Trends in Observation‐prone Emergency Department Visits Among Michigan Children, 2007–2011

ObjectivesTo the best of the authors’ knowledge, admission of children under observation status in community hospitals has not been examined. The hypothesis of this study was that there has been an increase in observation charge code use over time and variations in the application of observation charge codes across hospital types.MethodsThis was a cross‐sectional analysis of 5 years (2007 through 2011) of administrative claims data from Michigan residents enrolled in Medicaid, Blue Cross/Blue Shield of Michigan preferred provider organization, and Blue Cross Network health maintenance organization compiled into a single data set. Emergency department (ED) visits to facilities in Michigan made by children (younger than 18 years) were selected. Observation‐prone ED visits were identified based on the presence of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. Counts of observation‐prone ED visits were determined and descriptive statistics were calculated. Changes over time in the proportion of visits with observation charge codes by hospital type were assessed with chi‐square analysis.ResultsThe observation‐prone ICD‐9‐CM codes were identified in 881,622 ED visits made by children to 142 Michigan facilities during the 5‐year study period. Overall, the vast majority of visits (n = 646,499; 91.0%) with the selected ICD‐9‐CM codes resulted in discharge from the ED without associated observation or inpatient charge codes. Among the 64,288 visits that resulted in admission for observation or inpatient care, observation charge codes without inpatient charge codes were applied to 22,933 (35.7%) admissions, observation and inpatient charge codes were applied to 4,756 (7.4%) admissions, and inpatient charge codes without observation charge codes were applied to 36,599 (56.9%) admissions. Hospitals with pediatric ED and inpatient services (Type 1 and Type 2 hospitals) had higher proportions of ED visits that went on to admission for observation or inpatient care (15.9 and 10.7%) than hospitals without pediatric ED services (Type 3 and Type 4 hospitals; 7.2 and 3.7%). The proportion of admissions that had observation charge codes for all hospital types increased over time, most prominently among Type 1 and Type 2 hospitals.ConclusionsThe application of observation charge codes to Michigan children with observation‐prone conditions has increased over time across all hospital types. There is a need to evaluate pediatric observation care in diverse settings to compare the effectiveness of different models.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111217/1/acem12624-sup-0001-DataSupplementS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/111217/2/acem12624-sup-0002-DataSupplementS2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/111217/3/acem12624.pd

The Discovery of a Giant H-alpha Filament in NGC 7213

The nearby Seyfert galaxy NGC 7213 has been imaged in H-alpha and HI with the CTIO 1.5 m telescope and with the Australia Telescope Compact Array (ATCA), respectively. Optically NGC 7213 looks undisturbed and relatively featureless but the continuum-subtracted H-alpha image shows a 19 kpc long filament located approximately 18.6 kpc from the nucleus. The H-alpha filament could be neutral gas photo-ionized by the active nucleus, as has been suggested for the Seyfert galaxy NGC 5252, or shock-ionized by a jet interacting with the surrounding HI, as has been suggested for the radio galaxy PKS 2240-41. The HI map reveals NGC 7213 to be a highly disturbed system suggesting a past merging event.Comment: 14 pages including 4 figures and 1 table. Figures 1-4 are in jpeg format; Better quality images can be retrieved in postscript format at ftp://charon.nmsu.edu/pub/shameed/ ; Accepted for publication in ApJ Letter

Mediating the GM Foods Debate: Lessons from the Enduring Conflict Framework

Critics of the commercialization of Genetically Modified (GM) foods in Canada and the United States oppose the economic and political forces that create and approve the technology: the industry that develops it and the governments that approve its use. The conventional narrative pits the concerned public, labeled anti-GM, against the pro-GM interests of industry supported by business-friendly governments. Based on this binary view of the interests and motivations of stakeholders, conflict betwee

Dynamic association between perfusion and white matter integrity across time since injury in Veterans with history of TBI.

