State Variation in Potentially Burdensome Transitions among Assisted Living Residents at End of Life

Little is known about the quality of end-of-life care in assisted living (AL), particularly transitions at end of life. This study aims to provide a first national look at potentially burdensome transitions at end of life among AL residents and to examine how those vary by state. This is a retrospective cohort study of Medicare beneficiaries who died in 2018 and resided at a validated 9-digit ZIP code for an AL with 25 or more beds4 on the 120th day before death (N=37,668). Three types of potentially burdensome transitions were considered: 1) healthcare transitions during last 3 days of life, 2) three or more all-cause hospitalizations during the last 90 days of life, and 3) two or more hospitalizations for urinary tract infections, sepsis, pneumonia, and dehydration during last 120 days of life. Hospitalizations and decedents’ locations were obtained from multiple administrative claims records. Out of the 37,668 AL decedents, 7,015 (18.6%, 95% CI: 18.2%-19.0%) experienced at least one potentially burdensome transition. States varied widely in the rate of burdensome transitions, ranging from 30.9% in North Dakota to 8.9% in Wyoming. Our results support quality concerns for end-of-life care among AL residents. Future studies are needed to explain state variation and how it relates to factors such as residents’ co-morbidities, end-of-life care practices in AL, and state regulations. This study had two limitations. First, multiple hospitalizations for Medicare Advantage beneficiaries might be under-reported. Second, the results are not generalizable to persons in ALs with fewer than 25 beds.

The implementation potential of a method to monitor empirically-supported children’s mental health treatment through claims data

Background The delivery of evidence-supported treatments (EST) in children’s mental health could be a valuable measure for monitoring mental healthcare quality; however, efforts to monitor the use of EST in real world systems are hindered by the lack of pragmatic methods. This mixed methods study examined the implementation and agency response rate of a pragmatic, claims-based measure of EST designed to be applied as a universal quality measure for child psychotherapy encounters in a state Medicaid system. Methods Implementation potential of the EST measure was assessed with healthcare leader rankings of the reporting method’s acceptability, appropriateness and feasibility (n = 53), and post-implementation ratings of EST rate accuracy. Ability of the healthcare system to monitor EST through claims was measured by examining the agency responsivity in using the claims-based measure across 98 Medicaid-contracted community mental health (CMH) agencies in Washington State. Results The analysis found the reporting method had high implementation potential. The method was able to measure the use of an EST for 83% of children covered by Medicaid with 58% CMH agencies reporting > 0 ESTs in one quarter. Qualitative analyses revealed that the most significant barrier to reporting ESTs was the operability of electronic health record systems and agencies’ mixed views regarding the accuracy and benefits of reporting. Conclusions Measurement of child mental health ESTs through Medicaid claims reporting has acceptable implementation potential and promising real world responsiveness from CMH agencies in one state. Variation in reporting by agency site and low to moderate perceived value by agency leaders suggests the need for additional implementation supports for wider uptake.

School Autonomy Policies Lead to Increases in Principal Autonomy and Job Satisfaction

We explore whether decentralization of decision-making influences school principals’ subjective experience of autonomy, job demands, burnout, and job satisfaction. Using six-years of longitudinal data, we used two Australian education reforms as a natural experiment of the effect of decentralization. Exploiting state-to-state variation in the policies, we used difference-in-differences models, finding that the decentralization policies had a small influence on increasing self-perceptions of autonomy without increasing job demands. We also found that the policies had a small positive effect on job satisfaction.

Character-state evaluation when discriminating Thysanoptera taxa (Insecta)

Problems are discussed in evaluating character state variation in the insect order Thysanoptera, particularly in the family Phlaeothripidae, illustrated by two such problems in the genus Haplothrips Amyot & Serville. The synonymy of Jironiella Retana-Salazar & Soto-Rodriguez with Haplothrips is reconfirmed, and Haplothrips aliakbarii Mirab-balou & Miri is recognised as a new synonym of H. globiceps Bagnall.

Oxidation state variation in bis-calix[4]arene supported decametallic Mn clusters

The reaction of MnCl2·4H2O, H8L (2,2’-bis-p-tBu-calix[4]arene) and NEt3 in a dmf/MeOH solvent mixture results in the formation of a mixed valent decametallic cluster of formula [MnII6MnIII4(L)2(µ3-OH)4(µ-OH)4(MeOH)4(dmf)4(MeCN)2]·MeCN (3). Complex 3 crystallises in the monoclinic space group P21/n with the asymmetric unit comprising half of the compound. Structure solution reveals that the bis-calix[4]arene ligands are arranged such that one TBC[4] moiety in each has undergone inversion in order to accommodate a [MnIII4MnII6] metallic skeleton that describes three vertex-sharing [MnIII2MnII2] butterflies. The structure is closely related to the species [MnIII6MnII4(L)2(μ3-O)2(μ3-OH)2(μ-OMe)4(H2O)4(dmf)8]·4dmf (4), the major difference being the oxidation level of the Mn ions in the core of the compound. DFT calculations on the full structures reveal that replacing the MnIII ions in 4 for MnII ions in 3 results in a significant decrease in the magnitude of some antiferromagnetic exchange contributions, a switch from ferromagnetic to antiferromagnetic in others, and the loss of significant spin frustration.

Skewed Child Sex Ratios in India: A Revisit to Geographical Patterns and Socio-economic correlates

This study revisits the regional and socio-economic pattern of masculinisation of Child Sex Ratios (CSR), Sex Ratio at Birth (SRB) and Sex Ratio at Last Birth (SRLB) by using the successive rounds of National Family Health Survey (NFHS). Although the masculinisation of CSR continues in many Indian states as well as in different socio-economic settings, a tremendous change in previously established patterns of CSR can be observed from the findings. District-level analysis presents an intra-state variation in CSR, SRB and SRLB, which helps in identifying the emerging ‘hotspots’ of the problem. The decline in preference for a son and rise in skewed CSR, SRB and SRLB invites the attention of researchers towards drawbacks in the method of measurement of preference for a son as people are now more aware of the legal consequences of sex-selective abortions and underreport the same.

Computational Psychiatry Needs Time and Context

Why has computational psychiatry yet to influence routine clinical practice? One reason may be that it has neglected context and temporal dynamics in the models of certain mental health problems. We develop three heuristics for estimating whether time and context are important to a mental health problem: Is it characterized by a core neurobiological mechanism? Does it follow a straightforward natural trajectory? And is intentional mental content peripheral to the problem? For many problems the answers are no, suggesting that modeling time and context is critical. We review computational psychiatry advances toward this end, including modeling state variation, using domain-specific stimuli, and interpreting differences in context. We discuss complementary network and complex systems approaches. Novel methods and unification with adjacent fields may inspire a new generation of computational psychiatry. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

How High (Low) are the Possibilities of Teleworking in Mexico?

We estimate that about 10.6 percent of jobs could be done from home in Mexico, using 468 4-digit SINCO occupations and employment data in 2019. This is roughly half the estimate reported by Dingel and Neiman (2020) using teleworking criteria devised for the U.S. labor market. Owing to the peculiarities of the Mexican labor market, we report results by type of contract (formal and informal), geographical area, and gender. We validate our teleworking measure by exploiting the cross-state variation of real GDP per worker, the share of services in employment, and internet and computer access within the household. We find that the gap in teleworking possibilities favorable to females has its root in the disparate occupation structures across gender. During the pandemic, the decline in the share of non-telework jobs in females has been thrice as much as that in males