Termination Of Programs Research Articles

Alexithymia and its relation with eating disorders and obesity

This manuscript provides a review of current literature on the relationship between overweight and alexithymia as a psychological factor associated with obesity, as well as the role of alexithymia in the development of various abnormalities and eating disorders (ED). Obesity is a multifactorial disease, and lifestyle characteristics are the most important pathogenetic links on its development, as well as a complex of genetic, epigenetic, biological and psychological factors that cause accumulation of excessive fat and prevent effective reduction and retention of body weight. One possible reason for the increased prevalence of obesity in adults is poor emotional management, which can affect healthy eating behavior and lifestyle. It was found that overweight and obese people have a high prevalence of alexithymia, and also the study shows its prognostic role in the development of ED. Alexithymia is a factor that not only predisposes to weight gain, but is also a significant predictor of inefficiency and premature termination of programs for the treatment of obesity and ED. Timely diagnosis and correction of alexithymic syndrome can help in developing the effective treatment strategies for obese patients.

The Role of Mental Health Courts in Mitigating Family Violence.

Mental health courts are one potential means to mitigate violence against family members by people with mental illness. This study identified the rate at which cases of family violence come before a mental health court and the success of defendants charged with assaulting family members. In a sample of 1,456 defendants eligible to participate in a mental health court, descriptive statistics were used to report rates of admission of defendants charged with assaulting family members and their characteristics; a static group design was used to compare post-program rearrests among defendants who assaulted family members who successfully completed the program, who did not complete the program, and who did not participate despite being eligible; and logistic regression was used to determine the effect of participation on rearrest when controlling for demographic and clinical factors. The study found that family violence occurred in 24.7% of admitted cases. Most eligible defendants who assaulted family members (75.8%) participated in the court program, and among those who did, 72.2% successfully completed the program. Defendants who assaulted family members and had a positive program termination had a much lower rate of rearrest post-program completion compared with those who did not complete the program or did not participate despite being eligible, a finding that held when controlling for other factors. This study suggests that mental health courts can be an effective option for mitigating family violence committed by people with mental illness.

Criminal Deterrence when There Are Offsetting Risks: Traffic Cameras, Vehicular Accidents, and Public Safety

Numerous cities have enacted electronic monitoring programs at traffic intersections in an effort to reduce the high number of vehicle accidents. The rationale is that the higher expected fines for running a red light will induce drivers to stop and lead to fewer cross-road collisions. However, the cameras also incentivize drivers to accept a greater accident risk from stopping. We evaluate the termination of a monitoring program via a voter referendum using 12 years of geocoded police accident data. We find that the cameras changed the composition of accidents but no evidence of a reduction in total accidents or injuries. (JEL D72, K42, R41)

Impact of an Educational Program on knowledge and Practice of Patients with Chronic Obstructive Pulmonary Disease

Background: Worldwide, chronic obstructive pulmonary disease (COPD) is in the spotlight because of its morbidity, mortality and high prevalence. In Egypt is highlighted as a major public health problem. The aim of the present study was to evaluate the impact of an educational program on knowledge, practice, and self-efficacy of patients with stable chronic obstructive pulmonary disease. Quasi- experimental research design was utilized in this study. The sample was consisted of all available patients with stable COPD during the time of data collection. Four tools were used to collect data: first; Structured interview questionnaire which consisted ofsocio-demographic characteristics, and medical history. Second; the Bristol COPD Knowledge Questionnaire (BCKQ), third; Observational checklist which consisted of breathing exercises& inhaler use, and fourth; Self-Efficacy Scale for Patients with COPD. The result of the study concluded that there was a highly statistically significant difference in patients' total knowledge and practice pre and post program & pre and follow up program. Concerning total Self Efficacy there was no statistically significant difference between pre and post & pre and follow up scores, but there was a highly statistically significant difference between pre and post program regarding all self-efficacy issues except with weather ∕environment, while there was no statistically significant difference between pre and follow up program in all self-efficacy issues except in negative affect issues. The study concluded that after implementation of the educational program, remarkable improvements were occurred in knowledge, practice, and self-efficacy sub scores. The study recommended Continuous monitoring and evaluation of self-efficacy for patients to enhance disease management through establishing a rehabilitation program for patient to improve their self-efficacy. Promotion and enhancement of the self-care modalities to the patient; a strict written instruction with pictures about disease process, allowed foods , rest and physical activities and follow up should be continued after termination of educational program.

