Adapting DRGs: The British, Canadian and Australian Experiences

1994 ◽  
Vol 24 (3) ◽  
pp. 87-93
Author(s):  
John Pilla ◽  
Don Hindle

The DRG classification was developed in the United States, and has been widely used there for analytical and resource allocation purposes. Its utility has been recognised in other countries. Some have adopted US versions without change, and others have chosen to develop their own adaptations. This paper discusses the processes and outcomes of adaptation in Canada, Britain and Australia. An attempt is made to generalise the trends. It is concluded that there is a high degree of similarity of intent, although different solutions have been adopted in some cases. Where major differences remain, they are mostly a consequence of the lack of resources to pursue all opportunities for refinement at the same time. All three countries have correctly focused on involvement of their own clinician groups. However, they have tended to restrict their view to US experiences when looking overseas. It is argued that greater attention should be paid to sharing their ideas with countries with which they have a greater degree of similarity.

2012 ◽  
Vol 43 (4) ◽  
pp. 232-242 ◽  
Author(s):  
Phia S. Salter ◽  
Glenn Adams

Inspired by “Mother or Wife” African dilemma tales, the present research utilizes a cultural psychology perspective to explore the dynamic, mutual constitution of personal relationship tendencies and cultural-ecological affordances for neoliberal subjectivity and abstracted independence. We administered a resource allocation task in Ghana and the United States to assess the prioritization of conjugal/nuclear relationships over consanguine/kin relationships along three dimensions of sociocultural variation: nation (American and Ghanaian), residence (urban and rural), and church membership (Pentecostal Charismatic and Traditional Western Mission). Results show that tendencies to prioritize nuclear over kin relationships – especially spouses over parents – were greater among participants in the first compared to the second of each pair. Discussion considers issues for a cultural psychology of cultural dynamics.


Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Pat Croskerry

Abstract Medical error is now recognized as one of the leading causes of death in the United States. Of the medical errors, diagnostic failure appears to be the dominant contributor, failing in a significant number of cases, and associated with a high degree of morbidity and mortality. One of the significant contributors to diagnostic failure is the cognitive performance of the provider, how they think and decide about the process of diagnosis. This thinking deficit in clinical reasoning, referred to as a mindware gap, deserves the attention of medical educators. A variety of specific approaches are outlined here that have the potential to close the gap.


1973 ◽  
Vol 33 (3) ◽  
pp. 891-900 ◽  
Author(s):  
Itai Zak

The main problem posed in this study is: What are the content and structure of Jewish and American identity? The Jewish-American Identity Scale, which was adapted and refined for this study, was administered in 1971 to four samples, totaling 1006 Jewish-American college students from various parts of the United States. Initially, factor analysis was applied to the separate samples. Intersample comparisons of factor structures indicated a high degree of congruency; consequently, the samples were combined for subsequent analyses. Factor analysis of the test scores demonstrated that most of the common factor variance was appropriated by two relatively orthogonal factors. Items dealing with American identity and those dealing with Jewish identity had medium to high loadings on the two respective factors. These findings supported the hypothesis of the duality and the orthogonality of dimensions of Jewish and American identity, and cast doubt on the notion forwarded by some researchers that Jewish-American identity forms a bipolar continuum.


2021 ◽  
Vol 23 (1) ◽  
pp. 1
Author(s):  
Sigit S. Nugroho

Assessing the output of past foreign policy is instrumental for any country to learn policy-relevant insights, to appreciate its experience, and to improve its future conduct. To glean such insights, this article borrows Baldwin’s framework in assessing the success and failure in foreign policy. Using a case study analysis, it assesses the United States’ (U.S.) influence attempt towards Indonesia to resolve the 1999 East Timor humanitarian crisis. President Clinton’s decision to undergo an influence attempt primarily aimed to change Indonesia’s policy while gaining support from U.S. allies in the process. The article finds that Clinton’s decision was a highly successful attempt. This finding is based on several factors: (1) the attempt effectively attained the intended primary and secondary goals at a considerably high degree; (2) it was conducted at a considerably low cost for the U.S.; (3) it inflicted a high cost towards Indonesia; (4) the increase in Clinton’s stake strengthened the U.S. resolve to pursue the influence attempt; and (5) Clinton had successfully overcome the difficult undertaking as Indonesia possessed higher stake over East Timor. These findings provide some lessons for both U.S. and Indonesian foreign policymakers to chart future relations for the two nations.


