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Background and aims: A 12‐week placebo‐controlled, sequential parallel Accelerated Development of Additive Pharmacotherapy Treatment for Methamphetamine Use Disorder (ADAPT‐2) trial evaluated the effects of extended‐release injectable naltrexone plus extended‐release oral bupropion (NTX + BUPN) on methamphetamine (MA) use over two stages. This study reports on the previously unpublished stage 2 MA use in participants randomized at stage 1 to receive NTX + BUPN through both stages compared with those assigned to placebo. Design: This is a secondary analysis of the US National Institute on Drug Abuse (NIDA) ADAPT‐2 network trial. Setting: The parent ADAPT‐2 trial was carried out across multiple NIDA Clinical Trials Network (CTN) sites in the United States. Participants: This analysis includes 403 people with MA use disorder who participated in the ADAPT‐2 CTN trial. Intervention and comparator: NTX + BUPN was compared with placebo over the course of the trial. Measurement MA use was measured by urine drug screens conducted twice weekly for 12 weeks, then once in week 13 and once in week 16 post‐treatment follow‐up. Findings Participants on NTX + BUPN in stage 1 showed an additional 9.2% increase [95% confidence interval (CI), 0.09%–17.9%, P = 0.038] during stage 2 in their probability of testing negative for MA, with a total increase of 27.1% (95% CI, 13.2%–41.1%, P < 0.001) over the full 12 weeks of treatment. In contrast, participants on placebo in both stages increased in probability of testing MA‐negative by a total of 11.4% (95% CI, 4.1%–18.6%, P = 0.002) over all 12 weeks. The 12‐week increase among participants on NTX + BUPN was significantly greater—by 15.8% (95% CI, 4.5%–27.0%, P = 0.006)—than the increase among those on placebo. Conclusion: For people with methamphetamine (MA) use disorder receiving treatment with extended‐release injectable naltrexone plus extended‐release oral bupropion (NTX + BUPN), continued treatment with NTX + BUPN after 6 weeks is associated with additional reductions in MA use up to 12 weeks. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic stress disorder (PTSD) is associated with cognitive impairments. It is unclear whether problems persist after PTSD symptoms remit. Methods: Data came from 12 270 trauma-exposed women in the Nurses' Health Study II. Trauma and PTSD symptoms were assessed using validated scales to determine PTSD status as of 2008 (trauma/no PTSD, remitted PTSD, unresolved PTSD) and symptom severity (lifetime and past-month). Starting in 2014, cognitive function was assessed using the Cogstate Brief Battery every 6 or 12 months for up to 24 months. PTSD associations with baseline cognition and longitudinal cognitive changes were estimated by covariate-adjusted linear regression and linear mixed-effects models, respectively. Results: Compared to women with trauma/no PTSD, women with remitted PTSD symptoms had a similar cognitive function at baseline, while women with unresolved PTSD symptoms had worse psychomotor speed/attention and learning/working memory. In women with unresolved PTSD symptoms, past-month PTSD symptom severity was inversely associated with baseline cognition. Over follow-up, both women with remitted and unresolved PTSD symptoms in 2008, especially those with high levels of symptoms, had a faster decline in learning/working memory than women with trauma/no PTSD. In women with remitted PTSD symptoms, higher lifetime PTSD symptom severity was associated with a faster decline in learning/working memory. Results were robust to the adjustment for sociodemographic, biobehavioral, and health factors and were partially attenuated when adjusted for depression. Conclusion: Unresolved but not remitted PTSD was associated with worse cognitive function assessed six years later. Accelerated cognitive decline was observed among women with either unresolved or remitted PTSD symptoms. [ABSTRACT FROM AUTHOR]

The effects of randomization to mindfulness training (MT) or to a waitlist-control condition on psychological and physiological indicators of teachers' occupational stress and burnout were examined in 2 field trials. The sample included 113 elementary and secondary school teachers (89% female) from Canada and the United States. Measures were collected at baseline, post-program, and 3-month follow-up; teachers were randomly assigned to condition after baseline assessment. Results showed that 87% of teachers completed the program and found it beneficial. Teachers randomized to MT showed greater mindfulness, focused attention and working memory capacity, and occupational self-compassion, as well as lower levels of occupational stress and burnout at post-program and follow-up, than did those in the control condition. No statistically significant differences due to MT were found for physiological measures of stress. Mediational analyses showed that group differences in mindfulness and self-compassion at post-program mediated reductions in stress and burnout as well as symptoms of anxiety and depression at follow-up. Implications for teaching and learning are discussed.

The rapid emergence of severe acute hepatitis across several European countries and several geographical regions in the United States has created panic among health institutions, local authorities, governmental organizations and regulatory bodies. Early reporting, stringent surveillance and supportive care can temporarily help tackle this crisis. However, definitive containment measures and management require characterization of the clinical spectrum, epidemiological assessment and extensive investigations. Furthermore, a sound management strategy requires randomized trials to explore the treatment options. [ABSTRACT FROM AUTHOR]

This research study quantifies and describes suicide among South Asian Americans (SAAs), an emerging population that are underrepresented group in suicide research. The purpose of this study was to examine key characteristics of suicide deaths among SAAs. Data were employed from DuPage County, IL, a county with a large SAA population. Following federal recommendations for disaggregating Asian American data at a granular level, four SAA researchers used name recognition to identify all SAA cases classified as suicide in the DuPage County coroner's database from 2001 to 2017 (N = 38). Coroner's reports were analyzed for contextual details and correlating factors specific to each suicide. Overall, 76.3% of victims were male and 45.0% were married. An analysis of the coroner reports established that 71.1% of decedents showed behavioral disorders that were predisposing risk factors for suicide including mental health diagnoses (57.9%), and a reported prior suicide attempt (21.1%). Among these decedents only 34.2% had received any prior psychiatric care. Significant errors in racial classification of SAAs, lead to a gross undercount of SAA deaths by suicide with 55% of South Asian suicides assigned to a different race or ethnic group. Future studies must increase the scope of this research to other geographic locations with high concentrations of SAAs and examine the risk factors for suicide among SAAs, one of the fastest growing ethnic populations in the U.S. [ABSTRACT FROM AUTHOR]

