Medications Use and Patient Outcomes at Two Indianapolis Area Skilled Nursing Facilities: a Retrospective Chart Review

Background: Residential health care has changed over time. Skilled nursing facilities (SNF) as an alternative to standard long-term care are understudied. Objective: To describe current prescribing patterns of medication use in two Indianapolis SNFs. Method: Chart review to examine associations between medication use and outcomes such as weight changes, falls and re-hospitalization. Discharged patients had to be residents for at least 14 days. Results: 35 charts were reviewed. 17 (48.6%) patients were male, 22 (62.9%) were Caucasian, 15 (42.9%) had Medicaid, 6 subjects (17%) visited the emergency department, 5 (14.3%) visited the hospital during their stay at the selected facilities, 14 (40%) suffered falls, 23 (65.7%) took antidepressants, 15 (42.9%) received antibiotics and 4 (11.4%) had high anticholinergic burden. Duration of stay ranged from 14-362 days (median 41), age ranged from 40-95 (median 75), number of diagnoses 4-23, mean 12 (±4.105), weight change from loss of 52# to gain of 35.7# (median -5.6), Beer’s violations 0-3, mean 0.46 (±0.761) for patients aged ≥65 and the maximum scheduled medications at one time 3-24, mean 9.26 (±4.273). Of the 15 (42.9%) patients that received antibiotics there were 24 instances of use, 19 (79.2%) of those fit the facilities criteria for appropriate use of antibiotics. Conclusion: There are few associations between exposures: use of antibiotics or antidepressants, anticholinergic burden, or deviations from Beer’s criteria. This may be due to small sample size or be an indication of careful prescribing at these facilities

Double bracket dissipation in kinetic theory for particles with anisotropic interactions

We derive equations of motion for the dynamics of anisotropic particles directly from the dissipative Vlasov kinetic equations, with the dissipation given by the double bracket approach (Double Bracket Vlasov, or DBV). The moments of the DBV equation lead to a nonlocal form of Darcy's law for the mass density. Next, kinetic equations for particles with anisotropic interaction are considered and also cast into the DBV form. The moment dynamics for these double bracket kinetic equations is expressed as Lie-Darcy continuum equations for densities of mass and orientation. We also show how to obtain a Smoluchowski model from a cold plasma-like moment closure of DBV. Thus, the double bracket kinetic framework serves as a unifying method for deriving different types of dynamics, from density--orientation to Smoluchowski equations. Extensions for more general physical systems are also discussed.Comment: 19 pages; no figures. Submitted to Proc. Roy. Soc.

Trends in fire patterns in a southern African savanna under alternative land use practices

Climate, topography, vegetation and land use interact to influence fire regimes. Variable fire regimes may promote landscape heterogeneity, diversification in vegetation pattern and biotic diversity. The objective was to compare effects of alternative land use practices on landscape heterogeneity. Patch characteristics of fire scars were measured from 21 annual burn maps produced from 1972 to 2001 Landsat imagery. Trends in fire patterns under alternative land use practices were compared across a 250,000 ha savanna in southern Africa partitioned into three land use zones. Zone 1, Madikwe Game Reserve (MGR), has had mostly prescribed fires since 1993. Zone 2, cattle farms near MGR in South Africa (SAF), has experienced occasional fires. Zone 3, communal grazing lands in neighboring Botswana (BOT), has had the fewest fires. Cattle ranching was the predominant land use throughout the study area until 1992, when land use switched to conservation and eco-tourism in MGR. Sixteen landscape metrics were applied to this data set to uncover trends in the patch characteristics of the fire scars. A principal components analysis (PCA) reduced the dimensionality of the results so trends in the 10 most important size, shape, and proximity metrics could be better interpreted. The PCA results showed that more burning over time in MGR, and to a lesser extent in SAF, increased patch size, size variability, shape complexity and proximity, while fire exclusion in BOT produced no change or decreasing trends. We tested for significant differences in these metrics between the three land use zones and between two periods, 1972–1992 and 1993–2001. Most patch characteristics in MGR and SAF differed significantly from those in BOT, especially during the latter period, while between MGR and SAF they did not. Patch area, shape complexity and core area increased significantly between periods in MGR, while patch size, size variability and core area increased significantly between periods in SAF. In BOT, no patch characteristics changed significantly between periods. Within the time span analyzed for the study area, we conclude that increased fire occurrence promoted landscape heterogeneity while fire exclusion did not

A cautionary note on methods of comparing programmatic efficiency between two or more groups of DMUs in data envelopment analysis

In some applications of data envelopment analysis (DEA) there may be doubt as to whether all the DMUs form a single group with a common efficiency distribution. The Mann-Whitney rank statistic has been used to evaluate if two groups of DMUs come from a common efficiency distribution under the assumption of them sharing a common frontier and to test if the two groups have a common frontier. These procedures have subsequently been extended using the Kruskal-Wallis rank statistic to consider more than two groups. This technical note identifies problems with the second of these applications of both the Mann-Whitney and Kruskal-Wallis rank statistics. It also considers possible alternative methods of testing if groups have a common frontier, and the difficulties of disaggregating managerial and programmatic efficiency within a non-parametric framework. © 2007 Springer Science+Business Media, LLC

