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Racial and ethnic minority physicians are more likely to practice primary care and serve in underserved communities. However, there are micro-practice patterns within primary care specialties that are not well understood. To examine the differences among primary care physician practice locations by specialty and race/ethnicity, a retrospective study was conducted on U.S. medical graduates who were direct patient care physicians in 2012. The group-specific contributions to primary care accessibility were decomposed by individual group of minorities underrepresented in medicine (URM). Results confirm significant differences not only in their distribution across underserved areas but also in their racial/ethnic composition by primary care specialties, with internist most diverse and family physicians least diverse. However, stratified analysis shows that within each primary care subspecialty, URM physicians were more likely to practice in underserved areas than their White peers regardless of specific specialties.

In recent years direct ownership of physician practices by hospitals and health systems (that is, vertical integration) has become a prominent feature of the US health care system. One unexplored impact of vertical integration is the impact on referral patterns for common diagnostic tests and procedures and the associated spending. Using a 100 percent sample of 2013-16 Medicare fee-for-service claims data, we examined whether hospital and health system ownership of physician practices was associated with changes in site of care and Medicare reimbursement rates for ten common diagnostic imaging and laboratory services. After vertical integration, the monthly number of diagnostic imaging tests per 1,000 attributed beneficiaries performed in a hospital setting increased by 26.3 per 1,000, and the number performed in a nonhospital setting decreased by 24.8 per 1,000. Hospital-based laboratory tests increased by 44.5 per 1,000 attributed beneficiaries, and non-hospital-based laboratory tests decreased by 36.0 per 1,000. Average Medicare reimbursement rose by $6.38 for imaging tests and $0.57 for laboratory tests, which translates to $40.2 million and $32.9 million increases in Medicare spending, respectively, for the entire study period. This study highlights how the growing trend of vertical integration, combined with differences in Medicare payment between hospitals and nonhospital providers, leads to higher Medicare spending.

This study investigates the differential roles of corporate social responsibility (CSR) in the context of negative events. By categorizing CSR and negative events by their respective stakeholder groups, primary and secondary stakeholders, we theorize and test differential impacts of CSR and their interaction effects with different types of negative events. We propose that, while CSR toward secondary stakeholders offers the monotonous risk-tempering effect, CSR toward primary stakeholders has heterogeneous effects when facing negative events. Specifically, the effect of CSR toward primary stakeholders varies with the type of negative events. When negative events are associated with secondary stakeholders in the domain of morality, CSR toward primary stakeholders presents a risk-amplifying effect. When the negative events are associated with primary stakeholders in the domain of capability, however, CSR toward primary stakeholders does not present a significant risk-amplifying effect. In contrast, CSR toward secondary stakeholders presents the risk-tempering effect regardless of the type of negative events. We find general support for these arguments when we analyze the market responses to the news events of RepRisk, which provides data of various corporate negative events covered by the media.

