scholarly journals Coding errors in an analysis of the impact of pay-for-performance on the care for long-term cardiovascular disease: a case study

2014 ◽  
Vol 21 (2) ◽  
pp. 92-101 ◽  
Author(s):  
Simon De Lusignan ◽  
Benjamin Sun ◽  
Christopher Pearce ◽  
Christopher Farmer ◽  
Paul Stevens ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Pay For Performance ◽  
The Impact

scholarly journals Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Barbara Iyen ◽  
Stephen Weng ◽  
Yana Vinogradova ◽  
Ralph K. Akyea ◽  
Nadeem Qureshi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Cohort Study ◽  
Body Mass ◽  
World Health ◽  
Obese Adults ◽  
Bmi Trajectories ◽  
The Impact

Abstract Background Although obesity is a well-recognised risk factor for cardiovascular disease (CVD), the impact of long-term body mass index (BMI) changes in overweight or obese adults, on the risk of heart failure, CVD and mortality has not been quantified. Methods This population-based cohort study used routine UK primary care electronic health data linked to secondary care and death-registry records. We identified adults who were overweight or obese, free from CVD and who had repeated BMI measures. Using group-based trajectory modelling, we examined the BMI trajectories of these individuals and then determined incidence rates of CVD, heart failure and mortality associated with the different trajectories. Cox-proportional hazards regression determined hazards ratios for incident outcomes. Results 264,230 individuals (mean age 49.5 years (SD 12.7) and mean BMI 33.8 kg/m2 (SD 6.1)) were followed-up for a median duration of 10.9 years. Four BMI trajectories were identified, corresponding at baseline, with World Health Organisation BMI classifications for overweight, class-1, class-2 and class-3 obesity respectively. In all four groups, there was a small, stable upwards trajectory in BMI (mean BMI increase of 1.06 kg/m2 (± 3.8)). Compared with overweight individuals, class-3 obese individuals had hazards ratios (HR) of 3.26 (95% CI 2.98–3.57) for heart failure, HR of 2.72 (2.58–2.87) for all-cause mortality and HR of 3.31 (2.84–3.86) for CVD-related mortality, after adjusting for baseline demographic and cardiovascular risk factors. Conclusion The majority of adults who are overweight or obese retain their degree of overweight or obesity over the long term. Individuals with stable severe obesity experience the worst heart failure, CVD and mortality outcomes. These findings highlight the high cardiovascular toll exacted by continuing failure to tackle obesity.

scholarly journals Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease

2021 ◽  
Author(s):  
Rutao Wang ◽  
Scot Garg ◽  
Chao Gao ◽  
Hideyuki Kawashima ◽  
Masafumi Ono ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Revascularization ◽  
Long Term Outcomes ◽  
Vital Status ◽  
Increased Risk ◽  
Artery Disease ◽  
The Impact

Abstract Aims To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Methods The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Results Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08–1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83–1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in ≥ 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11–4.23, p < 0.001) compared to those without CVD. Conclusions The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization. Trial registration SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract

scholarly journals Nutrient retention behind a tropical mega-dam: a case study of the Sardar Sarovar Dam, India

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Harish Gupta ◽  
S. Kiran Kumar Reddy ◽  
Mounika Chiluka ◽  
Vamshikrishna Gandla
Keyword(s):  
Arabian Sea ◽  
Inorganic Nitrogen ◽  
Nutrient Retention ◽  
Significant Loss ◽  
N Removal ◽  
Narmada River ◽  
Sardar Sarovar ◽  
The Impact

AbstractIn this study, we demonstrate the impact of the construction of a mega-dam on the nutrient export regime of a large tropical river into the Arabian Sea. Long-term (11 years) fortnight nutrient parameters, upstream and downstream to Sardar Sarovar (SS) Dam, were examined to determine the periodical change in nutrient fluxes from the Narmada River, India. During this 11-year period, the average discharge of the Narmada River upstream to Rajghat (35.3 km3 year−1) was higher than that of downstream at Garudeshwar (33.9 km3 year−1). However, during the same period, the suspended sediment load was reduced by 21 million tons (MT) from 37.9 MT at Rajghat to 16.7 MT at Garudeshwar. Similarly, mean concentrations of dissolved silica (DSi) reduced from 470 (upstream) to 214 µM (downstream), dissolved inorganic phosphate (DIP) from 0.84 to 0.38 µM, and dissolved inorganic nitrogen (DIN) from 43 to 1.5 µM. It means that about 54%, 55%, and 96% flux of DSi, DIP, and DIN retained behind the dam, respectively. The estimated denitrification rate (80,000 kg N km−2 year−1) for the reservoir is significantly higher than N removal by lentic systems, globally. We hypothesize that processes such as biological uptake and denitrification under anoxic conditions could be a key reason for the significant loss of nutrients, particularly of DIN. Finally, we anticipated that a decline in DIN fluxes (by 1.13 × 109 mol year−1) from the Narmada River to the Arabian Sea might reduce the atmospheric CO2 fixation by 7.46 × 109 mol year−1.

