scholarly journals Associations between state scope of practice laws and US physician assistant wages from 1997 to 2017: a longitudinal analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e052849
Author(s):  
Virginia L Valentin ◽  
Shahpar Najmabadi ◽  
Trenton J Honda
Keyword(s):  
Longitudinal Analysis ◽  
Growth Models ◽  
Physician Assistant ◽  
Scope Of Practice ◽  
Individual Growth ◽  
Future Research ◽  
Small Range ◽  
Linear Regression Models ◽  
The Impact ◽  
Over Time

ObjectiveThe purpose of this study is to determine whether, and to what degree, variations in physician assistant (PA) state scope of practice (SOP) laws across states are associated with (1) PA median wage over time and (2) if a specific SOP key element has greater impact on PA median wage than others. We hypothesise that expanded SOP laws will be associated with higher PA wage.DesignLongitudinal analysis from 1997 to 2017.SettingFifty states and the District of Columbia (US capital region).ParticipantsEmployed PAs from 1997 to 2017.MethodsFour national data sets were combined to allow for longitudinal analysis of state-level annual PA wage and state SOP laws. We used linear regression models to explore the associations of SOP elements with PA wage in 5-year intervals and individual growth models to assess the change in PA annual wage over the study period.ResultsThere was a 220% increase in weighted PA annual wage over two decades. There was a positive linear correlation between annual wage and age in 2012 and 2017 (r=0.52, p<0.01; r=0.29, p=0.04, respectively). The adjusted R2 for individual SOP elements in the selected years were all small (range: 0.0–0.29), with no appreciable pattern across time for any SOP element. In 1997, several SOP laws show association with median wage but this impact disappears over time.ConclusionsPA median wage has risen over twofold in the past two decades, with the rise in PA wage mainly explained by time and provider age. In 1997 some SOP elements were associated with increased average wage; however, the impact of this increase diminished over time in all such instances. As the PA profession moves towards Optimal Team Practice, future research should examine if this move towards greater autonomy impacts wage.

The clinical course and interrelations of dementia related symptoms

2017 ◽  
Vol 30 (6) ◽  
pp. 859-866 ◽  
Author(s):  
Miriam L. Haaksma ◽  
Jeannie-Marie S. Leoutsakos ◽  
Jonne A. E. Bremer ◽  
Pauline Aalten ◽  
Inez H. G. B. Ramakers ◽  
...  
Keyword(s):  
Time Course ◽  
Multilevel Models ◽  
Growth Models ◽  
Neuropsychiatric Symptoms ◽  
Cognitive Status ◽  
Daily Functioning ◽  
Future Research ◽  
Dementia Severity ◽  
Highly Correlated ◽  
Over Time

ABSTRACTBackground:Dementia is a neurodegenerative syndrome that interferes with multiple aspects of life, including cognition, daily functioning, and behavior. Despite the large heterogeneity in symptom development, these three domains are seldom studied simultaneously. This study investigates how trajectories of these domains are interrelated within individuals over time, and how they in turn are related to dementia severity and quality of life (QoL).Methods:We used data from a longitudinal clinical cohort study, including 331 dementia patients. Cognitive status was measured using the Mini-Mental State Examination, daily functioning was measured with the disability assessment for dementia and neuropsychiatric symptoms (NPS) were scored using the neuropsychiatric inventory. We investigated the relationships in the time course of the various dementia domains using random effects multilevel models and parallel-process growth models.Results:Changes in cognition and daily functioning were highly correlated over time (r = 0.85, p < 0.01), as were changes in NPS and functioning (r = −0.60, p < 0.01), while changes in cognition and NPS were not (r = −0.20, p = 0.06). All three domains were strongly associated with dementia severity over time (p < 0.01). Decreased functioning and increased NPS were both associated with decreased QoL (β = 2.97, p < 0.01 and β = −2.41, p < 0.01, respectively), while cognition was not (β = 0.01, p = 0.93).Conclusion:This study demonstrates the heterogeneity of dementia progression between individuals and between different dementia domains within individuals. To improve our understanding of dementia progression, future research should embrace a broader perspective encompassing multiple outcome measures along with the patient's profile, including neurological factors as well as physical, social, and psychiatric health.

