Use of ICD-10 codes for identification of injection drug use-associated infective endocarditis is nonspecific and obscures critical findings on impact of medications for opioid use disorder

Background: No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use-associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods: We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results: ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48-2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19-1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed ( Conclusions: Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed

An Assessment of the Social Science Research Environment of the Sri Lankan State University System

Higher education institutions play a vital role in society in varied capacities, and one major contribution amongst it all is conducting research as a part of knowledge creation and dissemination. Social Science Research thereby provides valuable input for policy makers, decision makers and the public, in order to encourage the well-being of the society. Previous studies have highlighted the importance of conducting social science researches to address social issues and improve quality of life. However, the number of research conducted in this discipline in Sri Lanka is not adequate when compared to that of other countries in the region. Hence, this study aims to explore the present status and challenges that hinder the number of social science research conducted by academics in State Universities in Sri Lanka. The study conducted a detailed literature review that was followed by in-depth interviews with 50 academics representing five state universities in Sri Lanka. The universities were selected based on the availability of Social Sciences and Humanities Faculties/Departments. The data were then analysed qualitatively based on the Grounded Theory Method to achievestudy objectives. The study revealed three main categories that limit the number of social science researches conducted in State Universities in Sri Lanka. They are; organizational factors, individual factors, and policy related factors. In addition, collaboration with other universities/ faculties, publication opportunities, research awards, and research allowance were identified as aspects in support of social science research in Sri Lanka. The study findings significantly helps in policy making, to identify the present status as well as factors that can contribute to enhance the level of social science related research among academics of State Universities in Sri Lanka.KeywordsResearch Environment, Social Sciences Research, State Universitie

Adoption of Voluntary Environmental Standards: The Role of Signaling and Intrinsic Benefits in the Diffusion of the LEED Green Building Standards.

We examine the role of signaling and of intrinsic benefits in the adoption of the individual elements of the voluntary LEED (Leadership in Energy and Environmental Design) standards for green buildings. We use goodness-of-fit tests on data for all 442 LEED certified buildings and find that neither signaling nor pursuit of intrinsic benefits can independently explain the observed adoption pattern, but that a combination of the two factors can. We also find tentative evidence that the adoption decision is made sequentially: organizations first choose a level of certification (consistent with signaling), and then choose how many LEED elements to adopt given their chosen level of certification (consistent with pursuing intrinsic benefits). We relate our findings to some open questions in the literature on diffusion of technology and draw implications for the design and the future development of similar voluntary standards and eco-labels

Energy efficiency in small and medium-sized manufacturing firms: Order effects and the adoption of process improvement recommendations

In many manufacturing operations, profitable energy efficiency opportunities remain unexploited. Although previous studies have tried to explain the underinvestment, we focus on how the way in which a portfolio of opportunities is presented in a list affects adoption decisions. We use information on over 100,000 energy-saving recommendations made to more than 13,000 small and medium-sized manufacturing firms under the Industrial Assessment Centers program of the U.S. Department of Energy. We find that adoption rates are higher for initiatives appearing early in a list of recommendations. This sequence effect is consistent and large: simply moving a recommendation one position lower has the same effect on average as increasing up-front implementation cost by at least 17% from the average value. Given this impact of sequence on adoption of individual recommendations, we utilize variations within our data to examine how various sequencing approaches affect adoption at the portfolio level. Sequences in which recommendations are listed from best to worst payback achieve higher potential energy savings given the investments in energy efficiency made by the firms. We also observe a choice overload effect at the portfolio level, but the magnitude of this effect is small. © 2013 INFORMS