The psychological imprint of inequality: Economic inequality shapes achievement and power values in human life.

OBJECTIVE: This research investigates how economic inequality shapes basic human values across three cross-national, cross-regional, and longitudinal studies (Ntotal  = 219,697). METHODS: Study 1 examined the relationship between objective economic inequality and values across 77 societies from all five continents (n = 170,525). Study 2 examined the relationship between objective economic inequality and values across 51 regions in the United States (n = 48,559). Study 3 used a two-year longitudinal design to examine the relationship between perceived economic inequality and values (n = 613). RESULTS: Results from multilevel modeling and longitudinal analysis suggested that people who lived in areas with higher economic inequality and who perceived higher economic inequality were more likely to endorse achievement and power values. Moreover, people who perceived higher economic inequality were less likely to endorse benevolence values. These effects were robust in within-country tests (Studies 2 and 3) but not in the cross-country tests (Study 1) when accounting for sociodemographic characteristics. CONCLUSIONS: Our findings suggest that economic inequality may act as an antecedent of self-enhancement values, particularly within countries. In a world of rising economic inequality, this may over time lead to an overemphasis on achievement and power which have been shown to erode social cohesion.

Local housing market dynamics predict rapid shifts in cultural openness: A 9-year study across 199 cities.

Accumulating evidence suggests that culture changes in response to shifting socioecological conditions; economic development is a particularly potent driver of such change. Previous research has shown that economic development can induce slow but steady cultural changes within large cultural entities (e.g., countries). Here we propose that economically driven culture change can occur rapidly, particularly in smaller cultural entities (e.g., cites). Drawing on work in cultural dynamics, urban economics, and geographical psychology, we hypothesize that changes in local housing prices-reflecting changing availability of local amenities-can induce rapid shifts in local cultures of Openness. We propose two mechanisms that might underlie such cultural shifts: selective migration (i.e., people selectively moving to cities that offer certain amenities) and social acculturation (i.e., people adapting to changing amenities in their city). Based on trait Openness scores of 1,946,752 U.S. residents, we track annual changes in local Openness across 199 cities for 9 years (2006-2014). We link these data to annual information on local housing markets, an established proxy for local amenities. To test interdependencies between the time series of local housing markets and Openness, we use Panel Vector Autoregression modeling. In line with our hypothesis, we find robust evidence that rising housing costs predict positive shifts in local Openness but not vice versa. Additional analyses leveraging participants' duration of residence in their city suggest that both selective migration and social acculturation contribute to shifts in local Openness. Our study offers a new window onto the rapid changes of cultures at local levels. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Economic Burden of Postoperative Neurocognitive Disorders Among US Medicare Patients.

Importance: Postoperative neurocognitive disorders (PNDs) after surgical procedures are common and may be associated with increased health care expenditures. Objective: To quantify the economic burden associated with a PND diagnosis in 1 year following surgical treatment among older patients in the United States. Design, Setting, and Participants: This retrospective cohort study used claims data from the Bundled Payments for Care Improvement Advanced Model from 4285 hospitals that submitted Medicare Fee-for-service (FFS) claims between January 2013 and December 2016. All Medicare patients aged 65 years or older who underwent an inpatient hospital admission associated with a surgical procedure, did not experience a PND before index admission, and were not undergoing dialysis or concurrently enrolled in Medicaid were included. Data were analyzed from October 2019 and May 2020. Exposures: PND, defined as an International Classification of Diseases, Ninth or Tenth Revision, diagnosis of delirium, mild cognitive impairment, or dementia within 1 year of discharge from the index surgical admission. Main Outcomes and Measures: The primary outcome was total inflation-adjusted Medicare postacute care payments within 1 year after the index surgical procedure. Results: A total of 2 380 473 patients (mean [SD] age, 75.36 (7.31) years; 1 336 736 [56.1%] women) who underwent surgical procedures were included, of whom 44 974 patients (1.9%) were diagnosed with a PND. Among all patients, most were White (2 142 157 patients [90.0%]), presenting for orthopedic surgery (1 523 782 patients [64.0%]) in urban medical centers (2 179 893 patients [91.6%]) that were private nonprofits (1 798 749 patients [75.6%]). Patients with a PND, compared with those without a PND, experienced a significantly longer hospital length of stay (mean [SD], 5.91 [6.01] days vs 4.29 [4.18] days; P < .001), were less likely to be discharged home (9947 patients [22.1%] vs 914 925 patients [39.2%]; P < .001), and had a higher incidence of mortality at 1 year after treatment (4580 patients [10.2%] vs 103 767 patients [4.4%]; P < .001). After adjusting for patient and hospital characteristics, the presence of a PND within 1 year of the index procedure was associated with an increase of $17 275 (95% CI, $17 058-$17 491) in cost in the 1-year postadmission period (P < .001). Conclusions and Relevance: The findings of this cohort study suggest that among older Medicare patients undergoing surgical treatment, a diagnosis of a PND was associated with an increase in health care costs for up to 1 year following the surgical procedure. Given the magnitude of this cost burden, PNDs represent an appealing target for risk mitigation and improvement in value-based health care.