scholarly journals Substance Use Among Patients Receiving Out- and Inpatient Dependence Care: a Prospective Norwegian Cohort Study From 2016 to 2020

2021 ◽  
Author(s):  
Jørn Henrik Vold ◽  
Fatemeh Chalabianloo ◽  
Christer F. Aas ◽  
Else-Marie Løberg ◽  
Kjell Arne Johansson ◽  
...  
Keyword(s):  
Substance Use ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Severity Index ◽  
Future Research ◽  
Opioid Agonist ◽  
Low Threshold ◽  
The Mean ◽  
The Impact ◽  
Over Time

Abstract BackgroundContinuous use of amphetamines, alcohol, benzodiazepines, cannabis, cocaine, or opioids contributes to health impairments, increased morbidity, and overdose deaths among patients with substance use disorders (SUDs). This study evaluates the impact of inpatient detoxification, specialized opioid agonist therapy (OAT), and low-threshold municipality care on substance use over time. MethodsWe used data from a cohort of SUD patients in Norway through health assessments of self-reported substance use and sociodemographic and clinical factors. A total of 881 substance use measurements, including type and amount of substances, were assessed from 708 SUD patients in 2016-2020. Substance use for individual and total substances was calculated, creating a substance use severity index (SUSI) ranging from zero (no use) to one (daily use). We defined baseline as the first substance use measurement when the measurements were listed chronologically. Time was defined as years from baseline. We used a linear mixed model to analyze associations between the SUSI and inpatient detoxification, specialized OAT compared with low-threshold municipality care, as well as the factors like injecting substance use, gender, and age, presented with coefficients and 95% confidence intervals (CI).ResultsNeither inpatient detoxification (mean SUSI change: 0.01, -0.03;0.04) nor specialized OAT (0.03, -0.09;0.14) compared with low-threshold municipality care were associated with changes in substance use over time. Patients who were over 60 years of age (mean SUSI difference: -0.06, -0.13;0.00) had a lower SUSI than those under 30 years of age, while patients who injected substances had a higher SUSI than those who did not inject substances (0.18, 0.15;0.20) at baseline. The mean SUSI for the individual substances were 0.50 (standard deviation (SD): 0.38) for cannabis, 0.40 (0.37) for benzodiazepines, 0.33 (0.34) for amphetamines and cocaine, 0.31 (0.29) for alcohol, and 0.22 (0.31) for opioids at baseline. The mean SUSI of all substances was 0.35 (0.20). Conclusion The present study demonstrates that neither inpatient detoxification nor specialized OAT compared to low-threshold municipality care were associated with changes in substance use over time. Future research needs to evaluate the impact on substance use and healthy survival of multiple health care interventions to this patient group.

Surveillance Strategies for Tracking Sepsis Incidence and Outcomes

2020 ◽  
Vol 222 (Supplement_2) ◽  
pp. S74-S83
Author(s):  
Claire N Shappell ◽  
Michael Klompas ◽  
Chanu Rhee
Keyword(s):  
Electronic Health Record ◽  
Epidemiologic Studies ◽  
Clinical Syndrome ◽  
Future Research ◽  
Health Record ◽  
Clinical Indicators ◽  
Clinical Registries ◽  
Electronic Health ◽  
The Impact ◽  
Over Time

