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Family-centered care (FCC) is a partnership approach to health care decision-making between the family and health care provider. FCC is considered the standard of pediatric health care by many clinical practices, hospitals, and health care groups. Despite widespread endorsement, FCC continues to be insufficiently implemented into clinical practice. In this paper we enumerate the core principles of FCC in pediatric health care, describe recent advances applying FCC principles to clinical practice, and propose an agenda for practitioners, hospitals, and health care groups to translate FCC into improved health outcomes, health care delivery, and health care system transformation.

To examine whether the demographics of providers' prior year patient cohorts, providers' historic degree of catheter-based fractional flow reserve (FFR) utilization, and other provider characteristics were associated with post-catheterization performance of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). A retrospective, observational analysis of outpatient claims data was performed. All 2018 outpatient catheterization claims from a national organization offering commercial and Medicare Advantage health plans were examined. Claims were excluded if the patient had a prior catheterization in 2018, had any indications of CABG or valvular heart disease in the prior year of claims, or if the provider had ≤10 catheterization claims in 2017. Downstream PCI and CABG were determined by examining claims 0-30 days post-catheterization. Using multivariate mixed effects logistic regression with provider identity random effects, the association between post-catheterization procedures and provider characteristics was assessed, controlling for patient characteristics. The sample consisted of 31,920 catheterization claims pertaining to procedures performed by 964 providers. Among the catheterization claims, 8,554 (26.8%) were followed by PCI and 1,779 (5.6%) were followed by CABG. Catheterizations performed by providers with older prior year patient cohorts were associated with higher adjusted odds of PCI (1.78; CI: 1.26-2.53), even after controlling for patient age. Catheterizations performed by providers with greater historic use of FFR had significantly higher adjusted odds of being followed by PCI (1.73; CI: 1.26-2.37). Provider characteristics may impact whether patients receive a procedure post-catheterization. Further research is needed to characterize this relationship.

Human-mediated introductions of non-native species are expected to increase globally and threaten native biodiversity. Lepomis auritus (Redbreast Sunfish), a carnivorous freshwater fish native to rivers in eastern North America, has been introduced far outside of its native range due to its popularity in recreational fisheries. However, poor documentation of introductions and lack of thorough ichthyofaunal surveys before the mid-20th century have complicated our understanding of the establishment and spread of non-native L. auritus over the past 90 years, precluding effective management. We conducted phylogenomic analyses using ddRAD data from 197 specimens of L. auritus collected throughout the known geographic range of the species to reconstruct the introduction history of the species. Our protocols allow for the reconstruction of complicated introduction routes and reveal that L. auritus in Texas is the result of a single-source introduction from the Suwannee River, the population in the upper Tennessee River has two sources of introduction from the Savannah River and the northeastern rivers that drain into the Atlantic Ocean, and the populations in the middle Tennessee River and the Mobile River Basin have sources from the upper Tennessee River system and the Apalachicola River Basin. Ecological and evolutionary investigations of the non-native populations of L. auritus will broaden the understanding of invasion dynamics in species of Lepomis and other non-native freshwater fishes in North America. Our study provides critical information for the conservation of native populations and invasive management of non-native populations of L. auritus .

A storm surge model has been developed as part of a pilot study for The Commonwealth of the Bahamas. The hydrodynamic model, TELEMAC‐2D, is used to simulate the response of water level to tide and the wind and atmospheric pressure fields of hurricanes and subsequent inundation over land. The model is used by The Bahamas Department of Meteorology to forecast storm surge and flooding over the islands of Grand Bahama and Eleuthera for incoming hurricanes to assist in preparation for and management of hurricane surge events and has been used in a flood risk assessment, reported in a companion paper. The model has been optimised to run quickly while also resolving the bathymetry and topography that affect the development and propagation of storm surge. Wind fields are generated within TELEMAC‐2D based on hurricane warning bulletins. The model has been validated for its representation of water level and against tide gauge measurements during four historical hurricanes: Irene, Sandy, Matthew and Dorian. Factors contributing to uncertainty in forecast predictions are discussed and recommendations are provided to improve the performance in future. The pilot study provides a template for future expansion to cover the other inhabited islands of The Bahamas.

A hurricane surge and inundation risk assessment has been carried out for Grand Bahama and Eleuthera in The Bahamas. 10,000 years of synthetic hurricane tracks were generated based on a statistical analysis of historical hurricanes from 1979 to 2020 inclusive. The surge and inundation were modelled using a hydrodynamic TELEMAC‐2D model covering sea around The Bahamas and the land of the two islands. Predictions of flood extents and depths were mapped for return periods of up to 1000 years for present day conditions and three climate change scenarios to 2100. The flooding experienced over Grand Bahama during Hurricane Dorian in 2019, was estimated to have a return period of up to approximately 450 years. Under the climate change scenarios the likelihood of flooding similar to Hurricane Dorian was estimated to be approximately 1.7 times more likely in 2050 and up to 3.4 times as likely in 2100 under a high greenhouse gas emissions scenario. The storm surge maps can be used by the Bahamas Department of Meteorology and other government agencies for emergency management, planning of infrastructure and building resilience in response to climate change.