Regional variation in courage and entrepreneurship: The contrasting role of courage for the emergence and survival of start-ups in the United States.

OBJECTIVE: There is growing evidence that certain regional personality differences function as important drivers of regional economic development (e.g., via effects on entrepreneurship and innovation activity). The present investigation examines the impact that regional variation in the trait courage has on entrepreneurship. METHOD: Using data from a new large-scale internet-based study, we provide the first psychological map of courage across the United States (N = 390,341 respondents from 283 U.S. metropolitan regions). We apply regression analyses to relate regional courage scores to archival data on the emergence and survival of start-ups across American regions. RESULTS: Our mapping approach reveals comparatively high levels of regional courage in the Eastern and Southern regions of the United States. Regional courage scores were positively related to entrepreneurial activity, but negatively related to start-up survival-even when controlling for a wide variety of standard economic predictors. Several robustness checks corroborated these results. Finally, regional differences in economic risk-taking accounted for significant proportions of variance in the relationship between regional courage and entrepreneurship. CONCLUSION: Our results suggest that regional courage may contribute to a pattern of enterprising and also risky economic behavior, which can lead to high levels of entrepreneurial activity but also shorter start-up survival.

Experimental Assessment of the Degradation of "Unbiodegradable" Organic Solids in Activated Sludge.

In current process models activated sludge consists of biodegradable and unbiodegradable organic fractions. Recent evidence suggests that this approach may not be accurate because some of this "unbiodegradable" material may indeed be degradable. To improve sludge production predictions, it is important to know to what extent the "unbiodegradable" organic fraction is degradable. Assuming that volatile suspended solids (VSS) is a measure of the sum of biodegradable and unbiodegradable organic solids and the integral of the oxygen uptake rate (OUR) is representative of the biodegradable organics, the combination of these measurements can be used to predict the change of unbiodegradable organic solids within an aerobic digestion batch experiment. This procedure was used to estimate degradation rates of "unbiodegradable" VSS between 0.006 to 0.029 d(-1). The advantage of the proposed method is that the degradation rate can be determined directly based on measurements and relies on a limited number of assumptions.

Ethanol metabolites: their role in the assessment of alcohol intake.

BACKGROUND: Alcohol-related disorders are common, expensive in their course, and often underdiagnosed. To facilitate early diagnosis and therapy of alcohol-related disorders and to prevent later complications, questionnaires and biomarkers are useful. METHODS: Indirect state markers like gamma-glutamyl-transpeptidase, mean corpuscular volume, and carbohydrate deficient transferrin are influenced by age, gender, various substances, and nonalcohol-related illnesses, and do not cover the entire timeline for alcohol consumption. Ethanol (EtOH) metabolites, such as ethyl glucuronide, ethyl sulfate, phosphatidylethanol, and fatty acid ethyl esters have gained enormous interest in the last decades as they are detectable after EtOH intake. RESULTS: For each biomarker, pharmacological characteristics, detection methods in different body tissues, sensitivity/specificity values, cutoff values, time frames of detection, and general limitations are presented. Another focus of the review is the use of the markers in special clinical and forensic samples. CONCLUSIONS: Depending on the biological material used for analysis, ethanol metabolites can be applied in different settings such as assessment of alcohol intake, screening, prevention, diagnosis, and therapy of alcohol use disorders.

Secondary overtriage: the burden of unnecessary interfacility transfers in a rural trauma system.

