The Revolving Door: A Report on U.S. Hospital Readmissions

The U.S. health care system suffers from a chronic malady -- the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving.Some return trips are predictable elements of a treatment plan. Others are unplanned but difficult to prevent: patients go home, new and unexpected problems arise, and they require an immediate trip back to the hospital.But many of these readmissions can and should be prevented. They are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions they didn't understand, and not taking medications or getting the necessary follow-up care.The federal government has pegged the cost of readmissions for Medicare patients alone at $26 billion annually, and says more than$17 billion of it pays for return trips that need not happen if patients get the right care. This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients. This report is being released in conjunction with the Robert Wood John Foundation's Care About Your Care initiative, which is devoted to improving care transitions when people leave the hospital. It looks at the issue of readmissions in two ways: by the numbers and through the eyes of the people who live them

Implications of the X-ray Variability for the Mass of MCG-6-30-15

The bright Seyfert 1 galaxy \mcg shows large variability on a variety of time scales. We study the \aproxlt 3 day time scale variability using a set of simultaneous archival observations that were obtained from \rxte and the {\it Advanced Satellite for Cosmology and Astrophysics} (\asca). The \rxte\ observations span nearly $10^6$ sec and indicate that the X-ray Fourier Power Spectral Density has an rms variability of 16%, is flat from approximately 10^{-6} - 10^{-5} Hz, and then steepens into a power law $\propto f^{-\alpha}$ with \alpha\aproxgt 1. A further steepening to $\alpha \approx 2$ occurs between 10^{-4}-10^{-3} Hz. The shape and rms amplitude are comparable to what has been observed in \ngc and \cyg, albeit with break frequencies that differ by a factor of 10^{-2} and 10^{4}, respectively. If the break frequencies are indicative of the central black hole mass, then this mass may be as low as $10^6 {\rm M}_\odot$. An upper limit of $\sim 2$ ks for the relative lag between the 0.5-2 keV \asca band compared to the 8-15 keV \rxte band was also found. Again by analogy with \ngc and \cyg, this limit is consistent with a relatively low central black hole mass.Comment: 5 pages, 3 figures, LaTeX, uses emulateapj.sty and apjfonts.sty, revised version, accepted for publication in ApJ Letter

Pricing A Pig In A Poke: Endogenous Valuations And Storage Unit Auctions

Storage unit auctions have recently received widespread attention from reality shows and “get rich easy” business models. This study examines the pitfalls associated with winning storage unit auctions, commonly observed bidding strategies, participant behavior and auction methods. Storage unit auctions present a classic example of endogenous valuation using incomplete information and imperfect secondary markets. The examination of the contents of a storage unit auction yields a novel use for the facility and sheds light on the process that leads to a lien and sale

Evidence of widespread selection on standing variation in Europe at height-associated SNPs.

Strong signatures of positive selection at newly arising genetic variants are well documented in humans(1-8), but this form of selection may not be widespread in recent human evolution(9). Because many human traits are highly polygenic and partly determined by common, ancient genetic variation, an alternative model for rapid genetic adaptation has been proposed: weak selection acting on many pre-existing (standing) genetic variants, or polygenic adaptation(10-12). By studying height, a classic polygenic trait, we demonstrate the first human signature of widespread selection on standing variation. We show that frequencies of alleles associated with increased height, both at known loci and genome wide, are systematically elevated in Northern Europeans compared with Southern Europeans (P < 4.3 × 10(-4)). This pattern mirrors intra-European height differences and is not confounded by ancestry or other ascertainment biases. The systematic frequency differences are consistent with the presence of widespread weak selection (selection coefficients ∼10(-3)-10(-5) per allele) rather than genetic drift alone (P < 10(-15))

The C-Band All-Sky Survey (C-BASS): Constraining diffuse Galactic radio emission in the North Celestial Pole region

