129 results on '"Hughes JS"'
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2. SEVERITY OF ILLNESS: WHAT FACTORS MATTER TO PHYSICIANS? IT DEPENDS ON HOW YOU ASK
- Author
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Stone, DA and Hughes, JS
- Published
- 1996
3. An Evaluation of Appropriate Expressions of Toxicity in Aquatic Plant Bioassays as Demonstrated by the Effects of Atrazine on Algae and Duckweed
- Author
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Hughes, JS, primary, Alexander, MM, additional, and Balu, K, additional
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4. Introduction, Overview, Issues
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Wells, PG, primary, Butler, JN, additional, and Hughes, JS, additional
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5. Voluntary disclosure of precision information
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Hughes, JS, Pae, S., Hughes, JS, and Pae, S.
- Abstract
This paper presents a model of an entrepreneur's acquisition and voluntary disclosure of precision information as a supplement to primary disclosure of an estimate of a tradable asset's value. Our analysis shows that equilibrium disclosure can be characterized by four regions. For estimates above (below) the prior expectation of the asset value, the entrepreneur discloses only high (low) precision information. The main idea is to enhance (diminish) confidence in estimates that improve upon (detract from) prior beliefs. We further show that the entrepreneur over-invests in the acquisition of precision information due to the option value of discretion over disclosure. (C) 2003 Elsevier B.V. All rights reserved.
- Published
- 2004
6. Environmental Toxicology and Risk Assessment
- Author
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Landis, WG, primary, Hughes, JS, additional, and Lewis, MA, additional
- Published
- 1993
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7. Posterior internal compression arthrodesis of the ankle
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Sward, L, primary, Hughes, JS, additional, Howell, CJ, additional, and Colton, CL, additional
- Published
- 1992
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8. The strength of surgical repairs of the rotator cuff. A biomechanical study on cadavers
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Sward, L, primary, Hughes, JS, additional, Amis, A, additional, and Wallace, WA, additional
- Published
- 1992
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9. Surgical release of post-traumatic stiff elbow
- Author
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DH Sonnabend and Hughes Js
- Subjects
medicine.medical_specialty ,business.industry ,Stiff elbow ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,General Medicine ,business - Published
- 1996
10. Developing a prospective payment system based on episodes of care.
- Author
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Averill RF, Goldfield NI, Hughes JS, Eisenhandler J, and Vertrees JC
- Published
- 2009
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11. Redesigning the Medicare inpatient PPS to reduce payments to hospitals with high readmission rates.
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Averill RF, McCullough EC, Hughes JS, Goldfield NI, Vertrees JC, and Fuller RL
- Published
- 2009
12. Discoveries in Physical Sciences Having Social Significance
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Hughes Js
- Subjects
Atomic energy ,Sociology ,Social science ,Social significance ,Epistemology - Published
- 1948
13. Can portable glucose and lactate meters be a useful tool in quantifying stress of juvenile Chinook salmon?
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Vaage BM, Liss SA, Fischer ES, Khan F, and Hughes JS
- Abstract
Blood plasma analyses can provide researchers, aquaculture facilities and fisheries managers with valuable insights into the physiological state and welfare of fish. For example, glucose and lactate are part of the secondary stress response system, and elevated concentrations are indicators of stress. However, analysing blood plasma in the field can be logistically difficult and typically involves sample storage and transport to quantify concentrations in a laboratory setting. Portable glucose and lactate meters offer an alternative to laboratory assays and have shown to be relatively accurate in fish, but these tools have only been validated for a few fish species. The objective of this study was to investigate if portable meters could be reliably used in Chinook salmon ( Oncorhynchus tshawytscha ). As part of a larger stress response study, juvenile Chinook salmon (157 ± 17 mm fork length [mean ± standard deviation; SD]) were exposed to stress-inducing treatments and sampled for blood. Laboratory reference glucose concentrations (milligrams per deciliter; mg/dl; n = 70) were positively correlated with the Accu-Check Aviva meter (Roche Diagnostics, Indianapolis, IN) measurements ( R
2 = 0.79), although glucose values were 1.21 ± 0.21 (mean ± SD) times higher in the laboratory than with the portable meter. Lactate concentrations (milliMolar; mM; n = 52) of the laboratory reference were also positively correlated ( R2 = 0.76) with the Lactate Plus meter (Nova Biomedical, Waltham, MA) and were 2.55 ± 0.50 times higher than portable meter. Our results indicate both meters could be used to measure relative glucose and lactate concentrations in Chinook salmon and provide fisheries professionals with a valuable tool, particularly in remote field settings., Competing Interests: No conflict of interest was present in this research., (© The Author(s) 2023. Published by Oxford University Press and the Society for Experimental Biology.)- Published
- 2023
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14. Ligament Reconstruction and Interposition Arthroplasty of the Acromioclavicular Joint.
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Patel SS, Piggott RP, Spasojevic M, and Hughes JS
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- Humans, Arthroplasty methods, Clavicle surgery, Arthralgia surgery, Ligaments surgery, Acromioclavicular Joint surgery, Osteoarthritis surgery
- Abstract
Distal clavicle excision (DCE) for acromioclavicular (AC) joint primary osteoarthritis and post-traumatic arthritis has been shown to have good to excellent outcomes. However, there are studies that report significant rates of residual AC joint pain and distal clavicle instability after open and arthroscopic techniques. We describe a surgical technique for management of AC joint primary osteoarthritis, post-traumatic arthritis, and revision DCE that involves DCE with ligament reconstruction and tendon interposition arthroplasty. It provides distal clavicle stability and can theoretically reduce residual AC joint pain secondary to acromial abutment after DCE., Competing Interests: Conflicts of Interest and Source of Funding: J.S.H. has the following disclosures: Mathys Ltd: Paid presenter or speaker; Research support. Medartis: Paid presenter or speaker. Zimmer: IP royalties; Paid consultant; Paid presenter or speaker. For the remaining authors none were declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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15. Using Drugs or Non-Drugs Alternatives to Alter Mental States in the Online, Virtual Era.