Background: Many of the conditions of the COVID-19 pandemic were consistent with factors shown to be predictive of parental stress and burnout. The purpose of the current study was to use a retrospective pretest method to gain an understanding of the effects of the COVID-19 pandemic on levels of parental burnout and on parenting practices. Method: A brief survey was conducted using a retrospective pretest method to examine parental burnout (The Parental Burnout Assessment, Roskam et al, 2018) and parenting practices (The Alabama Parenting Questionnaire, Frick, 1991). The survey asked parent participants to answer questions about their experiences before and during the pandemic. Results: Findings indicated that the pandemic had a significant impact on parents, increasing overall levels of parental burnout and impacting parenting practices by reducing use of positive parenting strategies and increasing use of inconsistent discipline and corporal punishment. These changes in parenting practices were even more pronounced for parents whose levels of parental burnout moved from "normal" levels before the pandemic to clinical levels during the pandemic. Conclusion: The findings of the current study suggest that the COVID-19 pandemic has had a negative impact on levels of parental burnout and parenting practices. Although additional research is needed, the results suggest that there is a need for clinicians to understand the effects that the pandemic may have had on parents and families with an understanding that families may be at ongoing risk despite a relaxation of COVID-19 restrictions. [ABSTRACT FROM AUTHOR]

Background: Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using comparable individual-level, linked population health survey data and identical model specifications.Methods: The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Consistent variable definitions were used to estimate country-specific mortality hazard ratios with sex-specific Cox proportional hazard models, including smoking, alcohol, diet and physical activity, sociodemographic indicators and proximal factors including disease history.Results: A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 58,232 respondents and 497,909 person-years from the NHIS were included. Absolute mortality risk among those with a 'healthy profile' was higher in the United States compared to Canada, especially among women. Adjusted mortality hazard ratios associated with health behaviours were generally of similar magnitude and direction but often stronger in Canada.Conclusion: Even when methodological and population differences are minimal, the association of health behaviours and mortality can vary across populations. It is therefore important to be cautious of between-study variation when aggregating relative effect estimates from differing populations, and when using external effect estimates for population health research and policy development. [ABSTRACT FROM AUTHOR]

There is a large unmet need for effective treatment of major depressive disorder (MDD), an often chronic/recurrent disorder that affects 1 in 5 adults during their lifetime in the United States. Clinicians and individuals with MDD often rely on augmentation approaches given the low rate of remission with the initial antidepressant treatment. Therefore, the report by Savitz and colleagues on the safety and efficacy of seltorexant is of great interest because it provides initial evidence for the antidepressant potential of drugs targeting orexin neurotransmission. Findings of this study suggest that seltorexant 20 mg is more effective than placebo, especially in individuals with moderate or insomnia symptoms at baseline. Given that insomnia is a common feature of depression, orexin 2 receptor antagonists may serve as important new treatment alternatives for people with MDD. [ABSTRACT FROM AUTHOR]

Context: Patients with congenital adrenal hyperplasia (CAH) are exposed to hyperandrogenism and supraphysiologic glucocorticoids, both of which can increase risk of metabolic morbidity.Objective: Our aim was to evaluate cardiovascular and metabolic morbidity risk in a longitudinal study of patients with CAH spanning both childhood and adulthood.Design and Setting: Patients with classic CAH followed for a minimum of 5 years during both childhood and adulthood (n = 57) at the National Institutes of Health were included and compared with the US general population using NHANES data.Main Outcome Measures: Obesity, hypertension, insulin resistance, fasting hyperglycemia, and dyslipidemia.Results: Compared to the US population, patients with CAH had higher (P < 0.001) prevalence of obesity, hypertension, insulin resistance, fasting hyperglycemia, and low high-density lipoprotein (HDL) during childhood and obesity (P = 0.024), hypertension (P<0.001), and insulin resistance (P < 0.001) during adulthood. In our cohort, obesity, hypertension, fasting hyperglycemia, and hypertriglyceridemia began prior to age 10. During childhood, increased mineralocorticoid dose was associated with hypertension (P = 0.0015) and low HDL (P = 0.0021). During adulthood, suppressed androstenedione was associated with hypertension (P = 0.002), and high low-density lipoprotein (P = 0.0039) whereas suppressed testosterone (P = 0.003) was associated with insulin resistance. Elevated 17-hydroxyprogesterone, possibly reflecting poor disease control, was protective against high cholesterol (P = 0.0049) in children. Children whose mothers were obese (maternal obesity) had increased risk of obesity during adulthood (P = 0.0021). Obesity, in turn, contributed to the development of hypertension, insulin resistance, and hypertriglyceridemia in adulthood.Conclusion: Patients with CAH develop metabolic morbidity at a young age associated with treatment-related and familial factors. Judicious use of glucocorticoid and mineralocorticoid is warranted. [ABSTRACT FROM AUTHOR]

