BackgroundDespite numerous studies of geographic variation in healthcare cost and utilization at the local, regional, and state levels across the U.S., a comprehensive characterization of geographic variation in outcomes has not been published. Our objective was to quantify variation in US health outcomes in an all-payer population before and after risk-adjustment.Methods and FindingsWe used information from 16 independent data sources, including 22 million all-payer inpatient admissions from the Healthcare Cost and Utilization Project (which covers regions where 50% of the U.S. population lives) to analyze 24 inpatient mortality, inpatient safety, and prevention outcomes. We compared outcome variation at state, hospital referral region, hospital service area, county, and hospital levels. Risk-adjusted outcomes were calculated after adjusting for population factors, co-morbidities, and health system factors. Even after risk-adjustment, there exists large geographical variation in outcomes. The variation in healthcare outcomes exceeds the well publicized variation in US healthcare costs. On average, we observed a 2.1-fold difference in risk-adjusted mortality outcomes between top- and bottom-decile hospitals. For example, we observed a 2.3-fold difference for risk-adjusted acute myocardial infarction inpatient mortality. On average a 10.2-fold difference in risk-adjusted patient safety outcomes exists between top and bottom-decile hospitals, including an 18.3-fold difference for risk-adjusted Central Venous Catheter Bloodstream Infection rates. A 3.0-fold difference in prevention outcomes exists between top- and bottom-decile counties on average; including a 2.2-fold difference for risk-adjusted congestive heart failure admission rates. The population, co-morbidity, and health system factors accounted for a range of R2 between 18–64% of variability in mortality outcomes, 3–39% of variability in patient safety outcomes, and 22–70% of variability in prevention outcomes.ConclusionThe amount of variability in health outcomes in the U.S. is large even after accounting for differences in population, co-morbidities, and health system factors. These findings suggest that: 1) additional examination of regional and local variation in risk-adjusted outcomes should be a priority; 2) assumptions of uniform hospital quality that underpin rationale for policy choices (such as narrow insurance networks or antitrust enforcement) should be challenged; and 3) there exists substantial opportunity for outcomes improvement in the US healthcare system.
Cyclic peptide nanotubes (CPNs) exhibit impressive structural, mechanical and chemical properties in resemblance to beta-sheet proteins found in silks and amyloids, and show potential as supramolecular nanotubes that can be utilized to generate novel nanocomposites and nanoporous thin films. Quantifying the persistence length and thermomechanical fragmentation of CPNs is of great importance for establishing a theoretical basis of how to generate rectilinear nanostructures with controlled aspect ratio and rigidity. However, factors governing the elasticity and dynamical breaking of these supramolecular nanostructures remain to be fully understood. Here we present a statistical analysis of the Young's modulus and persistence length of CPNs using fully-atomistic molecular dynamic simulations in explicit solvent. We show that the measured properties exhibit a dependence on the magnitude of the shear force applied, and extrapolation to the quasi-static deformation case yields 0.46 μm for the persistence length and 7.8 GPa for the Young's modulus, in agreement with our experimental observations from TEM images. We establish a theoretical model for the spatial and temporal distribution of stochastic fracture, which we use to explain the simulation-based observations of spontaneous fragmentation under an applied shear force. Our methodology, blending theory, simulation and experiments provide a framework that can be utilized to investigate the mechanical behavior of self-assembling protein materials, paving the way for their design towards biological and industrial applications.
Discussion | In this study, which is to our knowledge the first to longitudinally examine sexual identity and sexual contact in a nationally representative sample of high school students, an increase was noted for nonheterosexual identity but not same-sex sexual contact. However, it is unclear to what extent this increase reflects a change in the true prevalence of nonheterosexual sexual identities or whether the observed increase was in part because of increased comfort with selfdisclosure.In terms of additional limitations, the YRBS questionnaire never explicitly defined the term sexual contact 4 and failed to adequately distinguish between same-sex and samegender sexual contact. 5 Moreover, some participants may have responded to the question assessing sex with their gender identity, leading to the incorrect classification of same-sex sexual contact. Furthermore, some youths in sexual minority groups may have felt their identity was not represented by the available responses to the question regarding sexual identity. Additionally, adolescents may have underreported nonheterosexual sexual identities and same-sex sexual contact because of persistent stigma associated with sensitive topics such as sexual identity. 6 Although the YRBS measures are imperfect, the apparent increase in nonheterosexual identity among youth in the US calls for greater vigilance among health care professionals regarding the heightened risks faced by these youths, such as bullying and mental health challenges.
Purpose The purpose of this paper is to present a case study describing a collaboration with Last Mile Health, a non-governmental organization, to develop a framework to inform its community healthcare networks in remote Liberia. Design/methodology/approach The authors detail the process of using the unique problem setting and available data to inform modeling and solution approaches. Findings The authors show how the characteristics of the Liberian setting can be used to develop a two-tier modeling framework. Given the operating constraints and remote setting the authors are able to model the problem as a special case of the location-routing problem that is computationally simple to solve. The results of the models applied to three districts of Liberia are discussed, as well as the collaborative process of the multidisciplinary team. Originality/value Importantly, the authors describe how the problem setting can enable the development of a properly scoped model that is implementable in practice. Thus the authors provide a case study that bridges the gap between theory and practice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.