Can municipality-based post-discharge follow-up visits including a general practitioner reduce early readmission among the fragile elderly (65+ years old)? A randomized controlled trial

Comparative StudyRandomized Controlled TrialThis is the final version of the article. Available from Taylor & Francis via the DOI in this record.OBJECTIVE: To evaluate how municipality-based post-discharge follow-up visits including a general practitioner and municipal nurse affect early readmission among high-risk older people discharged from a hospital department of internal medicine. DESIGN AND SETTING: Centrally randomized single-centre pragmatic controlled trial comparing intervention and usual care with investigator-blinded outcome assessment. INTERVENTION: The intervention was home visits with a general practitioner and municipal nurse within seven days of discharge focusing on medication, rehabilitation plan, functional level, and need for further health care initiatives. The visit was concluded by planning one or two further visits. Controls received standard health care services. PATIENTS: People aged 65 + years discharged from Holbæk University Hospital, Denmark, in 2012 considered at high risk of readmission. MAIN OUTCOME MEASURES: The primary outcome was readmission within 30 days. Secondary outcomes at 30 and 180 days included readmission, primary health care, and municipal services. Outcomes were register-based and analysis used the intention-to-treat principle. RESULTS: A total of 270 and 261 patients were randomized to intervention and control groups, respectively. The groups were similar in baseline characteristics. In all 149 planned discharge follow-up visits were carried out (55%). Within 30 days, 24% of the intervention group and 23% of the control group were readmitted (p = 0.93). No significant differences were found for any other secondary outcomes except that the intervention group received more municipal nursing services. CONCLUSION: This municipality-based follow-up intervention was only feasible in half the planned visits. The intervention as delivered had no effect on readmission or subsequent use of primary or secondary health care services.The Fund for Intersectoral Projects in Region Zealand, Denmark funded the project in 2011 and 2012. The funding agency had no influence on the analyses and interpretation of the results

Rekruitment Tropical Box Mussels, Septifer Bilocularis In Tiwoho Coastal Area

The purpose of this study was to determine 1) the types of substrates on which Septiver attached, and 2) the number of tropical boxes mussel recruits at different size aggregation. The meter was placed on one side of the mussel aggregation, and it was pulled up to the other side through the middle of the mussel aggregation.  There were two different sizes of aggregation, namely small aggregation with a diameter of 5-25 cm, and large aggregation with a diameter > 1 meter. Aggregation samples were carried out by placing a core with a diameter of 10 cm in the center of the small mussel aggregation, then at the edge and the middle position of the large aggregation. All aggregation in the core was removed and inserted into the labeled sample plastic. The sampling was applied 4 times on different mussel aggregations, as replication. The results show that young mussels (recruiters) are attached to algae stems, mussel byssus, and dead hard coral. The number of mussel recruits was square-root transformed to obtain homogeneity data, before being tested using One-Way Analysis of Variance.  The results showed that the recruitment of Septifer was influenced by the size of the aggregation (P 0.05).  Discussion of different factors affecting attachment occurs.Keywords: box mussel; Septifer; recruit; aggregation; larva; TiwohoAbstrakTujuan penelitian ini adalah untuk mengetahui 1) jenis-jenis substrat yang menjadi tempat menempel kerang mudah Septiver, dan 2) jumlah rekruit kerang kotak tropis pada ukuran aggregasi kerang yang berbeda. Pengukuran ukuran aggregasi kerang dilakukan dengan meletakkan meteran pada salah satu sisi aggregasi kerang, selanjutnya meteran ditarik sampai ke sisi yang lain melewati bagian tengah aggregasi kerang.  Ada 2 jenis ukuran aggregasi, yaitu aggregasi kecil dengan ukuran diameter aggregasi 5 – 25 cm, dan aggregasi besar, yaitu dengan ukuran diameter aggregasi kerang > 1 meter.   Pengukuran diameter aggregasi dilakukan  4 kali, masing-masing dengan aggregasi berbeda, sebagai ulangan.  Sampel aggregasi kerang dilakukan dengan meletakkan kor (‘cor’) dengan diameter 10 cm di bagian tengah pada aggregasi kerang kecil, posisi pinggir dan tengah aggregasi besar.  Sampel diambil juga sebanyak 4 kali (ulangan) pada masing aggregasi yang berbeda, sebagai ulangan. Kerang disortir dengan bantuan mikroskop, di mana kerang dengan ukuran 0.05). Faktor yang mempengaruhi penempelan dan rekruit dari agrregasi dengan ukuran berbeda didiskusikan.Kata kunci: Kerang Kotak; Septifer; recruit; aggregate; larva; Tiwoh

Phase separation transition in liquids and polymers induced by electric field gradients

Spatially uniform electric fields have been used to induce instabilities in liquids and polymers, and to orient and deform ordered phases of block-copolymers. Here we discuss the demixing phase transition occurring in liquid mixtures when they are subject to spatially nonuniform fields. Above the critical value of potential, a phase-separation transition occurs, and two coexisting phases appear separated by a sharp interface. Analytical and numerical composition profiles are given, and the interface location as a function of charge or voltage is found. The possible influence of demixing on the stability of suspensions and on inter-colloid interaction is discussed.Comment: 7 pages, 3 figures. Special issue of the J. Phys. Soc. Ja

The quality of different types of child care at 10 and 18 months. A comparison between types and factors related to quality.

