Readmission rates in not-for-profit vs. proprietary hospitals before and after the hospital readmission reduction program implementation.

BACKGROUND: The Patient Protection and Affordable Care Act established the Hospital Readmission Reduction Program (HRRP) to penalize hospitals with excessive 30-day hospital readmissions of Medicare enrollees for specific conditions. This policy was aimed at increasing the quality of care delivered to patients and decreasing the amount of money paid for potentially preventable hospital readmissions. While it has been established that the number of 30-day hospital readmissions decreased after program implementation, it is unknown whether this effect occurred equally between not-for-profit and proprietary hospitals. The aim of this study was to determine whether or not the HRRP decreased readmission rates equally between not-for-profit and proprietary hospitals between 2010 and 2012. METHODS: Data on readmissions came from the Dartmouth Atlas and hospital ownership data came from the Centers for Medicare and Medicaid Services. Data were joined using the Medicare provider number. Using a difference-in-differences approach, bivariate and regression analyses were conducted to compare readmission rates between not-for-profit and proprietary hospitals between 2010 and 2012 and were adjusted for hospital characteristics. RESULTS: In 2010, prior to program implementation, unadjusted readmission rates for proprietary and not-for-profit hospitals were 16.16% and 15.78%, respectively. In 2012, following program implementation, 30-day readmission rates dropped to 15.76% and 15.29% for proprietary and not-for-profit hospitals. The data suggest that the implementation of the Hospital Readmission Reduction Program had similar effects on not-for-profit and proprietary hospitals with respect to readmission rates, even after adjusting for confounders. CONCLUSIONS: Although not-for-profit hospitals had lower 30-day readmission rates than proprietary hospitals in both 2010 and 2012, they both decreased after the implementation of the HRRP and the decreases were not statistically significantly different. Thus, this study suggests that the Hospital Readmission Reduction Program was equally effective in reducing readmission rates, despite ownership status

Influence of the magnetic field sweeping rate on magnetic transitions in synthetic ferrimagnets with perpendicular anisotropy

International audienc

The impact of the resident duty hour regulations on surgical patients’ perceptions of care

Implementation of the 2003 Accreditation Council for Graduate Medical Education (ACGME) resident duty-hour regulations and access to publicly reported patient satisfaction measures have challenged administrators and clinicians to balance resident’s educational experience, patient care quality, and patients’ satisfaction and perceptions. A pre-post retrospective study design investigated association between implementation of ACGME regulations and patient satisfaction/perceptions using multinomial logistic regressions. The sample consisted of all surgical inpatients (July 2001 – June 2005), who responded to surveys at an academic medical center. Patients gave lower ratings for physician interactions (patient-physician interaction time, clinical updates, and courtesy) following the implementation of post-duty hour regulations. While the odds of patients rating “below good” post-implementation for physician survey questions (i.e., related to time spent, kept informed, and friendliness/ courtesy) were higher (i.e., 1.25 to 1.3) as compared to odds of rating “very good”, the overall rating of quality care improved post-implementation. This difference could be due to increased interaction of patients with other hospital personnel. To improve patient satisfactions and in turn their perceptions, initiatives such as workload balancing, hand-off protocols, patient communication, and interactive training for care providers are recommended. Finally, residency programs and institutions need to develop strategies for implementation of current and future ACGME duty hour regulations so as to balance patient safety, patient perceptions, and resident well-being

