Do Hotspotting Programs Improve Patient Outcomes? A Systematic Review

Background Hotspotting programs train interprofessional teams of health students and professionals to engage with healthcare “super-utilizers” to address individuals’ social needs and coordinate ongoing care and social services. The goal is to improve care for individuals who demonstrate high levels of health care utilization, or “super-utilizers” to reduce future utilization while improving health outcomes, particularly while transitioning from a recent hospital utilization event. Debate exists whether hotspotting programs are effective at both reducing utilization and improving patient wellness. Aims To systematically review the literature on the effect of hotspotting and similar models of transitional care on rates of health care utilization, (hospital admissions, emergency department and primary care visits) health outcomes (e.g., perceived health), and satisfaction with care and behavioral outcomes (e.g., medication adherence). Methods PubMed, EMBASE, SCOPUS, and CINAHL were searched from 2010 through April 2022 for RCTs and controlled observational studies, cohort studies, and before-after studies of hotspotting and similar interprofessional transitional care programs set in the US. Results A total of 10 studies were included, 5 were RCT or non-randomized controlled studies, 3 were cohort studies, and 2 were pre-post intervention studies. All studies reported on rates of hospital admissions, and 8 found lower rates in the hotspotting group than controls over 1-12 months, with 6 of these being statistically significant. In 6 studies reporting on ED visits, 5 were consistent in showing an association between hotspotting and lower rates of ED visits over 1-12 months. However, results were statistically significant in only 2 studies. In four studies that reported on primary care provider (PCP) visits, 1 did not compare results to a control group, and 2 found statistically significant increases in PCP visits 14 days to 1 year following enrollment in the intervention. Only 2 studies reported on outcomes related to patient behaviors and perceptions of health care. One reported on rates of medication adherence >80% after 6 months, finding no effect. The other reported on measures of self-rated physical health, mental health, and patient activation, finding no effect, as well as care quality (comprehensiveness and supportiveness of self-management) and demonstrated a significant benefit. Conclusions The evidence suggests hotspotting demonstrates a relationship with improved healthcare utilization outcomes overall, albeit results of studies are imprecise. A high level of heterogeneity was found among population descriptions, time points, outcomes, and outcome measures across studies. Further evaluation of hotspotting programs’ effects via longitudinal controlled trials will allow for better evaluation of the efficacy of hotspotting in improving rates of health care utilization, overall health, and quality of life for high-needs individuals.Master of Public Healt

Helium Incorporation into Scandium Fluoride, a Model Negative Thermal Expansion Material

Scandium trifluoride is a model negative thermal expansion (NTE) material. Its simple structure can be described as an A-site vacant perovskite, and it shows isotropic NTE over a very wide temperature range (up to ∼1100 K), due to transverse vibrational motion of the fluoride. Like many framework NTE materials, it undergoes a phase transition at low pressures, adopting a rhombohedral (R3̅c) structure at >0.7 GPa and 300 K in commonly used nonpenetrating pressure media, such as silicone oil. High pressure X-ray diffraction data and gas uptake/release measurements indicate that, on compression in helium above ∼200 K, helium is inserted into ScF3 to form the defect perovskite HexScF3. The incorporation of helium stiffens the structure and changes its phase behavior. At room temperature, complete filling of the structure with helium does not occur until >1.5 GPa. On compression, a cubic perovskite structure is maintained until ∼5 GPa. As the pressure was increased to ∼9.5 GPa, a further transition occurred at ∼7 GPa. The first transition at ∼5 GPa is likely to a tetragonal (P4/mbm) perovskite, but the detailed structure of the perovskite phase formed on compression above ∼7 GPa is unclear. Cooling down from 300 to 100 K in helium at ∼0.4 GPa leads to an approximate composition of He0.1ScF3. High pressure neutron diffraction measurements, in the temperature range 15–150 K show that the incorporation of helium increases the pressure at which the cubic (Pm3̅m) to rhombohedral (R3̅c) putative quantum structural phase transition occurs from close to 0 GPa to ∼0.2 GPa at 0 K

Replicable Associations between Common Mental Distress and Suicide Risk in Young People: Implications for Clinical Practice and Population Suicide Prevention

Background. Recent evidence suggests that multiple symptoms or diagnoses, partucularly when co-ocuring with non-suicidal self-harm, predict suicide risk more strongly than single diagnosis. / Method. Suicidal thought (ST) and non-suicidal self-injury (NSSI) were studies in two independent longitudinal UK samples of young people: the Neuroscience in Psychiatry (NSPN) 2400 cohort (n=2403) and the ROOTS cohort (n=1074). Participants, age 14-24 years, were recruited from primary health care registers, schools and colleges, and advertisements to complete quotas in age-sex strata. We calculated a score on a latent construct Common Mental Distress (the summary measure indexing a broad range of symptoms conventionally seen as components of distinct disorders). We examined the relative prevalence of ST and NSSI over the population distribution of mental distress; we used logistic regressions, IRT and ROC analyses to determine associations between suicide risks and mental distress (in continuous and above-the-norm categorical format); and pathway mediation models to examine longitudinal associations. / Outcomes. We found a dose-response relationship between levels of mental distress and suicide risk. In both cohorts the majority of all subjects experiencing ST (78% and 76%) and NSSI (66% and 71%) had scores on mental distress no more than two standard deviations above the population mean; higher scores indicated highest risk but were, by definition, infrequent. Mental distress contributed to the longitudinal persistence of ST and NSSI. / Interpretation. Universal prevention strategies reducing levels of mental distress in the whole population (in addition to screening) may prevent more suicides than approaches targeting youths with psychiatric disorders

