Accounting for the growth of observation stays in the assessment of Medicare\u27s Hospital Readmissions Reduction Program

IMPORTANCE: Decreases in 30-day readmissions following the implementation of the Medicare Hospital Readmissions Reduction Program (HRRP) have occurred against the backdrop of increasing hospital observation stay use, yet observation stays are not captured in readmission measures. OBJECTIVE: To examine whether the HRRP was associated with decreases in 30-day readmissions after accounting for observation stays. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a 20% sample of inpatient admissions and observation stays among Medicare fee-for-service beneficiaries from January 1, 2009, to December 31, 2015. Data analysis was performed from November 2021 to June 2022. A differences-in-differences analysis assessed changes in 30-day readmissions after the announcement of the HRRP and implementation of penalties for target conditions (heart failure, acute myocardial infarction, and pneumonia) vs nontarget conditions under scenarios that excluded and included observation stays. MAIN OUTCOMES AND MEASURES: Thirty-day inpatient admissions and observation stays. RESULTS: The study included 8 944 295 hospitalizations (mean [SD] age, 78.7 [8.2] years; 58.6% were female; 1.3% Asian; 10.0% Black; 2.0% Hispanic; 0.5% North American Native; 85.0% White; and 1.2% other or unknown). Observation stays increased from 2.3% to 4.4% (91.3% relative increase) of index hospitalizations among target conditions and 14.1% to 21.3% (51.1% relative increase) of index hospitalizations for nontarget conditions. Readmission rates decreased significantly after the announcement of the HRRP and returned to baseline by the time penalties were implemented for both target and nontarget conditions regardless of whether observation stays were included. When only inpatient hospitalizations were counted, decreasing readmissions accrued into a -1.48 percentage point (95% CI, -1.65 to -1.31 percentage points) absolute reduction in readmission rates by the postpenalty period for target conditions and -1.13 percentage point (95% CI, -1.30 to -0.96 percentage points) absolute reduction in readmission rates by the postpenalty period for nontarget conditions. This reduction corresponded to a statistically significant differential change of -0.35 percentage points (95% CI, -0.59 to -0.11 percentage points). Accounting for observation stays more than halved the absolute decrease in readmission rates for target conditions (-0.66 percentage points; 95% CI, -0.83 to -0.49 percentage points). Nontarget conditions showed an overall greater decrease during the same period (-0.76 percentage points; 95% CI, -0.92 to -0.59 percentage points), corresponding to a differential change in readmission rates of 0.10 percentage points (95% CI, -0.14 to 0.33 percentage points) that was not statistically significant. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that the reduction of readmissions associated with the implementation of the HRRP was smaller than originally reported. More than half of the decrease in readmissions for target conditions appears to be attributable to the reclassification of inpatient admission to observation stays

Radio and X-ray Signatures of Merging Neutron Stars

We describe the possible electromagnetic signals expected from the magnetospheric interactions of a neutron star binary prior to merger. We find that both radio and X-ray signals of detectable strength are possible. We discuss possible links with the phenomenon of gamma-ray bursts and describe the prospects for direct detection of these signals in searches for radio and X-ray transients.Comment: LaTeX, 9 pages plus 2 postscript figures. submitted to M.N.R.A.

Research Needs for Effective Transition in Lifelong Care of Congenital Genitourinary Conditions: A Workshop Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases

Over the last 5 decades, health-care advances have yielded quantum improvements in the life expectancy of individuals with congenital genitourinary conditions (CGCs), leading to a crisis of care. Many individuals with CGC enter adulthood unprepared to manage their condition. Pediatric CGC specialists lack training to manage adulthood-related health-care issues, whereas adult genitourinary specialists lack training within the context of CGCs. To address these challenges, the National Institutes of Diabetes and Digestive and Kidney Diseases convened individuals with CGCs and experts from a variety of fields to identify research needs to improve transitional urology care. This paper outlines identified research needs