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Mouton C, Hughes JS, and Olson JN
- Subjects
- Adult, Humans, Anxiety, Health Behavior, Emotions, Cognitive Behavioral Therapy
- Abstract
Background : In the 1970s a body of literature was generated advocating the alternatives approach for drug misuse prevention and rehabilitation which encouraged healthy nonchemical behaviors leading to reinforcing moods. Although this behaviorally oriented approach was overshadowed with the popularity of cognitive therapy in the 1980s, many of the recommended alternative behaviors remain embedded in cognitive approaches for drug misuse prevention and rehabilitation. One objective of the present study was to replicate, in part, two studies conducted in the 1970s which examined usage patterns of non-drug alternatives. A second objective was to explore of the use of newer technologies like the internet and the smartphone to alter emotional states. A third objective was to examine perceived stress and discrimination experiences on preferences for drug and non-drug alternatives. Methods : Three questionnaires were administered: use of drugs and non-drug alternatives in response to everyday emotions; the Everyday Discrimination Scale; and the Perceived Stress Scale. A total of 483 adults participated; their mean age was 39 years. Results : The results revealed that non-drug alternatives were preferred to drugs in treating experiences of anxiety, depression, and hostility, and to induce pleasure. Drugs were used most often to deal with pain. Experiences of discrimination increased perceptions of stress, and stress, in turn, affected the use of drugs to cope with a range of emotions. Social media and virtual activities were not preferred methods for altering negative moods. Conclusions : Social media may actually be a contributor or cause of distress, rather than a means for reducing it.
- Published
- 2023
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16. Problematic Risk Adjustment in National Healthcare Safety Network Measures.
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Fuller RL, Hughes JS, Atkinson G, and Aubry BS
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- Benchmarking, Fee-for-Service Plans, Hospital Bed Capacity, Humans, Intensive Care Units standards, Medicare standards, Quality Indicators, Health Care, Risk Adjustment standards, United States, Cross Infection prevention & control, Intensive Care Units organization & administration, Medicare organization & administration, Risk Adjustment organization & administration
- Abstract
This article reviews the risk-adjustment models underpinning the National Healthcare Safety Network (NHSN) standardized infection ratios. After first describing the models, the authors focus on hospital intensive care unit (ICU) designation as a variable employed across the various risk models. The risk-adjusted frequency with which ICU services are reported in Medicare fee-for-service claims data was compared as a proxy for determining whether reporting of ICU days is similar across hospitals. Extreme variation was found in the reporting of ICU utilization among admissions for congestive heart failure, ranging from 25% in the lowest admission hospital quartile to 95% in the highest. The across-hospital variation in reported ICU utilization was found to be unrelated to patient severity. Given that such extreme variation appears in a designation of ICU versus non-ICU utilization, the NHSN risk-adjustment models' dependence on nursing unit designation should be a cause for concern.
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- 2020
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17. A Middle-Ground Proposal for Making Health Care Premiums More Affordable.
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Averill RF and Hughes JS
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- Commerce, Medicare, Patient Protection and Affordable Care Act, Policy Making, United States, Insurance Coverage economics, Insurance, Health economics
- Abstract
Passage of any health care reform that addresses the rising cost of health care in the United States will be a difficult political challenge unless a middle-ground compromise between government control of health care insurance and free market approaches can be found. On the basis of the competitive market for Medicare supplemental insurance, a Medicare Adherence Policy insurance option is proposed that would leverage Medicare's authority to set prices to create a practical middle-ground reform that can strike a balance between the role of government and the free market.
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- 2019
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18. Nursing Home Compare Star Rankings and the Variation in Potentially Preventable Emergency Department Visits and Hospital Admissions.
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Fuller RL, Goldfield NI, Hughes JS, and McCullough EC
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- Aged, Aged, 80 and over, Humans, Retrospective Studies, United States epidemiology, Emergency Service, Hospital statistics & numerical data, Hospitalization statistics & numerical data, Nursing Homes standards, Nursing Homes statistics & numerical data, Quality of Health Care standards
- Abstract
Measurement of the quality of US health care increasingly emphasizes clinical outcomes over clinical processes. Nursing Home Compare Star Ratings are provided by Medicare to help select better nursing home care. The authors determined the rates and types of 2 important clinical outcomes-potentially preventable hospital admissions and potentially preventable emergency department (ED) visits-for a subset of 439,011 long-term nursing homes residents residing in 12,883 nursing homes throughout the United States over a 2-year period (2010-2011) and compared them with the Star Rating system. This study found that (1) the likelihood of potentially preventable events increases with increasing burden of chronic illness, (2) the principle reasons for hospital admissions and ED visits (eg, septicemia, pneumonia, confusion, gastroenteritis) are not part of existing nursing home quality measures, (3) the rate of potentially preventable admissions and ED visits for nursing homes residents varies greatly both across and within states, with 5 states having in excess of 20% more than the national average for both, and (4) the Nursing Home Compare Stars measure has limited correlation with rates of these potentially preventable events. Nursing Home Compare Star rankings could benefit by incorporating outcomes measures such as preventable hospitalizations and ED visits, and by comparing nursing home performance on results drawn from across states rather than within them. Such reform could better help users find nursing homes of higher quality and stimulate homes to improve quality in ways that benefit residents.
