Perceptions of the healthcare system among stakeholders

The U.S. healthcare system is rife with complexities and is consistently a source of political debate. One’s interaction with the system may directly impact the understanding of the system. The objective of this research is to examine the perceptions of the United States healthcare system from the viewpoint of healthcare providers, insurers, and consumers. Using a grounded theory approach, theoretical sampling was used to explore similarities and differences between the three groups of actors in the healthcare system. Data were collected through interviews with thirty-one participants using a semi-structured interview schedule. Themes of cost, access, and inefficiency emerged from the data. The theme of cost included the ability to pay, innovative care delivery, and relation to access. Access included the need for guidance, geographical proximity to healthcare, and socioeconomic status. The theme of inefficiency included how insurance dictates care, and the unwieldy system. Similarities among groups were the high cost of care, ability to pay, and complexity. Differences discovered were the insurers’ dual role as professional and consumer, providers’ informal access to care, and differing views on who is to blame for the high cost of healthcare. This research unveils perspectives of three stakeholders of actors in the healthcare system, providing a foundation for further research to better understand these perspectives in improving equity and access in healthcare. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Priming from the Pulpit: Extending Regulatory Focus Theory to Church Services

The purpose of this research note is to extend a powerful cognitive psychology theory—regulatory focus theory— to a specific nonprofit organization: churches. We apply this theory to the design of church services to model how church leaders can structure services to enhance congregant experience and generate positive behavioral outcomes. We present an experiment utilizing 126 adult Americans as initial evidence for our framework. The results indicate that using appropriate regulatory focus priming strategies can increase congregant donations

Parliamentary roll-call voting as a complex dynamical system:The case of Chile

A method is proposed to study the temporal variability of legislative roll-call votes in a parliament from the perspective of complex dynamical systems. We studied the Chilean Chamber of Deputies’ by analyzing the agreement ratio and the voting outcome of each vote over the last 19 years with a Recurrence Quantification Analysis and an entropy analysis (Sample Entropy). Two significant changes in the temporal variability were found: one in 2014, where the voting outcome became more recurrent and with less entropy, and another in 2018, where the agreement ratio became less recurrent and with higher entropy. These changes may be directly related to major changes in the Chilean electoral system and the composition of the Chamber of Deputies, given that these changes occurred just after the first parliamentary elections with non-compulsory voting (2013 elections) and the first elections with a proportional system in conjunction with an increase in the number of deputies (2017 elections) were held.</p

Chemical analysis of pottery demonstrates prehistoric origin for high-altitude alpine dairying

The European high Alps are internationally renowned for their dairy produce, which are of huge cultural and economic significance to the region. Although the recent history of alpine dairying has been well studied, virtually nothing is known regarding the origins of this practice. This is due to poor preservation of high altitude archaeological sites and the ephemeral nature of transhumance economic practices. Archaeologists have suggested that stone structures that appear around 3,000 years ago are associated with more intense seasonal occupation of the high Alps and perhaps the establishment of new economic strategies. Here, we report on organic residue analysis of small fragments of pottery sherds that are occasionally preserved both at these sites and earlier prehistoric rock-shelters. Based mainly on isotopic criteria, dairy lipids could only be identified on ceramics from the stone structures, which date to the Iron Age (ca. 3,000 - 2,500 BP), providing the earliest evidence of this practice in the high Alps. Dairy production in such a marginal environment implies a high degree of risk even by today’s standards. We postulate that this practice was driven by population increase and climate deterioration that put pressure on lowland agropastoral systems and the establishment of more extensive trade networks, leading to greater demand for highly nutritious and transportable dairy products

Effect of high-pressure torsion on microstructure, mechanical properties and corrosion resistance of cast pure Mg

© 2018, The Author(s). High-pressure torsion (HPT) processing was applied to cast pure magnesium, and the effects of the deformation on the microstructure, hardness, tensile properties and corrosion resistance were evaluated. The microstructures of the processed samples were examined by electron backscatter diffraction, and the mechanical properties were determined by Vickers hardness and tensile testing. The corrosion resistance was studied using electrochemical impedance spectroscopy in a 3.5% NaCl solution. The results show that HPT processing effectively refines the grain size of Mg from millimeters in the cast structure to a few micrometers after processing and also creates a basal texture on the surface. It was found that one or five turns of HPT produced no significant difference in the grain size of the processed Mg and the hardness was a maximum after one turn due to recovery in some grains. Measurements showed that the yield strength of the cast Mg increased by about seven times whereas the corrosion resistance was not significantly affected by the HPT processing

Recent advances in understanding the roles of whole genome duplications in evolution