The current movement that aligns the South Asian American population with Black cultures and Black Lives Matter is rooted in a deep history of the New Immigrants from the 19th century to the present. This essay integrates personal narrative with that of race in the United States and develops a historiography of the encounters between South Asian and African-American cultures. It interrogates the presumptions about how we perceive race, how scopophilic desire attenuates to the visual representation of people of colour. The cultural politics of skin colour and race were ambiguous in relation to South Asians and thus, racial slippage between what constituted brown and black played out in social and legal venues, thus defining who is citizen and who is excluded from having a voice in the body politic. Analysing this history is significant in articulating formations of cultural and political solidarities which are urgent in the present time of Black Lives Matter as South Asians link their racialization to that of African-Americans. It is through that we can move towards a liberatory and equitable future. [ABSTRACT FROM AUTHOR]

I find that managers manage earnings upward in the quarters preceding a debt-covenant violation, but downward in the quarter a violation occurs. And they continue to manage earnings downward while the firm remains in violation. Because this scenario can play out within a year, the use of yearly data to examine the debt-covenant hypothesis can be problematic. Further analysis shows that the earnings management around the debt-covenant violation is also done to improve the manager’s bargaining power in the renegotiation that follows the violation. Furthermore, I find no evidence of excessive earnings management by high-debt firms to stave off a violation, but I do find evidence that the Sarbanes–Oxley Act restrains managers from using accruals to stave off a violation. These results are based on examining 193,803 firm-quarters, 8,804 firms, and 2,035 new covenant violations spanning 1996 to 2007. [ABSTRACT FROM PUBLISHER]

Objective: To determine whether the exclusion of patients who die from adjusted 30-day readmission rates influences readmission rate measures and penalties under the Hospital Readmission Reduction Program (HRRP).Data Sources/study Setting: 100% Medicare fee-for-service claims over the period July 1, 2012, until June 30, 2015.Study Design: We examine the 30-day readmission risk across the three conditions targeted by the HRRP: acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia. Using logistic regression, we estimate the readmission risk for three samples of patients: those who survived the 30-day period after their index admission, those who died over the 30-day period, and all patients who were admitted to see how they differ.Data Collection/extraction Methods: We identified and extracted data for Medicare fee-for-service beneficiaries admitted with primary diagnoses of AMI (N = 497 931), CHF (N = 1 047 552), and pneumonia (N = 850 552).Results: The estimated hospital readmission rates for the survived and nonsurvived patients differed by 5%-8%, on average. Incorporating these estimates into overall readmission risk for all admitted patients changes the likely penalty status for 9% of hospitals. However, this change is randomly distributed across hospitals and is not concentrated amongst any one type of hospital.Conclusions: Not accounting for variations in mortality may result in inappropriate penalties for some hospitals. However, the effect of this bias is low due to low mortality rates amongst incentivized conditions and appears to be randomly distributed across hospital types. [ABSTRACT FROM AUTHOR]

The role of gut microbiomes as important regulators of mammalian health is increasingly recognized, although feline and canine gut microbiomes remain poorly characterized. In this proof-of-concept study, we assessed the utility of a direct-to-consumer approach to executing pet microbiome studies. We characterized the gut microbiomes of 238 pets (46 cats and 192 dogs) by generating ~11 million merged reads that were mapped to the V4 region of 16S ribosomal RNA gene at a sequencing depth of 45,806 (±22,325) reads per sample. Analyses of these reads revealed that both feline and canine gut microbiomes are dominated by three major phyla, namely Firmicutes, Proteobacteria, and Bacteroides and that alpha diversity is higher in the feline gut. In addition to interspecies differences between the feline and canine gut, we also detected appreciable intraspecies bacterial variation within the canine population. While the dogs in this dataset could be assigned to three distinct clusters based on their gut microbiome, no clustering was observed within the feline population. Integration of additional data obtained from survey questionnaires revealed that geography and body weight may be associated with canine gut microbiome composition. Furthermore, we found that both the inter and intraspecies differences are more pronounced at finer taxonomic levels, indicating that strain-level investigations may be necessary in the future. This study demonstrates that the direct-to-consumer approach overcomes existing limitations in pet microbiome research, for example, it allows collection of large numbers of pet samples. The direct-to-consumer approach has proven successful in human genomics as well as human microbiomics and this study demonstrates that by building partnerships with an engaged general public this approach can also propel the field of pet microbiomics forward. [ABSTRACT FROM AUTHOR]

In its position paper, ACP presents recommendations for how the United States can be prepared for future pandemics. The editorialist reflects on lessons learned from the COVID-19 pandemic and the ACP recommendations and provides additional suggestions to ensure that the United States will be ready when the next health crisis hits. [ABSTRACT FROM AUTHOR]

The article examines the impact of the U.S.' environmental policy on income inequality as of May 2019, highlighting the Clean Air Act (CAA). Topics include the National Ambient Air Quality Standards, standards associated with fine particulate matter and tropospheric ozone, and pollution-adjusted income. Also discussed is the monetary cost of premature death due to fine particulates and ozone.

This study evaluates COVID-19 case rates between high- and low-performing nursing homes based on CMS quality measures. [ABSTRACT FROM AUTHOR]

Growing evidence suggests that health aid can serve humanitarian and diplomatic ends. This study utilised the Fragile States Index (FSI) for the 47 nations of the World Health Organizations’ Africa region for the years 2005-2014 and data on health and non-health development aid spending from the United States (US) for those same years. Absolute amounts of health and non-health aid flows from the US were used as predictors of state fragility. We used time-lagged, fixed-effects multivariable regression modelling with change in FSI as the outcome of interest. The highest quartile of US health aid per capita spending (≥$4.00 per capita) was associated with a large and immediate decline in level of state fragility (b = −7.57; 95% CI, −14.6 to −0.51, P = 0.04). A dose-response effect was observed in the primary analysis, with increasing levels of spending associated with greater declines in fragility. Health per-capita expenditures were correlated with improved fragility scores across all lagged intervals and spending quartiles. The association of US health aid with immediate improvements in metrics of state stability across sub-Saharan Africa is a novel finding. This effect is possibly explained by our observations that relative to non-health aid, US health expenditures were larger and more targeted. [ABSTRACT FROM AUTHOR]

