The Impact of the Affordable Care Act’s Medicaid Expansion on Patients Admitted for Burns: An Analysis of National Data

Burns ◽  
2021 ◽  
Michael K. Dalton ◽  
Robert Riviello ◽  
John C. Kubasiak ◽  
Claire M. Sokas ◽  
Samia Y. Osman ◽  
2020 ◽  
Vol 41 (S1) ◽  
pp. s293-s294
Prachi Patel ◽  
Margaret A. Dudeck ◽  
Shelley Magill ◽  
Nora Chea ◽  
Nicola Thompson ◽  

Background: The NHSN collects data on mucosal barrier injury, laboratory-confirmed, bloodstream infections (MBI-LCBIs) as part of bloodstream infection (BSI) surveillance. Specialty care areas (SCAs), which include oncology patient care locations, tend to report the most MBI-LCBI events compared to other location types. During the update of the NSHN aggregate data and risk models in 2015, MBI-LCBI events were excluded from central-line–associated BSI (CLABSI) model calculations; separate models were generated for MBI-LCBIs, resulting in MBI-specific standardized infection ratios (SIRs). This is the first analysis to describe risk-adjusted incidence of MBI-LCBIs at the national level. Methods: Data were analyzed for MBI-LCBIs attributed to oncology locations conducting BSI surveillance from January 2015 through December 2018. We generated annual national MBI-LCBI SIRs using risk models developed from 2015 data and compared the annual SIRs to the baseline (2015) using a mid-P exact test. To account for the impact of an expansion in the MBI-LCBI organism list in 2017 from 489 organisms (32 genera) to 1,003 organisms (89 genera), we removed the MBI-LCBI events that met the newly added MBI organisms and generated additional MBI SIRs for 2017 and 2018. Results: The annual SIRs remained above 1 since 2015, indicating a greater number of MBI-LCBIs identified than were predicted based on the 2015 national data (Fig. 1). Each year’s SIR was significantly different than the national baseline, and the highest SIR was observed in 2017 (SIR, 1.377). In 2017, 12% of MBI events were attributed to an organism that was added to the MBI organism list, and in 2018 it was 10%. After removal of MBIs attributed to the expanded organisms, the 2017 and 2018 SIRs remained higher than those of previous years (1.241 and 1.232, respectively). Conclusions: The distinction of MBI-LCBIs from all other CLABSIs provides an opportunity to assess the burden of this infection type within specific patient populations. Since 2015, the increase of these events in the oncology population highlights the need for greater attention on prevention strategies pertinent to MBI-LCBI in this vulnerable population.Funding: NoneDisclosures: None

2020 ◽  
Vol 138 ◽  
pp. 106171
Kirsten Y. Eom ◽  
Marian Jarlenski ◽  
Robert E. Schoen ◽  
Linda Robertson ◽  
Lindsay M. Sabik

2020 ◽  
Siladitya Bhattacharya ◽  
Abha Maheshwari ◽  
Mariam Begum Ratna ◽  
Rik van Eekelen ◽  
Ben Willem Mol ◽  

Abstract STUDY QUESTION Can we use prediction modelling to estimate the impact of coronavirus disease 2019 (COVID 19) related delay in starting IVF or ICSI in different groups of women? SUMMARY ANSWER Yes, using a combination of three different models we can predict the impact of delaying access to treatment by 6 and 12 months on the probability of conception leading to live birth in women of different age groups with different categories of infertility. WHAT IS KNOWN ALREADY Increased age and duration of infertility can prejudice the chances of success following IVF, but couples with unexplained infertility have a chance of conceiving naturally without treatment whilst waiting for IVF. The worldwide suspension of IVF could lead to worse outcomes in couples awaiting treatment, but it is unclear to what extent this could affect individual couples based on age and cause of infertility. STUDY DESIGN, SIZE, DURATION A population-based cohort study based on national data from all licensed clinics in the UK obtained from the Human Fertilisation and Embryology Authority Register. Linked data from 9589 women who underwent their first IVF or ICSI treatment in 2017 and consented to the use of their data for research were used to predict livebirth. PARTICIPANTS/MATERIALS, SETTING, METHODS Three prediction models were used to estimate the chances of livebirth associated with immediate treatment versus a delay of 6 and 12 months in couples about to embark on IVF or ICSI. MAIN RESULTS AND THE ROLE OF CHANCE We estimated that a 6-month delay would reduce IVF livebirths by 0.4%, 2.4%, 5.6%, 9.5% and 11.8% in women aged <30, 30–35, 36–37, 38–39 and 40–42 years, respectively, while corresponding values associated with a delay of 12 months were 0.9%, 4.9%, 11.9%, 18.8% and 22.4%, respectively. In women with known causes of infertility, worst case (best case) predicted chances of livebirth after a delay of 6 months followed by one complete IVF cycle in women aged <30, 30–35, 36–37, 38–39 and 40–42 years varied between 31.6% (35.0%), 29.0% (31.6%), 23.1% (25.2%), 17.2% (19.4%) and 10.3% (12.3%) for tubal infertility and 34.3% (39.2%), 31.6% (35.3%) 25.2% (28.5%) 18.3% (21.3%) and 11.3% (14.1%) for male factor infertility. The corresponding values in those treated immediately were 31.7%, 29.8%, 24.5%, 19.0% and 11.7% for tubal factor and 34.4%, 32.4%, 26.7%, 20.2% and 12.8% in male factor infertility. In women with unexplained infertility the predicted chances of livebirth after a delay of 6 months followed by one complete IVF cycle were 41.0%, 36.6%, 29.4%, 22.4% and 15.1% in women aged <30, 30–35, 36–37, 38–39 and 40–42 years, respectively, compared to 34.9%, 32.5%, 26.9%, 20.7% and 13.2% in similar groups of women treated without any delay. The additional waiting period, which provided more time for spontaneous conception, was predicted to increase the relative number of babies born by 17.5%, 12.6%, 9.1%, 8.4% and 13.8%, in women aged <30, 30–35, 36–37, 38–39 and 40–42 years, respectively. A 12-month delay showed a similar pattern in all subgroups. LIMITATIONS, REASONS FOR CAUTION Major sources of uncertainty include the use of prediction models generated in different populations and the need for a number of assumptions. Although the models are validated and the bases for the assumptions are robust, it is impossible to eliminate the possibility of imprecision in our predictions. Therefore, our predicted live birth rates need to be validated in prospective studies to confirm their accuracy. WIDER IMPLICATIONS OF THE FINDINGS A delay in starting IVF reduces success rates in all couples. For the first time, we have shown that while this results in fewer babies in older women and those with a known cause of infertility, it has a less detrimental effect on couples with unexplained infertility, some of whom conceive naturally whilst waiting for treatment. Post-COVID 19, clinics planning a phased return to normal clinical services should prioritize older women and those with a known cause of infertility. STUDY FUNDING/COMPETING INTEREST(S) No external funding was received for this study. B.W.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548) and reports consultancy work for ObsEva, Merck, Merck KGaA, Guerbet and iGenomics. S.B. is Editor-in-Chief of Human Reproduction Open. None of the other authors declare any conflicts of interest. TRIAL REGISTRATION NUMBER N/A.

