Pediatric weekend admission and increased unplanned readmission rates

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/115940/1/jhm2426.pd

A Validated Method for Identifying Unplanned Pediatric Readmission

Objective To validate the accuracy of pre-encounter hospital designation as a novel way to identify unplanned pediatric readmissions and describe the most common diagnoses for unplanned readmissions among children. Study design We examined all hospital discharges from 2 tertiary care children's hospitals excluding deaths, normal newborn discharges, transfers to other institutions, and discharges to hospice. We performed blinded medical record review on 641 randomly selected readmissions to validate the pre-encounter planned/unplanned hospital designation. We identified the most common discharge diagnoses associated with subsequent 30-day unplanned readmissions. Results Among 166 994 discharges (hospital A: n = 55 383; hospital B: n = 111 611), the 30-day unplanned readmission rate was 10.3% (hospital A) and 8.7% (hospital B). The hospital designation of “unplanned” was correct in 98% (hospital A) and 96% (hospital B) of readmissions; the designation of “planned” was correct in 86% (hospital A) and 85% (hospital B) of readmissions. The most common discharge diagnoses for which unplanned 30-day readmissions occurred were oncologic conditions (up to 38%) and nonhypertensive congestive heart failure (about 25%), across both institutions. Conclusions Unplanned readmission rates for pediatrics, using a validated, accurate, pre-encounter designation of “unplanned,” are higher than previously estimated. For some pediatric conditions, unplanned readmission rates are as high as readmission rates reported for adult conditions. Anticipating unplanned readmissions for high-frequency diagnostic groups may help focus efforts to reduce the burden of readmission for families and facilities. Using timing of hospital registration in administrative records is an accurate, widely available, real-time way to distinguish unplanned vs planned pediatric readmissions

Galaxy clustering in the NEWFIRM Medium Band Survey: the relationship between stellar mass and dark matter halo mass at 1 < z < 2

We present an analysis of the clustering of galaxies as a function of their stellar mass at 1 < z < 2 using data from the NEWFIRM Medium Band Survey (NMBS). The precise photometric redshifts and stellar masses that the NMBS produces allows us to define a series of mass limited samples of galaxies more massive than 0.7, 1 and 3x10^10 Msun in redshift intervals centered on z = 1.1, 1.5 and 1.9 respectively. In each redshift interval we show that there exists a strong dependence of clustering strength on the stellar mass limit of the sample, with more massive galaxies showing a higher clustering amplitude on all scales. We further interpret our clustering measurements in the LCDM cosmological context using the halo model of galaxy clustering. We show that the typical halo mass of central and satellite galaxies increases with stellar mass, whereas the satellite fraction decreases with stellar mass, qualitatively the same as is seen at z < 1. We see little evidence of any redshift dependence in the stellar mass-to-halo mass relationship over our narrow redshift range. However, when we compare with similar measurements at z~0, we see clear evidence for a change in this relation. If we assume a universal baryon fraction, the ratio of stellar mass to halo mass reveals the fraction of baryons that have been converted to stars. We see that the peak in this star formation efficiency for central galaxies shifts to higher halo masses at higher redshift, moving from ~7x10^11 Msun at z~0 to ~3x10^12 Msun at z~1.5, revealing evidence of `halo downsizing'. Finally we show that for highly biased galaxy populations at z > 1 there may be a discrepancy between the measured space density and clustering and that predicted by the halo model. This could imply that there is a problem with one or more ingredients of the halo model at these redshifts, for instance the halo bias relation or the halo profile.Comment: Accepted for publication in ApJ. Correction made to typo in halo masses in conclusion

Pediatric hospital discharge interventions to reduce subsequent utilization: A systematic review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106901/1/jhm2134.pd

Discordant antibiotic therapy and length of stay in children hospitalized for urinary tract infection

BACKGROUND: Urinary tract infections (UTIs) are a common reason for pediatric hospitalizations. OBJECTIVE: To determine the effect of discordant antibiotic therapy (in vitro nonsusceptibility of the uropathogen to initial antibiotic) on clinical outcomes for children hospitalized for UTI. DESIGN/SETTING: Multicenter retrospective cohort study in children aged 3 days to 18 years, hospitalized at 5 children's hospitals with a laboratory‐confirmed UTI. Data were obtained from medical records and the Pediatric Hospital Information System (PHIS) database. PARTICIPANTS: Patients with laboratory‐confirmed UTI. MAIN EXPOSURE: Discordant antibiotic therapy. MEASUREMENTS: Length of stay and fever duration. Covariates included age, sex, insurance, race, vesicoureteral reflux, antibiotic prophylaxis, genitourinary abnormality, and chronic care conditions. RESULTS: The median age of the 216 patients was 2.46 years (interquartile range [IQR]: 0.27, 8.89) and 25% were male. The most common causative organisms were E. coli and Klebsiella species. Discordant therapy occurred in 10% of cases and most commonly in cultures positive for Klebsiella species, Enterobacter species, and mixed organisms. In adjusted analyses, discordant therapy was associated with a 1.8 day (95% confidence interval [CI]: 1.5, 2.1) longer length of stay [LOS], but not with fever duration. CONCLUSIONS: Discordant antibiotic therapy for UTI is common and associated with longer hospitalizations. Further research is needed to understand the clinical factors contributing to the increased LOS and to inform decisions for empiric antibiotic selection in children with UTIs. Journal of Hospital Medicine 2012; © 2012 Society of Hospital MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94298/1/1960_ftp.pd

The ADAMTS13-VWF axis is dysregulated in chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important consequence of pulmonary embolism that is associated with abnormalities in haemostasis. We investigated the ADAMTS13-von Willebrand factor (VWF) axis in CTEPH, including its relationship with disease severity, inflammation, ABO groups and ADAMTS13 genetic variants.ADAMTS13 and VWF plasma antigen levels were measured in patients with CTEPH (n=208), chronic thromboembolic disease without pulmonary hypertension (CTED) (n=35), resolved pulmonary embolism (n=28), idiopathic pulmonary arterial hypertension (n=30) and healthy controls (n=68). CTEPH genetic ABO associations and protein quantitative trait loci were investigated. ADAMTS13-VWF axis abnormalities were assessed in CTEPH and healthy control subsets by measuring ADAMTS13 activity, D-dimers and VWF multimeric size.Patients with CTEPH had decreased ADAMTS13 (adjusted β -23.4%, 95% CI -30.9- -15.1%, p<0.001) and increased VWF levels (β +75.5%, 95% CI 44.8-113%, p<0.001) compared to healthy controls. ADAMTS13 levels remained low after reversal of pulmonary hypertension by pulmonary endarterectomy surgery and were equally reduced in CTED. We identified a genetic variant near the ADAMTS13 gene associated with ADAMTS13 protein that accounted for ∼8% of the variation in levels.The ADAMTS13-VWF axis is dysregulated in CTEPH. This is unrelated to pulmonary hypertension, disease severity or markers of systemic inflammation and implicates the ADAMTS13-VWF axis in CTEPH pathobiology

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead