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Abbreviations: CI, confidence interval; HMOs, Health Maintenance Organizations; MDS, Minimum Data Set; RCTs, randomized controlled trials Provenance: Not commissioned; externally peer-reviewed Summary Points * Nursing home residents are a highly vulnerable population, and nursing home care quality has been a persistent focus of public concern. * There is considerable evidence from observational studies that public funding of care delivered in for-profit facilities is inferior to care delivered in public or nonprofit facilities. * The past decade has seen many industrialized countries increasing governmental payment for care of frail seniors in for-profit nursing homes, leading to questions about whether this leads to inferior care. * Many of Bradford Hill's guidelines for causation can be found in published studies supporting a causal link between for-profit ownership and inferior care. * The precautionary principle should be applied when developing policy for this frail and vulnerable population. Introduction Nursing homes, also called residential long-term care facilities or aged care homes, are regulated institutions providing around-the-clock medical and social care to (mainly) older people who are unable to live independently due to physical and/or mental disability. Because of the vulnerability of this population and frequent media reports of scandals across many industrialized countries [1], nursing home care quality has been a persistent focus of public concern.

The neural representation of a ‘biological self’ is linked theoretically to the control of bodily physiology. In an influential model, selfhood relates to internal agency and higher-order interoceptive representation, inferred from the predicted impact of efferent autonomic nervous activity on afferent viscerosensory feedback. Here we tested if an altered representation of physical self (illusory embodiment of an artificial hand) is accompanied by sustained shifts in autonomic activity. Participants (N = 37) underwent procedures for induction of the rubber hand illusion (synchronous stroking of own unseen hand and observed stroking of artificial hand) and a control condition (asychronous stroking). We recorded electrocardiography, electrodermal activity, and a non-invasive measure of multiunit skin sympathetic nerve activity (SKNA) from the chest. We compared these autonomic indices between task conditions, and between individuals who did and did not experience the illusion. Bayes factors quantified the strength of evidence for and against null hypotheses. Observed proprioceptive drift and subjective reports confirmed the efficacy of the synchronous (vs asynchronous) condition in inducing illusory hand ownership. Stringent discriminant analysis classified 24/37 individuals as experiencing the rubber hand illusion. Surprisingly, heart rate, heart rate variability, electrodermal activity, and SKNA measures revealed no autonomic differences between synchronous vs asynchronous conditions, nor between individuals who did or did not experience the rubber hand illusion. Bayes factors indicated substantial evidence for no physiological differences. In contrast to earlier reports, our autonomic data show the absence of a reliable change in physiological state during the rubber hand illusion. More encompassing perturbations of self-experience, for example in full body illusions, may nevertheless be coupled to, or facilitated by, changes in efferent autonomic activity and afferent viscerosensory feedback. Our findings suggest that such changes in bodily physiology are not sustained as an obligatory component of the rubber hand illusion.

Purpose: Patient care ownership (PCO) is a commitment to patient care with important implications for both patients and providers, and understanding PCO among trainees is an emerging area of study. Recently, Djulbegovic et al adapted a psychological ownership scale for graduate medical education (GME). Tailoring this scale for undergraduate medical education (UME) would strengthen the ability to measure and promote PCO among students, while directly linking this growth to the transition to GME. Method: Djulbegovic et al.’s PCO scale was adjusted through content expert input and cognitive interviews. This scale was administered to post-clerkship students at the University of Colorado School of Medicine after academic years 2020–21 and 2021–22. Exploratory factor analysis (EFA) was used to examine the underlying themes of the adapted scale in the 2020–21 sample. Confirmatory factor analysis (CFA) was performed in the 2021–22 sample to evaluate factors elucidated in EFA. Messick’s validity framework was used to guide collection of content, response process, and internal structure validity evidence. Results: The final scale included 16, 7-point Likert-style items. EFA modeling in the first sample suggested either a four-factor structure or a two-factor structure that was a simplification of the four-factor structure. CFA modeling in the second sample supported a four-factor model of PCO in medical students, named Advocacy, Decision-making, Opportunity, and Responsibility. Conclusions: This PCO scale demonstrated strong internal structure validity evidence and identified four factors contributing to PCO in medical students. Comparing these to Djulbegovic’s work elucidates differences between UME and GME learners’ experiences of PCO, chiefly in the opportunity of care ownership.

  [...]the universe of experiments performed, let alone possible, far exceeds the stamina of even the most earnest committees to promulgate definitions and criteria. The early successes of the Dublin Core (administrative metadata), Gene Ontology, and macromolecular crystallographic information file (mmCIF) (the latter two, descriptive metadata) encouraged the idea that metadata would naturally arise from ontologies and be exchanged through the web [27-29]. Workflow systems Increasingly, wet-bench and computational work form an integrated whole, but current workflow systems address either a portion of the wet-bench work--such as LabView's abilities to interconnect multiple instruments and their data--or computations [41].

Background. Recent work has highlighted a negative correlation between proprietary status and nursing home quality of care. This relationship might be explained by the context in which proprietary homes operate. However, another possible explanation is that some proprietary homes take excessive profit to the detriment of care quality. Objective. To examine the relationship between profit levels and quality in proprietary and nonproprietary nursing homes (NHs), accounting for resident and market characteristics. Methods. Data on 1098 free-standing NHs were taken from the California Office of State-wide Health Planning and Development, the On-line Survey Certification and Reporting System, and California licensing and statistical reports for 1998 and 1999. Tobit multivariate techniques were used to examine the relationship between deficiency citations and a range of explanatory variables, including profit. Results. Proprietary homes in California had significantly lower quality of care than nonproprietary homes. A stratified analysis revealed that, controlling for resident, facility, and market characteristics, profits located within the highest 14% of the proprietary sector's profit distribution were associated with significantly more total deficiencies and serious deficiencies. This relationship was not found in nonproprietary facilities. Other factors related to deficiencies included the ethnic mix of residents and facility size. Conclusions. Within the context in which proprietary homes operate, profit above a given threshold is associated with a higher number of deficiencies. Given this and the role of the proprietary sector in NH care, careful monitoring of profit levels in this sector appears warranted.

Properly structured and implemented, diagnostic patent pools could integrate complementary technologies, reduce transaction costs and spur innovation.

Although biobanks are vital for modern medical research, serious concerns have been raised about the legal basis and framework of such endeavours. This led the German ‘Telematics Platform for Medical Research Networks’ (‘Telematikplattform für Medizinische Forschungsnetze’, TMF) to initiate a project in 2004 that was designed to place German biobanks on a sound legal footing. This project involved the planning, writing and evaluation of an expert report that addresses in great detail the legal issues concerning property rights, medical professional regulations, general liability insurance, resource continuity and research secrecy. Here, we provide a brief summary of the major results of this project.

The search for valuable new products from among the world's stock of natural biological resources is mostly carried out by people from wealthy countries, and mostly takes place in developing countries that lack the research capacity to profit from it. Surely, the indigenous people should receive some compensation from it. But we must build a robust defense for this intuition, rooted in the Western moral traditions that are widely accepted in wealthy countries, if we are to put it into practice and enforce it.