Clinical Trials [and Tribulations]: The Immediate Effects of COVID-19 on IBD Clinical Research Activity in the UK.

There have been immediate and profound impacts of SARS-CoV-2 and COVID-19 on health care services worldwide, with major consequences for non COVID-19 related health care. Alongside efforts to reconfigure services and enable continued delivery of safe clinical care for patients with IBD, consideration must also be given to management of IBD research activity. In many centres there has been an effective shutdown of IBD clinical trial activity as research sites have switched focus to either COVID-19 related research or clinical care only. As a result, the early termination of trial programmes, and loss of potentially effective therapeutic options for IBD, has become a real and worrying prospect. Moreover, in many countries research activity has become embedded into clinical care—with clinical trials often providing access to new therapies or strategies—which would otherwise not have been available in standard clinical pathways. This pandemic has significant implications for the design, conduct, analysis, and reporting of clinical trials in IBD. In this Viewpoint, we share our experiences from a clinical and academic perspective in the UK, highlighting the early challenges encountered, and consider implications for patients and staff at research sites, sponsors, research ethics committees, funders, and regulators. We also offer potential solutions both for now and for when we enter a recovery phase from the pandemic.

HELPING PROFESSORS CRAFT STRATEGIES TO IMPROVE FIRST-YEAR ENGINEERING STUDENT SUCCESS USING WEEKLY FEEDBACK FORMS

Students’ success in their first year of an engineering program is of great attention and importance to engineering schools and students alike. While the influencing factors are complex and multifaceted, workload and wellbeing play an integral role in students’ success. Since professors can impact both of these factors through tailoring their delivery, in-class interaction, and workload expectation, the need for effective and continuous two-way communication pathways among students and professors focused on instruction, workload, and wellbeing aspects is evident. In this study, using weekly surveys covering the above-mentioned aspects and tailored to each week’s course activities, data was collected and analyzed to allow professors to understand the students’ perspectives on the assigned workload and effectiveness of the lecture delivery, along with additional information pertaining to the instructional environment. The aim of this work is to enable students to obtain a greater degree of ownership of their learning using clear and continuous communication channels with the instructional team, as well as realize the value in student-centric feedback forms. The study has concluded with valuable insights generated, and improvement in student participation and survey implementation over multiple revisions to the protocol. Although the COVID-19 pandemic led to the premature termination of the pilot program, key insights will be carried forth towards the following school year, with an emphasis on tailoring surveys for online learning, improving implementation, and more defined recommendations to improve the course.

Impact of an Educational Program on Self Efficacy of Patients with Chronic Obstructive Pulmonary Disease

Background: Worldwide, chronic obstructive pulmonary disease (COPD) is in the spotlight because of its morbidity, mortality and high prevalence. In Egypt is highlighted as a major public health problem. The aim of the present study was to evaluate the impact of an educational program on knowledge, practice, and self-efficacy of patients with stable chronic obstructive pulmonary disease. Research Design Quasi- experimental research design was utilized in this study. Subject& Methods, the sample was consisted of all available patients with stable COPD during the time of data collection. Two tools were used to collect data: Structured interview sheet which consisted ofsocio-demographic characteristics, and medical history. and; Self-Efficacy Scale for Patients with COPD. The result of the study concluded that there was no statistically significant difference between pre and post & pre and follow up scores, but there was a highly statistically significant difference between pre and post program all self-efficacy factors except with weather ∕environment, while there was no statistically significant difference between pre and follow up program in all self-efficacy factors except in negative affect factor. Conclusion, the study concluded that after implementation of the educational program, remarkable improvements were occurred in knowledge, practice, and self-efficacy sub scores. Recommendation, the study recommended continuous monitoring and evaluation of self-efficacy for patients, to enhance disease management through establishing a rehabilitation program for patient, and to improve their self-efficacy. Promotion and enhancement of the self-care modalities to the patient; a strict written instruction with pictures about disease process, allowed foods , rest and physical activities and follow up should be continued after termination of educational program.

