BACKGROUND & AIMS: :Using a national data base of urban hospitals, the effect of ownership (government, nonprofit, and for-profit) on the technical efficiency of hospitals was examined. Efficiency scores were computed using a method called data envelopment analysis. Controlling for environmental and hospital characteristics, for-profit hospitals were found somewhat less frequently and government hospitals consistently more frequently in the efficient category. When examining highly inefficient hospitals as a percentage of those receiving inefficient scores, for-profit hospitals appeared to be highly inefficient relative to the other ownership forms. Government and nonprofit hospitals were somewhat indistinguishable from one another regarding their percentages of highly inefficient scores. For-profit hospitals also tended to use supply and capital asset (hospital size) inputs less efficiently, and service and labor inputs more efficiently than hospitals in the other ownership categories.

背景与目标： : 使用国家城市医院数据库，检查了所有权 (政府，非营利组织和营利性) 对医院技术效率的影响。使用称为数据包络分析的方法计算效率得分。在控制环境和医院特征的情况下，发现营利性医院的频率降低了，而在有效类别中，政府医院的频率始终更高。当检查效率低下的医院占得分低下的医院的百分比时，相对于其他所有权形式，营利性医院似乎效率低下。政府和非营利性医院在效率低下的分数中所占的百分比彼此之间没有区别。营利性医院也倾向于使用供应和资本资产 (医院规模) 投入的效率较低，服务和劳动力投入的效率也高于其他所有权类别的医院。

BACKGROUND & AIMS: PURPOSE:Written asthma action plans (WAAPs) have become a core component of asthma management in Australia. We investigated ownership, utilisation and factors associated with ownership of asthma action plans by caregivers. METHODS:443/776 (57%) caregivers of children aged 2-14 years with asthma were identified from 32 GP clinics as part of a randomised controlled trial (RCT), and completed self-administered questionnaires. RESULTS:Only 29% of participants owned a WAAP, while 13% possessed verbal instructions, and 56% had no plan. An asthma action plan for children, which was developed by a general practitioner (GP) was more likely to comprise verbal instructions (p = 0.001), while action plans developed by paediatricians were more likely to be written (p < 0.001). Just over one half of caregivers (59%) reported discussing their child's action plan the last time they visited their doctor for asthma. Factors associated with WAAP ownership included nights waking (p = 0.013), self reported severity (p = 0.001), and days lost from school (p = 0.037). Children who had seen a GP in the last 3 months for asthma, or who had been to the Emergency Department (ED) or hospital were more likely to possess a WAAP (p < 0.001). Caregivers who were less satisfied with their child's asthma control were more likely to own a WAAP (p = 0.037). Caregivers with any action plan found it useful and 82% reported using their action plan for management of an acute attack. However, caregivers with a WAAP were more likely to adhere to the plan for an acute attack compared to caregivers with verbal instructions (OR = 4.5, p < 0.05). Caregivers with a WAAP were more knowledgeable about asthma (p = 0.002), better able to recognise the difference between preventer and reliever medications (p = 0.01), and better able to recognise an asthma attack (p = 0.006). CONCLUSIONS:Ownership of WAAPs in this group was still too low. Importantly, caregivers with written instructions were more knowledgeable about asthma and more likely to report following the action plan during an asthma attack.

背景与目标：

BACKGROUND & AIMS: :The US hospice industry, which provides palliative and supportive care to patients with terminal illness, has undergone substantial changes during the last decade. The magnitude of these changes has not been fully captured in previous studies or reports. In this longitudinal study of hospices active in Medicare during 1999-2009, we analyzed Provider of Services files to understand key shifts in the industry. We found evidence of substantial turbulence. One-fifth of Medicare-certified hospices active in 1999 had closed or withdrawn from the program by 2009, and more than 40 percent had experienced one or more changes in ownership. The most prominent trend was the shift in ownership type from nonprofit to for-profit ownership. Four out of five Medicare-certified hospices that entered the marketplace between 2000 and 2009 were for-profit. Hospices also became larger, as the proportion with 100 or more full-time employees doubled to 5 percent from 1999 to 2009. Although each of the Census regions had more hospices in 2009 than in 1999, the geographic distribution of hospices in the country changed, with proportionally more in the South and West. The impact of all of these changes on cost and quality of hospice care, as well as patient access, remains a critical area for future research.