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- 2019
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19. Are We Confident of Across-Hospital Mortality Comparisons?
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Fuller RL, Hughes JS, Goldfield NI, and Atkinson G
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- Cause of Death, Humans, Length of Stay, Medicare Payment Advisory Commission, Hospital Mortality, Reimbursement, Incentive
- Published
- 2018
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20. Will Hospital Peer Grouping by Patient Socioeconomic Status Fix the Medicare Hospital Readmission Reduction Program or Create New Problems?
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Fuller RL, Hughes JS, Goldfield NI, and Averill RF
- Subjects
- Benchmarking standards, Humans, Quality Indicators, Health Care, Risk Factors, Socioeconomic Factors, United States, Benchmarking organization & administration, Centers for Medicare and Medicaid Services, U.S. standards, Hospital Administration standards, Patient Readmission standards, Vulnerable Populations
- Abstract
Background: In 2016 the U.S. Congress directed the Centers for Medicare & Medicaid Services (CMS) to implement the 21st Century Cures Act to fix a flaw in the Hospital Readmissions Reduction Program (HRRP). One section of the Act is intended to remove bias in calculating penalties for hospitals treating large percentages of low socioeconomic status (SES) patients. A study was conducted to analyze the effect of the introduction of SES hospital peer groups on the number and distribution of the hospitals being penalized., Methods: The CMS analysis files for the fiscal year 2017 HRRP final rule and Disproportionate Share Hospital adjustments were used to assign hospital peer groups. The median excess readmission ratios for hospital peer groups were calculated, and the resulting pattern of hospital penalties within peer groups was analyzed., Results: The findings suggest that because CMS assigns individual HRRP penalties on six clinical conditions but proposes to assign hospitals to a single SES peer group based on all admissions, it will ignore substantial differences in the distribution of peer group medians across these conditions. For surgical cases, as expected, hospitals with fewer patients had higher readmission rates, while for medical cases, hospitals with fewer patients had fewer readmissions. These findings may result in distortion of the peer group adjustment intended to correct for SES., Conclusion: Hospital peer groups may create unintended redistributions of penalties through distortion of peer group medians. An observed relationship between lower-volume hospitals and fewer readmissions for medical conditions requires additional research to establish its basis., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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21. In a moral dilemma, choose the one you love: Impartial actors are seen as less moral than partial ones.
- Author
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Hughes JS
- Subjects
- Adult, Female, Humans, Male, Decision Making, Interpersonal Relations, Morals, Social Behavior, Social Perception
- Abstract
Although impartiality and concern for the greater good are lauded by utilitarian philosophies, it was predicted that when values conflict, those who acted impartially rather than partially would be viewed as less moral. Across four studies, using life-or-death scenarios and more mundane ones, support for the idea that relationship obligations are important in moral attribution was found. In Studies 1-3, participants rated an impartial actor as less morally good and his or her action as less moral compared to a partial actor. Experimental and correlational evidence showed the effect was driven by inferences about an actor's capacity for empathy and compassion. In Study 4, the relationship obligation hypothesis was refined. The data suggested that violations of relationship obligations are perceived as moral as long as strong alternative justifications sanction them. Discussion centres on the importance of relationships in understanding moral attributions., (© 2017 The British Psychological Society.)
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- 2017
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22. Quality Improvement Initiatives Need Rigorous Evaluation: The Case of Pressure Ulcers.
- Author
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Averill RF, Hughes JS, Fuller RL, and Goldfield NI
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- Cost Savings, Humans, Medicare organization & administration, Pressure Ulcer economics, Pressure Ulcer epidemiology, Program Evaluation, Quality Assurance, Health Care methods, Quality Assurance, Health Care organization & administration, Quality Improvement organization & administration, Reimbursement, Incentive, United States epidemiology, Pressure Ulcer prevention & control, Quality Improvement standards
- Abstract
The Partnership for Patients (PfP) and the Agency for Healthcare Research and Quality (AHRQ) have reported a 23.5% decline in hospital-acquired pressure ulcers (HAPU) over 4 years resulting in a cumulative cost savings of more than $10 billion and 49 000 averted deaths, claiming that this significant decline may have been spurred in part by Medicare payment incentives associated with severe (stage 3 or 4) HAPUs. Hospitals with a high rate of severe HAPUs have a payment penalty imposed, creating a financial disincentive to report severe HAPUs, possibly contributing to the magnitude of the reported decline. Despite the financial disincentive to report, the number of severe HAPUs found in claims data over the corresponding 4-year period did not decline but instead remained unchanged. The results from claims data, combined with some flaws in estimating HAPUs, call into question the validity of the decline in HAPUs reported by PfP and AHRQ.
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- 2017
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23. Is the CMS Hospital-Acquired Condition Reduction Program a Valid Measure of Hospital Performance?
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Fuller RL, Goldfield NI, Averill RF, and Hughes JS
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- Diagnosis-Related Groups statistics & numerical data, Hospital Bed Capacity statistics & numerical data, Humans, Quality of Health Care standards, Socioeconomic Factors, United States, Centers for Medicare and Medicaid Services, U.S. standards, Hospital Administration standards, Iatrogenic Disease epidemiology, Quality Indicators, Health Care standards
- Abstract
In October 2014, the Centers for Medicare & Medicaid Services began reducing Medicare payments by 1% for the bottom performing quartile of hospitals under the Hospital-Acquired Condition Reduction Program (HACRP). A tight clustering of HACRP scores around the penalty threshold was observed resulting in 13.2% of hospitals being susceptible to a shift in penalty status related to single decile changes in the ranking of any one of the complication or infection measures used to compute the HACRP score. The HACRP score also was found to be significantly correlated with several hospital characteristics including hospital case mix index. This correlation was not confirmed when an alternative method of measuring hospital complication performance was used. The sensitivity of the HACRP penalties to small changes in performance and correlation of the HACRP score with hospital characteristics call into question the validity of the HACRP measure and method of risk adjustment.