Randomized comparison of functional electric stimulation in posturally corrected position and motor program activating therapy: treating foot drop in people with multiple sclerosis

Functional electric stimulation (FES) is recommended for foot drop in multiple sclerosis, although little is known about its therapeutic effect. The aim of this study is to evaluate a therapeutic effect immediately and two months after program termination (persistent and delayed effect) of a new approach using FES in combination with correcting the patients' postural system. More specifically, we evaluate the effects of this approach on the patients' clinical functions and compared it with individual physiotherapy. Parallel randomized blind trial. Two-month-long treatments, functional electric stimulation in posturally corrected position (group 1) and neuroproprioceptive facilitation and inhibition physiotherapy called motor program activating therapy (group 2). Forty-four subjects with multiple sclerosis. Primary outcomes: gait (the 2-Minute Walk Test; Timed 25-Foot Walk test; Multiple Sclerosis Walking Scale-12) and balance (by e.g. Berg Balance Scale [BBS], the Activities-Specific Balance Confidence Scale [ABC], Timed Up-and-Go Test [TUG]). mobility, cognition, fatigue and subjects' perceptions (e.g. Multiple Sclerosis Impact Scale [MSIS], Euroqol-5 dimensions-5 levels [EQ-5D-5L]). Group 1 showed immediate therapeutic effect in BBS (P=0.008), ABC (P=0.04) and EQ-5D-5L (self-care, P=0.019, mobility P=0.005). The improvement in EQ-5D-5L persisted and in TUG-cognitive we documented a delayed effect (P=0.005). Group 2 showed an immediate improvement in BBS (P=0.025), MSIS (P=0.043) and several aspects of daily life (the effect on health today was significantly higher than in group 1, significant difference between groups P=0.038). FES in the posturally corrected position has an immediate therapeutic effect on balance and patients' perceptions comparable to motor program activating therapy, and higher persistent and even delayed therapeutic effect. The study results point to the importance of correcting the patients' posture when applying FES, the possibility to treat foot drop by individual physiotherapy and the activation of the patients' auto reparative processes.

The Association Between Evidence-Based Decision Making and Accreditation of State Health Departments.

To assess the association between evidence-based decision making, including implementation of evidence-based interventions (EBIs), with accreditation of state health departments through the Public Health Accreditation Board (PHAB). This was a cross-sectional, electronic survey of state health department practitioners. We utilized a survey instrument focused on evidence-based public health, de-implementation, and sustainability of public health programs. Survey questions were organized into 6 domains: (1) demographic information; (2) individual-level skills; (3) decision making on programs ending; (4) decision making on programs continuing; (5) organization/agency capacity; and (6) external influences. The targeted practitioners were randomly selected from the 3000-person membership of National Association of Chronic Disease Directors and program manager lists from key Centers for Disease Control and Prevention-supported programs in cancer and cancer risk factors. The final target audience for the survey totaled 1329 practitioners, representing all 50 states. The main outcome measures included the strength of association between a state's PHAB accreditation status and variables related to evidence-based public health and use of EBIs that fell within the individual participant skills, organization/agency capacity, and external influences domains. We received 643 valid responses (response rate = 48.4%), representing all 50 states, with 35 states being PHAB accredited. There was a statistically significant association between PHAB accreditation and state health department use of quality improvement processes (P = .002), leadership plans to implement EBIs (P = .009), and leadership reactions to EBI implementation issues (P = .004). Respondents from PHAB-accredited states were significantly more likely than participants from nonaccredited states to report greater engagement with legislators and governors regarding EBIs and 14% less likely to report the inappropriate termination of programs in their work unit (P = .05). The importance of accreditation relates to both internally focused functions and externally focused activities, especially regarding policy-related impact.

Automatic Verification of Liveness Properties in the Situation Calculus

In dynamic systems, liveness properties concern whether something good will eventually happen. Examples of liveness properties are termination of programs and goal achievability. In this paper, we consider the following theorem-proving problem: given an action theory and a goal, check whether the goal is achievable in every model of the action theory. We make the assumption that there are finitely many non-number objects. We propose to use mathematical induction to address this problem: we identify a natural number feature and prove by mathematical induction that for any values of the feature, the goal is achievable. Both the basis and induction steps are verified using first-order theorem provers. We propose a simple method to identify potential features which are the number of objects satisfying a certain formula by generating small models of the action theory and calling a classical planner to achieve the goal. We also propose to regress the goal via different actions and then verify whether the resulting goals are achievable. We implemented the proposed method and experimented with the blocks world domain and a number of other domains from the literature. Experimental results showed that most goals can be verified within a reasonable amount of time.

