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

Nociceptive neuropeptide increases and periorbital allodynia in a model of traumatic brain injury.

OBJECTIVE: This study tests the hypothesis that injury to the somatosensory cortex is associated with periorbital allodynia and increases in nociceptive neuropeptides in the brainstem in a mouse model of controlled cortical impact (CCI) injury. METHODS: Male C57BL/6 mice received either CCI or craniotomy-only followed by weekly periorbital von Frey (mechanical) sensory testing for up to 28 days post-injury. Mice receiving an incision only and naïve mice were included as control groups. Changes in calcitonin gene-related peptide (CGRP) and substance P (SP) within the brainstem were determined using enzyme-linked immunosorbent assay and immunohistochemistry, respectively. Activation of ionized calcium-binding adaptor molecule-1-labeled macrophages/microglia and glial fibrillary acidic protein (GFAP)-positive astrocytes were evaluated using immunohistochemistry because of their potential involvement in nociceptor sensitization. RESULTS: Incision-only control mice showed no changes from baseline periorbital von Frey mechanical thresholds. CCI significantly reduced mean periorbital von Frey thresholds (periorbital allodynia) compared with baseline and craniotomy-only at each endpoint, analysis of variance P \u3c .0001. Craniotomy significantly reduced periorbital threshold at 14 days but not 7, 21, or 28 days compared with baseline threshold, P \u3c .01. CCI significantly increased SP immunoreactivity in the brainstem at 7 and 14 days but not 28 days compared with craniotomy-only and controls, P \u3c .001. CGRP levels in brainstem tissues were significantly increased in CCI groups compared with controls (incision-only and naïve mice) or craniotomy-only mice at each endpoint examined, P \u3c .0001. There was a significant correlation between CGRP and periorbital allodynia (P \u3c .0001, r = -0.65) but not for SP (r = 0.20). CCI significantly increased the number of macrophage/microglia in the injured cortex at each endpoint up to 28 days, although cell numbers declined over weeks post-injury, P \u3c .001. GFAP(+) immunoreactivity was significantly increased at 7 but not 14 or 28 days after CCI, P \u3c .001. Craniotomy resulted in transient periorbital allodynia accompanied by transient increases in SP, CGRP, and GFAP immunoreactivity compared with control mice. There was no increase in the number of macrophage/microglia cells compared with controls after craniotomy. CONCLUSION: Injury to the somatosensory cortex results in persistent periorbital allodynia and increases in brainstem nociceptive neuropeptides. Findings suggest that persistent allodynia and increased neuropeptides are maintained by mechanisms other than activation of macrophage/microglia or astrocyte in the injured somatosensory cortex

Polar confinement of the Sun's interior magnetic field by laminar magnetostrophic flow

The global-scale interior magnetic field needed to account for the Sun's observed differential rotation can be effective only if confined below the convection zone in all latitudes, including the polar caps. Axisymmetric nonlinear MHD solutions are obtained showing that such confinement can be brought about by a very weak downwelling flow U~10^{-5}cm/s over each pole. Such downwelling is consistent with the helioseismic evidence. All three components of the magnetic field decay exponentially with altitude across a thin "magnetic confinement layer" located at the bottom of the tachocline. With realistic parameter values, the thickness of the confinement layer ~10^{-3} of the Sun's radius. Alongside baroclinic effects and stable thermal stratification, the solutions take into account the stable compositional stratification of the helium settling layer, if present as in today's Sun, and the small diffusivity of helium through hydrogen, chi. The small value of chi relative to magnetic diffusivity produces a double boundary-layer structure in which a "helium sublayer" of smaller vertical scale is sandwiched between the top of the helium settling layer and the rest of the confinement layer. Solutions are obtained using both semi-analytical and purely numerical, finite-difference techniques. The confinement-layer flows are magnetostrophic to excellent approximation. More precisely, the principal force balances are between Lorentz, Coriolis, pressure-gradient and buoyancy forces, with relative accelerations and viscous forces negligible. This is despite the kinematic viscosity being somewhat greater than chi. We discuss how the confinement layers at each pole might fit into a global dynamical picture of the solar tachocline. That picture, in turn, suggests a new insight into the early Sun and into the longstanding enigma of solar lithium depletion.Comment: Accepted by JFM. 36 pages, 10 figure

