Cost efficiency of university hospitals in the Nordic countries: a cross-country analysis

This paper estimates cost efficiency scores using the bootstrap bias-corrected procedure, including variables for teaching and research, for the performance of university hospitals in the Nordic countries. Previous research has shown that hospital provision of research and education interferes with patient care routines and inflates the costs of health care services, turning university hospitals into outliers in comparative productivity and efficiency analyses. The organisation of patient care, medical education and clinical research as well as available data at the university hospital level are highly similar in the Nordic countries, creating a data set of comparable decision-making units suitable for a cross-country cost efficiency analysis. The results demonstrate significant differences in university hospital cost efficiency when variables for teaching and research are entered into the analysis, both between and within the Nordic countries. The results of a second-stage analysis show that the most important explanatory variables are geographical location of the hospital and the share of discharges with a high case weight. However, a substantial amount of the variation in cost efficiency at the university hospital level remains unexplained.     

Cellulose nanofibrils prepared by gentle drying methods reveal the limits of helium ion microscopy imaging

TEMPO-oxidized cellulose nanofibrils (TCNFs) have unique properties, which can be utilised in many application fields from printed electronics to packaging. Visual characterisation of TCNFs has been commonly performed using Scanning Electron Microscopy (SEM). However, a novel imaging technique, Helium Ion Microscopy (HIM), offers benefits over SEM, including higher resolution and the possibility of imaging non-conductive samples uncoated. HIM has not been widely utilized so far, and in this study the capability of HIM for imaging of TCNFs was evaluated. Freeze drying and critical point drying (CPD) techniques were applied to preserve the open fibril structure of the gel-like TCNFs. Both drying methods worked well, but CPD performed better resulting in the specific surface area of 386 m² g⁻¹ when compared to 172 m² g⁻¹ and 42 m² g⁻¹ of freeze dried samples frozen in propane and nitrogen, respectively. HIM imaging of TCNFs was successful but high magnification imaging was challenging because the ion beam tended to degrade the TCNFs. The effect of the imaging parameters on the degradation was studied and an ion dose as low as 0.9 ion per nm² was required to prevent the damage. This study points out the differences between the gentle drying methods of TCNFs and demonstrates beam damage during imaging like none previously reported with HIM. The results can be utilized in future studies of cellulose or other biological materials as there is a growing interest for both the HIM technique and bio-based materials.

TEMPO-oxidized cellulose nanofibrils (TCNFs) have unique properties, which can be utilised in many application fields from printed electronics to packaging.     

Attention deficit hyperactivity and oppositional defiant disorder symptoms in adolescence and risk of substance use disorders—A general population-based birth cohort study

Background

Externalizing symptoms are associated with risk of future substance use disorder (SUD). Few longitudinal studies exist using general population-based samples which assess the spectrum of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms.

Aims/Objectives

We aimed to study the associations between adolescent ADHD symptoms and subsequent SUD and additionally examine whether the risk of SUD is influenced by comorbid oppositional defiant disorder (ODD) symptoms.

Methods

The Northern Finland Birth Cohort 1986 was linked to nationwide health care register data for incident SUD diagnoses until age 33 years (n = 6278, 49.5% male). ADHD/ODD-case status at age 16 years was defined using parent-rated ADHD indicated by Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire with 95% percentile cut-off. To assess the impact of ODD comorbidity on SUD risk, participants were categorized into four groups based on their ADHD/ODD case status. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to study associations between adolescent ADHD/ODD case statuses and subsequent SUD.

Results

In all, 552 participants (8.8%) presented with ADHD case status at the age of 16 years, and 154/6278 (2.5%) were diagnosed with SUD during the follow-up. ADHD case status was associated with SUD during the follow-up (HR = 3.84, 95% CI 2.69–5.50). After adjustments for sex, family structure, and parental psychiatric disorder and early substance use the association with ADHD case status and SUD remained statistically significant (HR = 2.60, 95% CI 1.70–3.98). The risk of SUD remained elevated in individuals with ADHD case status irrespective of ODD symptoms.

Conclusions

ADHD in adolescence was associated with incident SUD in those with and without symptoms of ODD. The association of ADHD and SUD persisted even after adjustment for a wide range of potential confounds. This emphasizes the need to identify preventative strategies for adolescents with ADHD so as to improve health outcomes.     

Haptic contents of a movie dynamically engage the spectator's sensorimotor cortex

Observation of another person's actions and feelings activates brain areas that support similar functions in the observer, thereby facilitating inferences about the other's mental and bodily states. In real life, events eliciting this kind of vicarious brain activations are intermingled with other complex, ever‐changing stimuli in the environment. One practical approach to study the neural underpinnings of real‐life vicarious perception is to image brain activity during movie viewing. Here the goal was to find out how observed haptic events in a silent movie would affect the spectator's sensorimotor cortex. The functional state of the sensorimotor cortex was monitored by analyzing, in 16 healthy subjects, magnetoencephalographic (MEG) responses to tactile finger stimuli that were presented once per second throughout the session. Using canonical correlation analysis and spatial filtering, consistent single‐trial responses across subjects were uncovered, and their waveform changes throughout the movie were quantified. The long‐latency (85–175 ms) parts of the responses were modulated in concordance with the participants’ average moment‐by‐moment ratings of own engagement in the haptic content of the movie (correlation r = 0.49; ratings collected after the MEG session). The results, obtained by using novel signal‐analysis approaches, demonstrate that the functional state of the human sensorimotor cortex fluctuates in a fine‐grained manner even during passive observation of temporally varying haptic events. Hum Brain Mapp 37:4061–4068, 2016. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.     