Effectiveness of a Multiprofessional, Online and Simulation-Based Difficult Conversations Training Program on Self-Perceived Competence of Oncology Healthcare Provider Trainees.

Effective communication between healthcare providers (HCPs) and patients is important for HCP well-being, patient engagement, and health outcomes. Yet, HCPs do not receive adequate communication skills training and report feeling unprepared for difficult conversations. A needs assessment of 64 cancer HCP trainees in Toronto, Canada, found that a majority of trainees rated themselves with low competency in communication skills to support patients through difficult conversations, while nearly all rated these skills as important to their practice. A blended multiprofessional communications program was developed including online theoretical learning and reflective practice in addition to in-person simulation with standardised patient actors. Since communication skills mastery is highly unlikely to occur at the termination of a single training program, the goal of the program was to stimulate participants' motivational beliefs about difficult conversations communication skills in order to deepen their commitment to learning and mastery. The motivational beliefs assessed included self-efficacy (self-perceived competence), intent to use techniques learned, and confidence in task mastery. After completing the course, participants' self-perceived competence in dealing with difficult conversations significantly increased by an average of 25 points (p < 0.001) on a rating scale of 1-100 (n = 40). Participants' intent to use techniques did not change significantly and remained high with an overall average of 89 points. After the course, participants rated their confidence in mastering techniques learned at an average score of 71 points. Multiprofessional, simulation-based training is an effective way to improve HCP trainees' motivational beliefs around having difficult conversations.

Rebates as incentives: The effects of a gym membership reimbursement program

A rich experimental literature demonstrates positive effects of pay-per-visit fitness incentives. However, most insurance plans that provide fitness incentives follow a different structure, offering membership reimbursements conditional on meeting a specific attendance threshold. We provide the first evidence in the literature on gym incentives of this structure, exploiting the introduction and subsequent discontinuation of a large-scale wellness program at a major American university. Our analysis leverages individual-level administrative data on gym attendance for the universe of students over a five-year period: the three years that the policy was in place, one year before implementation, and one year after termination. This provides us with 100,000 student-year observations and 1.5 million gym visits. Using bunching methods and difference-in-difference designs, we provide four empirical results. First, we document that the policy led to significant bunching at the attendance threshold. Second, we show that the program increased average gym visits by almost five visits per semester, a 20% increase from the mean. Third, we find that the policy not only motivated students who were previously near the threshold, but rather increased attendance across the entire visit distribution. Finally, we show that approximately 50% of the effect persists a year after program termination. Taken together, these results suggest that rebate-framed incentives with a high attendance threshold can induce healthy behaviors in the short-term, and that these positive behaviors persist even after the incentives have been removed.

The 2D Dependency Pair Framework for Conditional Rewrite Systems—Part II: Advanced Processors and Implementation Techniques

Proving termination of programs in ‘real-life’ rewriting-based languages like CafeOBJ, Haskell, Maude, etc., is an important subject of research. To advance this goal, faithfully capturing the impact in the termination behavior of the main language features (e.g., conditions in program rules) is essential. In Part I of this work, we have introduced a 2D Dependency Pair Framework for automatically proving termination properties of Conditional Term Rewriting Systems. Our framework relies on the notion of processor as the main practical device to deal with proofs of termination properties of conditional rewrite systems. Processors are used to decompose and simplify the proofs in a divide and conquer approach. With the basic proof framework defined in Part I, here we introduce new processors to further improve the ability of the 2D Dependency Pair Framework to deal with proofs of termination properties of conditional rewrite systems. We also discuss relevant implementation techniques to use such processors in practice.

Predictivity/Translatability of Toxicities Observed in Nonclinical Toxicology Studies to Clinical Safety Outcomes in Drug Development: Case Examples.

Nonclinical toxicology studies are conducted to characterize the potential toxicities and establish a safe starting dose for new drugs in clinical studies, but the question remains as to how predictable/translatable the nonclinical safety findings are to humans. In many cases, there is good concordance between nonclinical species and patients. However, there are cases for which there is a lack of predictivity or translatability that led to early termination of clinical studies due to unanticipated toxicities or early termination of programs before making it to the clinic due to unacceptable nonclinical toxicities assumed to be translatable. A few case examples of safety findings that are translatable versus safety findings that are not translatable and why they are not translateable were presented as a symposium at the 38th Annual Meeting of the American College of Toxicology in Palm Springs, California, and are discussed in this article.