Persistent Cellular Motion Control and Trapping Using Mechanotactic Signaling

Chemotactic signaling and the associated directed cell migration have been extensively studied owing to their importance in emergent processes of cellular aggregation. In contrast, mechanotactic signaling has been relatively overlooked despite its potential for unique ways to artificially signal cells with the aim to effectively gain control over their motile behavior. The possibility of mimicking cellular mechanotactic signals offers a fascinating novel strategy to achieve targeted cell delivery for in vitro tissue growth if proven to be effective with mammalian cells. Using (i) optimal level of extracellular calcium ([Ca2[superscript +] ][subscript ext] = 3 mM) we found, (ii) controllable fluid shear stress of low magnitude (σ < 0.5 Pa), and (iii) the ability to swiftly reverse flow direction (within one second), we are able to successfully signal Dictyostelium discoideum amoebae and trigger migratory responses with heretofore unreported control and precision. Specifically, we are able to systematically determine the mechanical input signal required to achieve any predetermined sequences of steps including straightforward motion, reversal and trapping. The mechanotactic cellular trapping is achieved for the first time and is associated with a stalling frequency of 0.06 ~ 0.1 Hz for a reversing direction mechanostimulus, above which the cells are effectively trapped while maintaining a high level of directional sensing. The value of this frequency is very close to the stalling frequency recently reported for chemotactic cell trapping [Meier B, et al. (2011) Proc Natl Acad Sci USA 108:11417–11422], suggesting that the limiting factor may be the slowness of the internal chemically-based motility apparatus.SUTD-MIT International Design Centre (Grant IDG31400104

Perturbing Dynamin Reveals Potent Effects on the Drosophila Circadian Clock

BACKGROUND: Transcriptional feedback loops are central to circadian clock function. However, the role of neural activity and membrane events in molecular rhythms in the fruit fly Drosophila is unclear. To address this question, we expressed a temperature-sensitive, dominant negative allele of the fly homolog of dynamin called shibire(ts1) (shi(ts1)), an active component in membrane vesicle scission. PRINCIPAL FINDINGS: Broad expression in clock cells resulted in unexpectedly long, robust periods (>28 hours) comparable to perturbation of core clock components, suggesting an unappreciated role of membrane dynamics in setting period. Expression in the pacemaker lateral ventral neurons (LNv) was necessary and sufficient for this effect. Manipulation of other endocytic components exacerbated shi(ts1)'s behavioral effects, suggesting its mechanism is specific to endocytic regulation. PKA overexpression rescued period effects suggesting shi(ts1) may downregulate PKA pathways. Levels of the clock component PERIOD were reduced in the shi(ts1)-expressing pacemaker small LNv of flies held at a fully restrictive temperature (29 degrees C). Less restrictive conditions (25 degrees C) delayed cycling proportional to observed behavioral changes. Levels of the neuropeptide PIGMENT-DISPERSING FACTOR (PDF), the only known LNv neurotransmitter, were also reduced, but PERIOD cycling was still delayed in flies lacking PDF, implicating a PDF-independent process. Further, shi(ts1) expression in the eye also results in reduced PER protein and per and vri transcript levels, suggesting that shibire-dependent signaling extends to peripheral clocks. The level of nuclear CLK, transcriptional activator of many core clock genes, is also reduced in shi(ts1) flies, and Clk overexpression suppresses the period-altering effects of shi(ts1). CONCLUSIONS: We propose that membrane protein turnover through endocytic regulation of PKA pathways modulates the core clock by altering CLK levels and/or activity. These results suggest an important role for membrane scission in setting circadian period

Ecological connectivity between the areas beyond national jurisdiction and coastal waters: Safeguarding interests of coastal communities in developing countries

The UN General Assembly has made a unanimous decision to start negotiations to establish an international, legally-binding instrument for the conservation and sustainable use of marine biological diversity within Areas Beyond National Jurisdiction (ABNJ). However, there has of yet been little discussion on the importance of this move to the ecosystem services provided by coastal zones in their downstream zone of influence. Here, we identify the ecological connectivity between ABNJ and coastal zones as critically important in the negotiation process and apply several approaches to identify some priority areas for protection from the perspective of coastal populations of Least Developed Countries (LDCs). Initially, we review the scientific evidence that demonstrates ecological connectivity between ABNJ and the coastal zones with a focus on the LDCs. We then use ocean modelling to develop a number of metrics and spatial maps that serve to quantify the connectivity of the ABNJ to the coastal zone. We find that the level of exposure to the ABNJ influences varies strongly between countries. Similarly, not all areas of the ABNJ are equal in their impacts on the coastline. Using this method, we identify the areas of the ABNJ that are in the most urgent need of protection on the grounds of the strength of their potential downstream impacts on the coastal populations of LDCs. We argue that indirect negative impacts of the ABNJ fishing, industrialisation and pollution, communicated via oceanographic, cultural and ecological connectivity to the coastal waters of the developing countries should be of concern