2020 ◽  
Vol 88 (1) ◽  
pp. 59-69
Lisa Marie Knowlton ◽  
Melody S. Dehghan ◽  
Katherine Arnow ◽  
Amber W. Trickey ◽  
Lakshika Tennakoon ◽  

2019 ◽  
Vol 50 (2) ◽  
pp. 237-255 ◽  
Joshua Meyer-Gutbrod

Abstract The U.S. Supreme Court’s decision to grant states the authority to reject Medicaid expansion under the Affordable Care Act without penalty threatened the implementation of this polarized health policy. While many Republican-controlled states followed their national allies and rejected Medicaid expansion, others engaged in bipartisan implementation. Why were some Republican states willing to reject the national partisan agenda and cooperate with Democrats in Washington? I focus on the role of electoral competition within states. I conclude that although electoral competition has been shown to encourage partisan polarization within the states, the combination of intergovernmental implementation and Medicaid expansion’s association with public welfare reverses this dynamic. I employ a Cox proportional-hazards model to examine the impact of state partisan ideology and competition on the likelihood of state Medicaid expansion. I find that strong inter-party competition mitigates the impact of more extreme partisan ideologies, encouraging potentially bipartisan negotiation with the federal administration.

2015 ◽  
Vol 91 (Suppl 2) ◽  
pp. A78.1-A78
H Ali ◽  
CC O’Connor ◽  
D Callander ◽  
D Saulo ◽  
S Graham ◽  

2020 ◽  
Vol 64 (9) ◽  
pp. 1638-1665 ◽  
Devorah Manekin ◽  
Reed M. Wood

Female combatants play a central role in rebel efforts to cultivate and disseminate positive narratives regarding the movement and its political goals. Yet, the effectiveness of such strategies in shaping audience attitudes or generating tangible benefits for the group remains unclear. We propose and test a theory regarding the channels through which female fighters advance rebel goals. We argue that female fighters positively influence audience attitudes toward rebel groups by strengthening observers’ beliefs about their legitimacy and their decision to use armed tactics. We further contend that these effects directly help them secure support from transnational nonstate actors and indirectly promote state support. We assess our arguments by combining a novel survey experiment in two countries with analyses of new cross-national data on female combatants and information about transnational support for rebels. The empirical results support our arguments and demonstrate the impact of gender framing on rebel efforts to secure support.

2016 ◽  
Vol 60 (8) ◽  
pp. 1446-1472 ◽  
Reed M. Wood ◽  
Thorin M. Wright

Natural disasters often cause significant human suffering. They may also provide incentives for states to escalate repression against their citizens. We argue that state authorities escalate repression in the wake of natural disasters because the combination of increased grievances and declining state control produced by disasters creates windows of opportunity for dissident mobilization and challenges to state authority. We also investigate the impact of the post-disaster humanitarian aid on this relationship. Specifically, we argue that inflows of aid in the immediate aftermath of disasters are likely to dampen the impact of disasters on repression. However, we expect that this effect is greater when aid flows to more democratic states. We examine these interrelated hypotheses using cross-national data on immediate-onset natural disasters and state violations of physical integrity rights between 1977 and 2009 as well as newly collected foreign aid data disaggregated by sector. The results provide support for both our general argument and the corollary hypotheses.

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