This systematic review examines what factors explain the diversity of findings regarding hospital ownership and quality. We identified 31 observational studies written in English since 1990 that used multivariate analysis to examine quality of care at nonfederal general acute, short-stay US hospitals. We find that pooled estimates of ownership effects are sensitive to the subset of studies included and the extent of overlap among hospitals analyzed in the underlying studies. Ownership does appear to be systematically related to differences in quality among hospitals in several contexts. Whether studies find for-profit and government-controlled hospitals to have higher mortality rates or rates of adverse events than their nonprofit counterparts depends on data sources, time period, and region covered. Policymakers should be aware of the underlying reasons for conflicting evidence in this literature, and the strengths and weaknesses of meta-analytic synthesis. The 'true' effect of ownership appears to depend on institutional context, including differences across regions, markets, and over time.

Human embryonic stem cells (hESCs) have the capacity to remain pluripotent and self-renew indefinitely. To discover novel players in the maintenance of hESCs, we have previously reported the generation of monoclonal antibodies that bind to cell surface markers on hESCs, and not to mouse embryonic stem cells or differentiated embryoid bodies. In this study, we have identified the antigen target of one such monoclonal antibody as the epithelial cell adhesion molecule (EpCAM). In undifferentiated hESCs, EpCAM is localized to Octamer 4 (OCT4)-positive pluripotent cells, and its expression is down-regulated upon differentiation. To further understand its biological function in hESCs, endogenous EpCAM expression was silenced using small interfering RNA. EpCAM knockdown had marginal negative effects on OCT4 and TRA-1-60 expression, however cell proliferation was decreased by >40%.Examination of lineage marker expression showed marked upregulation of endoderm and mesoderm genes in EpCAM-silenced cells, under both pluripotent and differentiating conditions. These results were validated using a hESC line whose EpCAM expression has been stably knocked down. Data from the stable line confirmed that downregulation of EpCAM decreases cell growth and increases gene expression in the endoderm and mesoderm lineages. In vivo, hESCs lacking EpCAM were able to form teratomas containing tissues representing the three germ layers, and gene expression analysis yielded marked increase in the endoderm marker alpha fetoprotein compared with control. Together these data demonstrate that EpCAM is a surface marker on undifferentiated hESCs and plays functional roles in proliferation and differentiation. STEM CELLS 2010;28:29-35 Disclosure of potential conflicts of interest is found at the end of this article.

We performed a retrospective analysis of hospital discharges for children with autism, in comparison to children with cerebral palsy, Down syndrome, mental retardation/intellectual disability, and the general population. Hospitalizations for autism increased nearly threefold over 10 years, especially at the oldest ages, while hospitalizations for the other groups did not change. Leading discharge diagnoses for each age group in children with autism included mental health and nervous system disorders. Older age, Caucasian ethnicity, and living in a region with a high number of pediatric beds predicted hospitalizations associated with mental health diagnoses. These findings underscore the need for comprehensive clinical services that address the complex needs of children with autism to prevent costly hospitalizations.

Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.

