scholarly journals Observational Study of the Distribution and Diversity of Interventional Pain Procedures Among Hospitals in the State of Iowa

2019 ◽  
Vol 3 (22;3) ◽  
pp. E157-E170
Author(s):  
Franklin Dexter
Keyword(s):  
Weighted Least Squares ◽  
The State ◽  
Critical Access Hospitals ◽  
Least Squares Regression ◽  
Pain Medicine ◽  
Hospital Size ◽  
Epidural Injections ◽  
Primary Responsibility ◽  
The Relationship ◽  
Caudal Epidural

Background: Critical access hospitals represent 61% of hospitals in the rural United States, and 68% of hospitals in Iowa. The role of small hospitals, such as critical access hospitals, in providing interventional chronic pain procedures is unknown. Objectives: We evaluated whether: a) the diversity of interventional pain procedures offered by hospitals is related to their size and is attributable principally to lumbosacral epidural injections; b) critical access hospitals contribute substantively to the count and diversity of pain procedures; and c) whether most interventional pain procedures performed at hospitals’ facilities are performed by relatively few proceduralists or by the cumulative activity of many clinicians. Study Design: This research involved an observational cohort design with a sample size of n = 283,940 interventional pain procedures. Setting: Data were collected from hospital-owned facilities in the state of Iowa from July 2012 through September 2017. Methods: The diversity of types of interventional pain procedures performed statewide was quantified in terms of the relative proportions of procedures at each hospital using the Herfindahl index. Bilinear weighted least squares regression quantified the relationship between the inverse of the Herfindahl and the percentage of procedures that were lumbar or caudal epidural. Kendall tau concordances quantified the relationship between counts of interventional pain procedures and hospital size. Using a blinded version of the National Provider Identifier of the clinician with primary responsibility for performing the principal procedure of the ambulatory visit, we calculated the percentage shares of interventional pain procedures performed by the 1% and 5% of proceduralists who performed the most procedures. Results: The diversity of types of procedures substantively differentiated among hospitals. Heterogeneity among hospitals in the proportion of procedures that were lumbar or caudal epidural injections substantively contributed to the heterogeneity among hospitals (P < .001). Hospitals performing more procedures tended to have greater diversity of types of procedures (P < .001). However, the strength of the concordance was small (Kendall τb = 0.332), showing substantial heterogeneity among hospitals. The 82 critical access hospitals statewide cumulatively accounted for 23.9% of interventional pain procedures. The critical access hospitals’ procedures were mostly (67.7%) lumbar or caudal epidural injections (P < .001), greater than the 48.9% of the other 41 hospitals (P < .001). Procedures were concentrated among proceduralists. The 1.0% of the proceduralists performing the most procedures performed 64.8% of procedures. The 5.0% of proceduralists performing the most procedures performed 87.7% of procedures. Limitations: The data are procedures were performed in hospital-owned facilities of Iowa. Conclusions: Although busier pain programs, based on procedures per week, generally performed more types of procedures, the variability was so large that the number of procedures a pain program performs per week cannot validly be used to infer the diversity of the hospital’s pain medicine practice. Hospitals with pain medicine programs that lack diversity in the types of procedures performed may provide limited options for patients and be susceptible to changes in payment for individual procedures. Relatively few proceduralists performed the vast majority of the procedures. Key words: Critical access hospitals, Herfindahl, interventional pain procedures, managerial epidemiology, pain medicine, state outpatient procedure database, lumbar epidural

scholarly journals Pharmacokinetics of Sparfloxacin in the Serum and Vitreous Humor of Rabbits: Physicochemical Properties That Regulate Penetration of Quinolone Antimicrobials

1998 ◽  
Vol 42 (6) ◽  
pp. 1417-1423 ◽  
Author(s):  
Weiguo Liu ◽  
Qing Feng Liu ◽  
Ruth Perkins ◽  
George Drusano ◽  
Arnold Louie ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Linear Regression ◽  
Protein Binding ◽  
Weighted Least Squares ◽  
Direct Injection ◽  
Elimination Rate ◽  
Vitreous Humor ◽  
Pharmacokinetic Parameters ◽  
Least Squares Regression ◽  
The Relationship