Adoptions of health behaviors are crucial for maintaining good health after type 2 diabetes mellitus (T2DM) diagnoses. However, adherence to glucoregulating behaviors like regular exercise and balanced diet can be challenging, especially for people living in lower-socioeconomic status (SES) communities. Providing cost-effective interventions that improve self-management is important for improving quality of life and the sustainability of health care systems. To evaluate a health coach intervention with and without the use of mobile phones to support health behavior change in patients with type 2 diabetes. In this noninferiority, pragmatic randomized controlled trial (RCT), patients from two primary care health centers in Toronto, Canada, with type 2 diabetes and a glycated hemoglobin/hemoglobin A1c (HbA1c) level of ≥7.3% (56.3 mmol/mol) were randomized to receive 6 months of health coaching with or without mobile phone monitoring support. We hypothesized that both approaches would result in significant HbA1c reductions, although health coaching with mobile phone monitoring would result in significantly larger effects. Participants were evaluated at baseline, 3 months, and 6 months. The primary outcome was the change in HbA1c from baseline to 6 months (difference between and within groups). Other outcomes included weight, waist circumference, body mass index (BMI), satisfaction with life, depression and anxiety (Hospital Anxiety and Depression Scale [HADS]), positive and negative affect (Positive and Negative Affect Schedule [PANAS]), and quality of life (Short Form Health Survey-12 [SF-12]). A total of 138 patients were randomized and 7 were excluded for a substudy; of the remaining 131, 67 were allocated to the intervention group and 64 to the control group. Primary outcome data were available for 97 participants (74.0%). While both groups reduced their HbA1c levels, there were no significant between-group differences in change of HbA1c at 6 months using intention-to-treat (last observation carried forward [LOCF]) (P=.48) or per-protocol (P=.83) principles. However, the intervention group did achieve an accelerated HbA1c reduction, leading to a significant between-group difference at 3 months (P=.03). This difference was reduced at the 6-month follow-up as the control group continued to improve, achieving a reduction of 0.81% (8.9 mmol/mol) (P=.001) compared with a reduction of 0.84% (9.2 mmol/mol)(P=.001) in the intervention group. Intervention group participants also had significant decreases in weight (P=.006) and waist circumference (P=.01) while controls did not. Both groups reported improvements in mood, satisfaction with life, and quality of life. Health coaching with and without access to mobile technology appeared to improve glucoregulation and mental health in a lower-SES, T2DM population. The accelerated improvement in the mobile phone group suggests the connectivity provided may more quickly improve adoption and adherence to health behaviors within a clinical diabetes management program. Overall, health coaching in primary care appears to lead to significant benefits for patients from lower-SES communities with poorly controlled type 2 diabetes. ClinicalTrials.gov NCT02036892; http://clinicaltrials.gov/ct2/show/NCT02036892 (Archived by WebCite at http://www.webcitation.org/6b3cJYJOD).

Background AR1001 (mirodenafil), a second‐generation oral phosphodiesterase 5 (PDE5) inhibitor, is being investigated as a disease‐modifying therapy for Alzheimer’s disease (AD). The phase 2 trial (AR1001‐ADP2‐US01) aimed to evaluate the safety and efficacy of AR1001 in patients with mild to moderate AD. After 26 weeks of once‐daily oral dosing, 10 mg and 30 mg AR1001 demonstrated acceptable safety profiles in this population. While there were no significant differences between the treatment groups for the primary endpoint, Alzheimer’s Disease Assessment Scale, cognitive subscale 13 (ADAS‐Cog‐13) at Week 26, plasma ptau‐181 and ptau‐217 AD biomarkers were significantly reduced in the 30 mg group compared to placebo. Method In this double‐blind, randomized, placebo‐controlled, parallel‐group trial, 210 patients diagnosed with mild to moderate AD were randomized to receive either placebo, AR1001 10 mg, or AR1001 30 mg. Participants were administered treatment once‐daily for 26 weeks. Participants were diagnosed clinically based on 2011 National Institute of Aging and Alzheimer’s Associations criteria and were allowed to be on concomitant AD medication such as acetylcholinesterase inhibitors and NMDA receptor antagonists with at least 3 months of stable dose prior to screening. Pre‐specified subgroup analyses based on concomitant AD medication were conducted for ADAS‐Cog 13 and key plasma biomarkers, including ptau‐181 and ptau‐217. Result Sixty‐seven and 69 participants were assigned to the placebo and AR1001 30 mg groups, respectively. At baseline, 36 of 67 (51.4%) participants on placebo and 46 of 69 (65.7%) participants on 30 mg AR1001 were on concomitant AD medication. Participants without concomitant AD medication treated with AR1001 30 mg (monotherapy) demonstrated a statistically significant improvement of 4.019 points over baseline at Week 26 (p=0.012) on ADAS‐Cog 13. AR1001 30 mg monotherapy group also demonstrated reductions of 1.361 pg/ml in plasma ptau‐181 (p=0.023) and 0.426 pg/mL in plasma ptau‐217 compared to placebo at Week 26. Conclusion The subgroup analysis of participants on AR1001 30 mg without concomitant AD medication suggests potential for AR1001 as a monotherapy for the treatment of Alzheimer’s disease.