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- 2017
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24. Enhanced Magnetization of Cobalt Defect Clusters Embedded in TiO 2-δ Films.
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Cortie DL, Khaydukov Y, Keller T, Sprouster DJ, Hughes JS, Sullivan JP, Wang XL, Le Brun AP, Bertinshaw J, Callori SJ, Aughterson R, James M, Evans PJ, Triani G, and Klose F
- Abstract
High magnetizations are desirable for spintronic devices that operate by manipulating electronic states using built-in magnetic fields. However, the magnetic moment in promising dilute magnetic oxide nanocomposites is very low, typically corresponding to only fractions of a Bohr magneton for each dopant atom. In this study, we report a large magnetization formed by ion implantation of Co into amorphous TiO
2-δ films, producing an inhomogeneous magnetic moment, with certain regions producing over 2.5 μB per Co, depending on the local dopant concentration. Polarized neutron reflectometry was used to depth-profile the magnetization in the Co:TiO2-δ nanocomposites, thus confirming the pivotal role of the cobalt dopant profile inside the titania layer. X-ray photoemission spectra demonstrate the dominant electronic state of the implanted species is Co0 , with a minor fraction of Co2+ . The detected magnetizations have seldom been reported before and lie near the upper limit set by Hund's rules for Co0 , which is unusual because the transition metal's magnetic moment is usually reduced in a symmetric 3D crystal-field environment. Low-energy positron annihilation lifetime spectroscopy indicates that defect structures within the titania layer are strongly modified by the implanted Co. We propose that a clustering motif is promoted by the affinity of the positively charged implanted species to occupy microvoids native to the amorphous host. This provides a seed for subsequent doping and nucleation of nanoclusters within an unusual local environment.- Published
- 2017
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25. Should the Positive Predictive Value be Used to Validate Complications Measures?
- Author
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Hughes JS
- Subjects
- Predictive Value of Tests, Sensitivity and Specificity
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- 2017
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26. How to measure the impacts of antibiotic resistance and antibiotic development on empiric therapy: new composite indices.
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Hughes JS, Hurford A, Finley RL, Patrick DM, Wu J, and Morris AM
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- Catheter-Related Infections epidemiology, Humans, Intensive Care Units, Pneumonia, Ventilator-Associated epidemiology, Retrospective Studies, Anti-Bacterial Agents therapeutic use, Catheter-Related Infections drug therapy, Drug Resistance, Bacterial, Microbial Sensitivity Tests methods, Pneumonia, Ventilator-Associated drug therapy
- Abstract
Objectives: We aimed to construct widely useable summary measures of the net impact of antibiotic resistance on empiric therapy. Summary measures are needed to communicate the importance of resistance, plan and evaluate interventions, and direct policy and investment., Design, Setting and Participants: As an example, we retrospectively summarised the 2011 cumulative antibiogram from a Toronto academic intensive care unit., Outcome Measures: We developed two complementary indices to summarise the clinical impact of antibiotic resistance and drug availability on empiric therapy. The Empiric Coverage Index (ECI) measures susceptibility of common bacterial infections to available empiric antibiotics as a percentage. The Empiric Options Index (EOI) varies from 0 to 'the number of treatment options available', and measures the empiric value of the current stock of antibiotics as a depletable resource. The indices account for drug availability and the relative clinical importance of pathogens. We demonstrate meaning and use by examining the potential impact of new drugs and threatening bacterial strains., Conclusions: In our intensive care unit coverage of device-associated infections measured by the ECI remains high (98%), but 37-44% of treatment potential measured by the EOI has been lost. Without reserved drugs, the ECI is 86-88%. New cephalosporin/β-lactamase inhibitor combinations could increase the EOI, but no single drug can compensate for losses. Increasing methicillin-resistant Staphylococcus aureus (MRSA) prevalence would have little overall impact (ECI=98%, EOI=4.8-5.2) because many Gram-positives are already resistant to β-lactams. Aminoglycoside resistance, however, could have substantial clinical impact because they are among the few drugs that provide coverage of Gram-negative infections (ECI=97%, EOI=3.8-4.5). Our proposed indices summarise the local impact of antibiotic resistance on empiric coverage (ECI) and available empiric treatment options (EOI) using readily available data. Policymakers and drug developers can use the indices to help evaluate and prioritise initiatives in the effort against antimicrobial resistance., Competing Interests: We do not have commercial or other associations that might pose a conflict of interest., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
- Published
- 2016
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27. The clinical outcome and activity levels of patients under 55 years treated with distal humeral hemiarthroplasty for distal humeral fractures: minimum 2-year follow-up.
- Author
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Smith GC, Bayne G, Page R, and Hughes JS
- Abstract
Background: The aim of the present study was to describe the clinical outcomes and activity levels of young patients after distal humeral hemiarthroplasty (DHH)., Methods: Six patients under 55 years (mean 44 years; range 29 years to 52 years) treated with DHH at a mean postoperative time of 81 months (range 24 months to 133 months) were studied retrospectively. Two other patients had been revised for aseptic loosening and were excluded., Results: The mean Mayo Elbow Score (MEPS) (88), Subjective Elbow Value (SEV) (89), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) (12) and American Shoulder and Elbow Surgeons (ASES) elbow pain (6), function (23) and satisfaction scores (9) were satisfactory. The mean University of California, Los Angeles (UCLA) activity score was 7.2., Conclusions: Although only rarely indicated, DHH has satisfactory clinical outcomes in young patients and allows a higher level of function than is generally advised after total elbow arthroplasty.
