computation of steady-state expectations without having to obtain the steady-state distribution is also considered. (C) 2013 Elsevier B.V. All rights reserved

Estimating the opportunity costs of bed-days.

Opportunity costs of bed-days are fundamental to understanding the value of healthcare systems. They greatly influence burden of disease estimations and economic evaluations involving stays in healthcare facilities. However, different estimation techniques employ assumptions that differ crucially in whether to consider the value of the second-best alternative use forgone, of any available alternative use, or the value of the actually chosen alternative. Informed by economic theory, this paper provides a taxonomic framework of methodologies for estimating the opportunity costs of resources. This taxonomy is then applied to bed-days by classifying existing approaches accordingly. We highlight differences in valuation between approaches and the perspective adopted, and we use our framework to appraise the assumptions and biases underlying the standard approaches that have been widely adopted mostly unquestioned in the past, such as the conventional use of reference costs and administrative accounting data. Drawing on these findings, we present a novel approach for estimating the opportunity costs of bed-days in terms of health forgone for the second-best patient, but expressed monetarily. This alternative approach effectively re-connects to the concept of choice and explicitly considers net benefits. It is broadly applicable across settings and for other resources besides bed-days