Publications by authors named "Jan Taylor"

50 Publications

Quantifying the Financial Impact of Delayed Adoption of CPT Code Changes in Radiology.

Curr Probl Diagn Radiol 2021 Mar 13. Epub 2021 Mar 13.

Division of Interventional Radiology, Department of Radiology, Duke Health, Durham, NC. Electronic address:

Purpose: To quantify the financial effect of delayed reporting of new moderate sedation (MS) Current Procedural Terminology (CPT) codes at an academic radiology practice, and to identify barriers to timely reporting.

Materials And Methods: Billing and reimbursement data was collected for a 28-month period (January 1, 2017-April 30, 2019). Reporting of new MS codes was identified and compared to the number of procedures performed by radiology over the study period. Using the number of procedures performed and payment data, losses were estimated. A root cause analysis was then performed to further understand delayed reporting.

Results: MS was reported with 2.5% of cases in 2017, 47.8% of cases in 2018 and 69.1% of cases in 2019. Appropriate coding was not achieved until June 2018, equating to a 17-month lag in implementation. Lost revenue from inaccurate reporting of MS alone was $21,357 ± $3,945 per month. Primary barriers to an efficient transition included (1) updating billing systems, (2-5) coder, nursing, technologist, and operator education and coordination, and (6) drafting and vetting new procedural report templates.

Conclusions: Delayed reporting of the new moderate sedation codes resulted in a $363,069 ± $67,065 loss of procedural revenue at an academic radiology practice. Primary drivers of the delay were lags in education and coordination at multiple points in the reporting chain. As healthcare policy shifts and changes to coding become more frequent and significant, timely adoption becomes more salient for radiologists.
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http://dx.doi.org/10.1067/j.cpradiol.2021.03.014DOI Listing
March 2021

Geographic patterns in seasonal changes of body mass, skull, and brain size of common shrews.

Ecol Evol 2021 Mar 14;11(6):2431-2448. Epub 2021 Feb 14.

Max Planck Institute of Animal Behavior Radolfzell Germany.

Some small mammals exhibit Dehnel's Phenomenon, a drastic decrease in body mass, braincase, and brain size from summer to winter, followed by a regrowth in spring. This is accompanied by a re-organization of the brain and changes in other organs. The evolutionary link between these changes and seasonality remains unclear, although the intensity of change varies between locations as the phenomenon is thought to lead to energy savings during winter.Here we explored geographic variation of the intensity of Dehnel's Phenomenon in . We compiled literature on seasonal changes in braincase size, brain, and body mass, supplemented by our own data from Poland, Germany, and Czech Republic.We analyzed the effect of geographic and climate variables on the intensity of change and patterns of brain re-organization.From summer to winter, the braincase height decreased by 13%, followed by 10% regrowth in spring. For body mass, the changes were -21%/+82%, respectively. Changes increased toward northeast. Several climate variables were correlated with these transformations, confirming a link of the intensity of the changes with environmental conditions. This relationship differed for the decrease versus regrowth, suggesting that they may have evolved under different selective pressures.We found no geographic trends explaining variability in the brain mass changes although they were similar (-21%/+10%) to those of the braincase size. Underlying patterns of change in brain organization in northeastern Poland were almost identical to the pattern observed in southern Germany. This indicates that local habitat characteristics may play a more important role in determining brain structure than broad scale geographic conditions.We discuss the techniques and criteria used for studying this phenomenon, as well as its potential presence in other taxa and the importance of distinguishing it from other kinds of seasonal variation.
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http://dx.doi.org/10.1002/ece3.7238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981214PMC
March 2021

Somatic Mutations and the Risk of Undifferentiated Autoinflammatory Disease in MDS: An Under-Recognized but Prognostically Important Complication.

Front Immunol 2021 19;12:610019. Epub 2021 Feb 19.

National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Wellcome Trust Brenner Building, St James's University Hospital, Leeds, United Kingdom.

We theorized that myelodysplastic syndrome (MDS) with somatic mutations and karyotype abnormalities are associated with autoinflammation, and that the presence of autoinflammatory disease affected prognosis in MDS. One hundred thirty-four MDS patients were assessed for the prevalence of autoinflammatory complications and its link with karyotypes and somatic mutation status. Autoinflammatory complications were described either as well-defined autoinflammatory diseases (AD) or undifferentiated "autoinflammatory disease" (UAD) (defined as CRP over 10.0 mg/L on five consecutive occasions, taken at separate times and not explained by infection). Several patient characteristics including demographic, clinical, laboratory, cytogenetics charts, and outcomes, were compared between different groups. Sixty-two (46.3%) patients had an autoinflammatory complication manifesting as arthralgia (43.5% . 23.6%, = 0.0146), arthritis (30.6% . 15.3%, = 0.0340), skin rash (27.4% . 12.5%, = 0.0301), pleuritis (14.5% . 4.2%, = 0.0371) and unexplained fever (27.4% . 0%, < 0.0001). AD were found in 7.4% of MDS patients (with polymyalgia rheumatic being the most frequently one). Classical autoimmune diseases were found only in 4 MDS patients (3.0%). Transcription factor pathway mutations () (OR 2.20 [95%CI 1.02-4.75], = 0.0451) and abnormal karyotypes (OR 2.76 [95%CI 1.22-6.26], = 0.0153) were associated with autoinflammatory complications. Acute leukaemic transformation was more frequent in MDS patients with autoinflammatory features than those without (27.4% . 9.7%, = 0.0080). Autoinflammatory complications are common in MDS. Somatic mutations of transcription factor pathways and abnormal karyotypes are associated with greater risk of autoinflammatory complications, which are themselves linked to malignant transformation and a worse prognosis.
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http://dx.doi.org/10.3389/fimmu.2021.610019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933213PMC
February 2021

Biophysical effects, safety and efficacy of raspberry leaf use in pregnancy: a systematic integrative review.

