Dual Status Research Articles

Abstract 29: Cardiac Surgery Episode Expenditures Associated With Healthcare-Associated Pneumonia

Objective: Pneumonia is the most common healthcare-associated infection (HAI) in patients undergoing cardiac surgery. While current efforts have focused on risk factors and clinical implications of pneumonia, few have examined its overall financial impact. Our objective was to compare 90-day episode expenditures for Medicare patients undergoing coronary artery bypass graft surgery (CABG) with and without pneumonia. Methods and Results: Using 2014-2015 Medicare Part A and B administrative claims data, we identified 50,550 patients undergoing isolated CABG. From this sample, we applied an established claims-based algorithm to identify 3,224 (6.4%) patients with new onset of pneumonia during their index admission and after their surgical procedure. Using generalized linear models, we found that average 90-day episode expenditures were 30% higher in patients with pneumonia ($55,442 vs. $42,745, p<0.001), adjusting for patient factors (age, sex, race, dual eligible status, and Elixhauser comorbidities) and hospital random intercepts (Table). Half of the added 90-day expenditures can be attributed to payments made for higher severity diagnosis-related group (DRG) billing codes in patients with pneumonia (+$6,275, p<0.001). The greatest relative increase in expenditures was for outlier hospitalization expenditures (+211%, p<0.001). Pneumonia was also associated with greater expenditures for post-discharge care, outpatient physician services, and readmissions, although these accounted for less than 20% of added expenditures. We estimated that 2% of all Medicare payments for CABG episodes during the study period are due to pneumonia. Conclusion: New onset pneumonia is associated with 30% higher 90-day episode expenditures in CABG, independent of patient case mix. Prevention efforts could reduce excessive hospital inpatient utilization and save payers hundreds of millions of dollars every year.

The Effectiveness of a Comprehensive Wellness Assessment on Medication Adherence in a Medicare Advantage Plan Diabetic Population.

The issue of medication nonadherence has generated significant interest because of its complexity from both cost and outcomes perspectives. Of the 3.2 billion prescriptions written annually in the United States, estimates indicate that half are not taken as prescribed, especially among patients with asymptomatic chronic conditions. The objective of this study was to assess whether a comprehensive wellness assessment (CWA) program helps improve medication adherence for oral diabetic medications, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE/ARBs) in a Medicare Advantage (MA) plan diabetic population. The Centers for Medicare & Medicaid Services includes these medications among its triple-weighted measures.The researchers used a retrospective panel study employing administrative claims data and member month-level enrollment data for members who were newly diagnosed with diabetes since 2010, allowing for up to 5 years of follow-up. The treatment variable of interest was whether the enrollee had undergone a CWA in the 12 months prior to the study. Results for the full sample show that a CWA visit in the prior 12 months is significantly associated with increased adherence to statin medication (incidence rate ratio [IRR]: 1.022, t-test: 2.51) and oral diabetes medication (IRR: 1.032, t-test: 3.00), but it is not significantly associated with adherence to ACE/ARB medication (IRR: 1.009, t-test: 1.09). Results vary considerably in subsamples stratified by dual Medicare and Medicaid eligibility status, presence of certain chronic conditions, and age. CWAs are most beneficial when targeted toward dual-eligible members or members younger than 65. On the basis of these findings, improving medication adherence by targeting CWA visits to certain MA member subcategories may be more cost-effective than using CWAs for the full MA membership.

Sentient beings and tradable products: The curious constitutional status of animals under Union law

This article aims to make sense of the ways in which a paradox manifests itself in the Union’s constitutional architecture: the dual status attributed to animals as both “products” and “sentient beings”. The introduction of the notion “sentient beings” in Article 13 TFEU purports to reshape the existing understanding of animal welfare in EU law. But, in practice, this shift creates clear tensions with the previous status of, and protections for, animals as “products” under Union law. The article seeks to explore the reasons for this “duality” and its possible consequences. In particular, the discussion is framed by the constitutional limits as to what the EU can achieve in the context of animal welfare, and the social and political context within which animal welfare has to operate. This leads to the question of whether the formal tensions under Union primary law relating to the dual status of animals are perhaps inevitable in contemporary legal systems which employ an animal welfare paradigm.