Abstract Sepsis is a leading cause of death and the target of intense efforts to improve recognition, management and outcomes. Accurate sepsis surveillance is essential to properly interpreting the impact of quality improvement initiatives, making meaningful comparisons across hospitals and geographic regions, and guiding future research and resource investments. However, it is challenging to reliably track sepsis incidence and outcomes because sepsis is a heterogeneous clinical syndrome without a pathologic reference standard, allowing for subjectivity and broad discretion in assigning diagnoses. Most epidemiologic studies of sepsis to date have used hospital discharge codes and have suggested dramatic increases in sepsis incidence and decreases in mortality rates over time. However, diagnosis and coding practices vary widely between hospitals and are changing over time, complicating the interpretation of absolute rates and trends. Other surveillance approaches include death records, prospective clinical registries, retrospective medical record reviews, and analyses of the usual care arms of randomized controlled trials. Each of these strategies, however, has substantial limitations. Recently, the US Centers for Disease Control and Prevention released an “Adult Sepsis Event” definition that uses objective clinical indicators of infection and organ dysfunction that can be extracted from most hospitals’ electronic health record systems. Emerging data suggest that electronic health record–based clinical surveillance, such as surveillance of Adult Sepsis Event, is accurate, can be applied uniformly across diverse hospitals, and generates more credible estimates of sepsis trends than administrative data. In this review, we discuss the advantages and limitations of different sepsis surveillance strategies and consider future directions.

Association Between Rapid Response Algorithms and Clinical Outcomes of Hospitalized Children

2021 ◽  
Vol 11 (12) ◽  
pp. 1385-1394
Author(s):  
Jonathan G. Sawicki ◽  
Dana Tower ◽  
Elizabeth Vukin ◽  
Jennifer K. Workman ◽  
Gregory J. Stoddard ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Pathways ◽  
Rapid Response ◽  
Future Research ◽  
Hospitalized Children ◽  
Rapid Response System ◽  
Response System ◽  
Algorithm Implementation ◽  
The Impact ◽  
Over Time

OBJECTIVES To evaluate whether the implementation of clinical pathways, known as pediatric rapid response algorithms, within an existing rapid response system was associated with an improvement in clinical outcomes of hospitalized children. METHODS We retrospectively identified patients admitted to the PICU as unplanned transfers from the general medical and surgical floors at a single, freestanding children’s hospital between July 1, 2017, and January 31, 2020. We examined the impact of the algorithms on the rate of critical deterioration events. We used multivariable Poisson regression and an interrupted time series analysis to measure 2 possible types of change: an immediate implementation effect and an outcome trajectory over time. RESULTS We identified 892 patients (median age: 4 [interquartile range: 1–12] years): 615 in the preimplementation group, and 277 in the postimplementation group. Algorithm implementation was not associated with an immediate change in the rate of critical deterioration events but was associated with a downward rate trajectory over time and a postimplementation trajectory that was significantly less than the preimplementation trajectory (trajectory difference of −0.28 events per 1000 non-ICU patient days per month; 95% confidence interval −0.40 to −0.16; P &lt; .001). CONCLUSIONS Algorithm implementation was associated with a decrease in the rate of critical deterioration events. Because of the study’s observational nature, this association may have been driven by unmeasured confounding factors and the chosen implementation point. Nevertheless, the results are a promising start for future research into how clinical pathways within a rapid response system can improve care of hospitalized patients.

Homicide, Acquisitive Crime, and Inflation: A City-Level Longitudinal Analysis

2021 ◽  
pp. 001112872110399
Author(s):  
Richard Rosenfeld ◽  
Matt Vogel
Keyword(s):  
Economic Policy ◽  
Longitudinal Analysis ◽  
Public Safety ◽  
Random Coefficients ◽  
Future Research ◽  
Homicide Rates ◽  
Panel Models ◽  
Acquisitive Crime ◽  
The Impact

Building on research by Rosenfeld et al., citylevel random coefficients panel models reveal a significant association between inflation and homicide rates that is only partially mediated by acquisitive crime. Inflation is more strongly associated with homicide rates in more disadvantaged cities. The impact of inflation on public safety should be considered when setting and evaluating economic policy. Future research should address the mechanisms, in addition to acquisitive crime, that link homicide and inflation.

scholarly journals Routine measurement of satisfaction with life and treatment aspects in mental health patients – the DIALOG scale in East London

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Franziska Mosler ◽  
Stefan Priebe ◽  
Victoria Bird
Keyword(s):  
Mental Health ◽  
Family Relationships ◽  
Satisfaction With Life ◽  
Demographic Data ◽  
Healthcare Services ◽  
Sensitivity Analyses ◽  
Linear Regression Models ◽  
Data Set ◽  
The Impact ◽  
Over Time