BMC Complement Med Ther 2021 Feb 9;21(1):56. Epub 2021 Feb 9.

University of Canberra, 11 Kirinari St, Bruce ACT, 2617, Australia.

Background: Childbearing women have been using various herbs to assist with pregnancy, labour and birth for centuries. One of the most common is raspberry leaf. The evidence base for the use of raspberry leaf is however under-developed. It is incumbent on midwives and other maternity care providers to provide women with evidence-based information so they can make informed choices. The aim of this study was to review the research literature to identify the evidence base on the biophysical effects, safety and efficacy of raspberry leaf in pregnancy.

Methods: A systematic, integrative review was undertaken. Six databases were searched to identify empirical research papers published in peer reviewed journals including in vitro, in vivo, human and animal studies. The search included the databases CINAHL, MEDLINE, Cochrane Library, Scopus and Web of Science Core Collection and AMED. Identified studies were appraised independently by two reviewers using the MMAT appraisal instrument. An integrative approach was taken to analysis.

Results: Thirteen studies were included. Five were laboratory studies using animal and human tissue, two were experiments using animals, and six were human studies. Included studies were published between 1941 and 2016. Raspberry leaf has been shown to have biophysical effects on animal and human smooth muscle including the uterus. Toxity was demonstrated when high doses were administered intravenously or intaperitoneally in animal studies. Human studies have not shown any harm or benefit though one study demonstrated a clinically meaningful (though non-statistically significant) reduction in length of second stage and augmentation of labour in women taking raspberry leaf.

Conclusions: Many women use raspberry leaf in pregnancy to facilitate labour and birth. The evidence base supporting the use of raspeberry leaf in pregnancy is weak and further research is needed to address the question of raspberry leaf's effectiveness.
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http://dx.doi.org/10.1186/s12906-021-03230-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871383PMC
February 2021

Comparative analysis of gene expression platforms for cell-of-origin classification of diffuse large B-cell lymphoma shows high concordance.

Br J Haematol 2021 Feb 29;192(3):599-604. Epub 2020 Nov 29.

Haematological Malignancy Diagnostic Service, St James' University Hospital, Leeds, UK.

Cell-of-origin subclassification of diffuse large B cell lymphoma (DLBCL) into activated B cell-like (ABC), germinal centre B cell-like (GCB) and unclassified (UNC) or type III by gene expression profiling is recommended in the latest update of the World Health Organization's classification of lymphoid neoplasms. There is, however, no accepted gold standard method or dataset for this classification. Here, we compare classification results using gene expression data for 68 formalin-fixed paraffin-embedded DLBCL samples measured on four different gene expression platforms (Illumina wG-DASL arrays, Affymetrix PrimeView arrays, Illumina TrueSeq RNA sequencing and the HTG EdgeSeq DLBCL Cell of Origin Assay EU using an established platform agnostic classification algorithm (DAC) and the classifier native to the HTG platform, which is CE marked for in vitro diagnostic use (CE-IVD). Classification methods and platforms show a high level of concordance, with agreement in at least 80% of cases and rising to much higher levels for classifications of high confidence. Our results demonstrate that cell-of-origin classification by gene expression profiling on different platforms is robust, and that the use of the confidence value alongside the classification result is important in clinical applications.
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http://dx.doi.org/10.1111/bjh.17246DOI Listing
February 2021

Financial Effect of Unbundling Moderate Sedation from Procedural Codes in Radiology.

J Vasc Interv Radiol 2020 Aug;31(8):1302-1307.e1

Division of Interventional Radiology, Duke Health, DUMC Box 3808, Durham, NC, 27710.

Purpose: To assess and quantify the financial effect of unbundling newly unbundled moderate sedation codes across major payors at an academic radiology practice.

Materials And Methods: Billing and reimbursement data for 23 months of unbundled moderate sedation codes were analyzed for reimbursement rates and trends. This included 10,481 and 28,189 units billed and $443,257 and $226,444 total receipts for codes 99152 (initial 15 minutes of moderate sedation) and 99153 (each subsequent 15 minute increment of moderate sedation), respectively. Five index procedures-(i) central venous port placement, (ii) endovascular tumor embolization, (iii) tunneled central venous catheter placement, (iv) percutaneous gastrostomy placement, and (v) percutaneous nephrostomy placement-were identified, and moderate sedation reimbursements for Medicare and the dominant private payor were calculated and compared to pre-bundled reimbursements. Revenue variation models across different patient insurance mixes were then created using averages from 4 common practice settings among radiologists (independent practices, all hospitals, safety-net hospitals, and non-safety-net hospitals).

Results: Departmental reimbursement for unbundled moderate sedation in FY2018 and FY2019 totaled $669,701.34, with high per-unit variability across payors, especially for code 99153. Across the 5 index procedures, moderate sedation reimbursement decreased 1.3% after unbundling and accounted for 3.9% of procedural revenue from Medicare and increased 11.9% and accounted for 5.5% of procedural revenue from the dominant private payor. Between different patient insurance mix models, estimated reimbursement from moderate sedation varied by as much as 29.9%.

Conclusions: Departmental reimbursement from billing the new unbundled moderate sedation codes was sizable and heterogeneous, highlighting the need for consistent and accurate reporting of moderate sedation. Total collections vary by case mix, patient insurance mix, and negotiated reimbursement rates.
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http://dx.doi.org/10.1016/j.jvir.2020.04.034DOI Listing
August 2020

Daily energy expenditure in white storks is lower after fledging than in the nest.

J Exp Biol 2020 01 28;223(Pt 2). Epub 2020 Jan 28.

Department of Migration, Max Planck Institute of Animal Behavior, 78315 Radolfzell, Germany.

