Persistence of the invasive bird-parasitic fly Philornis downsi over the host interbreeding period in the Galapagos Islands.

Many parasites of seasonally available hosts must persist through times of the year when hosts are unavailable. In tropical environments, host availability is often linked to rainfall, and adaptations of parasites to dry periods remain understudied. The bird-parasitic fly Philornis downsi has invaded the Galapagos Islands and is causing high mortality of Darwin's finches and other bird species, and the mechanisms by which it was able to invade the islands are of great interest to conservationists. In the dry lowlands, this fly persists over a seven-month cool season when availability of hosts is very limited. We tested the hypothesis that adult flies could survive from one bird-breeding season until the next by using a pterin-based age-grading method to estimate the age of P. downsi captured during and between bird-breeding seasons. This study showed that significantly older flies were present towards the end of the cool season, with ~ 5% of captured females exhibiting estimated ages greater than seven months. However, younger flies also occurred during the cool season suggesting that some fly reproduction occurs when host availability is low. We discuss the possible ecological mechanisms that could allow for such a mixed strategy.

Cost outcomes of supplemental nurse staffing in a large medical center.

Use of agency-employed supplemental nurses on nursing personnel costs was examined in 19 adult patient care units in a large academic medical center. Results indicated that the modest use of supplemental nurses was cost-efficient with regard to overall nursing personnel costs, but heavy reliance on supplemental nurses to meet staffing needs was not cost-efficient. In addition, there was no statistical difference in hourly personnel cost between the use of supplemental nurses and overtime worked by permanent nurses.

Assessing variation in utilization for acute myocardial infarction in New York State.

BACKGROUND: Wide variations exist in healthcare expenditures, though most prior studies have assessed aggregate utilization. We sought to examine healthcare utilization variation in New York State by assessing hospitals in peer groups of similar capabilities. METHODS: Using charge data in New York State from the 2008 Statewide Planning and Research Cooperative System (SPARCS) and cost-to-charge ratios at the cost-center level drawn from Institutional Cost Reports, we calculated total, routine, and ancillary costs for patients discharged with an acute myocardial infarction (AMI) diagnosis in 2008. We assessed the correlation of these cost data to Hospital Referral Region (HRR) Medicare reimbursement data from the 2007 Dartmouth Atlas of Health Care. After describing hospital level cost variability, we examined characteristics associated with higher costs within peer groups of similar cardiac care capabilities. RESULTS: We found greater costs in hospitals providing the highest level of cardiovascular services, with cardiac surgery capable hospitals and non-invasive hospitals having total costs of $21,166 and $9268 per AMI discharge, and ancillary costs of $12,006 and $4167 per AMI discharge, respectively. Substantial variability in utilization existed in all levels of hospitals and across individual departmental cost centers. The two factors most frequently associated with higher total and ancillary costs across peer groups were patient case mix index and major or minor teaching status. CONCLUSIONS: Significant variation in cost per AMI discharge exists even within peer groups of hospitals with similar cardiac care capabilities. IMPLICATIONS: These findings support measurement and analysis at the hospital level to further understand the reasons for variation in utilization.

Quality outcomes of hospital supplemental nurse staffing.

Use of supplemental RNs (SRNs) is common practice among US hospitals to fill gaps in nurse staffing. The objective of this study was to examine the relationship between use of SRNs and patient outcomes. Multilevel modeling was performed to analyze hospital administrative data from 19 hospital units in a large tertiary medical center for the years 2003 to 2006. Patient outcomes included in-hospital mortality, medication errors, falls, pressure ulcers, and patient satisfaction with nurses. Use of SRNs ranged from 0% to 30.4% of total RN hours per unit quarter. Among 188 of the 304 unit quarters in which SRNs were used, the average SRN use was 9.8% in non-ICUs and 6.4% in ICUs. All observed effects of SRN use on patient outcomes were nonsignificant. Use of SRNs was substantial and varied widely by unit. No evidence was found that links SRN use to either adverse or positive patient outcomes.

Supplemental nurses are just as educated, slightly less experienced, and more diverse compared to permanent nurses.

In the past three decades, the shortage of nurses willing to work in hospitals has been a persistent challenge in the United States. Hiring supplemental registered nurses-nurses on short-term contracts obtained through an external staffing agency-has been common to fill gaps in nurse staffing. But there has been insufficient evidence about supplemental nurse workforce trends to inform workforce policy. To address this concern, we compared qualifications and characteristics of supplemental nurses with those of permanent nurses during 1984-2008. The two groups shared similar education levels in terms of possessing a baccalaureate or higher degree. Supplemental nurses were somewhat less experienced than permanent nurses, averaging fifteen years of experience in 2008 compared to eighteen years for permanent nurses. The supplemental nurse workforce was more diverse racially and ethnically and more likely to be male than the permanent nurse workforce. These data show that employing supplemental nurses could help meet the challenges of an aging nursing workforce, the projected future shortage of nurses, and an increasingly diverse US population.

Children's Preventive Care Use Under Two Mature Medicaid Managed Care Plans in California.

We investigated the extent to which children continuously enrolled in two mature county-organized Medicaid managed care plans for 6, 12, and 24 months received recommended well-child visits and immunizations. We also investigated whether any improvements in compliance were evident during the period 1989-92. Compliance was low for well-child visits and immunizations at the recommended ages regardless of eligibility group. Although slight improvements in immunizations were made over time, little progress was made in compliance with well-child visits. Continued vigilance is required to achieve the government's goal of 90 percent immunization compliance among 2-year-olds.