Risk Factors for Frequent Readmissions and Barriers to Transplantation in Patients with Cirrhosis

Background: Hospital readmission rate is receiving increasing regulatory scrutiny. Patients with cirrhosis have high hospital readmissions rates but the relationship between frequent readmissions and barriers to transplantation remains unexplored. The goal of this study was to determine risk factors for frequent readmissions among patients with cirrhosis and identify barriers to transplantation in this population. Methods: We retrospectively reviewed medical records of 587 patients with a confirmed diagnosis of cirrhosis admitted to a large tertiary care center between May 1, 2008 and May 1, 2009. Demographics, clinical factors, and outcomes were recorded. Multivariate logistic regression was performed to identify risk factors for high readmission rates. Transplant-related factors were assessed for patients in the high readmission group. Results: The 587 patients included in the study had 1557 admissions during the study period. A subset of 87 (15%) patients with 5 or more admissions accounted for 672 (43%) admissions. The factors associated with frequent admissions were non-white race (OR = 2.45, p = 0.01), diabetes (OR = 2.04, p = 0.01), higher Model for End-Stage Liver Disease (MELD) score (OR = 35.10, p30) and younger age (OR = 0.98, p = 0.02). Among the 87 patients with ≥5 admissions, only 14 (16%) underwent liver transplantation during the study period. Substance abuse, medical co-morbidities, and low (<15) MELD scores were barriers to transplantation in this group. Conclusions: A small group of patients with cirrhosis account for a disproportionately high number of hospital admissions. Interventions targeting this high-risk group may decrease frequent hospital readmissions and increase access to transplantation. © 2013 Ganesh et al

Operational experience, improvements, and performance of the CDF Run II silicon vertex detector

The Collider Detector at Fermilab (CDF) pursues a broad physics program at Fermilab's Tevatron collider. Between Run II commissioning in early 2001 and the end of operations in September 2011, the Tevatron delivered 12 fb-1 of integrated luminosity of p-pbar collisions at sqrt(s)=1.96 TeV. Many physics analyses undertaken by CDF require heavy flavor tagging with large charged particle tracking acceptance. To realize these goals, in 2001 CDF installed eight layers of silicon microstrip detectors around its interaction region. These detectors were designed for 2--5 years of operation, radiation doses up to 2 Mrad (0.02 Gy), and were expected to be replaced in 2004. The sensors were not replaced, and the Tevatron run was extended for several years beyond its design, exposing the sensors and electronics to much higher radiation doses than anticipated. In this paper we describe the operational challenges encountered over the past 10 years of running the CDF silicon detectors, the preventive measures undertaken, and the improvements made along the way to ensure their optimal performance for collecting high quality physics data. In addition, we describe the quantities and methods used to monitor radiation damage in the sensors for optimal performance and summarize the detector performance quantities important to CDF's physics program, including vertex resolution, heavy flavor tagging, and silicon vertex trigger performance.Comment: Preprint accepted for publication in Nuclear Instruments and Methods A (07/31/2013

Statistical optimization for lipase production from solid waste of vegetable oil industry

<p>The production of biofuel using thermostable bacterial lipase from hot spring bacteria out of low-cost agricultural residue olive oil cake is reported in the present paper. Using a lipase enzyme from <i>Bacillus licheniformis</i>, a 66.5% yield of methyl esters was obtained. Optimum parameters were determined, with maximum production of lipase at a pH of 8.2, temperature 50.8°C, moisture content of 55.7%, and biosurfactant content of 1.693 mg. The contour plots and 3D surface responses depict the significant interaction of pH and moisture content with biosurfactant during lipase production. Chromatographic analysis of the lipase transesterification product was methyl esters, from kitchen waste oil under optimized conditions, generated methyl palmitate, methyl stearate, methyl oleate, and methyl linoleate.</p

Major and minor fisheries harbours of India. 8. Fisherries harbours along the coasts of North Andhra Pradesh, Orissa and West Bengal

The present account gives information about the three major and five minor fisheries harbours along the coasts of north Andhra Pradesh, Orissa and West Benga

Calcific myofibrosis due to pentazocine abuse: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pentazocine, a synthetic narcotic analgesic, is commonly used for the relief of moderate to severe pain secondary to various conditions. It is usually well tolerated; however, adverse effects are not uncommon, especially when higher doses are used and when it is used in a dependent fashion. There have been reports of various complications associated with its use, including skin fibrosis, skin ulceration, abnormal skin pigmentation and symmetrical myopathy with fibrous myopathy. Fibrosis has usually been reported in the muscles at the site of injection of the drug. Being opioid in nature, it has a high abuse potential.</p> <p>Case presentation</p> <p>Here we report a case of pentazocine-induced calcific myofibrosis in a 42-year-old man involving muscles which were not injected with pentazocine.</p> <p>Conclusion</p> <p>This case highlights the care that needs to be taken when prescribing opioid analgesics, such as pentazocine, as routine painkillers. Patients who have history of substance abuse are more likely to abuse other agents, including prescription drugs. Rare consequences such as calcific myofibrosis are devastating and can cause significant lifelong disability.</p

Search for Charmless Two-body Baryonic Decays of B Mesons

We report the results of a search for the rare baryonic decays $B^0 \to p\bar{p}$, $\Lambda\bar{\Lambda}$, and $B^+ \to p\bar{\Lambda}$. The analysis is based on a data set of $31.7\times 10^6 B\bar{B}$ events collected by the Belle detector at the KEKB $e^+e^-$ collider. No statistically significant signals are found, and we set branching fraction upper limits ${\mathcal B}(B^0 \to p\bar{p}) < 1.2 \times 10^{-6}$, ${\mathcal B}(B^0 \to \Lambda\bar{\Lambda}) < 1.0 \times 10^{-6}$, and ${\mathcal B}(B^+ \to p\bar{\Lambda}) < 2.2 \times 10^{-6}$ at the 90% confidence level.Comment: 6 pages, 4 figures and 1 table. Submitted to Phys. Rev. D Rapid Communication

Search for Direct CP Violation in B -> K pi Decays

We search for direct CP violation in flavor specific B -> K pi decays by measuring the rate asymmetry between charge conjugate modes. The search is performed on a data sample of 11.1 million B B bar events recorded on the Upsilon(4S) resonance by the Belle experiment at KEKB. We measure 90% confidence intervals in the partial rate asymmetry A_CP of -0.25 < A_CP(K-/+ pi+/-) < 0.37, -0.40 < A_CP(K-/+ pi^0) < 0.36, and -0.53 < A_CP(K^0 pi-/+) < 0.82. By combining the K-/+ pi+/- and K-/+ pi^0 final states, we conclude that -0.22 < A_CP[K-/+(pi+/- + pi^0)] < 0.25 at the 90% confidence level.Comment: Submitted to PRD Rapid Communication