Abstract Aims The DIALOG scale has been implemented as a routine patient outcome and experience measure (PROM/PREM) in a mental health trust in East London since 2017. The resulting healthcare dataset was used to estimate satisfaction with life and treatment aspects over time and factors associated with it. Methods Variables available from the Trust were DIALOG items, service level, clinical and basic demographic data. Data was extracted in February 2019. Data is described using a range of descriptive statistics and looking at the subgroups: treatment stage, diagnosis, service type. Predictors for average DIALOG scores across patients was explored with clustered linear regression models. A fixed effect model was chosen to estimate the impact of clinical and service related variables on patient’s average DIALOG scores over time. Sensitivity analyses with the whole data set and complete cases were carried out. Results Of the original 18,481 DIALOG records 12, 592 were kept after data cleaning (5646 patients). The average DIALOG score was 4.8 (SD 1.0) on the 7-point scale. Average satisfaction with life aspects (PROM) was 4.65 (SD 1.1) and with treatment aspects (PREM) was 5.25 (SD 1.17). Across all 11 items, “job situation” scored lowest (mean 4.05) and “meetings with professionals” highest (mean 5.5). Satisfaction for all items increased over time (average increase 0.47). The largest increase was in “mental health” (0.94) and the smallest in “family relationships” (0.34). Conclusions Patients in mental healthcare services were “fairly satisfied” in both life and treatment aspects with improvements seen over time. These results will act as a benchmark for clinical services currently implementing DIALOG across the UK and inform local service developments.

scholarly journals Neural representation of words within phrases: Temporal evolution of color-adjectives and object-nouns during simple composition

2020 ◽  
Author(s):  
Maryam Honari-Jahromi ◽  
Brea Chouinard ◽  
Esti Blanco-Elorrieta ◽  
Liina Pylkkänen ◽  
Alona Fyshe
Keyword(s):  
Picture Naming ◽  
Temporal Evolution ◽  
Naming Task ◽  
Neural Representation ◽  
Future Research ◽  
Crack Open ◽  
Speech Planning ◽  
The Impact ◽  
Over Time ◽  
Time Point

ABSTRACTIn language, stored representations of lexical items combine into an infinitude of complex expressions. While the neuroscience of composition has begun to mature, we do not yet understand how the stored representations evolve and morph during composition. New decoding techniques allow us to crack open this very hard question: we can train a model to recognize a representation in one context or time-point and assess its accuracy in another. We combined the decoding approach with magnetoencephalography recorded during a picture naming task to investigate the temporal evolution of noun and adjective representations during speech planning. We tracked word representations as they combined into simple two-word phrases, using single words and two-word lists as non-combinatory controls. We found that nouns were generally more decodable than adjectives, suggesting that noun representations were stronger and/or more consistent across trials than those of adjectives. When training and testing across contexts and times, the representations of isolated nouns were recoverable when those nouns were embedded in phrases, but not so if they were embedded in lists. Adjective representations did not show a similar consistency across isolated and phrasal contexts. Noun representations in phrases also sustained over time in a way that was not observed for any other pairing of word class and context. These findings offer a new window into the temporal evolution and context sensitivity of word representations during composition, revealing a clear asymmetry between adjectives and nouns. The impact of phrasal contexts on the decodability of nouns may be due to the nouns’ status as head of phrase—an intriguing hypothesis for future research.

scholarly journals Status of Retinoids and Carotenoids and Associations with Clinical Outcomes in Maternal-Infant Pairs in Nigeria

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1286 ◽  
Author(s):  
Corrine Hanson ◽  
Elizabeth Lyden ◽  
Ann Anderson-Berry ◽  
Nicholas Kocmich ◽  
Amy Rezac ◽  
...  
Keyword(s):  
Vitamin A ◽  
Clinical Outcomes ◽  
Vitamin A Deficiency ◽  
Plasma Concentrations ◽  
Future Research ◽  
Linear Regression Models ◽  
Nigerian Women ◽  
Plasma Retinol ◽  
Highly Correlated ◽  
The Impact

