The Welfare Consequences of Hospital Mergers

In the 1990s the US hospital industry consolidated. This paper estimates the impact of the wave of hospital mergers on welfare focusing on the impact on consumer surplus for the under-65 population. For the purposes of quantifying the price impact of consolidations, hospitals are modeled as an input to the production of health insurance for the under-65 population. The estimates indicate that the aggregate magnitude of the impact of hospital mergers is modest but not trivial. In 2001, average HMO premiums are estimated to be 3.2% higher than they would have been absent any hospital merger activity during the 1990s. In 2003, we estimate that because of hospital mergers private insurance rolls declined by approximately .3 percentage points or approximately 695,000 lives with the vast majority of those who lost private insurance joining the ranks of the uninsured. Our estimates imply that hospital mergers resulted in a cumulative consumer surplus loss of over $42.2 billion between 1990 and 2001. It is estimated that all but a modest$95.4 million of the loss in consumer surplus is transferred from consumers to providers

A systematic review of shared decision making interventions in child and youth mental health: synthesising the use of theory, intervention functions, and behaviour change techniques

Reviews around interventions to improve shared decision making (SDM) for child and youth mental health have produced inconclusive findings on what approaches increase participation. Importantly, the previous reviews did not explore the use of theory, as well as mechanisms of change (intervention functions) and active units of change (behaviour change techniques). The aim of this review was to explore these factors and ascertain how, if at all, these contribute to SDM. Five databases were searched up until April 2020. Studies met inclusion criteria if they were: (a) an intervention to facilitate SDM; (b) aimed at children, adolescence, or young people aged up to 25, with a mental health difficulty, or their parents/guardians; and (c) included a control group. Data were extracted on patient characteristics, study design, intervention, theoretical background, intervention functions, behaviour change techniques, and SDM. Quality assessment of the studies was undertaken using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Eight different interventions met inclusion criteria. The role of theory to increase SDM remains unclear. Specific intervention functions, such as 'education' on SDM and treatment options and 'environmental restructuring' using decision aids, are being used in SDM interventions, as well as 'training' for clinicians. Similarly, behaviour change techniques linked to these, such as 'adding objects to the environment', 'discussing pros/cons', and clinicians engaging in 'behavioural practice/rehearsal'. However, as most studies scored low on the quality assessment criteria, as well as a small number of studies included and a low number of behaviour change techniques utilised, links between behaviour change techniques, intervention functions and increased participation remain tentative. Intervention developers and clinicians may wish to consider specific intervention functions and behaviour change techniques to facilitate SDM

Counseling for Young People and Families Affected by Child Sexual Exploitation and Abuse: A Qualitative Investigation of the Perspective of Young People, Parents, and Professionals

Despite growing awareness of the negative impact of child sexual exploitation on young people’s psychological, emotional and relational lives, little is known about how counseling can support young people and their families. The aim of this study was to explore the experience of counseling for young people and parents affected by child sexual exploitation and abuse, with a view to examining what facilitates progress, from the perspective of young people, parents and professionals. In-depth semi-structured interviews were conducted with 10 young people, 8 parents and 7 professionals and were analyzed using thematic analysis. Findings suggest that through counseling, young people experienced affective and relational improvements that were attributed to the process. Characteristics of the counseling relationship that facilitated progress included being able to talk openly in a caring, non-judgmental and unpressurized environment, as well as receiving advice, techniques or solutions within a holistic approach. Facets of service delivery were also highlighted, including the provision of confidentiality, flexibility and consistency, along with a multi-agency approach that promoted engagement. Perceived obstacles to progress included resistance at the outset and service location issues

Predictive value of respiratory symptoms and bronchial hyperresponsiveness to diagnose asthma in New Zealand

SummaryRespiratory symptoms are often used as the only diagnostic criteria for asthma in epidemiological surveys and the clinical diagnosis of asthma relies primarily on a detailed history. The aim of this study is to predict the diagnostic value of 11 different respiratory symptoms to diagnose asthma, and to determine if bronchial hyperresponsiveness (BHR) improves the predictive value of these respiratory symptoms.A random sample of 1257 subjects aged 20–44 years old in 3 different areas of New Zealand were selected between March 1991 and December 1992 to answer the European Community Respiratory Health Survey questionnaire on respiratory symptoms. Of these, 784 underwent bronchial challenge with methacholine. The prevalence of current doctor diagnosed asthma (DDA) defined as asthma confirmed by a physician and an asthma attack in the last 12 months was 8.3%. Wheezing with dyspnoea is the single best predictor of diagnosed asthma with a sensitivity of 82%, a specificity of 90% and a Youden's index of 0.72. Wheezing alone is more sensitive (94%) but less specific (76%), with a Youden's index of 0.70. The addition of BHR to asthma symptoms decreases sensitivity and increases specificity with a small increase in Youden's index to 0.75. In New Zealand adults, a history of wheezing with BHR best predicts a diagnosis of asthma but wheezing alone or with dyspnoea are the two best symptoms for predicting asthma

Rigorous Physicochemical Framework for Metal Ion Binding by Aqueous Nanoparticulate Humic Substances: Implications for Speciation Modeling by the NICA-Donnan and WHAM Codes