Background The US government created five-star rating systems to evaluate hospital, nursing homes, home health agency and dialysis centre quality. The degree to which quality is a property of organisations versus geographical markets is unclear. Objectives To determine whether high-quality healthcare service sectors are clustered within US healthcare markets. Design Using data from the Centers for Medicare and Medicaid Services' Hospital, Dialysis, Nursing Home and Home Health Compare databases, we calculated the mean star ratings of four healthcare sectors in 304 US hospital referral regions (HRRs). For each sector, we ranked HRRs into terciles by mean star rating. Within each HRR, we assessed concordance of tercile rank across sectors using a multirater kappa. Using t-tests, we compared characteristics of HRRs with three to four top-ranked sectors, one to two top-ranked sectors and zero top-ranked sectors. Results Six HRRs (2.0% of HRRs) had four top-ranked healthcare sectors, 38 (12.5%) had three top-ranked health sectors, 71 (23.4%) had two top-ranked sectors, 111 (36.5%) had one top-ranked sector and 78 (25.7%) HRRs had no top-ranked sectors. A multirater kappa across all sectors showed poor to slight agreement (K=0.055). Compared with HRRs with zero top-ranked sectors, those with three to four top-ranked sectors had higher median incomes, fewer black residents, lower mortality rates and were less impoverished. Results were similar for HRRs with one to two top-ranked sectors. Conclusions Few US healthcare markets exhibit high- quality performance across four distinct healthcare service sectors, suggesting that high-quality care in one sector may not be dependent on or improve care quality in other sectors. Policies that promote accountability for quality across sectors (eg, bundled payments and shared quality metrics) may be needed to systematically improve quality across sectors. [ABSTRACT FROM AUTHOR]

Importance: Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs.Objective: To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations.Evidence: Analysis of data primarily from 2013-2016 from key international organizations including the Organisation for Economic Co-operation and Development (OECD), comparing underlying differences in structural features, types of health care and social spending, and performance between the United States and 10 high-income countries. When data were not available for a given country or more accurate country-level estimates were available from sources other than the OECD, country-specific data sources were used.Findings: In 2016, the US spent 17.8% of its gross domestic product on health care, and spending in the other countries ranged from 9.6% (Australia) to 12.4% (Switzerland). The proportion of the population with health insurance was 90% in the US, lower than the other countries (range, 99%-100%), and the US had the highest proportion of private health insurance (55.3%). For some determinants of health such as smoking, the US ranked second lowest of the countries (11.4% of the US population ≥15 years smokes daily; mean of all 11 countries, 16.6%), but the US had the highest percentage of adults who were overweight or obese at 70.1% (range for other countries, 23.8%-63.4%; mean of all 11 countries, 55.6%). Life expectancy in the US was the lowest of the 11 countries at 78.8 years (range for other countries, 80.7-83.9 years; mean of all 11 countries, 81.7 years), and infant mortality was the highest (5.8 deaths per 1000 live births in the US; 3.6 per 1000 for all 11 countries). The US did not differ substantially from the other countries in physician workforce (2.6 physicians per 1000; 43% primary care physicians), or nursing workforce (11.1 nurses per 1000). The US had comparable numbers of hospital beds (2.8 per 1000) but higher utilization of magnetic resonance imaging (118 per 1000) and computed tomography (245 per 1000) vs other countries. The US had similar rates of utilization (US discharges per 100 000 were 192 for acute myocardial infarction, 365 for pneumonia, 230 for chronic obstructive pulmonary disease; procedures per 100 000 were 204 for hip replacement, 226 for knee replacement, and 79 for coronary artery bypass graft surgery). Administrative costs of care (activities relating to planning, regulating, and managing health systems and services) accounted for 8% in the US vs a range of 1% to 3% in the other countries. For pharmaceutical costs, spending per capita was $1443 in the US vs a range of $466 to $939 in other countries. Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218 173 in the US compared with a range of $86 607 to $154 126 in the other countries.Conclusions and Relevance: The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. As patients, physicians, policy makers, and legislators actively debate the future of the US health system, data such as these are needed to inform policy decisions. [ABSTRACT FROM AUTHOR]