Many juvenile birds turn into long-distance migrants within weeks of fledging. This transition involves upheavals in their energy management as major changes in growth and activity occur. Understanding such ontogenetic transitions in energy allocation has been difficult because collecting continuous data on energy costs in wild developing birds was previously largely impossible. Here, we continuously measured heart rate and fine-scale movements of 20 free-living juvenile white storks () using on-board bio-loggers to explore individual and environmental factors relating to daily mean heart rate. In addition, we explored which specific energy management strategy storks use during these crucial early life stages. We found that daily mean heart rate increased with overall movement activity, and increasing body temperature, but that it decreased with age. Further, we found that during the nestling period, when growth costs are high, activity costs are low, and post-fledging that activity costs are increased while maintenance costs are low, indicating a constraint on overall energy use in both phases. Our observations are consistent with the hypothesis that individuals invested more energy per unit time while still in the nest than after fledging despite the high costs of flight.
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http://dx.doi.org/10.1242/jeb.219337DOI Listing
January 2020

Exploratory Study of MYD88 L265P, Rare NLRP3 Variants, and Clonal Hematopoiesis Prevalence in Patients With Schnitzler Syndrome.

Arthritis Rheumatol 2019 12 14;71(12):2121-2125. Epub 2019 Oct 14.

NIHR, Leeds, UK.

Objective: To assess the prevalence of the MYD88 L265P mutation and variants within NLRP3 and evaluate the status of oligoclonal hematopoiesis in 30 patients with Schnitzler syndrome (SchS).

Methods: Thirty patients with SchS were recruited from 3 clinical centers. Six patients with known acquired cryopyrin-associated periodic syndromes (aCAPS) were included as controls. Allele-specific oligonucleotide-polymerase chain reaction was used for the detection of the MYD88 L265P variant, next-generation sequencing was applied to analyze NLRP3 and 28 genes associated with myelodysplastic syndrome, and gene scanning was performed for the detection of X chromosome inactivation.

Results: Activating NLRP3 mutations were not present in 11 SchS patients who had not been sequenced for this gene previously. The MYD88 L265P variant was present in 9 of 30 SchS patients, and somatic mutations associated with clonal hematopoiesis were identified in 1 of 30 patients with SchS and 1 of 6 patients with aCAPS. Evidence of nonrandom X chromosome inactivation was detected in 1 female patient with SchS and 1 female patient with aCAPS.

Conclusion: A shared molecular mechanism accounting for the pathogenesis of inflammation in SchS remains elusive. Clonal hematopoiesis is not associated with other somatic mutations found in individuals with SchS or aCAPS.
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http://dx.doi.org/10.1002/art.41030DOI Listing
December 2019

Effects of a topical botanically-enriched salve on cutaneous oxygenation.

J Wound Care 2019 Feb;28(Sup2):S16-S22

Helfgott Research Institute, National University of Natural Medicine, Portland, US.

Objective: There is a medical need to evaluate new treatments that may improve wound healing. This study aimed to determine if Original Healing Salve (OHS, Puremedy, Inc.) a topical, botanically-enriched salve (BES), changes distal leg tissue oxygenation in people with type 2 diabetes.

Method: A randomised, controlled, crossover, double-blinded clinical trial comparing changes in cutaneous oxygen delivery (mean TcPO) on multiple sites of the lower extremity following application of a botanically-enriched topical salve, as compared with application of the salve's base in patients with type 2 diabetes. Subjects were recruited from the general population as a convenience sample.

Results: A total of 16 participants were recruited. Analysis of the primary outcome demonstrated no statistically significant difference in TcPO at 30 minutes postapplication when comparing the BES to the base salve (BS) on the leg (-0.39±8.54mmHg; p=0.86). Analyses of secondary outcomes at 30 minutes postapplication indicated that mean TcPO was significantly higher than preapplication levels among subjects receiving both the BES (3.70±6.62mmHg; p=0.04) and BS on the leg (4.08±5.21mmHg; p=0.007). On the foot, mean TcPO at 30 minutes postapplication was higher in the BES compared with the BS, this difference was not significant (0.98±8.59mmHg; p=0.66). Mean TcPO was higher than preapplication levels among subjects receiving both the BES (1.21±7.70mmHg; p=0.54) and BS on the foot (2.19±7.27mmHg; p=0.25). These differences were non-significant.

Conclusion: These findings support consideration of topical treatments containing botanical ingredients to increase cutaneous oxygen delivery in the lower extremity in patients with type 2 diabetes.
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http://dx.doi.org/10.12968/jowc.2019.28.Sup2.S16DOI Listing
February 2019

The use of targeted sequencing and flow cytometry to identify patients with a clinically significant monocytosis.

Blood 2019 03 3;133(12):1325-1334. Epub 2019 Jan 3.

Epidemiology and Cancer Statistics Group, University of York, York, United Kingdom.

The diagnosis of chronic myelomonocytic leukemia (CMML) remains centered on morphology, meaning that the distinction from a reactive monocytosis is challenging. Mutational analysis and immunophenotyping have been proposed as potential tools for diagnosis; however, they have not been formally assessed in combination. We aimed to investigate the clinical utility of these technologies by performing targeted sequencing, in parallel with current gold standard techniques, on consecutive samples referred for investigation of monocytosis over a 2-year period (N = 283). Results were correlated with the morphological diagnosis and objective outcome measures, including overall survival (OS) and longitudinal blood counts. Somatic mutations were detected in 79% of patients, being invariably identified in those with a confirmed diagnosis (99%) but also in 57% of patients with nondiagnostic bone marrow features. The OS in nondiagnostic mutated patients was indistinguishable from those with CMML ( = .118) and significantly worse than in unmutated patients ( = .0002). On multivariate analysis, age, ASXL1, CBL, DNMT3A, NRAS, and RUNX1 mutations retained significance. Furthermore, the presence of a mutation was associated with a progressive decrease in hemoglobin/platelet levels and increasing monocyte counts compared with mutation-negative patients. Of note, the immunophenotypic features of nondiagnostic mutated patients were comparable to CMML patients, and the presence of aberrant CD56 was highly specific for detecting a mutation. Overall, somatic mutations are detected at high frequency in patients referred with a monocytosis, irrespective of diagnosis. In those without a World Health Organization-defined diagnosis, the mutation spectrum, immunophenotypic features, and OS are indistinguishable from CMML patients, and these patients should be managed as such.
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http://dx.doi.org/10.1182/blood-2018-08-867333DOI Listing
March 2019

The future in their hands: Graduating student midwives' plans, job satisfaction and the desire to work in midwifery continuity of care.