Latest knowledge on the reactivity of charged nanoparticulate complexants toward aqueous metal ions is discussed in mechanistic detail. We present a rigorous generic description of electrostatic and chemical contributions to metal ion binding by nanoparticulate complexants, and their dependence on particle size, particle type (i.e., reactive sites distributed within the particle body or confined to the surface), ionic strength of the aqueous medium, and the nature of the metal ion. For the example case of soft environmental particles such as fulvic and humic acids, practical strategies are delineated for determining intraparticulate metal ion speciation, and for evaluating intrinsic chemical binding affinities and heterogeneity. The results are compared with those obtained by popular codes for equilibrium speciation modeling (namely NICA-Donnan and WHAM). Physicochemical analysis of the discrepancies generated by these codes reveals the a priori hypotheses adopted therein and the inappropriateness of some of their key parameters. The significance of the characteristic time scales governing the formation and dissociation rates of metal−nanoparticle complexes in defining the relaxation properties and the complete equilibration of the metal− nanoparticulate complex dispersion is described. The dynamic features of nanoparticulate complexes are also discussed in the context of predictions of the labilities and bioavailabilities of the metal species

Electrochemical methods for speciation of trace elements in marine waters. Dynamic aspects

The contribution of electrochemical methods to the knowledge of dynamic speciation of toxic trace elements in marine waters is critically reviewed. Due to the importance of dynamic considerations in the interpretation of the electrochemical signal, the principles and recent developments of kinetic features in the interconversion of metal complex species will be presented. As dynamic electrochemical methods, only stripping techniques (anodic stripping voltammetry and stripping chronopotentiometry) will be used because they are the most important for the determination of trace elements. Competitive ligand ex- change-adsorptive cathodic stripping voltammetry, which should be considered an equilibrium technique rather than a dynamic method, will be also discussed because the complexing parameters may be affected by some kinetic limitations if equilibrium before analysis is not attained and/or the flux of the adsorbed complex is in fluenced by the lability of the natural complexes in the water sample. For a correct data interpretation and system characterization the comparison of results obtained from different techniques seems essential in the articulation of a serious discussion of their meaning

Nurses\u27 Alumnae Association Bulletin - Volume 7 Number 11

Anna M. Shafer Barton Memorial Division Births Changes in the Ophthalmology Division Change of Address Clara Melville Fund Continental Tour Deceased Digest of Meetings Inter-County Hospitalization Plan Katherine Childs\u27 Letter Lost Members Marriages Miscellaneous Nursing Home Committee\u27s Report Physical Advantages President James L. Kauffman\u27s Letter President\u27s Greeting Private Duty Section Prizes Relief Fund School Nursing Silhouette of a Public Health Nurse Rooming-in of Infant with Mother Staff Activities The Student White Haven Divisio

Snow‐Atmosphere Humidity Exchange at the Ice Sheet Surface Alters Annual Mean Climate Signals in Ice Core Records

Surface processes alter the water stable isotope signal of the surface snow after deposition. However, it remains an open question to which extent surface post-depositional processes should be considered when inferring past climate information from ice core records. Here, we present simulations for the Greenland Ice Sheet, combining outputs from two climate models with an isotope-enabled snowpack model. We show that surface vapor exchange and associated fractionation imprint a climate signal into the firn, resulting in an increase in the annual mean value of δ18O by +2.3‰ and a reduction in d-excess by −6.3‰. Further, implementing isotopic fractionation during surface vapor exchange improves the representation of the observed seasonal amplitude in δ18O from 65.0% to 100.2%. Our results stress that surface vapor exchange is important in the climate proxy signal formation and needs consideration when interpreting ice core climate records

Laser-plasma interactions in long-scale-length plasmas under direct-drive National Ignition Facility conditions

Laser-plasma interaction experiments have been carried out on the OMEGA laser system [T. R. Boehly et al., Opt. Commun. 133, 495 (1997)] under plasma conditions representative of the peak of a 1.5 MJ direct-drive laser pulse proposed for the National Ignition Facility (NIF). Plasmas have been formed by exploding 18–20 μm thick CH foils and by irradiating solid CH targets from one side, using up to 20 kJ of laser energy with phase plates installed on all beams. These plasmas and the NIF plasmas are predicted to have electron temperatures of 4 keV and density scale lengths close to 0.75 mm at the peak of the laser pulse. The electron temperature and density of the exploding-foil plasmas have been diagnosed using time-resolved x-ray spectroscopy and stimulated Raman scattering, respectively, and are consistent with predictions of the two-dimensional Eulerian hydrodynamics code SAGE [R. S. Craxton and R. L. McCrory, J. Appl. Phys. 56, 108 (1984)]. When the solid-target or exploding-foil plasmas were irradiated with an f/6f/6 interaction beam at 1.5×1015 W/cm2,1.5×1015W/cm2, well above the NIF f/8f/8 cluster intensity of ∼ 2×1014 W/cm2,∼2×1014W/cm2, stimulated Brillouin backscattering (SBS) was found to be completely inhibited. A conservative upper limit of direct-backscattered SRS was found to be ∼5% from the solid targets. SRS and SBS are thus unlikely to have a significant impact on target performance at the peak of the NIF direct-drive laser pulse. © 1999 American Institute of Physics.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/70094/2/PHPAEN-6-5-2072-1.pd