2021 ◽  
Author(s):  
Aneta Duda

"This article discusses the concept of brandcasting in the particular case of a controversial advertorial (ADL) - paid messages in the media sponsored by organized interests to create and sustain a favorable environment to pursue their respective goals. An advertorial is an advertisement masquerading as a journalistic article, blurring the dividing line between editorial content and advertorials. Based on the content analysis technique of 284 advertorials of Newsweek, Polityka and Time, the most widely circulated and read weekly newsmagazine in Poland and the United States of America, the author documents the placement of ADL: proportions of commercial and non-commercial content, detailed typologies, brand positioning, sponsor disclosures, the degree of similarity with journalistic texts and corporate and non-corporate interests. The newspaper advertorial borrows, or just steals editorial credibility from the newspaper and pollutes reliable information. There, of course, might be a place for such kind of advertisements, but they should be more thoroughly distinguished form editorial content than is currently the case. As shown in the article, media do not place sponsor disclosures prominently."


Author(s):  
Cherian George

The United States has exceptionally strong Constitutional protections for free speech, but also for religious freedom. This chapter considers how this unique legal framework affects hate spin in the country. It finds that although hate speech can be expressed with a high degree of impunity, strong anti-discrimination laws limit the harms caused by such speech. Hate spin can, nonetheless, succeed in fostering fear and cultivating prejudice against minorities. The chapter examines how a network of anti-Muslim activists have used hate spin to campaign against mosque building, to oppose multi-cultural textbooks, and to introduce legislation protecting states from the fabricated threat of encroaching Muslim law. Beyond their stated goals, which may be frustrated by courts, these campaigns often have the symbolic purpose of spreading Islamophobia.


1986 ◽  
Vol 11 (3) ◽  
pp. 447-532 ◽  
Author(s):  
H. W. Arthurs ◽  
R. Weisman ◽  
F. H. Zemans

This article seeks to weave together the limited information available on the legal professions of the Canadian provinces. Following the same general format as the other comparative studies in this series, it also offers several critical observations of special interest to readers in the United States, whose experience the Canadian bar so closely tracks. The phenomenon of stratification—familiar to American observers—is clearly visible in the Canadian legal profession. Combined with other centrifugal forces, it threatens the unity of a profession which, until recently, has managed to preserve a high degree of cohesion in training, ideology, and institutional structures. On the other hand, in certain respects, the Canadian experience seems to differ from that of the United States, especially in the strength and peculiar structure of publicly funded legal aid schemes, in the profession's continuing formal autonomy and relative immunity from public regulation, and in its long-lasting attachment to apprenticeship as a necessary stage in professional formation. These and other convergences and divergences between the two countries raise questions of general significance: To what extent do the similarities between Canada and the United States verify the assumption implicit in the theoretical literature (principally Abel, Freidson, and Larson) that there is an empirical referent for something called legal professionalism? And to what extent do the differences suggest that containing societies contribute distinctive characteristics to their legal professions, whose qualities are therefore highly contingent?


