An investigation of biases in Patient Safety Indicator score distribution among hospital cohorts

Denman Research Forum- 2nd Place, Health Professions-ClinicalThe Centers for Medicare and Medicaid Services (CMS) have implemented a hospital reimbursement system that incentivizes payment proportional to the quality of care delivered and performance on certain metrics. One such metric is the Agency for Healthcare Research and Quality’s Patient Safety Indicator 90 (PSI-90). It is composed of eight individual indicators designed to flag adverse patient events that are potentially preventable, such as post-operative wound dehiscence and accidental lacerations. CMS publicly reports four of these individual PSI scores (6, 12, 14 and 15) in addition to the composite PSI-90. Previous studies question the PSIs’ validity beyond screening purposes and furthermore question the underlying administrative data’s ability to accurately and reliably flag such events. This study looks to analyze biases in PSI score distribution for hospitals depending on teaching status, differences in patient demographics and lastly, interactions between teaching status and patient demographic factors and their ability to account for differences in PSI rates. Significant differences were found between teaching and non-teaching hospitals for PSIs 6, 12, 15 and 90 (p<0.01). Inpatient volume and patient severity (p<0.01) were found to be significantly different between teaching status cohorts. Lastly, significant differences in PSI scores were found between patient severity quartiles for PSI 6, 15 and 90 (p<0.05) and between socio-economic quartiles for PSI 6, 12, 15 and 90 (p<0.05); but interaction between patient severity and teaching status was only significant for PSI 90 (p<0.05) and between socioeconomic and teaching statuses for PSI 6 (p<0.05). These results indicate current PSI score distributions may be biased against teaching hospitals for 4 out of 5 PSI measures. Further studies will involve assessing the adequacy of risk-adjustment methodology for PSI metrics. Until then, use of PSI metrics to determine federal reimbursement can lead to bias against teaching hospitals.A three-year embargo was granted for this item.Academic Major: Health Information Management and System

Who do you Blame in Local Finance? An Analysis of Municipal Financing in Italy

A 1999 reform allowed Italian Mayors to partially substitute a more accountable source of tax revenue (the property tax) with a less transparent one (a surcharge on the personal income tax). Theoretical analysis suggests this should give incompetent Mayors a less costly way to hide themselves, so allowing them to be more easily re-elected. An empirical analysis on Piedmont municipalities confirms these hypotheses.partial decentralization, fiscal federalism, transparency, political behavior

Who do you blame in local finance? An analysis of municipal financing in Italy

A 1999 reform allowed Italian Mayors to partially substitute a more accountable source of tax revenue (the property tax) with a less trans- parent one (a surcharge on the personal income tax). Theoretical anal- ysis suggests this should give incompetent Mayors a less costly way to hide themselves, so allowing them to be more easily re-elected. An em- pirical analysis on Piedmont municipalities conrms these hypotheses.Partial decentralization, fiscal federalism, transparency, political behavior.

Benedetto Croce y El problema del mal en el horizonte del pensamiento hegeliano

Entre los pensadores modernos que han afrontado de forma particularmente significativa el problema del mal, hay que recordar a Benedetto Croce. El presente ensayo trata no tanto de la completa doctrina crociana relativa al problema del mal, sino la 'respuesta' dada en su interpretación de Hegel, partiendo de la consideración de que el mal es necesario, pues sin él no habría realidad, la cual resulta de la síntesis de bien y de mal.Among those modern philosophers who have studied significantly the problem of evil, Benedetto Croce must be without doubt mentioned. The present essay focuses not on Croce’s complete theory of evil, but on the “answer” he offered in his interpretation of Hegel’s writings, considering that evil is necessary since, without it, reality couldn’t exist and that reality is a synthesis of good and evil

Polarization Doped Nanowire Devices as an Alternative to Impurity Doping

Engineering: 2nd Place (The Ohio State University Edward F. Hayes Graduate Research Forum)It is difficult to control electrical conductivity in wide band gap semiconductors using impurity doping because of large ionization energies in these materials. Polarization-induced doping in compositionally graded heterostructures is a possible alternative to impurity doping in certain wide band gap materials. Here we present compositionally graded AlGaN nanowires grown on Si(111) substrates by plasma-assisted molecular beam epitaxy that utilize polarization-induced doping to form p-n junctions. GaN quantum wells are inserted into the nanowires to create polarization-induced nanowire light emitting diodes (PINLEDs) that emit ultraviolet light. Variable temperature electrical measurements show that dopants in the structure are ionized by polarization-induced charge and therefore do not freeze-out at cryogenic temperatures. Furthermore, electroluminescence measurements show that polarization-induced charge alone (i.e. with no intentionally added dopants) can be used to form working LEDs.No embarg