The quality of care offered in four different types of non-parental child care to 307 infants at 10 months old and 331 infants at 18 months old was compared and factors associated with higher quality were identified. Observed quality was lowest in nurseries at each age point, except that at 18 months they offered more learning activities. There were few differences in the observed quality of care by child-minders, grandparents and nannies, although grandparents had somewhat lower safety and health scores and offered children fewer activities. Cost was largely unrelated to quality of care except in child-minding, where higher cost was associated with higher quality. Observed ratios of children to adults had a significant impact on quality of nursery care; the more infants or toddlers each adult had to care for, the lower the quality of the care she gave them. Mothers' overall satisfaction with their child's care was positively associated with its quality for home-based care but not for nursery settings

Cumulative and Differential Effects of Early Child Care and Middle Childhood Out-of-School Time on Adolescent Functioning.

Effects associated with early child care and out-of-school time (OST) during middle childhood were examined in a large sample of U.S. adolescents (N = 958). Both higher quality early child care AND more epochs of organized activities (afterschool programs and extracurricular activities) during middle childhood were linked to higher academic achievement at age 15. Differential associations were found in the behavioral domain. Higher quality early child care was associated with fewer externalizing problems, whereas more hours of early child care was linked to greater impulsivity. More epochs of organized activities was associated with greater social confidence. Relations between early child care and adolescent outcomes were not mediated or moderated by OST arrangements in middle childhood, consistent with independent, additive relations of these nonfamilial settings

Going beyond defining: Preschool educators\u27 use of knowledge in their pedagogical reasoning about vocabulary instruction

Previous research investigating both the knowledge of early childhood educators and the support for vocabulary development present in early childhood settings has indicated that both educator knowledge and enacted practice are less than optimal, which has grave implications for children\u27s early vocabulary learning and later reading achievement. Further, the nature of the relationship between educators\u27 knowledge and practice is unclear, making it difficult to discern the best path towards improved knowledge, practice, and children\u27s vocabulary outcomes. The purpose of the present study was to add to the existing literature by using stimulated recall interviews and a grounded approach to examine how 10 preschool educators used their knowledge to made decisions about their moment-to-moment instruction in support of children\u27s vocabulary development. Results indicate that educators were thinking in highly context-specific ways about their goals and strategies for supporting vocabulary learning, taking into account important knowledge of their instructional history with children and of the children themselves to inform their decision making in the moment. In addition, they reported thinking about research-based goals and strategies for supporting vocabulary learning that went beyond simply defining words for children. Implications for research and professional development are discussed

Subharmonic Shapiro steps and assisted tunneling in superconducting point contacts

We analyze the current in a superconducting point contact of arbitrary transmission in the presence of a microwave radiation. The interplay between the ac Josephson current and the microwave signal gives rise to Shapiro steps at voltages V = (m/n) \hbar \omega_r/2e, where n,m are integer numbers and \omega_r is the radiation frequency. The subharmonic steps (n different from 1) are a consequence of the ocurrence of multiple Andreev reflections (MAR) and provide an unambiguous signature of the peculiar ac Josephson effect at high transmission. Moreover, the dc current exhibits a rich subgap structure due to photon-assisted MARs.Comment: Revtex, 4 pages, 4 figure

SeaWiFS Postlaunch Technical Report Series

The Sea-viewing Wide Field-of-view Sensor (SeaWiFS) was originally calibrated by the instrument's manufacturer, Santa Barbara Research Center (SBRC), in November 1993. In preparation for an August 1997 launch, the SeaWiFS Project and the National Institute of Standards and Technology (NIST) undertook a second calibration of SeaWiFS in January and April 1997 at the facility of the spacecraft integrator, Orbital Sciences Corporation (OSC). This calibration occurred in two phases, the first after the final thermal vacuum test, and the second after the final vibration test of the spacecraft. For the calibration, SeaWiFS observed an integrating sphere from the National Aeronautics and Space Administration (NASA) Goddard Space Flight Center (GSFC) at four radiance levels. The spectral radiance of the sphere at these radiance levels was also measured by the SeaWiFS Transfer Radiometer (SXR). In addition, during the calibration, SeaWiFS and the SXR observed the sphere at 16 radiance levels to determine the linearity of the SeaWiFS response. As part of the calibration analysis, the GSFC sphere was also characterized using a GSFC spectroradiometer. The 1997 calibration agrees with the initial 1993 calibration to within +/- 4%. The new calibration coefficients, computed before and after the vibration test, agree to within 0.5%. The response of the SeaWiFS channels in each band is linear to better than 1%. In order to compare to previous and current methods, the SeaWiFS radiometric responses are presented in two ways: using the nominal center wave-lengths for the eight bands; and using band-averaged spectral radiances. The band-averaged values are used in the flight calibration table. An uncertainty analysis for the calibration coefficients is also presented