Identifying prognostic factors for clinical outcomes and costs in four high-volume surgical treatments using routinely collected hospital data

Identifying prognostic factors (PFs) is often costly and labor-intensive. Routinely collected hospital data provide opportunities to identify clinically relevant PFs and construct accurate prognostic models without additional data-collection costs. This multicenter (66 hospitals) study reports on associations various patient-level variables have with outcomes and costs. Outcomes were in-hospital mortality, intensive care unit (ICU) admission, length of stay, 30-day readmission, 30-day reintervention and in-hospital costs. Candidate PFs were age, sex, Elixhauser Comorbidity Score, prior hospitalizations, prior days spent in hospital, and socio-economic status. Included patients dealt with either colorectal carcinoma (CRC, n = 10,254), urinary bladder carcinoma (UBC, n = 17,385), acute percutaneous coronary intervention (aPCI, n = 25,818), or total knee arthroplasty (TKA, n = 39,214). Prior hospitalization significantly increased readmission risk in all treatments (OR between 2.15 and 25.50), whereas prior days spent in hospital decreased this risk (OR between 0.55 and 0.95). In CRC patients, women had lower risk of in-hospital mortality (OR 0.64), ICU admittance (OR 0.68) and 30-day reintervention (OR 0.70). Prior hospitalization was the strongest PF for higher costs across all treatments (31–64% costs increase/hospitalization). Prognostic model performance (c-statistic) ranged 0.67–0.92, with Brier scores below 0.08. R-squared ranged from 0.06–0.19 for LoS and 0.19–0.38 for costs. Identified PFs should be considered as building blocks for treatment-specific prognostic models and information for monitoring patients after surgery. Researchers and clinicians might benefit from gaining a better insight into the drivers behind (costs) prognosis

Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

textabstractThere is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008–2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores

Erosion of Farmer Field Schools in Ecuador: Politics of Agricultural Science and Development Practice

The recognition that innovation occurs in networks of heterogeneous actors and requires broad systemic support beyond knowledge brokering has resulted in a changing landscape of the intermediary domain in an increasingly market-driven agricultural sector in developing countries. This paper presents findings of an explorative case study that looked at 22 organisations identified as fulfilling an intermediary role in the Kenyan agricultural sector. The results show that these organisations fulfill functions that are not limited to distribution of knowledge and putting it into use. The functions also include fostering integration and interaction among the diverse actors engaged in innovation networks and working on technological, organisational and institutional innovation. Further, the study identified various organisational arrangements of innovation intermediaries with some organisations fulfilling a specialised innovation brokering role, even as other intermediaries take on brokering as a side activity, while still substantively contributing to the innovation process. Based on these findings we identify a typology of 4 innovation intermediation arrangements, including technology brokers, systemic brokers, enterprise development support and input access support. The results indicate that innovation brokering is a pervasive task in supporting innovation and will require policy support to embed it in innovation support arrangements. The paper is not normative about these arrangements

Ex Ante Scale Dynamics Analysis in the Policy Debate on Sustainable Biofuels in Mozambique

In this paper, we explore how ex ante scale dynamics analysis can contribute to better understanding of interactions between scales and levels, and how these interactions influence solution space in policy processes. In so doing, we address opportunities and challenges of conducting ex ante scale dynamics analysis as part of an action-oriented social science research approach that seeks to enhance its contribution to more scale-sensitive policy development. The policy debate on sustainable biofuels in Mozambique provides the empirical context in which we analyze interactions across administrative, institutional, and economic scales and levels, and how these interactions influence the space in which policy solutions can be explored and designed. On the basis of the analysis, we conclude that ex ante scale dynamics analysis can contribute to: (1) increasing awareness of interactions between scales and levels, and their implications for policy, (2) identifying immediate and potential matches and mismatches between scales and levels, and developing (adaptive) capacity to address them, and (3) identifying stakeholders and their scale- and level-related interests that can provide the basis for collaborative multi-stakeholder learning. Consequently, ex ante scale dynamics analysis can provide an important contribution to balancing and harmonizing interactions across different scales and levels, from which innovative and scale-sensitive policy responses can emerge. As part of an action-oriented, social science research approach, careful attention needs to be paid to processes of scale and level inclusion and exclusion when conducting scale dynamics analysis

Raman spectroscopy for guidance of vulvar cancer surgery:A pilot study

For vulvar squamous cell carcinoma (VSCC), the mainstay of treatment is surgical removal with tumour-free margins. Surgeons still operate without objective tools that provide margin-status. This study assesses Raman spectroscopy potentiality for distinguishing ex-vivo VSCC from healthy tissue in 11 patients. Grid-based Raman maps were obtained from processed spectra. Water content and C-H band ratio (2,910-2,966 cm(-1) / 2810-2890 cm(-1)) were calculated per spectrum and used as linear discriminant parameters. Healthy tissue was differentiated from VSCC with 0.90 discriminative power, 0.79 sensitivity and 0.86 specificity.This is an important step towards the development of objective tools for VSCC surgical guidance

A genome-wide screen identifies genes that suppress the accumulation of spontaneous mutations in young and aged yeast cells

To ensure proper transmission of genetic information, cells need to preserve and faithfully replicate their genome, and failure to do so leads to genome instability, a hallmark of both cancer and aging. Defects in genes involved in guarding genome stability cause several human progeroid syndromes, and an age-dependent accumulation of mutations has been observed in different organisms, from yeast to mammals. However, it is unclear whether the spontaneous mutation rate changes during aging and whether specific pathways are important for genome maintenance in old cells. We developed a high-throughput replica-pinning approach to screen for genes important to suppress the accumulation of spontaneous mutations during yeast replicative aging. We found 13 known mutation suppression genes, and 31 genes that had no previous link to spontaneous mutagenesis, and all acted independently of age. Importantly, we identified PEX19, encoding an evolutionarily conserved peroxisome biogenesis factor, as an age-specific mutation suppression gene. While wild-type and pex19Δ young cells have similar spontaneous mutation rates, aged cells lacking PEX19 display an elevated mutation rate. This finding suggests that functional peroxisomes may be important to preserve genome integrity specifically in old cells