- Published
- 2016
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28. Rethinking Medicare Payment Adjustments for Quality.
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Averill RF, Fuller RL, McCullough EC, and Hughes JS
- Subjects
- Health Care Reform, Health Policy, Humans, United States, Medicare economics, Quality Assurance, Health Care economics, Reimbursement Mechanisms organization & administration
- Abstract
Payment reforms aimed at linking payment and quality have largely been based on the adherence to process measures. As a result, the attempt to pay for value is getting lost in an overly complex attempt to measure value. The "Incentivizing Health Care Quality Outcomes Act of 2014" (HR 5823) proposes to replace the existing patchwork of process and outcomes quality measures with a uniform, coordinated, and comprehensive outcomes-based quality measurement system. The Outcomes Act represents a shift in payment policy toward getting value instead of an increasingly complex attempt to measure value.
- Published
- 2016
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29. Comparison of the Properties of Regression and Categorical Risk-Adjustment Models.
- Author
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Fuller RL, Averill RF, Muldoon JH, and Hughes JS
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- Insurance, Health, Reimbursement, Managed Care Programs economics, Policy Making, United States, Population Surveillance, Regression Analysis, Risk Adjustment statistics & numerical data
- Abstract
Clinical risk-adjustment, the ability to standardize the comparison of individuals with different health needs, is based upon 2 main alternative approaches: regression models and clinical categorical models. In this article, we examine the impact of the differences in the way these models are constructed on end user applications.
- Published
- 2016
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30. Adjusting Population Risk for Functional Health Status.
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Fuller RL, Hughes JS, and Goldfield NI
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- Health Expenditures statistics & numerical data, Humans, Managed Care Programs, Medicare, Population Surveillance, United States, Health Status Indicators, Risk Adjustment, Risk Assessment
- Abstract
Risk adjustment accounts for differences in population mix by reducing the likelihood of enrollee selection by managed care plans and providing a correction to otherwise biased reporting of provider or plan performance. Functional health status is not routinely included within risk-adjustment methods, but is believed by many to be a significant enhancement to risk adjustment for complex enrollees and patients. In this analysis a standardized measure of functional health was created using 3 different source functional assessment instruments submitted to the Medicare program on condition of payment. The authors use a 5% development sample of Medicare claims from 2006 and 2007, including functional health assessments, and develop a model of functional health classification comprising 9 groups defined by the interaction of self-care, mobility, incontinence, and cognitive impairment. The 9 functional groups were used to augment Clinical Risk Groups, a diagnosis-based patient classification system, and when using a validation set of 100% of Medicare data for 2010 and 2011, this study found the use of the functional health module to improve the fit of observed enrollee cost, measured by the R(2) statistic, by 5% across all Medicare enrollees. The authors observed complex nonlinear interactions across functional health domains when constructing the model and caution that functional health status needs careful handling when used for risk adjustment. The addition of functional health status within existing risk-adjustment models has the potential to improve equitable resource allocation in the financing of care costs for more complex enrollees if handled appropriately. (Population Health Management 2016;19:136-144).
- Published
- 2016
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31. Response to Commentaries on "Rethinking Medicare Payment Adjustments for Quality".
- Author
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Averill RF, Fuller RL, McCullough EC, and Hughes JS
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- Quality Assurance, Health Care, United States, Health Expenditures, Medicare
- Published
- 2016
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32. Response to Commentaries on "Comparison of the Properties of Regression and Categorical Risk-Adjustment Models".
- Author
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Fuller RL, Averill RF, Muldoon JH, and Hughes JS
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- Humans, Models, Theoretical
- Published
- 2016
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33. Introducing the Date and Acquaintance Rape Avoidance Scale.
- Author
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Resendez JR and Hughes JS
- Subjects
- Adult, Female, Humans, Sexual Behavior statistics & numerical data, Social Perception, Young Adult, Crime Victims classification, Prejudice, Rape prevention & control, Surveys and Questionnaires standards
- Abstract
We present the Date and Acquaintance Rape Avoidance Scale (DARAS). The DARAS is a measure of a woman's behaviors used to avoid date and acquaintance rape. Three factor structures were possible. The DARAS may have measured several factors related to alcohol and drug use, self-defense, and date behaviors; 2 factors related to behaviors to avoid acquaintance versus date rape; or a single factor that represented general vigilance. The data revealed a highly reliable, 63 item single factor that was correlated with stranger rape avoidance, rejection of rape myths, hostile sexist beliefs about men, and benevolent sexist beliefs about women. The creation of the DARAS adds to the growing body of research on rape avoidance. The DARAS is key to understanding the behaviors women employ to avoid date rape. Rather than placing the responsibility for rape on the victim, the DARAS was developed as a theoretical and applied tool that can be used to improve theory and construct rape education and prevention programs.
- Published
- 2016
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34. Mind attributions about moral actors: intentionality is greater given coherent cues.
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Hughes JS and Trafimow D
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- Adolescent, Adult, Cues, Female, Humans, Judgment, Male, Young Adult, Intention, Morals, Social Perception, Theory of Mind
- Abstract
Attributions about intentionality and the capacity for agency were explored from coherence perspectives. Coherence perspectives suggest that social perceivers use information about an actor's motives, traits, and the outcomes of action to create meaningful explanations of action. According to the typecasting theory, intentionality and agency attributions should be related and predicted by one's role in a moral dyad. Across four studies, with different operational definitions of moral dyads and agency, we found evidence in favour of coherence perspectives. Social perceivers relied on mental states, character, and behavioural cues to make intentionality judgments. Further, intentionality attributions about behaviours were unrelated to inferences about agency. The discussion centres on the importance of coherent explanation in moral judgment., (© 2014 The British Psychological Society.)
