University of Louisville

Severe alcohol-associated hepatitis (sAH) is a leading indication for liver transplant (LT). However, access to LT begins with referral, a step that may not have been previously characterized using prospective multicenter data with detailed measures of social determinants of health. To examine the association of clinical severity and neighborhood disadvantage with referral, wait-listing, transplant, and short-term mortality in patients hospitalized with sAH. This prospective multicenter cohort study was a secondary analysis of the Alcohol-Associated Hepatitis Network observational cohort. It included patients hospitalized with sAH (Model for End-Stage Liver Disease [MELD] >20) across 5 US transplant centers from May 6, 2019, to November 8, 2023. Clinical, demographic, and social determinants of health data, including the Area Deprivation Index (ADI), were collected prospectively. Clinical severity (MELD score) and neighborhood-level disadvantage (ADI). The primary outcomes were referral for LT evaluation, wait-listing, and receipt of LT, and the secondary outcome was 180-day mortality. Logistic regression and generalized additive models were used to evaluate independent and interactive associations of MELD and ADI with outcomes. The cohort included 325 patients (mean [SD] age, 44.8 [10.2] years; 197 males [60.6%]). The mean (SD) MELD score was 29.2 (7.6), and the mean (SD) ADI was 56.2 (24.4). Only 120 patients (36.9%) were referred for LT. In multivariable analysis, higher MELD scores were associated with lower referral odds (odds ratio, 1.13 [95% CI, 1.07-1.18]; P < .001). ADI was not associated with referral odds (odds ratio, 0.99 [95% CI, 0.97-1.00]; P = .06). Generalized additive model analyses demonstrated significant MELD × ADI interactions for referral (P for interaction = .01), wait-listing (P for interaction = .004), and mortality (P for interaction = .01). At a MELD score 20 to 30, referral probability was 40% to 60% among patients with an ADI less than 30 vs 20% among those with an ADI 30 or more. Among patients with a MELD score 20 to 30, mortality exceeded 20% in those with an ADI 60 or more compared with 10% to 20% in those with an ADI less than 20. In this multicenter cohort study of severe alcohol-associated hepatitis, neighborhood disadvantage was associated with referral at intermediate MELD scores. These findings suggest that referral is a critical leverage point for interventions and that outreach and navigation strategies informed by social context may improve access to LT.

Provision of psychotherapy during medication management checks has decreased, despite its benefits. The authors evaluated the feasibility and acceptability of integrating recovery-oriented cognitive therapy (CT-R) into psychiatric medication management visits for individuals with schizophrenia spectrum disorders through the Increasing Medication Check Participation Through Applying CT-R (IMPACT) program. All participants who started IMPACT (N=22) completed the 12-month treatment. Study psychiatrists provided elements of CT-R in 74% of sessions. Patients had significant improvements in overall symptoms (Cohen's d=0.83) and social functioning (Cohen's d=0.88) and a moderate improvement in beliefs about recovery. This study provides preliminary evidence that IMPACT is an acceptable and feasible treatment for individuals with schizophrenia spectrum disorders. A randomized controlled trial of IMPACT appears to be warranted.

Purpose This study aims to examine the market reaction to, and the performance of companies recognized for extensive remote-work opportunities. To identify firms that offer extensive remote work prospects for potential employees, the authors use the Virtual Vocations “Top 100 Companies to Watch for Fully Remote Jobs” list, published annually since 2016, to determine whether top remote work firms outperform unranked companies on both short-term and long-term bases. Design/methodology/approach This paper uses event study methodology including calculating abnormal returns and cumulative abnormal returns, and raw- and just-adjusted returns for the sample compared to market returns and matched samples. In addition, regression-based analysis for the Carhart four-factor and Fama–French five-factor models, a buy and a hold abnormal returns model. Profitability measures [return on equity (ROE) and return on assets (ROA)] are included. Findings The authors find that the announcement effect for listed firms is negative. The authors find limited evidence that long-term raw and risk-adjusted returns outperform matched samples, and in some cases, the S&amp;P 500 and Russell 2000 indices. ROA and ROE experience decreases of 3.55 and 8.48 percentage points, respectively, in the year following the ranking. The authors do find that smaller firms that offer extensive remote work opportunities may achieve superior long-term performance, as evidenced by both raw and risk-adjusted returns. The more positive returns associated with remote work may be due to better monitoring, control and the ability to manage the performance of fully remote workers in smaller companies. Originality/value These mixed results are promising for remote work and additional research. The COVID-19 pandemic changed work dynamics and showed that many companies can function effectively in a remote work environment, particularly those in the Information Technology, Health care and Financial sectors. As technological developments advance, the work landscape will likely continue to evolve. The findings indicate some support for superior long-term performance in raw and risk-adjusted returns for those firms embracing remote work, which bodes well for the future.

BACKGROUNDPosttraumatic syringomyelia (PTS) refers to an elongated, intramedullary spinal cyst, representing a spectrum of severity and a variable interval after spinal cord injury (SCI). It typically presents with worsening motor and/or sensory function after a period of relative symptom stability following injury. The worsening ascends rostrally to include spinal cord levels previously intact above the level of injury. Rarely, PTS cavities extend rostrally to brainstem levels.OBSERVATIONSThe case presented demonstrates nearly the full spectrum of features associated with PTS. The onset of worsening occurred relatively early, about 1 year after motor complete SCI at the T2–3 level. The delayed onset of worsening symptoms of the PTS included asymmetric sensory and motor deficits that extended rostral to the upper extremities, face, and swallowing, and caudal to include back pain.LESSONSThe authors highlight key features of PTS, including 1) bilateral ascending expansile syrinx in the peridorsal horn gray matter, 2) medullary extension with trigeminal nucleus symptoms consistent with syringobulbia, and 3) evidence of spontaneous remission or collapsing cord sign. Additionally, risk factors for early PTS are discussed, including motor complete thoracic SCI with spinal stenosis on MRI. Operative management included hardware removal, laminectomy, spinal cord untethering with wide syringostomy, and duraplasty.https://thejns.org/doi/10.3171/CASE25797

Abstract This paper explores the relationships among tying, partial integration (PI), and full integration (FI) when an input monopolist can require downstream buyers to purchase a competitively supplied input from it (tying) or integrate forward in the downstream market. Both tying and integration foreclose the independent supply of the other input, yet we show that tying and PI are always equivalent in equilibrium, even under general production technologies—extending Blair and Kaserman, who focus on FI and linearly homogeneous production. In contrast, tying and FI are not always equivalent; we derive necessary and sufficient conditions for their equivalence and show that, when nonequivalent, tying can generate higher total welfare than FI. We also identify conditions under which either practice can be Pareto improving relative to the non‐tying/non‐integration benchmark. These findings contribute to the economic foundation for evaluating tying and integration in antitrust policy.