1973 ◽  
Vol 30 (12) ◽  
pp. 2386-2392
Author(s):  
W. F. Royce

The salmon fishery of the United States illustrates the major principles and problems of fishery management: regulation of the fishery, maintenance of the environment, and artificial augmentation of the stocks. It also includes controls both in fresh water and on the high seas. The industry has experienced the age-old conflicts between large- and small-scale fisheries, and administrators have had to wrestle with the problem of allocating the catch among various contenders. This problem has been confused with that of conservation. Prohibition of salmon traps, restrictions on size and mode of operation of purse seines, and prohibition of monofilament gillnets are examples of the kinds of compromises made between allocation and conservation.Dams, pollution, and other modifications of the freshwater environment have endangered salmon stocks. An early response was to raise salmon artificially and release them. For many years this technique was unsuccessful, and when it was evaluated most hatcheries were closed. In recent years the preservation of the genetic identity of the stock and improved diets and schedules of release have resulted in greater success of hatcheries. Spawning channels show promise of additional success. Another practice of value has been development of devices to pass fish over dams, both upstream and down.Control of fishing to provide adequate spawning has concentrated on manipulation of individual population units, an enormously complicated task since the number of these in United States streams is in the order of 10,000. Of these about 100 major ones are under separate control. Regulations depend on forecasts, since fishing takes place before the salmon reach spawning grounds. Forecasts have improved greatly in recent years, although much remains to be done.Among problems on which no great progress has been made are: extent and consequences of genetic change produced by selective fishing; causes of cycles, and alterations in these; effects of changing environment, especially subtle ones of temperature, dissolved oxygen, and pollution; control of recruitment, including release of hardy young. Difficult economic problems include: the tendency for regulations to favor inefficient operators; high costs of research and regulation, borne not by users but by public funds.Administrative achievements include: a high degree of environmental protection; remarkably parallel regulations in the three States principally involved, Alaska, Washington, and Oregon; successful joint regulation of international fisheries in cooperation with Canada and Japan.Problems which will continue to exist and increase in difficulty include protection of the environment of the salmon, rivalries between many diverse interest groups, and improvement in culture operations. The major step of restricting entry into the commercial salmon fishery is being contemplated in several locations.


1973 ◽  
Vol 33 (1) ◽  
pp. 232-251 ◽  
Author(s):  
Harry N. Scheiber

Expropriation of private property by government is seldom found on the list of policies which have influenced the course of economic development in American history. To be sure, the once-vigorous myth of antebellum laisser-faire has been discarded; and it is no longer taken as a startling proposition that governmental interventions to promote and regulate the economy occurred regularly throughout the nineteenth century. But for two reasons, I think, expropriation as an instrument of conscious resource allocation has failed to receive from historians the attention it deserves.


2000 ◽  
Vol 38 (9) ◽  
pp. 3323-3328 ◽  
Author(s):  
Maria Lucia C. Tondella ◽  
Tanja Popovic ◽  
Nancy E. Rosenstein ◽  
D. B. Lake ◽  
George M. Carlone ◽  
...  

Because the Neisseria meningitidis serogroup B (NMSB) capsule is poorly immunogenic in humans, immunization strategies have focused on noncapsular antigens. Both PorA and to a lesser extent PorB are noncapsular protein antigens capable of inducing protective bactericidal antibodies, and vaccines based on the outer membrane protein (OMP) components of serogroup B meningococci have been shown to be effective in clinical trials. Multiple PorA antigens seem to be needed to prevent endemic meningococcal disease around the world, and a hexavalent PorA-based meningococcal vaccine has recently been developed in The Netherlands. To evaluate the distribution of NMSB PorA and PorB antigens in the United States, serosubtyping and serotyping were done on 444 NMSB strains isolated in the active surveillance areas of the United States (total population, 32 million) during the period 1992 to 1998. A total of 244 strains were isolated from sporadic cases of meningococcal disease, and 200 strains were isolated from an epidemic in Oregon. A panel of 16 mouse monoclonal antibodies reactive with PorA and 15 monoclonal antibodies reactive with PorB were used. Among the NMSB isolates obtained from sporadic cases, the most prevalent serosubtypes were P1.7,16 (14.3%), P1.19,15 (9.8%), P1.7,1 (8.6%), P1.5,2 (7.8%), P1.22a, 14 (7.8%), and P1.14 (5.3%) and the most prevalent serotypes were 4,7 (27.5%), 15 (16%), 14 (8.6%), 10 (6.1%), 1 (4.9%), and 2a (3.7%). A multivalent PorA-based OMP vaccine aimed at the six most prevalent serosubtypes could have targeted about half of the sporadic cases of NMSB disease that occurred between 1992 and 1998 in the surveillance areas. Twenty serosubtypes would have had to be included in a multivalent vaccine to achieve 80% coverage of strains causing sporadic disease. The relatively large number of isolates that did not react with murine monoclonal antibodies indicates that DNA sequence-based variable region typing of NMSB will be necessary to provide precise information on the distribution and diversity of PorA antigens and correlation with nonserosubtypeable isolates. The high degree of variability observed in the PorA and PorB proteins of NMSB in the United States suggests that vaccine strategies not based on OMPs should be further investigated.


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