The Mizrahi Body in War Literature

The article examines the literary representation of the Mizrahi soldier in the wars during Israel’s first decade, a subject that is almost entirely absent from literary and scholarly discourse about that period. The texts discussed were written during the 1950s and 1960s by hegemonic writers and present “Orientalized” soldiers who fought in the war. The Mizrahi soldier has a dual status: he participates in the battle for the country’s borders while simultaneously presenting a threat to its social and cultural image. These issues are examined by exposing the orientalist gaze on the ambivalent representation of the Mizrahi body, which shifts between the figure of the legendary warrior and the animalistic lump of flesh.

Dually Enrolled Beneficiaries Have Higher Episode Costs On The Medicare Spending Per Beneficiary Measure.

Cost measures are a growing part of Medicare's value-based payment programs. Medicare Spending per Beneficiary (MSPB) is the cost measure included in Medicare's Hospital Value-Based Purchasing (VBP) Program. Beneficiaries who are dually enrolled in Medicare and Medicaid are known to have higher spending on care, but it is unknown whether spending on the MSPB measure varies based on dual enrollment and whether this has implications for the performance of safety-net hospitals. We found that after adjustment for comorbidities, dually enrolled beneficiaries had 4.3percent higher spending, which was primarily driven by higher costs in the postacute setting associated with use of institutional postacute care. Hospitals in the highest quintile of the disproportionate share hospital index had poorer performance on the MSPB measure, and were more likely to be penalized under VBP. After adjustment for dual status, differences in MSPB performance between safety-net and non-safety-net hospitals were no longer significant. This suggests that differences in performance between the two types of hospitals were driven at least in part by differences in their patient populations. However, overall VBP payment impacts were largely unchanged after the MSPB measure was adjusted for dual-enrollment status.

Mental Health and Coping Patterns in Jewish Gay Men in Israel: The Role of Dual Identity Conflict, Religious Identity, and Partnership Status

ABSTRACTThis study examined the effects of dual-identity conflict, religious identity (religious/spiritual vs. sexual), and partnership status on the coping strategies and mental health of gay Jewish men in modern Israeli society. Participants were 73 religious and 71 secular gay men recruited via e-mail, social networking sites, and online resources targeting sexual minority men. Participants were assessed via measures of identity conflict, mental health, and coping strategies. Jewish gay men who reported more severe identity conflict also reported using less problem-focused and avoidance coping and more emotion-focused coping strategies and reported poorer mental health than their less identity-conflicted counterparts. Furthermore, gay men who self-identified as religious reported poorer mental health as well as less problem-focused coping and more emotion-focused coping compared to secular men. Religious gay men in romantic relationships reported lower intensities of dual-identity conflict and better mental health compared to their nonpartnered counterparts.

Implications of violation on organizational commitment: Dual status public sector employees

The public sector is experiencing unprecedented change due to budgetary, structural and operational challenges. This study evaluates the relationship between violation and organizational commitment...

The Manuscript as an Ambigraphic Medium: Hoccleve’s Scribes, Illuminators, and Their Problems

This essay argues that late medieval manuscript producers were both aware of and at times troubled by the ontological ambiguity of the medium in which they worked. Nelson Goodman’s aesthetic philosophy provides an apt framework for characterizing this ambiguity, which rests on the manuscript’s dual status as both an allograph and an autograph. Embodying features of both, the manuscript demands a third category, which I term the “ambigraph.” Through an examination of manuscripts of Hoccleve’s Regiment of Princes, I demonstrate how both scribes and illuminators struggled with a self-referential text that presents itself as both an original document and the performance of a script. When called upon by the text they copied to produce pictorial evidence of Chaucer’s likeness, scribes and illuminators left behind evidence in both word and image of their perturbation at this brief, as well as their reluctance and refusal to fulfill it. These exertions, I argue, offer a practical theorization of a premodern media concept in lieu of such a theorization in words.