Random Hamiltonian in thermal equilibrium

A framework for the investigation of disordered quantum systems in thermal equilibrium is proposed. The approach is based on a dynamical model--which consists of a combination of a double-bracket gradient flow and a uniform Brownian fluctuation--that `equilibrates' the Hamiltonian into a canonical distribution. The resulting equilibrium state is used to calculate quenched and annealed averages of quantum observables.Comment: 8 pages, 4 figures. To appear in DICE 2008 conference proceeding

Knee joint neuromuscular activation performance during muscle damage and superimposed fatigue

This study examined the concurrent effects of exercise-induced muscle damage and superimposed acute fatigue on the neuromuscular activation performance of the knee flexors of nine males (age: 26.7 ± 6.1yrs; height 1.81 ± 0.05m; body mass 81.2 ± 11.7kg [mean ± SD]). Measures were obtained during three experimental conditions: (i) FAT-EEVID, involving acute fatiguing exercise performed on each assessment occasion plus a single episode of eccentric exercise performed on the first occasion and after the fatigue trial; (ii) FAT, involving the fatiguing exercise only and; (iii) CON consisting of no exercise. Assessments were performed prior to (pre) and at lh, 24h, 48h, 72h, and 168h relative to the eccentric exercise. Repeated-measures ANOVAs showed that muscle damage within the FAT-EEVID condition elicited reductions of up to 38%, 24%) and 65%> in volitional peak force, electromechanical delay and rate of force development compared to baseline and controls, respectively (F[io, 80] = 2.3 to 4.6; p to 30.7%>) following acute fatigue (Fp; i6] = 4.3 to 9.1; p ; Fp, iq = 3.9; p <0.05). The safeguarding of evoked muscle activation capability despite compromised volitional performance might reveal aspects of capabilities for emergency and protective responses during episodes of fatigue and antecedent muscle damaging exercise

Relative CC"-Numerical Ranges for Applications in Quantum Control and Quantum Information

Motivated by applications in quantum information and quantum control, a new type of $C$"-numerical range, the relative $C$"-numerical range denoted $W_K(C,A)$, is introduced. It arises upon replacing the unitary group U(N) in the definition of the classical $C$"-numerical range by any of its compact and connected subgroups $K \subset U(N)$. The geometric properties of the relative $C$"-numerical range are analysed in detail. Counterexamples prove its geometry is more intricate than in the classical case: e.g. $W_K(C,A)$ is neither star-shaped nor simply-connected. Yet, a well-known result on the rotational symmetry of the classical $C$"-numerical range extends to $W_K(C,A)$, as shown by a new approach based on Lie theory. Furthermore, we concentrate on the subgroup $SU_{\rm loc}(2^n) := SU(2)\otimes ... \otimes SU(2)$, i.e. the $n$-fold tensor product of SU(2), which is of particular interest in applications. In this case, sufficient conditions are derived for $W_{K}(C,A)$ being a circular disc centered at origin of the complex plane. Finally, the previous results are illustrated in detail for $SU(2) \otimes SU(2)$.Comment: accompanying paper to math-ph/070103

Hamiltonian statistical mechanics

A framework for statistical-mechanical analysis of quantum Hamiltonians is introduced. The approach is based upon a gradient flow equation in the space of Hamiltonians such that the eigenvectors of the initial Hamiltonian evolve toward those of the reference Hamiltonian. The nonlinear double-bracket equation governing the flow is such that the eigenvalues of the initial Hamiltonian remain unperturbed. The space of Hamiltonians is foliated by compact invariant subspaces, which permits the construction of statistical distributions over the Hamiltonians. In two dimensions, an explicit dynamical model is introduced, wherein the density function on the space of Hamiltonians approaches an equilibrium state characterised by the canonical ensemble. This is used to compute quenched and annealed averages of quantum observables.Comment: 8 pages, 2 figures, references adde

High-fidelity fast quantum transport with imperfect controls

Effective transport of quantum information is an essential element of quantum computation. We consider the problem of transporting a quantum state by using a moving potential well, while maintaining the encoded quantum information. In particular, we look at a set of cases where the input control defining the position of the potential well is subject to different types of distortion, each of which is motivated by experimental considerations. We show that even under these conditions, we are able to perfectly transfer the quantum information non-adiabatically over any given distance.Comment: 4 pages, 4 figure

Quantum control of the hyperfine-coupled electron and nuclear spins in alkali atoms

We study quantum control of the full hyperfine manifold in the ground-electronic state of alkali atoms based on applied radio frequency and microwave fields. Such interactions should allow essentially decoherence-free dynamics and the application of techniques for robust control developed for NMR spectroscopy. We establish the conditions under which the system is controllable in the sense that one can generate an arbitrary unitary on the system. We apply this to the case of $^{133}$Cs with its $d=16$ dimensional Hilbert space of magnetic sublevels in the $6S_{1/2}$ state, and design control waveforms that generate an arbitrary target state from an initial fiducial state. We develop a generalized Wigner function representation for this space consisting of the direct sum of two irreducible representation of SU(2), allowing us to visualize these states. The performance of different control scenarios is evaluated based on the ability to generate high-fidelity operation in an allotted time with the available resources. We find good operating points commensurate with modest laboratory requirements.Comment: 14 pages, 7 figures; corrected typo