Effects of Route Complexity and Lighting on Route Following in Alzheimer's Disease and Posterior Cortical Atrophy.

Objective: Visual processing deficits arising in dementia are associated with particular functional disability. This study aimed to investigate the effects of the built environment on mobility and navigation in people with dementia-related visual loss.

Methods: Participants with posterior cortical atrophy (PCA; "visual-variant Alzheimer's"; n = 11), typical Alzheimer's disease (tAD; N = 10), and controls (n = 13) repeatedly walked down routes within a simplified real-world setting.

Providers Paid Substantially Less By Marketplace Nongroup Insurers Than By Employer Small-Group Plans, 2021.

Numerous studies show that employer plans pay providers significantly more than Medicare, but less is known about prices in nongroup plans sold both on and off the Marketplaces established by the Affordable Care Act (ACA), where narrow networks and low-cost insurers are more prevalent. We estimated prices for three market segments (Marketplace nongroup, off-Marketplace nongroup, and employer small group) and three types of services (professional, outpatient hospital, and inpatient hospital) relative to a Medicare benchmark. We used 2021 claims data covering virtually all enrollment in ACA risk-adjusted plans.

Increased Aortic Stiffness With Acute Exercise in Heart Failure: Assessment by Cardiovascular Magnetic Resonance.

This study aimed to investigate the acute changes in proximal aortic distensibility, a measure of aortic stiffness, induced by acute exercise in participants with and without heart failure (HF). Participants with HF (n = 24) and without HF (n = 26) underwent cardiovascular magnetic resonance (CMR) (1.5 T) imaging at rest and after submaximal supine bicycle ergometry.

Association Between Medicare Site-Based Payment Policy, Physician Practice Characteristics, and Vertical Integration Among Oncologists.

Purpose: Medicare's differential payments for services delivered in physician offices versus hospital outpatient settings incentivize hospital-physician integration (ie, vertical integration) across many specialties, but evidence for oncologists is mixed. We examined the association of Medicare site-based payment policy and physician practice characteristics, including service volume and diversity, with vertical integration among oncologists in 2013-2019.

Methods: Using the Medicare Provider Utilization and Payment Data and Medicare Data on Provider Practice and Specialty in 2013-2019, we extracted nonintegrated medical/hematologic oncologists (hereafter oncologists) in 2013 and followed them through 2019.

Subclinical association of aortic stiffness with cardiac structure and function in African-Americans: The Jackson Heart Study.

Cardiovascular disease (CVD) morbidity and mortality are high among black adults. We aimed to study the granular subclinical relations of aortic stiffness and left ventricular (LV) function and remodeling in blacks, in whom limited data are available. In the Jackson Heart Study, 1050 U.

Recruitment of European sea bass (Dicentrarchus labrax) in northerly UK estuaries indicates a mismatch between spawning and fisheries closure periods.

European sea bass (Dicentrarchus labrax) is a species of high commercial and recreational value, but it exhibits highly variable recruitment rates and has been subject to recent declines. Emergency management measures put in place to protect spawning stocks include the annual closure of commercial and recreational fisheries over a 2-month, February-March, window. Whether this protection measure is having the desired outcome for this data-poor species remains unclear.

Spontaneous Migration of Ventriculoperitoneal Shunt Into the Right Heart and Pulmonary Vasculature.

A 73-year-old woman with ventriculoperitoneal (VP) shunt presented for stress echocardiogram for evaluation of chest pain. Transthoracic echocardiogram revealed an incidental right heart mass representing a migrated VP shunt. This case highlights the role of multimodality cardiac imaging in diagnosing right heart masses and the multidisciplinary approach to management.

(Linnaeus, 1758) Population Structure in the Northeast Atlantic Inferred from Landmark-Based Body Morphometry.