The Family of Man in Poland: An Exhibition as a Democratic Space?

The exhibition entitled The Family of Man, which was designed by Edward Steichen and presented for the fi rst time in 1955 at the Museum of Modern Art in New York, belongs to the most famous and most controversial photographic expositions of the 20th century. Usually perceived in the light of the anachronistic, West-centric vision of humanism, i.e. as an embodiment of Modernist views on photography, it constitutes a good example of the museum’s infl uence as a Modernist “social instrument”. However, contemporary theories in exhibition studies offer a more complex interpretation. The present work provides insight into this process by referring to the views of Mieke Bal (on the “cinematic effect” of photographic exhibitions, the narrative and relational aspect of expositions), Fred Turner (on the space of an avant-garde exhibition as the realisation of the political and social idea of a “democratic personality”) and Ariella Azoulay (on exhibition space as a “visual declaration of human rights” and the fi eld for a “photographic social contract”). The primary aim of the present article is to set The Family of Man within the framework of Polish exhibition practices. The complex origins of the American project can be traced back to avant-garde experiments with exhibition space conducted in the Bauhaus movement and in Soviet Constructivism (the psychology of perception, “photo-murals”); the analysis focuses on the political and propagandistic aspects. An analysis of the above issues provides the starting point for considering the signifi cance and probable reception of the exhibition’s spatial arrangement in the milieu of Polish architects and designers as well as its Polish variant as prepared by Stanisław Zamecznik and Wojciech Fangor. It was therefore useful to refer to Oskar Hansen and his theory of Open Form, as he cooperated with Zamecznik and Fangor at the time. Models of avant-garde and Modernist “utopian thinking” are juxtaposed, thus making it possible to perceive the process of reception in the light of its effectiveness. The article also discusses The Family of Man as a model for projects with propaganda undertones, i.e. the so-called “problem-oriented exhibitions”. It mentions attempts at adapting Steichen’s design of exhibition space to the needs of the offi cial narrative in the People’s Republic of Poland. Finally, it uncovers the ambivalent nature of the infl uence of The Family of Man and the dual status of the exhibition as both a propagandistic project and as an anti-systemic space supporting the ideal of a creative, free individual.

Interview with director Jayan K. Cherian

In this interview with Judith Misrahi-Barak and Nicole Thiara, Jayan K. Cherian discusses his work as an independent filmmaker in India and the USA, his artistic and political commitment, and the challenges he has faced with the Central Board of Film Certification in India after the release of his first feature film Papilio Buddha (2013), which focuses on Dalit land struggles in Kerala, and again with his second feature film KaBodyscapes (2016). The interview explores how holding a dual status as an American citizen and an Overseas Citizen of India makes his situation more complex because it offers him both the freedom and constraints of being a permanent outsider. The discussion of Papilio Buddha and its representation of the Dalit land struggle is the focus of the interview. He also speaks about his intended audience(s) and the way he works on location with his crews. Since Cherian is a poet and a writer as well as a filmmaker, he explains his choices for specific media, in the particular contexts in which he positions himself.

The refugee camp as a space of multiple ambiguities and subjectivities

Analyses of refugee camps have criticised Agamben's conceptualisation of exception, understood as the juridical production of ‘bare life’ by the sovereign. They have emphasised the multiplicity of actors and exclusionary dynamics involved in the production of exception, as well as the politicisation of space. This scholarship has however stayed framed around an ‘exclusionary paradigm’. This article proposes a complementary way to move beyond Agamben's analysis of the camp by reconsidering the idea of a ‘zone of indistinction’ between exclusion and inclusion. It refers to Palestinian refugee camps in Jordan, where many dwellers have a dual status of ‘refugee-citizen’. It analyses how the subject and citizenship are ambiguously constructed as simultaneously excluded and included – and not solely included through an exclusion. To explore these complex spatial dynamics of exclusion and inclusion, the analysis addresses the exercise of three forms of power – sovereignty, discipline and government – by focusing on the materiality of the camp and the practices of authorities managing space. These powers are ambiguously contributing to the inclusion of the camp and its dwellers in the territory of the Jordanian state, as well as in the neoliberal city of Amman, while maintaining the character of the camp as an excluded humanitarian and temporary space. Through this process, camp dwellers are recast not only as assisted subjects and beneficiaries, but also as autonomous and productive subjects, as well as entrepreneurs and consumers. This article therefore argues that the camp needs to be re-considered as a space of multiple ambiguities and subjectivities aimed at creating a differentiation in the city.