背景与目标： : 美国临终关怀行业为绝症患者提供姑息和支持性护理，在过去十年中发生了重大变化。这些变化的幅度在以前的研究或报告中尚未完全捕捉到。在这项对1999-2009年期间活跃于Medicare的临终关怀的纵向研究中，我们分析了服务文件的提供者，以了解该行业的主要变化。我们发现了大幅湍流的证据。五分之一的医疗保险认证的收容所活跃1999年已经关闭或退出该计划2009年，超过40% 的人经历了一次或多次所有权变更。最突出的趋势是所有权类型从非营利性向营利性所有权的转变。进入市场的五分之四的经过医疗保险认证的收容所2000年和2009是营利性的。收容所也变得更大，因为拥有100名或更多全职员工的比例翻了一番，达到5% 名1999年2009年。尽管每个人口普查地区的收容所2009年都比1999年多，但该国收容所的地理分布发生了变化，南部和西部的收容所比例更大。所有这些变化对临终关怀的成本和质量以及患者的访问的影响仍然是未来研究的关键领域。

BACKGROUND & AIMS: BACKGROUND:Dog ownership has been associated with higher rates of physical activity (PA) in several populations but no study to date has focused on cancer survivors. The purpose of this study was to examine the associations between dog ownership and PA among cancer survivors and to examine correlates of dog ownership. METHODS:A stratified random sample of 2062 breast cancer survivors, prostate cancer survivors, and colorectal cancer survivors was mailed a questionnaire assessing PA, social cognitive, dog ownership, demographic, and medical variables. RESULTS:Overall, 25% of the sample was dog owners (DOs). There were no significant differences in moderate, vigorous, or total PA minutes between DOs and non-dog owners. There was a significant difference in light PA minutes in favor of DOs (153 vs 112 minutes; 95% CI = 4 to 77; P = .030), however, this was largely restricted to breast cancer survivors (143 vs 79 minutes; 95% CI = 25 to 102; P = .001) who also reported fewer vigorous PA minutes (18 vs 39 minutes; 95% CI = -42 to -1; P = .042). Survivors were more likely to be DOs if they had breast cancer (P = .054), a higher income (P = .021), radiation therapy (P = .029), chemotherapy (P = .010), were younger (P < .001), employed (P < .001), and a current smoker (P = .015). Few social cognitive variables were associated with DO. CONCLUSIONS:Dog ownership among cancer survivors was not associated with moderate-to-vigorous PA but was associated with light PA. Further research is necessary to determine if promoting dog ownership and dog walking among cancer survivors may increase PA and possibly improve health outcomes.

背景与目标：

BACKGROUND & AIMS: :In most taxa, owners win fights when defending a territory against intruders. We calculated effect sizes for four factors that potentially contribute to an 'owner advantage'. We studied male fiddler crabs Uca mjoebergi, where owners won 92% of natural fights. Owners were not more successful because they were inherently better fighters (r=0.02). There was a small effect (r=0.18) of the owner's knowledge of territory quality (food availability) and a medium effect (r=0.29) of his having established relations with neighbours (duration of active tenure), but neither was statistically significant. There was, however, a significant effect due to the mechanical advantage the owner gained through access to the burrow during fights (r=0.48, p<0.005).

背景与目标： : 在大多数分类单元中，所有者在捍卫入侵者的领土时会赢得战斗。我们计算了四个可能有助于 “所有者优势” 的因素的效应大小。我们研究了雄性招潮蟹Uca mjoebergi，那里的主人赢得了92% 的自然战斗。所有者并没有更成功，因为他们本质上是更好的战斗机 (r = 0.02)。所有者对领土质量 (食物供应) 的了解有很小的影响 (r = 0.18)，而与邻居建立关系 (有效任期的持续时间) 有中等影响 (r = 0.29)，但都没有统计学意义。但是，由于所有者在战斗中通过进入洞穴获得的机械优势而产生了显着影响 (r = 0.48，p<0.005)。