ABSTRACT We have used a recently described animal model to characterize the ocular pharmacokinetics of sparfloxacin in vitreous humor of uninfected albino rabbits following systemic administration and direct intraocular injection. The relationships of lipophilicity, protein binding, and molecular weight to the penetration and elimination of sparfloxacin were compared to those of ciprofloxacin, fleroxacin, and ofloxacin. To determine whether elimination was active, elimination rates following direct injection with and without probenecid or heat-killed bacteria were compared. Sparfloxacin concentrations were measured in the serum and vitreous humor by a biological assay. Protein binding and lipophilicity were determined, respectively, by ultrafiltration and oil-water partitioning. Pharmacokinetic parameters were characterized with RSTRIP, an iterative, nonlinear, weighted, least-squares-regression program. The relationship between each independent variable and mean quinolone concentration or elimination rate in the vitreous humor was determined by multiple linear regression. The mean concentration of sparfloxacin in the vitreous humor was 59.4% ± 12.2% of that in serum. Penetration of sparfloxacin, ciprofloxacin, fleroxacin, and ofloxacin into, and elimination from, the vitreous humor correlated with lipophilicity (r 2 > 0.999). The linear-regression equation describing this relationship was not improved by including the inverse of the square root of the molecular weight and/or the degree of protein binding. Elimination rates for each quinolone were decreased by the intraocular administration of probenecid. Heat-killedStaphylococcus epidermidis decreased the rate of elimination of fleroxacin. Penetration of sparfloxacin into the noninflamed vitreous humor was greater than that of any quinolone previously examined. There was an excellent correlation between lipophilicity and vitreous entry or elimination for sparfloxacin as well as ciprofloxacin, fleroxacin, and ofloxacin. There are two modes of quinolone translocation into and out of the vitreous humor: diffusion into the eye and both diffusion and carrier-mediated elimination out of the vitreous humor.

Emotion Appraisals Predict Neuroticism and Extraversion

2015 ◽  
Vol 36 (1) ◽  
pp. 1-10
Author(s):  
Andrew Comensoli ◽  
Carolyn MacCann
Keyword(s):  
University Students ◽  
The State ◽  
The Relationship

The current study proposes and refines the Appraisals in Personality (AIP) model in a multilevel investigation of whether appraisal dimensions of emotion predict differences in state neuroticism and extraversion. University students (N = 151) completed a five-factor measure of trait personality, and retrospectively reported seven situations from the previous week, giving state personality and appraisal ratings for each situation. Results indicated that: (a) trait neuroticism and extraversion predicted average levels of state neuroticism and extraversion respectively, and (b) five of the examined appraisal dimensions predicted one, or both of the state neuroticism and extraversion personality domains. However, trait personality did not moderate the relationship between appraisals and state personality. It is concluded that appraisal dimensions of emotion may provide a useful taxonomy for quantifying and comparing situations, and predicting state personality.

GAGASAN PEMIKIRAN DAN GERAKAN DAKWAH M. NATSIR DI INDONESIA

1970 ◽  
Vol 4 (2) ◽  
pp. 284-295
Author(s):  
Muridan Muridan
Keyword(s):  
Boarding School ◽  
Religious Discourse ◽  
The State ◽  
Islamic State ◽  
The Relationship ◽  
Islamic Values

M. Natsir was one of the most prominent figures in religious discourse and movement in Indonesia. He was ada’wa reformer as well as a politician and a statesman.His most well known ideas were about the relationship between Islamand state, Islam and Pancasila, and his idea on da’wa. He stated that a country would be Islamic because of neither itsformal name as an Islamic state nor its Islamic state principles. The principles of the state could be generally formulated aslong as they referred to the Islamic values. Natsir also stated that the essence of Pancasila didn’t contradict with Islam; evensome parts of it went after the goals of Islam. However, it didn’t mean that Pancasila was identical with Islam. In relation toda’wa, he stated that it should be the responsibility of all Muslims, not only the responsibility of kiai or ulama. To make a da’wamovement successful, he suggested that it needed three integrated components; masjid, Islamic boarding school, andcampus.