Women Birth 2020 Feb 10;33(1):e59-e66. Epub 2018 Dec 10.

Faculty of Health, University of Canberra, Australia; Centenary Hospital for Women and Children, ACT, Australia. Electronic address:

Background: Midwife-led continuity of care models benefit women and the midwives who work in them. Australian graduate midwives are familiar with, and educated to provide, continuity of care to women although the opportunity to work exclusively in positions providing continuity of care on graduation is uncommon.

Aim: To explore the immediate and aspirational employment plans and workforce choices, reasons for staying in midwifery and perceptions around factors likely to influence job satisfaction of midwives about to graduate from one Australian university during the years 2012-2016.

Methods: This longitudinal study draws on survey responses from five cohorts of midwifery students in their final year of study.

Findings: Ninety five out of 137 midwifery students responded to the survey. Almost nine out of ten respondents either aspired to work in a continuity of care model or recognised that they would gain job satisfaction by providing continuity of care to women. Factors leading to job satisfaction identified included making a difference to the women for whom they care, working in models of care which enabled them to provide women with 'the care I want to give', and having the ability to make autonomous midwifery decisions.

Conclusion: Aligning early graduate work experiences with continuity of care models may have a positive impact on the confidence and professional development of graduate midwives, which in turn may lead to greater satisfaction and retention among a workforce already committed to supporting the maternity healthcare reform agenda.
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http://dx.doi.org/10.1016/j.wombi.2018.11.011DOI Listing
February 2020

Prospective Safety Evaluation of a Cardiovascular Health Dietary Supplement in Adults with Prehypertension and Stage I Hypertension.

J Altern Complement Med 2019 Feb 14;25(2):249-256. Epub 2018 Sep 14.

1 Helfgott Research Institute, National University of Natural Medicine, Portland, OR.

Objective: To prospectively examine the long-term safety of a cardiovascular health dietary supplement by assessing a comprehensive set of safety measures.

Design: Single-arm, open-label study.

Location: National University of Natural Medicine, Portland, OR.

Subjects: Thirty adults with screening blood pressure readings consistent with prehypertension or stage I hypertension.

Intervention: One caplet per day of a dietary supplement for 6 months. The investigated herbal-mineral supplement contains several ingredients, most notably Rauwolfia serpentina.

Outcome Measures: Primary measures included b-type natriuretic peptide (NT-proBNP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), estimated glomerular filtration rate (eGFR), electrolytes, and the Patient Health Questionnaire (PHQ-9). Exploratory measures included physical vital signs, cholesterol levels, high-sensitivity cardiac troponin-I, cystatin C, endothelin, interleukin (IL)-6, IL-17a, tumor necrosis factor-α, high-sensitivity C-reactive protein, blood counts, and the Patient Reported Outcome Measure Information System (PROMIS) Sleep Disturbance Short Form 8b.

Results: NT-proBNP, AST, ALT, eGFR, sodium, calcium, magnesium, PHQ-9 score, and the majority of exploratory measures did not change. However, serum potassium increased (p < 0.05), systolic blood pressure decreased (p < 0.0001), and diastolic blood pressure decreased (p < 0.0001). There were no serious adverse events, but 30% of participants withdrew citing potential side effects, most commonly nasal congestion or fatigue; most participants who reported nasal congestion also reported concomitant seasonal allergies. Adherence to the supplement was 90.9%.

Conclusions: The findings of this study suggest that the investigated dietary supplement is safe for long-term use in adults with prehypertension and stage I hypertension. Additional results of this study, particularly the increase in serum potassium and decreases in systolic and diastolic blood pressure, are promising and suggest that future research on this dietary supplement, or its ingredients, should further explore effects on blood pressure and biologic mechanisms of action, which may involve potassium-sparing and diuretic effects.
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http://dx.doi.org/10.1089/acm.2018.0311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389760PMC
February 2019

Oxidative damage and antioxidant defense are assay and tissue-dependent both in captive and wild-caught bank voles () before and after reproduction.

Ecol Evol 2018 Aug 6;8(15):7543-7552. Epub 2018 Jul 6.

Institute of Biology University of Białystok Białystok Poland.

Reproduction is costly and life-history theory predicts that current parental investment will result in lower survival or decreased future reproduction. The physiological mechanisms mediating the link between reproduction and survival are still under debate and elevated oxidative damage during reproduction has been proposed as a plausible candidate. Previous studies of oxidative stress during reproduction in animals under natural conditions have been restricted to analyses of blood. Herein, we measured the level of oxidative damage to lipids (tiobarbituric-acid-reactive substances) and proteins (carbonyls) in the liver, kidneys, heart and skeletal muscles in free-living bank vole females from spring and autumn generations, before and after reproduction. Antioxidant defense in the liver and kidneys was also determined. We expected oxidative damage to tissues and hypothesized that the damage would be more uniform between tissues in wild animals compared to those breeding under laboratory conditions. Considering all combinations of markers/tissues/generations, oxidative damage in females did not differ before and after reproduction in 12 comparisons, was lower after reproduction in three comparisons, and was higher after breeding in one comparison. The total glutathione was significantly increased after reproduction only in the liver of the autumn generation and there was no change in catalase activity. Our results confirm-for the first time in the field-previous observations from laboratory studies that there is no simple link between oxidative stress and reproduction and that patterns depend on the tissue and marker being studied. Overall, however, our study does not support the hypothesis that the cost of reproduction in bank voles is mediated by oxidative stress in these tissues.
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http://dx.doi.org/10.1002/ece3.4187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6106179PMC
August 2018

Making the hidden seen: A narrative analysis of the experiences of Assumption of Care at birth.