ObjectiveCerebral blood flow (CBF) plays a critical role in the maintenance of neuronal integrity, and CBF alterations have been linked to deleterious white matter changes. Although both CBF and white matter microstructural alterations have been observed within the context of traumatic brain injury (TBI), the degree to which these pathological changes relate to one another and whether this association is altered by time since injury have not been examined. The current study therefore sought to clarify associations between resting CBF and white matter microstructure post-TBI.Methods37 veterans with history of mild or moderate TBI (mmTBI) underwent neuroimaging and completed health and psychiatric symptom questionnaires. Resting CBF was measured with multiphase pseudocontinuous arterial spin labeling (MPPCASL), and white matter microstructural integrity was measured with diffusion tensor imaging (DTI). The cingulate cortex and cingulum bundle were selected as a priori regions of interest for the ASL and DTI data, respectively, given the known vulnerability of these regions to TBI.ResultsRegression analyses controlling for age, sex, and posttraumatic stress disorder (PTSD) symptoms revealed a significant time since injury × resting CBF interaction for the left cingulum (p < 0.005). Decreased CBF was significantly associated with reduced cingulum fractional anisotropy (FA) in the chronic phase; however, no such association was observed for participants with less remote TBI.ConclusionsOur results showed that reduced CBF was associated with poorer white matter integrity in those who were further removed from their brain injury. Findings provide preliminary evidence of a possible dynamic association between CBF and white matter microstructure that warrants additional consideration within the context of the negative long-term clinical outcomes frequently observed in those with history of TBI. Additional cross-disciplinary studies integrating multiple imaging modalities (e.g., DTI, ASL) and refined neuropsychiatric assessment are needed to better understand the nature, temporal course, and dynamic association between brain changes and clinical outcomes post-injury

Tissue flow induces cell shape changes during organogenesis

In embryonic development, programmed cell shape changes are essential for building functional organs, but in many cases the mechanisms that precisely regulate these changes remain unknown. We propose that fluid-like drag forces generated by the motion of an organ through surrounding tissue could generate changes to its structure that are important for its function. To test this hypothesis, we study the zebrafish left-right organizer, Kupffer's vesicle (KV), using experiments and mathematical modeling. During development, monociliated cells that comprise the KV undergo region-specific shape changes along the anterior-posterior axis that are critical for KV function: anterior cells become long and thin, while posterior cells become short and squat. Here, we develop a mathematical vertex-like model for cell shapes, which incorporates both tissue rheology and cell motility, and constrain the model parameters using previously published rheological data for the zebrafish tailbud [Serwane et al.] as well as our own measurements of the KV speed. We find that drag forces due to dynamics of cells surrounding the KV could be sufficient to drive KV cell shape changes during KV development. More broadly, these results suggest that cell shape changes could be driven by dynamic forces not typically considered in models or experiments

Validation and preliminary data from a health-related quality of life questionnaire for owners of dogs with cardiac disease

BACKGROUND: Cardiac disease in dogs impacts the quality of life (QoL) of their owners, but owners\u27 QoL has not been comprehensively assessed in this population. OBJECTIVES: To develop, validate, and provide preliminary data from a health-related QoL (hrQoL) questionnaire for owners of dogs with cardiac disease. SUBJECTS: A total of 141 owners of dogs with cardiac disease were studied. METHODS: An owner hrQoL (O-hrQoL) questionnaire containing 20 items related to areas of a person\u27s life that could be impacted by caring for a dog with cardiac disease was developed and administered to owners of dogs with cardiac disease. The highest possible total score was 100, with higher scores indicating a worse hrQoL. Readability, internal consistency, face and construct validity, and item-total correlations were assessed. RESULTS: Median O-hrQoL score was 35 (range, 0-87). The questionnaire had good internal consistency (Cronbach\u27s alpha = 0.933), construct validity (Spearman\u27s r = 0.38-0.53; Kendall\u27s tau = 0.30-0.43; P \u3c .001), and item-total correlation (Spearman\u27s r = 0.44-0.79; Kendall\u27s tau = 0.34-0.66; all P \u3c .001). Fifty percent of owners indicated a negative effect of dogs\u27 cardiac disease on their own QoL, but all owners responded that caring for their dogs either had strengthened (n = 76; 53.9%) or had no effect on their relationship with their dog (n = 65; 46.1%). CONCLUSIONS AND CLINICAL IMPORTANCE: The O-hrQoL questionnaire had good validity, and results suggest that owners\u27 QoL is significantly impacted by caring for dogs with cardiac disease. Additional research on effective approaches to minimizing the negative effects of a dog\u27s cardiac disease on the owner is warranted

A Hybrid Lagrangian Variation Method for Bose-Einstein Condensates in Optical Lattices

Solving the Gross--Pitaevskii (GP) equation describing a Bose--Einstein condensate (BEC) immersed in an optical lattice potential can be a numerically demanding task. We present a variational technique for providing fast, accurate solutions of the GP equation for systems where the external potential exhibits rapid varation along one spatial direction. Examples of such systems include a BEC subjected to a one--dimensional optical lattice or a Bragg pulse. This variational method is a hybrid form of the Lagrangian Variational Method for the GP equation in which a hybrid trial wavefunction assumes a gaussian form in two coordinates while being totally unspecified in the third coordinate. The resulting equations of motion consist of a quasi--one--dimensional GP equation coupled to ordinary differential equations for the widths of the transverse gaussians. We use this method to investigate how an optical lattice can be used to move a condensate non--adiabatically.Comment: 16 pages and 1 figur