Vitamin A is an essential nutrient in pregnancy, and other carotenoids have been independently associated with maternal-infant outcomes. The objective of this study was to quantify the status of vitamin A and carotenoids in Nigerian maternal-infant pairs at delivery, compare these to a cohort from a developed nation, and determine the impact on clinical outcomes. Maternal and cord blood samples were collected in 99 Nigerian mother-infant pairs. Concentrations of lutein + zeaxanthin, β-cryptoxanthin, lycopene, α- and β-carotenes, and retinol were measured using HPLC. Descriptive statistics were calculated and Spearman coefficients were used to assess correlations between maternal and cord measurements; Mann-Whitney tests were used to compare median plasma values between dichotomous variables. Linear regression models were used to adjust for relevant confounders. A p < 0.05 was considered statistically significant. Thirty-five percent of mothers had plasma retinol concentrations ≤0.70 µmol/L; 82% of infants had plasma retinol concentrations ≤0.70 µmol/L at delivery. Maternal and infant concentrations of vitamin A compounds were highly correlated and were associated with newborn growth and Apgar scores. Despite plasma concentrations of pro-vitamin A carotenoids higher than those reported in other populations, pregnant Nigerian women have a high prevalence of vitamin A deficiency. As vitamin A related compounds are modifiable by diet, future research determining the clinical impact of these compounds is warranted.

Awareness of age-related gains and losses and their associations with psychological well-being: A longitudinal examination

2021 ◽  
Author(s):  
Bethany R Wilton-Harding ◽  
Tim D Windsor
Keyword(s):  
Growth Models ◽  
Later Life ◽  
Well Being ◽  
Psychological Needs ◽  
Basic Psychological Needs ◽  
Community Dwelling ◽  
Psychological Well Being ◽  
Age Related ◽  
The Impact ◽  
Over Time

Abstract Objectives How people experience their own aging is more strongly linked to well-being than chronological age. This study examined associations of awareness of age-related change (AARC) with between-person differences and longitudinal changes in psychological well-being (PWB). We expected that higher AARC-gains would be associated with higher PWB and increases in PWB over time. Conversely, we expected higher AARC-losses would be associated with lower PWB, and steeper decline in PWB over time. Furthermore, we tested the interaction of AARC-gains and AARC-losses to examine whether negative associations between AARC-losses and PWB would be weaker among those reporting higher AARC-gains. Method Data were collected in three waves from a 12-month longitudinal study of 408 community-dwelling older adults (aged 60+). Multilevel growth models were used to analyze associations between AARC and a composite measure of PWB which included key components of PWB identified in self-determination theory (satisfaction and frustration of basic psychological needs), as well as vitality, and life engagement. Results At the between-person level, higher AARC-gains and lower AARC-losses were consistently associated with higher PWB. Furthermore, associations between AARC-losses and lower PWB were weaker among those with higher AARC-gains. There was no evidence to suggest the interplay of AARC-gains and AARC-losses had implications for change in PWB over time. Discussion Appreciation of age-related gains may buffer the impact of AARC-losses on PWB. However, longitudinal studies conducted over varying macro- and micro-time scales are needed to better understand the developmental significance of AARC for later life.

Policies Towards Minority Populations

2013 ◽  
Author(s):  
Richard Fording ◽  
John Poe
Keyword(s):  
Public Policy ◽  
Content Analysis ◽  
Political Science ◽  
Local Governments ◽  
Minority Group ◽  
Future Research ◽  
Minority Populations ◽  
Recent Trends ◽  
The Impact ◽  
Over Time

In this chapter the authors explore two decades of research on the policies that have evolved from struggles for minority group inclusion. They focus on minority-targeted policies that are most relevant to state or local governments. As part of this effort the authors report the results of a content analysis of nine major political science and public policy journals. They find that the volume of research on minority-targeted policies has remained steady over time, but there have been significant changes in the content of these studies. In addition the authors dissect the research to examine the major questions that have been studied in the literature, as well as what we have learned about the politics and the impact of minority-targeted policies. They conclude by highlighting some recent trends in this literature that seem promising, as well as suggesting avenues for future research.

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