Background: Mexicans and US Mexican Hispanics share modifiable determinants of premature mortality. We compared trends in mortality at ages 30-69 in Mexico and among US Mexican Hispanics from 1995 to 2015.Methods: We examined nationally representative statistics on 4.2 million Mexican and 0.7 million US deaths to examine cause-specific mortality. We used lung cancer indexed methods to estimate smoking-attributable deaths stratified by high and lower burden Mexican states.Results: In 1995-99, Mexican men had about 30% higher relative risk of death from all causes than US Mexican Hispanic men, and this difference nearly doubled to 58% by 2010-15. The divergence between Mexican and US Mexican Hispanic women over this time period was less marked. Among US Mexican Hispanics, declines in the risk of smoking-attributable death constituted about 25-30% of the declines in the overall risk of death. However, among Mexican men the declines in the risk of smoking-attributable deaths were offset by increases in causes of death not due to smoking. Homicide rates (mostly from guns) rose among men in Mexico from 2005 to 2010, but not among Mexican women or US Mexican Hispanic men or women. The probability at 30-69 years of death from cardiac disease diverged significantly between Mexicans and US Mexican Hispanics, reaching 10% and 5% for men, and 7% and 2% for women, respectively.Conclusions: Large differences in premature mortality between otherwise genetically and culturally similar groups arise from a few modifiable factors, most notably smoking, untreated diabetes and homicide. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives The US health care system is marked by a high degree of fragmentation in both delivery and financing. Some evidence suggests that attempts to reduce fragmentation have led to significant provider consolidation, including hospital acquisitions of physician groups, or 'vertical integration.' The objective was to use time-series data to quantify trends in and characteristics of hospital acquisitions of physician practices. A secondary objective was to use case studies to determine the motivations for these acquisitions and to identify what integration results from these transactions. Methods Data on annual hospital acquisition of physician practices was used to quantify trends and characteristics of acquiring hospitals between 2006 and 2013. Four in-depth case studies, including structured interviews with hospital leadership, were then conducted of recent hospital acquisitions of primary care practices. Results Acquisitions of physician practices have been increasing over the last decade and peaked in 2011. Most acquisitions were of small primary care, multi-specialty, or cardiology practices. The case studies revealed that the primary motivation for hospital acquisitions was to increase referrals and negotiate higher payment rates. These transactions resulted in very limited clinical integration, while all acquiring hospitals sought to integrate health information systems. Conclusions Among 4 case-studies of hospital acquisition of physician practices, the primary motivation was financial and competitive motivations. This suggests that policymakers should be mindful of the potential negative effects of these acquisitions on health care costs, as well as the uncertainty of clinical benefits. Policymakers may need supplementary strategies to deliver the goals of reduced costs and improved quality of care. [ABSTRACT FROM AUTHOR]

Objective: The primary goal of this study was to evaluate a new form of non-linear frequency compression (NLFC) in children. The new NLFC processing scheme is adaptive and potentially allows for a better preservation of the spectral characteristics of the input sounds when compared to conventional NLFC processing. Design: A repeated-measures design was utilised to compare the speech perception of the participants with two configurations of the new adaptive NLFC processing to their performance with the existing NLFC. The outcome measures included the University of Western Ontario Plurals test, the Consonant-Nucleus-Consonant word recognition test, and the Phonak Phoneme Perception test. Study sample: Study participants included 14 children, aged 6–17 years, with mild-to-severe low-frequency hearing loss and severe-to-profound high-frequency hearing loss. Results: The results indicated that the use of the new adaptive NLFC processing resulted in significantly better average word recognition and plural detection relative to the conventional NLFC processing. Conclusion: Overall, the adaptive NLFC processing evaluated in this study has the potential to significantly improve speech perception relative to conventional NLFC processing. [ABSTRACT FROM AUTHOR]

The extent to which recent large increases in hospitals' adoption of electronic health record (EHR) systems can be attributed to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 is uncertain and debated. Because only short-term acute care hospitals were eligible for the act's meaningful-use incentive program, we used national hospital data to examine the differential effect of HITECH on EHR adoption among eligible and ineligible hospitals in the periods before (2008-10) and after (2011-15) implementation of the program. We found that annual increases in EHR adoption rates among eligible hospitals went from 3.2 percent in the pre period to 14.2 percent in the post period. Ineligible hospitals experienced much smaller annual increases of 0.1 percent in the pre period and 3.3 percent in the post period, a significant difference-in-differences of 7.9 percentage points. Our results support the argument that recent gains in EHR adoption can be attributed specifically to HITECH, which suggests that the act could serve as a model for ways to drive the adoption of other valuable technologies. [ABSTRACT FROM AUTHOR]

The purpose of this study is to assess the impact of micro enterprises in employment and income generation post-2008 financial crisis in United States. The paper uses a causal correlation research design employing Linear Regression and Kernel Regression analysis. It establishes a stronger positive correlation between employment and income creation as measured by annual payroll for micro firms than that for other firm sizes. The paper suggests that developing micro-enterprises have proven return on investment, making a case for further initiatives by the government and development organizations. Findings from this study will provide useful information to shape economic development policies. [ABSTRACT FROM AUTHOR]

Importance: Few studies have analyzed contemporary data on outcomes at US teaching hospitals vs nonteaching hospitals.Objective: To examine risk-adjusted outcomes for patients admitted to teaching vs nonteaching hospitals across a broad range of medical and surgical conditions.Design, Setting, and Participants: Use of national Medicare data to compare mortality rates in US teaching and nonteaching hospitals for all hospitalizations and for common medical and surgical conditions among Medicare beneficiaries 65 years and older.Exposures: Hospital teaching status: major teaching hospitals (members of the Council of Teaching Hospitals), minor teaching hospitals (other hospitals with medical school affiliation), and nonteaching hospitals (remaining hospitals).Main Outcomes and Measures: Primary outcome was 30-day mortality rate for all hospitalizations and for 15 common medical and 6 surgical conditions. Secondary outcomes included 30-day mortality stratified by hospital size and 7-day mortality and 90-day mortality for all hospitalizations as well as for individual medical and surgical conditions.Results: The sample consisted of 21 451 824 total hospitalizations at 4483 hospitals, of which 250 (5.6%) were major teaching, 894 (19.9%) were minor teaching, and 3339 (74.3%) were nonteaching hospitals. Unadjusted 30-day mortality was 8.1% at major teaching hospitals, 9.2% at minor teaching hospitals, and 9.6% at nonteaching hospitals, with a 1.5% (95% CI, 1.3%-1.7%; P < .001) mortality difference between major teaching hospitals and nonteaching hospitals. After adjusting for patient and hospital characteristics, the same pattern persisted (8.3% mortality at major teaching vs 9.2% at minor teaching and 9.5% at nonteaching), but the difference in mortality between major and nonteaching hospitals was smaller (1.2% [95% CI, 1.0%-1.4%]; P < .001). After stratifying by hospital size, 187 large (≥400 beds) major teaching hospitals had lower adjusted overall 30-day mortality relative to 76 large nonteaching hospitals (8.1% vs 9.4%; 1.2% difference [95% CI, 0.9%-1.5%]; P < .001). This same pattern of lower overall 30-day mortality at teaching hospitals was observed for medium-sized (100-399 beds) hospitals (8.6% vs 9.3% and 9.4%; 0.8% difference between 61 major and 1207 nonteaching hospitals [95% CI, 0.4%-1.3%]; P = .003). Among small (≤99 beds) hospitals, 187 minor teaching hospitals had lower overall 30-day mortality relative to 2056 nonteaching hospitals (9.5% vs 9.9%; 0.4% difference [95% CI, 0.1%-0.7%]; P = .01).Conclusions and Relevance: Among hospitalizations for US Medicare beneficiaries, major teaching hospital status was associated with lower mortality rates for common conditions compared with nonteaching hospitals. Further study is needed to understand the reasons for these differences. [ABSTRACT FROM AUTHOR]