Embedding non-projective Mori dream space

This paper is devoted to extend some Hu-Keel results on Mori dream spaces (MDS) beyond the projective setup. Namely, $\Q$-factorial algebraic varieties with finitely generated class group and Cox ring, here called \emph{weak} Mori dream spaces (wMDS), are considered. Conditions guaranteeing the existence of a neat embedding of a (completion of a) wMDS into a complete toric variety are studied, showing that, on the one hand, those which are complete and admitting low Picard number are always projective, hence Mori dream spaces in the sense of Hu-Keel. On the other hand, an example of a wMDS does not admitting any neat embedded \emph{sharp} completion (i.e. Picard number preserving) into a complete toric variety is given, on the contrary of what Hu and Keel exhibited for a MDS. Moreover, termination of the Mori minimal model program (MMP) for every divisor and a classification of rational contractions for a complete wMDS are studied, obtaining analogous conclusions as for a MDS. Finally, we give a characterization of a wMDS arising from a small $\Q$-factorial modification of a projective weak $\Q$-Fano variety.

The issue of legal regulation of languages in Ukraine

The article raises the issue of implementing constitutional norms on ensuring the rights of national minorities by Ukraine. It is established that certain provisions of the Law of Ukraine “On Education” dated 05 September 2017 have been criticized both at national and international level as regards termination of curricular programs in languages of national minorities other than EU languages. It is determined that a change in language policy resulted in a conflict of interest in Chernivtsi on 17 October 2017 between representatives of Romanian national minority and representatives of NGOs "Right Sector" and "Freedom" as to the right to study in their native language. It is established that Ukraine, in violation of the international obligations defined by international treaties in the field of protecting the rights of national minorities, including those ratified by Ukraine, did not take into account the relevant recommendations of the Parliamentary Assembly of the Council of Europe, the Venice Commission, the Advisory Committee on the Framework Convention for the Protection of National Minorities, Office of the United Nations High Commissioner for Human Rights, United Nations Monitoring Mission, Council of Europe Commissioner for Human Rights, UN Special Rapporteur on Minorities.According to the results of the analysis, it is established that there is no special law determining the spheres of public life and measures to guarantee the rights of national minorities. The respective guarantees for teaching in the mother tongue were not established in the law on the status of the state language dated 25 April 2019.It is concluded that to resolve this problem, it is necessary to adopt a constitutional law that would determine the procedure for the use of national minority languages. In connection with this, the object of research is Draft Law of Ukraine "On Languages in Ukraine" No. 1103 submitted for consideration to the Verkhovna Rada on 29 August 2019 by V.V. Novynskiy, M.S. Mahomedov and others. Formal-legal, comparative-legal and logical methods are applied.The content of Part 5 of Article 53 of the Constitution of Ukraine is analyzed, it was concluded that it did not set an alternative, but it sets a mandatory obligation to perform all actions of the state to guarantee the rights of national minorities.It is concluded that it is necessary to adopt a special law on languages in Ukraine in order to implement the Constitution of Ukraine. It is recommended that the Verkhovna Rada of Ukraine include Draft law No. 1103 on the agenda, consider it, and adopt it as a basis in the first reading. It is recommended to adopt laws related to the draft law on national and cultural autonomy, on indigenous peoples of Ukraine, on national minorities (new version), on local referenda, on an all-Ukrainian referendum.

On ranking functions for single-path linear-constraint loops

Program termination is a fundamental research topic in program analysis. In this paper, we present a new complete polynomial-time method for the existence problem of linear ranking functions for single-path loops described by a conjunction of linear constraints, when variables range over the reals (or rationals). Unlike existing methods, our method does not depend on Farkas’ Lemma and provides us with counterexamples to existence of linear ranking functions, when no linear ranking function exists. In addition, we extend our results established over the rationals to the setting of the integers. This deduces an alternative approach to deciding whether or not a given SLC loop has a linear ranking function over the integers. Finally, we prove that the termination of bounded single-path linear-constraint loops is decidable over the reals (or rationals).