IMPORTANCE: Unnecessary interfacility transfer of minimally injured patients to a level I trauma center (secondary overtriage) can cause inefficient use of resources and personnel within a regional trauma system. OBJECTIVE: To describe the burden of secondary overtriage in a rural trauma system with a single level I trauma center. DESIGN: Retrospective analysis of institutional trauma registry data. SETTING: Dartmouth Hitchcock Medical Center, a rural level I trauma center. PATIENTS: A total of 7793 injured patients evaluated by the trauma service at Dartmouth Hitchcock Medical Center from January 1, 2007, to December 31, 2011. EXPOSURE: Evaluation by the trauma service. MAIN OUTCOMES AND MEASURES: Patients transferred from another hospital to Dartmouth Hitchcock Medical Center who did not require an operation, had an Injury Severity Score lower than 15, and were discharged alive within 48 hours of admission. RESULTS: Of the 7793 evaluated patients, 4796 (62%) were transferred from other facilities. When compared with scene calls (n = 2997), transferred patients had a similar median Injury Severity Score of 9, but 24% of transferred adult patients and 49% of transferred pediatric patients met our definition of secondary overtriage. The overtriaged patients were most likely to have injuries of the head and neck (56%), followed by skin and soft-tissue injuries (41%). Seventy-two unique institutions transferred trauma patients to Dartmouth Hitchcock Medical Center, but 36% of the overtriaged patients were from 5 institutions. CONCLUSIONS AND RELEVANCE: The incidence of secondary overtriage in our rural trauma center is 26%, with head and neck injuries being the most common reason for transfer. Costs for transportation and additional evaluation for such a significant percentage of patients has important resource utilization implications. Effective regionalization of rural trauma care should include methods to limit secondary overtriage.

[Rage against the machine -- necessity of robotic assisted prostatectomy]. / Die Macht der Maschinen - Notwendigkeit der roboterassistierten Prostatektomie.

During the last decade urologists have faced a dramatic increase in robotic surgery. Despite the exceptional acceptance of this technique there is a complete lack of evidence for the equi-efficacy or superiority of this technique compared to open or laparoscopic prostatectomy. There is now an increasing body of evidence for the evaluation of robotic assisted prostatectomy. Robotic assisted prostatectomy is a safe procedure. The rate of technical failure is small. The rate of surgical complications is comparable with that of open or conventional laparoscopic prostatectomy. Similar to the conventional laparoscopic prostatectomy there is a trend for a minor blood loss and a smaller transfusion rate compared to the retropubic approach. In recent meta-analyses there is no advatage regarding the oncological or functional outcome for robotic prostatectomy. Neither the rate of positive surgical margins nor the rate of biochemical recurrence favours robotic prostatectomy. Regarding functional outcome some publications describe better results for urinary and sexual function for robotic surgery. Careful evaluation of these data reveals a low level of evidence due to a strong bias in favour of robotic surgery. In contrast, recent analysis of "Medicare" data reveal a considerable poorer urinary function after robotic prostatectomy compared to open retropubic prostatectomy. The Urological Board of the Helios Hospital Group does not recommend the use of a robotic device for radical prostatectomy.

Al13Fe4 as a low-cost alternative for palladium in heterogeneous hydrogenation.

Replacing noble metals in heterogeneous catalysts by low-cost substitutes has driven scientific and industrial research for more than 100 years. Cheap and ubiquitous iron is especially desirable, because it does not bear potential health risks like, for example, nickel. To purify the ethylene feed for the production of polyethylene, the semi-hydrogenation of acetylene is applied (80 × 10(6) tons per annum; refs 1-3). The presence of small and separated transition-metal atom ensembles (so-called site-isolation), and the suppression of hydride formation are beneficial for the catalytic performance. Iron catalysts necessitate at least 50 bar and 100 °C for the hydrogenation of unsaturated C-C bonds, showing only limited selectivity towards semi-hydrogenation. Recent innovation in catalytic semi-hydrogenation is based on computational screening of substitutional alloys to identify promising metal combinations using scaling functions and the experimental realization of the site-isolation concept employing structurally well-ordered and in situ stable intermetallic compounds of Ga with Pd (refs 15-19). The stability enables a knowledge-based development by assigning the observed catalytic properties to the crystal and electronic structures of the intermetallic compounds. Following this approach, we identified the low-cost and environmentally benign intermetallic compound Al(13)Fe(4) as an active and selective semi-hydrogenation catalyst. This knowledge-based development might prove applicable to a wide range of heterogeneously catalysed reactions.

[Impact of magnetic resonance therapy on sickness absence of patients with nerve root irritation following a lumbar disc problem]. / Effekte der Kernspinresonanztherapie auf Krankenstand bei Patienten mit Nervenwurzelirritation infolge eines lumbalen Bandscheibenvorfalls.