Exploiting the competitive ability of crops is essential to develop cost-effective and sustainable weed management practices. Reduced row spacing, increased seeding rates, and selection of competitive cultivars can potentially manage crop–weed competition in cotton, soybean, wheat, and corn. These cultural weed management practices facilitate a more rapid development of crop canopy that adversely affect the emergence, density, growth, biomass, and subsequently the seed production of weeds during a growing season. These cultural practices can also favour the weed suppressive ability of the crop by influencing the canopy architecture traits (plant height, canopy density, leaf area index, rate of leaf area development, and leaf distribution). These crop-competition attributes can potentially reduce the risk of crop yield losses due to interference from weed cohorts that escape an early- or a late-season post-emergence herbicide application. Furthermore, reduced row spacing, increased seeding rates, and weed-competitive cultivars are effective in reducing reliance on a single site-of-action herbicides, thereby reducing the selection pressure for development of herbicide-resistant weed populations in a cropping system. [ABSTRACT FROM AUTHOR]

The federally funded, HUD-administered Neighborhood Stabilization Program (NSP) was enacted in the wake of the financial recession to mitigate the underlying adverse neighborhood effects associated with foreclosed properties. We examined the neighborhood price impacts of NSP-funded foreclosure rehabilitation undertaken by Habitat for Humanity in Dallas County, Texas, using a difference-in-difference framework. Foreclosure rehabilitation projects in Dallas County produced an average 15% increase in neighborhood home prices that sold up to 30 months after the rehabilitated property sale and within 0.1 miles of the rehabilitated property. Foreclosure rehabilitation that involved significant exterior repairs was associated with the largest estimated effect sizes. Results suggest that NSP funding in Dallas County effectively targeted homes that had the potential to have the most severe neighborhood impacts and that rehabilitation was an effective means of reversing neighborhood price externalities associated with blighted foreclosed properties. [ABSTRACT FROM AUTHOR]

Background: Growing evidence shows that hospitals are increasingly employing physicians.Objective: To examine changes in U.S. acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model.Design: Retrospective cohort study of U.S. acute care hospitals between 2003 and 2012.Setting: U.S. nonfederal acute care hospitals.Participants: 803 switching hospitals compared with 2085 nonswitching control hospitals matched for year and region.Intervention: Hospitals' conversion to an employment relationship with any of their privileged physicians.Measurements: Risk-adjusted hospital-level mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions.Results: In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. Relative to regionally matched controls, switching hospitals were more likely to be large (11.6% vs. 7.1%) or major teaching hospitals (7.5% vs. 4.5%) and less likely to be for-profit institutions (8.8% vs. 19.9%) (all P values <0.001). Up to 2 years after conversion, no association was found between switching to an employment model and improvement in any of 4 primary composite quality metrics.Limitations: The measure of integration used depends on responses to the American Hospital Association annual questionnaire, yet this measure has been used by others to examine effects of integration. The study examined performance up to 2 years after evidence of switching to an employment model; however, beneficial effects may have taken longer to appear.Conclusion: During the past decade, hospitals have increasingly become employers of physicians. The study's findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care.Primary Funding Source: Agency for Healthcare Research and Quality and National Science Foundation Graduate Research Fellowship. [ABSTRACT FROM AUTHOR]

Introduction: About 92% of US older adults have at least one chronic disease or medical condition and 77% have at least two. Low-income and uninsured adults in particular experience a higher burden of comorbidities, and the Medicaid expansion provision of the Affordable Care Act was designed to improve access to healthcare in this population group. However, a significant number of US states have declined expansion. The purpose of this study is to determine the distribution of low-income and uninsured adults in expanded versus non-expanded states, and evaluate the prevalence of comorbidities in both groups.Methods: Data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) dataset was analyzed, and Medicaid expansion status was assessed from the Center for Medicare and Medicaid Services report on State Medicaid and CHIP Income Eligibility Standards. Next, age adjusted mean number of comorbidities between expanded and non-expanded states was compared, with adjustment for socio-demographic differences.Results: Expanded states had a higher proportion of adults with income of at least $50,000 per year (39.6% vs. 35.5%, p<0.01) and a lower proportion of individuals with no health insurance coverage (15.2% vs. 20.3%, p<0.01) compared with non-expanded states. Among the uninsured, there was a higher proportion of obese (31.6% vs. 26.9%, p<001), and higher average number of comorbidities (1.62 vs. 1.52, p<0.01) in non-expanded states compared to expanded states. Overall, the prevalence of comorbidities was higher among BRFSS participants in states that did not expand Medicaid compared with those in expanded states.Conclusion: States without Medicaid expansion have a greater proportion of poor, uninsured adults with more chronic diseases and conditions. [ABSTRACT FROM AUTHOR]