scholarly journals Evaluation of the Impact of Timber Truck Configuration and Tare Weight on Payload Efficiency: An Australian Case Study

Forests ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 855
Author(s):  
Mark W. Brown
Keyword(s):  
Load Management ◽  
Vehicle Design ◽  
Forest Industry ◽  
Post Operation ◽  
Gross Vehicle Weight ◽  
Australian Case ◽  
Trends Over Time ◽  
The Impact

The forest industry tends to plan, and model transportation costs based on the potential payload benefits of increased legal gross vehicle weight (GVW) by deploying different configurations, while payload benefits of a configuration can be significantly influenced by the vehicle design tare weight. Through this research the relative benefit of increased legal GVW of different configurations is compared across Australia over a 13-year period from 2006 to 2019, by examining data collected post operation across multiple operations. This approach is intended to offer realistic insight to real operations not influenced by observation and thus reflect long-term operating behaviour. The inclusion of the three most common configuration classes in Australian forestry over a 13-year period has also allowed the exploration of load management between configurations and potential trends over time. When considering the legal GVW and the tare weight impacts across the fleets, the semi-trailer has an 8 t payload disadvantage compared to B-Doubles and 19.6 t disadvantage compared to road trains.

scholarly journals Storm Driven Migration of the Napatree Barrier, Rhode Island, USA

Geosciences ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 330
Author(s):  
Bryan A. Oakley
Keyword(s):  
Rhode Island ◽  
Shoreline Change ◽  
Aerial Photographs ◽  
Tropical Storms ◽  
Lower Intensity ◽  
Storm Activity ◽  
The Impact ◽  
Washover Fan

Napatree Point, an isolated barrier in southern Rhode Island, provides a case study of barrier spit migration via storm driven overwash and washover fan migration. Documented shoreline changes using historical surveys and vertical aerial photographs show that the barrier had little in the way of net change in position between 1883 and 1939, including the impact of the 1938 hurricane. The barrier retreated rapidly between 1945 and 1975, driven by both tropical and extra-tropical storms. The shoreline position has been largely static since 1975. The removal of the foredune during the 1938 hurricane facilitated landward shoreline migration in subsequent lower intensity storms. Dune recovery following the 1962 Ash Wednesday storm has been allowed due to limited overwash and barrier migration over the last several decades. Shoreline change rates during the period from 1945–1975 were more than double the rate of shoreline change between 1939 and 2014 and triple the rate between 1883 and 2014, exceeding the positional uncertainty of these shoreline pairs. The long-term shoreline change rates used to calculate coastal setbacks in Rhode Island likely underestimate the potential for rapid shoreline retreat over shorter time periods, particularly in a cluster of storm activity. While sea-level rise has increased since 1975, the barrier has not migrated, highlighting the importance of storms in barrier migration.

scholarly journals The Impact of COVID-19 on Hospitality Industry in Greece and Its Treasured Santorini Island

2021 ◽  
Vol 13 (14) ◽  
pp. 7906
Author(s):  
Nikola Medová ◽  
Lucie Macková ◽  
Jaromir Harmacek
Keyword(s):  
Social Impact ◽  
Tourism Sector ◽  
Challenges And Opportunities ◽  
Multiple Variables ◽  
Hospitality Sector ◽  
Tourism And Hospitality ◽  
The Impact ◽  
Further Development

This paper focuses on the dynamic of the recent upheaval in the tourism and hospitality sector due to the COVID-19 epidemic in Greece and Santorini island. It uses the case study of a country one-fourth of whose GDP consists of tourism. We compare the available statistical data showing the change in variables in the previous years with 2020 and look into the new challenges and opportunities posed by the drop in the numbers of visitors and flights. We focus mainly on the economic and social impact on the destination and possible future scenarios for further development in the area. Data show a significant effect of the pandemic on multiple variables, such as the long-term trend of the importance of tourism sector in GDP in Greece, the number of flights and visitors to Greece and Santorini island, and the contribution of tourism and travel to GDP. Based on the available data, we also construct three foresight scenarios that describe the possible futures for Santorini island in terms of the pandemic evolution. These scenarios may help various stakeholders and policymakers to be better prepared for different developments that may appear.

A case study of noise pollution levels during the restrictions period due to COVID-19.

2021 ◽  
Vol 263 (6) ◽  
pp. 206-214
Author(s):  
David Montes-González ◽  
Juan Miguel Barrigón-Morillas ◽  
Ana Cristina Bejarano-Quintas ◽  
Manuel Parejo-Pizarro ◽  
Guillermo Rey-Gozalo ◽  
...  
Keyword(s):  
Noise Pollution ◽  
Urban Environments ◽  
Control Measures ◽  
Acoustic Measurements ◽  
Pollution Levels ◽  
The World ◽  
The Impact ◽  
The City

The pandemic of coronavirus disease (COVID-19) led to the need for drastic control measures around the world to reduce the impact on the health of the population. The confinement of people in their homes resulted in a significant reduction in human activity at every level (economic, social, industrial, etc.), which was reflected in a decrease in environmental pollution levels. Studying the evolution of parameters, such as the level of environmental noise caused by vehicle traffic in urban environments, makes it possible to assess the impact of this type of measure. This paper presents a case study of the acoustic situation in Cáceres (Spain) during the restriction period by means of long-term acoustic measurements at various points of the city.

