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15 results

Seemed Like a Good Idea
  • Alchemy versus Evidence-Based Approaches to Healthcare Management Innovation
  • Mark Pauly, Flaura Winston, Mary Naylor, Kevin Volpp, Lawton Robert Burns, Ralph Muller, David Asch, Rachel Werner, Bimal Desai, Krisda Chaiyachati, Benjamin Chartock
  • Published online:
    14 July 2022
    Print publication:
    28 July 2022
  • Consumers, public officials, and even managers of health care and insurance are unhappy about care quality, access, and costs. This book shows that is because efforts to do something about these problems often rely on hope or conjecture, not rigorous evidence of effectiveness. In this book, experts in the field separate the speculative from the proven with regard to how care is rendered, how patients can be in control, how providers should be paid, and how disparities can be reduced – and they also identify the issues for which evidence is currently missing. It provides an antidote to frustration and a clear-eyed guide for forward progress, helping health care and insurance innovators make better decisions on deciding whether to go ahead now based on current evidence, to seek and wait for additional evidence, or to move on to different ideas. It will be useful to practitioners in hospital systems, medical groups, and insurance organizations and can also be used in executive and MBA teaching.

  • Sequence stratigraphy, basin morphology and sea-level history for the Permian Kapp Starostin Formation of Svalbard, Norway

  • DAVID P. G. BOND, DIERK P. G. BLOMEIER, ANNA M. DUSTIRA, PAUL B. WIGNALL, DANIEL COLLINS, THOMAS GOODE, RALPH D. GROEN, WERNER BUGGISCH, STEPHEN E. GRASBY
  • Journal:
    Geological Magazine / Volume 155 / Issue 5 / July 2018
    Published online by Cambridge University Press:
    09 January 2017, pp. 1023-1039
    • Article
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  • Based on seven measured sections from Svalbard, the marine strata of the Permian Kapp Starostin Formation are arranged into seven transgressive–regressive sequences (TR1–TR7) of c. 4–5 Ma average duration, each bound by a maximum regressive surface. Facies, including heterozoan-dominated limestones, spiculitic cherts, sandstones, siltstones and shales, record deposition within inner, middle and outer shelf areas. The lowermost sequence, TR1, comprises most of the basal Vøringen Member, which records a transgression across the Gipshuken Formation following a hiatus of unknown duration. Temperate to cold, storm-dominated facies established in inner to middle shelf areas between the latest Artinskian and Kungurian. Prolonged deepening during sequences TR2 and TR3 was succeeded by a long-term shallowing-upward trend that lasted until the latest Permian (TR4–TR7). A major depocentre existed in central and western Spitsbergen while to the north, Dickson Land remained a shallow platform, leading to a shallow homoclinal ramp in NE Spitsbergen and Nordaustlandet. The Middle Permian extinction (late Capitanian) is recorded near the base of TR6 in deeper parts of the basin only; elsewhere this sequence is not recorded. Likewise the youngest sequence, TR7, extending to the upper formational contact of latest Permian age, is found only in the basin depocentre. Comparison with age-equivalent strata in the Sverdrup Basin of Canada reveals a remarkably similar depositional history, with, for example, two (third-order) sea-level cycles recorded in the Late Permian of both regions, in keeping with the global record. Sequence stratigraphy may therefore be a powerful correlative tool for onshore and offshore Permian deposits across NW Pangaea.

  • Dispersal of Staphylococcus aureus Into the Air Associated With a Rhinovirus Infection

  • Stefano Bassetti, Werner E. Bischoff, Mark Walter, Barbara A. Bassetti-Wyss, Lori Mason, Beth A. Reboussin, Ralph B. D'Agostino, Jr, Jack M. Gwaltney, Jr, Michael A. Pfaller, Robert J. Sherertz
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 26 / Issue 2 / February 2005
    Published online by Cambridge University Press:
    21 June 2016, pp. 196-203
    Print publication:
    February 2005
  • Objective:

    To determine whether healthy adult nasal carriers of Staphylococcus aureus can disperse S. aureus into the air after rhinovirus infection.

    Design:

    We investigated the “cloud” phenomenon among adult nasal carriers of S. aureus experimentally infected with a rhinovirus. Eleven volunteers were studied for 16 days in an airtight chamber wearing street clothes, sterile garb, or sterile garb plus surgical mask; rhinovirus inoculation occurred on day 2. Daily quantitative air, nasal, and skin cultures for S. aureus; cold symptom assessment; and nasal rhinovirus cultures were performed.

    Setting:

    Wake Forest University School of Medicine, Winston-Salem, North Carolina.

    Participants:

    Wake Forest University undergraduate or graduate students who had persistent nasal carriage of S. aureus for 4 or 8 weeks.

    Results:

    After rhinovirus inoculation, dispersal of S. aureus into the air increased 2-fold with peak increases up to 34-fold. Independent predictors of S. aureus dispersal included the time period after rhinovirus infection and wearing street clothes (P < .05). Wearing barrier garb but not a mask decreased dispersal of S. aureus into the air (P < .05).

    Conclusion:

    Virus-induced dispersal of S. aureus into the air may have an important role in the transmission of S. aureus and other bacteria.

  • Airborne Dispersal as a Novel Transmission Route of Coagulase-Negatwe Staphylococci Interaction Between Coagulase-Negative Staphylococci and Rhinovirus Infection

  • Werner E. Bischoff, Stefano Bassetti, Barbara A. Bassetti-Wyss, Michelle L. Wallis, Brian K. Tucker, Beth A. Reboussin, Ralph B. D'Agostino, Jr., Michael A. Pfaller, Jack M. Gwaltney, Jr., Robert J. Sherertz
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 25 / Issue 6 / June 2004
    Published online by Cambridge University Press:
    02 January 2015, pp. 504-511
    Print publication:
    June 2004
  • Objective:

    To investigate whether rhinovirus infection leads to increased airborne dispersal of coagulase-negative staphylococci (CoNS).

    Design:

    Prospective nonrandomized intervention trial.

    Setting:

    Wake Forest University School of Medicine, Winston-Salem, North Carolina.

    Participants:

    Twelve nasal Staphylococcus aureus-CoNS carriers among 685 students screened for S. aureus nasal carriage.

    Interventions:

    Participants were studied for airborne dispersal of CoNS in a chamber under three conditions (street clothes, sterile gown with a mask, and sterile gown without a mask). After 2 days of pre-exposure measurements, volunteers were inoculated with a rhinovirus and observed for 14 days. Daily quantitative nasal and skin cultures for CoNS and nasal cultures for rhinovirus were performed. In addition, assessment of cold symptoms was performed daily, mucous samples were collected, and serum titers before and after rhinovirus inoculation were obtained. Sneezing, coughing, and talking events were recorded during chamber sessions.

    Results:

    All participants had at least one nasal wash positive for rhinovirus and 10 developed a symptomatic cold. Postexposure, there was a twofold increase in airborne CoNS (P = .0004), peaking at day 12. CoNS dispersal was reduced by wearing a gown (57% reduction, P < .0001), but not a mask (P = .7). Nasal and skin CoNS colonization increased after rhinovirus infection (P<.05).

    Conclusions:

    We believe this is the first demonstration that a viral pathogen in the upper airways can increase airborne dispersal of CoNS in nasal S. aureus carriers. Gowns, gloves, and caps had a protective effect, whereas wearing a mask did not further reduce airborne spread.