The Changing Geography of Outpatient Procedures

Since the early 80s, many surgical procedures have moved from the inpatient to outpatient setting. Outpatient surgical visits now account for about two-thirds of all surgical visits in the U.S. Over the same period, freestanding ambulatory surgery centers (ASCs) have arisen as alternatives to traditional hospital-based outpatient surgical departments. The number of ASCs grew from 240 in 1983 to 5,174 in 2008. The growth of ASCs raises safety concerns about the risk of complications and adequate access to emergency care. This Issue Brief summarizes evidence from one state about the changing geography of outpatient procedures and the possible risks associated with these changes

Physician Division of Labor and Patient Selection for Outpatient Procedures

Little is known about the ability of incentives to influence decisions by physicians regarding choices of settings for care delivery. In the context of outpatient procedural care, the emergence of freestanding ambulatory surgery centers (ASCs) as alternatives to hospital-based outpatient departments (HOPDs) creates a unique opportunity to study this question. We advance a model where physicians’ division of labor between ASCs and HOPDs affects the medical complexity of patients treated in low-acuity settings (i.e. ASCs). Analyses of outpatient surgical procedure data show that physicians working exclusively in low-acuity settings (i.e. ASCs) treat patients of significantly higher medical complexity in these settings than do physicians who also practice in higher-acuity settings (i.e. HOPDs). This discrepancy shrinks with increasing procedural risk and with increasing distance between ASCs and acute care hospitals

Affording to Wait: Medicare Initiation and the Use of Health Care

Delays in receipt of necessary diagnostic and therapeutic medical procedures related to the timing of Medicare initiation at age 65 years have potentially broad welfare implications. We use 2005–2007 data from Florida and North Carolina to estimate the effect of initiation of Medicare benefits on healthcare utilization across procedures that differ in urgency and coverage. In particular, we study trends in the use of elective procedures covered by Medicare to treat conditions that vary in symptoms; these are compared with elective surgical procedures not eligible for Medicare reimbursement, and to a set of urgent and emergent procedures. We find large discontinuities in health services utilization at age 65 years concentrated among low urgency, Medicare‐reimbursable procedures, most pronounced among screening interventions and treatments for minimally symptomatic disease

2014 Decompression Sickness/Extravehicular Activity Risks Standing Review Panel

The 2014 Decompression Sickness (DCS)/Extravehicular Activity (EVA) Risks Standing Review Panel (from here on referred to as the SRP) met for a site visit in Houston, TX on November 4 - 5, 2014. The SRP reviewed the Research Plans for The Risk of Decompression Sickness and the Risk of Injury and Compromised Performance due to EVA Operations, as well as the Evidence Reports for both of these Risks. The SRP found that the NASA DCS/EVA team did an excellent job of presenting their research plans. The SRP considers it critical that NASA proceeds with the high priority tasks identified in this report (DCS1, DCS3, DCS5). The highest priority is to determine the acceptable DCS and hypoxia risk associated with the planned human exploration beyond low Earth orbit. The risk of DCS is highly dependent upon the pressure within the exploration vehicle. If slightly more hypoxia is permitted then (even with the same percentage of oxygen) the pressure within the exploration vehicle can be lowered thus further mitigating the risk of DCS. The second highest priority is to test and validate the recommended 8.2psi/34% O2 atmosphere. Development of procedures and equipment for human exploration missions are very limited until the results of this testing are completed. The SRP also suggests that DCS7 be separated into two Gaps. Gap DCS7 should deal with DCS treatment while a new Gap should be created to deal with the long-term effects of DCS. The SRP also encourages NASA to increase collaboration with other organizations and pool resources where possible. The current NASA DCS/EVA team has the extensive expertise and a wealth of knowledge in this area. The SRP suggests that increased manpower for this team would be highly productive

DIstributed VIRtual System (DIVIRS) Project

The development of Prospero moved from the University of Washington to ISI and several new versions of the software were released from ISI during the contract period. Changes in the first release from ISI included bug fixes and extensions to support the needs of specific users. Among these changes was a new option to directory queries that allows attributes to be returned for all files in a directory together with the directory listing. This change greatly improves the performance of their server and reduces the number of packets sent across their trans-pacific connection to the rest of the internet. Several new access method were added to the Prospero file method. The Prospero Data Access Protocol was designed, to support secure retrieval of data from systems running Prospero

Swimming against the tide: resilience of a riverine turtle to recurrent extreme environmental events

Extreme environmental events (EEEs) are likely to exert deleterious effects on populations. From 1996 to 2012 we studied the nesting dynamics of a riverine population of painted turtles (Chrysemys picta) that experienced seven years with significantly definable spring floods. We used capture–mark–recapture methods to estimate the relationships between more than 5 m and more than 6 m flood events and population parameters. Contrary to expectations, flooding was not associated with annual differences in survival, recruitment or annual population growth rates of the adult female segment of the population. These findings suggest that female C. pictaexhibit resiliency to key EEE, which are expected to increase in frequency under climate change

Heráclito y la vía de la interioridad

There are elements in Heraclitus that are enticing to modern readers in that they point toward a certain intimacy of consciousness. Having read the fragments of this philosopher, we propose a reading that harmonizes his assertions about universality with his assertions about self-knowledge, in which we believe we can glimpse the discovery of self-awareness. In Heraclitus’ view, humans possess a soul with an unlimited horizon and a capacity to access the logos. A person must pursue introspection, listen to the logos, and find the unity of all things and himself. This will enable us to gain a deeper understanding of the interiority of self-awareness without sacrificing its connection to the universal. Furthermore, individuals must speak the logos to themselves to act according to it. By acting otherwise, one would be acting against his own inner self

Heráclito y la vía de la interioridad

There are elements in Heraclitus that are enticing to modern readers in that they point toward a certain intimacy of consciousness. Having read the fragments of this philosopher, we propose a reading that harmonizes his assertions about universality with his assertions about self-knowledge, in which we believe we can glimpse the discovery of self-awareness. In Heraclitus’ view, humans possess a soul with an unlimited horizon and a capacity to access the logos. A person must pursue introspection, listen to the logos, and find the unity of all things and himself. This will enable us to gain a deeper understanding of the interiority of self-awareness without sacrificing its connection to the universal. Furthermore, individuals must speak the logos to themselves to act according to it. By acting otherwise, one would be acting against his own inner self. En Heráclito se encuentran algunos elementos atrayentes para los lectores modernos por cuanto apuntan a cierta intimidad de la conciencia. Proponemos una lectura de los fragmentos de este filósofo armonizando sus afirmaciones sobre la universalidad con sus palabras sobre el conocimiento de sí mismo, en el cual creemos ver un descubrimiento de la autoconciencia. Para Heráclito, el serhumano posee un alma de ilimitado horizonte y en condiciones de acceder al logos que guía toda la realidad: debe recorrer la vía de la interioridad, prestar oído al logos y hallar en él la unidad de sí mismo y de las demás cosas. Podría revelarse aquí una comprensión de la interioridad de la autoconciencia sin detrimento de su acceso a lo universal. Asimismo, el hombre debe decirse a sí mismo el logos para obrar conforme a él. Comportarse de otra manera significaría actuar en contra de la propia  interioridad