Improving Patient Decision-Making in Health Care

Outlines regional variations within Minnesota in rates of patients with similar conditions receiving elective surgery, the concept of shared decision making, treatment choices for eight conditions, and steps for ensuring patients make informed decisions

Bose-Einstein Quantum Phase Transition in an Optical Lattice Model

Bose-Einstein condensation (BEC) in cold gases can be turned on and off by an external potential, such as that presented by an optical lattice. We present a model of this phenomenon which we are able to analyze rigorously. The system is a hard core lattice gas at half-filling and the optical lattice is modeled by a periodic potential of strength $\lambda$. For small $\lambda$ and temperature, BEC is proved to occur, while at large $\lambda$ or temperature there is no BEC. At large $\lambda$ the low-temperature states are in a Mott insulator phase with a characteristic gap that is absent in the BEC phase. The interparticle interaction is essential for this transition, which occurs even in the ground state. Surprisingly, the condensation is always into the $p=0$ mode in this model, although the density itself has the periodicity of the imposed potential.Comment: RevTeX4, 13 pages, 2 figure

The role of exercise in atrial fibrillation prevention and promotion: Finding optimal ranges for health

The cardiovascular benefits of regular exercise have been well described, including a significant reduction in cardiovascular morbidity and mortality for those meeting recommended guidelines. Yet the impact of physical activity on the incidence of atrial fibrillation (AF) has been less clear. This review seeks to define the optimal dose and duration for the prevention and treatment of AF. In doing so, we review the evidence that supports a decline in AF risk for those who achieve a weekly physical activity dose slightly above the current recommended guidelines. Furthermore, we identify the reduced AF incidence in those individuals who attain a cardiorespiratory fitness of 8 METs (metabolic equivalents of task) or more during maximal exercise testing. Finally, we review the evidence that shows an excess of AF among regular participants of endurance exercise

Bioaccessibility performance data for fifty-seven elements in guidance material BGS 102

BGS 102, a guidance material for bioaccessible arsenic (As) and lead (Pb), was produced during validation of the in vitro Unified Bioaccessibility Method (UBM). This paper reports a compilation of reproducible bioaccessible guidance values for fifty-five additional elements in BGS 102, providing guidance for analysts to broaden the scope of UBM analyses for a wider range of elements based on data collected over an average of 60 separate analytical batches per element. Data are presented in categories for both gastric (STOM) and gastrointestinal (STOM + INT) extraction phases, where reproducibility, measured as relative standard deviation (RSD) was; ≤ 10% RSD for 27 elements (Mg, Al, Si, P, Ca, Cr, Mn, Co, Ni, As, Rb, Sr, Y, Ba, La, Ce, Pr, Nd, Sm, Eu, Tb, Gd, Dy, Ho, Er, Tm, Yb); between 10 and 20% RSD for 10 elements (Li, K, V, Fe, Cu, Zn, Cd, Lu, Pb, U); and ≥ 20% RSD for 19 elements in the gastric phase (Be, B, S, Ti, Ga, Se, Zr, Nb, Mo, Ag, Sn, Sb, Cs, Hf, Ta, W, Tl, Bi, Th). Two elements (Mg, Rb) met the ≤ 10% RSD criteria in the UBM gastrointestinal extraction phase due to the alkaline conditions of this phase precipitating out the majority of determinands. Certain elements, including Na, K, Zn and Se, were found to be a significant component of the extraction fluids with proportionally higher concentrations compared to the guidance material. Bioaccessible fractions (%BAF) were also calculated, but were found to be a less reproducible format for confirming the accuracy of measurements. The low concentration of some elements of interest in BGS 102, such as antimony (Sb), justifies the preparation of an alternative certified reference material (CRM). This paper presents an opportunity to broaden the scope of the UBM method to address food security issues (e.g. Fe and Zn micronutrient deficiencies) and contributions to dietary intake from extraneous dust or soil through evidence of the analytical possibilities and current limitations requiring further investigation

Lattice formulation of (2,2) supersymmetric gauge theories with matter fields

We construct lattice actions for a variety of (2,2) supersymmetric gauge theories in two dimensions with matter fields interacting via a superpotential.Comment: 13 pages, 2 figures. Appendix added, references updated, typos fixe