Identifying keys to success in reducing readmissions using the ideal transitions in care framework

Background: Systematic attempts to identify best practices for reducing hospital readmissions have been limited without a comprehensive framework for categorizing prior interventions. Our research aim was to categorize prior interventions to reduce hospital readmissions using the ten domains of the Ideal Transition of Care (ITC) framework, to evaluate which domains have been targeted in prior interventions and then examine the effect intervening on these domains had on reducing readmissions. Methods: Review of literature and secondary analysis of outcomes based on categorization of English-language reports published between January 1975 and October 2013 into the ITC framework. Results: 66 articles were included. Prior interventions addressed an average of 3.5 of 10 domains; 41% demonstrated statistically significant reductions in readmissions. The most common domains addressed focused on monitoring patients after discharge, patient education, and care coordination. Domains targeting improved communication with outpatient providers, provision of advanced care planning, and ensuring medication safety were rarely included. Increasing the number of domains included in a given intervention significantly increased success in reducing readmissions, even when adjusting for quality, duration, and size (OR per domain, 1.5, 95% CI 1.1 - 2.0). The individual domains most associated with reducing readmissions were Monitoring and Managing Symptoms after Discharge (OR 8.5, 1.8 - 41.1), Enlisting Help of Social and Community Supports (OR 4.0, 1.3 - 12.6), and Educating Patients to Promote Self-Management (OR 3.3, 1.1 - 10.0). Conclusions: Interventions to reduce hospital readmissions are frequently unsuccessful; most target few domains within the ITC framework. The ITC may provide a useful framework to consider when developing readmission interventions

A demand-driven approach for a multi-agent system in Supply Chain Management

This paper presents the architecture of a multi-agent decision support system for Supply Chain Management (SCM) which has been designed to compete in the TAC SCM game. The behaviour of the system is demand-driven and the agents plan, predict, and react dynamically to changes in the market. The main strength of the system lies in the ability of the Demand agent to predict customer winning bid prices - the highest prices the agent can offer customers and still obtain their orders. This paper investigates the effect of the ability to predict customer order prices on the overall performance of the system. Four strategies are proposed and compared for predicting such prices. The experimental results reveal which strategies are better and show that there is a correlation between the accuracy of the models' predictions and the overall system performance: the more accurate the prediction of customer order prices, the higher the profit. © 2010 Springer-Verlag Berlin Heidelberg

Sawja: Static Analysis Workshop for Java

Static analysis is a powerful technique for automatic verification of programs but raises major engineering challenges when developing a full-fledged analyzer for a realistic language such as Java. This paper describes the Sawja library: a static analysis framework fully compliant with Java 6 which provides OCaml modules for efficiently manipulating Java bytecode programs. We present the main features of the library, including (i) efficient functional data-structures for representing program with implicit sharing and lazy parsing, (ii) an intermediate stack-less representation, and (iii) fast computation and manipulation of complete programs

Levels of extra-pair paternity are associated with parental care in penduline tits (Remizidae)

In most passerine birds, individuals attempt to maximise their fitness by providing parental care while also mating outside their pair bond. A sex-specific trade-off between these two behaviours is predicted to occur since the fitness benefits of extra-pair mating differs between the sexes. We use nest observations and parentage analysis to reveal a negative association between male care and the incidence of extra-pair paternity across three species of penduline tit (Remizidae)

Prospective blinded evaluation of a novel sensing methodology designed to reduce inappropriate shocks by the subcutaneous implantable cardioverter-defibrillator

Background: Most inappropriate shocks from the subcutaneous implantable cardioverter-defibrillator (S-ICD) are caused by cardiac oversensing. A novel sensing methodology, SMART Pass (SP; Boston Scientific Corporation, Natick, MA), aims to reduce cardiac oversensing. Objective: The purpose of this study was to evaluate the effect of SP on shocks in ambulatory patients with S-ICD. Methods: Patients implanted in 2015–2016 and enrolled in a remote patient monitoring system were included and followed for 1 year. Shocks were adjudicated by 3 independent blinded reviewers as appropriate or inappropriate. Shock incidence was calculated for patients with SP programmed enabled or disabled at implantation, censoring patients when SP programming changed or at the last transmission. The SP setting (enabled vs disabled) was modeled as a time-dependent Cox regression variable. Results: The cohort consisted of 1984 patients, and a total of 880 shocks were adjudicated. At implantation, SP was enabled in 655 patients (33%) and disabled in 1329 patients (67%). SP reduced the risk for the first inappropriate shock by 50% (P <.001) and the risk for all inappropriate shocks by 68% (P <.001) in multivariate analysis adjusted for age and device programming. The incidence of inappropriate shocks was 4.3% in the SP enabled arm vs 9.7% in the SP disabled arm. The incidence of appropriate shocks was similar (5.2

Winnowing Wheat from Chaff: The Chunking GA

In this work, we investigate the ability of a Chunking GA (ChGA) to reduce the size of variable length chromosomes and control bloat. The ChGA consists of a standard genetic algorithm augmented by a communal building block memory system and associated memory chromosomes and operators. A new mxn MaxSum fitness function used for this work is also described. Results show that a ChGA equipped with memory capacity equal to or greater than the minimal size of an optimal solution naturally eliminates unexpressed genes. © Springer-Verlag Berlin Heidelberg 2004

Post-Newtonian Gravitational Radiation

1 Introduction 2 Multipole Decomposition 3 Source Multipole Moments 4 Post-Minkowskian Approximation 5 Radiative Multipole Moments 6 Post-Newtonian Approximation 7 Point-Particles 8 ConclusionComment: 46 pages, in Einstein's Field Equations and Their Physical Implications, B. Schmidt (Ed.), Lecture Notes in Physics, Springe

The choline transporter Slc44a2 controls platelet activation and thrombosis by regulating mitochondrial function

Genetic factors contribute to the risk of thrombotic diseases. Recent genome wide association studies have identified genetic loci including SLC44A2 which may regulate thrombosis. Here we show that Slc44a2 controls platelet activation and thrombosis by regulating mitochondrial energetics. We find that Slc44a2 null mice (Slc44a2(KO)) have increased bleeding times and delayed thrombosis compared to wild-type (Slc44a2(WT)) controls. Platelets from Slc44a2(KO) mice have impaired activation in response to thrombin. We discover that Slc44a2 mediates choline transport into mitochondria, where choline metabolism leads to an increase in mitochondrial oxygen consumption and ATP production. Platelets lacking Slc44a2 contain less ATP at rest, release less ATP when activated, and have an activation defect that can be rescued by exogenous ADP. Taken together, our data suggest that mitochondria require choline for maximum function, demonstrate the importance of mitochondrial metabolism to platelet activation, and reveal a mechanism by which Slc44a2 influences thrombosis