T2 relaxation reveals spatial collagen architecture in articular cartilage: a comparative quantitative MRI and polarized light microscopic study.

It has been suggested that orientational changes in the collagen network of articular cartilage account for the depthwise T2 anisotropy of MRI through the magic angle effect. To investigate the relationship between laminar T2 appearance and collagen organization (anisotropy), bovine osteochondral plugs (N = 9) were T2 mapped at 9.4T with cartilage surface normal to the static magnetic field. Collagen fibril arrangement of the same samples was studied with polarized light microscopy, a quantitative technique for probing collagen organization by analyzing its ability to rotate plane polarized light, i.e., birefringence (BF). Depthwise variation of safranin O-stained proteoglycans was monitored with digital densitometry. The spatially varying cartilage T2 followed the architectural arrangement of the collagen fibril network: a linear positive correlation between T2 and the reciprocal of BF was established in each sample, with r = 0.91 +/- 0.02 (mean +/- SEM, N = 9). The current results reveal the close connection between the laminar T2 structure and the collagen architecture in histologic zones.     

Serum Neurofilament Light Chain Concentration Correlates with Infarct Volume but Not Prognosis in Acute Ischemic Stroke

Background and Purpose: We studied serum neurofilaments diagnostic value in patients with acute ischemic stroke (AIS) or TIA and evaluated any correlation with symptom severity, cerebral infarction volume, aetiology, and clinical outcome. Methods: One hundred and thirty-six patients (101 with AIS, and 35 with TIA) were included. Acute-phase serum neurofilament light chain (sNfL) was analyzed with a novel ultrasensitive single molecule array (Simoa). Cerebral infarction volume was measured from brain computed tomography in the subacute phase (>2 days). Stroke aetiology was defined by trial of ORG 10172 in acute stroke treatment classification, severity by National Institute of Health stroke scale (NIHSS) and the degree of disability by the Modified Rankin Scale (mRS) after 90 days. Results: sNfL was markedly higher in patients with AIS (89.5 pg/mL [IQR: 44.7-195.3]) than with TIA (25.2 pg/mL [IQR: 14.6-48.0]), P= <.001), also after adjusting for age, NIHSS, and stroke volume (P= .003). In receiver operating characteristic analysis, sNfL concentration greater than or equal to 49 pg/mL proved to be the best cut-off value to differentiate between patients with stroke and those with TIA (sensitivity of 73% and specificity of 80%). sNfL concentration significantly correlated with cerebral infarction volume (r = .413, P= <.001), this association remained significant after adjusting for established predictors (P= .019). Patients with AIS due to cardioembolism or large artery atherosclerosis had the highest sNfL concentrations. NIHSS on admission (r = .343, P = <.001) and mRS scores after 3 months (r = .306, P = .004) correlated with sNfL concentration, however functional outcome 3 months after stroke was not associated with sNfL after adjusting for potential confounders. Conclusions: Cases with stroke were distinguishable from those with TIA following the determination of sNfL in the blood samples. The presence and amount of axonal damage estimated by sNfL correlated with the final cerebral infarction volume but was not predictive of degree of disability.     

The Cost Efficiency and Clinical Quality of Institutional Long-Term Care for the Elderly

This study applied the stochastic frontier cost function with inefficiency effects to estimate the association between quality of care and cost efficiency in institutional long-term care wards for the elderly in Finland. We used several clinical quality indicators for indicating adverse care processes and outcomes, based on the Resident Assessment Instrument (RAI)/Minimum Data Set (MDS). Average cost inefficiency among the wards was 22%. We found an association between the clinical quality indicators and cost inefficiency. Higher prevalence of pressure ulcers was associated with higher costs, whereas the higher prevalence of use of depressants and hypnotics increased inefficiency.     

Productive efficiency and its determinants in the Finnish Public Dental Service

OBJECTIVE: Our objective was to investigate the cost efficiency of the Public Dental Service (PDS), which, until 2000, was responsible for organising dental care for children and younger adults born in 1956 and later. METHODS: Input and output data and information on various organisational and environmental characteristics were collected from 228 municipal PDS units in Finland. First, non-parametric data envelopment analysis (DEA) was employed to assess efficiency. In the second stage, econometric Tobit analysis was used to explore various predictors of cost efficiency, technical efficiency and allocative efficiency. As input in the DEA model we used personnel full-time equivalents and material and other costs expressed in monetary terms, and as output we used the number of treated patients. RESULTS: The study showed big differences in cost efficiency between the PDS units studied. The average cost inefficiency was 30%. Approximately two-thirds of the observed cost inefficiency was because of technical inefficiency and one-third because of allocative inefficiency. High state-subsidy levels, and a high proportion of young patients predicted inefficiency, and young population and low socioeconomic conditions in the municipality predicted efficiency. The results also indicated that many PDS units could have improved allocative efficiency by increasing the relative numbers of auxiliaries in relation to dentists. On the other hand, some units were too small to employ full-time dental hygienists efficiently. CONCLUSIONS: In the Finnish PDS, there are uncommitted resources that could be reallocated so as to improve overall efficiency.