An investigation into the appointment role and success of examinership in Ireland performance management in the public sector: an evaluation of the usefulness of pmds in institutes of technology in the bmw region

As part of the national partnership agreements performance management (PM) systems have been introduced to the public service. The Performance Management and Development System (PMDS) was first implemented in the civil service and was subsequently adapted for the higher education sector in 2005. Due to the current economic climate the government has been forced to reduce expenditure in the public sector. Now more than ever there is a greater demand on public servants to perform their jobs effectively and efficiently. This approach is not only emphasised by the government but also echoed by public demands for accountability. A PM concept, such as the PMDS, is seen as a model that could deliver such efficiencies within the higher education sector. The higher education sector, in particular academic staff, poses a problem for any PM system. The difficulties arise in assessing a lecturer’s performance. Each lecturer has a range of tasks within their role and each carry out these tasks in individual ways. The challenges faced by a PM system are how to set standard for service delivery for a lecturer and how then to measure them. This research evaluates the PMDS system within several Institutes of Technology (IOTs). It focuses on academic staff, examining the usefulness of the PMDS to both staff and management. It first identifies what the PMDS seeks to achieve before describing the process itself. It then explores different aspects of the PMDS identifying its strengths and weaknesses as well as future improvements. The research consists of a review of the relevant literature in the subject area and also primary research. The primary research conducted produced both qualitative and quantitative information. Questionnaires were issued to a sample of lecturers from the IOTs under review and six interviews were carried out with a sample of managers. This multi method approach allowed for further exploration of the subject area while also enhancing the validity of the results. The results indicate that the PMDS has proven useful in some aspects but that the system overall is in need of improvement. It has been more successful with regard to the development of staff but has fallen short in its usefulness for PM in the IOTs. These shortfalls are the consequence of faults with the system itself but some are also due to external factors within the higher education sector. It is clear there is the potential for a more meaningful role for the PMDS within the IOTs provided that the current challenges both inside and outside the system are addressed

Hêgemonía: Hegemony, Classical and Modern

"Hegemony" is a term from the vocabulary of classical Greek history which was deliberately revived in the 19th century to describe a modern phenomenon. In its classical context, the clear denotation of “hegemony” is a military-political hierarchy, not one of wealth or cultural prestige; although both economic and cultural resources could serve to advance military-political hegemony, they were not at all of the essence. Hegemonic relations were conscious, and based upon complex motives and capacities. Individuals, peoples and states could desire, seek, struggle for, get, keep, lose and regain hegemony. Hegemony was sought or exercised over nations, over territories, over the land or the sea, or over tôn holôn, "the whole"; but "territories" turn out to be the states and nations thereon, "the land" and "the sea" actually meant "the mainland states" and "the island states," and tôn holôn was the world system, the whole system of interacting states. Hegemonic power relationships in the classical style are alive and well today; far from being time-bound, place-bound or culture-bound, hegemony in the classical sense is a transhistorical and transcultural fact that merits comparative-civilizational and comparative-world-systems study. While bilateral, alliance, and regional hegemonies are far more frequent both today and in the past, the most useful hegemony for study in a comparative civilizations/world systems context is systemwide hegemony: a unipolar influence structure that falls short of universal empire.</jats:p

Hêgemonía: Hegemony, Classical and Modern

"Hegemony" is a term from the vocabulary of classical Greek history which was deliberately revived in the 19th century to describe a modern phenomenon. In its classical context, the clear denotation of hegemony is a military-political hierarchy, not one of wealth or cultural prestige; although both economic and cultural resources could serve to advance military-political hegemony, they were not at all of the essence. Hegemonic relations were conscious, and based upon complex motives and capacities. Individuals, peoples and states could desire, seek, struggle for, get, keep, lose and regain hegemony. Hegemony was sought or exercised over nations, over territories, over the land or the sea, or over tôn holôn, "the whole"; but "territories" turn out to be the states and nations thereon, "the land" and "the sea" actually meant "the mainland states" and "the island states," and tôn holôn was the world system, the whole system of interacting states. Hegemonic power relationships in the classical style are alive and well today; far from being time-bound, place-bound or culture-bound, hegemony in the classical sense is a transhistorical and transcultural fact that merits comparative-civilizational and comparative-world-systems study. While bilateral, alliance, and regional hegemonies are far more frequent both today and in the past, the most useful hegemony for study in a comparative civilizations/world systems context is systemwide hegemony: a unipolar influence structure that falls short of universal empire

Power Polarity In The Far Eastern World System, 1025 BCAD 1850: Narrative And 25-Year Interval Data

Power polarity in the Far Eastern macro-social system is assessed at twenty five year intervals 1050 BC-AD 1850. Consistent with analysis of Indic system data, there is no support for the theory that the normal world-system power configuration is multipolar, hegemonic, or universal-empire. Instead several different "stability epochs" are discerned