BACKGROUND: The prevalence of spinal symptoms in Western industrialised countries ranges up to 80 %. Back pain ranks second among the most common reasons to seek medical advice. The resulting financial burden on the health-care system is proportional to the subjectively experienced pain. The aim of the present study was to determine whether the use of magnetic resonance therapy alters the duration of sickness absence in patients with discogenic radiculopathy. PATIENTS AND METHOD: In a double-blind prospective randomised study, the use of magnetic resonance therapy for back pain in patients with discogenic radiculopathy was evaluated in the context of health economics. Patients aged 20 to 55 years with lumboischialgia and no indication for surgery were included in the study. The primary variable was the number of days of sickness absence in a study group before and after magnetic field therapy, and in a control group. The number of days of sickness absence was determined on the basis of a pain diary and by telephone inquiry. RESULTS: Patients who were treated with an activated magnetic resonance therapy device had significantly fewer days of sickness absence (p = 0.009) when evaluated by personal telephone calls. The duration of sickness absence before therapy was 14.7 days and that after therapy 5.8 days. In contrast, the days of sickness absence in the control group were 7.6 days before therapy and 13.8 days after therapy. The duration of symptoms was negatively correlated with the days of sickness absence. Patients who reported a burden at work had more days of sickness absence (8.3 days) than those with no burden at work (3.2 days). This correlation does not apply to familial burden. The cost-effectiveness analysis showed different degrees of compensation of the cost of magnetic resonance therapy, depending on the occupational group. Direct and indirect costs of magnetic resonance therapy were compensated by 16.9 fewer days of sickness absence among workers, 11.4 fewer days of sickness absence among employees, and 9.1 fewer days of sickness absence among civil servants. CONCLUSION: Based on the number of days of sickness absence, the study confirmed that a relatively economical alternative technique is able to provide pain relief as well as benefit the health economy. Unemployed patients or patients who have submitted an application for a pension may be problematic because they may not wish to be pronounced healthy by their doctors.

[Meeting the needs of the European working time directive in german medical profession]. / Sollarbeitszeit und maximale Arbeitszeit bei angestellten Ärzten.

The legal obligation of the European Working Time Directive with its implementation into a German Working Hours Act requires German hospitals to give up old structures and requires the implementation of new working time models. The failure of the revision of the European Working Time Directive in April 2009 prevented that any changes of status quo might happen in the near future. Fundamental terms of the working law for the medical area have been elucidated and have been implemented into concrete calculation formulas. The planned working time has been clearly determined. Particularly, on-call duties and a signed "OptOut-declaration" have huge effects on the upper limit of the working time that is to be determined. Shift duty leads to the greatest limitations of the upper limit of the working time. The Working Hours Act defines the maximal, available, individual working time budget and thus the working time budget of a hospital and it limits the maximal availability of the service providers of a hospital as well as defining the maximal personnel costs. Transparency in this area lays the foundation for an effective time management and the creation of new working time models in accordance with the European Working Time Directive as well as the Working Hours Act and the "TVÄ" (labour contract for doctors at municipal hospitals). It is possible, with the knowledge of the maximal working time budget and the thereof resulting personnel costs, to calculate the economical revenues better. The reallocation of the working time of doctors enables efficiency enhancement. It is necessary to demand a clear definition of the tasks of doctors with the consequential discharge of tasks that should not/do not belong to the responsibilities of a doctor. This would lead to a more attractive working environment for doctors at hospitals and thus to an improvement of the care of the patients. The implementation of the European Time Directive is not to be seen as unrealizable, as has been generally heard; instead, it enables the urgently necessary structural reform at German hospitals.

Optimizing heroin-assisted treatment (HAT): assessment of the contribution of direct ethanol metabolites in identifying hazardous and harmful alcohol use.

BACKGROUND: Heavy alcohol consumption may accelerate the progression of hepatitis C-related liver disease and/or limit efforts at antiviral treatment in opioid-dependent patients receiving heroin-assisted treatment (HAT). Our study aims to assess alcohol intake among HAT patients by self-reports compared to direct ethanol metabolites. METHOD: Fifty-four patients in HAT were recruited from the centre for HAT at the University of Basel, Switzerland. The patients completed the Alcohol Use Disorder Identification Test (AUDIT), a self-report questionnaire on past-week ethanol intake and provided samples for the determination of ethyl glucuronide (UEtG) and ethyl sulphate (UEtS) in urine and of ethyl glucuronide (HEtG) in hair. RESULTS: Eighteen patients scored above the AUDIT cut-off levels. Twenty-six patients tested positive for UEtG and 29 for UEtS. HEtG identified ethanol intake of more than 20 g/d in 20 additional cases that did not appear in the AUDIT. Using the total score of the AUDIT, HEtG detected 14 additional cases of relevant alcohol intake. CONCLUSIONS: The findings of this study, which is the first assessing alcohol intake in HAT patients using direct ethanol metabolites and self reports, suggest the complementary use of both. Improved detection of hazardous or harmful alcohol consumption in the context of HCV and heroin dependence will allow for earlier intervention in this population. This ultimately will contribute to an improvement in quality of life of patients in HAT. Furthermore, a significant reduction of costs can be achieved through a reduction of complications caused by alcohol intake.