Findings from a Survey of Health Care Delivery Innovation Centers

Health care innovation centers around the country are working to discover, develop, test, and spread new models of care delivery--in hospitals, clinics, and patients' homes. Between November 2014 and January 2015, The Commonwealth Fund conducted an online survey of innovation centers affiliated with health care organizations to learn about their potential role in promoting health system transformation.Survey findings presented in this chartpack reveal how innovation centers define innovation, what factors into investment decisions, which technologies are most commonly used, and much more. While innovation centers have the potential to contribute to health system transformation, it appears that to succeed they will need sustainable funding and greater integration with clinical enterprises. The survey also reveals that innovation centers may benefit from collaboration to identify solutions to common problems and develop a mechanism for spreading their work

Many Labs 2: Investigating Variation in Replicability Across Samples and Settings

We conducted preregistered replications of 28 classic and contemporary published findings, with protocols that were peer reviewed in advance, to examine variation in effect magnitudes across samples and settings. Each protocol was administered to approximately half of 125 samples that comprised 15,305 participants from 36 countries and territories. Using the conventional criterion of statistical significance (p \u3c .05), we found that 15 (54%) of the replications provided evidence of a statistically significant effect in the same direction as the original finding. With a strict significance criterion (p \u3c .0001), 14 (50%) of the replications still provided such evidence, a reflection of the extremely highpowered design. Seven (25%) of the replications yielded effect sizes larger than the original ones, and 21 (75%) yielded effect sizes smaller than the original ones. The median comparable Cohen’s ds were 0.60 for the original findings and 0.15 for the replications. The effect sizes were small (\u3c 0.20) in 16 of the replications (57%), and 9 effects (32%) were in the direction opposite the direction of the original effect. Across settings, the Q statistic indicated significant heterogeneity in 11 (39%) of the replication effects, and most of those were among the findings with the largest overall effect sizes; only 1 effect that was near zero in the aggregate showed significant heterogeneity according to this measure. Only 1 effect had a tau value greater than .20, an indication of moderate heterogeneity. Eight others had tau values near or slightly above .10, an indication of slight heterogeneity. Moderation tests indicated that very little heterogeneity was attributable to the order in which the tasks were performed or whether the tasks were administered in lab versus online. Exploratory comparisons revealed little heterogeneity between Western, educated, industrialized, rich, and democratic (WEIRD) cultures and less WEIRD cultures (i.e., cultures with relatively high and low WEIRDness scores, respectively). Cumulatively, variability in the observed effect sizes was attributable more to the effect being studied than to the sample or setting in which it was studied

Project Safe Flight: Making New York Safe for Migratory Birds

More than 100 species of migratory birds pass through New York City during spring and fall migrations. Located at the nexus of several migratory routes, New York City’s tall buildings and reflective glass pose a serious threat to over 100 species of migratory birds. Since 1997, NYC Audubon has led Project Safe Flight (PSF), a volunteer-based citizen-science project, with the goal of monitoring and mitigating bird collisions. We examined 16 years of PSF data, during which volunteers collected over 6,000 birds of 126 different species. The top two species, White-throated Sparrow and Common Yellowthroat, make up 23% of all collisions. The fall migration has a higher average number of collisions than spring. Distinct phenological trends in species composition are apparent, with American Woodcock making up the majority of early spring collisions and Dark-eyed Junco being the most common in late fall. Because birds may be overlooked by volunteers or be taken by scavengers or maintenance crews after collisions, we performed a persistence study and found that the recovery of bird carcasses was highly variable between sites. This ongoing study is important in developing a database of bird collisions to help elucidate and reduce the causes of urban bird collisions

Racial and Ethnic Health Disparities among Fifth-Graders in Three Cities

http://dx.doi.org/10.1056/NEJMsa111435

‘None of Us Sets Out To Hurt People’: The Ethical Geographer and Geography Curricula in Higher Education

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Geography in Higher Education on 22nd January 2008, available online: https://doi.org/10.1080/03098260701731462This paper examines ethics in learning and teaching geography in higher education. It proposes a pathway towards curriculum and pedagogy that better incorporates ethics in university geography education. By focusing on the central but problematic relationships between (i) teaching and learning on the one hand and research on the other, and (ii) ethics and geography curricula, the authors’ reflections illustrate how ethics may be better recognized within those curricula. They discuss issues affecting teaching and learning about ethics in geography, and through identification of a range of examples identify ways to enhance the integration of ethical issues into university geography curricula