The study of geometric morphometrics among stocks has proven to be a valuable tool in delineating fish spatial distributions and discriminating distinct population units. Variations in fish body morphology can be linked to genetic factors or to phenotypic adaptability in response to environmental variables. The tub gurnard () is a demersal species that usually lives in the bottom of the continental shelf, being widely distributed along the northeast Atlantic, Mediterranean and Black seas.

FLAMINGO: calibrating large cosmological hydrodynamical simulations with machine learning.

To fully take advantage of the data provided by large-scale structure surveys, we need to quantify the potential impact of baryonic effects, such as feedback from active galactic nuclei (AGN) and star formation, on cosmological observables. In simulations, feedback processes originate on scales that remain unresolved. Therefore, they need to be sourced via subgrid models that contain free parameters.

Price spillovers and specialization in health care: The case of children's hospitals.

Specialty hospitals tend to negotiate higher commercial insurance payments, even for relatively routine procedures with comparable clinical quality across hospital types. How specialty hospitals can maintain such a price premium remains an open question. In this paper, we examine a potential (horizontal) differentiation effect in which patients perceive specialty hospitals as sufficiently distinct from other hospitals, so that specialty hospitals effectively compete in a separate market from general acute care hospitals.

Forecasting ward-level bed requirements to aid pandemic resource planning: Lessons learned and future directions.

During the COVID-19 pandemic, there has been considerable research on how regional and country-level forecasting can be used to anticipate required hospital resources. We add to and build on this work by focusing on ward-level forecasting and planning tools for hospital staff during the pandemic. We present an assessment, validation, and deployment of a working prototype forecasting tool used within a modified Traffic Control Bundling (TCB) protocol for resource planning during the pandemic.

Can improvement in delivery of smoking cessation care be sustained in psychiatry inpatient settings through a system change intervention? An analysis of statewide administrative health data.

Objective: This study evaluated maintenance of improved delivery of smoking cessation assistance in adult acute psychiatry inpatient units 3 years post statewide implementation of a system change intervention through analysis of a statewide administrative health dataset.

Method: Rates of documenting smoking status and providing a brief smoking cessation intervention (the Smoking Cessation Clinical Pathway) in all eligible Queensland public adult acute psychiatry inpatient units ( = 57) during the implementation phase (October 2015-September 2017) of a system change intervention were compared to the maintenance phase (October 2017-October 2020) using interrupted time series analysis.

Results: Across implementation and maintenance phases, the percentage of discharges from psychiatry inpatient units that had a smoking status recorded remained high with the statewide average exceeding 90% (implementation phase 93.

Effects of the visual environment on object localization in posterior cortical atrophy and typical Alzheimer's disease.

Introduction: Visual processing deficits in Alzheimer's disease are associated with diminished functional independence. While environmental adaptations have been proposed to promote independence, recent guidance gives limited consideration to such deficits and offers conflicting recommendations for people with dementia. We evaluated the effects of clutter and color contrasts on performances of everyday actions in posterior cortical atrophy and memory-led typical Alzheimer's disease.

Cultural similarity and impartiality on voting bias: The case of FIFA's World's Best Male Football Player Award.

Previous studies on voting bias in competitive awards have not fully considered the role of cultural similarity. Using data for the Best FIFA Men's Player Award, we evaluate the extent of voting bias in this Award using three cultural similarity factors (cultural distance, cultural clusters, and collectivism), six established in-group factors (nationality, club, league, geography, ethnicity, religion, and language) and the impartiality of the voter's country. Using statistical and econometric methods, we find that voter-player cultural similarity is positively associated with voting bias and find no evidence of impartiality when it comes to cultural or national ties.

Association of Children's Hospital Status With Value for Common Surgical Conditions.

Importance: Although children's hospitals (CH) provide a substantial proportion of highly specialized pediatric care in the United States, the value of CH compared with non-children's hospitals (NCH) for routine surgical procedures is unknown.

Objective: To examine the value of CH for routine surgical procedures by assessing clinical outcomes and payment data.