The Hallowed Eve: Dimensions of Culture in a Calendar Festival in Northern Ireland

In Northern Ireland, Halloween is such a major celebration that it is often called the Irish Christmas. A day of family reunions, meals, and fun, Halloween brings people of all ages together with rhyming, storytelling, family fireworks, and community bonfires. Perhaps most important, it has become a day that transcends the social conflict found in this often troubled nation. Through the extensive use of interviews, The Hallowed Eve offers a fascinating look at the various customs, both past and present, that mark the celebration of the holiday. Looking through the lenses of gender, ethnicity, and religious affiliation, Jack Santino examines how the traditions exist in a nonthreatening, celebratory way to provide a model of how life could be in Northern Ireland. Halloween, concludes Santino, is a marriage of death and life, a joining of cultural opposites: indoor and outdoor, domesticity and wildness, male and female, old and young. Although current folk and popular traditions can be divisive, Halloween in Northern Ireland is universally considered to belong to everyone, regardless of their background or political leanings. The holiday is a dramatic example of how a community comes together one day a year, and these Northern Irish traditions capture the fundamental and everyday dimensions of life in Ulster. The definitive look as the uniquely Irish origins of Halloween. —Green Man Review An excellent and incisive probe into what a festival means to a separated culture and how it succeeds, though only for a day, in bringing the two warring factions of Northern Ireland together. —Journal of Popular Culture The variety of Halloween folklore and customs that Santino presents is a window into culture. As such, The Hallowed Eve is often more instructive about fundamental and everyday dimensions of life in Northern Ireland than simplistic, journalistic images of a hopelessly bigoted and war-torn province broadcast to the wider world. —New Hibernia Review The history and ways the Irish celebrate are interesting to read about and let us know more about the culture of the Irish, yesterday and today. —Ohioana Quarterly Depicts a tradition that is not just a celebration but, in a sense, a time of community healing, even if only for one day a year. —Ozarks Mountaineer Santino\u27s past work has associated him as firmly with the American celebration of Halloween as witches, black cats, and vampires. The Hallowed Eve will broaden readers\u27 understanding of the holiday as celebrated in Northern Ireland, and explode some piously held beliefs concerning the relationship of the American and Irish holidays as thoroughly as an M-80 in a jack-o-lantern. —Erika Bradyhttps://uknowledge.uky.edu/upk_folklore/1002/thumbnail.jp

Bent Knee Adaptor for Experimental Testing of Prostheses

Novel prosthetic devices must undergo testing as part of their development. Testing with amputees is problematic at the development stage due to safety and administrative burdens. A bent-knee adaptor allows able-bodied individuals to wear a prosthesis and facilitate prototype testing. An existing bent-knee adaptor was used as a basis to design an improved device. The existing adaptor did not preserve alignment between thigh and prosthesis, resulting in unnatural walking. 3D scanning and printing technologies were used to design the new adaptor. Solid modeling was used to verify that the new design would withstand the loads associated with walking. The device was 3D-printed and attached to a prosthesis, and a preliminary walking test was conducted. Improvements will be required in terms of a better fit between the user\u27s thigh and the adaptor. A systematic procedure will be followed to tune the prosthesis control system. For this, the subject will wear a safety harness and walk over a treadmill. The user will undergo a natural learning process to improve walking.https://engagedscholarship.csuohio.edu/u_poster_2016/1054/thumbnail.jp

Contemporary Occupational Heroes

Paper

Bent Knee Adaptor for Experimental Testing of Prostheses

Novel prosthetic devices must undergo testing as part of their development. Testing with amputees is problematic at the development stage due to safety and administrative burdens. A bent-knee adaptor allows able-bodied individuals to wear a prosthesis and facilitate prototype testing. An existing bent-knee adaptor was used as a basis to design an improved device. The existing adaptor did not preserve alignment between thigh and prosthesis, resulting in unnatural walking. 3D scanning and printing technologies were used to design the new adaptor. Solid modeling was used to verify that the new design would withstand the loads associated with walking. The device was 3D-printed and attached to a prosthesis, and a preliminary walking test was conducted. Improvements will be required in terms of a better fit between the user\u27s thigh and the adaptor. A systematic procedure will be followed to tune the prosthesis control system. For this, the subject will wear a safety harness and walk over a treadmill. The user will undergo a natural learning process to improve walking.https://engagedscholarship.csuohio.edu/u_poster_2016/1054/thumbnail.jp