- Published
- 2015
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35. Effects of forest spatial structure on insect outbreaks: insights from a host-parasitoid model.
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Hughes JS, Cobbold CA, Haynes K, and Dwyer G
- Subjects
- Animals, Ecosystem, Models, Biological, Moths physiology, Population Dynamics, Forests, Host-Parasite Interactions, Insecta physiology, Trees parasitology
- Abstract
Understanding how cycles of forest-defoliating insects are affected by forest destruction is of major importance for forest management. Achieving such an understanding with data alone is difficult, however, because population cycles are typically driven by species interactions that are highly nonlinear. We therefore constructed a mathematical model to investigate the effects of forest destruction on defoliator cycles, focusing on defoliator cycles driven by parasitoids. Our model shows that forest destruction can increase defoliator density when parasitoids disperse much farther than defoliators because the benefits of reduced defoliator mortality due to increased parasitoid dispersal mortality exceed the costs of increased defoliator dispersal mortality. This novel result can explain observations of increased outbreak duration with increasing forest fragmentation in forest tent caterpillar populations. Our model also shows that larger habitat patches can mitigate habitat loss, with clear implications for forest management. To better understand our results, we developed an approximate model that shows that defoliator spatial dynamics can be predicted from the proportion of dispersing animals that land in suitable habitat. This approximate model is practically useful because its parameters can be estimated from widely available data. Our model thus suggests that forest destruction may exacerbate defoliator outbreaks but that management practices could mitigate such effects.
- Published
- 2015
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36. Indications of biased risk adjustment in the hospital readmission reduction program.
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Fuller RL, Atkinson G, and Hughes JS
- Subjects
- Centers for Medicare and Medicaid Services, U.S., Chronic Disease, Humans, Risk Adjustment, United States, Hospitalization economics, Patient Readmission economics
- Abstract
The Centers for Medicare and Medicaid Services hospital readmission reduction program administers substantial penalties to hospitals with excess readmissions. In our analysis of Medicare claims data, we find hospitals with the highest percentages of patients with several chronic conditions and advanced age have excess readmission ratios that are overstated because of inadequate risk adjustment. The distribution of chronic conditions and age is sufficient to cause 4.5% (heart failure), 6.2% (pneumonia), and 13.8% (acute myocardial infarction) of high disproportionate share hospitals to inappropriately receive penalties out of keeping with the intent of the hospital readmission reduction program. We believe that the risk adjustment model underlying the HRRP requires urgent independent review.
- Published
- 2015
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37. Postadmission sepsis as a screen for quality problems: a case-control study.
- Author
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Hughes JS, Eisenhandler J, Goldfield N, Weinberg PG, and Averill R
- Subjects
- Aged, Aged, 80 and over, Case-Control Studies, Catheterization, Central Venous adverse effects, Catheterization, Peripheral adverse effects, Female, Guideline Adherence statistics & numerical data, Humans, Male, Middle Aged, New York epidemiology, Quality Indicators, Health Care, Quality of Health Care statistics & numerical data, Risk Factors, Cross Infection epidemiology, Quality Assurance, Health Care methods, Sepsis epidemiology
- Abstract
The present on admission (POA) indicator used with diagnosis codes listed in hospital discharge abstracts makes it possible to screen for possible in-hospital complications, which may in turn point to quality of care problems. A case-control study was performed among 382 patients from 30 New York State hospitals to see if lapses in quality were associated with the development of postadmission sepsis. Cases with hospital-acquired sepsis (labeled not POA) were compared with matched controls without sepsis. The authors found that central venous catheters and emergently inserted peripheral intravenous catheters were associated with subsequent development of sepsis. Urethral catheters were associated with sepsis for medical patients but not for surgical patients. Adherence to several process of care guidelines was incomplete but none occurred statistically significantly more frequently among sepsis cases than controls. Using discharge abstract diagnosis codes to determine the presence of postadmission complications shows promise for identifying areas for quality improvement., (© 2013 by the American College of Medical Quality.)
- Published
- 2014
- Full Text
- View/download PDF
38. Unexpected σ bond rupture during the reaction of N-methyl-1,2,4-triazoline-3,5-dione with acenaphthylene and indene.
- Author
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Breton GW, Hughes JS, Pitchko TJ, Martin KL, and Hardcastle K
- Abstract
The reaction of N-methyl-1,2,4-triazoline-3,5-dione (MeTAD) with acenaphthylene and indene leads not only to the formation of the expected [2 + 2] diazetidine cycloadducts but also to unexpected 2:1 adducts of MeTAD with substrate. The structures of the products derived from acenaphthylene were confirmed by X-ray crystallography. A similar distribution of products was afforded from indene. The 2:1 adducts appear to derive from a diradical intermediate, the radical centers of which are strongly stabilized by the bridging urazoyl ring and benzylic delocalization. The triplet states of these diradical intermediates may be trapped via exposure to molecular oxygen to afford oxygen-containing adducts. Computational studies at the (U)B3LYP/6-31G* level provide additional support for the conclusions of our experimental work.
- Published
- 2014
- Full Text
- View/download PDF
39. Distributing shared savings for population health management.
- Author
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Averill RF, Goldfield N, and Hughes JS
- Subjects
- Delivery of Health Care, Economics, Hospital, Humans, Quality Assurance, Health Care economics, Reimbursement Mechanisms economics, Cost Savings, Health Status, Outcome Assessment, Health Care economics, Reward
- Abstract
Lessons from outcomes-based fee-for-service payment models that can be applied to population health management models include the following: Focus on outcomes, not processes. Limit the number of outcomes measures used. Ensure that the amount distributed is substantial enough to motivate behavior change. Communicate results clearly and transparently. Ensure that the financial consequence of poor performance is proportional to the cost increase it generates. Focus on reducing the rate of excess preventable outcomes.