Ancient whole-genome duplications (WGDs)—paleopolyploidy events—are key to solving Darwin’s ‘abominable mystery’ of how flowering plants evolved and radiated into a rich variety of species. The vertebrates also emerged from their invertebrate ancestors via two WGDs, and genomes of diverse gymnosperm trees, unicellular eukaryotes, invertebrates, fishes, amphibians and even a rodent carry evidence of lineage-specific WGDs. Modern polyploidy is common in eukaryotes, and it can be induced, enabling mechanisms and short-term cost-benefit assessments of polyploidy to be studied experimentally. However, the ancient WGDs can be reconstructed only by comparative genomics: these studies are difficult because the DNA duplicates have been through tens or hundreds of millions of years of gene losses, mutations, and chromosomal rearrangements that culminate in resolution of the polyploid genomes back into diploid ones (rediploidisation). Intriguing asymmetries in patterns of post-WGD gene loss and retention between duplicated sets of chromosomes have been discovered recently, and elaborations of signal transduction systems are lasting legacies from several WGDs. The data imply that simpler signalling pathways in the pre-WGD ancestors were converted via WGDs into multi-stranded parallelised networks. Genetic and biochemical studies in plants, yeasts and vertebrates suggest a paradigm in which different combinations of sister paralogues in the post-WGD regulatory networks are co-regulated under different conditions. In principle, such networks can respond to a wide array of environmental, sensory and hormonal stimuli and integrate them to generate phenotypic variety in cell types and behaviours. Patterns are also being discerned in how the post-WGD signalling networks are reconfigured in human cancers and neurological conditions. It is fascinating to unpick how ancient genomic events impact on complexity, variety and disease in modern life

Effect of the Diesel, Inhibitor, and CO 2

In order to determine the diesel contribution in the coadsorption process of the oil-soluble inhibitors, electrochemical impedance spectroscopy measurements have been carried out to study the performance of oil-soluble inhibitors in both presence and absence of diesel and CO2. The results showed that the presence of the oil phase provides some protection to the steel because the water-soluble fractions are capable of being adsorbed on the steel surface thereby reducing the corrosion rate. The oily phase does not contribute to the adsorption process of the inhibitor because the inhibitor is absorbed into the water-soluble fractions. The oil-soluble inhibitors are effective only when the solution is saturated with CO2. CO2 saturation causes a decrease in the pH of the solution causing both an increase of the inhibitor solubility and a better dispersion of the inhibitor into the electrolyte

Evaluation of the Performance of Routine Information System Management (PRISM) framework: evidence from Uganda

<p>Abstract</p> <p>Background</p> <p>Sound policy, resource allocation and day-to-day management decisions in the health sector require timely information from routine health information systems (RHIS). In most low- and middle-income countries, the RHIS is viewed as being inadequate in providing quality data and continuous information that can be used to help improve health system performance. In addition, there is limited evidence on the effectiveness of RHIS strengthening interventions in improving data quality and use. The purpose of this study is to evaluate the usefulness of the newly developed Performance of Routine Information System Management (PRISM) framework, which consists of a conceptual framework and associated data collection and analysis tools to assess, design, strengthen and evaluate RHIS. The specific objectives of the study are: a) to assess the reliability and validity of the PRISM instruments and b) to assess the validity of the PRISM conceptual framework.</p> <p>Methods</p> <p>Facility- and worker-level data were collected from 110 health care facilities in twelve districts in Uganda in 2004 and 2007 using records reviews, structured interviews and self-administered questionnaires. The analysis procedures include Cronbach's alpha to assess internal consistency of selected instruments, test-retest analysis to assess the reliability and sensitivity of the instruments, and bivariate and multivariate statistical techniques to assess validity of the PRISM instruments and conceptual framework.</p> <p>Results</p> <p>Cronbach's alpha analysis suggests high reliability (0.7 or greater) for the indices measuring a promotion of a culture of information, RHIS tasks self-efficacy and motivation. The study results also suggest that a promotion of a culture of information influences RHIS tasks self-efficacy, RHIS tasks competence and motivation, and that self-efficacy and the presence of RHIS staff have a direct influence on the use of RHIS information, a key aspect of RHIS performance.</p> <p>Conclusions</p> <p>The study results provide some empirical support for the reliability and validity of the PRISM instruments and the validity of the PRISM conceptual framework, suggesting that the PRISM approach can be effectively used by RHIS policy makers and practitioners to assess the RHIS and evaluate RHIS strengthening interventions. However, additional studies with larger sample sizes are needed to further investigate the value of the PRISM instruments in exploring the linkages between RHIS data quality and use, and health systems performance.</p