Women Birth 2019 Feb 30;32(1):e1-e11. Epub 2018 Apr 30.

University of Canberra and ACT Government Health Directorate, Australia. Electronic address:

Background: Being involved in any child protection system is complex and multifaceted and none more so than in non-voluntary Assumption of Care which occurs in New South Wales when, for child protection concerns, the Department of Family and Community Services removes a newborn baby from her/his mother.

Objective: This research studied childbearing women's and professionals' experiences of Assumption of Care at birth to increase understanding of individual participants' stories, how they made sense of meanings and how these experiences framed their lives.

Method: A narrative inquiry framework guided interviews with four groups: childbearing women, midwives, social workers and Family and Community Services case managers. Holistic form was used for reading, interpreting and analysing the narratives.

Findings: This research found unwanted emotional (isolation, shame, guilt, loss, disenfranchised grief) and physical consequences (depression, substance abuse complications) for women experiencing an Assumption of Care at the time of birth. There were also conflicting ethical and moral positions for the professionals involved. The use/abuse of power, concealment of facts and disenfranchised grief were identified as intertwined plots that caused or increased tensions.

Discussion: Both the women and the professionals felt pressure from trying to achieve competing and overlapping roles. The unwanted effects of Assumption of Care are exacerbated by the current child protection and maternity care systems.

Conclusion: To address the tensions raised in this study, we suggest a two-fold change to maternity care for women at risk of an Assumption of Care: a therapeutic justice model of maternity care and continuity of midwifery care with a dedicated midwife. Introducing these changes could increase women's and children's safety and wellbeing.
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http://dx.doi.org/10.1016/j.wombi.2018.04.009DOI Listing
February 2019

Women's motivation, perception and experience of complementary and alternative medicine in pregnancy: A meta-synthesis.

Midwifery 2018 Apr 6;59:81-87. Epub 2017 Dec 6.

Faculty of Health, Disciplines of Nursing and Midwifery, University of Canberra, Bruce, ACT 2617, Australia; University of Canberra, Building 10 Level B, College St, Bruce, ACT 2617, Australia.

Background: complementary and Alternative Medicine use during pregnancy is popular in many countries, including Australia. There is currently little evidence to support this practice, which raises the question of women's motivation for use of these therapies and the experiences they encounter.

Objective: this study aims to explore the perceptions, motivations and experiences of pregnant women with regard to their use of Complementary and Alternative Medicine during pregnancy.

Methods: a systemic review and meta-synthesis of the available research was conducted. Five databases were explored - CINAHL Plus, Medline, PubMed, AMED and Web of Science using the search terms complementary and alternative medicine; pregnancy; and pregnant. Articles included in this meta-synthesis were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses tool.

Findings: ten initial themes were drawn from the six studies. These ten themes were summarised by three cluster themes. The results suggest that women are using Complementary and Alternative Medicine in their pregnancy as a means of supporting their sense of self-determination, to pursue a natural and safe childbirth, and because they experience a close affiliation with the philosophical underpinnings of Complementary and Alternative Medicine as an alternative to the biomedical model.

Conclusion: these findings are important to practitioners, policy makers, governing bodies and researchers, providing insight into the motivations for Complementary and Alternative Medicine use by women in pregnancy.
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http://dx.doi.org/10.1016/j.midw.2017.11.007DOI Listing
April 2018

Metabolic Rate of Diploid and Triploid Edible Frog Pelophylax esculentus Correlates Inversely with Cell Size in Tadpoles but Not in Frogs.

Physiol Biochem Zool 2017 Mar/Apr;90(2):230-239. Epub 2016 Nov 17.

In multicellular organisms, cell size may have crucial consequences for basic parameters, such as body size and whole-body metabolic rate (MR). The hypothesis predicts that animals composed of smaller cells (a higher membrane surface-to-cell volume ratio) should have a higher mass-specific MR because a large part of their energy is used to maintain cell membranes and ionic gradients. In this article, we investigated the link between cell size and MR in diploid and triploid tadpoles and froglets of the hybridogenetic frog Pelophylax esculentus. In our previous study, we showed that triploids had significantly larger cells (erythrocytes, hepatocytes, and epidermal cells were measured). Therefore, we hypothesized that triploid tadpoles and froglets would have a lower standard metabolic rate (SMR). Our study demonstrated for the first time two distinct effects of polyploidy/cell size on MR within a single species developing in both aquatic and terrestrial habitats. As we hypothesized, diploid tadpoles had a higher SMR than triploids, whereas in froglets, ploidy did not affect the SMR. We also found that the water temperatures in which tadpoles were reared had no effect on the SMR of froglets after metamorphosis. Based on our results and other reports, we suggest that cell size may have more consequences for whole-body MR in aquatic habitats than in terrestrial habitats because oxygen is less available in water and its availability in relation to oxygen demand decreases with temperature.
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http://dx.doi.org/10.1086/689408DOI Listing
July 2017

Profound seasonal shrinking and regrowth of the ossified braincase in phylogenetically distant mammals with similar life histories.

Sci Rep 2017 02 13;7:42443. Epub 2017 Feb 13.