Difference-in-difference (DD) methods are a common strategy for evaluating the effects of policies or programs that are instituted at a particular point in time, such as the implementation of a new law. The DD method compares changes over time in a group unaffected by the policy intervention to the changes over time in a group affected by the policy intervention, and attributes the “difference-in-differences” to the effect of the policy. DD methods provide unbiased effect estimates if the trend over time would have been the same between the intervention and comparison groups in the absence of the intervention. However, a concern with DD models is that the program and intervention groups may differ in ways that would affect their trends over time, or their compositions may change over time. Propensity score methods are commonly used to handle this type of confounding in other non-experimental studies, but the particular considerations when using them in the context of a DD model have not been well investigated. In this paper, we describe the use of propensity scores in conjunction with DD models, in particular investigating a propensity score weighting strategy that weights the four groups (defined by time and intervention status) to be balanced on a set of characteristics. We discuss the conceptual issues associated with this approach, including the need for caution when selecting variables to include in the propensity score model, particularly given the multiple time point nature of the analysis. We illustrate the ideas and method with an application estimating the effects of a new payment and delivery system innovation (an accountable care organization model called the “Alternative Quality Contract” (AQC) implemented by Blue Cross Blue Shield of Massachusetts) on health plan enrollee out-of-pocket mental health service expenditures. We find no evidence that the AQC affected out-of-pocket mental health service expenditures of enrollees.

Objectives. We assessed whether geographic information available at the time of asthma admission predicts time to reutilization (readmission or emergency department revisit). Methods. For a prospective cohort of children hospitalized with asthma in 2008 and 2009 in Cincinnati, Ohio, we constructed a geographic social risk index from geocoded home addresses linked to census tract extreme poverty and high school graduation rates and median home values. We examined geographic risk associations with reutilization and caregiver report of hardship. Results. Thirty-nine percent of patients reutilized within 12 months. Compared with those in the lowest geographic risk stratum, those at medium and high risk had 1.3 (95% confidence interval [CI] = 0.9, 1.9) and 1.8 (95% CI = 1.4, 2.4) the risk of reutilization, respectively. Caregivers of children at highest geographic risk were 5 times as likely to report more than 2 financial hardships (P < .001) and 3 times as likely to report psychological distress (P = .001). Conclusions. A geographic social risk index may help identify asthmatic children likely to return to the hospital. Targeting social risk assessments and interventions through geographic information may help to improve outcomes and reduce disparities.

BackgroundStress caused by hospitalisations and transition periods can place patients at a heightened risk for adverse health outcomes. Additionally, hospitalisations and transitions to home may be experienced in different ways by families with different resources and support systems. Such differences may perpetuate postdischarge disparities.ObjectiveWe sought to determine, qualitatively, how the hospitalisation and transition experiences differed among families of varying socioeconomic status (SES).MethodsFocus groups and individual interviews were held with caregivers of children recently discharged from a children's hospital. Sessions were stratified based on SES, determined by the percentage of individuals living below the federal poverty level in the census tract or neighbourhood in which the family lived. An open-ended, semistructured question guide was developed to assess the family's experience. Responses were systematically compared across two SES strata (tract poverty rate of <15% or ≥15%).ResultsA total of 61 caregivers who were 87% female and 46% non-white participated; 56% resided in census tracts with ≥15% of residents living in poverty (ie, low SES). Interrelated logistical (eg, disruption in-home life, ability to adhere to discharge instructions), emotional (eg, overwhelming and exhausting nature of the experience) and financial (eg, cost of transportation and meals, missed work) themes were identified. These themes, which were seen as key to the hospitalisation and transition experiences, were emphasised and described in qualitatively different ways across SES strata.ConclusionsFamilies of lower SES may experience challenges and stress from hospitalisations and transitions in different ways than those of higher SES. Care delivery models and discharge planning that account for such challenges could facilitate smoother transitions that prevent adverse events and reduce disparities in the postdischarge period.Trial registration numberNCT02081846; Pre-results.

Acid mine drainage (AMD) affects thousands of stream miles in the Appalachian region of the USA and results in elevated concentrations of iron and aluminum in the stream water and sediments and wide ranging pH values. It was hypothesized that these conditions would lead to increased P buffering capacity of the sediments which in turn would cause a decrease in dissolved reactive phosphorus (DRP) in the water column. In the lab fresh Fe, Al, and Mn oxide precipitates all adsorbed DRP strongly but over different pH ranges. Sulfate and calcium ions inhibited adsorption of DRP with Fe oxides but the effect was less apparent with Al oxides. In the field DRP concentration was reduced 54-90% just downstream of an AMD input compared to upstream of the input. In addition the sediment buffering capacity increased and equilibrium phosphate concentration decreased dramatically downstream of the AMD inputs. The strength of the effect and the widespread occurrence of AMD suggest that AMD could be altering the P dynamics of streams and rivers throughout the Appalachian region.

In 2008, researchers suggested the concept of the “Triple Aim” to improve health care in the United States.1 The Triple Aim includes the goals of providing a better experience for individual patients while reducing costs and improving outcomes for populations. Many private and governmental payers, employers, and health care institutions have adopted these goals. Several institutions have implemented systems and processes of care (eg, the perioperative surgical home, enhanced recovery models) to address surgical outcomes and have achieved very good results.2,3 More perioperative team members need to direct focused attention on their patients’ preparedness for surgery. Organized preoperative clinics may be the operational key to this preparation.