The comparative analysis of the welfare attitude in accordance with the dual status of taxpayer and welfare recipient by using data linkage

ABSTRACT
 BackgroundData linkage is a method to form a complete data that can provide more abundant information by combining a plurality of different data files. In this study, we construct the matched data combined with Korea Welfare Panel Survey and National Survey of Tax and Benefit by using statistical matching methodology. We aim to provide the empirical and advisable evidence for tax and welfare policy by analyzing about the welfare attitude in accordance with the welfare status of taxpayer or welfare recipient using matched data. 
 ResultsAccording to the analysis results, people with dual status of taxpayer above the tax break-even point and welfare recipient due to recent enlargement of welfare programs are relatively more positive about the expansion of the universal welfare than taxpayers who never receive welfare benefit. Also, in the group with dual status, the recognition that the current tax burden of middle class is low is relatively higher and the negative thinking about the need to increase tax burden for the enlargement of the universal welfare programs is relatively lower than the group who pay tax but never receive welfare benefit.

Determinants of the quality of internet investor relations – a study of companies listed on the JSE#

Investor relations is the field of management that is concerned with the relationships between companies and investors, and as such involves a wide variety of information types, for example mandatory, voluntary, financial, non-financial, qualitative and quantitative. While South Africa has recently been ranked number one for the strength of its auditing and reporting standards for the seventh consecutive year (IRBA, 2016), investor relations as a wider and voluntary concept, is largely un-researched in South Africa. The purpose of the study was to establish the determinants of Internet investor relations (IIR).The quality of IIR was measured for a sample of 85 JSE-listed companies using a measurement instrument that consists of 346 attributes. From the literature, as discussed in the literature review, 15 company characteristics were identified that could explain IIR quality. Stepwise regression model-building was used to develop a regression model that best explains IIR quality.Company size, leverage, being audited by a big four audit company, JSE industry membership, free float and dual listing status were found statistically significant independent variables, explaining 68.76% of the variation in the dependent variable, IIR. Contributions to the body of knowledge, study limitations and the need for further research are discussed in the conclusion.

Административно-силовые методы причисления старообрядцев к единоверию в Томской губернии

Using archival sources, the author examines the urgent problem of the spread of common belief and, accordingly, the transition conditions of the Old Believersin it. Common Faith Church was one of the most common methods of struggle of the government and the official Orthodox Church with "developing a split." In the 19th century the Tomsk province was able to create 13 Churches of Common Faith. However, the conversion of the Old Believers in the Church of Common Faith as well as keeping people there often wore a voluntative character. Active use of administrative and police apparatus allowed local officials and clergy of the Synod of the Church to quickly form the Parish of Common Faith, to achieve official recognition, honors and state cash prize. Common Faith Church was supposed to exist in the alien to it official Orthodoxy system with its anti-split” paradigm. The Common Believers were severely restricted in their rights. They resented their dual status: they were neither nikonians, nor Old Believers. Accordingly, the Common Faith did not receive the expected wide- scaled spread. On unconditional rights only a small part of the Old Believers accepted the Common Faith.DOI 10.14258/izvasu(2017)5-08

The Importance of Interagency Collaboration for Crossover Youth

Crossover or dually involved youth are youth enmeshed in the child welfare system (CWS) and juvenile justice system (JJS). Given their dual status and high needs, attention has recently focused on how to best respond to them in an integrated, interagency fashion. The Crossover Youth Practice Model (CYPM) is designed to facilitate interagency collaboration between the CWS and JJS in order to enhance services and diversion to these youths. This study reports on the benefits and challenges that the JJS and CWS, as well as the personnel working within them, experience by participating in a CYPM effort in a Midwestern county, and provides recommendations for continued improvements in interagency collaborations for crossover youth.

