Influence of Hospital Characteristics on Hospital Transfer Destinations for Patients With Stroke.

BACKGROUND: Patients with stroke are frequently transferred between hospitals. This may have implications on the quality of care received by patients; however, it is not well understood how the characteristics of sending and receiving hospitals affect the likelihood of a transfer event. Our objective was to identify hospital characteristics associated with sending and receiving patients with stroke. METHODS: Using a comprehensive statewide administrative dataset, including all 78 Massachusetts hospitals, we identified all transfers of patients with ischemic stroke between October 2007 and September 2015 for this observational study. Hospital variables included reputation (US News and World Report ranking), capability (stroke center status, annual stroke volume, and trauma center designation), and institutional affiliation. We included network variables to control for the structure of hospital-to-hospital transfers. We used relational event modeling to account for complex temporal and relational dependencies associated with transfers. This method decomposes a series of patient transfers into a sequence of decisions characterized by transfer initiations and destinations, modeling them using a discrete-choice framework. RESULTS: Among 73 114 ischemic stroke admissions there were 7189 (9.8%) transfers during the study period. After accounting for travel time between hospitals and structural network characteristics, factors associated with increased likelihood of being a receiving hospital (in descending order of relative effect size) included shared hospital affiliation (5.8× higher), teaching hospital status (4.2× higher), stroke center status (4.3× and 3.8× higher when of the same or higher status), and hospitals of the same or higher reputational ranking (1.5× higher). CONCLUSIONS: After accounting for distance and structural network characteristics, in descending order of importance, shared hospital affiliation, hospital capabilities, and hospital reputation were important factor in determining transfer destination of patients with stroke. This study provides a starting point for future research exploring how relational coordination between hospitals may ensure optimized allocation of patients with stroke for maximal patient benefit.

A Framework for Reconstructing Archaeological Networks Using Exponential Random Graph Models.

Reconstructing ties between archaeological contexts may contribute to explain and describe a variety of past social phenomena. Several models have been formulated to infer the structure of such archaeological networks. The applicability of these models in diverse archaeological contexts is limited by the restricted set of assumptions that fully determine the mathematical formulation of the models and are often articulated on a dyadic basis. Here, we present a general framework in which we combine exponential random graph models with archaeological substantiations of mechanisms that may be responsible for network formation. This framework may be applied to infer the structure of ancient networks in a large variety of archaeological settings. We use data collected over a set of sites in the Caribbean during the period AD 100-400 to illustrate the steps to obtain a network reconstruction.

Contemporaneous Statistics for Estimation in Stochastic Actor-Oriented Co-evolution Models.

Stochastic actor-oriented models (SAOMs) can be used to analyse dynamic network data, collected by observing a network and a behaviour in a panel design. The parameters of SAOMs are usually estimated by the method of moments (MoM) implemented by a stochastic approximation algorithm, where statistics defining the moment conditions correspond in a natural way to the parameters. Here, we propose to apply the generalized method of moments (GMoM), using more statistics than parameters. We concentrate on statistics depending jointly on the network and the behaviour, because of the importance of their interdependence, and propose to add contemporaneous statistics to the usual cross-lagged statistics. We describe the stochastic algorithm developed to approximate the GMoM solution. A small simulation study supports the greater statistical efficiency of the GMoM estimator compared to the MoM.

Social relations and life satisfaction: the role of friends.

Social capital is defined as the individual's pool of social resources found in his/her personal network. A recent study on Italians living as couples has shown that friendship relationships, beyond those within an individual's family, are an important source of support. Here, we used data from Aspects of Daily Life, the Italian National Statistical Institute's 2012 multipurpose survey, to analyze the relation between friendship ties and life satisfaction. Our results show that friendship, in terms of intensity (measured by the frequency with which individuals see their friends) and quality (measured by the satisfaction with friendship relationships), is positively associated to life satisfaction.

Reconstructing Archaeological Networks with Structural Holes.

Model-based reconstruction is an approach to infer network structures where they cannot be observed. For archaeological networks, several models based on assumptions concerning distance among sites, site size, or costs and benefits have been proposed to infer missing ties. Since these assumptions are formulated at a dyadic level, they do not provide means to express dependencies among ties and therefore include less plausible network scenarios. In this paper we investigate the use of network models that explicitly incorporate tie dependence. In particular, we consider exponential random graph models, and show how they can be applied to reconstruct networks coherent with Burt's arguments on closure and structural holes (Burt 2001). The approach is illustrated on data from the Middle Bronze Age in the Aegean.

Classic Maya bloodletting and the cultural evolution of religious rituals: quantifying patterns of variation in hieroglyphic texts.

Religious rituals that are painful or highly stressful are hypothesized to be costly signs of commitment essential for the evolution of complex society. Yet few studies have investigated how such extreme ritual practices were culturally transmitted in past societies. Here, we report the first study to analyze temporal and spatial variation in bloodletting rituals recorded in Classic Maya (ca. 250-900 CE) hieroglyphic texts. We also identify the sociopolitical contexts most closely associated with these ancient recorded rituals. Sampling an extensive record of 2,480 hieroglyphic texts, this study identifies every recorded instance of the logographic sign for the word ch'ahb' that is associated with ritual bloodletting. We show that documented rituals exhibit low frequency whose occurrence cannot be predicted by spatial location. Conversely, network ties better capture the distribution of bloodletting rituals across the southern Maya region. Our results indicate that bloodletting rituals by Maya nobles were not uniformly recorded, but were typically documented in association with antagonistic statements and may have signaled royal commitments among connected polities.

Processing of GB virus B non-structural proteins in cultured cells requires both NS3 protease and NS4A cofactor.

The identification of antivirals and vaccines against hepatitis C virus (HCV) infection is hampered by the lack of convenient animal models. The need to develop surrogate models has recently drawn attention to GB virus B (GBV-B), which produces hepatitis in small primates. In a previous study in vitro, it was shown that GBV-B NS3 protease shares substrate specificity with the HCV enzyme, known to be crucial for virus replication. In this report, GBV-B NS3 activity on GBV-B precursor proteins has been analysed in a cell-based system. It is shown that mature protein products are obtained that are compatible with the cleavage sites proposed on the basis of sequence homology with HCV and that GBV-B NS4A protein is required as a cofactor for optimal enzymatic activity. Experiments in vitro supported by a structural model mapped the region of NS4A that interacts with NS3 and showed that the GBV-B cofactor cannot be substituted for by its HCV analogue.