BACKGROUND & AIMS: :Body ownership can be experimentally investigated with the rubber hand illusion (RHI), in which watching a rubber hand stroked synchronously with one's own hidden hand induces a feeling of ownership over the rubber hand. The aim of this study was to investigate response to the RHI in high (N = 21) and low (N = 19) hypnotizable individuals in normal waking state and in hypnosis. Response to the RHI was measured via a question on the illusory feeling of ownership and with proprioceptive drift. The Highs expressed an overall feeling of more ownership over the rubber hand in both the normal waking state and hypnosis, although both groups gave higher ownership scores after synchronous than after asynchronous stroking and the difference between conditions was similar across groups. Conversely, the proprioceptive drift appeared to be differentially modulated by hypnosis and hypnotic suggestibility: it was increased in the Highs and decreased in the Lows after hypnosis induction. These findings hint at an interplay between hypnotic suggestibility and hypnosis in modulating response to the RHI. The selective breakdown of proprioceptive drift among the Lows suggests resistance to recalibrate one's own limb in hypnosis.

背景与目标： : 身体所有权可以通过橡胶手幻觉 (RHI) 进行实验研究，在这种幻觉中，看着橡胶手与自己的隐藏手同步抚摸会产生对橡胶手的所有权感。这项研究的目的是调查在正常清醒状态和催眠状态下，高 (n   =   21) 和低 (n   =   19) 可催眠个体对RHI的反应。对RHI的反应是通过一个关于虚幻的所有权感觉和本体感受漂移的问题来衡量的。在正常的清醒状态和催眠状态下，尽管两组在同步后的所有权得分均高于异步抚摸后的所有权得分，并且两组之间的条件差异相似，但高点总体上表示对橡胶手拥有更多所有权。相反，本体感受漂移似乎受到催眠和催眠暗示性的不同调节: 催眠诱导后，它在高点增加，在低点减少。这些发现暗示了催眠暗示和催眠在调节对RHI的反应中的相互作用。在低点之间本体感受漂移的选择性分解表明，在催眠过程中抵制重新校准自己的肢体。

BACKGROUND & AIMS: :There is notorious inconsistency regarding mental health benefits of dog ownership, partially due to repeated cross-sectional studies comparing dog owners and non-owners, without taking into account the heterogeneity of dog-owner dyads, especially the activities with which the owners are involved. This study aimed to develop a comprehensive framework of the most important dog human related activities and their impact on owner well-being. Six focus groups with 35 dog owners were conducted, and their audio transcripts thematically analysed. Dog human related activities and themes of activities were linked to their reported changes in well-being through matrix coding. A framework of 58 dog human related activities linked with their specific hedonic well-being, life satisfaction and eudaimonic well-being outcomes was generated. Most activities were reported to improve owner's well-being, (e.g. human-dog tactile interaction increases owner's self-esteem), and a minority was mainly associated with negative outcomes. The richness of the framework presented in this study reinforces the importance of assessing dog ownership well-being outcomes based on specific dog human related activities with which dog owners are involved. This new and systematic investigative approach should decrease inconsistencies in the field and facilitate mental health interventions and study designs of a higher level of evidence.

背景与目标： : 关于养狗的精神卫生利益存在着臭名昭著的不一致，部分原因是反复比较养狗人和非养狗人的横断面研究，而没有考虑到养狗人二元组的异质性，尤其是养狗人参与的活动。这项研究旨在为最重要的与狗有关的人类活动及其对主人福祉的影响制定一个全面的框架。由35位狗主人组成的六个焦点小组进行了主题分析，并对其音频记录进行了主题分析。与狗有关的人类活动和活动主题通过矩阵编码与其报告的幸福感变化联系在一起。产生了58种与狗有关的人类相关活动的框架，这些活动与其特定的享乐感，生活满意度和eudaimonic幸福感相关。据报道，大多数活动都是为了改善主人的幸福感 (例如，人与狗的触觉互动会增加主人的自尊心)，而少数人主要与负面结果有关。本研究中提出的框架的丰富性加强了根据狗主人参与的特定与狗人类相关的活动评估狗的所有权福祉结果的重要性。这种新的系统调查方法应减少现场的不一致之处，并促进精神卫生干预和更高水平证据的研究设计。

