The impact of an extreme climatic disturbance and different fertilization treatments on plant development, phenology, and yield of two cultivar groups of Solanum betaceum Cav

[EN] Changing climatic conditions impose a challenge both to biodiversity and food security. The effects of climate change affect different aspects of the plant or crop, such as morphological and phenological aspects, as well as yield. The effects of greenhouse conditions might be comparable in some cases to a permanent extreme disturbance in climate and weather, thus, contributing to our knowledge on climate change impacts on plant species. We have investigated the differences for 23 traits in two cultivar groups of an Andean traditional crop, Solanum betaceum, under two different environmental conditions that correspond to the traditional practices in the open field and three cultural managements under greenhouse conditions (no fertilization or control, organic, and mineral). We found that traditional practices in the open field are the less productive. Moreover, in warmer and drier conditions the treatment with organic fertilization was the most productive. Greenhouse conditions, however, delay production. We further identified traits that differentiate both cultivar groups and traits that are linked to either the new climate conditions or the fertilization treatments. Fruit characteristics were quite homogeneous between the two cultivar groups. Overall, our results provide insight on the consequences that climate change effects might exert on crops such as tree tomato, reveal that greenhouses can be a robust alternative for tree tomato production, and highlight the need to understand how different managements are linked to different solutions to fulfil the farmers' demands.M.X.R.-G. was funded by Secretaria Nacional de Educacion Superior, Ciencia, Tecnologia e Innovacion (SENESCYT: www.educacionsuperior.gob.ec/) with a Prometeo Fellowship. This research was co-financed by Universidad Politecnica de Madrid, http://www.upm.es/ (Ayudas para proyectos semilla de investigacion PID para Latinoamerica, proyecto AL14-PID-09: http://www.upm.es/sfs/Rectorado/Vicerrectarode%20de%20Relaciones%,20Internacionales/America%20Latina/AyudaLA_Adjud13.pdf) and Universidad Tecnica Tecnica Paticular de Loja, https://www.utpl.edu.ec/ (proyecto PROY_FIN_CCAA_ 0016). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Tandazo-Yunga, J.; Ruíz-González, MJ.; Rojas, J.; Capa-Mora, E.; Prohens Tomás, J.; Alejandro, J.; Acosta-Quezada, P. (2017). The impact of an extreme climatic disturbance and different fertilization treatments on plant development, phenology, and yield of two cultivar groups of Solanum betaceum Cav. PLoS ONE. 12(12). https://doi.org/10.1371/journal.pone.0190316Se0190316121

The extent and determinants of variations in nursing home staffing and practice

Evidence from both anecdotal and investigative sources suggests that nursing home staffing and clinical practice varies considerably across geographical area, even after the functional status of nursing home residents is taken into account. This dissertation documents the existence of significant inter-regional variation in nursing home staffing and clinical practice, and identifies regional market characteristics associated with variation. The conceptual model guiding this analysis assumes that the output of the nursing home production process is measurable along the dimensions of quantity and quality. Severity-adjusted prevalence rates for nursing home clinical practices represent quality. Staffing is modeled as an input into the production of both quality and quantity. As efficient providers, nursing home providers have the incentive to substitute across and within categories of inputs as relative wages change. Since all facilities within a circumscribed market area face the same wage structure, they have the same incentives for substitution, a potential source of variability between markets. Structural characteristics of the market which determine the supply and demand for quality were identified from industrial organization theory and incorporated into a simultaneous equation model. The unit of analysis for this study is the county. Information on nursing homes was obtained from a 1987 federal survey. The Area Resource File provided variables describing the structure of the nursing home market. The model was estimated by 2SLS regression. In reduced form, the model was estimated by weighted least squares. Substitution in response to relative wages or to the relative supply of nursing home personnel is strongly suggested by the results. Evidence for substitution between labor and capital is also obtained from the results of the 2SLS estimations. Competition in the nursing home market was hypothesized to enhance the quality of nursing home services. Results indicate that in markets in which regulation attempts to limit capacity or contain costs, quality is lower. However, the degree of competitive rivalry or the availability of community substitutes for nursing home care does not have an association with nursing home quality. This study contributes to current knowledge of nursing home markets, and has implications for the understanding of the working of health care markets in general. It demonstrates that rather than resulting in waste and duplication with little or no identifiable contribution to quality, non-price competition may lead to beneficial increases in the quality of care provided in nursing homes. By considering a treatment setting in which physician participation and incentives do not predominate, this research should contribute to our understanding of the determinants of variation in all health care settings

Hospital Inefficiency: What is the Impact of Membership in Different Types of Systems?

The primary objective of this study is to assess whether systematic differences in inefficiency are associated with hospital membership in different types of systems. We employed the Battese/Coelli simultaneous stochastic frontier analysis (SFA) technique to estimate hospital cost inefficiency. Mean estimated inefficiency was 8.42%. Membership in different types of systems was related to estimated cost inefficiency (p < .05). Compared to hospitals that were members of centralized health systems, membership in centralized physician/insurance or decentralized systems was associated with decreased inefficiency; membership in independent systems was associated with increased inefficiency

The use of contract licensed nursing staff in U.S. nursing homes.

The extent to which nursing homes rely on the use of contracted licensed staff, factors associated with this staffing practice, and the resultant effect on the quality of resident care has received little public attention. Merging the On-line Survey Certification and Reporting System database with the Area Resource File from 1992 through 2002, the authors regressed organizational and market-level variables on the use of 5 percent or more contract full-time equivalent registered nurses and licensed practical nurses. Since 1997, the proportion of facilities using 5 percent or more contract licensed staff more than tripled. Use of contract nurses was associated with more deficiency citations, characteristics of poorer facilities, and tight labor markets. Nursing homes increasingly rely on contract nurses. The failure of nursing homes to attract and retain a competent, stable workforce creates a vicious cycle of staffing practices, which may lead to decline in quality of care

Home Health Care Quality, Its Costs and Implications for Home Health Value-Based Purchasing

The Home Health Value-based Purchasing (HHVBP) demonstration, incorporating a payment formula designed to incentivize both high-quality care and quality improvement, is expected to become a national program after 2022, when the demonstration ends. This study investigated the relationship between costs and several quality dimensions, to inform HHVBP policy. Using Medicare cost reports, OASIS and Home Health Compare data for 7,673 home health agencies nationally, we estimated cost functions with instrumental variables for quality. The estimated net marginal costs varied by composite quality measure, baseline quality, and agency size. For four of the five composite quality measures, the net marginal cost was negative for low-quality agencies, suggesting that quality improvement was cost saving for this agency type. As the magnitude of the net marginal cost is commensurate with the payment incentive planned for HHVBP, it should be considered when designing the incentives for HHVBP, to maximize their effectiveness