A comparison of high versus low dose of exercise training in exercise-based cardiac rehabilitation: a randomized controlled trial with 12-months follow-up

Objective: To assess if a higher dose of exercise training in exercise-based cardiac rehabilitation could affect improvements in aerobic capacity and muscle strength. Design: Assessor-blinded randomized controlled trial with 12-months follow-up. Setting: Aarhus University Hospital, Aarhus, Denmark. Subjects: A total of 164 cardiac patients referred to exercise-based cardiac rehabilitation were recruited. Interventions: Patients were randomized to 1-hour exercise sessions either three times weekly for 12 weeks (36 sessions, high-dose group) or twice weekly for 8 weeks (16 sessions, low-dose group). The same standardized exercise and intensity protocol including aerobic and muscle strength training was used in all participants. Main measures: Primary outcome was changes in VO2peak. Secondary outcomes were changes in maximal workload, muscle strength and power. Measures were obtained at baseline, after termination of the rehabilitation programme and at follow-up after 6 and 12 months. Results: After the end of intervention, statistically significant between-group differences were seen in favour of the high-dose group in all outcomes: VO2peak 2.6 (mL kg−1 min−1) (95% confidence interval (CI): 0.4–4.8), maximal workload 0.3 W kg−1 (95%CI: 0.02–0.5), isometric muscle strength 0.7 N m kg−1 (95%CI: 0.1–1.2) and muscle power 0.3 W kg−1 (95%CI: 0.04–0.6). After 12 months, a significant between-group difference only persisted in VO2peak and maximal workload. Conclusion: A higher dose of exercise training had a small effect on all outcomes at termination of intervention. A long-term effect persisted in VO2peak and maximal workload. Although the effect was small, it is an important finding because VO2peak is the most important predictor of all-cause mortality in cardiac patients.

Modular verification for almost-sure termination of probabilistic programs

In this work, we consider the almost-sure termination problem for probabilistic programs that asks whether a given probabilistic program terminates with probability 1. Scalable approaches for program analysis often rely on modularity as their theoretical basis. In non-probabilistic programs, the classical variant rule (V-rule) of Floyd-Hoare logic provides the foundation for modular analysis. Extension of this rule to almost-sure termination of probabilistic programs is quite tricky, and a probabilistic variant was proposed by Fioriti and Hermanns in POPL 2015. While the proposed probabilistic variant cautiously addresses the key issue of integrability, we show that the proposed modular rule is still not sound for almost-sure termination of probabilistic programs. Besides establishing unsoundness of the previous rule, our contributions are as follows: First, we present a sound modular rule for almost-sure termination of probabilistic programs. Our approach is based on a novel notion of descent supermartingales. Second, for algorithmic approaches, we consider descent supermartingales that are linear and show that they can be synthesized in polynomial time. Finally, we present experimental results on a variety of benchmarks and several natural examples that model various types of nested while loops in probabilistic programs and demonstrate that our approach is able to efficiently prove their almost-sure termination property.

Do Financial Incentives Change Length-of-stay Performance in Emergency Departments? A Retrospective Study of the Pay-for-performance Program in Metro Vancouver.

Pay-for-performance (P4P) programs have been implemented in various forms to reduce emergency department (ED) patient length of stay (LOS). This retrospective study investigated to what extent the timing of patient disposition in Metro Vancouver EDs was influenced by a LOS-based P4P program. We analyzed ED visit records of four major hospitals in Metro Vancouver, Canada. For each ED, we individually tested whether LOS was distributed discontinuously at the LOS target before and after the P4P program was terminated. For the P4P effective period, we examined whether patients discharged just prior to the LOS target had a higher 7-day return-and-admission (RA) rate-the probability that a patient, after being discharged home, returned to any ED within 7 days and was admitted to an inpatient unit-than patients discharged just after the target. Prior to the termination of the P4P program, in all four EDs, the LOS density of admitted patients was discontinuous and had a significant drop at the P4P 10-hours admission LOS target; a similar phenomenon was observed among discharged patients at the 4-hours discharge LOS target, but only in the two lower-volume EDs. Furthermore, in a lower-volume ED, patients who were discharged right before the 4-hours P4P LOS target had a higher 7-day RA rate than patients discharged right after the LOS target. After the termination of the discharge incentive, the discontinuity at the discharge LOS target became less evident, but patients were still more frequently admitted just before 10 hours in three of the four EDs as the local health authority continued to support the admission incentive scheme after the government terminated the P4P program. The LOS-based financial incentive scheme appears to have influenced the timing of ED patient dispositions. The results suggest mixed consequences of the P4P program-it can reduce access block for admitted patients but may also lead to discharges associated with return visits and admissions.