Can Experience Improve Hospital Management?

Background

Experience curve effects were first observed in the industrial arena as demonstrations of the relationship between experience and efficiency. These relationships were largely determined by improvements in management efficiency and quality of care. In the health care industry, volume-outcome relationships have been established with respect to quality of care improvement, but little is known about the effects of experience on management efficiency. Here, we examine the relationship between experience and hospital management in Japanese hospitals.

Methods

The study sample comprised individuals who had undergone surgery for unruptured abdominal aortic aneurysms and had been discharged from participant hospitals between April 1, 2006 and December 31, 2008. We analyzed the association between case volume (both at the hospital and surgeon level) and postoperative complications using multilevel logistic regression analysis. Multilevel log-linear regression analyses were performed to investigate the associations between case volume and length of stay (LOS) before and after surgery.

Results

We analyzed 909 patients and 849 patients using the hospital-level and surgeon-level analytical models, respectively. The odds ratio of postoperative complication occurrence for an increase of one surgery annually was 0.981 (P<0.001) at the hospital level and 0.982 (P<0.001) at the surgeon level. The log-linear regression analyses showed that shorter postoperative LOS was significantly associated with high hospital-level case volume (coefficient for an increase of one surgery: −0.006, P = 0.009) and surgeon-level case volume (coefficient for an increase of one surgery: −0.011, P = 0.022). Although an increase of one surgery annually at the hospital level was statistically associated with a reduction of preoperative LOS by 1.1% (P = 0.006), there was no significant association detected between surgeon-level case volume and preoperative LOS (P = 0.504).

Conclusion

Experience at the hospital level may contribute to the improvement of hospital management efficiency.     

Can Dreams During Pregnancy Predict Postpartum Depression?

Postpartum depression (henceforth PPD) is an emotional disturbance which occurs in as much as 20% of the childbearing population. This study attempted to ascertain whether dreams, offering unconscious expression of internal emotional processes, could help to identify early signs of PPD. It was hypothesized that differences would be found in the emotional dream work of pregnant women who either later developed or did not develop PPD. 166 women participated in the two stages of the study. During stage I, the women were interviewed in the last trimester of their first pregnancies. The interview included a demographic questionnaire and an account of a dream. During stage II, the women were interviewed 6–10 weeks after giving birth. The second interview included only the EPDS scale for affirming or denying the occurrence of PPD. The findings of the study confirm the hypothesis that dreams of pregnant women can differentiate among women who are or are not at-risk for PPD. It was found that more unpleasant dreams and dreams expressing apprehension were found among women who did not later develop PPD, than among women who did develop PPD.     

Can R*s Predict Invasion in Semi-arid Grasslands?

We estimated R*s and tested the applicability of R* theory on nonindigenous plant invasions in semi-arid rangeland. R* is the concentration of a resource that a species requires to survive in a habitat. R* theory predicts that a species with a lower R* for the most limiting resource will competitively displace a species with a higher R* under equilibrium conditions. In a greenhouse, annual sunflower (Helianthus annuus L.), bluebunch wheatgrass (Agropyron spicatum Pursh), and spotted knapweed (Centaurea maculosa Lam.) were grown in monoculture and 2- and 3-species mixtures for three growth periods in an attempt to reduce soil NO₃-N concentrations below each species’ R*. At the end of each growth period, aboveground biomass by species and soil plant available nitrogen were sampled. Decreasing biomass coupled with decreasing soil plant available nitrogen was used to quantify R*s for the three species. R*s for annual sunflower, bluebunch wheatgrass, and spotted knapweed were estimated to be 0.6±0.16 ppm NO₃⁻, less than 0.05 ppm NO₃⁻, and 0.6±0.13 ppm NO₃⁻, respectively. Estimated R*s did not predict the outcome of competition among species. To successfully predict plant community dynamics on semi-arid rangeland with and without the presence of a nonindigenous invasive species, a more comprehensive model that includes mechanisms in addition to competition may have to be considered. We speculate that R* theory may prove most useful for predicting the outcome of competition within functional groups.     

Macroparasite Infections of Amphibians: What Can They Tell Us?

Understanding linkages between environmental changes and disease emergence in human and wildlife populations represents one of the greatest challenges to ecologists and parasitologists. While there is considerable interest in drivers of amphibian microparasite infections and the resulting consequences, comparatively little research has addressed such questions for amphibian macroparasites. What work has been done in this area has largely focused on nematodes of the genus Rhabdias and on two genera of trematodes (Ribeiroia and Echinostoma). Here, we provide a synopsis of amphibian macroparasites, explore how macroparasites may affect amphibian hosts and populations, and evaluate the significance of these parasites in larger community and ecosystem contexts. In addition, we consider environmental influences on amphibian-macroparasite interactions by exploring contemporary ecological factors known or hypothesized to affect patterns of infection. While some macroparasites of amphibians have direct negative effects on individual hosts, no studies have explicitly examined whether such infections can affect amphibian populations. Moreover, due to their complex life cycles and varying degrees of host specificity, amphibian macroparasites have rich potential as bioindicators of environmental modifications, especially providing insights into changes in food webs. Because of their documented pathologies and value as bioindicators, we emphasize the need for broader investigation of this understudied group, noting that ecological drivers affecting these parasites may also influence disease patterns in other aquatic fauna.     