This study examines how personal research collaboration and advice networks of academic faculty in six fields of science and engineering affect three kinds of satisfaction: satisfaction with rewards; satisfaction with reputation of department and institution; and satisfaction with professional recognition and visibility of research. The study includes determinants found in the literature such as perceived influence on departmental decisions, departmental provision of resources, and perceptions of time spent on service and other controls. Using data collected from a national survey of academic faculty in six fields of science and engineering in Carnegie designated Research I universities, regression models test literature derived hypotheses. Findings show that the effects of network structure and resources on satisfaction depend on the kind of satisfaction studied. Non-network variables demonstrate associations with satisfaction that are generally expected from the literature. The paper provides evidence of the critical role that personal research collaboration and advice networks play for scientists' satisfaction. It also raises important questions about the complex relationships between network structures and resources, and satisfaction. Conclusions present implications for university and departmental administrators. [ABSTRACT FROM AUTHOR]

The article focuses on the Hospital Readmissions Reduction Program (HRRP). It states that HRRP is part of the U.S. Affordable Care Act and creates financial penalties for hospitals that have higher-than-expected hospitalization readmission rates within 30 days of discharge for Medicare patients suffering from conditions such as heart failure. It suggests that HRRP's benefits might be significantly smaller than early data suggested. It talks about changes in coding practice by hospitals.

We examine the impact of social capital on audit fees. We find that firms headquartered in U.S. counties with high social capital pay lower audit fees. Social capital measures the level of mutual trust in a region. Our results suggest that auditors judge the trustworthiness of their clients based on where the firm is headquartered and charge a premium when they trust the firm less. The basis of our results is the examination of more than 28,000 audit fees for more than 5,000 firms spanning the period of 2000 to 2009. The results are robust to controlling for a large number of firm-level and county-level characteristics. [ABSTRACT FROM AUTHOR]

The recent uptick in hospital adoption of electronic health records (EHRs) has been accompanied by growing concerns among some policy makers that hospitals may use these systems to select billing codes that reflect more intensive care or a sicker patient population in order to generate more revenue through higher reimbursements. Such “upcoding” would increase overall health care spending. We used national data to examine whether new adoption of EHRs was associated with increases in coded patient acuity or Medicare payments. We found that hospitals that adopted EHRs increased billing to Medicare, but at a rate comparable to that of matched controls of non-EHR adopters. In our difference-in-differences models, patient acuity and payment per discharge were essentially the same between adopters and nonadopters. We also failed to find a relationship between adoption and either patient acuity or payment within groups of hospitals that may be more likely to use EHRs to increase coding and revenue, such as for-profit hospitals and those in highly competitive markets. Thus, we found no empirical evidence to suggest that hospitals are systematically using EHRs to increase reimbursement. Our findings should reduce concerns that EHR adoption by itself will increase the costs of hospital care. [ABSTRACT FROM AUTHOR]

Abstract: The present study performs the spatial and temporal trend analysis of the annual and seasonal time-series of a set of uniformly distributed 249 stations precipitation data across the state of North Carolina, United States over the period of 1950–2009. The Mann–Kendall (MK) test, the Theil–Sen approach (TSA) and the Sequential Mann–Kendall (SQMK) test were applied to quantify the significance of trend, magnitude of trend, and the trend shift, respectively. Regional (mountain, piedmont and coastal) precipitation trends were also analyzed using the above-mentioned tests. Prior to the application of statistical tests, the pre-whitening technique was used to eliminate the effect of autocorrelation of precipitation data series. The application of the above-mentioned procedures has shown very notable statewide increasing trend for winter and decreasing trend for fall precipitation. Statewide mixed (increasing/decreasing) trend has been detected in annual, spring, and summer precipitation time series. Significant trends (confidence level≥95%) were detected only in 8, 7, 4 and 10 nos. of stations (out of 249 stations) in winter, spring, summer, and fall, respectively. Magnitude of the highest increasing (decreasing) precipitation trend was found about 4mm/season (−4.50mm/season) in fall (summer) season. Annual precipitation trend magnitude varied between −5.50mm/year and 9mm/year. Regional trend analysis found increasing precipitation in mountain and coastal regions in general except during the winter. Piedmont region was found to have increasing trends in summer and fall, but decreasing trend in winter, spring and on an annual basis. The SQMK test on “trend shift analysis” identified a significant shift during 1960−70 in most parts of the state. Finally, the comparison between winter (summer) precipitations with the North Atlantic Oscillation (Southern Oscillation) indices concluded that the variability and trend of precipitation can be explained by the Oscillation indices for North Carolina. [Copyright &y& Elsevier]

Accountable care organizations (ACOs) have attracted interest from many policy makers and clinical leaders because of their potential to improve the quality of care and reduce costs. Federal ACO programs for Medicare beneficiaries are now up and running, but little information is available about the baseline characteristics of early entrants. In this descriptive study we present data on the structural and market characteristics of these early ACOs and compare ACOs' patient populations, costs, and quality with those of their non-ACO counterparts at baseline. We found that ACO patients were more likely than non-ACO patients to be older than age eighty and had higher incomes. ACO patients were less likely than non-ACO patients to be black, covered by Medicaid, or disabled. The cost of care for ACO patients was slightly lower than that for non-ACO patients. Slightly fewer than half of the ACOs had a participating hospital. Hospitals that were in ACOs were more likely than non-ACO hospitals to be large, teaching, and not-for-profit, although there was little difference in their performance on quality metrics. Our findings can be useful in interpreting the early results from the federal ACO programs and in establishing a baseline to assess the programs' development. [ABSTRACT FROM AUTHOR]