Shifting perspectives on coastal impacts and adaptation

The Intergovernmental Panel on Climate Change reports reflect evolving attitudes in adapting to sea-level rise by taking a systems approach and recognizing that multiple responses exist to achieve a less hazardous coast.info:eu-repo/semantics/publishedVersio

Economic analysis of a transesophageal echocardiography-guided approach to cardioversion of patients with atrial fibrillation The ACUTE economic data at eight weeks

AbstractObjectivesThe aim of this study was to compare the relative cost of a transesophageal echocardiography (TEE)-guided strategy versus conventional strategy for patients with atrial fibrillation (AF) >2 days duration undergoing electrical cardioversion over an eight-week period.BackgroundThe Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) trial found no difference in embolic rates between the two approaches. However, the TEE-guided strategy had a shorter time to cardioversion and a lower rate of composite bleeding. While similar clinical efficacy was concluded, the relative cost of these two strategies has not been explored.MethodsTwo economic approaches were employed in the ACUTE trial. The first approach was based on hospital charge data from complete hospital Universal Billing Code of 1992 forms, a detailed hospital charge questionnaire, or imputation. Regression analysis was used to investigate the added cost of adverse events. The second economic approach involved the development of an independent analytic model simulating treatment and actual ACUTE outcome costs as a validation of clinically derived data. Sensitivity analysis was performed on the analytic model to investigate the potential range in cost differences between the strategies.ResultsA total of 833 of the 1,222 patients were enrolled from 53 U.S. sites; TEE-guided (n = 420) and conventional (n = 413). At eight-week follow-up, total mean costs did not significantly differ between the two groups, respectively ($6,508 vs.$6,239; difference of $269; p = 0.50). Cumulative costs were 24% higher in the conventional group, primarily due to increased incidence of bleeding and hospital costs associated with bleeding. A separate analytic model showed that treatment costs were higher for the TEE-guided strategy, but outcome costs were higher for the conventional strategy. Sensitivity analysis of the analytic model illustrated that varying the incidence and cost of major bleeding and the cost of TEE had the greatest impact on cost differences between the two groups.ConclusionsIn patients with AF >2 days duration undergoing electrical cardioversion, the TEE-guided group showed little difference in patient costs compared with the conventional group. The TEE strategy had higher initial treatment costs but lower outcome-associated costs. Cumulative costs were 24% higher in the conventional group, primarily due to bleeding. The TEE-guided strategy is an economically feasible approach compared with the conventional strategy

Long-ranged attraction between disordered heterogeneous surfaces

Long-ranged attractions across water between two surfaces that are randomly covered with (mobile) positive and negative charge domains have been attributed to induced correlation of the charges (positive lining up with negative) as the surfaces approach. Here we show, by directly measuring normal forces under a rapid shear field, that these attractions may not in fact be due to such correlations. It is rather the inherent interaction-asymmetry between equally- and between oppositely-charged domains that results in the long-ranged attraction even in the complete absence of any charge correlation

A Controlled Trial of Isoniazid in Persons with Anergy and Human Immunodeficiency Virus Infection Who Are at High Risk for Tuberculosis

BACKGROUND Patients with human immunodeficiency virus (HIV) infection and latent tuberculosis are at substantial risk for the development of active tuberculosis. As a public health measure, prophylactic treatment with isoniazid has been suggested for HIV-infected persons who have anergy and are in groups with a high prevalence of tuberculosis. METHODS We conducted a multicenter, randomized, double-blind, placebo-controlled trial of six months of prophylactic isoniazid treatment in HIV-infected patients with anergy who have risk factors for tuberculosis infection. The primary end point was culture-confirmed tuberculosis. RESULTS The study was conducted from November 1991 through June 1996. Over 90 percent of the patients had two or more risk factors for tuberculosis infection, and nearly 75 percent of patients were from greater New York City. After a mean follow-up of 33 months, tuberculosis was diagnosed in only 6 of 257 patients in the placebo group and 3 of 260 patients in the isoniazid group (risk ratio, 0.48; 95 percent confidence interval, 0.12 to 1.91; P=0.30). There were no significant differences between the two groups with regard to death, death or the progression of HIV disease, or adverse events. CONCLUSIONS Even in HIV-infected patients with anergy and multiple risk factors for latent tuberculosis infection, the rate of development of active tuberculosis is low. This finding does not support the use of isoniazid prophylaxis in high-risk patients with HIV infection and anergy unless they have been exposed to active tuberculosis