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Introduction: Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. We have demonstrated the validity of a bedside targeted swallow evaluation following cardiac surgery. Since dysphagia following liver transplantation is not well examined, we evaluated the efficacy of this swallow screen method in postoperative liver transplant patients. Methods: This was a prospective trial involving adult patients who underwent liver transplant surgery at our institution over a 5-month period. Within 24 hours of extubation and prior to the initiation of oral intake, all patients were evaluated using the targeted swallow screen, which is a direct assessment of mental status and laryngeal sensation/elevation upon swallowing of progressively larger amounts of water. A fiberoptic endoscopic evaluation of swallowing was requested for failed screenings. Results: During the study, 50 patients were screened. Twenty (40%) failed the targeted swallow screen, while 18 (90%)/20 failed the subsequent fiberoptic endoscopic examination (overall dysphagia incidence = 40%). Patients with dysphagia were older and had significantly longer intensive care unit and hospital stays. The screening test had a 90% sensitivity and a specificity of 83% for detecting dysphagia. Conclusion: The true incidence of dysphagia following liver transplantation appears to be significantly higher than previously recognized. A simple bedside swallow screen can efficiently screen these patients for dysphagia. Our findings require further validation and may support programs for reduction and early detection of dysphagia. [ABSTRACT FROM AUTHOR]

Local governments prioritize spending on various types and levels of public services. Although scholars have shown that citizen preferences and institutional factors, such as economic, political, and legal arrangements, play a role in resource allocation, scholars have not systematically examined the impact of local elected officials’ own ideological preferences on service prioritization. A better understanding of the impact of personal ideology on local government resource allocation is needed as this provision of funds has implications for democratic governance and responsiveness. We develop and use a novel measure of local elected official ideology using a 2011 survey of California local elected officials to test the hypothesis that local decision-maker ideology affects attitudes on funding-specific service categories. We find evidence that local elected officials’ attitudes toward service reductions are associated with both their own individual ideology, measured on the conservative–liberal spectrum, and the ideology of their constituents. [ABSTRACT FROM AUTHOR]

Objective. We tested the Analytical Hierarchy Process tool for its use in public health to identify potential gaps in emergency preparedness by local health departments (LHDs) in California and Hawaii during a radiological emergency. Methods. We developed a dedicated tool called All-Hazards Preparedness Squared (AHP2) that can be used by those who are responsible for all-hazards preparedness planning and response to guide them while making strategic decisions both in preparing for and responding to a slow-moving incident while it is unfolding. The tool is an Internet-based survey that can be distributed among teams responsible for emergency preparedness and response. Twenty-eight participants from 16 LHDs in California and Hawaii responsible for coordinating preparedness and response in a radiological emergency participated in using the tool in 2013. We used the data to compare the perceived importance of different elements of preparedness among participants and identify gaps in preparedness of their organizations for meeting the challenges presented by a radiological incident. Results. Clarity of information and transfer of information (to and from agency to public, state, and federal partners) were public health officials’ dominant concerns while responding to an emergency. Participants also found that there were gaps in the adequacy of training and awareness of the chain of command during a radiological emergency. Conclusion. This preliminary study indicates that the AHP2 tool could be used for decision making in all-hazards preparedness planning and response. [ABSTRACT FROM AUTHOR]

Explaining strategies of political action committee (PAC) contributions to candidates takes two forms. Scholars emphasize either PAC or candidate characteristics as having more explanatory power over variation in PAC contributions, and this choice results in different expectations for PAC contribution patterns. Using California fruit, nut, and wine PACs, this research revisits a much-debated question: Why do PACs give to some candidates and not others? The findings indicate a mediated model best explains PAC contributions, as these PACs contribute money according to legislator characteristics but predominantly within the state of California. [ABSTRACT FROM AUTHOR]