Max Planck Institute for Ornithology, Department of Migration and Immuno-ecology, 78315 Radolfzell, Germany.

Ontogenetic changes in skull shape and size are ubiquitous in altricial vertebrates, but typically unidirectional and minimal in full-grown animals. Red-toothed shrews exhibit a rare exception, where the shape, mass and size of the skull, brain, and several major organs, show significant bidirectional seasonal changes. We now show a similar but male-biased shrinking (16%) and regrowth (8%) in the standardized braincase depth of least weasels (Mustela nivalis). Juvenile weasels also exhibit a growth overshoot, followed by a shrinkage period lasting until the end of their first winter. Only male weasels then regrow during their second summer. High-resolution CT scans suggest areas of the skull are affected differently during shrinking and regrowth in both species. This suggests multiple evolutionary drivers: while the shrinking likely facilitates survival during seasonal low resource availability in these high-metabolic mammals with year-round activity, the regrowth may be most strongly influenced by high investment into reproduction and territories, which is male-biased in the weasels. Our data provide evidence for convergent evolution of skull and thus brain shrinkage and regrowth, with important implications for understanding adaptations to changing environments and for applied research on the correlated changes in bone structure, brain size and the many other affected organs.
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http://dx.doi.org/10.1038/srep42443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304206PMC
February 2017

A researcher's journey: Exploring a sensitive topic with vulnerable women.

Women Birth 2017 Feb 26;30(1):63-69. Epub 2016 Aug 26.

Midwifery University of Canberra, Australia; ACT Government Health Directorate, Australia.

Background: The conduct of research regardless of the subject or methods employed brings responsibilities and challenges. These are greater when dealing with sensitive topics and vulnerable groups and therefore researchers must navigate a range of complex issues and make choices in relation to practical, ethical and philosophical concerns. While literature dealing with research methodologies and research design may assist to some degree, it cannot provide a clear pathway or template as each research project must respond to a unique set of circumstances. We can however, also learn from sharing our stories and critical reflections on our research processes.

Objective: The purpose of this article is to highlight the practical and methodological issues arising from researching a sensitive topic with vulnerable women experiencing an Assumption of Care.

Discussion: Research involving topics that are deeply personal and private combined with a vulnerable population can be complex and challenging for the researcher. Although some issues were anticipated from the literature, others encountered in this study were unexpected. Special considerations and prerequisites were necessary to build mutual trust and share power with women who had experienced an Assumption of Care at birth. Narrative Inquiry was a good methodological fit for this study as it privileged the voices of women and insisted that their experiences be considered within the context of their lives.

Conclusion: Although Narrative Inquiry is a suitable choice for researching sensitive topics with vulnerable women specific considerations are still required to ensure the benefits of this research for both participants and researchers. Family and Community Service (FACS) have now replaced the formerly known Department of Community Services (DoCS) and in consideration of the timing of this study this article uses the terminology as DoCS.
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http://dx.doi.org/10.1016/j.wombi.2016.07.003DOI Listing
February 2017

The right way and the wrong way of getting out of a chair.

Authors:
Jan Taylor

Nurs Stand 2016 Apr;30(35):32

Many thanks for publishing our article 'An integrated practice approach to mobility care for older people' (CPD, March 16). It looked great, however I have one comment. The picture on the Contents page to help locate the article in the magazine is misleading. It illustrates a common mistake when assisting people with mobility; encouraging or letting them put their hands on their walker when they attempt to stand.
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http://dx.doi.org/10.7748/ns.30.35.32.s38DOI Listing
April 2016

Low Temperature and Polyploidy Result in Larger Cell and Body Size in an Ectothermic Vertebrate.

Physiol Biochem Zool 2016 Mar-Apr;89(2):118-29. Epub 2016 Jan 13.

Previous studies reported that low temperatures result in increases in both cell size and body size in ectotherms that may explain patterns of geographic variation of their body size across latitudinal ranges. Also, polyploidy showed the same effect on body size in invertebrates. In vertebrates, despite their having larger cells, no clear effect of polyploidy on body size has been found. This article presents the relationship between temperature, cell size, growth rate, and body size in diploid and polyploid hybridogenetic frog Pelophylax esculentus reared as tadpoles at 19° and 24°C. The size of cells was larger in both diploid and triploid tadpoles at 19°C, and triploids had larger cells at both temperatures. In diploid and triploid froglets, the temperature in which they developed as tadpoles did not affect the size of their cells, but triploids still had larger cells. Triploid tadpoles grew faster than diploids at 19°C and had larger body mass; there was no clear difference between ploidies in growth rate at 24°C. This indicates better adaptation of triploid tadpoles to cold environment. This is the first report on the increase of body mass of a polyploid vertebrate caused by low temperature, and we showed relationship between increase in cell size and increased body mass. The large body mass of triploids may provide a selective advantage, especially in colder environments, and this may explain the prevalence of triploids in the northern parts of the geographic range of P. esculentus.
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http://dx.doi.org/10.1086/684974DOI Listing
January 2017

Sense of coherence and women׳s birthing outcomes: A longitudinal survey.

Midwifery 2016 Mar 2;34:158-165. Epub 2015 Dec 2.

Faculty of Health, University of Canberra, ACT 2617, Australia.

Background: in Western countries, caesarean section rates are increasing at an alarming rate. This trend has implications for women׳s health and calls into question the use of pathogenesis to frame maternity services. The theory of salutogenesis offers an alternative as it focuses on health rather than illness. Sense of coherence (SOC), the cornerstone of salutogenesis, is a predictive indicator of health. This study aimed to explore associations between pregnant women׳s SOC, their birthing outcomes and factors associated with SOC changes.

Methods: a longitudinal survey was conducted where women completed a questionnaire in the antenatal and postnatal period. Questionnaire one provided information on SOC scores, Edinburgh Postnatal Depression Scale (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. Questionnaire two provided information on SOC scores, EPDS scores and birthing outcomes.