- Published
- 2014
40. Unreconstructable acute distal humeral fractures and their sequelae treated with distal humeral hemiarthroplasty: a two-year to eleven-year follow-up.
- Author
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Smith GC and Hughes JS
- Subjects
- Adult, Aged, Aged, 80 and over, Algorithms, Female, Follow-Up Studies, Humans, Humeral Fractures complications, Humerus injuries, Humerus surgery, Intra-Articular Fractures complications, Male, Middle Aged, Osteotomy, Range of Motion, Articular, Retrospective Studies, Treatment Outcome, Elbow Injuries, Elbow Joint surgery, Hemiarthroplasty adverse effects, Humeral Fractures surgery, Intra-Articular Fractures surgery
- Abstract
Background: The aim of this study was to describe for the first time the medium to long-term outcome after distal humeral hemiarthroplasty (DHH)., Methods: Twenty-six patients (mean age, 62; range, 29-92 years) treated with DHH for intra-articular distal humeral fractures and its sequelae were studied retrospectively., Results: Four patients had died and 4 had been revised to total elbow arthroplasty: 2 for periprosthetic fractures and 2 for primary component loosening (all in prostheses without an anterior flange). Six other complications had occurred: ulnar neuritis, 4; stiffness, 1; and wound necrosis, 1. Seventeen patients underwent assessment at a mean of 80 months after surgery. The mean values of the American Shoulder and Elbow Surgeons (ASES) elbow score (pain, 9.93; function, 25; satisfaction, 9.06); Mayo Elbow Performance Score (90); Quick Disabilities of Arm, Shoulder and Hand (19), and EuroQol EQ5D (Index, 0.84; Visual Analog Scale, 80) outcome measures demonstrated good function and satisfaction with little pain. The mean flexion extension arc was 116°. There was no evidence of instability. Radiologic evidence of ulnar wear was seen in 13 patients and may be related to prosthetic design to some extent. Worse wear was associated with a higher ASES pain score, lower satisfaction score, and lower EuroQoL Visual Analog Scale of quality of life. Degree of wear correlates with time after surgery but not with age at the time of surgery., Conclusion: DHH offers a treatment option for unreconstructable distal humeral fractures and is associated with a good long-term outcome., Level of Evidence: Level IV, case series, treatment study., (Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
41. Medicare payment penalties for unrelated readmissions require second look.
- Author
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Averill RF, Goldfield N, and Hughes JS
- Subjects
- Insurance, Health, Reimbursement, Organizational Policy, United States, Centers for Medicare and Medicaid Services, U.S. economics, Compensation and Redress, Patient Readmission economics
- Published
- 2013
42. Hospital readmission rates: the impacts of age, payer, and mental health diagnoses.
- Author
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Fuller RL, Atkinson G, McCullough EC, and Hughes JS
- Subjects
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Child, Preschool, Humans, Infant, Medicaid statistics & numerical data, Medicare, Middle Aged, Patient Readmission trends, Quality of Health Care, Substance-Related Disorders, United States, Young Adult, Mental Disorders diagnosis, Patient Readmission statistics & numerical data, Reimbursement, Incentive
- Abstract
We examine impacts of age, payer, and mental health conditions upon hospital readmissions and the comparability of same-hospital and multiple-hospital readmission rates. Medicaid primary payment and extreme age are associated with significantly higher readmission rates. We find low correlation between same-hospital and multiple-hospital readmission rates and identify urban hospitals with high proportions of Medicaid patients and mental health admissions as factors driving the use of multiple hospitals within readmission chains. Hospital payment incentives and performance measures using readmission rates will be distorted if factors leading to higher readmission rates are ignored, or if readmissions to different hospitals cannot be identified.
- Published
- 2013
- Full Text
- View/download PDF
43. Inferences about character and motive influence intentionality attributions about side effects.
- Author
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Hughes JS and Trafimow D
- Subjects
- Female, Humans, Intention, Judgment, Male, Young Adult, Character, Motivation, Social Perception
- Abstract
In two studies, we predicted and found that inferences about motive and character influence intentionality attributions about foreseeable consequences of action (i.e., side effects). First, we show that inferences about intentionality are greater for good side effects than bad side effects when a target person's character is described positively. In Study 2, we manipulated information about a target person and found that inferences about intentionality were greater when side effects were consistent with a target person's character and motives. Overall, our data cast doubt on the generality of the side-effect effect. We discuss our findings and their implications for future research on intentionality and social perception., (©2011 The British Psychological Society.)
- Published
- 2012
- Full Text
- View/download PDF
44. Inappropriate use of payment weights to risk adjust readmission rates.
- Author
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Fuller RL, Goldfield NI, Averill RF, and Hughes JS
- Subjects
- Data Interpretation, Statistical, Diagnosis-Related Groups statistics & numerical data, Humans, Models, Statistical, Prospective Payment System organization & administration, Patient Readmission statistics & numerical data, Reimbursement, Incentive organization & administration, Reimbursement, Incentive statistics & numerical data, Risk Adjustment methods
- Abstract
In this article, the authors demonstrate that the use of relative weights, as incorporated within the National Quality Forum-endorsed PacifiCare readmission measure, is inappropriate for risk adjusting rates of hospital readmission.