Gagasan Pemikiran dan Gerakan Dakwah M. Natsir di Indonesia

1970 ◽  
Vol 3 (1) ◽  
pp. 63-74
Author(s):  
Muridan Muridan
Keyword(s):  
Boarding School ◽  
Religious Discourse ◽  
The State ◽  
Islamic State ◽  
The Relationship ◽  
Islamic Values

M. Natsir was one of the most prominent figures in religious discourse and movement in Indonesia. He was ada’wa reformer as well as a politician and a statesman. His most well known ideas were about the relationship between Islamand state, Islam and Pancasila, and his idea on da’wa. He stated that a country would be Islamic because of neither itsformal name as an Islamic state nor its Islamic state principles. The principles of the state could be generally formulated aslong as they referred to the Islamic values. Natsir also stated that the essence of Pancasila didn’t contradict with Islam; evensome parts of it went after the goals of Islam. However, it didn’t mean that Pancasila was identical with Islam. In relation toda’wa, he stated that it should be the responsibility of all Muslims, not only the responsibility of kyai or ulama. To make ada’wamovement successful, he suggested that it needed three integrated components; masjid, Islamic boarding school, andcampus.

In a word, I’ve been there

2019 ◽  
pp. 246-256
Author(s):  
A. K. Zholkovsky
Keyword(s):  
The State ◽  
Female Characters ◽  
Political Situation ◽  
The Core ◽  
The Relationship ◽  
Core Problem ◽  
Typical Solution

In his article, A. Zholkovsky discusses the contemporary detective mini-series Otlichnitsa [A Straight-A Student], which mentions O. Mandelstam’s poem for children A Galosh [Kalosha]: more than a fleeting mention, this poem prompts the characters and viewers alike to solve the mystery of its authorship. According to the show’s plot, the fact that Mandelstam penned the poem surfaces when one of the female characters confesses her involvement in his arrest. Examining this episode, Zholkovsky seeks structural parallels with the show in V. Aksyonov’s Overstocked Packaging Barrels [Zatovarennaya bochkotara] and even in B. Pasternak’s Doctor Zhivago [Doktor Zhivago]: in each of those, a member of the Soviet intelligentsia who has developed a real fascination with some unique but unattainable object is shocked to realize that the establishment have long enjoyed this exotic object without restrictions. We observe, therefore, a typical solution to the core problem of the Soviet, and more broadly, Russian cultural-political situation: the relationship between the intelligentsia and the state, and the resolution is not a confrontation, but reconciliation.

Bastard Feudalism and the Framing of Thirteenth-Century England

2018 ◽  
Author(s):  
Peter Coss
Keyword(s):  
Middle Ages ◽  
Thirteenth Century ◽  
Twelfth Century ◽  
The State ◽  
The Other ◽  
Great Work ◽  
Early Middle Ages ◽  
The One ◽  
The Relationship

In the introduction to his great work of 2005, Framing the Early Middle Ages, Chris Wickham urged not only the necessity of carefully framing our studies at the outset but also the importance of closely defining the words and concepts that we employ, the avoidance ‘cultural sollipsism’ wherever possible and the need to pay particular attention to continuities and discontinuities. Chris has, of course, followed these precepts on a vast scale. My aim in this chapter is a modest one. I aim to review the framing of thirteenth-century England in terms of two only of Chris’s themes: the aristocracy and the state—and even then primarily in terms of the relationship between the two. By the thirteenth century I mean a long thirteenth century stretching from the period of the Angevin reforms of the later twelfth century on the one hand to the early to mid-fourteenth on the other; the reasons for taking this span will, I hope, become clearer during the course of the chapter, but few would doubt that it has a validity.

The Concept of the Political

2018 ◽  
Author(s):  
Benjamin A. Schupmann
Keyword(s):  
Civil War ◽  
The State ◽  
The Political ◽  
Mass Movements ◽  
The Status ◽  
The Relationship

Chapter 2 reinterprets Schmitt’s concept of the political. Schmitt argued that Weimar developments, especially the rise of mass movements politically opposed to the state and constitution, demonstrated that the state did not have any sort of monopoly over the political, contradicting the arguments made by predominant Weimar state theorists, such as Jellinek and Meinecke. Not only was the political independent of the state, Schmitt argued, but it could even be turned against it. Schmitt believed that his contemporaries’ failure to recognize the nature of the political prevented them from adequately responding to the politicization of society, inadvertently risking civil war. This chapter reanalyzes Schmitt’s political from this perspective. Without ignoring enmity, it argues that Schmitt also defines the political in terms of friendship and, importantly, “status par excellence” (the status that relativizes other statuses). It also examines the relationship between the political and Schmitt’s concept of representation.

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