Importance A small proportion of patients account for the majority of US health care spending, and understanding patterns of spending among this cohort is critical to reducing health care costs. The degree to which preventable acute care services account for spending among these patients is largely unknown. Objective To quantify preventable acute care services among high-cost Medicare patients. Design, Setting, and Participants We summed standardized costs for each inpatient and outpatient service contained in standard 5% Medicare files from 2009 and 2010 across the year for each patient in our sample, and defined those in the top decile of spending in 2010 as high-cost patients and those in the top decile in both 2009 and 2010 as persistently high-cost patients. We used standard algorithms to identify potentially preventable emergency department (ED) visits and acute care inpatient hospitalizations. A total of 1 114 469 Medicare fee-for-service beneficiaries aged 65 years or older were included. Main Outcomes and Measures Proportion of acute care hospital and ED costs deemed preventable among high-cost patients. Results The 10% of Medicare patients in the high-cost group were older, more often male, more often black, and had more comorbid illnesses than non-high-cost patients. In 2010, 32.9% (95% CI, 32.9%-32.9%) of total ED costs were incurred by high-cost patients. Based on validated algorithms, 41.0% (95% CI, 40.9%-41.0%) of these costs among high-cost patients were potentially preventable compared with 42.6% (95% CI, 42.6%-42.6%) among non-high-cost patients. High-cost patients accounted for 79.0% (95% CI, 79.0%-79.0%) of inpatient costs, 9.6% (95% CI, 9.6%9.6%) of which were due to preventable hospitalizations; 16.8% (95% CI, 16.8%16.8%) of costs within the non-high-cost group were due to preventable hospitalizations. Comparable proportions of ED spending (43.3%; 95% CI, 43.3%-43.3%) and inpatient spending (13.5%; 95% CI, 13.5%-13.5%) were preventable among persistently high-cost patients. Regions with high primary care physician supply had higher preventable spending for high-cost patients. Conclusions and Relevance Among a sample of patients in the top decile of Medicare spending in 2010, only a small percentage of costs appeared to be related to preventable ED visits and hospitalizations. The ability to lower costs for these patients through better outpatient care may be limited. [ABSTRACT FROM AUTHOR]

There is growing international interest in the role that hospital boards of directors play in improving the quality of health care. In England the National Health Service created a program to help boards become more effective at ensuring quality. We sought to evaluate how boards at English hospitals are engaged in quality, and we conducted the first national survey of the governance practices of the chairpersons of English hospitals. The survey was completed by 132 of 171 board chairs. We compared the results to those of a survey of the chairs of US hospital boards that we published in 2010. We found that English board chairs had more expertise in quality-of-care issues and spent a greater proportion of their time on quality of care than their US counterparts. At the same time, the association in England between hospital performance on quality metrics and board engagement in quality was generally not as substantial as was evident in our earlier US survey. English board chairs tend to greatly overestimate the quality performance of their hospitals, much as their US counterparts do. Our analysis suggests that there is room for improvement in both countries to bolster board expertise and focus on key quality metrics, and to hold managers accountable for the delivery of safe, effective health care. [ABSTRACT FROM AUTHOR]

This article examines the hazards of smoking in the 21st-century and the benefits of smoking cessation in the U.S. The study revealed that smokers lose at least one decade of life expectancy compared to non-smokers. It also showed that cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90 percent.

The article focuses on a study regarding the prevalence of pediatric readmissions in the hospitals. It mentions that health care systems use readmission rates to assess the quality of hospital care and according to the Affordable care act, the U.S. Centers for Medicare and Medicaid Services can reduce Medicare payments for the centers with high readmission rates. The study reveals that the rate of unplanned readmissions at 30 days among patients admitted to pediatric hospitals was 6.5 percent. It mentions that sickle cell anemia has the highest percentage of readmission.

Self-medication can be possible for minor and chronic-recurring illnesses which are well known to patients. Around 200 drugs are approved for over-the-counter (OTC) purposes from the prescription by FDA. Such switches are called Rx to OTC switches. The criteria for switch include a low potential for misuse or abuse, safety, efficacy and effective use. Many substances have successfully switched from Rx to OTC and much are in-line. However, the switch in different countries is different due to differences in traditions, situation for starting, regulatory procedures, political support, and levels of information/education of patients. In 1975, the FDA formalized a process of switching prescription drugs to OTC status by establishing methods, through the individually initiated petition, as a supplement to a new drug application, and through the OTC review process. The OTC sector, while less profitable than the prescription market, is still viewed as being immensely profitable by industries. Switching of drugs from prescription to OTC status provides cost-containment in medico's expense, supports the self-help movement, and also fulfills market expansion motives. Looking at the present trends it is very likely that more and more medications will fall into the ambit of OTC medication. [ABSTRACT FROM AUTHOR]

Evidence for spatially coherent, but different, U.S. summer precipitation and surface air temperature anomalies during the evolving phase and during the summers following the peak phase of the winter El Niño is presented. The spatial patterns during the decaying phase of El Niño are distinctive from patterns in the preceding summer when El Niño is in its evolving phase, that is, the traditional 'simultaneous' composite patterns associated with El Niño. The analysis of a multimodel ensemble of global atmospheric models forced by observed sea surface temperature further confirms that the differences in the U.S. summer precipitation and surface temperature anomalies between the developing and decaying phases of El Niño are a result of the atmospheric response to tropical warm SST anomalies that are shifted eastward and are confined east of 120°W during the decaying phase of El Niño. Given the distinctive pattern, and relatively large amplitude of these anomalies during the decaying phase of El Niño, the results may have implications for the seasonal prediction of U.S. summer precipitation and temperature following winter El Niños. [ABSTRACT FROM AUTHOR]