Helping to Support CPC+ Initiative to Integrate Behavioral Health Within Primary Care: A Team-Based Approach to Improving Depression Management

AIM: The objective of this project is to increase the rate of documented successful treatment of depression for both new and established diagnoses of depression at Jefferson Internal Medicine Associates (JIMA) from 29% to 50% over 12 months.https://jdc.jefferson.edu/patientsafetyposters/1027/thumbnail.jp

Socioeconomic Disparities Exist in Access to Rotator Cuff Repair Surgery

Background: The relationship of socioeconomic disparity in access to rotator cuff repair (RCR) has not been well studied. Socioeconomic, racial, and ethnic disparities in access to surgical management of rotator cuff tears have previously been described in patients with commercial insurance. This study is a population-level analysis which investigates racial and ethnic disparities in access to surgical rotator cuff repair across multiple health insurance statuses. Purpose: (1) Is non-white race and ethnicity associated with lower rates of RCR? (2) Do these associations change throughout different insurance statuses? Methods: We used the Healthcare Cost and Utilization Project (HCUP) database to identify patients who underwent elective RCR in Florida, Maryland, Iowa, and Wisconsin in 2016 and 2017. White and non-white patients who underwent RCR were compared by insurance status. To evaluate whether demographics of patients who underwent RCR reflected the general population, patients within the HCUP sample were compared to US census-level data for the same states and years, including a subgroup analysis by insurance status. Results: There were 81,607 patients in the HCUP sample who underwent rotator cuff repair, of whom 81% were white and 19% were non-white. 55% had commercial insurance, 39% had Medicare insurance, and 5% had Medicaid insurance. Compared to census data, all races/ethnicities other than non-Hispanic white were underrepresented in the sample of patients who underwent rotator cuff repair (p Conclusion: This analysis of disparities is the first large database study to examine the relationship between gender, race, insurance status, and elective RCR. Regardless of insurance status, patients who underwent elective RCR were more likely to be white and male when compared with the general population, suggesting a persistence of disparities

Firewall? or Wall on Fire? A Unified Framework of Conflict Contagion and the Role of Ethnic Exclusion

While some borders are real firewalls against conflicts, others appear like tinder just waiting for the smallest spark. Only recently has research focused on the transnational perspective of conflict and current research has focused mostly on isolated aspects of this phenomenon. In this article, we provide a unified framework for conflict contagion that takes into account receiver, sender, dyad, and network effects. This is a novel perspective on conflict contagion, and our empirical results suggest that distinguishing between sender and receiver effects allows for a better understanding of spillover effects. We provide insights that especially excluded ethnic groups impact the risk of countries sending and receiving conflicts from its neighbors

17-Hydroxyprogesterone Caproate Does Not Prevent Preterm Birth in Women with a Twin Pregnancy and a Prior Singleton Spontaneous Preterm Birth

INTRODUCTION: Prior spontaneous preterm birth (sPTB) is a risk factor for recurrent sPTB. Weekly 17-hydroxyprogesterone caproate (17P) is used to prevent sPTB in singletons, but there is insufficient evidence on its benefit in twin pregnancies. OBJECTIVE: We hypothesized that 17P weekly injections would reduce the likelihood of sPTB in women carrying a twin pregnancy with a history of singleton sPTB. METHODS: We performed a retrospective case control study of women with a twin gestation and prior singleton sPTB between 2005 and 2016. The study group consisted of women with a twin gestation that received weekly 17P starting at 16 to 20 weeks versus those who did not. The primary outcome was twin sPTB discharge. RESULTS: Of 79 patients included, 27 women received weekly 17P and 52 did not. There were no statistically significant differences in maternal demographics (except maternal age) or in the rate of sPTB controls. There was no statistically significant difference in the rate of sPTB weeks, mean birth weight, or mode of delivery between study and control groups. Composite neonatal morbidity occurred in 20 neonates (74%) in the study group and in 41 control pregnancies (79%). DISCUSSION: Weekly 17P injections do not appear to decrease the incidence of sPTB or neonatal complications in twin pregnancies with a history of prior singleton sPTB. This study will therefore guide future patient management on this common obstetric dilemma

Convincing State-Builders? Disaggregating Internal Legitimacy in Abkhazia

De facto states, functional on the ground but unrecognized by most states, have long been black boxes for systematic empirical research. This study investigates de facto states’ internal legitimacy—people's confidence in the entity itself, the regime, and institutions. While internal legitimacy is important for any state, it is particularly important for de facto states, whose lack of external legitimacy has made internal legitimacy integral to their quest for recognition. We propose that the internal legitimacy of de facto states depends on how convincing they are to their “citizens” as state-builders. Using original data from a 2010 survey in Abkhazia, we examine this argument based on respondent perceptions of security, welfare, and democracy. Our findings suggest that internal legitimacy is shaped by the key Weberian state-building function of monopoly of the legitimate use of force, as well as these entities’ ability to fulfill other aspects of the social contract

Reactions of hydrogen and oxygen atoms on interstellar grain analogues

The region of space between stars, the interstellar medium, has been found to contain over 160 chemical species to date. These molecules are contained within regions of gas and dust, measuring several light years across, known as interstellar dust clouds. Many of these molecular species are formed in the gas phase, for example, via the reactions of molecules with ions. However, some critical gas phase processes are often slow due to the low temperatures and pressures found in the interstellar medium and cannot readily account for the abundances of some species. Consequently reactions on the surfaces of interstellar dust grains are often invoked to explain the abundances some molecules. These dust grains represent approximately 1 % of the mass of a typical interstellar dust cloud and typically consist of carbon, silicates or metal oxides. The temperature of these interstellar dust grains is low enough (~ 10 K) that over time icy mantles consisting of simple atomic and molecular species can build up on their surfaces. Whether and how these simple species can be processed to form more complex molecules such as alcohols, simple sugars and potentially amino acids is a key astrochemical problem. One way in which astrophysical ices can be processed to form more complex species is via the reactions of species within the ice with simple free radicals such as H, C, N and O. This thesis therefore presents experimental studies of the reactions of atomic species with some astrophysically relevant molecular ices under interstellar conditions. Since hydrogen and oxygen are the first and third most abundant elements in the interstellar medium respectively, these experiments have specifically focussed upon the reactions of hydrogen and oxygen atoms. In addition to the characterization of surface reactions between key astrochemical species, kinetic parameters for use in astrochemical models are derived from these experiments

Splitting It Up: The spduration Split-Population Duration Regression Package for Time-Varying Covariates

We present an implementation of split-population duration regression in the spduration (Beger et al., 2017) package for R that allows for time-varying covariates. The statistical model accounts for units that are immune to a certain outcome and are not part of the duration process the researcher is primarily interested in. We provide insights for when immune units exist, that can significantly increase the predictive performance compared to standard duration models. The package includes estimation and several post-estimation methods for split-populationWeibull and log-logistic models. We provide an empirical application to data on military coups