The HIPASS Catalogue - II. Completeness, Reliability, and Parameter Accuracy

The HI Parkes All Sky Survey (HIPASS) is a blind extragalactic HI 21-cm emission line survey covering the whole southern sky from declination -90 to +25. The HIPASS catalogue (HICAT), containing 4315 HI-selected galaxies from the region south of declination +2, is presented in Meyer et al. (2004a, Paper I). This paper describes in detail the completeness and reliability of HICAT, which are calculated from the recovery rate of synthetic sources and follow-up observations, respectively. HICAT is found to be 99 per cent complete at a peak flux of 84 mJy and an integrated flux of 9.4 Jy km/s. The overall reliability is 95 per cent, but rises to 99 per cent for sources with peak fluxes >58 mJy or integrated flux > 8.2 Jy km/s. Expressions are derived for the uncertainties on the most important HICAT parameters: peak flux, integrated flux, velocity width, and recessional velocity. The errors on HICAT parameters are dominated by the noise in the HIPASS data, rather than by the parametrization procedure.Comment: Accepted for publication in MNRAS. 12 pages, 11 figures. Paper with higher resolution figures can be downloaded from http://hipass.aus-vo.or

Open Science principles for accelerating trait-based science across the Tree of Life.

Synthesizing trait observations and knowledge across the Tree of Life remains a grand challenge for biodiversity science. Species traits are widely used in ecological and evolutionary science, and new data and methods have proliferated rapidly. Yet accessing and integrating disparate data sources remains a considerable challenge, slowing progress toward a global synthesis to integrate trait data across organisms. Trait science needs a vision for achieving global integration across all organisms. Here, we outline how the adoption of key Open Science principles-open data, open source and open methods-is transforming trait science, increasing transparency, democratizing access and accelerating global synthesis. To enhance widespread adoption of these principles, we introduce the Open Traits Network (OTN), a global, decentralized community welcoming all researchers and institutions pursuing the collaborative goal of standardizing and integrating trait data across organisms. We demonstrate how adherence to Open Science principles is key to the OTN community and outline five activities that can accelerate the synthesis of trait data across the Tree of Life, thereby facilitating rapid advances to address scientific inquiries and environmental issues. Lessons learned along the path to a global synthesis of trait data will provide a framework for addressing similarly complex data science and informatics challenges

Evidence for Reflected Light from the Most Eccentric Exoplanet Known

This is an author-created, un-copyedited version of an article published in The Astrophysical Journal. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at https://doi.org/10.3847/0004-637X/821/1/65.Planets in highly eccentric orbits form a class of objects not seen within our solar system. The most extreme case known among these objects is the planet orbiting HD20782, with an orbital period of 597days and an eccentricity of 0.96. Here we present new data and analysis for this system as part of the Transit Ephemeris Refinement and Monitoring Survey. We obtained CHIRON spectra to perform an independent estimation of the fundamental stellar parameters. New radial velocities from Anglo-Australian Telescope and PARAS observations during periastron passage greatly improve our knowledge of the eccentric nature of the orbit. The combined analysis of our Keplerian orbital and Hipparcos astrometry show that the inclination of the planetary orbit is >1.22, ruling out stellar masses for the companion. Our long-term robotic photometry show that the star is extremely stable over long timescales. Photometric monitoring of the star during predicted transit and periastron times using Microvariability and Oscillations of STars rule out a transit of the planet and reveal evidence of phase variations during periastron. These possible photometric phase variations may be caused by reflected light from the planet’s atmosphere and the dramatic change in star–planet separation surrounding the periastron passage.Peer reviewedFinal Accepted Versio