The influence of deaf people’s dual category status on sign language planning: the British Sign Language (Scotland) Act (2015)

ABSTRACTThrough the British Sign Language (Scotland) Act, British Sign Language (BSL) was given legal status in Scotland. The main motives for the Act were a desire to put BSL on a similar footing with Gaelic and the fact that in Scotland, BSL signers are the only group whose first language is not English who must rely on disability discrimination legislation to secure access to services in their own language. I argue this is caused by deaf peoples’ dual category status, meaning they are seen within public policy as both a linguistic minority and a disability group. This article analyses how this status informed the Act’s parliamentary scrutiny and implementation measures. Data come from parliamentary debates, discussions on social media and interviews with key players involved in the process. The article demonstrates that despite the Parliament’s desire to treat BSL signers as any other language minority, the Act was subjected to a particular set of discourses which exposed it to a degree of scrutiny not experienced by discourses for spoken minority language legislation, and which points to the political and societal context in which sign languages and signers operate.

The Extremities of Racial Meaning

The Extremities of Racial Meaning

A Childhood Cut Short: Child Deaths in Penal Custody and the Pains of Child Imprisonment

AbstractThe death of a child in penal custody is an infrequent, but particularly tragic, event. In seeking to explain such events, the tendency has been to focus on individual pathology or vulnerability. This article begins from the premise that in order to better understand child deaths in penal custody, it is necessary to move beyond such explanations and consider the wider systematic, cultural, operational, and policy issues. It contributes to the debate by exploring the specific ‘pains of child imprisonment’ as narrated by teenage boys (aged 15–17 years) in an English young offender institution (YOI). It is argued that, trapped in ‘kidulthood’, the dual status of child prisoners poses experiential, conceptual, and practical complexities, but it also produces pains, losses, and burdens that are unique to childhood.

Neologism and Dual Gender Status

Wazobia, the name of the female king in Tess Onwueme’s play The Reign of Wazobia, is a neologism derived from Yorùbá, Igbó, and Hausa respectively, the three dominant languages in Nigeria. Motivated by the relevance of Onwueme’s lexical selection and the socio-political contexts in which the play is set, the essay relies on pragmatic contexts of language usage to analyse the coinage of the name to ascertain whether it dramatizes a political attempt to advocate unity between the three major ethnic groups in Nigeria. The essay also interrogates Wazobia’s dual gender status, and the feminist implications of the fact that she does not rule as a woman but as either a man or an androgynous figure. Wazobia’s dual gender and the illegal extension of her three-year regency raise a number of questions, some of which appear to contradict Onwueme’s well-articulated feminist stance. The essay shows that the neologism of Wazobia is largely restricted to a feminist stance, canvassing intra-gender unity among all Nigerian women as a prerequisite for attaining power and emergence into politics and spaces of leadership. Wazobia’s gender duality is interpreted as Onwueme’s rejection of gender-associated restrictions. This dual status also embodies socio-political implications for unity in the male/female divide, and the Igbóo/Hausa/Yorùbá division. The work interprets the favourable treatment of Wazobia’s tyranny as Onwueme’s feminist bias and political aspirations for women.

RECOGNITION AND THE CHARACTER OF SENECA'S MEDEA

This article examines the character and identity of Seneca's Medea. Focusing on the recognition scene at the end of the play, I investigate how Medea constructs herself both as a literary figure and as an implied human personality. The concluding scene of Seneca'sMedearaises crucial questions about self-coherence and recognisability: in contrast to other moments ofanagnōrisisin Greco-Roman drama, it confirms the pre-existing facets of Medea's identity, rather than revealing new ones. This concept of recognition as self-confirmation is also integral to Seneca's Stoic view of human selfhood, and Medea's use of Stoic principles in this play reinforces her dual status as textual entity and quasi-person.