Can Amphipod Behavior Help to Predict Chronic Toxicity of Sediments?

Amphipods are widely used in both acute and chronic (sub-lethal) sediment tests. Acute sediment tests provide relatively rapid results, but may fail to detect moderately toxic contaminants that are bound to the sediment, whereas chronic life-cycle tests are rarely performed as they are time consuming and expensive. Observations during chronic testing of oil-contaminated sediment suggested that there may be a link between the behavior of the marine amphipod Corophium volutator and reduction in growth rate. Behavior tests were performed with six individual amphipods per treatment using sediment spiked with weathered Forties oil with burrowing time, re-emergence from sediment, and activity prior to burrowing as endpoints. Further behavior tests were used to predict the chronic toxicity of sediments spiked with three crude oils each with a dominant unresolved complex mixture of hydrocarbons (UCM). The effect of sediment type on behavior was also investigated. The results suggested that although the behavior test could not be used alone as a viable alternative to sediment toxicity tests, it could prove useful as an adjunct to acute tests, and help select sediments that deserve further investigation.     

Can Global Weed Assemblages Be Used to Predict Future Weeds?

Predicting which plant taxa are more likely to become weeds in a region presents significant challenges to both researchers and government agencies. Often it is done in a qualitative or semi-quantitative way. In this study, we explored the potential of using the quantitative self-organising map (SOM) approach to analyse global weed assemblages and estimate likelihoods of plant taxa becoming weeds before and after they have been moved to a new region. The SOM approach examines plant taxa associations by analysing where a taxon is recorded as a weed and what other taxa are recorded as weeds in those regions. The dataset analysed was extracted from a pre-existing, extensive worldwide database of plant taxa recorded as weeds or other related status and, following reformatting, included 187 regions and 6690 plant taxa. To assess the value of the SOM approach we selected Australia as a case study. We found that the key and most important limitation in using such analytical approach lies with the dataset used. The classification of a taxon as a weed in the literature is not often based on actual data that document the economic, environmental and/or social impact of the taxon, but mostly based on human perceptions that the taxon is troublesome or simply not wanted in a particular situation. The adoption of consistent and objective criteria that incorporate a standardized approach for impact assessment of plant taxa will be necessary to develop a new global database suitable to make predictions regarding weediness using methods like SOM. It may however, be more realistic to opt for a classification system that focuses on the invasive characteristics of plant taxa without any inference to impacts, which to be defined would require some level of research to avoid bias from human perceptions and value systems.     

Can Particulate Air Sampling Predict Microbial Load in Operating Theatres for Arthroplasty?

Several studies have proposed that the microbiological quality of the air in operating theatres be indirectly evaluated by means of particle counting, a technique derived from industrial clean-room technology standards, using airborne particle concentration as an index of microbial contamination. However, the relationship between particle counting and microbiological sampling has rarely been evaluated and demonstrated in operating theatres. The aim of the present study was to determine whether particle counting could predict microbiological contamination of the air in an operating theatre during 95 surgical arthroplasty procedures. This investigation was carried out over a period of three months in 2010 in an orthopedic operating theatre devoted exclusively to prosthetic surgery. During each procedure, the bacterial contamination of the air was determined by means of active sampling; at the same time, airborne particulate contamination was assessed throughout the entire procedure. On considering the total number of surgical operations, the mean value of the total bacterial load in the center of the operating theatre proved to be 35 CFU/m³; the mean particle count was 4,194,569 no./m³ for particles of diameter ≥0.5 µm and 13,519 no./m³ for particles of diameter ≥5 µm. No significant differences emerged between the median values of the airborne microbial load recorded during the two types of procedure monitored. Particulates with a diameter of ≥0.5 µm were detected in statistically higher concentrations (p<0.001) during knee-replacement procedures. By contrast, particulates with a diameter of ≥5 µm displayed a statistically higher concentration during hip-replacement procedures (p<0.05). The results did not reveal any statistically significant correlation between microbial loads and particle counts for either of the particle diameters considered (≥0.5 µm and ≥5 µm). Consequently, microbiological monitoring remains the most suitable method of evaluating the quality of air in operating theatres.     