The LCES HIRES/Keck Precision Radial Velocity Exoplanet Survey

This document is the Accepted Manuscript version of the following article: R. Paul Butler, et al, The LCES HIRES/Keck Precision Radial Velocity Exoplanet Survey, The Astronomical Journal, Vol 153 (5), 19 pp., published 13 April 2017. The Version of Record is available online at doi: https://doi.org/10.3847/1538-3881/aa66ca. Paper data available at: http://home.dtm.ciw.edu/ebps/data/. © 2017. The American Astronomical Society. All rights reserved.We describe a 20-year survey carried out by the Lick-Carnegie Exoplanet Survey Team (LCES), using precision radial velocities from HIRES on the Keck-I telescope to find and characterize extrasolar planetary systems orbiting nearby F, G, K, and M dwarf stars. We provide here 60,949 precision radial velocities for 1,624 stars contained in that survey. We tabulate a list of 357 significant periodic signals that are of constant period and phase, and not coincident in period and/or phase with stellar activity indices. These signals are thus strongly suggestive of barycentric reflex motion of the star induced by one or more candidate exoplanets in Keplerian motion about the host star. Of these signals, 225 have already been published as planet claims, 60 are classified as significant unpublished planet candidates that await photometric follow-up to rule out activity-related causes, and 54 are also unpublished, but are classified as "significant" signals that require confirmation by additional data before rising to classification as planet candidates. Of particular interest is our detection of a candidate planet with a minimum mass of 3.9 Earth masses and an orbital period of 9.9 days orbiting Lalande 21185, the fourth-closest main sequence star to the Sun. For each of our exoplanetary candidate signals, we provide the period and semi-amplitude of the Keplerian orbital fit, and a likelihood ratio estimate of its statistical significance. We also tabulate 18 Keplerian-like signals that we classify as likely arising from stellar activity.Peer reviewedFinal Accepted Versio

Development of a Novel Renal Activity Index of Lupus Nephritis in Children and Young Adults

OBJECTIVE: Noninvasive estimation of the degree of inflammation seen on kidney biopsy with lupus nephritis (LN) remains difficult. The objective of this study was to develop a Renal Activity Index for Lupus (RAIL) that, based solely on laboratory measures, accurately reflects histologic LN activity. METHODS: We assayed traditional LN laboratory tests and 16 urine biomarkers (UBMs) in children (n = 47) at the time of kidney biopsy. Histologic LN activity was measured by the National Institutes of Health activity index (NIH-AI) and the tubulointerstitial activity index (TIAI). High LN-activity status (versus moderate/low) was defined as NIH-AI scores >10 (versus ≤10) or TIAI scores >5 (versus ≤5). RAIL algorithms that predicted LN-activity status for both NIH-AI and TIAI were derived by stepwise multivariate logistic regression, considering traditional biomarkers and UBMs as candidate components. The accuracy of the RAIL for discriminating by LN-activity status was determined. RESULTS: The differential excretion of 6 UBMs (neutrophil gelatinase-associated lipocalin, monocyte chemotactic protein 1, ceruloplasmin, adiponectin, hemopexin, and kidney injury molecule 1) standardized by urine creatinine was considered in the RAIL. These UBMs predicted LN-activity (NIH-AI) status with >92% accuracy and LN-activity (TIAI) status with >80% accuracy. RAIL accuracy was minimally influenced by concomitant LN damage. Accuracies between 71% and 85% were achieved without standardization of the UBMs. The strength of these UBMs to reflect LN-activity status was confirmed by principal component and linear discriminant analyses. CONCLUSION: The RAIL is a robust and highly accurate noninvasive measure of LN activity. The measurement properties of the RAIL, which reflect the degree of inflammatory changes as seen on kidney biopsy, will require independent validation

Evidence for reflected light from the most eccentric exoplanet known

Planets in highly eccentric orbits form a class of objects not seen within our Solar System. The most extreme case known amongst these objects is the planet orbiting HD 20782, with an orbital period of 597 days and an eccentricity of 0.96. Here we present new data and analysis for this system as part of the Transit Ephemeris Refinement and Monitoring Survey (TERMS). We obtained CHIRON spectra to perform an independent estimation of the fundamental stellar parameters. New radial velocities from AAT and PARAS observations during periastron passage greatly improve the our knowledge of the eccentric nature of the orbit. The combined analysis of our Keplerian orbital and Hipparcos astrometry show that the inclination of the planetary orbit is > 1.25 degrees, ruling out stellar masses for the companion. Our long-term robotic photometry show that the star is extremely stable over long timescales. Photometric monitoring of the star during predicted transit and periastron times using MOST rule out a transit of the planet and reveal evidence of phase variations during periastron. These possible photometric phase variations are likely caused by reflected light from the planet's atmosphere and the dramatic change in star--planet separation surrounding the periastron passage