BACKGROUND & AIMS: :Introduction The Statement from the American Heart Association has emphasized a need for novel strategies that can reduce the risk of cardiovascular disease (CVD). Taking a dog for a walk forces its owner to take physical activity. Several studies have explored the relationship between pet ownership and CVD and most reported benefits. This issue has not been investigated in dialysis patients. The aim of the study was to analyze the influence of pet ownership on health and physical activity in hemodialysis patients. Methods 270 chronic hemodialysis patients (172 male, 98 female, mean age 62.7 ± 14.0 years, hemodialysis vintage 4 ± 5 years) took part in the survey focused on their general health and physical activity. Findings Two hundred nineteen (81%) patients were mobile. One hundred sixteen participants had dog at home (43%). An additional physical activity was reported by 46 dog owners (40%) compared with 34 (23%) of nonowners (P = 0.002). Patients who often go for a walk were more often pet owners 49 (57%) than nonowners (n = 37, 43%; P = 0.004). Pet owners were younger (58.3 ± 13.6 vs. 66 ± 13.5 years). Body mass index (BMI) was similar. Patients with BMI from upper tertile (>27.5 kg/m(2) ) and from lower (<23.9) were more often dog owners than from the middle (52.9%, 43.7%, and 31.4%). Dog owners were on dialysis for longer time (5.0 ± 6.5 vs. 3.5 ± 3.7 years; P = 0.02). Discussion Dog ownership appears to positively influence the level of physical activity. Age but not time on dialysis seems to be the most important factor that influences a decision to own a pet and undertake physical activity.

背景与目标： : 简介美国心脏协会的声明强调了需要新的策略来降低心血管疾病 (CVD) 的风险。带狗散步迫使它的主人进行体育锻炼。几项研究探讨了宠物所有权与CVD之间的关系以及大多数报告的益处。尚未在透析患者中研究此问题。该研究的目的是分析宠物所有权对血液透析患者健康和身体活动的影响。方法270例慢性血液透析患者 (男172例，女98例，平均年龄62.7   ±   14.0岁，血液透析年限4   ±   5岁) 参加调查，重点关注其一般健康状况和身体活动情况。结果发现有219 (81%) 名患者是流动的。一百十六名参与者家里有狗 (43%)。与34 (23%) 的非主人 (p   =   0.002) 相比，46个狗主人 (40%) 报告了额外的身体活动。经常散步的患者是宠物主人49 (57%)，而不是非主人 (n   =   37，43%; P   =   0.004)。宠物主人更年轻 (58.3   ±   13.6对66   ±   13.5岁)。体重指数 (BMI) 相似。上三等分 (> 27.5千克/m(2)) 和下三等分 (<23.9) 的BMI患者比中间 (52.9%，43.7% 和31.4%) 的狗主人更常见。养犬人接受透析的时间较长 (5.0   ±   6.5 vs. 3.5   ±   3.7年; P   =   0.02)。讨论狗的所有权似乎对体育锻炼水平产生了积极影响。年龄而不是透析时间似乎是影响决定拥有宠物和进行体育锻炼的最重要因素。

BACKGROUND & AIMS: BACKGROUND:Sleeping under insecticide-treated mosquito nets/long-lasting insecticidal nets (ITNs/LLINs henceforth referred to as ITNs) is one of the core interventions recommended by the World Health Organization to reduce malaria transmission and prevent malaria in high-risk communities, such as migrants, by preventing mosquito bites. The malaria burden among the migrant population is a big challenge for malaria elimination in Myanmar. In this context, this study aimed to assess the ownership and utilization of ITNs and to understand the barriers to distribution and utilization of ITNs among the high-risk migrant communities in the Regional Artemisinin Resistance Initiative (RAI) project areas of Myanmar. METHODS:A sequential mixed methods study (quantitative component: cross-sectional study involving analysis of secondary data available from a survey conducted among migrant households in the RAI project areas of Myanmar in 2016 followed by a descriptive qualitative component in 2018). A total of 17 focus group discussions (involving 121 participants) with different groups of migrants and 17 key-informant interviews with key programme stakeholders were conducted in 4 selected townships of RAI project areas. RESULTS:Of 3230 migrant households, 63.3% had at least one ITN while 36% had sufficient ITNs (i.e., 1 ITN per 2 persons). Regarding ITN utilization, about 52% of household members reported sleeping under an ITN the previous night, which is similar among under-fives and pregnant women. Over half of all bed nets were ITNs, with nearly one-third having holes or already undergone repairs. The qualitative findings revealed that the key challenges for ITN utilization were insufficient ITNs in households and dislike of ITNs. The barriers to ITN distribution were incomplete migrant mapping due to resource constraints (time, money, manpower) and difficulties in transportation and carrying ITNs. CONCLUSION:This study highlights poor ownership and utilization of ITNs among migrants in the RAI project areas of Myanmar and barriers to their ownership and utilization. To achieve universal coverage and utilization, more programmatic support by the programme is needed to carry out complete migrant mapping and continuous ITN distribution in remote locations.

