Strategies for Hospitals After Implementation of Reimbursement Cuts to the Outpatient Prospective Payment System

Healthcare costs have continued to increase in the United States. The Centers for Medicare and Medicaid Services (CMS) have proposed policy changes to reduce inequities between hospital outpatient centers and independent freestanding facilities when reimbursing for the same service. The purpose of this quantitative study was to explore if there was a difference in the payments to the Outpatient Prospective Payment System between the years 2017 and 2018 to assist hospital administrators in preparing for Medicare reimbursement cuts. The study was grounded in the agency theory and aimed to determine the relationship among the provider, payer, and patient. The research questions were designed to determine a statistically significant relationship between the reimbursement of monies for outpatient and inpatient billing between 2017 and 2018. The descriptive quantitative study utilized publicly available secondary data published by CMS to see if there was a change in outpatient and inpatient payments and procedures billed to Medicare between 2017 and 2018. The sample size for this quantitative study was 64 and was limited to New Jersey hospitals. The statistical analysis used for this study was the paired-samples Wilcoxon test to determine whether there was a statistically significant difference between the three variables chosen. The results from this study showed a statistically significant difference in outpatient payments, services, and inpatient hospital volume from 2017 to 2018. There was an increase in outpatient spending and volume and a decrease in inpatient volume. The findings of this study will help hospital administrators create positive social change by closing the healthcare equity gap, increasing transparency in healthcare costs, and promoting patient-centered care

Comparison of rapid detection assays for grapevine leafroll disease associated closteroviruses

Three rapid detection assays (ELISA, dsRNA analysis and ISEM) were compared for their sensitivity, specificity, and simplicity in the detection of grapevine leafroll associated closteroviruses (GLRaV). Each was found to have advantages and disadvantages for routine testing. ELISA is sensitive and easy to use, but different antisera are needed to detect different GLRaV types. Because mixing or blending of antisera can produce good results in a single ELISA test, each antiserum does not need to be used separately unless it is important to determine the type of GLRaV present. DsRNA analysis can detect all the types of GLRaV tested but has a relatively low sensitivity and is labor intensive, which makes it unsuitable for testing large numbers of samples. Furthermore, dsRNA does not give unequivocal diagnosis of GLRaV infections. ISEM is sensitive and rapid. However, like ELISA, this technique requires an antiserum to each GLRaV type tested and an electron microscopy. Our recommendation is that ELISA should be used with multiple antisera for large scale testing programs. Samples for which ELISA results are inconclusive should be retested with ISEM and/or dsRNA. When the disease status of an individual sample must be determined conclusively, a few grams of tissue should be processed to concentrate the virus and then subjected to ELISA and examination by electron microscopy with negative staining. A dsRNA analysis should be carried out as well

Study of macular and optic disk blood flow by angio‐OCT in Glucose‐6‐Phosphate Dehydrogenase (G6PD) deficient men and age‐related G6PD‐normal subjects

Purpose: The reported prevalence of Glucose‐6‐Phosphate Dehydrogenase (G6PD) deficiency in Sardina, Italy, ranges from 8% to 15%. Hemizygous males have totally deficient erythrocytes. Evidence indicates that patients with G6PD deficiency are protected against ischemic heart and cerebrovascular disease, colorectal cancer, retinal vein occlusion, and nonarteritic anterior ischemic optic neuropathy. The purpose of this study was to study the macular and optic disk blood flow by angio‐OCT in G6PD‐deficient men and age‐related G6PD‐normal subjects and ascertain whether, or not, there are statistically significant differences between the two groups Methods: 22 G6PD‐deficient men and 22 perfectly age‐matched G6PD‐normal controls were examined at the Ophthalmology Unit, University of Sassari, Sassari, Italy. A complete review of the medical history and a complete ophthalmological examination, including ETDRS best corrected visual acuity, slit‐lamp biomicroscopy of the anterior segment, applanation tonometry, and fundus examination, was carried out. An HD 6‐mm Angio‐Retina and a 4.5‐mm Angio Disk (RT‐Vue, Optovue XR‐100 with Angio Vue, CA) examination were also performed Results: Only 1 eye per patients was included in the analysis, for a total of 22 eyes in each group. All the exported parameters about retinal and disk flow were evaluated. No statistical differences between the two groups were found, even after controlling for the effects of age, hypertension and hypercholesterolemia (p = 0.9). Conclusions: Results suggest that G6PD‐deficient and G6PD‐normal men have similar macular and optic disk blood flow. Larger scale studies are necessary to confirm these findings

Fluticasone furoate/vilanterol (100/25; 200/25 μg) improves lung function in COPD: a randomised trial.