Validating the primary provider theory in emergency medicine

2008 ◽  
Vol 21 (2) ◽  
pp. 120-130 ◽  
Author(s):  
Joseph S. Guarisco ◽  
Stefoni A. Bavin
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Pay For Performance ◽  
Medical Center ◽  
Waiting Times ◽  
Emergency Department Visits ◽  
Business Success ◽  
Content Type ◽  
The Impact

PurposeThe purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables, patient satisfaction is distinctly and primarily linked to physician behaviors and secondarily to waiting times.Design/methodology/approachThe case study began by creating incentives motivating physicians to reflect and improve behaviors (patient interactions) and practice patterns (workflow efficiency). The Press Ganey Emergency Department Survey was then utilized to track the impact of the incentive programs and to ascertain any relationship between patient satisfaction with the provider and global patient satisfaction with emergency department visits by measuring patient satisfaction over an eight quarter period.FindingsThe findings were two‐fold: firstly, the concept of “pay for performance” as a tool for physician motivation was valid; and secondly, the impact on global patient satisfaction by increases in patient satisfaction with the primary provider was significant and highly correlated, as proposed by Aragon.Practical implicationsThese findings can encourage hospitals and physician groups to place a high value on the performance of primary providers of patient care, provide incentives for appropriate provider behaviors through “pay for performance” programs and promote physician understanding of the links between global patient satisfaction with physician behaviors and business growth, malpractice reduction, and other key measures of business success.Originality/valueThere are no other case studies prior to this project validating the Primary Provider Theory in an urban medical center; this project adds to the validity and credibility of the theory in this setting.

scholarly journals Colonial Values and Asylum Care in Brazil: Reclaiming the Streets Through Carnival in Rio de Janeiro

2020 ◽  
pp. 155-161
Author(s):  
Julia Evangelista ◽  
William A. Fulford
Keyword(s):  
Local Community ◽  
Well Being ◽  
Colonial History ◽  
Self Confidence ◽  
History Of ◽  
The Impact ◽  
Mental Well Being ◽  
The City

AbstractThis chapter shows how carnival has been used to counter the impact of Brazil’s colonial history on its asylums and perceptions of madness. Colonisation of Brazil by Portugal in the nineteenth century led to a process of Europeanisation that was associated with dismissal of non-European customs and values as “mad” and sequestration of the poor from the streets into asylums. Bringing together the work of the two authors, the chapter describes through a case study how a carnival project, Loucura Suburbana (Suburban Madness), in which patients in both long- and short-term asylum care play leading roles, has enabled them to “reclaim the streets,” and re-establish their right to the city as valid producers of culture on their own terms. In the process, entrenched stigmas associated with having a history of mental illness in a local community are challenged, and sense of identity and self-confidence can be rebuilt, thus contributing to long-term improvements in mental well-being. Further illustrative materials are available including photographs and video clips.

Numerical Modelling of a District Scale Groundwater Heat Pump Operation: Case Study from Colchester, UK

2021 ◽  
Author(s):  
Taha Sezer ◽  
Abubakar Kawuwa Sani ◽  
Rao Martand Singh ◽  
David P. Boon
Keyword(s):  
Large Scale ◽  
District Level ◽  
Thermal Plume ◽  
Injection Wells ◽  
Term Operation ◽  
Heating And Cooling ◽  
Groundwater Heat Pump ◽  
The Impact

&lt;p&gt;Groundwater heat pumps (GWHP) are an environmentally friendly and highly efficient low carbon heating technology that can benefit from low-temperature groundwater sources lying in the shallow depths to provide heating and cooling to buildings. However, the utilisation of groundwater for heating and cooling, especially in large scale (district level), can create a thermal plume around injection wells. If a plume reaches the production well this may result in a decrease in the system performance or even failure in the long-term operation. This research aims to investigate the impact of GWHP usage in district-level heating by using a numerical approach and considering a GWHP system being constructed in Colchester, UK as a case study, which will be the largest GWHP system in the UK. Transient 3D simulations have been performed pre-construction to investigate the long-term effect of injecting water at 5&amp;#176;C, into a chalk bedrock aquifer. Modelling suggests a thermal plume develops but does not reach the production wells after 10 years of operation. The model result can be attributed to the low hydraulic gradient, assumed lack of interconnecting fractures, and large (&gt;500m) spacing between the production and injection wells. Model validation may be possible after a period operational monitoring.&lt;/p&gt;

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