背景与目标：

BACKGROUND & AIMS: :Body 'ownership' defines which things belong to us and can be manipulated by signals from cutaneous or muscle receptors. Whether signals from muscle proprioceptors on their own influence perceived ownership is unknown. We used finger-joint movement to induce illusory ownership of an artificial finger without vision. We coupled the subject's index finger to an artificial finger 12 cm above it. The experimenter held the subject's other index finger and thumb on the artificial finger and passively moved them congruently or incongruently for 3 min with the index finger and the grasping index finger and thumb intact or anaesthetised. When intact, congruent movement (19 subjects) reduced perceived vertical distance between index fingers to 1.0 (0.0, 2.0) cm [median (IQR)] from 3.0 (3.0, 4.0) cm with incongruent movement (P < 0.01). Simply grasping the artificial finger reduced perceived spacing between the grasping and test index fingers from 6.0 (5.0, 9.0) cm to 3.0 (3.0, 6.0) cm (P < 0.01), a new grasp illusion. Digital anaesthesia eliminated this grasp effect, after which congruent movement still reduced the perceived spacing between the index fingers to 1.0 (0.0, 2.75) cm compared to 4.0 (3.25, 6.0) cm with incongruent movement (P < 0.001). Subjects more strongly agreed that they were holding their own finger after congruent but not incongruent movement (P < 0.01). We propose that the brain generates possible scenarios and tests them against available sensory information. This process can function without vision or motor commands, and with only one channel of somatic information.

背景与目标： : 身体的 “所有权” 定义了哪些东西属于我们，并且可以通过来自皮肤或肌肉受体的信号来操纵。来自肌肉本体感受器的信号对其自身的影响是否感知所有权是未知的。我们使用手指关节运动来诱导没有视力的人造手指的虚幻所有权。我们将对象的食指与12厘米在其上方的人造手指耦合。实验者将受试者的另一食指和拇指握在人造手指上，并在食指和握持的食指和拇指完整或麻醉的情况下被动地一致或不一致地移动它们3分钟。当完整时，全等运动 (19名受试者) 将食指之间的感知垂直距离从3.0 (3.0，4.0) cm减少到1.0 (0.0，2.0) cm [中值 (IQR)]，运动不一致 (P <0.01)。简单地抓取人工手指将抓取和测试食指之间的感知间距从6.0 (5.0，9.0) cm减少到3.0 (3.0，6.0) cm (P <0.01)，这是一种新的抓取错觉。数字麻醉消除了这种抓握效果，此后，与具有不一致运动的4.0 (3.25，6.0) cm相比，全等运动仍将食指之间的感知间距减小到1.0 (0.0，2.75) cm (P <0.001)。受试者更强烈地同意，他们在一致但不一致的运动后握住自己的手指 (P <0.01)。我们建议大脑生成可能的场景，并根据可用的感觉信息对其进行测试。此过程可以在没有视觉或运动命令的情况下运行，并且仅具有一个躯体信息通道。

BACKGROUND & AIMS: OBJECTIVES:In this study we explored the association between rates of household firearm ownership and homicide across the United States, by age groups. METHODS:We used cross-sectional time-series data (1988-1997) to estimate the association between rates of household firearm ownership and homicide. RESULTS:In region- and state-level analyses, a robust association between rates of household firearm ownership and homicide was found. Regionally, the association exists for victims aged 5 to 14 years and those 35 years and older. At the state level, the association exists for every age group over age 5, even after controlling for poverty, urbanization, unemployment, alcohol consumption, and nonlethal violent crime. CONCLUSIONS:Although our study cannot determine causation, we found that in areas where household firearm ownership rates were higher, a disproportionately large number of people died from homicide.