The C-Band All-Sky Survey C-BASS is a high-sensitivity all-sky radio survey at an angular resolution of 45 arcmin and a frequency of 4.7 GHz. We present a total intensity 4.7 GHz map of the North Celestial Pole (NCP) region of sky, above declination +80 deg, which is limited by source confusion at a level of ~0.6 mK rms. We apply the template-fitting (cross-correlation) technique to WMAP and Planck data, using the C-BASS map as the synchrotron template, to investigate the contribution of diffuse foreground emission at frequencies ~20-40 GHz. We quantify the anomalous microwave emission (AME) that is correlated with far-infrared dust emission. The AME amplitude does not change significantly (<10%) when using the higher frequency C-BASS 4.7 GHz template instead of the traditional Haslam 408 MHz map as a tracer of synchrotron radiation. We measure template coefficients of $9.93\pm0.35$ and $9.52\pm0.34$ K per unit $\tau_{353}$ when using the Haslam and C-BASS synchrotron templates, respectively. The AME contributes $55\pm2\,\mu$K rms at 22.8 GHz and accounts for ~60% of the total foreground emission. Our results suggest that a harder (flatter spectrum) component of synchrotron emission is not dominant at frequencies >5 GHz; the best-fitting synchrotron temperature spectral index is $\beta=-2.91\pm0.04$ from 4.7 to 22.8 GHz and $\beta=-2.85\pm0.14$ from 22.8 to 44.1 GHz. Free-free emission is weak, contributing ~$7\,\mu$K rms (~7%) at 22.8 GHz. The best explanation for the AME is still electric dipole emission from small spinning dust grains.Comment: 18 pages, 6 figures, version matches version accepted by MNRA

Evidence of Widespread Selection on Standing Variation in Europe at Height-Associated SNPs

Strong signatures of positive selection at newly arising genetic variants are well-documented in humans, but this form of selection may not be widespread in recent human evolution. Because many human traits are highly polygenic and partly determined by common, ancient genetic variation, an alternative model for rapid genetic adaptation has been proposed: weak selection acting on many pre-existing (standing) genetic variants, or polygenic adaptation. By studying height, a classic polygenic trait, we demonstrate the first human signature of widespread selection on standing variation. We show that frequencies of alleles associated with increased height, both at known loci and genome-wide, are systematically elevated in Northern Europeans compared with Southern Europeans $(p<4.3×10^{−4})$. This pattern mirrors intra-European height differences and is not confounded by ancestry or other ascertainment biases. The systematic frequency differences are consistent with the presence of widespread weak selection (selection coefficients $~10^{−3}–10^{−5}$ per allele) rather than genetic drift alone $(p<10^{−15})$

Searching for non-Gaussianity in the VSA data

We have tested Very Small Array (VSA) observations of three regions of sky for the presence of non-Gaussianity, using high-order cumulants, Minkowski functionals, a wavelet-based test and a Bayesian joint power spectrum/non-Gaussianity analysis. We find the data from two regions to be consistent with Gaussianity. In the third region, we obtain a 96.7% detection of non-Gaussianity using the wavelet test. We perform simulations to characterise the tests, and conclude that this is consistent with expected residual point source contamination. There is therefore no evidence that this detection is of cosmological origin. Our simulations show that the tests would be sensitive to any residual point sources above the data's source subtraction level of 20 mJy. The tests are also sensitive to cosmic string networks at an rms fluctuation level of $105 \mu K$ (i.e. equivalent to the best-fit observed value). They are not sensitive to string-induced fluctuations if an equal rms of Gaussian CDM fluctuations is added, thereby reducing the fluctuations due to the strings network to $74 \mu K$ rms . We especially highlight the usefulness of non-Gaussianity testing in eliminating systematic effects from our data.Comment: Minor corrections; accepted for publication to MNRA

Exome sequencing of Finnish isolates enhances rare-variant association power.

Exome-sequencing studies have generally been underpowered to identify deleterious alleles with a large effect on complex traits as such alleles are mostly rare. Because the population of northern and eastern Finland has expanded considerably and in isolation following a series of bottlenecks, individuals of these populations have numerous deleterious alleles at a relatively high frequency. Here, using exome sequencing of nearly 20,000 individuals from these regions, we investigate the role of rare coding variants in clinically relevant quantitative cardiometabolic traits. Exome-wide association studies for 64 quantitative traits identified 26 newly associated deleterious alleles. Of these 26 alleles, 19 are either unique to or more than 20 times more frequent in Finnish individuals than in other Europeans and show geographical clustering comparable to Mendelian disease mutations that are characteristic of the Finnish population. We estimate that sequencing studies of populations without this unique history would require hundreds of thousands to millions of participants to achieve comparable association power