- Published
- 2012
- Full Text
- View/download PDF
45. Professionalism: teaching professional responsibility in medical education.
- Author
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Burrow GN, Hughes JS, and Gifford RH
- Subjects
- Curriculum, Humans, Schools, Medical, United States, Competency-Based Education methods, Education, Medical, Undergraduate, Professional Competence standards, Social Responsibility
- Published
- 2012
- Full Text
- View/download PDF
46. Intentional inferences are not more likely than unintentional ones: some evidence against the intentionality bias hypothesis.
- Author
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Hughes JS, Sandry J, and Trafimow D
- Subjects
- Adolescent, Bias, Female, Humans, Male, Motivation, Reaction Time, Reading, Semantics, Young Adult, Intention, Judgment, Social Behavior, Social Perception
- Abstract
We conducted a study to test the hypothesis that inferences about intentionality are biased toward an intentional interpretation. Contrary to previous research, participants were no more likely to judge ambiguous actions as intentional in a speeded compared to an unspeeded condition. Further, participants were faster to respond and more consistent in responding to unintentional rather than intentional actions.
- Published
- 2012
- Full Text
- View/download PDF
47. Paying for outcomes, not performance: lessons from the Medicare Inpatient Prospective Payment System.
- Author
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Averill RF, Hughes JS, and Goldfield NI
- Subjects
- Cost Control standards, Health Care Reform economics, Health Care Reform standards, Health Services Accessibility economics, Health Services Accessibility standards, Humans, Medicare economics, Outcome Assessment, Health Care economics, Outcome Assessment, Health Care standards, Patient Protection and Affordable Care Act economics, Patient Protection and Affordable Care Act standards, Patient Readmission economics, Patient Readmission standards, Prospective Payment System economics, Quality Assurance, Health Care economics, Quality Assurance, Health Care standards, Reimbursement, Incentive economics, United States, Medicare standards, Prospective Payment System standards, Reimbursement, Incentive standards
- Abstract
Drawing on lessons learned from the implementation of the Medicare Inpatient Prospective Payment System (IPPS), the authors propose principles for the design and implementation of a hospital payment system based on paying for outcomes.
- Published
- 2011
- Full Text
- View/download PDF
48. Pictorial review: 'fishtail deformity' of the elbow.
- Author
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Hayter CL, Giuffre BM, and Hughes JS
- Subjects
- Child, Epiphyses injuries, Humans, Magnetic Resonance Imaging, Osteoarthritis diagnosis, Osteoarthritis etiology, Osteonecrosis diagnosis, Osteonecrosis etiology, Tomography, X-Ray Computed, Humeral Fractures complications, Humeral Fractures diagnosis, Humerus injuries, Joint Deformities, Acquired diagnosis, Joint Deformities, Acquired etiology
- Abstract
Fishtail deformity of the elbow is characterised by a contour abnormality of the distal humerus, which develops when the lateral trochlear ossification centres fails to develop or resorbs. It is an uncommon complication usually following a distal humeral fracture in childhood. Whilst initially presumed to be a benign condition, long-term follow-up suggests that patients with fishtail deformity are prone to functional impairment, ongoing pain and the development of early osteoarthrosis. This paper reviews the imaging findings in fishtail deformity, the proposed aetiology and the potential long-term complications., (© 2010 The Authors. Journal of Medical Imaging and Radiation Oncology © 2010 The Royal Australian and New Zealand College of Radiologists.)
- Published
- 2010
- Full Text
- View/download PDF
49. Radiological implications of the use of uranium in vaseline glass.
- Author
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Watson SJ and Hughes JS
- Subjects
- Humans, Petrolatum, Radiation Dosage, Radiation Injuries etiology, Uranium adverse effects, Glass analysis, Glass chemistry, Radiation Injuries prevention & control, Radiation Protection methods, Uranium analysis
- Abstract
Uranium oxides have been used as colourants in glassware since the 19th century and this type of glass is commonly referred to as vaseline glass. There are many collectors of vaseline glass in the UK who obtain pieces from the UK antiques market or from abroad. Dose rate measurements were made for a number of items of vaseline glass, and the uranium content of one item was measured. Potential doses to collectors were considered, along with implications for trade and transport due to the uranium content of the glassware. It was concluded that generally items of vaseline glass could give rise to low skin doses from beta radiation, though frequent wearing of necklaces made from vaseline glass may lead to doses in excess of the HPA (Health Protection Agency) dose criterion for consumer products that are not related to safety. Registration under the Radioactive Substances Act will not be required and almost all items of vaseline glass should be suitable for sending through the Royal Mail. For those items not accepted by Royal Mail, it is understood that the transport regulations for radioactive materials would not apply.
- Published
- 2010
- Full Text
- View/download PDF
50. Intentionality attributions about perfect and imperfect duty violations.
- Author
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Hughes JS and Trafimow D
- Subjects
- Adult, Analysis of Variance, Female, Humans, Male, Southwestern United States, Intention, Moral Obligations, Social Behavior, Social Perception
- Abstract
Intentionality attributions were explored by drawing on the distinction between perfect and imperfect moral duties. Previous research has shown that perfect duty violations carry greater attributional weight than imperfect duty violations (Trafimow & Trafimow, 1999; Trafimow, Bromgard, Finlay, & Ketelaar, 2005). In Studies 1 and 2, the distinction between perfect and imperfect duties was replicated with intentionality judgments, and perfect duty violations received higher intentionality attributions than imperfect duty violations. In Study 3 this effect was reversed by manipulating information about an agent's mental intentions or plans to perform a behavior. That is, participants attributed less intentionality to perfect duty violations compared to imperfect duty violations when a mental intention to perform the behavior was absent.
- Published
- 2010
- Full Text
- View/download PDF
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