Can Neck Circumference Predict Metabolic Syndrome? An Experience From A University Community

Objective: Neck circumference (NC) is associated with cardiovascular risk factors. The data for the measurement of the NC to predict metabolic syndrome (MetS) are limited. The objectives of this study were to determine the capability of the NC to detect MetS and to identify the optimal cutoff points of the NC among Thais.Methods: Participants who were aged ≥50 years who attended the Healthy Ageing Khon Kaen University Campus Project between March 2012 and April 2015 were recruited to this cohort study specific for atherosclerotic-related diseases. Baseline characteristics, anthropometric measures including NC, and metabolic profiles were collected. MetS was identified using the criteria of the National Cholesterol Educational Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Foundation (IDF).Results: There were 201 males and 386 females recruited for this study. The areas under the receiver operating characteristic (ROC) curves (AUCs) of NC based on the IDF criteria for females and males were 0.79 (95% confidence interval [CI] 0.75, 0.84) and 0.84 (95% CI 0.79, 0.9), respectively. For the NCEP ATP III criteria, the AUCs were 0.77 (95% CI 0.72, 0.82) in females and 0.71 (95% CI 0.64, 0.78) in males. An NC of 39 cm using IDF criteria for makes was determined as the optimal cutoff point to identify subjects with MetS. An NC of 33 cm for females was the best cutoff point for determining which subjects had MetS using both criteria.Conclusion: NC measurement and the use of established cutoff points is useful for predicting MetS in older Thai people.Abbreviations:AUC = area under the curveBMI = body mass indexCI = confidence intervalDM = diabetes mellitusHDL = high-density lipoproteinIDF = International Diabetes FoundationMetS = metabolic syndromeNC = neck circumferenceNCEP ATP III = National Cholesterol Educational Program Adult Treatment Panel IIIROC = receiver operating characteristicWC = waist circumference     

Can Insomnia in Pregnancy Predict Postpartum Depression? A Longitudinal,Population-Based Study

Background

Insomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression.

Methods

A longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms.

Results

After delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia.

Limitations

Depression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study.

Conclusions

Although women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression.     

Can Environment Predict Cryptic Diversity? The Case of Niphargus Inhabiting Western Carpathian Groundwater

In the last decade, several studies have shown that subterranean aquatic habitats harbor cryptic species with restricted geographic ranges, frequently occurring as isolated populations. Previous studies on aquatic subterranean species have implied that habitat heterogeneity can promote speciation and that speciation events can be predicted from species’ distributions. We tested the prediction that species distributed across different drainage systems and karst sectors comprise sets of distinct species. Amphipods from the genus Niphargus from 11 caves distributed along the Western Carpathians (Romania) were investigated using three independent molecular markers (COI, H3 and 28S). The results showed that: 1) the studied populations belong to eight different species that derive from two phylogenetically unrelated Niphargus clades; 2) narrow endemic species in fact comprise complexes of morphologically similar species that are indistinguishable without using a molecular approach. The concept of monophyly, concordance between mitochondrial and nuclear DNA, and the value of patristic distances were used as species delimitation criteria. The concept of cryptic species is discussed within the framework of the present work and the contribution of these species to regional biodiversity is also addressed.     

Can We Predict Personality in Fish? Searching for Consistency over Time and across Contexts

The interest in animal personality, broadly defined as consistency of individual behavioural traits over time and across contexts, has increased dramatically over the last years. Individual differences in behaviour are no longer recognised as noise around a mean but rather as adaptive variation and thus, essentially, raw material for evolution. Animal personality has been considered evolutionary conserved and has been shown to be present in all vertebrates including fish. Despite the importance of evolutionary and comparative aspects in this field, few studies have actually documented consistency across situations in fish. In addition, most studies are done with individually housed fish which may pose additional challenges when interpreting data from social species. Here, we investigate, for the first time in fish, whether individual differences in behavioural responses to a variety of challenges are consistent over time and across contexts using both individual and grouped-based tests. Twenty-four juveniles of Gilthead seabream Sparus aurata were subjected to three individual-based tests: feed intake recovery in a novel environment, novel object and restraining and to two group-based tests: risk-taking and hypoxia. Each test was repeated twice to assess consistency of behavioural responses over time. Risk taking and escape behaviours during restraining were shown to be significantly consistent over time. In addition, consistency across contexts was also observed: individuals that took longer to recover feed intake after transfer into a novel environment exhibited higher escape attempts during a restraining test and escaped faster from hypoxia conditions. These results highlight the possibility to predict behaviour in groups from individual personality traits.     

Infections and autoimmunity--good or bad?

The relationship between infections and autoimmunity is complex. Current evidence indicates that microbes can initiate, enhance, or, conversely, abrogate autoimmunity. In this paper, we will review experimental examples illustrating mechanisms involved in these three scenarios. Microbial infections can act as environmental triggers inducing or promoting autoimmunity resulting in clinical manifestations of autoimmune disease in genetically predisposed individuals. However, increasing evidence suggests the opposite outcome, which is the prevention or amelioration of autoimmune processes following microbial encounters. These latter observations support conceptually the "hygiene hypothesis," suggesting that cleaner living conditions will lead to enhanced incidence of autoimmune disorders, asthma, and allergies. Because proof of concept in humans is difficult to obtain, we will discuss relevant animal model data in context with likely or proven human associations. Knowledge of mechanisms that underlie either positive or negative effects of infections on autoimmunity will facilitate exploration of molecular details for prospective clinical studies in the future.