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Increasing regionalization of pediatric care has led to interfacility transfer of children with general pediatric conditions at rates similar to those of high-risk adults, which may delay appropriate treatment. We sought to identify common medical diagnoses that did not require significant advanced intervention and that had high rates of discharge within 1 day of interfacility transfer. Using the Pediatric Health Information System (PHIS) database, we identified all transfers into PHIS-participating children’s hospitals in 2019. We excluded encounters for mental health, labor/maternity, primary newborn diagnoses, and direct admissions to an intensive care unit. Eligible encounters were categorized by duration of hospitalization and basic vs advanced intervention after transfer. Of 286,905 transfers, 197,386 (68.6%) met inclusion criteria. Cough, febrile seizures, croup, and allergic reactions required advanced interventions

With the increased empirical and theoretical support for common factors in the psychotherapy literature, marriage and family therapy (MFT) scholars have begun discussing the inclusion of common factors in MFT training. However, there is very little empirical research on common factors training or how to include common factors in MFT curricula. The purpose of this phenomenological study was to investigate MFT students' experience with common factors training. Seventeen master's degree students who received training in common factors participated in the study. Data was comprised of participants' journal reflections and focus group interviews on their experience learning about common factors and how this influenced their work with clients. Participants' responses to the training were overwhelmingly positive and highlighted the ways in which studying common factors enhanced their confidence, understanding of MFT models, conceptual abilities, and clinical practice. Additional results and discussion about incorporating common factors in MFT training are presented.

Investments in global health have more than doubled over the past decade, generating a cadre of new institutions. To date, most of the funded research in global health has focused on discovery, and, more recently, on the development of new tools, which has tightened the implementation bottleneck. This article introduces the concept of global health delivery and the need to catalog and analyze current implementation efforts to bridge gaps in delivery. Global health delivery is complex and context-dependent and requires an interdisciplinary effort, including the application of strategic principles. Furthermore, delivery is necessary to ensure that the investments in research, discovery, and development generate value for patients and populations. This article discusses the application of value-based delivery to global health. It provides some examples of approaches to aggregating implicit knowledge to inform practice. With global health delivery, the aim is to transform global health scale-up from a series of well-intentioned but often disconnected efforts to a value-based movement based upon 21st-century technology, standards, and efficiency. Mt Sinai J Med 78:458–469, 2011 © 2011 Mount Sinai School of Medicine

One pathway by which infant mammals gain information about their environment is through ingestion of milk. We assessed the relationship between stress-induced cortisol concentrations in milk, maternal and offspring plasma, and offspring temperament in rhesus monkeys. Milk was collected from mothers after a brief separation from their infants at 3–4 months postpartum, and blood was drawn at this time for both mothers and infants. Offspring temperament was measured at the end of a 25-hr assessment. Cortisol concentrations in milk were in a range comparable to those found in saliva, and were positively correlated with maternal plasma levels. Mothers of males had higher cortisol concentrations in milk than did mothers of females, and cortisol concentrations in maternal milk were related to a Confident temperament factor in sons, but not daughters. This study provides the first evidence that naturally occurring variation in endogenous glucocorticoid concentrations in milk are associated with infant temperament. © 2010 Wiley Periodicals, Inc. Dev Psychobiol 53: 96–104, 2011.

There is considerable support for the effectiveness of psychotherapies regardless of their individual theoretical underpinnings. They all evidence substantial positive outcomes, particularly if they contain common elements. These include a therapeutic relationship within an appropriate setting, a rationale for why the client is unhappy or distressed and in need of therapy, and procedures for effecting positive change. We interpret these common elements as a process of learning that promotes the client's independence, friendship formation and maintenance, competence, and physical health. © 2009 Wiley Periodicals, Inc.

Objective. To identify costs among rheumatoid arthritis (RA) patients receiving alternative disease-modifying antirheumatic drug (DMARD) therapies. Methods. Using managed care organization data, we identified members who (a) were prescribed any DMARD therapy for two consecutive months between July 1993 and February 1998, (b) were aged ≥18 years, (c) had ≥6 months of DMARD-free enrollment prior to the first DMARD, and (d) had a diagnosis of RA. Results. The average age of the cohort (n = 571) was 51 years, and 70% were women. Mean duration of enrollment following initiation of DMARD therapy (observation period) was 19.5 months; 28.8% of patients switched DMARD regimens. The average monthly cost of care was $853, of which $294 (34%) was for RA-coded medical services. Monthly RA-coded costs varied by DMARD: hydroxychloroquine $227 (n = 252), methotrexate $340 (n = 185); sulfasalazine $233 (n = 49), and other mono/combination therapy $425 (n = 85) (P = 0.001). Conclusion. Costs of RA-coded care in patients receiving DMARDs are low and vary by DMARD.