Does quality of care systematically differ among government-owned, private not-for-profit, and for-profit hospitals? A large empirical literature provides conflicting evidence. Through quantitative review of 46 studies since 1990, we find that several study features that can explain divergent results: analytic methods, disease studied, and data sources. For unprofitable care, how studies handle market competition and regional differences account for substantial variation. Policymakers should be aware that differences in results appear to arise predominantly from differences between studies' analytic methods. Moreover, conventional methods of meta-analytic synthesis should be applied with great caution given the considerable overlap among studied hospitals. Karen Eggleston II. MethodsLiterature Search, Selection and Extraction Data Sources. Our literature search employed the keywords "hospitals," "ownership,""for-profit," "not-for-profit," "nonprofit," and their combinations. Databases included Medline, EconLit (Economics Literature), and Proquest/ABI (for dissertations), as well as hand search and work cited in previous qualitative reviews. 3 We included all published and unpublished articles States that used multivariate analysis to study hospital performance. The hospital sample had to include hospitals from at least two of our three included ownership forms (government-owned, private not-for-profit and private for-profit). We excluded studies that only compared subcategories of ownership (such as religious vs. secular private not-for-profits) or focused on hospitals of the Department of Veterans Affairs. From the 340 studies fitting these selection 4 criteria, we further narrowed down the field to studies examining one or more of the following outcomes: financial performance; patient outcomes (mortality, complications, and other adverse outcomes); uncompensated care, unprofitable services or other measures of community benefits; or staffing. Two authors (Eggleston and Shen) independently applied these selection criteria, achieving 7% discrepancy in coding, with consensus resolution of all differences. From the 169 citations that fell within this outcome scope, we excluded duplicates (such as dissertations and subsequently published papers), studies with very small sample sizes (fewer than 50 hospitals), and studies that did not report needed data (e.g., ownership coefficients in a regression) and for which authors were unable to supply that data.Through this search and selection process, we identified 141 studies. In this paper, we report results from analysis of the 46 studies in two broad categories: 31 studies of patient outcomes; and 15 studies of uncompensated care, unprofitable services, or other measures of community benefits (henceforth referred to jointly as "unprofitable care"). We include the complete bibliography of the included studies in the appendix. Data extraction.We extracted data needed to construct measures of treatment effect and to test our pre-specified hypotheses about underl...

Failure to secure the airway is an important cause of morbidity and mortality during resuscitations. We compared the rate of successful intubation of the King Vision™ aBlade™ channeled and non-channeled video laryngoscopes, and McGRATH™ MAC video laryngoscope when used by junior doctors to intubate a simulated difficult airway in an out-of-hospital setting. 105 junior doctors were recruited in a crossover study to perform tracheal intubation with the three video laryngoscopes on a simulated difficult airway using the SimMan® 3G manikin. Primary outcome was the rate of successful intubations. Secondary outcomes were time-to-visualization, time-to-intubation and ease of use. Rates of successful intubations were higher for King Vision channeled and McGrath compared to the King Vision non-channeled (85.7% and 82.9% respectively versus 24.8%; p<0.001). Amongst the participants who had successful intubations, King Vision channeled and McGrath had shorter mean time-to-intubation compared to the King Vision non-channeled (41.3±20.3s and 38.5±18.7s respectively versus 53.8±23.8s, p<0.004;). There was no significant difference in the rate of successful intubation and mean time-to-intubation between King Vision channeled and McGrath. The King Vision channeled and McGrath video laryngoscopes demonstrated superior intubation success rates compared to King Vision non-channeled laryngoscope when used by junior doctors for intubating simulated difficult airway in an out-of-hospital setting. We postulated that the presence of a guidance channel in the King Vision channeled laryngoscope and the familiarity of the blade curvature and handling of the McGrath could have accounted for their improved intubation success rates.

Background. Many states have passed legislation mandating that health plans provide direct access to obstetricians/gynecologists (hereinafter ''ob/gyns'') for women, limiting the ability of plans to require referrals or otherwise restrict access. One benefit of these laws may be improved preventive screening rates, but no literature has examined the relationship between ob/gyn direct access laws and use of breast cancer and cervical cancer screening. Data and Methods. We use repeated cross-sections of privately insured women age 18-64 (Pap test) and 40-64 (mammography) from the Behavioral Risk Factor Surveillance System for 1996-2000, linked to data on the presence of ob/gyn direct access laws by state. Outcome measures are receipt of mammography and receipt of a Pap test within the past 2 years. Regression analyses are used to assess the relationship between the presence of ob/gyn direct access laws and screening, adjusting for a range of individual characteristics, fixed state characteristics, and time trends. Results. We find no statistically significant relationships between the presence of an ob/gyn direct access law and receipt of either mammography or Pap test screening. We explore a range of alternate specifications and find none that yield clear evidence of a relationship. Conclusions. Laws requiring direct access to ob/gyns are not associated with large or consistent measurable impacts on use of cancer screening.

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