背景与目标：

BACKGROUND & AIMS: :There is growing concern about the operations of the municipal agencies responsible for supplying potable water and treating sewage, spurred by (1) difficulties of maintaining aging capital stocks in times of tightening fiscal constraints, (2) the water pollution generated by these agencies, (3) problems associated with service quality and reliability, and (4) the recognition of the role played by utilities in allocating scarce water resources. These concerns have lead to a heightened scrutiny of these agencies with increased interest in reforming their operations. In particular, this has focused on an examination of whether the ownership of water utilities is a factor explaining their behavior and whether changing their ownership will lead to improvements in their operations. The purpose of this paper was to critically assess what is known regarding the relationship between the ownership and performance of municipal water utilities. There are a number of theoretical arguments that support the prediction that privately owned water utilities will out-perform comparable publicly funded utilities. These arguments draw on property-rights and public choice theories and principle agent models in order to emphasize the difficulty that governments have in monitoring and providing proper incentives for utility managers. Empirical evidence was obtained from the United States, the United Kingdom, and France based on a variety of performance indicators. These data revealed that there was no compelling evidence of private utilities outperforming public utilities or that privatizing water utilities leads to improvements in performance.

背景与目标： : 由于 (1) 在财政紧缩时期难以维持老化的资本存量，(2) 这些机构产生的水污染，(3) 与服务质量和可靠性相关的问题，以及 (4) 认识到公用事业在分配稀缺水资源方面所起的作用。这些担忧导致对这些机构的审查更加严格，对改革其业务越来越感兴趣。特别是，这集中在检查自来水公司的所有权是否是解释其行为的一个因素，以及改变其所有权是否会导致其运营的改善。本文的目的是严格评估有关市政自来水公司所有权与绩效之间关系的已知知识。有许多理论论点支持以下预测: 私人自来水公司的性能将超过可比的公共公用事业。这些论点借鉴了产权和公共选择理论以及主要代理模型，以强调政府在监督和为公用事业管理者提供适当激励方面的困难。根据各种绩效指标，从美国，英国和法国获得了经验证据。这些数据显示，没有令人信服的证据表明私人公用事业的表现优于公用事业，或者将公用事业私有化可以改善绩效。

BACKGROUND & AIMS: :Schizophrenia is a severe psychiatric disorder, in which patients experience an abnormal sense of self. While deficits in sensorimotor self-representation (agency) are well documented in schizophrenia, less is known about other aspects of bodily self-representation (body ownership). Here, we tested a large cohort (N = 59) of chronic schizophrenia patients and matched controls (N = 30) on a well-established body illusion paradigm, the Full Body Illusion (FBI). In this paradigm, changes in body ownership are induced through prolonged multisensory stimulation, in which participants are stroked on their back while seeing the stroking on the back of a virtual body. When the felt and seen stroking are synchronous, participants typically feel higher identification with the seen body as well as a drift in self-location towards it. However, when the stroking is asynchronous, no such changes occur. Our results show no evidence for abnormal body ownership in schizophrenia patients. A meta-analysis of previous work corroborates this result. Thus, while schizophrenia patients may be impaired in the sense of agency, their multisensory bodily self-representation, as tested here, seems to be unaffected by the illness.

背景与目标： : 精神分裂症是一种严重的精神疾病，患者会经历异常的自我意识。虽然精神分裂症中有充分记录了感觉运动自我表示 (代理) 的缺陷，但对身体自我表示 (身体所有权) 的其他方面知之甚少。在这里，我们测试了一个大型队列 (N = 59) 的慢性精神分裂症患者和匹配的对照组 (N = 30) 在一个完善的身体错觉范例，即全身错觉 (FBI) 上。在这种范例中，身体所有权的变化是通过长时间的多感官刺激引起的，在这种刺激中，参与者在看到虚拟身体背面的抚摸时被抚摸。当毛毡和看见的抚摸同步时，参与者通常会对所看见的身体产生更高的认同感，并会自我定位。但是，当行程是异步的时，不会发生此类更改。我们的结果没有证据表明精神分裂症患者的身体所有权异常。对先前工作的荟萃分析证实了这一结果。因此，尽管精神分裂症患者在代理意义上可能会受到损害，但正如这里所测试的那样，他们的多感官身体自我表现似乎不受疾病的影响。