Findings: 1074 women completed questionnaire one and 753 women completed questionnaire two. Compared to women with low antenatal SOC, women with high antenatal SOC were less likely to experience caesarean section (OR 0.437 95% CI 0.209-0.915) and more likely to experience assisted vaginal birth (AVB) (OR 3.108 95% CI 1.557-6.203). Higher birth satisfaction, higher antenatal EPDS scores and lower antenatal SOC were associated with an increase in SOC. Epidural, AVB and decreased birth satisfaction were associated with a decrease in SOC.

Conclusion: high sense of coherence in pregnant women is associated with half the likelihood of caesarean section compared to women with low sense of coherence. Women׳s sense of coherence is raised and lowered by degree of satisfaction with their births and lowered by some labour interventions.
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http://dx.doi.org/10.1016/j.midw.2015.11.017DOI Listing
March 2016

Embedding continuity of care experiences: An innovation in midwifery education.

Midwifery 2016 Feb 22;33:40-2. Epub 2015 Nov 22.

School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia.

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http://dx.doi.org/10.1016/j.midw.2015.11.014DOI Listing
February 2016

Reproduction is not costly in terms of oxidative stress.

J Exp Biol 2015 Dec 30;218(Pt 24):3901-10. Epub 2015 Oct 30.

Department of Animal Ecology, Institute of Biology, University of Białystok, Ciołkowskiego 1 J, Białystok 15-245, Poland

One of the core assumptions of life-history theory is the negative trade-off between current and future reproduction. Investment in current reproduction is expected to decrease future reproductive success or survival, but the physiological mechanisms underlying these costs are still obscure. To test for a role of oxidative stress, we measured oxidative damage to lipids and proteins in liver, heart, kidneys and muscles, as well as the level of antioxidants (total glutathione and catalase), in breeding and non-breeding bank voles. We used females from lines selected for high aerobic metabolism and non-selected control lines and manipulated their reproductive investment by decreasing or increasing litter size. Unlike in most previous studies, the females reared four consecutive litters (the maximum possible during a breeding season). Contrary to predictions, oxidative damage in reproducing females was decreased or not changed, and did not differ between the selected and control lines. Oxidative damage to lipids and proteins in the liver was lower in females that weaned enlarged litters than in non-breeding ones, and was intermediate in those with reduced litters. Oxidative damage to proteins in the heart also tended to be lower in breeding females than in non-breeding ones. A negative relationship between the level of oxidative damage and activity of catalase in kidneys indicated a protective action of antioxidants. In conclusion, our study falsified the hypothesis that oxidative stress is a part of the proximate physiological mechanism underlying the fundamental life-history trade-off between current and future reproduction.
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http://dx.doi.org/10.1242/jeb.126557DOI Listing
December 2015

Sense of coherence and childbearing choices: A cross sectional survey.

Midwifery 2015 Nov 29;31(11):1081-6. Epub 2015 Jul 29.

Faculty of Health, University of Canberra, ACT 2617, Australia.

Background: as concern for increasing rates of caesarean section and interventions in childbirth in Western countries mounts, the utility of the risk approach (inherent in the biomedical model of maternity care) is called into question. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. We hypothesised that there is a relationship between a woman's SOC and the childbirth choices she makes in pregnancy.

Methods: the study aims to investigate the relationship between SOC and women's pregnancy and anticipated labour choices. A cross sectional survey was conducted where eligible women completed a questionnaire that provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics.

Findings: 1074 pregnant women completed the study. Compared to women with low SOC, women with high SOC were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with women's pregnancy choices.

Conclusion: this study relates SOC to physical and emotional health in pregnancy as women with high SOC were less likely to identify pregnancy conditions, had less depressive symptoms and perceived higher levels of support compared to women with low SOC. Interestingly, SOC was not associated with pregnancy choices known to increase normal birth rates. More research is required to explore the relationship between SOC and women's birthing outcomes.
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http://dx.doi.org/10.1016/j.midw.2015.07.012DOI Listing
November 2015

Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital.

Women Birth 2015 Dec 17;28(4):279-84. Epub 2015 Jul 17.

University of Canberra, Bruce, ACT, Australia; Centenary Hospital for Women and Children, ACT, Australia.

Background: There is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth.

Aim: The aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital.

Methods: A retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05.

Results: Data for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p=0.002) and spontaneous vaginal birth (38% vs. 22.4% p=<0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p=0.050) and caesarean sections (18.8% vs. 22.5% p=0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes.

Conclusion: Strategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population.
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http://dx.doi.org/10.1016/j.wombi.2015.06.005DOI Listing
December 2015

Examining the Validity and Reliability of Antonovsky's Sense of Coherence Scale in a Population of Pregnant Australian Women.

Eval Health Prof 2015 Jun 29;38(2):280-9. Epub 2015 Mar 29.

Faculty of Health, University of Canberra, Australian Capital Territory, Australia.

Antonovsky's Orientation to Life questionnaires were developed to measure sense of coherence (SOC). Although the SOC 13 instrument is widely used to measure health in general populations, it has not been assessed in pregnant women. If the SOC 13 is to be used to assess women's childbearing health, it requires further examination. The purpose of the research is to assess the psychometric properties of Antonovsky's SOC 13 questionnaire in pregnant women. When administered to 718 pregnant Australian women, the construct validity of the SOC 13 was difficult to establish. The SOC 9 was created by removing 4 items and provided best data fit. The SOC 13 and SOC 9 were found to have sound criterion validity, internal reliability, and equivalence between versions. It is hoped that the present study will stimulate additional research on SOC scales to examine their ability to assess women's childbearing health.
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http://dx.doi.org/10.1177/0163278715578558DOI Listing
June 2015

Guilty until proven innocent?--the Assumption of Care of a baby at birth.