SummaryBackgroundOnce-daily combination treatment is an attractive maintenance therapy for COPD. However, the dose of inhaled corticosteroid to use in a once-daily combination is unknown. We compared two strengths of fluticasone furoate (FF) plus vilanterol (VI), the same strengths of the individual components, and placebo.MethodsMulticentre, randomised, 24-week, double-blind, placebo-controlled, parallel-group study in stable, moderate-to-severe COPD subjects (N = 1224). Subjects were randomised to FF/VI (200/25 μg; 100/25 μg), FF (200 μg; 100 μg), VI 25 μg, or placebo, once daily in the morning. Co-primary efficacy endpoints; 0–4 h weighted mean (wm) FEV1 on day 168, and change from baseline in trough (23–24 h post-dose) FEV1 on day 169. The primary safety objective was adverse events (AEs).ResultsThere was a statistically significant (p < 0.001) increase in wm FEV1 (209 ml) and trough FEV1 (131 ml) for FF/VI 200/25 μg vs. placebo; similar changes were seen for FF/VI 100/25 μg vs. placebo. Whereas the difference between FF/VI 200/25 μg and VI 25 μg in change from baseline trough FEV1 (32 ml) was not statistically significant (p = 0.224), the difference between FF/VI 200/25 μg and FF 200 μg for wm FEV1 (168 ml) was significantly different (p < 0.001). VI 25 μg significantly improved wm and trough FEV1 vs. placebo (209 ml and 131 ml, respectively). No increase was seen in on-treatment AEs or serious AEs (SAEs), with active therapy vs. placebo.ConclusionsFF/VI provides rapid and significant sustained improvement in FEV1 in subjects with moderate-to-severe COPD, which was not influenced by the dose of FF. These data suggest that FF/VI may offer clinical efficacy in COPD and warrants additional study.GSK study number: HZC112207.ClinicalTrials.gov: NCT01054885

Monitoring the incidence of Xylella fastidiosa infection in olive orchards using ground-based evaluations, airborne imaging spectroscopy and Sentinel-2 time series through 3-D radiative transfer modelling

Outbreaks of Xylella fastidiosa (Xf) in Europe generate considerable economic and environmental damage, and this plant pest continues to spread. Detecting and monitoring the spatio-temporal dynamics of the disease symptoms caused by Xf at a large scale is key to curtailing its expansion and mitigating its impacts. Here, we combined 3-D radiative transfer modelling (3D-RTM), which accounts for the seasonal background variations, with passive optical satellite data to assess the spatio-temporal dynamics of Xf infections in olive orchards. We developed a 3D-RTM approach to predict Xf infection incidence in olive orchards, integrating airborne hyperspectral imagery and freely available Sentinel-2 satellite data with radiative transfer modelling and field observations. Sentinel-2A time series data collected over a two-year period were used to assess the temporal trends in Xf-infected olive orchards in the Apulia region of southern Italy. Hyperspectral images spanning the same two-year period were used for validation, along with field surveys; their high resolution also enabled the extraction of soil spectrum variations required by the 3D-RTM to account for canopy background effect. Temporal changes were validated with more than 3000 trees from 16 orchards covering a range of disease severity (DS) and disease incidence (DI) levels. Among the wide range of structural and physiological vegetation indices evaluated from Sentinel-2 imagery, the temporal variation of the Atmospherically Resistant Vegetation Index (ARVI) and Optimized Soil-Adjusted Vegetation Index (OSAVI) showed superior performance for DS and DI estimation (r2VALUES>0.7, p < 0.001). When seasonal understory changes were accounted for using modelling methods, the error of DI prediction was reduced 3-fold. Thus, we conclude that the retrieval of DI through model inversion and Sentinel-2 imagery can form the basis for operational vegetation damage monitoring worldwide. Our study highlight the value of interpreting temporal variations in model retrievals to detect anomalies in vegetation health.Data collection was partially supported by the European Union's Horizon 2020 research and innovation programme through grant agreements POnTE (635646) and XF-ACTORS (727987). A. Hornero was supported by research fellowship DTC GEO 29 “Detection of global photosynthesis and forest health from space” from the Science Doctoral Training Centre (Swansea University, UK). The authors would also like to thank QuantaLab-IAS-CSIC (Spain) for laboratory assistance and the support provided during the airborne campaigns and image processing. B. Landa, C. Camino, M. Montes-Borrego, M. Morelli, M. Saponari and L. Susca are acknowledged for their support during the field campaigns, as well as IPSP-CNR and Dipartimento di Scienze del Suolo (Università di Bari, Italy) as host institutions

Individualized Stabilization Criteria–Driven Ranibizumab versus Laser in Branch Retinal Vein Occlusion

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Individualized Ranibizumab Regimen Driven by Stabilization Criteria for Central Retinal Vein Occlusion

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Impact of Baseline Retinal Nonperfusion and Macular Retinal Capillary Nonperfusion on Outcomes in the COPERNICUS and GALILEO Studies

To evaluate the impact of baseline retinal capillary nonperfusion (RNP) and macular retinal capillary nonperfusion (MNP) status on outcomes at week&nbsp;24 (W24)

Divergent abiotic spectral pathways unravel pathogen stress signals across species

Abstract: Plant pathogens pose increasing threats to global food security, causing yield losses that exceed 30% in food-deficit regions. Xylella fastidiosa (Xf) represents the major transboundary plant pest and one of the world’s most damaging pathogens in terms of socioeconomic impact. Spectral screening methods are critical to detect non-visual symptoms of early infection and prevent spread. However, the subtle pathogen-induced physiological alterations that are spectrally detectable are entangled with the dynamics of abiotic stresses. Here, using airborne spectroscopy and thermal scanning of areas covering more than one million trees of different species, infections and water stress levels, we reveal the existence of divergent pathogen- and host-specific spectral pathways that can disentangle biotic-induced symptoms. We demonstrate that uncoupling this biotic–abiotic spectral dynamics diminishes the uncertainty in the Xf detection to below 6% across different hosts. Assessing these deviating pathways against another harmful vascular pathogen that produces analogous symptoms, Verticillium dahliae, the divergent routes remained pathogen- and host-specific, revealing detection accuracies exceeding 92% across pathosystems. These urgently needed hyperspectral methods advance early detection of devastating pathogens to reduce the billions in crop losses worldwide