BACKGROUND & AIMS: BACKGROUND:Peritoneal dialysis (PD) provides outcomes similar to hemodialysis, but its use has decreased in the United States despite its potential for substantial taxpayer savings. We undertook this study to determine the relationship between dialysis unit ownership with PD use and outcomes. STUDY DESIGN:Observational study. SETTING & PARTICIPANTS:All incident dialysis patients (1996 to 2004) from the US Renal Data System. PREDICTOR:Large dialysis organization (LDO), defined as corporations owning 20 or more freestanding dialysis units located in more than 1 state. OUTCOMES & MEASUREMENTS:Odds for an incident dialysis patient undergoing PD and hazards for death on follow-up in incident PD patients for each of the 5 LDOs (non-LDO as reference). RESULTS:During the 9-year period, 785,531 patients started maintenance dialysis therapy; the proportion receiving care in LDOs increased from 39% to 63%. There were consistent differences in PD use. It was significantly lower in LDO 2 (adjusted odds ratio [OR], 0.66; 95% confidence interval [CI], 0.64 to 0.68), LDO 3 (OR, 0.82; 95% CI, 0.80 to 0.85), and LDO 4 (OR, 0.96; 95% CI, 0.92 to 0.995) and higher in LDO 1 (adjusted OR, 1.06; 95% CI, 1.02 to 1.11) and LDO 5 (adjusted OR, 1.09; 95% CI, 1.06 to 1.12). Between 2000 and 2004, LDO 2 had the least use and greatest risk of death (hazard ratio, 1.08; 95% CI, 1.02 to 1.14); LDO 1 had greater use and the lowest death risk (hazard ratio, 0.87; 95% CI, 0.78 to 0.96). LIMITATIONS:Only cross-sectional associations can be described. CONCLUSIONS:Three of the 5 LDOs had consistently lower PD use. Patients treated in the LDO with the lowest use of PD had the greatest risk of death. Understanding relationships among providers, physicians, and dialysis modality use may help devise strategies for increasing PD use in appropriate patients. This has the potential to reduce the cost of renal replacement therapy and further improve outcomes.

背景与目标：

BACKGROUND & AIMS: :Alcohol use and firearm ownership are risk factors for violent injury and death. To determine whether firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours, the author conducted a cross-sectional study using Behavioral Risk Factor Surveillance System data for eight states in the USA from 1996 to 1997 (the most recent data available). Altogether, 15 474 respondents provided information on firearm exposure. After adjustment for demographics and state of residence, firearm owners were more likely than those with no firearms at home to have ≥5 drinks on one occasion (OR 1.32; 95% CI 1.16 to 1.50), to drink and drive (OR 1.79; 95% CI 1.34 to 2.39) and to have ≥60 drinks per month (OR 1.45; 95% CI 1.14 to 1.83). Heavy alcohol use was most common among firearm owners who also engaged in behaviours such as carrying a firearm for protection against other people and keeping a firearm at home that was both loaded and not locked away. The author concludes that firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours.

背景与目标： : 酒精使用和枪支拥有权是暴力伤害和死亡的风险因素。为了确定枪支所有权和特定枪支相关行为是否与酒精相关风险行为相关，作者使用行为风险因素监测系统数据对美国1996年1997年的八个州进行了横断面研究 (最新数据)。总共有15名474受访者提供了有关枪支暴露的信息。在人口统计和居住状态调整后，枪支拥有者比没有枪支的人更有可能在一次 (或1.32; 95% CI 1.16至1.50) 喝 ≥ 5杯酒，酒后驾车 (或1.79; 95% CI 1.34至2.39) 和每月 ≥ 60杯饮料 (或1.45; 95% CI 1.14至1.83)。在枪支拥有者中，大量饮酒是最常见的，他们也从事一些行为，例如携带枪支以保护他人免受伤害，并将枪支放在家里，既装满又没有锁起来。作者得出的结论是，枪支所有权和与枪支相关的特定行为与酒精相关的危险行为有关。