Individual Nurse Productivity in Preparing Patients for Discharge Is Associated with Patient Likelihood of 30-Day Return to Hospital

Objective: Applied to value-based health care, the economic term “individual productivity” refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient’s likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits]. Research Design: Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics. Subjects: A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016. Measures: Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return. Results: Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (−0.48 absolute percentage points, P\u3c0.001) and an ED visit (−0.29 absolute percentage points, P=0.042). Conclusions: Variability in individual clinician productivity can have implications for acute care quality patient outcomes

Collapse arrest and soliton stabilization in nonlocal nonlinear media

We investigate the properties of localized waves in systems governed by nonlocal nonlinear Schrodinger type equations. We prove rigorously by bounding the Hamiltonian that nonlocality of the nonlinearity prevents collapse in, e.g., Bose-Einstein condensates and optical Kerr media in all physical dimensions. The nonlocal nonlinear response must be symmetric, but can be of completely arbitrary shape. We use variational techniques to find the soliton solutions and illustrate the stabilizing effect of nonlocality.Comment: 4 pages with 3 figure

Energetics of oxygen-octahedra rotations in perovskite oxides from first principles

We use first-principles methods to study oxygen-octahedra rotations in ABO3 perovskite oxides. We focus on the short-period, perfectly antiphase or in-phase, tilt patterns that characterize most compounds and control their physical (e.g., conductive, magnetic) properties. Based on an analytical form of the relevant potential energy surface, we discuss the conditions for the stability of polymorphs presenting different tilt patterns, and obtain numerical results for a collection of thirty-five representative materials. Our results reveal the mechanisms responsible for the frequent occurrence of a particular structure that combines antiphase and in-phase rotations, i.e., the orthorhombic Pbnm phase displayed by about half of all perovskite oxides and by many non-oxidic perovskites. The Pbnm phase benefits from the simultaneous occurrence of antiphase and in-phase tilt patterns that compete with each other, but not as strongly as to be mutually exclusive. We also find that secondary antipolar modes, involving the A cations, contribute to weaken the competition between different tilts and play a key role in their coexistence. Our results thus confirm and better explain previous observations for particular compounds. Interestingly, we also find that strain effects, which are known to be a major factor governing phase competition in related (e.g., ferroelectric) perovskite oxides, play no essential role as regards the relative stability of different rotational polymorphs. Further, we discuss why the Pbnm structure stops being the ground state in two opposite limits, for large and small A cations, showing that very different effects become relevant in each case. Our work thus provides a comprehensive discussion on these all-important and abundant materials, which will be useful to better understand existing compounds as well as to identify new strategies for materials engineering

Modulational instability in periodic quadratic nonlinear materials

We investigate the modulational instability of plane waves in quadratic nonlinear materials with linear and nonlinear quasi-phase-matching gratings. Exact Floquet calculations, confirmed by numerical simulations, show that the periodicity can drastically alter the gain spectrum but never completely removes the instability. The low-frequency part of the gain spectrum is accurately predicted by an averaged theory and disappears for certain gratings. The high-frequency part is related to the inherent gain of the homogeneous non-phase-matched material and is a consistent spectral feature.Comment: 4 pages, 7 figures corrected minor misprint

On the convex central configurations of the symmetric (ℓ + 2)-body problem

For the 4-body problem there is the following conjecture: Given arbitrary positive masses, the planar 4-body problem has a unique convex central configuration for each ordering of the masses on its convex hull. Until now this conjecture has remained open. Our aim is to prove that this conjecture cannot be extended to the (ℓ + 2)-body problem with ℓ ⩾ 3. In particular, we prove that the symmetric (2n + 1)-body problem with masses m1 = … = m2n−1 = 1 and m2n = m2n+1 = m sufficiently small has at least two classes of convex central configuration when n = 2, five when n = 3, and four when n = 4. We conjecture that the (2n + 1)-body problem has at least n classes of convex central configurations for n > 4 and we give some numerical evidence that the conjecture can be true. We also prove that the symmetric (2n + 2)-body problem with masses m1 = … = m2n = 1 and m2n+1 = m2n+2 = m sufficiently small has at least three classes of convex central configuration when n = 3, two when n = 4, and three when n = 5. We also conjecture that the (2n + 2)-body problem has at least [(n +1)/2] classes of convex central configurations for n > 5 and we give some numerical evidences that the conjecture can be true

Comparing modelled predictions of neonatal mortality impacts using LiST with observed results of community-based intervention trials in South Asia

Background There is an increasing body of evidence from trials suggesting that major reductions in neonatal mortality are possible through community-based interventions. Since these trials involve packages of varying content, determining how much of the observed mortality reduction is due to specific interventions is problematic. The Lives Saved Tool (LiST) is designed to facilitate programmatic prioritization by modelling mortality reductions related to increasing coverage of specific interventions which may be combined into packages

Muon spin rotation measurements of the superfluid density in fresh and aged superconducting PuCoGa5_5

We have measured the temperature dependence and magnitude of the superfluid density $\rho_{\rm s}(T)$ via the magnetic field penetration depth $\lambda(T)$ in PuCoGa$_5$ (nominal critical temperature $T_{c0} = 18.5$ K) using the muon spin rotation technique in order to investigate the symmetry of the order parameter, and to study the effects of aging on the superconducting properties of a radioactive material. The same single crystals were measured after 25 days ($T_c = 18.25$ K) and 400 days ($T_c = 15.0$ K) of aging at room temperature. The temperature dependence of the superfluid density is well described in both materials by a model using d-wave gap symmetry. The magnitude of the muon spin relaxation rate $\sigma$ in the aged sample, $\sigma\propto 1/\lambda^2\propto\rho_s/m^*$, where $m^*$ is the effective mass, is reduced by about 70% compared to fresh sample. This indicates that the scattering from self-irradiation induced defects is not in the limit of the conventional Abrikosov-Gor'kov pair-breaking theory, but rather in the limit of short coherence length (about 2 nm in PuCoGa$_5$) superconductivity.Comment: 11 page

Superconductivity and Quantum Criticality in CeCoIn_5

Electrical resistivity measurements on a single crystal of the heavy-fermion superconductor CeCoIn_5 at pressures to 4.2 GPa reveal a strong crossover in transport properties near P^* \approx 1.6 GPa, where T_c is a maximum. The temperature-pressure phase diagram constructed from these data provides a natural connection to cuprate physics, including the possible existence of a pseudogap.Comment: 4 pages, 4 figure

Discrete embedded solitons

We address the existence and properties of discrete embedded solitons (ESs), i.e., localized waves existing inside the phonon band in a nonlinear dynamical-lattice model. The model describes a one-dimensional array of optical waveguides with both the quadratic (second-harmonic generation) and cubic nonlinearities. A rich family of ESs was previously known in the continuum limit of the model. First, a simple motivating problem is considered, in which the cubic nonlinearity acts in a single waveguide. An explicit solution is constructed asymptotically in the large-wavenumber limit. The general problem is then shown to be equivalent to the existence of a homoclinic orbit in a four-dimensional reversible map. From properties of such maps, it is shown that (unlike ordinary gap solitons), discrete ESs have the same codimension as their continuum counterparts. A specific numerical method is developed to compute homoclinic solutions of the map, that are symmetric under a specific reversing transformation. Existence is then studied in the full parameter space of the problem. Numerical results agree with the asymptotic results in the appropriate limit and suggest that the discrete ESs may be semi-stable as in the continuous case.Comment: A revtex4 text file and 51 eps figure files. To appear in Nonlinearit