Internet-based cognitive-behavioural treatment (ICBT) for anxiety disorders has shown some promise, but no study has yet examined unguided ICBT in primary care. This randomized controlled trial (RCT) investigated whether a transdiagnostic, unguided ICBT programme for anxiety disorders is effective in primary care settings, after a face-to-face consultation with a physician (MD). We hypothesized that care as usual (CAU) plus unguided ICBT would be superior to CAU in reducing anxiety and related symptoms among patients with social anxiety disorder (SAD), panic disorder with or without agoraphobia (PDA) and/or generalized anxiety disorder (GAD). Adults (n = 139) with at least one of these anxiety disorders, as reported by their MD and confirmed by a structured diagnostic interview, were randomized. Unguided ICBT was provided by a novel transdiagnostic ICBT programme ('velibra'). Primary outcomes were generic measures, such as anxiety and depression symptom severity, and diagnostic status at post-treatment (9 weeks). Secondary outcomes included anxiety disorder-specific measures, quality of life, treatment adherence, satisfaction, and general psychiatric symptomatology at follow-up (6 months after randomization). CAU plus unguided ICBT was more effective than CAU at post-treatment, with small to medium between-group effect sizes on primary (Cohen's d = 0.41-0.47) and secondary (Cohen's d = 0.16-0.61) outcomes. Treatment gains were maintained at follow-up. In the treatment group, 28.2% of those with a SAD diagnosis, 38.3% with a PDA diagnosis, and 44.8% with a GAD diagnosis at pretreatment no longer fulfilled diagnostic criteria at post-treatment. The unguided ICBT intervention examined is effective for anxiety disorders when delivered in primary care.

Digital technology has become a central aspect of higher education, inherently affecting all aspects of the student experience. It has also been linked to an increase in behavioural, affective and cognitive student engagement, the facilitation of which is a central concern of educators. In order to delineate the complex nexus of technology and student engagement, this article systematically maps research from 243 studies published between 2007 and 2016. Research within the corpus was predominantly undertaken within the United States and the United Kingdom, with only limited research undertaken in the Global South, and largely focused on the fields of Arts & Humanities, Education, and Natural Sciences, Mathematics & Statistics. Studies most often used quantitative methods, followed by mixed methods, with little qualitative research methods employed. Few studies provided a definition of student engagement, and less than half were guided by a theoretical framework. The courses investigated used blended learning and text-based tools (e.g. discussion forums) most often, with undergraduate students as the primary target group. Stemming from the use of educational technology, behavioural engagement was by far the most often identified dimension, followed by affective and cognitive engagement. This mapping article provides the grounds for further exploration into discipline-specific use of technology to foster student engagement.

Abstract The last two decades have witnessed an unprecedented rise in government restrictions on foreign funding to nongovernmental organizations (NGOs). Often in the name of defending the nation from outside influences, over 60 countries have implemented laws limiting foreign funding to NGOs. We use event history analyses to evaluate domestic and global explanations for the adoption of these policies over the period 1994–2015. Prior work has argued that funding restrictions result from real or perceived threats to political regimes, especially in countries with competitive elections. We add to this story by situating it in a larger global and cultural context: new funding laws are part of a growing backlash against the liberal international order, which has long sponsored international and domestic NGOs devoted to issues such as human rights and the environment. In an era of increasing resistance toward globally linked civil society groups—the primary carriers of liberal world society—NGO funding restrictions are now diffusing widely across the international system. We argue that restriction policies will be most common among countries that are linked to illiberal or anti-Western organizations and discourses in the international community. Moreover, adoption will accelerate as more countries do it, representing a growing “wave” or backlash against the liberal international order. Findings support the prior literature as well as our new arguments regarding illiberal international organizations and global backlash.

A major shortcoming of current models of ideological prejudice is that although they can anticipate the direction of the association between participants' ideology and their prejudice against a range of target groups, they cannot predict the size of this association. I developed and tested models that can make specific size predictions for this association. A quantitative model that used the perceived ideology of the target group as the primary predictor of the ideology-prejudice relationship was developed with a representative sample of Americans (N = 4,940) and tested against models using the perceived status of and choice to belong to the target group as predictors. In four studies (total N = 2,093), ideology-prejudice associations were estimated, and these observed estimates were compared with the models' predictions. The model that was based only on perceived ideology was the most parsimonious with the smallest errors.