Design, Setting, And Participants: This retrospective cohort study examined pediatric patients undergoing 1 of 13 commonly performed surgical procedures between 2010 and 2015 with 90-day follow-up using administrative data from the Health Care Cost Institute.

Encouraging openness in health care: Policy and practice implications of a mixed-methods study in the English National Health Service.

Objective: The National Health Service (NHS) in England has introduced a range of policy measures aimed at fostering greater openness, transparency and candour about quality and safety. We draw on the findings of an evaluation of the implementation of these policies in NHS organisations, with the aim of identifying key implications for policy and practice.

Methods: We undertook a mixed-methods policy evaluation, comprising four substudies: a longitudinal analysis of data from surveys of NHS staff and service users; interviews with senior stakeholders in NHS provider organisations and the wider system; a survey of board members of NHS provider organisations and organisational case studies across acute, community and mental health, and ambulance services.

The effect of Functional Electrical Stimulation-assisted posture-shifting in bone mineral density: case series-pilot study.

Study Design: A training intervention study using standing dynamic load-shifting Functional Electrical Stimulation (FES) in a group of individuals with complete spinal cord injury (SCI) T2 to T10.

Objectives: Investigate the effect of FES-assisted dynamic load-shifting exercises on bone mineral density (BMD).

Setting: University Lab within the Biomedical Engineering METHODS: Twelve participants with ASIA A SCI were recruited for this study.

Realist evaluation of Schwartz rounds® for enhancing the delivery of compassionate healthcare: understanding how they work, for whom, and in what contexts.

Background: Healthcare work is known to be stressful and challenging, and there are recognised links between the psychological health of staff and high-quality patient care. Schwartz Center Rounds® (Rounds) were developed to support healthcare staff to re-connect with their values through peer reflection, and to promote more compassionate patient care. Research to date has focussed on self-report surveys that measure satisfaction with Rounds but provide little analysis of how Rounds 'work' to produce their reported outcomes, how differing contexts may impact on this, nor make explicit the underlying theories in the conceptualisation and implementation of Rounds.

Effectiveness of a group intervention to reduce the psychological distress of healthcare staff: a pre-post quasi-experimental evaluation.

Background: Work stress and compassion fatigue are prevalent among healthcare staff and their negative effects on staff well-being and patient care are well-known. This paper reports on the implementation and evaluation of Schwartz Rounds® (Rounds) in UK healthcare organizations, predominantly part of the National Health Service (NHS). Rounds are one-hour, typically monthly, multidisciplinary forums during which clinical and nonclinical healthcare staff discuss the emotional and social demands of delivering patient care.

Hospital Pricing Following Integration with Physician Practices.

The past decade has witnessed a new wave of hospital-physician integration, with the fraction of hospitals owning any office-based physician practice increasing from 28% in 2009 to 53% in 2015 nationwide. We offer one of the first hospital-level longitudinal analyses in examining how hospital-physician integration affects hospital prices in the modern healthcare environment. We find a robust 3-5% increase in hospital prices following integration.

Learning from the first wave: Lessons about managing patient flow and resource utilization on medical wards at providence health during the COVID-19 pandemic.

We report the successful implementation of a modified Traffic Control Bundling (TCB) protocol called "Red, Yellow and Green" on the inpatient medical units at St. Paul's Hospital in Vancouver, Canada during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. The modified TCB protocol demonstrates an important example on how hospitals can rapidly reorganize operational and clinical processes to reallocate existing capacity to minimize exposure, improve traffic flow and reduce nosocomial transmissions of COVID-19 to health care workers (HCWs) and other patients.

Individual variation in Achilles tendon morphology and geometry changes susceptibility to injury.

The unique structure of the Achilles tendon, combining three smaller sub-tendons, enhances movement efficiency by allowing individual control from connected muscles. This requires compliant interfaces between sub-tendons, but compliance decreases with age and may account for increased injury frequency. Current understanding of sub-tendon sliding and its role in the whole Achilles tendon function is limited.