Women Birth 2015 Mar 8;28(1):65-70. Epub 2014 Dec 8.

Faculty of Health/Midwifery, University of Canberra, ACT 2601, Australia.

Background: This paper provides an overview of the history of child protection, the associated law and the 2008 amendments to the Child and Young Persons (Care and Protection) Act 1998 in relation to the Assumption of Care at birth practice.

Objective: To explore the current practice of an Assumption of Care (AOC) where a newborn baby is removed from his/her mother at the time of birth, particularly focussing on the impact of the AOC on midwives.

Discussion: Assumption of Care practices in NSW raise significant issues for midwives in relation to the midwifery codes of ethics and conduct and importantly, to their ability to work in ways that honour a "woman-centred care" philosophy. When midwives are exposed to conflict between workplace and personal or professional values such as the practice of AOC cognitive dissonance can occur.

Conclusions: Further research is required to understand the impact of current Assumption of Care. Broader research to not only look at effect on the midwife but also on other health professionals involved and the women who personally experience the removal of their baby at the time of birth. Consideration must also be given to ways of working with vulnerable families to enhance the acceptability and efficacy of maternity services and with associated agencies will decrease the need for Assumption of Care at birth.
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http://dx.doi.org/10.1016/j.wombi.2014.10.008DOI Listing
March 2015

The GOBLET training portal: a global repository of bioinformatics training materials, courses and trainers.

Bioinformatics 2015 Jan 4;31(1):140-2. Epub 2014 Sep 4.

The Genome Analysis Centre, Norwich, ELIXIR, Wellcome Trust Genome Campus, Hinxton, UK, The Swedish University for Agricultural Sciences, Uppsala, Sweden, European Molecular Biology Laboratory, Heidelberg, Germany, Ontario Institute for Cancer Research, Toronto, Canada, Instituto Gulbenkian de Ciência, Oeiras, Portugal, The University of New South Wales, Sydney, Australia, Netherlands Bioinformatics Centre, Department of Bioinformatics, Radboud Medical Center, Nijmegen, The Netherlands, CSC - IT Center for Science Ltd., Espoo, Finland, Whitehead Institute for Biomedical Research, MIT, Cambridge, MA, USA, CSIRO, Bioinformatics Core, Canberra, Australia, The Sainsbury Laboratory, Norwich Research Park, Norwich, UK, SIB Swiss Institute of Bioinformatics, 1 Rue Michel Servet, Genève, Switzerland, Academis, Illstrasse 12, 12161 Berlin, Germany, The Nowgen Centre, 29 Grafton Street, Manchester, UK, Department of Physics, Sapienza University, Rome, Italy, The Roslin Institute, Edinburgh, UK and The University of Manchester, Manchester, UK.

Summary: Rapid technological advances have led to an explosion of biomedical data in recent years. The pace of change has inspired new collaborative approaches for sharing materials and resources to help train life scientists both in the use of cutting-edge bioinformatics tools and databases and in how to analyse and interpret large datasets. A prototype platform for sharing such training resources was recently created by the Bioinformatics Training Network (BTN). Building on this work, we have created a centralized portal for sharing training materials and courses, including a catalogue of trainers and course organizers, and an announcement service for training events. For course organizers, the portal provides opportunities to promote their training events; for trainers, the portal offers an environment for sharing materials, for gaining visibility for their work and promoting their skills; for trainees, it offers a convenient one-stop shop for finding suitable training resources and identifying relevant training events and activities locally and worldwide.

Availability And Implementation: http://mygoblet.org/training-portal.
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http://dx.doi.org/10.1093/bioinformatics/btu601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4271145PMC
January 2015

"Continuity of care" experiences in midwifery education: perspectives from diverse stakeholders.

Nurse Educ Pract 2014 Sep 13;14(5):573-8. Epub 2014 Apr 13.

The University of Canberra, Faculty of Health, Canberra, ACT 2601, Australia. Electronic address:

At least 20 continuity-of-care experiences are compulsory for student midwives in Australia, but little is known about this learning component. This paper presents an analysis of continuity experiences in one Region, incorporating diverse stakeholder perspectives from student midwives, maternity managers and registered midwives, with the aim of better understanding and optimizing experiences. Qualitative methods were utilized, employing mainly focus groups. Participants included 15 student midwives from the Regional University, 14 midwives and six managers, employed at the Regional referral hospital. Four themes were identified in the data; "woman-centred care", "counting the cost", "mutual benefits" and "into the future". The significant benefits of student continuity-of-care experiences were outlined by all three participant groups. Continuity experiences for student midwives facilitated the development of a woman-centred focus in the provision of maternity care. While the experience was challenging for students it was beneficial not only to them, but to registered midwives, the maternity services, and ultimately childbearing women. In order to appropriately prepare midwives for existing and future maternity services, and to continue to meet women's needs in all service delivery models, we require midwives who are well grounded in a woman-centred care philosophy and have had exposure to various care models.
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http://dx.doi.org/10.1016/j.nepr.2014.01.014DOI Listing
September 2014

Hospital affiliations, co-branding, and consumer impact.

Health Mark Q 2014 ;31(1):65-77

a Marketing Department , UK HealthCare , Lexington , Kentucky.

Alliances, affiliations, and partnerships continue to grow as one way for health care organizations to better serve their customers and compete with other organizations and networks. These organizational relationships are often promoted through co-branding joint programs and services. A study of consumers was conducted and shows that these organizational relationships positively affect consumer future behavior and benefit the organizations involved. Most importantly, the benefits of these organizational relationships grow as familiarity and understanding of the "new" partner in the market increases.
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http://dx.doi.org/10.1080/07359683.2014.874873DOI Listing
August 2015