Evaluation of long-term health care services through a latent Markov model with covariates

We focus on the evaluation of the long-term health care services provided to elderly patients by nursing homes of four different health districts in the Umbria region (Italy). To this end, we analyze data coming from a longitudinal survey aimed at assessing several aspects of patient health conditions and develop an extended version of the latent Markov model with covariates, which allows us to deal with dropout and intermittent missing data patterns that are common in longitudinal studies. Maximum likelihood estimates are obtained by a two-step approach that allows for fast estimation of model parameters and prevents some drawbacks of the standard maximum likelihood method encountered in the presence of many response variables and covariates. In the application to the observed data, we show how to obtain indicators of the effectiveness of the health care services delivered by each health district, by means of a resampling procedure.     

The need to improve communication about scope changes: frustration as an indicator of operational inefficiencies

Early and timely sharing of information can provide a sustainable competitive advantage. However, even if lean information management aims to improve this information flow, it has mainly been investigated in ‘operations-based’ companies. This paper fills this gap, drawing upon the experience of the authors working within a large project-based company engaged in the ‘engineer and manufacture to order’ of a complex piece of equipment costing millions of dollars, for its strategic long-term client, both working in the same industrial field, i.e. nuclear decommissioning. This research investigates the information flow regarding scope changes between the project-based company and the long-term client adapting and applying a five-step framework to highlight operational inefficiencies, reduce the corresponding transaction costs and increase the overall company’s competitiveness. This is exemplified through a particular case, but can be applied to other project-based companies dealing with strategic clients involved in long-term relationships.     

Make-or-break during production: shedding light on change-orders,rework and contractors margin in construction

A considerable amount of research has examined the cost performance of construction projects, yet there has been a paucity of studies that have examined the impact that client initiated change-orders and rework have on contractors. This paper seeks to add further clarity to this issue by replicating previous empirically-based research to establish the validity and reliability of the key issues influencing a contractor's cost performance. A total of 98 projects were used to examine the value of rework and change-orders and their influence on a contractor's margin. Only 65% of projects experienced a cost increase, though a mean rework cost of 0.39% of the contracted value was incurred. The difference between approved client change-orders and those by the contractor for subcontractors was 0.5% of the total costs incurred, which adversely impacted the organisation's profit. Margin losses may well have been higher as rework is seldom formally documented and reported.     

The Impact of Blamer‐softening on Romantic Attachment in Emotionally Focused Couples Therapy

Emotionally Focused Couples Therapy (EFT; Johnson, 2004 ) treats relationship distress by targeting couples' relationship‐specific attachment insecurity. In this study, we used hierarchical linear modeling (Singer & Willett, 2003 ) to examine intercept and slope discontinuities in softened couples' trajectories of change in relationship satisfaction and relationship‐specific attachment over the course of therapy from a total sample of 32 couples. Softened couples (n = 16) reported a significant increase in relationship satisfaction and a significant decrease in attachment avoidance at the softening session. Although softened couples displayed an initial increase in relationship‐specific attachment anxiety at the softening session, their scores significantly decreased across post‐softening sessions. Results demonstrated the importance of the blamer‐softening change event in facilitating change in EFT.     

Late-onset hypogonadism: the advantages of treatment with human chorionic gonadotropin rather than testosterone

The traditional pharmacological treatment of patients with late onset hypogonadism (LOH) is represented by different formulations of testosterone (T) or alternatively by the extractive human chorionic gonadotropin (HCG). The hormone replacement treatment (HRT) is associated with the potential increase of hematocrit, serum concentrations of prostate-specific antigen (PSA) and prostate volume. Moreover, the gynecomastia represent a condition frequently associated with HRT. Recent evidences showed the role of leydig cells in the 25-hydroxylation of vitamin D and the elevated frequency of hypovitaminosis D among LOH patients. Finally, another important aspect of LOH is represented by the frequency of secondary infertility due to age or to traditional HRT. This study evaluated 40 LOH patients treated for 6 months with extractive HCG (n?=?10 patients) and three different formulations of T: transdermal (n?=?10 patients), undecaonate (n?=?10 patients) and enantate (n?=?10 patients). Hormonal, anthropometric, metabolic and sperm parameters were evaluated and compared. Moreover, the main safety parameters and the results of the main questionnaires were evaluated. After treatment, HCG group showed serum concentrations of 25-OH-vitamin D significantly higher (p?p?p?p?相似文献   

Predicting Key Change Events in Emotionally Focused Couple Therapy

In emotionally focused couple therapy (EFT), the blamer‐softening event helps individuals express and respond to partners’ unmet attachment needs. This study examined the impact of this event in relation to attachment at intake and changes in marital satisfaction from pre‐ to posttherapy. Thirty‐two couples were provided an average of 21 sessions of EFT. Hierarchical linear modeling revealed that the occurrence of a softening event significantly predicted increased marital satisfaction. Furthermore, the occurrence of a softening event significantly moderated the relationship between attachment avoidance at intake and change in marital satisfaction from pre‐ to posttherapy. For couples who had a softening event, partners with higher levels of attachment avoidance were less likely to have positive changes in marital satisfaction.     

Predicting Change in Marital Satisfaction Throughout Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT) is an empirically validated approach to couple therapy that uses attachment theory to understand the needs and emotions of romantic partners. EFT is recognized as one of the most effective approaches to couple therapy, but to guide therapists in their use of EFT, a theoretically based model to predict change is needed. This study tested such a model by recruiting 32 couples, and 14 therapists who provided approximately 21 sessions of EFT. Couples completed self‐report measures of marital satisfaction, attachment security, relationship trust, and emotional control at pre‐ and posttherapy and after each therapy session. Results of hierarchical linear modeling suggested that individuals higher on self‐report attachment anxiety and higher levels of emotional control had greater change in marital satisfaction across EFT sessions. Assessing attachment security at the start of therapy will inform therapists of the emotion regulating strategies used by couples and may help couples achieve positive outcomes from EFT.